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Advances in Experimental Medicine and Biology 1292
Innovations in Cancer Research and Regenerative Medicine
Cancer Biology
and Advances
in Treatment
Advances in Experimental Medicine
and Biology
Volume 1292
Series Editors
WIM E. CRUSIO, Institut de Neurosciences Cognitives et Intégratives
d’Aquitaine, CNRS and University of Bordeaux, Pessac Cedex, France
HAIDONG DONG, Departments of Urology and Immunology, Rochester,
Minnesota, USA
JOHN D. LAMBRIS, University of Pennsylvania, Philadelphia, Pennsylva-
nia, USA
HEINFRIED H. RADEKE, Clinic of the Goethe University Frankfurt Main,
Institute of Pharmacology & Toxicology, Frankfurt am Main, Hessen, Germany
NIMA REZAEI, Tehran University of Medical Sciences, Research Center
for Immunodeficiencies, Children’s Medical Center, Tehran, Iran
JUNJIE XIAO, School of Life Science, Shanghai University, Cardiac Regenera-
tion and Ageing Lab, Institute of Cardiovascular Sciences, Shanghai, China
Subseries Editor
PHUC VAN PHAM, Stem Cell Institute, University of Science, Vietnam
National University, Ho Chi Minh City, Vietnam
Innovations in Cancer Research and Regenerative Medicine is based on a bi-
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Contents
v
vi Contents
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
Contributors
vii
viii Contributors
Van Bang Nguyen Center for Gene and Protein Research, Vietnam Military
Medical University, Hanoi, Vietnam
Ebenyi Emeka Onwe Department of Pathology, Faculty of Medicine and
Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
Medical Laboratory Science Department, Ebonyi State University, Abakaliki,
Nigeria
Malina Osman Department of Medical Microbiology and Parasitology,
Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang,
Selangor, Malaysia
Khuong Duy Pham Laboratory of Stem Cell Research and Application,
University of Science Ho Chi Minh City, Ho Chi Minh City, Vietnam
Viet Nam National University Ho Chi Minh City, Ho Chi Minh City, Vietnam
Le Anh Tuan Pham Hanoi Medical University, Hanoi, Vietnam
Phuc Van Pham Laboratory of Stem Cell Research and Application, Uni-
versity of Science Ho Chi Minh City, Ho Chi Minh City, Vietnam
Stem Cell Institute, University of Science Ho Chi Minh City, Ho Chi Minh
City, Vietnam
Viet Nam National University Ho Chi Minh City, Ho Chi Minh City, Vietnam
Laboratory of Cancer Research, University of Science Ho Chi Minh City, Ho
Chi Minh City, Vietnam
Chinh-Nhan Phan-Lu Stem Cell Institute, University of Science, VNUHCM,
Ho Chi Minh City, Vietnam
Laboratory of Cancer Research, University of Science, VNUHCM, Ho Chi
Minh City, Vietnam
Nhan Lu-Chinh Phan Laboratory of Stem Cell Research and Application,
University of Science Ho Chi Minh City, Ho Chi Minh City, Vietnam
Stem Cell Institute, University of Science Ho Chi Minh City, Ho Chi Minh
City, Vietnam
Viet Nam National University Ho Chi Minh City, Ho Chi Minh City, Vietnam
Mohd Nor Gohar Rahman Surgery Department, School of Medical Sciences,
Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
Mohamed Saleem Regenerative Medicine Cluster, Advanced Medical and
Dental Institute, Universiti Sains Malaysia, Penang, Malaysia
Genomix Lab Sdn Bhd, Petaling Jaya, Selangor, Malaysia
Ch’ng Ewe Seng Oncology and Radiological Sciences Cluster, Advanced
Medical and Dental Institute, Universiti Sains Malaysia, Penang, Malaysia
Thanh Van Ta Center for Gene and Protein Research, Hanoi Medical
University, Hanoi, Vietnam
Hanoi Medical University, Hanoi, Vietnam
Hanoi Medical University Hospital, Hanoi, Vietnam
x Contributors
Ngoc Bao To Stem Cell Institute, University of Science Ho Chi Minh City,
Ho Chi Minh City, Vietnam
Vietnam National University Ho Chi Minh City, Ho Chi Minh City, Vietnam
Duyen Ho-Khanh Tran Stem Cell Institute, University of Science Ho Chi
Minh City, Ho Chi Minh City, Vietnam
Vietnam National University Ho Chi Minh City, Ho Chi Minh City, Vietnam
Thao Phuong Tran Stem Cell Institute, University of Science, VNUHCM,
Ho Chi Minh City, Vietnam
Thi Thuy Hang Tran Hanoi Medical University, Hanoi, Vietnam
Thinh Huy Tran Center for Gene and Protein Research, Hanoi Medical
University, Hanoi, Vietnam
Hanoi Medical University Hospital, Hanoi, Vietnam
Van Anh Tran Hanoi Medical University, Hanoi, Vietnam
Van Khanh Tran Center for Gene and Protein Research, Hanoi Medical
University, Hanoi, Vietnam
Hong Anh Trinh Center for Gene and Protein Research, Vietnam Military
Medical University, Hanoi, Vietnam
Kiet Dinh Truong Medical Genetic Institute, Ho Chi Minh City, Vietnam
Trung The Van Ho Chi Minh City Medicine and Pharmacy University,
Hospital of Dermatology – Ho Chi Minh City, Ho Chi Minh City, Vietnam
Arimokwu Nimbi Vivian Department of Occupational Safety and Health,
Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang,
