1. The autophagy protein LC3A correlates with hypoxia and is a prognostic marker of patient survival in clear cell ovarian cancer
- Author
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Jaeline E, Spowart, Katelin N, Townsend, Hassan, Huwait, Sima, Eshragh, Nathan R, West, Jenna N, Ries, Steve, Kalloger, Michael, Anglesio, Sharon M, Gorski, Peter H, Watson, C Blake, Gilks, David G, Huntsman, and Julian J, Lum
- Subjects
Adult ,Aged, 80 and over ,Ovarian Neoplasms ,Apoptosis ,Kaplan-Meier Estimate ,Middle Aged ,Hypoxia-Inducible Factor 1, alpha Subunit ,Prognosis ,Immunohistochemistry ,Cell Hypoxia ,Cell Line, Tumor ,Multivariate Analysis ,Autophagy ,Humans ,Female ,Microtubule-Associated Proteins ,Biomarkers ,Adenocarcinoma, Clear Cell ,Aged ,Carbonic Anhydrases ,Retrospective Studies - Abstract
Clear cell ovarian cancer histotypes exhibit metabolic features associated with resistance to hypoxia and glucose deprivation-induced cell death. This metabolic characteristic suggests that clear cell ovarian cancers activate survival mechanisms not typical of other epithelial ovarian cancers. Here we demonstrate that microtubule-associated protein 1 light chain 3A (LC3A), a marker of autophagy, is related to hypoxia and poor prognosis in clear cell ovarian cancer. In 485 ovarian tumours, we found that LC3A was significantly associated with poor progression-free (p = 0.0232), disease-specific (p = 0.0011) and overall patient survival (p = 0.0013) in clear cell ovarian cancer patients, but not in other subtypes examined. LC3A was an independent prognostic marker of reduced disease-specific [hazard ratio (HR): 2.55 (95% CI 1.21-5.37); p = 0.014] and overall survival [HR: 1.95 (95% CI 1.00-3.77); p = 0.049] in patients with clear cell ovarian carcinoma. We also found a strong link between autophagy and hypoxia as LC3A staining revealed a significant positive association with the hypoxia-related proteins carbonic anhydrase-IX and HIF-1α. The functional link between hypoxia and autophagy was demonstrated using clear cell and high-grade serous cell lines that were subjected to hypoxia or hypoxia + glucose deprivation. Clear cell carcinoma lines displayed greater autophagy induction and were subsequently more sensitive to inhibition of autophagy under hypoxia compared to the high-grade serous lines. Together, our findings indicate that hypoxia-induced autophagy may be crucial to the clinical pathology of clear cell ovarian cancer and is a potential explanation for histological subtype differences in patient disease progression and outcomes.
- Published
- 2012