Journal List > Korean J Urol > v.49(8) > 1005161

Han, Chae, Jeong, Kim, Yun, Lee, and Kim: Clinical Significance of the Expression of Gli2 and Gli3 in Bladder Cancer

Abstract

Purpose

The HedgehogGli (HHGli) signaling pathway controls many aspects of tissue patterning, cell proliferation, differentiation and regeneration, and regulates the number of cells in various organs. Inappropriate and uncontrolled activation of the HHGli signaling pathway has been demonstrated in a variety of human cancers. The Gli1, Gli2, and Gli3 genes encoding the Gli family transcription factors play a role as HH effectors. This study examined the significance in Gli2 and Gli3 expression in human bladder cancer.

Materials and Methods

The tumor tissues were obtained from 144 patients with a primary bladder cancer. The mRNA levels of Gli2, and Gli3 were examined using a real-time polymerase chain reaction (PCR) assay in 144 tumor specimens, and immunohistochemical staining was performed on 127 tumor paraffin blocks. The relationships between their expression and the pathological or clinical characteristics, such as tumor stage, grade, recurrence and progression were also analyzed.

Results

Gli2 mRNA expression was higher in the invasive bladder tumors than in the superficial bladder tumors (p<0.001) but, there was no difference in Gli3 mRNA expression according to the tumor stage and grade. The multivariate Cox regression model revealed that Gli2 mRNA expression (hazards ratio (HR): 2.329, 95% confidence interval (CI): 1.043-5.202, p=0.039) was the only strong predictor of superficial bladder tumor recurrence. Kaplan-Meier analysis also showed identical results (log-rank test, p=0.043).

Conclusions

The enhanced expression of Gli2 mRNA was strongly correlated with the recurrence of superficial bladder cancer. These results suggest that Gli2 may be a useful marker for assessing the recurrence of superficial bladder cancer in human bladder cancers.

REFERENCES

1.Kim WJ., Chung JI., Hong JH., Kim CS., Jung SI., Yoon DK. Epidemiological study for urologic cancer in Korea (1998-2002). Korean J Urol. 2004. 45:1081–8.
2.Hudson MA., Catalona WJ. Urothelial tumors of the bladder, upper tracts and prostate. Gillenwater JY, Grayhack JT, editors. editors.Adult and pediatric urology. 3rd ed.St. Louis: Mosby;1996. 1379-464.
3.Messing EM. Urothelial tumors of the bladder. Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. editors.Campbell-Walsh urology. 9th ed.Pennsylvania: Saunders;2006. 2426-7.
4.Beachy PA., Karhadkar SS., Berman DM. Tissue repair and stem cell renewal in carcinogenesis. Nature. 2004. 432:324–31.
crossref
5.Kopper L., Hajdu M. Tumor stem cells. Pathol Oncol Res. 2004. 10:69–73.
crossref
6.Ingham PW., McMahon AP. Hedgehog signaling in animal development: paradigms and principles. Genes Dev. 2001. 15:3059–87.
crossref
7.Berman DM., Karhadkar SS., Hallahan AR., Pritchard JI., Eberhart CG., Watkins DN, et al. Medulloblastoma growth inhibition by hedgehog pathway blockade. Science. 2002. 297:1559–61.
crossref
8.Thayer SP., di Magliano MP., Heiser PW., Nielsen CM., Roberts DJ., Lauwers GY, et al. Hedgehog is an early and late mediator of pancreatic cancer tumorigenesis. Nature. 2003. 425:851–6.
crossref
9.Ruiz i Altaba A., Palma V., Dahmane N. Hedgehog-Gli signalling and the growth of the brain. Nat Rev Neurosci. 2002. 3:24–33.
10.Ruiz i Altaba A. The works of GLI and the power of hedgehog. Nat Cell Biol. 1999. 1:E147–8.
crossref
11.Sinicrope FA., Ruan SB., Cleary KR., Stephens LC., Lee JJ., Levin B. Bcl-2 and p53 oncoprotein expression during colorectal tumorigenesis. Cancer Res. 1995. 55:237–41.
12.Bland JM., Altman DG. Transformations, means, and confidence intervals. BMJ. 1996. 312:1079.
13.Sylvester RJ., van der Meijden AP., Oosterlinck W., Witjes JA., Bouffioux C., Denis L, et al. Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables: a combined analysis of 2596 patients from seven EORTC trials. Eur Urol. 2006. 49:466–75.
crossref
14.Marigo V., Davey RA., Zuo Y., Cunningham JM., Tabin CJ. Biochemical evidence that patched is the Hedgehog receptor. Nature. 1996. 384:176–9.
crossref
15.Bhardwaj G., Murdoch B., Wu D., Baker DP., Williams KP., Chadwick K, et al. Sonic hedgehog induces the proliferation of primitive human hematopoietic cells via BMP regulation. Nat Immunol. 2001. 2:172–80.
crossref
16.Lai K., Kaspar BK., Gage FH., Schaffer DV. Sonic hedgehog regulates adult neural progenitor proliferation in vitro and in vivo. Nat Neurosci. 2003. 6:21–7.
crossref
17.Machold R., Hayashi S., Rutlin M., Muzumdar MD., Nery S., Corbin JG, et al. Sonic hedgehog is required for progenitor cell maintenance in telencephalic stem cell niches. Neuron. 2003. 39:937–50.
crossref
18.Hooper JE., Scott MP. The Drosophila patched gene encodes a putative membrane protein required for segmental patterning. Cell. 1989. 59:751–65.
crossref
19.Ha YS., Yun SJ., Kim YJ., Lee SC., Kim WJ. Utility of Smo as a prognostic marker for human bladder tumors. Korean J Urol. 2007. 48:997–1003.
crossref
20.Katoh Y., Katoh M. Hedgehog signaling pathway and gastrointestinal stem cell signaling network (review). Int J Mol Med. 2006. 18:1019–23.
crossref
21.Xie J., Murone M., Luoh SM., Ryan A., Gu Q., Zhang C, et al. Activating smoothened mutations in sporadic basal-cell carcinoma. Nature. 1998. 391:90–2.
crossref
22.Sasaki H., Nishizaki Y., Hui C., Nakafuku M., Kondoh H. Regulation of Gli2 and Gli3 activities by an amino-terminal repression domain: implication of Gli2 and Gli3 as primary mediators of Shh signaling. Development. 1999. 126:3915–24.
crossref
23.Shin SH., Kogerman P., Lindstrom E., Toftgard R., Biesecker LG. GLI3 mutations in human disorders mimic Drosophila cubitus interruptus protein functions and localization. Proc Natl Acad Sci USA. 1999. 96:2880–4.
crossref
24.Stecca B., Ruiz i Altaba A. The therapeutic potential of modulators of the Hedgehog-Gli signaling pathway. J Biol. 2002. 1:9.
25.Kinzler KW., Bigner SH., Bigner DD., Trent JM., Law ML., O'Brien SJ, et al. Identification of an amplified, highly expressed gene in a human glioma. Science. 1987. 236:70–3.
crossref
26.Snijders AM., Schmidt BL., Fridlyand J., Dekker N., Pinkel D., Jordan RC, et al. Rare amplicons implicate frequent deregulation of cell fate specification pathways in oral squamous cell carcinoma. Oncogene. 2005. 24:4232–42.
crossref
27.Gordon AT., Brinkschmidt C., Anderson J., Coleman N., Dockhorn-Dworniczak B., Pritchard-Jones K, et al. A novel and consistent amplicon at 13q31 associated with alveolar rhabdomyosarcoma. Genes Chromosomes Cancer. 2000. 28:220–6.
crossref
28.Al-Sukhun S., Hussain M. Molecular biology of transitional cell carcinoma. Crit Rev Oncol Hematol. 2003. 47:181–93.
crossref