Selangor, Malaysia
Phuc Hong Vo Stem Cell Institute, University of Science Ho Chi Minh City,
Ho Chi Minh City, Vietnam
Cancer Research Laboratory, University of Science Ho Chi Minh City, Ho
Chi Minh City, Vietnam
Vietnam National University Ho Chi Minh City, Ho Chi Minh City, Vietnam
Chi Dung Vu Center for Gene and Protein Research, Hanoi Medical
University, Hanoi, Vietnam
Vietnam National Children Hospital Hanoi, Vietnam, Department of Medical
Genetics, Metabolism & Endocrinology, Hanoi, Vietnam
Md Azlan Mohamed Abdul Wahab Regenerative Medicine Cluster,
Advanced Medical and Dental Institute, Universiti Sains Malaysia, Penang,
Malaysia
Badrul Hisham Yahaya Regenerative Medicine Cluster, Advanced Medi-
cal & Dental Institute (AMDI), Universiti Sains Malaysia, Kepala Batas,
Penang, Malaysia
Narazah Mohd Yusoff Regenerative Medicine Cluster, Advanced Medical
and Dental Institute, Universiti Sains Malaysia, Penang, Malaysia
Contributors xi
M. Saleem
Regenerative Medicine Cluster, Advanced Medical and
H. Mahsin
Dental Institute, Universiti Sains Malaysia, Penang,
Pathology Department, Seberang Jaya Hospital, Seberang
Malaysia
Prai, Malaysia
Genomix Lab Sdn Bhd, Petaling Jaya, Selangor, Malaysia e-mail: hakimah@moh.gov.my
e-mail: drsaleem@genomixlab.com
C. E. Seng
M. B. Ghazali Oncology and Radiological Sciences Cluster, Advanced
Regenerative Medicine Cluster, Advanced Medical and Medical and Dental Institute, Universiti Sains Malaysia,
Dental Institute, Universiti Sains Malaysia, Penang, Penang, Malaysia
Malaysia e-mail: eschng@usm.my
Surgery Department, Seberang Jaya Hospital, Seberang I. A. Khalid
Prai, Malaysia Surgery Department, Seberang Jaya Hospital, Seberang
Prai, Malaysia
M. A. M. A. Wahab, N. M. Yusoff, and B. H. Yahaya (*)
Regenerative Medicine Cluster, Advanced Medical and M. N. G. Rahman
Dental Institute, Universiti Sains Malaysia, Penang, Surgery Department, School of Medical Sciences,
Malaysia Universiti Sains Malaysia, Kubang Kerian, Kelantan,
e-mail: azlan.wahab@usm.my; narazah@usm.my; Malaysia
badrul@usm.my e-mail: mngohar@usm.my
1
2 M. Saleem et al.
each of the BRCA1 and BRCA2 genes. Women who inherit mutations in either the
Variant-free haplotypes (TAT-AG for BRCA1 BRCA1 or BRCA2 gene are at a significant risk
and ATA-AAT for BRCA2) were observed at a of developing the disease when compared with
frequency of more than 50% on each gene the general population, and both contribute
along with variable frequencies of derived equally to early-on-set breast cancer (Peto et al.
haplotypes. The variant 30 -subhaplotype CGC 1999). The disease risk in women with these
displayed strong LD with 50 -subhaplotypes mutations has been shown to increase monotoni-
GA, AA, and GG on BRCA1 gene. Haplotypes cally with age, with a lifetime risk of up to 87%
ATA-AGT, ATC-AAT, and ATA-AAC were (Palma et al. 2006).
the variant haplotypes frequent on BRCA2 The spectrum of mutations in BRCA1 and
gene. Although the clinical significance of BRCA2 genes varies significantly between differ-
these derived haplotypes has not yet been ent geographic populations. Molecular suscepti-
established, it is expected that some of these bility screening for early-onset breast cancer,
haplotypes, especially the less frequent therefore, begins with screening a given popula-
subhaplotypes, eventually will be shown to tion for pathological mutations in both BRCA1
be indicative of a predisposition to early- and BRCA2 in a well-defined cohort with the
onset breast cancer. disease. To date, many reports of genetic
associations for individual mutations give a single
Keywords account of the phenotype and are mostly
unreplicated in subsequent studies (Breast Cancer
BRCA1 · BRCA2 · Breast cancer · Early onset
Association Consortium 2006; Loannidis et al.
2001). Identifying the combination of different
variants on a single DNA molecule
(i.e. haplotype determination) is a much more
1 Introduction efficient and informative approach to identifying
the underlying genetic mutants that increase the
Breast cancer is ranked as the most common susceptibility to complex disease traits. The
malignancy (18%) among Malaysians, and it is arrangement of alleles at the polymorphic loci
the most frequently diagnosed cancer (31.3%) in scattered throughout the BRCA1 and BRCA2
Malaysian women irrespective of their ethnic genes is not random: Depending on the linkage
group (Lim et al. 2008). The annual incidence of disequilibrium (LD), the non-random association
breast cancer relative to other malignancies between these mutant alleles exists in a series of
among women aged 15–49 years is 39.1%. In patterns called haplotypes. The linked alleles in
general, a Malaysian woman has a 1 in 20 chance these LD blocks co-segregate as haplotypic units
of developing this complex and heterogeneous of inheritance.
