Evaluating DNA damage response (DDR) activation in human prostate cancer

Background: Prostate cancer is the most frequently diagnosed cancer in Canadian men and is the third deadliest after lung and colon cancers. Currently, prostate cancer treatments are based on results obtained of digital rectal exam, Gleason scores from biopsy specimens and serum PSA (Prostatic Specific Antigen) levels. The identification of specific biomarkers for diagnosis and prognosis, as well as new therapeutic targets, is quickly paving the way for personalized medicine. Ideally, in the future, patient care will include molecular signature of a patient's disease to guide for a more efficient treatment. In this thesis, we evaluated the DNA damage response (DDR) as a potential biomarker in prostate cancer. DNA lesions in mammalian cells trigger the DDR signalling cascade that orchestrates DNA repair and activate cell cycle checkpoints to preserve genome integrity. Loss of genome stability is usually associated with cancer development, and activated DDR signalling in cells with genomic instability act as a cancer barrier in several pre-neoplastic human lesions, including prostate cancer. Thus, the DDR is an important cancer suppression mechanism. The DDR is also activated in response to anti- cancer agents including radiation therapy (RT) and DNA-damaging chemotherapies. Pre- existing DDR levels in prostate cancer cells may influence the outcome of these cancer treatments. DDR signalling has been detected during human prostate cancer progression from low levels in normal prostate cells to high levels in high-grade prostatic intraepithelial neoplasia (HG-PIN). However, DDR signalling variations detected from HG-PIN to adenocarcinoma remain unclear, and no correlations were performed with patient clinical outcome data. Our hypothesis is that the levels of persistent DDR signalling activity will be variable with different grades and aggressiveness of prostate cancer. The levels of this activity could be correlated with the clinical responses to treatments and could even predict this process. We believe that having new biomarkers will help personalizing cancer treatment and certainly increase treatments’ efficiency. Our objectives are to characterize the occurrence of DDR activation in prostate carcinoma and to correlate it with patients’ survival and responsiveness to treatment. Methods: We used tissue microarrays (TMAs) from human radical prostatectomy specimens of 300 men with prostate cancer and estimated the level of DDR protein expression in the stromal and epithelial compartments of normal and aggressive cancer tissues. The expression level of the DDR markers p53 binding protein-1 (53BP1), phosphorylated H2AX (p-H2AX), p65 (p65 subunit of Nuclear Factor (NF-κB) and phosphorylated checkpoint kinase-2 (p-CHK2) was quantified using immunofluorescence (IF) coupled to high-content automated imaging. The quantification of our DDR markers was first validated on an experimental TMA (TMA-cell) including normal and irradiated (to induce DDR signalling) cultured human fibroblasts. The data was quantified using binary layers commonly used to classify pixels in an image so areas could be analysed independently allowing the segregation of specific compartments including nuclei, epithelia and stroma. Arithmetic operations were performed to render values corresponding to DDR activation that were then correlated with clinical outcomes such as biochemical recurrence and occurrence of bone metastasis. Results: We found that low levels of p65 protein expression in the nuclear epithelial compartments of normal prostate tissue were associated with a reduced probability of biochemical failure (which corresponds to a rise in the serum level of PSA in prostate cancer patients following treatment, surgery in this cohort of patients). Moreover, we also observed that low levels of 53BP1 protein expression in the nuclear epithelial compartments of normal and cancerous prostate tissue were associated with a lower incidence of bone metastasis. Conclusion: These results confirm that p65 has prognostic value in patients with prostate adenocarcinoma. Based on our results, we suggest that 53BP1 marker may have a prognostic value as well. The validation of other markers and particularly DDR markers may correlate with patients’ outcome. With longer follow-up, it may translate into correlation with survival. Levels of DDR activity in cancer tissue could be used in daily clinic as part of the patient’s diagnostic profile as much as his prostatic specific antigen (PSA) or Gleason score in order to predict response and personalize the treatment in order to guide the patients towards the most appropriate treatment amongst all those available for their prostate cancer.

Keyphrases: DNA damage response (DDR), prostate cancer, DDR marker, biomarker