Metastasis is a major cause of mortality in cancer patients. However, the mechanisms governing the metastatic process remain elusive, and few accurate biomarkers exist for predicting whether metastasis will occur, something that would be invaluable for guiding therapy. We report here that the carboxypeptidase E gene (CPE) is alternatively spliced in human tumors to yield an N-terminal truncated protein (CPE-ΔN) that drives metastasis. mRNA encoding CPE-ΔN was found to be elevated in human metastatic colon, breast, and hepatocellular carcinoma (HCC) cell lines. In HCC cells, cytosolic CPE-ΔN was translocated to the nucleus and interacted with histone deacetylase 1/2 to upregulate expression of the gene encoding neural precursor cell expressed, developmentally downregulated gene 9 (Nedd9) -which has been shown to promote melanoma metastasis. Nedd9 upregulation resulted in enhanced in vitro proliferation and invasion. Quantification of mRNA encoding CPE-ΔN in HCC patient samples predicted intrahepatic metastasis with high sensitivity and specificity, independent of cancer stage. Similarly, high CPE-ΔN mRNA copy numbers in resected pheochromocytomas/ paragangliomas (PHEOs/PGLs), rare neuroendocrine tumors, accurately predicted future metastasis or recurrence. Thus, CPE-ΔN induces tumor metastasis and should be investigated as a potentially powerful biomarker for predicting future metastasis and recurrence in HCC and PHEO/PGL patients.
IntroductionCancer mortality often results from metastatic disease and is not the direct effect of the primary tumor. With advances in cancer treatment, control of the primary tumor can be managed by multimodal therapy; however, metastatic disease is frequently refractory to the same therapeutic approaches. Thus, identification of biomarkers that could accurately predict future metastasis from the state of the primary tumor would be invaluable for guiding therapy.Currently, determination of the likelihood of developing metastatic disease is based on morphological and histological criteria such as the size of the primary tumor, local invasion, tumor differentiation together with vascular and capsular invasion, and the presence of cancer cells in lymph nodes. Although these criteria put many patients in a very high-risk category for metastatic disease, a significant number of them do not develop metastatic spread. On the other hand, patients with favorable conventional prognostic factors may still develop metastasis.Numerous mechanisms have been described that modulate metastatic potential, including those both endogenous and exogenous to the tumor cells. Such alterations may recruit genes