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Center for the Study for Reproductive Biology and Womens Health, Departments of Developmental and Molecular Biology and OB/GYN and Womens Health,, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, New York 10461, USA
(Requests for offprints should be addressed to J W Pollard; Email: pollard@aecom.yu.edu)
* (H Zhang and T McElrath contributed equally to this work)
| Abstract |
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| Introduction |
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It has been shown by studies, mostly in tissue culture cells, that the duration of the cell cycle is regulated by the binding of the regulatory cyclins with their cyclin-dependent kinase (CDK) partners (Sherr 1994). Positive activation of CDK involves assembly with their cyclin partners and phosphorylation by cyclin activating kinase. On the other hand, interaction with CDK inhibitors (CDI) negatively regulates their activity (Sherr 1996, Sherr & Roberts 1999). The active CDKs phosphorylate their nuclear protein substrates, members of the retino-blastoma (pRb) family of pocket proteins, which, in turn, alleviates the negative control of these proteins over certain transcription factors, such as the E2Fs, required for cell cycle progression (Ewen et al. 1993, Sherr 1996, Sherr & Roberts 1999). Different cyclins act sequentially through G1, with members of the cyclin D family activating CDK4 and CDK6 first, followed by cyclin E/CDK2 at the G1/S phase transition and cyclin A/CDK2 throughout S phase (Ohtsubo & Roberts 1993, Sherr 1994). In this scenario the D-type cyclins are considered to be the sensors of external signals, modulating the rate of cell division (Sherr 1994).
The high potency natural estrogen, estradiol-17ß (E2), when given to ovariectomized mice results in a synchronized wave of DNA synthesis in the luminal and glandular epithelium of the uterus beginning at 6 h and peaking at 1215 h after administration, followed by a wave of cell division and re-entry into another cell cycle (Finn & Martin 1970, Kaye et al. 1972, Martin et al. 1973, 1976, Tong & Pollard 2002). Recently, we have shown that E2 controls the uterine epithelial cell cycle through the activation of cyclin dependent kinases which resulted in hyperphosphorylation of pRb and p107 and subsequently enhanced cell cycle progression (Tong & Pollard 1999). Estrogen treatment of breast carcinoma cells results in a dramatic elevation of cyclin D1 mRNA and protein (Matsushime et al. 1991, 1994, Musgrove et al. 1993, 1994, Prall et al. 1997). However, in uterine epithelial cells in vivo there was only a moderate induction of cyclin D1 by E2 and most of this was at a later stage than the phosphorylation of pRb (Tong & Pollard 1999). Instead, E2 mobilized cyclin D1 and to a lesser extent CDK4 from the cytoplasm to the nucleus, thus giving the active kinase complex access to its nuclear localized pRb family of substrates (Tong & Pollard 1999). These data suggest that the mobilization of cyclin D1 into the nucleus is a central regulatory point for estrogen action in the uterus.
In the mouse uterus, tamoxifen is an agonist inducing epithelial cell proliferation while showing little to no antagonistic effect in the presence of E2 (Martin & Middleton 1978, Klotz et al. 2000). Long-term administration induces persistent changes in the uterus including cystic hyperplasia in the glands (Martin & Middleton 1978). This contrasts with the rat where tamoxifen was as effective as ovariectomy in reducing proliferating cell nuclear antigen (PCNA) expression, a marker for cell proliferation, although the effects were somewhat cell type specific (Rumpel et al. 1995), and in chickens where it is fully antagonistic without estrogenic properties (Sutherland et al. 1977). Humans appear to be more similar to mice than to rats in their uterine responses, since tamoxifen acts agonistically stimulating cell proliferation (Ismail 1996, Jordan & Morrow 1999, Willen et al. 2002). These differences could be mediated through different metabolic routes. However, there have been no species-specific variations in estrogen metabolism identified to date. This has led to the concept of target site-specific regulation and many have focused upon differential estrogen receptor (ER) modulation by tamoxifen (Jordan & Morrow 1999).
