B. T. Craig1, Y. Zhu2, E. J. Rellinger1, D. R. Gius2, J. Qiao1, D. H. Chung1 1Vanderbilt University Medical Center,Pediatric Surgery,Nashville, TN, USA 2Northwestern University,Radiation Oncology,Chicago, IL, USA
Introduction: High-risk neuroblastoma (NB) is an aggressive pediatric cancer characterized by metastasis and disease relapse despite aggressive multimodality treatment protocols, which include chemo- and radiation therapy. Only a subset of high-risk NB patients will respond to treatment, and some will even progress while on treatment. Alteration of the redox homeostasis toward elevated reactive oxygen species (ROS) is a significant mechanism of action for many chemotherapeutic agents and radiation. However, the underlying ROS levels in NB and how this may contribute to treatment responses remain poorly understood. The purpose of this study was to define the steady-state ROS level in high-risk NB and to test the hypothesis that aggressive cellular behavior, which may predict treatment failure, is regulated by ROS.
Methods: Undifferentiated (high-risk) and differentiated (low-risk) patient NB sections were assessed for steady-state ROS levels by immunohistochemical staining for 4-hydroxynonenal (4HNE), which detects intracellular lipid peroxidation, a byproduct of elevated ROS. Three well-established human NB cell lines, MYCN-amplified (BE(2)-C) and MYCN-non-amplified (SK-N-AS and SK-N-SH), subsets of high-risk, metastatic disease were examined for our study. To assess for the steady-state ROS levels, superoxide and hydroperoxide oxidation products were detected by staining for DHE and CDCFH2, using the oxidation-insensitive analog CDCF as a negative control. Cells were treated with N-acetylcysteine (NAC; 10 mM), a thiol antioxidant, daily for 5 d and assessed for cell growth (population doubling time, Td=0.693/ln(Nt/N0), Nt=cell number at time t, N0=cell number at time 0) and anchorage-independent growth (growth on 0.4%/0.8% liquid/solid agarose soft agar, 3 wk incubation, 0.05% crystal violet staining for quantification of colony formation).
Results: 4HNE expression, an indicator of lipid peroxidation, was higher in undifferentiated (high-risk) patient tumor sections as compared to differentiated (low-risk) tumor sections. Interestingly, different levels of steady-state ROS were observed between the three high-risk in vitro cell lines (Fig. A). Treatment with antioxidant NAC inhibited growth of the aggressive BE(2)-C cells (Fig. B), and significantly attenuated anchorage-independent colony growth in soft agar (Fig. C), a well-established in vitro measure of tumorigenicity.
Conclusion: We report a novel observation that different steady-state ROS levels exist among high-risk NB, and that shifting the redox balance affects aggressive cellular behavior. Our data suggest that differences in ROS level could contribute to treatment resistance in high-risk NB.