disease in her lifetime (Dahlui et al. 2011), com- The BRCA1 and BRCA2 genes are normally
pared with 1 in 8 in Europe (Wahid 2014). involved in the sophisticated DNA repair process,
Most breast cancer cases are sporadic, but a especially the homologous recombination path-
few are ascribed to inherited germline mutations way of double-strand break (DSB) repair
in a couple of susceptibility genes that segregate mechanisms. The most common germline
with the disease (Arver et al. 2000). Pathological mutations in breast cancer patients occur in
germline mutations in the two tumour suppressor these two genes. The incidence of variants in the
genes, BRCA1 and BRCA2, are the best known coding region of the BRCA1 and BRCA2 genes in
genetic factors known to confer a strong predis- early-onset breast cancer patients from Malaysia
position for familial breast and ovarian cancer in has been accurately determined (Toh et al. 2008).
women (Wooster and Weber 2003; Breast Cancer However, whether the common variants at these
Linkage Consortium 1997). Other less suscepti- loci contribute to a common variant haplotype
ble genes subsume CHEK2, ATM, and TP53. across the exons of BRCA1 and BRCA2 has not
The BRCA1 and BRCA2 Genes in Early-Onset Breast Cancer Patients 3
been determined in a similar cohort of early-onset respective medical records and direct interviews.
breast cancer patients. It is generally accepted that Other data gathered were lymph node status,
haplotype renders more information than single tumour grade and size, and expression of hor-
marker analysis. In this study, we characterised mone receptors.
the structure and distribution of haplotypes on the
BRCA1 and BRCA2 genes in the Malaysian multi-
ethnic population with early-onset breast cancer 2.2 Genetic Marker Selection
and explored the use of these haplotypes for dis-
ease predictability. Toh Kang et al. (2008) sequenced the entire cod-
ing region and splice junctions and characterised
14 mutations in the BRCA1 gene and 17 mutations
2 Methods in the BRCA2 gene in a cohort of early-onset
breast cancer patients from Malaysia (Toh et al.
2.1 Case Selection 2008). Using their findings as the source of the
frequent allele distribution among Malaysian with
Seventy randomly selected unrelated patients early-onset breast cancer, we selected 11 SNPs in
diagnosed with breast cancer at or before the age the BRCA1 gene and 10 SNPs in the BRCA2
of 40 years were recruited into the study from the genes to genotype our cohort. We also genotyped
surgery department of Hospital Seberang Jaya in the 185delAG deletion in BRCA1 exon 2. Tables 1
Penang, Malaysia. The study population was com- and 2 provide details about these SNP markers.
posed of 43 Malays, 19 Chinese, 5 Indians, and
3 subjects from whom ethnicity could not be
ascertained. This retrospective study was 2.3 Molecular Testing
approved by the Human Ethics Committee of
Universiti Sains Malaysia and the Ethics Review For each patient, DNA was extracted from
Board of the Ministry of Health, Malaysia. Writ- EDTA-anticoagulated blood using the DNA iso-
ten informed consent for genetic analysis of blood lation kit from Qiagen (Hilden, Germany)
was obtained from all participants at the time of according to the manufacturer’s instruction.
phlebotomy. Each SNP marker was amplified using 50 ng of
The medical and family histories, genomic DNA with four primers in a single PCR
histopathological diagnoses, and demographic reaction (Table 3). The 185delAG deletion in
variables were obtained by review of the exon 2 of the BRCA1 gene was genotyped using
Table 1 BRCA1 mutations in women with breast cancer before the age of 40 years
Table 3 (continued)
Ch position BRCA1 Tm
(NC_000017.11:g) Marker Name Oligos 50 >30 ( C)
43093454C > T Rs4986850 FI CTTCAGCTCTGGGAAAGTATCGCTTTT 60.0
RI GCCAAATGAACAGACAAGTAAAAGACCTG
FO TGTTTTTGCCTTCCCTAGAGTGCTAACT
RO AGCACCTAAAAAGAATAGGCTGAGGAGG
43115746C > T Rs1800062 FI CAAACTTACTTGCAAAATATGTGGTCAAAT 60.0
RI TGATCAAGGAACCTGTCTCCACACAG
FO AATGGAGTTGGATTTTTCGTTCTCACTT
RO GAACTTGAGGCCTTATGTTGACTCAGTC
BRCA2 (NC_000013.11:g)
32332343A > C RS766173 FI AAGACCACATTGGAAAGTCAATGCTAA 62.5
RI TGTTTCATATACTTCATCTTCTAGGACGTG
FO AAATGCCAAGTACTCAGAATAACCCTTT
RO GGTTTTTAGATTTTTCACATTCATCAGC
