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2002.modelo Ortotópico de OSCC. Myers
2002.modelo Ortotópico de OSCC. Myers
Jeffrey N. Myers,1 F. Christopher Holsinger, into the tongues of mice, these cells metastasized to regional
Samar A. Jasser, B. Nebiyou Bekele, and lymph nodes in 30% of mice and to the lungs in 20%.
Conclusions: In this orthotopic murine model, oral
Isaiah J. Fidler tongue cancer recapitulates the behavior of human SCCOT,
Departments of Head and Neck Surgery [J. N. M., F. C. H., S. A. J.], allowing for detailed studies of its biology and therapy.
Biostatistics [B. N. B.], and Cancer Biology [J. N. M., I. J. F.], The
University of Texas M.D. Anderson Cancer Center, Houston, Texas
77030-4009 Introduction
HNSCC2 remains a significant public health problem (1).
Cancers of the oral cavity and pharynx alone account for
ABSTRACT 363,000 new cases worldwide and almost 200,000 deaths an-
Purpose: Despite advances in our understanding, pre- nually (2). In 2001, these tumors are predicted to account for
vention, and treatment of head and neck squamous cell 30,100 new cancers, representing 3% of all cancers in the
carcinoma (SCC), the 5-year survival rates for patients re- United States, equal in incidence to leukemia and greater than
main low. This poor prognosis for head and neck SCC and all of the endocrine tumors. In particular, SCCOT is among the
SCC of the oral tongue (SCCOT) in particular reflects a most common tumors of the head and neck (3). Despite ad-
limited understanding of the mechanisms of local and re- vances in our understanding, prevention, and treatment, the
gional metastasis, which accounts for a majority of deaths. 5-year survival rates for patients with SCCOT have not im-
To analyze the molecular and cellular mechanisms of me- proved in the past 25 years and remain ⬃50%. This high
tastasis, we have developed an orthotopic nude mouse model mortality is considerably worse than rates for breast, cervical, or
of SCCOT. colorectal cancer (3). This poor prognosis for SCCOT may
Experimental Design: Nude mice were injected submu- reflect a limited understanding of the mechanisms of local and
cosally in the tongue or subcutis with human squamous cell regional metastasis, which accounts for a majority of deaths.
carcinoma of the oral cavity cell lines Tu159, Tu167, and Regional metastasis strongly correlates with tumor recur-
MDA1986. The mice were necropsied and examined for the rence and mortality (4 – 8). Extension of cervical metastases
presence of primary tumors, and regional and systemic outside the lymph node capsule (extracapsular spread) is an
metastases. even worse clinical indicator (9, 10). In a recent retrospective
Results: For all three of the squamous cell carcinoma of review of ⬎250 patients from 1980 –1995 with SCCOT, overall
the oral cavity cell lines, tumors developed more readily in the and disease-specific survival rates for patients with extracapsu-
orthotopic site, the tongue, than in the ectopic subcutis. lar spread were 30% and 50%, respectively (11). Distant me-
tastasis developed in 24.4% of patients with regional metastasis
MDA1986 cells were highly tumorigenic, particularly at the
but in only 3.3% of patients without neck disease.
orthotopic site, with as few as 5 ⴛ 103 cells producing tumors
Despite these abundant data, little is known regarding the
in all of the mice. In contrast, s.c. tumor formation required at
tumor biology of regional metastases of SCCOT. Furthermore,
least 1 ⴛ 105 cells. The tumorigenicity observed between those
there is no reliable animal model for study. Therefore, we have
mice given submucosal inoculation and those mice given s.c.
developed an orthotopic model of SCCOT metastases by inject-
inoculation (P < 0.0001). Regional metastases initially oc-
ing cell lines from human oral cavity SCC into the tongue of
curred in <10% of mice. To generate tumor lines of increased
nude mice. In this model, local tumor growth, and regional and
metastatic potential, regional metastases were isolated from
distant metastases demonstrated a histopathological similarity to
cervical lymph nodes after the development of orthotopic SCCOT primary tumors from patients. Finally, these tumors
tongue tumors. Serial passage of these lymph nodes resulted in recapitulate the regional and distant metastatic patterns seen in
a cell line more metastatic than its parental line. When injected patients with SCCOT.
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294 Mouse Model of SCCOT
(12) were obtained from the laboratory of Dr. Gary L. Clayman, with a 30-gauge hypodermic needle. Mice were then examined
The University of Texas M.D. Anderson Cancer Center. B16- every other day for the development of tongue tumors and
BL6 melanoma cell lines were used to determine the feasibility weight loss. The mice were killed by CO2 inhalation when they
of the orthotopic injection procedure and have been described had lost ⬎ 25% of their preinjection body weight.
previously (13–15).