Fig. 1.
Time to recurrence in superficial bladder tumor with Gli2 mRNA expression levels.
kju-49-696f1.tif
Fig. 2.
Immunohistochemical staining of Gli2 in the normal bladder mucosa (A), superficial bladder tumor (B), invasive bladder tumor (C) and Gli3 in normal bladder mucosa (D), superficial bladder tumor (E), invasive bladder tumor (F).
kju-49-696f2.tif
Table 1.
Clinical and pathological features of the primary bladde transitional cell carcinomas
Variables No. of patients (%
Sex
Male 119 (82.6)
Female 25 (17.4)
Age (years) 65.3±11.2
Stage
Superficial 92 (63.9)
Invasive 52 (36.1)
Grade
Low 91 (63.2)
High 53 (36.8)
Superficial recurrence
Non-recurred 64 (69.6)
Recurred 28 (30.4)
Progression
Non-progressed 119 (82.6)
Progressed 25 (17.4)
Invasive bladder cancer progression 9 (36.0)
Superficial bladder cancer progression 16 (64.0)
Survival
Alive 92 (63.9)
Deceased 52 (36.1)
Cancer specific cause 29 (55.8)
Other cause 23 (44.2)
Table 2.
Gli2 and Gli3 mRNA expression levels of primary bladder transitional cell carcinomas
Variables Gli2* p-value Gli3* p-value
Stage <0.001 0.649
Superficial 3.8 (2.9-4.9) 6.3 (4.9-8.2)
Invasive 13.9 (9.3-20.7) 7.0 (4.6-10.8)
Grade 0.155 0.617
Low 5.3 (3.9-7.1) 6.9 (5.3-8.9)
High 7.6 (5.0-11.5) 6.1 (4.0-9.3)

* 103 copies/μl,

: Student’s t-test

Table 3.
Multivariate analysis for the prediction the recurrence of superficial bladder cancer
Variables HR (95% CI) p-value
Age (≤65 vs >65 years) 1.011 (0.414-2.469) 0.981
Sex (male vs female) 1.782 (0.624-5.092) 0.281
Stage (Ta vs T1) 1.672 (0.542-5.157) 0.371
Grade (low vs high) 1.106 (0.542-5.157) 0.854
Number
Single Reference -
2 to 7 1.156 (0.447-2.987) 0.756
>8 1.720 (0.491-6.030) 0.397
Size (≤3cm vs >3cm) 1.084 (0.491-2.393) 0.842
Gli 2 (low vs high) 2.329 (1.043-5.202) 0.039
Gli 3 (low vs high) 0.579 (0.252-1.333) 0.199

HR: hazards ratio, CI: confidence interval

Table 4.
Gli2 and Gli3 immunohistochemical staining scores in primary bladder transitional cell carcinomas
Variables No. (%) Gli2 p-value* Gli3 p-value*
Stage 0.008 0.039
Superficial 76 (59.8) 5.47±2.16 6.03±2.15
Invasive 51 (40.2) 6.21±2.27 6.97±2.67
Grade 0.023 0.010
Low 80 (63.0) 5.34±1.77 5.96±2.37
High 47 (37.6) 6.28±2.62 7.11±2.51

* : Mann-Whitney U test

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