32332421T > A RS79483201 FI AAGATAGTTTTTCATTATGTTTTTCTAGAT 55.4
RI TACTTTTTGTAGATTTTTTGTTCTGCT
FO AATGTGCTTCTGTTTTATACTTTAACAG
RO CTTCAGATACAAATGAGTATTTTTCTTT
32332592A > C Rs144848 FI ACTGATCCATTAGATTCAAATGTAGTAC 55.8
RI CTTCCACTCTCAAAGGGCTTCTGGTT
FO CAAGACTAGGAAAAAAATTTTCCATGAA
RO AGGTCTTTTTCTGAAATATTTTGGTCAC
32336584T > C RS1801499 FI CTGCAGCATGTCACCCAGTACAAAAC 63.0
RI AAGTCAGTATCACTGTATTCCACTTTTTAA
FO GAAAAGAAGCTGTTCACAGAATGATTCT
RO AGATTTGTGTTTTGGTTGAATTGTACCT
32337326A > G RS1799944 FI AATACCAGAAAAAAATAATGATTACAGGG 55.8
RI GGACCTAAGAGTCCTGCCCATTTTTT
FO TTTTGTCTTCCAAGTAGCTAATGAAAGG
RO CCTTTTGGCTAGGTGTTAAATTATGGTT
32337751A > G RS1801406 FI AGTCAGTTTGAATTTACTCAGTTTAGACAA 63.0
RI GTACTCTTCTGCAATATGTAGCTTTGC
FO TCAAGCTCTCTGAACATAACATTAAGAA
RO AAGATAAACTTATTGGATGTACCTCTGC
32337800A > G RS80358589 FI GTACATTTGAAGTGCCTGAAAACCCGA 63.0
RI TTCCTCAGAAGTGGTCTTTAAGATAGTAAC
FO TGTGTTGAAATTGTAAATACCTTGGCAT
RO CTAAACAGTTTCACAGCTTTTTGCAGAG
32338162T > C RS543304 FI TTATCTTCAAGTAAATGTCATGATTCTTTT 59.0
RI TGATTTTCTATCTTAAACATTGAACCG
FO TTTACTCAGTTTAGAAAACCAAGCTACA
RO AACTTCCAAAAAAGTTAAATCTGACAAA
32338933A > G RS202022822 FI AGGGACAACCCGAACGTGATGAAACGA 61.9
RI TGAAAACCCAATAGAGTAGGTTCTTTTAC
FO CAAGTGGGAAAAATATTAGTGTCGCCAA
RO TGTACTTTAGGGTCTTTGCCCATTGATG
32339667G > A RS80358755 FI CTCTCAAAAAATAAACTTGATTCGGA 55.8
RI AACATTCTTCAATACTGGCTCAAGAC
FO CAACCAGAAAGAATAAATACTGCAGATT
RO TATTAGATATGGACAATTTAATGGCTGC
FI Forward inner, RI Reverse inner, FO Forward outer, RO Reverse outer
6 M. Saleem et al.
the allele-specific Gap-PCR assay with the follow- association with triple-negative tumours
ing primers: forward inner (wild-type allele) ( p ¼ 0.411).
50 -TGACTTACCAGATGGGACACTC-30 , reverse
inner (Gap primer complementary to 185delGA
deletion) 50 -GCTATGCAGAAAATCTTAGTG- 3.2 SNP Marker Characteristics
30 , forward outer 50 -TTCCCGGACCACAGGA
TTTG-30 , and reverse outer 50 -AGGCCTTGATT Eleven SNPs loci were genotyped on the BRCA1
GGTGTTGGT-30 . gene. Among the 70 early-onset breast cancer
patients, 7.2% (5/70) had variant alleles observed
in 1–3 SNP markers, and 67.1% (47/70) had
variant alleles observed in 4–6 markers. Interest-
2.4 LD and Haplotype Analysis
ingly, 25.7% (18/70) of patients showed homozy-
gosity for the wild-type allele at all 11 markers.
Pairwise LD between the studied markers was
None of the Malaysian patients had the
measured using the statistic D0 . LD blocks were
rs80357713 (185delAG) deletion. Of the
detected using the solid spine algorithm in
remaining 11 polymorphic markers genotyped in
Haploview software. The frequencies of
the BRCA1 gene, 7 were missense and 4 were
haplotypes in the BRCA1 and BRCA2 genes
synonymous mutations. Of these 11 markers,
were deduced from diploid genotypes using the
5 were not used for haplotype determination
accelerated partition-ligation-expectation-
because one (rs80356892) significantly violated
maximisation (EM) algorithm method as
HWE (χ 2 p < 0.05), and the other 4 were either
described by Qin et al. (2002) using Haploview
not polymorphic (rs273899691, rs273898682,
4.2 (Barrett et al. 2005). To evaluate deviation
and rs1800062), or the minor allele frequency
from Hardy-Weinberg equilibrium (HWE), we
(MAF) was less than 1% (rs4986850).
used the χ 2 test with 1 df.
For the BRCA2 gene, at least one heterozygous
individual was detected at ten SNP markers stud-
ied. However, three (rs80358589, rs202022822,
3 Results and rs80358755) of the ten markers studied were
removed from haplotype analysis because they
3.1 Clinical Characteristics were not polymorphic (MAF < 1%) in the sample.
The PCR allele call rate was 100% for all of
Histological examination showed that 56 of the the markers studied on BRCA1 and BRCA2 genes
70 (80%) patients had invasive ductal cell carci- except for rs1799944 at the BRCA2 gene, which
noma, 6 (8.6%) had ductal cell carcinoma in situ, achieved 97.1%. The cohort was assumed to be
and a few others presented with less common selected randomly as all markers, except for one
histological types, including 2 cases of mucinous (rs80356892), were in conformity with HW equi-
and 3 cases of medullary carcinoma. Forty-six librium (χ 2 p > 0.05).
patients had cancer on the right side, and the
remaining 24 had their tumour on the left side.
