Open Access Research article

Expression of Six1 in luminal breast cancers predicts poor prognosis and promotes increases in tumor initiating cells by activation of extracellular signal-regulated kinase and transforming growth factor-beta signaling pathways

Ritsuko Iwanaga1, Chu-An Wang2, Douglas S Micalizzi23, J Chuck Harrell4, Paul Jedlicka5, Carol A Sartorius5, Peter Kabos6, Susan M Farabaugh2, Andrew P Bradford1 and Heide L Ford1237*

Author Affiliations

1 Department of Obstetrics and Gynecology, University of Colorado School of Medicine, 12700 East 19th Ave, Aurora, CO 80238 USA

2 Program in Molecular Biology, University of Colorado School of Medicine, 12800 East 19th Ave., Aurora, CO 80238 USA

3 Medical Scientist Training Program, University of Colorado School of Medicine, 12800 East 19th Ave., Aurora, CO 80238 USA

4 Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Campus Box 7295, Chapel Hill, NC 27599 USA

5 Department of Pathology, University of Colorado School of Medicine, 12800 East 19th Ave., Aurora, CO 80238 USA

6 Department of Medicine, University of Colorado School of Medicine, 12800 East 19th Ave., Aurora, CO 80238 USA

7 Department of Pharmacology, University of Colorado School of Medicine, 12800 East 19th Ave., Aurora, CO 80238 USA

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Breast Cancer Research 2012, 14:R100  doi:10.1186/bcr3219

Published: 5 July 2012

Abstract

Introduction

Mammary-specific overexpression of Six1 in mice induces tumors that resemble human breast cancer, some having undergone epithelial to mesenchymal transition (EMT) and exhibiting stem/progenitor cell features. Six1 overexpression in human breast cancer cells promotes EMT and metastatic dissemination. We hypothesized that Six1 plays a role in the tumor initiating cell (TIC) population specifically in certain subtypes of breast cancer, and that by understanding its mechanism of action, we could potentially develop new means to target TICs.

Methods

We examined gene expression datasets to determine the breast cancer subtypes with Six1 overexpression, and then examined its expression in the CD24low/CD44+ putative TIC population in human luminal breast cancers xenografted through mice and in luminal breast cancer cell lines. Six1 overexpression, or knockdown, was performed in different systems to examine how Six1 levels affect TIC characteristics, using gene expression and flow cytometric analysis, tumorsphere assays, and in vivo TIC assays in immunocompromised and immune-competent mice. We examined the molecular pathways by which Six1 influences TICs using genetic/inhibitor approaches in vitro and in vivo. Finally, we examined the expression of Six1 and phosphorylated extracellular signal-regulated kinase (p-ERK) in human breast cancers.

Results

High levels of Six1 are associated with adverse outcomes in luminal breast cancers, particularly the luminal B subtype. Six1 levels are enriched in the CD24low/CD44+ TIC population in human luminal breast cancers xenografted through mice, and in tumorsphere cultures in MCF7 and T47D luminal breast cancer cells. When overexpressed in MCF7 cells, Six1expands the TIC population through activation of transforming growth factor-beta (TGF-β) and mitogen activated protein kinase (MEK)/ERK signaling. Inhibition of ERK signaling in MCF7-Six1 cells with MEK1/2 inhibitors, U0126 and AZD6244, restores the TIC population of luminal breast cancer cells back to that observed in control cells. Administration of AZD6244 dramatically inhibits tumor formation efficiency and metastasis in cells that express high levels of Six1 ectopically or endogenously. Finally, we demonstrate that Six1 significantly correlates with phosphorylated ERK in human breast cancers.

Conclusions

Six1 plays an important role in the TIC population in luminal breast cancers and induces a TIC phenotype by enhancing both TGF-β and ERK signaling. MEK1/2 kinase inhibitors are potential candidates for targeting TICs in breast tumors.