There have been few studies on the molecular basis of this agonistic action in the uterus. Some have analyzed the induction of specific estrogen-responsive genes that might affect cell proliferation such as transforming growth factor-ß1, vascular endothelial growth factor (VEGF) and insulin-like growth factor (IGF)-I/IGF binding proteins (Hung & Pollak 1995, Sartor et al. 1995, Hyder et al. 1996, Klotz et al. 2000, Mueller et al. 2003), but none have specifically addressed the control of the cell cycle machinery in uterine epithelial cells with the exception of some studies on cyclin D expression (Geum et al. 1997). However, in cancer cells in culture there have been several studies that have explored the antagonistic effect of tamoxifen (Watts et al. 1994, Planas-Silva & Weinberg 1997), although these actions have not necessarily been dependent upon the ER (Lee et al. 2000). A central mechanism appears to be through the induction of the CDIs, p21WAF1 and p27KIP1, combined with a reduction in cyclin D1 protein that acts to inhibit cyclin D/CDK4 and cyclin E/CDK2 activity and arrest cell cycle progression (Wilcken et al. 1997, Lee et al. 1999, 2000, Doisneau-Sixou et al. 2003). Interestingly, over-expression of cyclin D1 (Wilcken et al. 1997) or cyclin E can alleviate tamoxifen inhibition of MCF-7 cells in culture (Dhillon & Mudryj 2002). In some cases cyclin E can also replace cyclin D1 function in regulating the cell cycle (Lukas et al. 1997, Geng et al. 1999). Furthermore, over-expression of cyclin E can stimulate cell cycle transit without influencing cyclin D1/CDK4 activity or pRb phosphorylation (Lukas et al. 1997). Since cyclin D1 appears to be a major point of control for E2 regulation of the uterine epithelium, then an explanation for tamoxifens agonist role without fully activating the estrogen receptor may be that tamoxifen exerts its action in a manner different from that of E2 through regulating other components of the cell cycle such as cyclin E. Given the diverse receptor- and non-receptor-mediated effects of tamoxifen and its importance in breast cancer chemotherapy in humans, we analyzed the proliferation response to tamoxifen in the mouse uterine epithelial cells in vivo and its effects on the cyclin-dependent cell cycle machinery in these cells. We found that it is an impeded estrogen with a
200 000-fold lower potency than E2 but that it exerts its effects on cell proliferation in a manner similar to E2.
| Materials and Methods |
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Adult female CD1 mice (Charles River, Wilmington, MA, USA), maintained in a 12-h light:12-h darkness cycle and weighing 2530 g, were ovariectomized, rested for two weeks, followed by two days of priming with E2 as described (Tong & Pollard 1999). Six days later, groups of 35 mice were given one of the following treatments: (i) peanut oil, (ii) 50 ng E2, (iii) a range of concentrations (0.1251.5 mg/mouse) of tamoxifen. All hormones were purchased from Sigma and administered subcutaneously in peanut oil.
At various times after hormone treatment mice were killed, uteri removed and weighed, and either processed for immunohistochemistry or the luminal epithelium was removed for biochemical analysis as described previously (Tong & Pollard 1999). In some cases, to assess the percentage of cells in S-phase, BrdU was given intra-peritoneally 2 h before killing as described by Tong & Pollard (1999).
Immunohistochemistry
Uteri were fixed overnight in Bouins solution or peroxidelysine2% paraformaldehyde0.5% glutaldehyde (PLPG) and processed for paraffin embedding. Transverse sections (5 µm) through the mid-point of the uterus were prepared and immunostained for BrdU incorporation, or for PCNA, cyclin A, CDK2, CDK4 or cyclin D1 protein as described (Tong & Pollard 1999). Polyclonal antibodies to CDK2 (sc-163), CDK4 (sc-260), p107 (sc-318) and cyclin A (sc-596) were obtained from Santa Cruz Biotechnology, Santa Cruz, CA, USA and validated by peptide inhibition and titration as described (Tong & Pollard 1999). Monoclonal antibodies to pRb (G3245) were obtained from Pharmingen (San Diego, CA, USA), for cyclin D1 (DCS-6) they were obtained from Neomarkers (Freemont, CA, USA) and for PCNA (PC10) they were obtained from Boehringer Mannheim. Controls also included incubation in normal serum corresponding to the source of the antibody used and omission of the primary antibody. These were uniformly negative. To determine the percentage of nuclear positive luminal and glandular epithelial cells for each of these antibody stains, all the epithelial cells were scored in representative sections from the mid-point of the uterus and means ±S.D. from a minimum of 6 mice were derived.