None of the patients had history of contralateral 3.3 LD and Haplotypes
cancer. Scarff-Bloom-Richardson grades I, II, and
III were present in 8, 30, and 32 cases, respec- Linkage analysis from the BRCA1 genotype data
tively. Ipsilateral lymph node positivity (N+) was revealed two distinct LD blocks based on the
seen in 30 (42.8%) patients. Mastectomy was threshold of D0 > 0.8 (Fig. 1). The SNPs
conducted in 51 (71.8%) of the patients. rs1799966, rs1060915, and rs16942 were in
Twenty-three patients had a triple-negative near complete LD and belong to a 3-
tumour. None of the haplotypes observed in the 0
-subhaplotype block of 20 kb spanning from
BRCA genes showed a statistically significant exon 16 to the 30 region of exon 11. The three
The BRCA1 and BRCA2 Genes in Early-Onset Breast Cancer Patients 7
rs16941
rs1799966
rs1060915
rs1799949
rs16942
rs16940
Block 1 (20 kb) Block 2 (0 kb)
1 2 3 4 7 9 B
01
02
03
07
09
97 68 57 93
71 64 TAT .542 AG .542
CGC .437 GA .394
71 96 94
CGT .014 AA .050
97
GG .015
.99
Fig. 1 (a) Pairwise linkage disequilibrium (LD) D0 graph for the six SNPs of the BRCA1 gene as generated by
Haploview. The colour scheme denotes the magnitude of D0 . (b) Haplotypes observed for the BRCA1 gene
subhaplotypes observed in this block were TAT markers was <2.0. The second LD block was
(54.2%), CGC (43.7%), and CGT (1.4%). The present in exon 11 and included rs1799944,
second haplotype block, which spans a 229 bp rs1801406, and rs543304. Although this block
region within exon 11, was represented by exhibited a strong LD, the LOD score for
rs16940 and rs1799949 and had a strong LD rs1799944 with the other two SNPs was <2.0.
value (D0 ¼ 0.93). Four subhaplotypes were Four haplotypes were deduced on each LD
observed in this block: AG (54.2%), GA block at the BRCA2 gene: 50 -subhaplotypes in
(39.4%), AA (5%), and GG (1.5%). The two block 1 were ATA (57.1), ATC (36.4%), CTA
blocks were separated by SNP rs16941, which (5.0%), and CAA (1.4%), and 30 -subhaplotypes
showed decaying LD with the neighbouring poly- in block 2 were AAT (52.9%), AGT (30.6%),
morphic markers. AAC (15.0%), and GGT (1.5%).
For the BRCA2 gene, all 70 patients genotyped
for the 10 markers had at least 1 SNP positive for
a variant allele. Seven markers flanking the 3.4 Family History and Mutation
mutations (rs766173, rs79483201, rs144848,
rs1801499, rs1799944, rs1801406, and Of the 70 patients with breast cancer, 15 had at
rs543304) in the BRCA2 gene were used for LD least 1 affected relative. Of these 15 patients,
and haplotype determinations. These polymor- 5 did not have any variation at any of the loci
phic markers formed two discrete LD blocks genotyped on the BRCA1 gene. However they all
(Fig. 2). The first block containing three markers had variations on the BRCA2 gene. The strongest
(rs766173, rs79483201, and rs144848) spans a heritable component was seen in the Chinese
249 bp region on exon 10 and showed strong ethnic group, as 6 out of 19 (31.6%) had an
LD. However, the LOD score between the affected first- or second-degree relative. Of these
8 M. Saleem et al.
RS79483201
RS766173
RS144848
RS1801499
RS1799944
RS1801406
RS543304
Block 1 (0 kb) Block 2 (0 kb)
1 2 3 4 5 6 8
30 B
01
02
03
05
06
08
35
45 48 23 ATA .571 AGT .306
42 78 ATC .364 AAT .529
2
CTA .050 AAC .150
CAA .014 GGT .015
2
.85
Fig. 2 (a) Pairwise linkage disequilibrium (LD) D0 prime graph for the seven SNPs of the BRCA2 gene as generated by
Haploview. The colour scheme denotes the magnitude of D0 . (b) Haplotypes observed for the BRCA2 gene
six Chinese patients, four were negative for were observed from a geographically distant
mutations at BRCA1 loci, but they all had Manitoba population (Frosk et al. 2007),
mutations on the BRCA2 gene. suggesting that the high-frequency polymorphic
markers on the BRCA1 and BRCA2 genes are
common in distinct global populations. The AG
4 Discussion dinucleotide deletion at rs80357713 at codon
23 (widely known in the literature as 185delAG)
This study was conducted to explore the structure found in BRCA1-linked early-onset breast cancer
and distribution of haplotypes in BRCA1 and patients of Jewish origin (Struewing et al. 1995)
BRCA2 genes in patients with early-onset breast was not observed in our sample cohort.
cancer from the Malaysian multi-ethnic popula- Of the 70 randomly selected patients in our
tion. The allele frequencies observed in our study study, 21.4% of patients had a family history of
revealed discernible differences, especially at the breast cancer. This is slightly higher than the
high-frequency alleles, when compared with a global average of 15% (Madigan et al. 1995;
cohort of similar phenotype from Malaysia but Colditz et al. 1993; Slattery and Kerber 1993).