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Clinical Cancer Research 295
Statistical Analyses SCCOC MDA1986. The MDA1986 cell line was highly
Tumorigenicity of MDA1986 SCCOC. For this pilot tumorigenic, particularly at the orthotopic site, with as few as
study, standard maximum likelihood based methods were not 5 ⫻ 103 cells producing tumors in all of the mice. In contrast,
applicable. Exact logistic regression was used to assess both the s.c. tumor formation required an injection of at least 1 ⫻ 105
tumorigenicity of SCCOC in mice and the effects of orthotopic cells. The results of the tumorigenicity study of the MDA1986
(submucosal) versus ectopic (s.c.) tumor development. Four to cell line are summarized in Table 1. Furthermore, in the exact
five mice were inoculated at each level/dilution combination (56 logistic regression model the difference in tumorigenicity ob-
mice total). The regression model included terms for the dilution served between those mice given submucosal inoculation and
effect (ranging from 1 ⫻ 103 to 5 ⫻ 106 cells) and for the those mice given s.c. inoculation was statistically significant
inoculation location (submucosal versus s.c.). The Ps for the (P ⬍ 0.0001).
location effect were evaluated against an ␣ significance level of The Metastatic Pathways of Human SCCOT Are
0.05. Recapitulated in the Orthotopic Nude Mouse Model of
Selection of Human SCCOC Cell Line Tu167 for SCCOT. For mice injected sublingually with the Tu167 tumor
Greater Metastatic Potential. Fisher’s exact test and cross- cells, only 4% developed lymph node metastasis, and none of
tabulation was used to compare the rates of regional and lung these animals had detectable pulmonary metastases. Two meth-
metastasis in 45 mice inoculated with the TU167 cell line versus ods were used to identify cervical and distant metastasis. Im-
10 mice injected with Tu167GLN1 cell line. The p value for this munohistochemical staining with an anticytokeratin antibody
test was evaluated against an ␣ significance level of 0.05. (data not shown) was performed to confirm the epidermoid
All of the statistical computations were performed on a character of each metastasis.
Dell 600 mHz PC using the SAS statistical system and S-plus Selection of SCCOC Cell Lines for Greater Metastatic
(Cary, NC). Potential. This initially low rate of regional metastases for
Tu167 provided us with a model system for characterizing the
biological processes and specific molecules critical for the de-
RESULTS velopment of cervical and systemic metastases. Our objective
Human SCCOC Cell Lines Form Tumors when In- was to generate tumor lines of increased metastatic potential by
jected Submucosally into the Tongues of Nude Mice. The identifying regional metastases within the small, cervical lymph
highly metastatic B16-BL6 melanoma cells, implanted into nodes of mice after the development of orthotopic tongue
the tongues of the syngeneic C57 BL/6 mice, formed tumors in tumors.
the tongues of all of the injected mice and yielded high rates of At first, it was quite difficult to identify these uncommon
regional metastases (Fig. 1, A and B), demonstrating the feasi- metastases, in part because the unique location of the tongue
bility of this orthotopic (submucosal lingual) injection tech- leads to rapid weight loss, necessitating early sacrifice. To
nique. Next, we injected three different human SCCOC cell identify microscopic regional metastases earlier, the Tu167 cell
lines (MDA1986, Tu159, and Tu167) into the tongues of nude line was transfected with GFP, and the resultant cell line, Tu167
mice. The injection of 5 ⫻ 106 cells produced tongue tumors in tumor cells expressing GFP, was orthotopically implanted into
all of the injected mice, regardless of the cell line used. The the tongue of the nude mouse. Visible lingual tumors developed,
orthotopic SCCOC tumors resulting from submucosal injection and the mice were sacrificed after ⬎25% preinjection weight
of Tu167 (Fig. 1C) were very similar in histological appearance loss. At necropsy, fluorescence stereomicroscopy was used to
to that of primary human SCCOT specimens (Fig. 1D), dem- identify metastatic GFP-transfected tumor cells. This method
onstrating keratin pearls and intercellular bridging. readily identified both primary tongue tumors (Fig. 1E) and
Tumorigenicity in Orthotopic and Ectopic Organs. submandibular metastasis of GFP-expressing Tu159 (Fig. 1F).
For the three human SCCOC cell lines, a spectrum of tumori- Both of tumors were confirmed histologically (Fig. 1G).
genicity was observed related to tumor cell line, concentration, Metastatic tumor cells from lymph nodes containing a
and site of injection. These trends are described below. fluorescent tumor were harvested and grown in culture. The
SCCOC Tu159. Tongue tumors developed in all of the resulting tumor cell line, Tu167G-LN1, was expanded and re-
mice injected with 5 ⫻ 104, 1 ⫻ 105, 5 ⫻ 105, 1 ⫻ 106, and 5 ⫻ injected into the tongues of 10 mice. With this new cell line,
106 Tu159 cells. s.c. tumors developed in none of the animals cervical (Fig. 1H) and distant metastases (Fig. 1I) were seen
inoculated with 5 ⫻ 104 cells and in only one of five animals with greater frequency (see Table 2). Using Fisher’s exact test,
and three of five animals inoculated with Tu159 at 1 ⫻ 105 and there was a statistically significant difference in regional and
5 ⫻ 105 cells, respectively. All of the mice injected 1 ⫻ 106 and lung metastases rates between Tu167 and Tu167G-LN1 (P ⫽
5 ⫻ 106 with Tu159 cells developed s.c. tumors. These data 0.0004).
show that the Tu159 cells are more tumorigenic at the orthotopic
site than the ectopic s.c. tissue.