Biochemical analysis of cell cycle regulatory proteins
Uterine epithelial cell lysates were prepared in either the gel electrophoresis buffer or in kinase buffer, as described in detail before (Tong & Pollard 1999), at various times after hormone treatment using a method that gave an epithelial extract of < 95% purity (Fagg et al. 1979, Tong & Pollard 1999). Protein concentration was measured using the Bradford reagent. Equal amounts of protein per treatment group were separated by SDS-gel electrophoresis and transferred to Immonobilon P membrane (Millepore, Billerica, MA, USA). After blocking non-specific binding using dried milk, filters were probed with antibodies against cyclin D1, E and A, pRb and p107, and CDK4, CDK2 and PCNA as described (Tong & Pollard 1999). Specific binding was detected using an enhanced chemoluminescence system after incubation with an appropriate secondary antibody linked to horseradish peroxidase as described (Tong & Pollard 1999). The immunodetection for each protein was shown to be in the linear portion of the curve by titration of the lysates and antibody, and the signal was quantified by densitometry (Tong & Pollard 1999).
Immune complex kinase assays were performed after immunoprecipitation of the uterine lysates with anti-cyclin E, anti-cyclin A, anti-CDK4 and anti-CDK2 antibodies as described (Tong & Pollard 1999, Chen & Pollard 2003). Histone H1 was used as the substrate for anti-cyclin E, cyclin A and CDK2 immunoprecipitates while GSK pRb (Amino acids 769921, Santa Cruz) was used as the substrate for CDK4. The reaction products were separated by SDS-gel electrophoresis followed by autoradiography as described (Tong & Pollard 1999). All experiments involving protein analysis were derived from five mice per group and were repeated at least twice with similar results. Blots shown are representative of these repeat experiments.
Statistical analysis
Statistical analysis was performed using ANOVA with Dunnetts multiple comparisons test to determine the significance of the effect of tamoxifen at various times/ doses versus the control. For single time point comparisons between E2 and tamoxifen treatments, Students t-test was used.
| Results |
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A single injection of 50 ng to E2 ovariectomized mice stimulates uterine luminal and glandular cell proliferation with a peak of cells detected with anti-BrdU antibody in S-phase 15 h after administration. At this stage, ~90% of cells have incorporated BrdU. This dose of E2 has been demonstrated to be maximal (Martin et al. 1973). Consistent with this induction of DNA synthesis there is a concurrent nuclear localization of PCNA, the
-sub-unit of DNA polymerase, and cyclin A synthesis and its nuclear localization (Tong & Pollard 1999). E2 also stimulates uterine edema and this is often used as a surrogate marker for estrogenicity (Martin et al. 1973). Consequently, we used the four parameters of BrdU incorporation, PCNA nuclear localization, cyclin A synthesis and nuclear localization, and uterine edema to determine the responsiveness of the mouse uterus to tamoxifen over a range of doses from 0.125 to 1.5 mg/mouse. These responses were measured at 16 h after hormone administration because this is also the time point of maximal response (see below).