from a different geographic district (Toh et al. This value means that four out of every five
2008). Moreover, four SNPs—rs273899691 women who developed early-onset breast cancer
(2931A > G) and rs273898682 (2286A > T) on did not have an affected relative. A similar ratio,
BRCA1 and rs80358589 (3445A > G) and 8 out of 9, was reported from a large familial
rs202022822 (4578A > G) on BRCA2—that breast cancer meta-analysis including 52 epidemi-
were shown to have a MAF of 2.7% in the previ- ological studies (Collaborative Group on Hor-
ous sample were not polymorphic in our sample monal Factors in Breast Cancer 2001). Family
due to homozygosity for wild-type allele at these history is a strong risk factor for breast cancer
loci. However, comparable allele frequencies globally in every population. However, it has
The BRCA1 and BRCA2 Genes in Early-Onset Breast Cancer Patients 9
been consistently observed that most women with breast cancer. Furthermore, the observation that
a first degree relative with the disease do not this variant haplotype had a high frequency in our
develop breast cancer in their lives, and those early-onset breast cancer patients and that it was
few who develop it are above the age of structurally composed of all variant alleles is con-
50 when the diagnosis was first made (Collabora- sistent with the hypothesis that it is likely to
tive Group on Hormonal Factors in Breast Cancer contribute to genetic predisposition to breast can-
2001). These findings suggest that the risk alleles cer and that it may be involved in the pathogene-
and their haplotypes on BRCA genes segregated sis of tumour formation. The predicted protein
in the general population are by and large low in derived from this haplotype (CGC GA) has a
frequency; thus, the probability of inheriting a glycine, serine and arginine, and leucine and ser-
risk haplotype is relatively low. ine at those positions, which represents a differ-
ence of two amino acid substitutions compared to
the wild type. The exact functional consequence
5 BRCA1 Haplotypes of this variant haplotype, represented by five
nucleotide substitutions, is not clear and may
LD analysis of the six polymorphic markers on vary from truncated protein formation to inactiva-
the BRCA1 gene in the early-onset breast cancer tion of mRNA.
patients revealed that two distinct blocks of The other lower-frequency haplotypes
tightly linked SNP loci defined the haplotype observed in this study may confer a greater risk
structure of the phenotype (Fig. 1). They were for inherited susceptibility to breast cancer as
clustered in two small distinct regions located at these rare haplotypes may only be associated
the 30 end of exon 11 (block 1), including exons with early-onset breast cancer and not distributed
16 and 13, and within exon 11 (block 2). These in the general population.
blocks were separated by bi-alleles at locus
rs16941 (MAF 0.408) that showed decaying LD
with the surrounding SNP loci; this finding is 6 BRCA2 Haplotypes
suggestive of an evolutionary mechanism, possi-
bly selection. Block 1 was represented by two Germline mutations in the BRCA2 gene predis-
missense mutations at rs1799966 and rs16942 pose carriers to early-onset breast cancer. The
and one synonymous mutation at rs1060915, observation that all 70 patients had a variant
whereas the block2 subhaplotype had two synon- allele, at least at 1 locus was a clue to the diversity
ymous mutations at rs16940 and rs1799949. of this gene in the population.
Together, the most common haplomolecule Similar to BRCA1, LD analysis of the geno-
(TAT-AG) from both blocks formed the normal type data from the BRCA2 gene showed two
ancestral haplotype that corresponds to wild-type distinct blocks interrupted by locus rs1801499,
alleles in the references sequence NC_000017.11: which showed decay of the non-random associa-
g. The others were all variant haplotypes. tion with the surrounding SNP markers. As evi-
The most common variant haplomolecule dent by the LD chart (Fig. 2), the reduced
among the five interlinked loci, CGC GA, was association could be due to a plausible degree of
found in nearly 40% of the BRCA1 genes studied recombination at locus rs1801499, whereas the
in our sample. A structurally similar haplotype, increased haplotype diversity was due to the low
named B1, was present at high frequency (25%) minor allele frequencies at rs79483201A (1.4%)
in familial breast cancer patients from the and rs1799944G (1.5%). All three SNP loci that
Manitoba population (Frosk et al. 2007). Despite formed LD block 1 at exon 10 were composed of
the vast geographic and genetic distance between missense substitutions, whereas the LD block
the two cohorts, the presence of a structurally 2 located on exon 11 was composed of one mis-
similar variant haplotype in a similar phenogroup sense and two synonymous loci. Together, these
is phenomenal; it suggests that the haplotype, in two LD blocks defining the variant-free
part, has a high-risk probability for early-onset haplomolecule ATA-AAT was observed at a
10 M. Saleem et al.
frequency of more than 52% of the BRCA2 genes 289. Although its significance in breast cancer is
studied. This mutant-free haplomolecule uncertain, carriers of this allele have nonsignifi-
represents the normal and common haplotype on cant increased risk of lymphoma (Breast Cancer
the BRCA2 gene that is distributed in the general Linkage Consortium 1999).
population. The discovery that BRCA gene mutations con-
The variant haplotypes of the BRCA2 gene fer significant risk for familial early-onset breast
were a complex of different combinations of cancer coupled with increased public literacy
subhaplotypes between LD block 1 (5- about personal genomics has led to widespread
0
-subhaplotype) and block 2 (30 -subhaplotype) demand, especially from the relatives of index
and are derived from the ancestral normal haplo- patients, for genetic profiling of BRCA1 and
type. As shown in Fig. 2, the normal 5- BRCA2 to predict the inherited risk of developing
0
-subhaplotype ATA derived from LD block breast cancer. Some of the variant haplotypes
1 combined with either AGT or AAC from the described herein, especially the less frequent
30 -subhaplotype formed the majority of variant ones, may contribute to risk of early-onset breast
haplotypes. The ATA-AGT arrangement was the cancer in the Malaysian population. The
most common variant haplotype, and it differed realisation that haplotypes play a substantial role
from the normal haplotype by a single-nucleotide in defining the risk of cancer comes from the fact
substitution of unknown significance at the sec- that they are often the starting point for attempts
ond nucleotide of the 30 -subhaplotype to locate the genes involved in disease processes.
