Purpose
MUC4 shows aberrant expression in early pancreatic lesions and a high specificity for pancreatic cancer (PC). It thus has a high potential to be a sensitive and specific biomarker. Unfortunately, its low serum level limits its diagnostic/prognostic potential. We here report that a multi-faceted acute phase protein lipocalin 2, regulated by MUC4, could be a potential diagnostic/prognostic marker for pancreatic cancer.
Experimental Designs and Results
Overexpression/knockdown, luciferase reporter and molecular inhibition studies revealed that MUC4 regulates lipocalin 2 by stabilizing HER2 and stimulating AKT, which results in the activation of NF-κB. Immunohistochemical analyses of lipocalin 2 and MUC4 showed a significant positive correlation between MUC4 and lipocalin 2 in primary, metastatic tissues (Spearman correlation coefficient 0.71, p-value=0.002) from rapid autopsy tissue sample from PC patients as well as in serum and tissue samples from spontaneous KRASG12D mouse PC model (Spearman correlation coefficient 0.98, p-value <0.05). Lipocalin 2 levels increased progressively with disease advancement (344.2 ±22.8 ng/ml for 10 week to 3067.2±572.6 for 50 week; p<0.0001). In human PC cases, significantly elevated levels of lipocalin 2 were observed in PC patients (148±13.18 ng/ml) in comparison to controls (73.27±4.9 ng/ml, p-value=0.014). Analyses of pre- and post-chemotherapy patients showed higher lipocalin 2 levels in pre-chemotherapy patients (121.7 ng/ml, 95% C.I. 98.1–150.9) in comparison to the post-chemotherapy (92.6 ng/ml, 95% C.I. 76.7–111.6, p-value=0.06) group.
Conclusions
The present study delineates the association and the downstream mechanisms of MUC4-regulated elevation of lipocalin-2 (via HER2/AKT/NF-κB) and its clinical significance for prognosis of pancreatic cancer.