Abstract:
Colorectal cancer (CRC) is the third most common cancer and a major public health
issue worldwide. Survival rate of patients with CRC depends upon early diagnosis of the
disease. In that CRC is mostly asymptomatic at an early stage and typically diagnosed only
at advanced stages, implementation of screening strategies for early detection is highly
desirable. Notwithstanding the fact that continuous development in screening protocols and
available treatment options has resulted in a considerable decline in the CRC mortality rate
in the developed nations, the scope of benefits so far has not extended to the developing
nations like Pakistan where most of the patients present at the advanced stage with resultant
poor survival rates. Currently available invasive, semi-invasive and non-invasive
diagnostic/screening methods [e.g., carcinoembryonic antigen (CEA), faecal occult blood
test (FOBT), colonoscopy, sigmoidoscopy, computed tomography (CT) scan or barium
enema, etc.] have significantly improved the patient survival rates for CRC. However, some
of the blood- and stool-based clinical tests, currently in practice, lack sufficient level of
sensitivity and/or specificity. Hence, there remains a compelling need for developing more
reliable, sensitive and specific non-invasive methods and the molecular markers for earlystage
diagnosis CRC, to ensure increased survival rate of the patients and better disease
management.
Proteomic strategies to identify markers for the diagnosis of cancers (such as lung,
liver, pancreas breast and ovarian cancers) at an early stage have been employed with
noteworthy results. To extend these studies, we have utilized two dimensional gel
electrophoresis (2D-PAGE) and mass spectrometry (MS) for expression profiling of
proteins extracted from the freshly frozen human colorectal cancer tissue specimens and
the comparable regions of adjacent normal mucosa (serving as controls) with an aim of
identifying novel CRC associated proteins. Based on the anatomic/Duke’s staging, the
vi
collected CRC tissue samples (n=12) were grouped as 1) Stage B, 2) Stage C, and 3) Stage
D samples. Equal amounts of the protein from tissue lysates of tumor and adjacent normal
mucosa were resolved by 2D-PAGE followed by colloidal coomassie blue staining. On
average, 505±216 spots in normal and 497±221 in tumor tissue lysate appeared when the
colloidal-coomassie stained gels of the three CRC patient groups were compared. To select
statistically significant, differentially stained gel spots, the quantification of individual
spots was performed using ImageMaster 2D platinum (v. 7.0) software program. During
the initial screening, 49 gel spots were found to have at-least one fold change in staining
with p-value ≤0.05. False discovery rate (FDR) estimation of the data was performed with
value set as ≤0.1 reflecting that more than 90% of the findings are accurate.
The selected spots were subjected to identification by MALDI-TOF and/or liquid
chromatography-based tandem mass spectrometry (LC-MS/MS). In the case of MALDITOF-
MS data analysis, the threshold value for positive hits of peptide mass finger printing
(PMF) score was set as ≥79 whereas in the case of LC-MS/MS, only the proteins identified
with >95% probability were considered for further analysis. These analyses led to the
identification of 21 distinct proteins.
In silico characterization of the proteins identified by MS analysis (MALDI-TOFMS
and LC-MS/MS) analysis was also performed. More specifically, the proteins of data
sets were uploaded in Protein ANalysis THrough Evolutionary Relationships (PANTHER)
database that categorized all proteins into molecular functions, biological processes and
cellular components. Gene ontology (GO) data search for molecular functions classified
these proteins based on of their binding, receptor activity, structural molecule activity,
catalytic activity, antioxidant activity and transporter activity. In the context of biological
processes, these proteins were found to be involved in ten major categories of biological
processes viz., cellular component organization or biogenesis, cellular processes,
vii
localization, biological regulation, response to stimulus, developmental process,
multicellular organismal process, biological adhesion, metabolic process and immune
system process. Data analysis using Search Tool for the Retrieval of Interacting
Genes/Proteins (STRING) database was also performed for an overview of the functionally
connected proteins. It was found that two proteins PSME1 (proteasome activator subunit
1) and FABP5 functionally separated proteins than rest of proteins in our data set. So we
performed individual network analysis of these two proteins and our protein of interest,
ACTBL2. Collectively ACTBL2 appears to interact with proteins in cells that have
potential to arrest cell growth, elicit tumorigenesis and promote cell migration. PSME1
directly involved in regulation of proteasome activity and FABP5 is important in cellular
lipid catabolic process. Further for differentially expressed proteins, disease assessment
was performed by Ingenuity Pathways Analysis (IPA). Most proteins showed up to be
important in cancer. These prediction analyses by different tools all support together that
experimentally identified proteins are vital in health and disease and could be beneficial if
carefully studied in disease assessment.
In the present study about 50% of the identified proteins were represented by more
than one spots, generally 2-5 which could be due to difference in PTMs or alternative
splicing. Therefore, the intensities of multiple gel spots that corresponded to the same
protein were pooled/summed up and their statistical significance was re-calculated. Four
gel spots that qualified four tier criteria (fold change >1.5, p-value ≤ 0.05, PMF score ≥79
and FDR analysis ≤0.05), were selected for further validation analysis. Two gel spots
showed greater staining in the CRC samples compared to the matched samples from the
normal tissue region while two showed decreased staining for the same comparison. These
four spots include six proteins; beta-tropomyosin (TPM2), ACTBL2, PSME1, prohibitin
viii
(PHB), annexin A2 (ANXA2) and myosin light chain 9 (MYL9). Out of these six proteins
five had previously been reported to be associated with colorectal cancer.
In that ACTBL2 was identified in CRC at greater abundance than in normal tissue
and had not previously been associated with CRC, we verified the mass spectrometry data
by performing immunohistochemistry (IHC) for ACTBL2 in six paraffin embedded
formalin fixed (FFPE) CRC patients samples and respective controls which were obtained
from the Biorepository and Tissue Research Facility, University of Virginia, USA for
validation of selected proteins.. From the mass spectrometry experiments above, PSME1
also appeared to be in high abundance in CRC samples compared to normal tissue. Given
that PSME1 has previously been associated with CRC in some patients, we decided to
perform IHC on another panel of CRC patient samples as well. For ACTBL2, significantly
higher staining was observed in all six patient samples with p-value ≤0.005 and fold change
+3.5. These results are similar to those obtained from the 2DE/MS data. However, in the
case of PSME1, the IHC results showed marginally higher staining only in three out of six
CRC patient samples when compared with the normal epithelium. This suggested that
PSME1 is not upregulated in CRC patients. The higher abundance observed in 2DE/MS
data for PSME1 could be due to the greater staining of spot CRC-05 containing two other
upregulated proteins i.e., ANXA2 and PHB.
Thus, ACTBL2 association and differential upregulation in colorectal cancer is
novel, and as such may contribute to our understanding of the colorectal carcinogenesis and
potentially serve a function in developing markers for colorectal cancer. Uncovering the
differentially expressed proteins in colorectal cancer observed in this study will be
important to understand the CRC carcinogenesis. However for more precise statistically
significant proteins, much larger number of samples are needed along with testing the
samples in serum/plasma samples. Respective studies have been started in our laboratory.