Abstract. Expression of thymidylate synthase (TS) in tumor cells is frequently suggested as an important prognostic factor for patients scheduled for chemotherapy with 5-fluorouracil (5-FU). However, clinical evidence does not fully support such an anticipation. We studied the expression of rTSß, a reverse orientation gene of TS, as a 5-FU resistance marker in patients with primary breast cancer. Expression of rTSß was examined in 129 patients with newly diagnosed breast cancer and five breast cancer cell lines by immunohistochemistry, immunocytochemistry and immunoblotting. Clinically, expression of rTSß was found to correlate with survival of the patients (p=0.023) when patients received chemotherapeutic regimen containing 5-FU. In vitro, rTSß expression was found to correlate with 5-FU resistance in breast cancer cell lines. Notably, in the 5-FU-resistant cells, rTSß was identified in the nucleus, whereas in the 5-FUsensitive cells, rTSß was found in the cytoplasm. Nuclear localization of rTSß was further found to be associated with protein farnesylation. Therefore, nuclear expression of rTSß could be a novel 5-FU resistance marker in patients with primary breast cancer.
IntroductionBreast cancer is the second most prevalent malignancy and the fourth leading cause of cancer death in Taiwanese women (1). Although the death rate of uterine cervical cancer has decreased significantly in the past two decades due to the improvement in the early detection of the disease by pap smear among women over 35 years of age; for breast cancer, not only has the incidence increased markedly, but also the age of tumor occurrence has decreased dramatically, which is about ten years younger than that of the Western population (2-4).Clinically, depending upon the status of estrogen and/or progesterone receptors in cancer cells, some patients receive non-steroidal anti-estrogen tamoxifen for hormonal therapy (5). However, most of the patients could only choose adjuvant chemotherapy containing 5-fluorouracil (5-FU) after surgery. 5-FU is a pro-drug that is converted to fluorouridine to interfere with RNA synthesis, or to 5-fluoro-2'-deoxyuridine-5'-monophosphate (FdUMP) to inhibit thymidylate synthase (TS) and the consequent DNA synthesis. In the presence of N 5 , 10 -methylene tetrahydrofolate, FdUMP further forms a stable ternary complex with TS to inhibit synthesis of deoxythymidine monophosphate (dTMP) (reviewed in ref. 6). TS expression in tumor cells is considered as a key prognostic factor for patients receiving chemotherapy containing 5-FU (7).However, clinical evidence did not fully support this expectation (6,(8)(9)(10)(11)(12)(13). On the other hand, expression of the rTS (ENOSF1) gene (14-16) was found to be closely associated with 5-FU sensitivity besides nucleotide metabolism-related enzymes, e.g., thymidine phosphorylase, ribonucleotide reductase, uridine phosphorylase and thymidine kinase (17-19) that directly affects pyrimidine synthesis in de novo or salvage pathways (11).The rTS is located with the TS gene on the...