Sixteen hours post-administration tamoxifen induced a doubling of uterine wet weight even at the lowest dose of 0.125 mg/mouse, with little further increase up to 1.5 mg/mouse (Fig. 1A
; P< 0.001). This indicates a nearly maximal response at 0.125 mg/mouse. In contrast, a tamoxifen dose of 0.125 mg/mouse did not induce an increase in cells incorporating BrdU (Fig. 1B
). This required 0.25 mg/mouse to produce a statistically significant increase (P< 0.01), with the plateau of response attained at 0.5 mg/mouse when approximately 50% of cells were in DNA synthesis (Fig. 1B
). This was significantly lower than the response to E2 (data not shown; P< 0.001). Consistent with this increase in DNA synthesis, there was a dose-related increase in the concentration of cyclin A measured by Western blotting with anti-cyclin A antibodies in uterine luminal epithelial lysates (Fig. 1C
, insert), although maximal amounts were not detected until 1.0 mg/mouse was administered, at which point it was induced to a similar level to that attained after treatment with 50 ng E2. Cyclin A acts in concert with its CDK2 partner in the nucleus to phosphorylate nuclear localized pRb-family substrates required for progression through S-phase and it is therefore an index of DNA synthesis (Sherr 1996). Thus the percentage of cyclin A nuclear positive cells was scored following immunohistochemistry of transverse uterine sections using anti-cyclin A antibodies. The lowest dose of 0.125 mg did not cause a significant elevation in cyclin A positive cells. This required 0.25 mg (P< 0.01, control vs tamoxifen treated) with the doseresponse reaching a plateau at 0.5 mg/mouse, exactly mimicking the doseresponse of incorporation of BrdU, although with only 30% of the epithelial cells being scored positive for this cyclin at this time-point (Fig. 1C
).
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In these preliminary experiments we have shown that tamoxifen induces a significant dose-dependent increase in DNA synthesis in the luminal epithelium of ovariectomized mice. Given that 0.5 mg/mouse marked the inflection point of the doseresponse curve, 1.0 mg/mouse was chosen for subsequent experiments because this produced a maximal response for all four parameters measured. Since 50 ng/mouse E2 is a maximal dose, this indicates that tamoxifen is ~200 000 times less potent than E2 in this organ and never achieves full estrogenicity.
Time course of uterine response to tamoxifen
We next determined the time-course of responses to 1.0 mg/mouse tamoxifen in ovariectomized, primed mice. This dose induced a dramatic and significant (P< 0.001) increase in wet weight with a 50% increase within 4 h of administration (P< 0.01, control vs 4 h tamoxifen treated). This progressively increased over time to reach approximately threefold the control weight at 24 h where it remained throughout the duration of the experiment until 72 h post-injection (Fig. 2A
). The pattern of BrdU incorporation into luminal epithelium cells followed that observed following a single injection of E2 (Martin et al. 1973) with the first significant increase in BrdU-positive luminal epithelial cells found at 8 h after injection (Fig. 2B
; P< 0.01). This value reached a peak at 1216 h, followed by a steady decline to below control steady-state values by 48 h (Fig. 2B
). The peak value of ~50% of luminal epithelial cells incorporating BrdU was significantly less than the ~90% observed following a single injection of 50 ng E2 (Fig. 2B,D
; P< 0.001 Students t-test). This effect on BrdU incorporation is illustrated in Fig. 2D
. BrdU-positive cells in the glandular epithelium followed a similar pattern except the amplitude was much lower both in the untreated control and in the drug-treated group (Fig. 2B
). Furthermore, the incorporation of BrdU into these cells persisted over the 72 h of the experiment.
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These data confirm and significantly extend previous studies (Martin & Middleton 1978) that conclude that the proliferative responses to tamoxifen in uterine epithelial cells show a similar time course to those observed after E2 treatment.
Tamoxifen regulation of the cell cycle machinery
The hyperphosphorylation of the pRb family of proteins is thought to be central to the regulation of the mammalian cell cycle (Sherr 1996). Consequently, we examined the phosphorylation of pRB and p107 in response to 1.0 mg tamoxifen for up to 48 h post-treatment. In the control untreated uterine epithelial lysates, both pRb and p107 mostly run as a single band on SDS-PAGE corresponding to the hypo-phosphorylated forms of these molecules (Fig. 3
) (Tong & Pollard 1999). Eight hours after tamoxifen treatment phosphorylated bands characterized by a lower electrophoretic mobility were visible for both pRb and p107. These phosphorylated forms increased and persisted until 24 h after treatment before they declined 48 h post treatment (Fig. 3
).