SCCOC Tu167. In the mice injected with Tu167, tongue DISCUSSION
tumors were found in all of the animals injected submucosally Treatment failure in HNSCC results primarily from re-
with at least 1 ⫻ 105 cells. However, only one of five mice gional and distant metastasis. To study the mechanism of
developed s.c. tumors when injected with 1 ⫻ 105, 5 ⫻ 105, or metastasis in SCCOT, we have developed a reliable, ortho-
1 ⫻ 106 cells, indicating at least a 50-fold difference in the topic nude mouse model. First, we verified the feasibility of
minimal tumorigenic dose between the tongue and subcutis sublingual injection and the development of regional metas-
(Table 1). tases using the pigmented B16-BL6 melanoma cell line in
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296 Mouse Model of SCCOT
Fig. 1 A and B, regional metastasis from orthotopic sublingual implantation of B16-BL6 melanoma. The tongues of C57BL/6 black mice were
inoculated with syngeneic B16-BL6 melanoma cells, and mice were killed after 14 days and necropsy performed. An obvious tumor is seen in the
tongue. Bilateral metastases are easily identified by melanotic pigmentation within the cervical lymph nodes. C and D, comparative histopathology
showing the resemblance between orthotopic oral tongue cancer in the nude mouse and human SCCOT. Photomicrographs of (C) the Tu167 human
SCCOC cell line grown orthotopically in the tongue of nude mouse and (D) a human SCCOT tumor. E–G, visualization of orthotopic tongue tumor
and regional metastasis in situ with GFP. Tu159GFP was inoculated submucosally in the tongue of each mouse; the mouse was killed, and the tumor
was visualized under a dissecting fluorescence microscope. The primary tumor in the tongue (E) is readily apparent. An area of fluorescence, noted
in the submandibular region (F), was resected, revealing metastatic tumor on microscopic examination (G; H&E). H, regional metastasis of the
orthotopic TU167G-LN1 SCCOC. Photomicrograph of a cervical lymph node from a nude mouse in which the Tu167G-LN1 line was grown
orthotopically, showing a subcapsular metastatic tumor (H&E). I, distant pulmonary metastasis from the orthotopic TU167G-LN1 SCCOC.
Photomicrograph of a lung from a nude mouse in which the Tu167G-LN1 line was grown orthotopically, revealing distant metastatic tumor (H&E).
syngeneic mice. Next, three different human SCC oral cavity The orthotopic nude mouse model also provides an invalu-
tumor lines were then injected submucosally into the tongues able method for in vivo selection and generation of tumor cell
of nude mice: Tu167, derived from a primary tumor of the lines of greater regional and distant metastatic potential. Ini-
floor of mouth; Tu159, from a primary SCCOT; and tially, only 4.4% of mice injected with Tu167 developed cervi-
MDA1986, cultured from a cervical metastasis of human cal lymph node metastases. After serial passages, the more
SCCOT. All of the tumor lines were more tumorigenic in the metastatic cell line Tu167G-LN1 was identified. When ortho-
orthotopic site than in the subcutis. This nude mouse model topically reimplanted, Tu167G-LN1 cells produced a 30% rate
of oral cavity cancer substantiates the orthotopic principle of regional lymphatic metastasis. Pulmonary metastasis did not
that tumor cells grow better in their tissue of origin than in an develop in mice injected with Tu167 cells, whereas 20% of the
ectopic (s.c.) site. mice injected with Tu167G-LN1 had metastases in the lungs.
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Clinical Cancer Research 297
Table 1 Tumorigenicity of MDA1986 SCCOC in ectopic versus Table 2 Selection of human SCCOC cell line Tu167 for greater
orthotopic tissues metastatic potential
Groups of 6 –10-week old nude mice were inoculated s.c. along the Groups of 6 –10-week-old nude mice were inoculated submuco-
flank or submucosally in the tongue with the indicated numbers of cells sally in the tongue with 1 ⫻ 106 cells of the SCC cell line Tu167 or
of the human oral cavity SCC cell line, MDA1986. Mice were then Tu167GLN1. The latter cell line was derived from in vivo passage of
observed for tumor formation. Tu167 in the orthotopic SCCOC tumor model by placement of a cervical
lymph node in culture. Mice were then observed for tumor formation
% mice with and subjected to necropsy, and the number of mice with cervical and/or
MDA1986 (no. % mice with s.c. tongue tumors pulmonary metastases was tabulated.
cells injected) tumors (ectopic) (orthotopic)
No. mice with regional No. mice with lung
1 ⫻ 103 0 100%
Cell line metastasis metastasis
5 ⫻ 104 0 100%
1 ⫻ 104 40% 100% Tu167 2/45 0/45
5 ⫻ 105 100% 100% TU167GLN1 3/10 2/10
1 ⫻ 106 100% 100%
5 ⫻ 106 100% 100%
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298 Mouse Model of SCCOT
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An Orthotopic Nude Mouse Model of Oral Tongue Squamous
Cell Carcinoma
Jeffrey N. Myers, F. Christopher Holsinger, Samar A. Jasser, et al.
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