(NM_000059.3:c. 3396A > G). The ATA-AAC Recently, haplotypes have been applied for risk
arrangement differed from the normal haplotype assessment for various complex diseases such as
by one nucleotide substitution at the third nucleo- non-small cell lung cancer (NSCLC) and early-
tide of the 30 -subhaplotype (rs543304, onset coronary artery disease (CAD) and
Val1269Val), and it may not pose a risk for myocardial infarction (MI). These studies
early-onset breast cancer because the substitution revealed that a specific interleukin-1B haplotype
is a synonymous polymorphism. Interestingly, correlated well with increased risk of NSCLC
the variant 50 -subhaplotype ATC on block (Landvik et al. 2009) and a rare haplotype in
1 complexed only with the normal 30 - LRP8 conferred significant risk of early-onset
-subhaplotype AAT, and this combination formed CAD/MI (Shen et al. 2014). These findings pro-
another common variant haplotype structure that vide strong empirical support for the hypothesis
differed from the normal haplotype by a single that haplotype analysis could be used as a molec-
missense substitution at the third nucleotide of the ular screening tool to screen BRCA genes to
50 -subhaplotype (rs144848, NM_000059.3:c. assess potential risk and susceptibility for early-
1114A > C); this subhaplotype involves a non- onset breast cancer. However, the usefulness of
conservative amino acid change in the region of these derived haplotypes to predict risk of early-
the protein that interacts with histone onset breast cancer needs to be assessed using a
acetyltransferase (Healey et al. 2000). Baynes powerful association study.
et al. (2007) previously showed that this SNP
(rs144848) is not associated with breast cancer
risk (Baynes et al. 2007); however, in its hetero- 7 Conclusion
zygous genotype state (AC), it has been signifi-
cantly associated with epithelial ovarian cancer In conclusion, we identified common and rare
(Beesley et al. 2007). haplotypes of the BRCA1 and BRCA2 genes in
The rare variant haplomolecule CTA-AGT early-onset breast cancer patients. The high-
differed from the variant-free haplotype by two frequency haplotypes of these two genes may be
nucleotides, one on each subhaplotype. The rare regarded as the common haplotypes distributed in
50 subhaplotype CTA in the BRCA2 gene with the the Malaysian population. The less common
minor allele C (MAF ¼ 0.064) at rs766173 has an derived haplotypes found in the breast cancer
asparagine to histidine substitution at position patients may serve as novel molecular markers
The BRCA1 and BRCA2 Genes in Early-Onset Breast Cancer Patients 11
that may be of potential significance in screening Collaborative Group on Hormonal Factors in Breast Can-
to identify patients at high risk for early-onset cer. (2001). Familial breast cancer: Collaborative
reanalysis of individual data from 52 epidemiological
breast cancer. The risk associated with these studies including 58,209 women with breast cancer
haplotypes needs to be evaluated in a prospective and 101,986 women without the disease. Lancet, 358,
case control study designed to validate their 1389–1399.
importance before they are used as molecular Dahlui, M., Ramli, S., & Bulgiba, A. M. (2011). Breast
cancer prevention and control programs in Malaysia.
diagnostic markers for the Malaysian population. Asian Pacific Journal of Cancer Prevention, 12,
1631–1634.
Acknowledgement Authors would like to extend nurses Frosk, P., Burgess, S., Dyck, T., Jobse, R., & Spriggs,
and technical staff in the Department of Surgery, Hospital E. L. (2007). The use of ancestral haplotypes in the
Seberang Jaya, Ministry of Health Malaysia, Hospital molecular diagnosis of familial breast cancer. Genetic
Universiti Sains Malaysia (HUSM) and Clinical Trial Testing, 11, 208–215.
Centre, and Advanced Medical and Dental Institute Healey, C. S., Dunning, A. M., Teare, M. D., Chase, D.,
(AMDI), Universiti Sains Malaysia for helping us in sam- Parker, L., et al. (2000). A common variant in BRCA2
ple collection and patient recruitments. is associated with both breast cancer risk and prenatal
viability. Nature Genetics, 26, 362–364.
Landvik, N. E., Hart, K., Skaug, V., Stangeland, L. B.,
Conflict of Interests None Haugen, A., et al. (2009). A specific interleukin-1B
haplotype correlates with high levels of IL1B mRNA
in the lung and increased risk of non-small cell lung
cancer. Carcinogenesis, 30, 1186–1192.
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https://doi.org/10.1007/5584_2018_148
# Springer International Publishing AG 2018
Published online: 24 April 2018
13
14 L.-H. Nguyen-Thi et al.
strongly inhibited MCF-7 cells in both 2D and or cancer-like diseases in recent years, there has
3D conditions. Interestingly, the IC50 of PTE been no official publication in the literature on its
in 3D model was remarkably lower than in 2D anticancer effects.
(IC50 value was 168.9 11.65 μg/ml com- Cell-based assays are considered to be the
pared to 260.8 16.54 μg/ml, respectively). foundation for drug development process, e.g.,
The invasion assay showed that PTE for the development of anticancer drugs. Initial
completely inhibited invasion of MCF-7 cells promising results of new drug candidates in cell-
at 250 μg/mL concentration. Also, flow based assays provide insight and rationale for
cytometry results indicated that PTE effectively further evaluation in animal-based models
induced apoptosis in MCF-7 spheroids in 3D (Charoen et al. 2014; Hutmacher 2010). Although
condition at 250 μg/mL concentration. Conclu- 2D cancer cell culture has a long history of usage,
sion: The results from this study emphasize the in anticancer drug development, there are many
promise of PTE in cancer therapy. limitations which have been reported on in recent
years (Edmondson et al. 2014). Notably, 2D can-
Keywords cer cell culture models fail to mimic the natural
structure of a tumor. This leads to the differences
3D tumor sphere · Anticancer · Apoptosis ·
in the response of monolayer cancer cells (versus
Extract · MCF-7 · Multicellular tumor
natural tumors) to the tested candidate drugs
spheres · Paramignya trimera · Tirapazamine ·
(Edmondson et al. 2014).