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After the initial phosphorylation of pRb and p107 by cyclin D1/CDK4 or CDK6, the subsequent phosphorylation is performed by CDK2 in association with cyclin E or cyclin A. As assessed by Western blotting, tamoxifen produced a modest elevation in cyclin E concentrations in the luminal epithelial cells approximately 8 h after administration and this declined between 24 and 48 h to below the control untreated levels (Fig. 5A
). In contrast and consistent with the documented sequence of events following E2 treatment of the uterus (Tong & Pollard 1999), cyclin A concentration in the uterine epithelial cells did not show a change until 12 h after tamoxifen administration after which it reached a peak at 1624 h before declining at 48 h (Fig. 5A
). This was paralleled by the detection, by immunostaining, of nuclear cyclin A at 12 and 16 h post-tamoxifen treatment with an anti-cyclin A antibody (Fig. 5B
).
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| Discussion |
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(Tong & Pollard 2002). Estrogens are also mitogenic in the mammary epithelium that is also a target organ because of expression of the ER (Bocchinfuso & Korach 1977, Daniel et al. 1987, Haslam 1988). In both the uterine and mammary epithelium, E2 activates the cyclin/cyclin-dependent kinase cell cycle machinery. First, members of the cyclin D family, together with their partners CDK4 and CDK6, are activated followed by induction of cyclin E- and cyclin-A-CDK2 activity. This results in the sequential phosphorylation of the central cell cycle regulatory molecule, pRb, and progression into S-phase (Clarke & Sutherland 1990, Tong & Pollard 2002, Doisneau-Sixou et al. 2003). In the uterus, in contrast to mammary epithelial cells in culture, E2 does not result in an elevation of cyclin D1 early in the cell cycle but instead mobilizes a pre-existent cytoplasmic pool to move into the nucleus. Similarly, cyclin D1s cytoplasmic partner, CDK4, is also accumulated in the nucleus in response to E2 and this complex results in the first pRb phosphorylation at Thr 807/811 specifically in these epithelial cells (Tong & Pollard 1999, Chen & Pollard 2003). This appears to be a central node in the regulation of uterine epithelial cell proliferation by sex steroid hormones because progesterone, a hormone that completely inhibits the E2-induced uterine epithelial cell proliferation, blocks entry of cyclin D1 into the nucleus and completely inhibits pRb phosphorylation (Tong & Pollard 1999). The importance of the mobilization of cyclin D in the E2-induced proliferative response is further emphasized by studies of cyclin D1 null mutant mice that undergo E2-induced proliferation through compensation by cyclin D2 that completely replaces cyclin D1 in its nuclear accumulation, CDK4 activation and phosphorylation of pRb (Chen & Pollard 2003). In both mice and humans, tamoxifen is an agonist in the uterus and an antagonist in the breast despite binding to the ER in both these tissues (Jordan & Morrow 1999). The ER has two transcriptional activation domains, AF-1 and AF-2. AF-1 activity is stimulated by tamoxifen binding but AF-2 is inhibited (Smith et al. 1997, McDonnell 1999) while E2 activates both AF-1 and AF-2 (Webb et al. 1995, Smith et al. 1997, Jordan & Morrow 1999). This results in the differential recruitment of receptor co-factors that could result in interpretation of estrogen signals as either inhibitory or stimulatory (Smith et al. 1997, Jordan & Morrow 1999, Dutertre & Smith 2000, Pearce et al. 2003). Tamoxifen has also been reported to have some non-receptor-mediated effects (Altan et al. 1999). Thus, it is an important question whether its proliferative effects in the uterus use the same mechanism as E2 or whether there is activation of alternative pathways. For example, there are reports that tamoxifen can activate cyclin E/CDK2 and thereby activate cell proliferation independently of cyclinD1/CDK4 (Dhillon & Mudryj 2002).
