title: Primary tumour expression of the cysteine cathepsin inhibitor Stefin A inhibits distant metastasis in breast cancer.
abstract: Using the clinically relevant 4T1-derived syngeneic murine model of spontaneous mammary metastasis to bone, we have identified the cysteine cathepsin inhibitor Stefin A as a gene differentially expressed in primary and metastatic mammary tumours. In primary tumours, Stefin A expression correlated inversely with metastatic potential in 4T1-derived lines and was not detected in tumour cells in culture, indicating induction only within the tumour microenvironment. Enforced expression of Stefin A in the highly metastatic 4T1.2 cell line significantly reduced spontaneous bone metastasis following orthotopic injection into the mammary gland. Consistent with the mouse data, Stefin A expression correlated with disease-free survival (absence of distant metastasis) in a cohort of 142 primary tumours from breast cancer patients. This was most significant for patients with invasive ductal carcinoma expressing Stefin A, who were less likely to develop distant metastases (log rank test, p = 0.0075). In a multivariate disease-free survival analysis (Cox proportional hazards model), Stefin A expression remained a significant independent prognostic factor in patients with invasive ductal carcinoma (p = 0.0014), along with grade and progesterone receptor (PR) status. In human lung and bone metastases, we detected irregular Stefin A staining patterns, with expression often localizing to micrometastases (<0.2 mm) in direct contact with the stroma. We propose that Stefin A, as a cysteine cathepsin inhibitor, may be a marker of increased cathepsin activity in metastases. Using immunohistology, the cathepsin inhibitor was detected co-expressed with cathepsin B in lung and bone metastases in both the murine model and human tissues. We conclude that Stefin A expression reduces distant metastasis in breast cancer and propose that this may be due to the inhibition of cysteine cathepsins, such as cathepsin B.
authors.affiliation: Research Division, Peter MacCallum Cancer Centre, East Melbourne, Australia 3002. belinda.parker@petermac.org
authors.forename: B S
authors.initials: BS
authors.lastname: Parker
authors.forename: D R
authors.initials: DR
authors.lastname: Ciocca
authors.forename: B N
authors.initials: BN
authors.lastname: Bidwell
authors.forename: F E
authors.initials: FE
authors.lastname: Gago
authors.forename: M A
authors.initials: MA
authors.lastname: Fanelli
authors.forename: J
authors.initials: J
authors.lastname: George
authors.forename: J L
authors.initials: JL
authors.lastname: Slavin
authors.forename: A
authors.initials: A
authors.lastname: Möller
authors.forename: R
authors.initials: R
authors.lastname: Steel
authors.forename: N
authors.initials: N
authors.lastname: Pouliot
authors.forename: B  L
authors.initials: B
authors.lastname: Eckhardt
authors.forename: M A
authors.initials: MA
authors.lastname: Henderson
authors.forename: R L
authors.initials: RL
authors.lastname: Anderson
mesh_terms: D000818:Animals; D014408:Biomarkers, Tumor / Q000032:analysis; D001859:Bone Neoplasms / Q000235:genetics / Q000378:metabolism* / Q000556:secondary*; D001943:Breast Neoplasms / Q000188:drug therapy / Q000235:genetics / Q000378:metabolism*; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy / Q000235:genetics / Q000378:metabolism*; D016022:Case-Control Studies; D055312:Cystatin A; D015891:Cystatins / Q000032:analysis* / Q000235:genetics / Q000378:metabolism; D015853:Cysteine Proteinase Inhibitors / Q000032:analysis* / Q000235:genetics / Q000378:metabolism; D018572:Disease-Free Survival; D005260:Female; D015870:Gene Expression; D006801:Humans; D007150:Immunohistochemistry; D015552:Injections, Intralesional; D051379:Mice; D009361:Neoplasm Invasiveness / Q000473:pathology; D011379:Prognosis; D016016:Proportional Hazards Models; D020133:Reverse Transcriptase Polymerase Chain Reaction
chemical_list: D014408:Biomarkers, Tumor; D055312:Cystatin A; D015891:Cystatins; D015853:Cysteine Proteinase Inhibitors