title: Mechanisms driving local breast cancer recurrence in a model of breast-conserving surgery.
abstract: OBJECTIVE
  We aimed to identify mechanisms driving local recurrence in a model of breast-conserving surgery (BCS) for breast cancer.
  
  
  BACKGROUND
  Breast cancer recurrence after BCS remains a clinically significant, but poorly understood problem. We have previously reported that recurrent colorectal tumours demonstrate altered growth dynamics, increased metastatic burden and resistance to apoptosis, mediated by upregulation of phosphoinositide-3-kinase/Akt (PI3K/Akt). We investigated whether similar characteristics were evident in a model of locally recurrent breast cancer.
  
  
  METHODS
  Tumours were generated by orthotopic inoculation of 4T1 cells in two groups of female Balb/c mice and cytoreductive surgery performed when mean tumour size was above 150 mm(3). Local recurrence was observed and gene expression was examined using Affymetrix GeneChips in primary and recurrent tumours. Differential expression was confirmed with quantitative real-time polymerase chain reaction (qRT-PCR). Phosphorylation of Akt was assessed using Western immunoblotting. An ex vivo heat shock protein (HSP)-loaded dendritic cell vaccine was administered in the perioperative period.
  
  
  RESULTS
  We observed a significant difference in the recurrent 4T1 tumour volume and growth rate (p < 0.05). Gene expression studies suggested roles for the PI3K/Akt system and local immunosuppression driving the altered growth kinetics. We demonstrated that perioperative vaccination with an ex vivo HSP-loaded dendritic cell vaccine abrogated recurrent tumour growth in vivo (p = 0.003 at day 15).
  
  
  CONCLUSIONS
  Investigating therapies which target tumour survival pathways such as PI3K/Akt and boost immune surveillance in the perioperative period may be useful adjuncts to contemporary breast cancer treatment.
authors.affiliation: Department of Academic Surgery, Cork University Hospital, Cork, Ireland. mylessmith@hotmail.com
authors.forename: Myles J
authors.initials: MJ
authors.lastname: Smith
authors.forename: Aedín C
authors.initials: AC
authors.lastname: Culhane
authors.forename: Shane
authors.initials: S
authors.lastname: Killeen
authors.forename: Maura A
authors.initials: MA
authors.lastname: Kelly
authors.forename: Jiang H
authors.initials: JH
authors.lastname: Wang
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Cotter
authors.forename: Henry P
authors.initials: HP
authors.lastname: Redmond
mesh_terms: D000818:Animals; D014408:Biomarkers, Tumor / Q000235:genetics / Q000378:metabolism; D015153:Blotting, Western; D001853:Bone Marrow / Q000378:metabolism; D001943:Breast Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D019496:Cancer Vaccines / Q000627:therapeutic use; D003713:Dendritic Cells / Q000276:immunology / Q000378:metabolism; D004195:Disease Models, Animal; D005260:Female; D020869:Gene Expression Profiling; D006360:Heat-Shock Proteins / Q000627:therapeutic use; D006801:Humans; D051379:Mice; D008807:Mice, Inbred BALB C; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000378:metabolism; D020411:Oligonucleotide Array Sequence Analysis; D019869:Phosphatidylinositol 3-Kinases / Q000378:metabolism; D010766:Phosphorylation; D051057:Proto-Oncogene Proteins c-akt / Q000378:metabolism; D012333:RNA, Messenger / Q000235:genetics / Q000378:metabolism; D020133:Reverse Transcriptase Polymerase Chain Reaction; D015398:Signal Transduction; D015996:Survival Rate; D014407:Tumor Cells, Cultured
chemical_list: D014408:Biomarkers, Tumor; D019496:Cancer Vaccines; D006360:Heat-Shock Proteins; D012333:RNA, Messenger; D019869:Phosphatidylinositol 3-Kinases; D051057:Proto-Oncogene Proteins c-akt