Anuradha Sehrawat, Kozue Sakao, Rajiv Dhir, Su-Hyeong Kim, Kumar Chandra-Kuntal, Rachel C. Jankowitz, Jan H. Beumer, Eun-Ryeong Hahm, Julie A. Arlotti, Anna A. Powolny, Joomin Lee, and Shivendra V. Singh
Novel approaches for chemoprevention of breast cancer are clinically attractive because many risk factors associated with this disease (eg, genetic predisposition, late-age at first full-term pregnancy, early menarche, and late menopause) are not easily modifiable (1–3). Breast cancer continues to be a leading cause of cancer-related death in women worldwide (4) despite tremendous advances towards targeted therapies and personalized medicine (5,6). Primary prevention of breast cancer is feasible considering successful clinical application of selective estrogen receptor modulators (eg, tamoxifen and raloxifene) (7,8). However, this strategy is ineffective against estrogen receptor–negative breast cancers, and it is associated with risk of rare but serious side effects, including increased risk of uterine cancer, thromboembolism, cataracts, and perimenopausal symptoms (7,8). Use of the aromatase inhibitor (AI) exemestane is now an effective strategy for prevention of breast cancer in postmenopausal women (9,10). Although long-term effects of AIs are still under study, their use raises concerns for potential for increased cardiovascular risk (10,11). For example, combined analysis of multiple randomized controlled trials comparing AIs with tamoxifen reveals higher incidence of grade 3 and 4 cardiovascular events associated with use of AIs (10,11). Increased risk of bone fracture is another potential adverse effect of AIs (10). Edible plants continue to gain traction in the ongoing search for novel chemopreventative agents (12,13). Phenethyl isothiocyanate (PEITC) is one such promising bioactive component of edible cruciferous vegetables (eg, watercress). PEITC occurs naturally as a thioglucoside conjugate, gluconasturtiin (14,15), and is produced by myrosinase-catalyzed hydrolytic breakdown of gluconasturtiin upon processing (cutting or chewing) of cruciferous vegetables (14). The anticancer potential of PEITC was initially recognized by Wattenberg, who showed that 7,12-dimethylbenz[a]- anthracene–induced mammary cancer development was inhibited in Sprague-Dawley rats that were administered PEITC 4 hours before challenge with the carcinogen (16). Likewise, administration of PEITC inhibited N-nitrosobenzylmethylamine–induced esophageal carcinogenesis in rats (17). More recent studies have now established the efficacy of PEITC as a chemopreventative agent in transgenic mouse models of colon or intestinal cancer or of prostate cancer (18,19). Successful clinical realization of a cancer chemopreventative strategy is contingent upon systematic investigations: from “flask”-based cellular studies to identify promising agents and to define the mechanisms of their action; to “fur”(animal)-based studies focusing not only on bioavailability, safety, and efficacy assessments but also on discovery of biomarker(s) associated with response; to “folks” in clinical trials, with a pilot biomarker modulation trial followed by larger studies with cancer incidence as the primary endpoint. The discovery of biomarkers associated with response is especially desirable for cancer chemopreventative agents because cancer incidence is too rigorous an endpoint for cancers with long latency, such as breast cancer. Previous studies from our laboratory have shown that PEITC treatment, in association with apoptosis induction, decreases viability of cancer cells, including BRI-JM04, a breast cancer cell line derived from a mammary tumor in a mouse mammary tumor virus–neu (MMTV-neu) transgenic mouse (20,21). By contrast, MCF-10A cells, a spontaneously immortalized and nontumorigenic human mammary epithelial cell line derived from a patient with fibrocystic breast disease, are substantially more resistant than breast cancer cells to PEITC-induced apoptosis (21). PEITC-induced apoptosis in BRI-JM04 cells is regulated by B-cell lymphoma 2 interacting mediator of cell death (Bim) (21). These in vitro observations prompted us to test PEITC-mediated mammary cancer chemoprevention in mice, with two objectives: 1) to determine in vivo efficacy of dietary PEITC administration for chemoprevention of breast cancer using MMTV-neu model, which not only faithfully recapitulates aspects of human disease progression but also mimics human epidermal growth factor receptor-2 (HER-2/neu) overexpression and amplification in a subset of human breast cancers (22–24), and 2) to identify biomarker(s) associated with PEITC exposure that could be potentially useful in future clinical investigations.