title: Medroxyprogesterone acetate elevation of Nm23-H1 metastasis suppressor expression in hormone receptor-negative breast cancer.
abstract: BACKGROUND
  Reestablishment of metastasis suppressor gene expression may constitute a therapeutic strategy for high-risk breast cancer patients. We previously showed that medroxyprogesterone acetate (MPA), a progestin that has been tested as treatment for advanced breast cancer, elevates expression of the Nm23-H1 metastasis suppressor gene in hormone receptor-negative metastatic human breast carcinoma cell lines in vitro via a glucocorticoid receptor-based mechanism. Here, we tested whether MPA treatment inhibits metastatic colonization of a hormone receptor-negative breast cancer cell line in vivo.
  
  
  METHODS
  We tested the soft-agar colony-forming efficiency of untransfected MDA-MB-231T human breast carcinoma cells and MDA-MB-231T cells transfected with antisense Nm23-H1 in the presence and absence of MPA. Pharmacokinetic studies were used to establish dose and injection schedules that led to MPA serum levels in mice similar to those achievable in humans. For in vivo studies, nude mice were injected intravenously with MDA-MB-231T cells. After 4 weeks, mice were randomized to control or MPA arms. Endpoints included incidence, number, and size of gross pulmonary metastases; Nm23-H1 protein expression in gross metastases; and side effects. All statistical tests were two-sided.
  
  
  RESULTS
  MPA reduced colony formation of MDA-MB-231T cells by 40%-50% but had no effect on colony formation of Nm23-H1 antisense transfectants. Metastases developed in 100% (95% confidence interval [CI] = 78% to 100% and 77% to 100%, respectively) of control mice injected with MDA-MB-231T cells. In two independent experiments, only 73% (95% CI = 45% to 92%) and 64% (95% CI = 35% to 87%) of mice injected with 2 mg of MPA developed metastases. Mice injected with 2 mg of MPA showed reductions in the mean numbers, per mouse, of all metastases and of large (>3 mm) metastases (P = .04 and .013, respectively). Nm23-H1 was expressed at high levels in 43% of pulmonary metastases in MPA-treated mice but only 13% of metastases in untreated mice. Mice receiving at least 1-mg doses of MPA gained more weight than control-treated mice but exhibited no bone density alterations or abnormal mammary fat pad histology.
  
  
  CONCLUSIONS
  Our preclinical results show that MPA appears to elevate Nm23-H1 metastasis suppressor gene expression, thereby reducing metastatic colonization. The data suggest a new use for an old agent in a molecularly defined subset of breast cancer patients.
authors.affiliation: Women's Cancers Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA.
authors.forename: Diane
authors.initials: D
authors.lastname: Palmieri
authors.forename: Douglas O
authors.initials: DO
authors.lastname: Halverson
authors.forename: Taoufik
authors.initials: T
authors.lastname: Ouatas
authors.forename: Christine E
authors.initials: CE
authors.lastname: Horak
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Salerno
authors.forename: Jennifer
authors.initials: J
authors.lastname: Johnson
authors.forename: W Douglas
authors.initials: WD
authors.lastname: Figg
authors.forename: Melinda
authors.initials: M
authors.lastname: Hollingshead
authors.forename: Stephen
authors.initials: S
authors.lastname: Hursting
authors.forename: David
authors.initials: D
authors.lastname: Berrigan
authors.forename: Seth M
authors.initials: SM
authors.lastname: Steinberg
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Merino
authors.forename: Patricia S
authors.initials: PS
authors.lastname: Steeg
mesh_terms: D000818:Animals; D018931:Antineoplastic Agents, Hormonal / Q000494:pharmacology*; D014408:Biomarkers, Tumor / Q000378:metabolism*; D015153:Blotting, Western; D001943:Breast Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000378:metabolism*; D045744:Cell Line, Tumor; D016373:DNA, Antisense; D005260:Female; D015972:Gene Expression Regulation, Neoplastic / Q000187:drug effects*; D016147:Genes, Tumor Suppressor / Q000187:drug effects*; D006801:Humans; D007150:Immunohistochemistry; D017258:Medroxyprogesterone Acetate / Q000494:pharmacology*; D051379:Mice; D054778:NM23 Nucleoside Diphosphate Kinases; D009701:Nucleoside-Diphosphate Kinase / Q000097:blood / Q000187:drug effects* / Q000378:metabolism*; D014162:Transfection
chemical_list: D018931:Antineoplastic Agents, Hormonal; D014408:Biomarkers, Tumor; D016373:DNA, Antisense; D054778:NM23 Nucleoside Diphosphate Kinases; D017258:Medroxyprogesterone Acetate; C517938:NME1 protein, human; C517939:Nme1 protein, mouse; D009701:Nucleoside-Diphosphate Kinase