In this report we show that tamoxifen induces luminal and glandular epithelial cell proliferation with a time course similar to E2. In these responses it acts as a classical impeded estrogen with about 200 000-fold lower potency than E2 and never achieves a full estrogenic response. However, unlike other impeded estrogens such as estriol (Martin et al. 1976), its effects persist particularly upon the glandular epithelium and edema, suggesting long-term low level receptor occupancy. This results in cystic hyperplasia upon continuous administration (Martin & Middleton 1978). The different estrogenic effects are also obviously differentially regulated by tamoxifen since a full response upon water imbibition is affected at doses that do not induce DNA synthesis, and these responses are greater and more persistent than observed with E2. This may suggest that as well as the proliferation regulation through the ER, there is some non-genomic action perhaps through the activation of VEGF (Hyder et al. 1996), known to be at least partially responsible for the edema in the uterus. It can also be concluded, as it has been by other workers (Carthew et al. 1999), that the uterotropic effects of an estrogen as measured by increased wet weight is not a reliable marker for the proliferative activity of these compounds. Interestingly, nuclear staining for PCNA, the
sub-unit of DNA polymerase-
, is also increased significantly over control levels at tamoxifen doses that do not affect DNA synthesis. Furthermore, the expression of PCNA in response to maximal doses of tamoxifen continues beyond the time when the cells are actively synthesizing DNA. PCNA expression and nuclear localization is often used as a surrogate marker for cell proliferation (Hyde-Dunn & Jones 1997) but at least in the uterus it appears to be an unreliable marker for such events. Indeed, in the uterus it has been detected in apoptotic cells in the uterine lumen (Lai et al. 2000).
Despite these discrepancies in doseresponse for some uterotropic activities, the action of tamoxifen upon the cell cycle machinery in the uterine epithelium is similar to that observed upon E2 stimulation. This cell proliferation as found after E2 treatment is restricted to the luminal and glandular epithelium over the first 48 h of treatment, with no involvement of stromal cells. Tamoxifen causes the mobilization of cyclin D1 into the nucleus from the cytoplasm of these epithelial cells. This results in phosphorylation of the nuclear substrate, pRb and p107. Thereafter, cyclin E/CDK2 is activated, followed by a dramatic induction of cyclin A, and a further elevation of CDK2 activity. This results in cells entering into S-phase coincident with the nuclear localization of PCNA. The kinetics of these effects are similar to those seen in mice treated with E2 although the percentage of cells entering S-phase is lower. Thus tamoxifen appears to regulate the uterine epithelial cell cycle through the same mechanism as E2 and does not do so by triggering a down-stream event such as cyclin E expression independent of the canonical activation of cyclin D1/CDK4. Since the ER is essential for the E2-induced uterine proliferative responses (Korach 1994), these data suggest that activation of the AF-1 transcriptional regulatory sequences on the ER is sufficient to induce uterine epithelial cell proliferation. It will be interesting to study what aspect of ER activation is required for the E2-induced proliferation response in the mammary epithelium since tamoxifen inhibits this activity. Studies in cell culture have shown that this inhibitory effect is usually by suppression of cyclin D1 synthesis and induction of the CDIs, p18INK4C, p21WAF1 and p27KIP1 (Planas-Silva & Weinberg 1997, Doisneau-Sixou et al. 2003). In the uterus, these inhibitors do not appear to play essential roles in regulating cell proliferation since null mutations in them do not impair female fertility that is dependent upon this proliferation (Tong et al. 1998, Zindy et al. 2001). Thus the biological responses to tamoxifen in the uterus and mammary gland cells are opposite and therefore the definition of the molecular basis for them should help define the action of tamoxifen and E2 in different target tissues and provide a rationale for more selective therapies against estrogen-responsive breast cancers.
| Acknowledgements |
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| Funding |
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This work was supported by a grant from the NIH, R01 CA 89617 and the Albert Einstein College of Medicine Cancer Center, P30 CA 13330. J W P is the Sheldon and Betty E Feinberg Senior Faculty Scholar in Cancer Research. There is no conflict of interest that would prejudice the impartiality of this work.
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Received 10 October 2004
Accepted 14 October 2004
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