Toxicity · TPZ · Xao tam phan
Researchers therefore developed 3D cell cul-
ture models to bridge the gap between 2D cell-
based assays and preclinical animal models/trials.
Abbreviations Thus, a large number of publications have since
demonstrated the promise and benefits of 3D
DOX Doxorubicin model (versus 2D). Notably, 3D models are able
ECM Extracellular matrix to imitate many characteristics of the in vivo
FBS Fetal bovine serum tumor, including cell morphology, proliferation,
MCTS Multicellular tumor spheres cell-cell interactions, cell-ECM interactions, and
PTE Paramignya trimera extract gene/protein expression profiles (Nguyen et al.
PI Propidium iodide 2016; Sutherland 1988). The use of 3D cell
TPZ Tirapazamine models has remarkably increased in the last
decade (Ferro et al. 2014). Numerous 3D cell
culture systems have been developed to meet the
growing need for optimal 3D cell culture, with
each system having distinct advantages and
1 Introduction disadvantages. Among the 3D cell culture
systems, “hanging drop” is an effective technique
Traditional herbal medicines have been used to for 3D cell culture that is used in drug develop-
improve people’s health for over a thousand ment. The hanging drop method is popular due to
years. Plant-derived compounds are being its ability to generate spheroids which are homog-
remarkably recognized as useful complementary enous in size and shape, for the number of cells
medicines in cancer treatment (Yin et al. 2013). required, and for its application for high-
Xao tam phan (Paramignya trimera) is a Viet- throughput screening (Kelm et al. 2003; Pham
namese herbal medicine which was shown to 2015; Timmins and Nielsen 2007).
contain high levels of phenols, saponins, In recent years, 3D cell models (rather than 2D
flavonoids, proanthocyanidins, and antioxidant cell models) have been demonstrated to be more
agents (Nguyen et al. 2017). Although this herb effective at mimicking the structure and
has been widely used for the treatment of cancer characteristics of cancer cells in tumors, hence
Anti-cancer Effect of Xao Tam Phan Paramignya trimera Methanol Root. . . 15
more accurately reflecting the possible in vivo using the AxioVision microscope software (Carl
tumor response (Kijanska 2016; Smith et al. Zeiss).
2012). Being a tropical country, Vietnam has
tremendous potential in cancer drug screening
due to its diversity of herbs. Paramignya trimera 2.3 PI Staining for Necrotic Core
is among the many promising candidates and is Detection
the focus of the study herein. Nonetheless, a 3D
cancer cell model for testing toxicity of extracts Spheroids of MCF-7 cells were transferred from
and compounds is still relatively a new concept. the hanging drop plate onto flat-bottom 96-well
This study aimed to evaluate the toxicity of plates. Cells were then incubated for 1 h in
Paramignya trimera extract (PTE) on 100 μL of cell culture medium supplemented
microtumor spheres of MCF-7, created using with 1 μL of propidium iodide (PI; Sigma-
hanging drop technique. Aldrich, St Louis, MO). After washing with
PBS, spheroids were observed under fluorescent
microscope.
2 Materials and Methods
transferred to low-attachment 96-well plates and Lakes, NJ). For spheroids, after 48 h of treatment
treated with various concentrations of the drugs with DOX, TPZ, or PTE, cells were trypsinized
for 48 h. and dispersed into single-cell suspension by gen-
Spheroids were treated with DOX at the fol- tle pipetting. The cells were processed as per
lowing concentrations: 10000 μM, 5000 μM, instructions of the AnnexinV-FITC Apoptosis
2500 μM, 1250 μM, 600 μM, 300 μM, and Detection Kit. Flow cytometric evaluation of the
150 μM. Spheroids were treated with TPZ at the cells was conducted using a flow cytometer
following concentrations: 500 μM, 250 μM, (BD Biosciences, CA, USA), equipped with
125 μM, 60 μM, 30 μM, 15 μM, and 7.5μM. CellQuest Pro software.
Lastly, spheroids were treated with PTE at the
following concentrations: 2000 μg, 1000 μg,
500 μg, 250 μg, 125 μg, and 60 μg. 2.8 Statistical Analysis
AlamarBlue® cell viability assay was then
used to determine cell viability. DOX and TPZ The results were presented as mean SD. Statisti-
were chosen for our research study. Sigmoidal cal analyses were performed using GraphPad
dose-response curves for 2D and 3D systems Prism 7.0 (GraphPad Software Inc., San Diego,
were generated using GraphPad Prism 7.0 (San CA, USA). P < 0.05 was considered to be statisti-
Diego, CA, USA), and the IC50 values for each cally significant. IC50 value was calculated by
system were interpolated. GraphPad Prism 7.0 software based on the formu-
lation: Fifty ¼ (Top+Baseline)/2 and Y ¼ Bot-
tom + (Top-Bottom)/(1 + 10^((LogIC50-X)
2.6 Spheroid Invasion Assay *HillSlope + log((Top-Bottom)/(Fifty-Bottom)-1).
Fig. 1 Development of microtumor spheres of MCF-7 1-day intervals from day 1 to day 9 via light microscopy.
under light microscopy. MCF-7 cells (2500 cells/well) Spheres retained their round shape until day 9 (Magnifica-
were seeded onto a hanging drop plate. Spheroids formed tion: X4)
after 2 days in culture. Spheroid images were captured at
Author: A. V. Sutton
Language: English
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