Abstract. Our aim was to determine the association of human papillomavirus (HPV) infection with the expression of ATPase family AAA domain containing 3A (ATAD3A), an anti-autophagy factor, in uterine cervical cancer (UCC). The HPV genotype was determined by an Easychip HPV blot assay. ATAD3A expression was determined by immunohistochemical staining. High-risk HPV (hrHPV) was detected in 184 (88.9%) of 207 UCC cases. ATAD3A expression was detected in 164 (79.2%) UCC cases. A significant correlation was found between ATAD3A expression and the presence of hrHPV (p<0.001), FIGO stage (p=0.014), lymph node involvement (p=0.001), c-MET expression (p<0.001), interleukin-8 (p=0.03) and patient survival (p=0.0016). Interestingly, silencing of E6/E7 expression decreased ATAD3A expression and cell survival. Moreover, knockdown of ATAD3A (ATAD3A kd ) expression or addition of resveratrol, increased cellular autophagy and apoptosis and reduced drug resistance. Resveratrol reduced ATAD3A expression, and increased abrasion of the mitochondrial outer membrane as well as numbers of autophagosomes, the phenomena that were frequently found in ATAD3A kd cells. In conclusion, our results show that HPV infection correlates with increased ATAD3A expression and drug resistance in UCC. Persistent HPV infection may stabilize ATAD3A expression to inhibit cell autophagy and apoptosis as well as to increase drug resistance.
IntroductionUterine cervical cancer (UCC) is the most prevalent cancer, and the fifth leading cause of cancer-related deaths in Taiwanese women (1). High incidence and mortality of the disease was in part due to the conservative attitude toward the Papanicolaou smear, because even though the disease could be detected at the early stages the method was considered intrusive, and in part due to the high infection rate of human papillomavirus (HPV) among the diseased women (2). HPV infection is a potential etiologic cause for UCC development (3,4). Among 95 known HPV (5), genotypes 16, 18, 52 and 58 are categorized as high-risk and most frequently detected in Taiwanese UCC patients (6-9). Carcinogenicity of the high-risk HPV (hrHRV) is closely associated with E6 and E7 proteins, which can respectively inhibit activities of tumor suppressors, p53 and retinoblastoma protein (pRB), to interrupt cell growth regulation (10). Besides carcinogenesis, persistent HPV infection further correlates with tumor recurrence, cancer cell radiosensitivity and the resulting poor prognosis (11-13).Oncogene activation is also crucial for tumorigenesis and cancer progression; in particular, genes that are associated with disease advancement and, possibly, resistance to irradiation and anticancer chemotherapeutics. By using differential display, we have identified overexpression of dihydrodiol dehydrogenase (DDH) in non-small cell lung cancer (14). Using microarrays, we further found that DDH was overexpressed in cisplatin-resistant ovarian cancer cells (15). Clinically, patients with elevated DDH have a higher tumor recurrence rate and lymph node...