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Background: Pancreatic ductal adenocarcinoma (PDAC) is the 4th leading cause of cancer death worldwide and compared to other malignancies its share in cancer mortality is expected to rise further. This is due to a lack of sensitive diagnostic tools that would permit earlier detection in a potentially curable stage and the very slow progress in finding effective drug treatments for pancreatic cancer. Key Messages: Aside from genetic predispositions and environmental agents, chronic pancreatitis is by far the greatest risk factor for PDAC. It also shares several etiological factors with pancreatic cancer and represents its most challenging differential diagnosis. Biomarkers that can distinguish between chronic pancreatitis and PDAC may therefore be suitable for the latter's early detection. Moreover, targeting the natural history of chronic pancreatitis would be one approach to prevent PDAC. Targeting tumor-cell signaling directly by interfering with receptor tyrosine kinases has shown some efficacy, although the results in clinical trials were less encouraging than for other cancers. Other compounds developed have targeted the formation of extracellular matrix around the tumor, the proteolytic activity in the tumor environment, histone deacetylases, hedgehog signaling and heat shock proteins, but none has yet found its way into routine patient care. Attempts to individualize treatment according to the tumor's somatic mutation profile are novel but so far impractical. Conclusions: Progress in the treatment of pancreatic cancer has been exceedingly slow and mostly dependent on improved pharmaceutical preparations or combinations of established chemotherapeutic agents. The promise of major breakthroughs implied in targeting tumor signal transduction events has so far not materialized.
In the post genomic era, novel “Omics” technologies like genomics and proteomics can be used in powerful screening approaches to provide unbiased lists of candidate genes and proteins and thus facilitate a comprehensive analysis of complex diseases such as cancer, which would not have been possible applying traditional genetic and biochemical approaches alone. During my PhD tenure I applied functional genomics screening technologies including proteomics in combination with traditional biochemical and cell biology approaches in two disease oriented projects: 1. Characterization of the role of BCL11b in Human T cell lymphomas (and) 2. Elucidation of the mechanism of pathophysiology of Johanson Blizzard Syndrome using UBR1 knockout mice and JBS patients’ lymphoblasts cell lines.
1.Characterization of the role of BCL11b in Human T cell lymphomas
: The Bcl11b protein belongs to the C2H2-family of Krueppel-like zinc finger proteins and thus is a member of the largest family of transcription factors in eukaryotes. It was shown to be important for a variety of functions such as T cell differentiation, normal development of central nervous system and DNA damage response. Malignant T cells undergo apoptotic cell death upon BCL11B down-regulation. However, the detailed mechanism of this cell death is not fully understood. Two dimensional difference in-gel electrophoresis (2D-DIGE), mass spectrometry and cell biological experiments were employed to investigate the functional impact of knock down of BCL11B in malignant T cell lines such as Jurkat and huT78. To further confirm the findings of these experiments, changes in protein patterns were also recorded after down-regulation of BCL11B expression in Jurkat cells over expressing BcL-xL and in Jurkat cells over expressing BCL11B. These experiments provide evidence for the involvement of the mitochondrial apoptotic pathway and increased levels of cleavage fragments of known caspase targets such as myosin, spectrin and vimentin were observed after BCL11B knockdown. The findings suggest an involvement of ERM proteins, which were up-regulated and phosphorylated upon BCL11B down-regulation. Besides ERM proteins, PDCD5, a key regulator of apoptosis, was also found at increased levels upon down regulation of BCL11B. Moreover, the levels of several proteins implicated in cell cycle entry, including DUT-N, UCK2, MAT1, CDK6, MCM4 and MCM6 were elevated, which might lead to uncontrolled cell cycle progression, uracil misincorporation and cell death. Interestingly, an inverse regulation pattern, i.e. decreased levels of ERM proteins, DUT-N, UCK2 and PDCD5 was seen upon over expression of BCL11B in Jurkat cells. In summary, proteome analyses revealed several previously unidentified mechanisms which could significantly contribute to the cell death following BCL11B knockdown.
2.Elucidation of the mechanism of pathophysiology of Johanson Blizzard Syndrome using UBR1 knockout mice and JBS patients’ lymphoblasts cell lines
: Johanson-Blizzard syndrome (JBS; OMIM 243,800), which was first described in 1971, is a rare autosomal recessively inherited genetic disorder with a unique combination of congenital abnormalities. The most constant clinical feature of JBS is the loss of exocrine pancreatic function due to progressive destruction of pancreatic acini. Genome wide linkage analysis identified the disease associated locus in the 15q14-q21 chromosome region and high-throughput sequencing of this region revealed several truncated and some missense mutations in the UBR1 gene. UBR1 gene contains 47 exons and spans over 161 kilobases. The UBR1 protein belongs to the E3 ubiquitin ligase family and is an important component of the N-end rule pathway of ubiquitous protein degradation. It was hypothesized that stabilization of direct and unique substrates of UBR1 could be the main cause of the JBS pathophysiology. So far sequencing of the UBR1 gene is the only available diagnostic procedure. However, sequencing might not always allow precise prediction of residual UBR1 activity. Hence, this study was started to develop a protein based diagnostic assay for the detection of subclinical cases of JBS and to identify signalling pathways contributing to the pathophysiology of this complex disorder using a murine UBR1 knockout model. 2D-DIGE proteome analysis was carried out for a comparative evaluation of lymphoblast samples of 14 patients and 11 controls. Principal component Analysis (PCA) clearly discriminated JBS patients from controls. However, 4 JBS patients differed from the rest and resembled controls more closely. Western-blot analysis revealed residual UBR1 levels in these patients, which were linked to a milder phenotype. Hierarchical clustering of the three groups (controls, patients with residual UBR1 levels and patients without UBR1) showed group-specific characteristic differences in the abundance of differentially regulated proteins. Quantification of a panel of five selected protein spots encompassing Interferon-induced GTP binding protein, HLA class II histocompatibility antigen, Annexin A6, FK506-binding protein 4 and GRP78 permitted discrimination of controls and JBS patients with mild phenotypes. Of note, the molecular chaperones GRP78 (BiP) and FK506BP were consistently altered in level in JBS patients and probably constitute UBR1 dependent substrates. This suggested JBS as an ER-stress related disease also indicating a possible way of therapeutic intervention. Comparative proteome analysis of UBR1 knockout and wild type animals after caerulein treatment revealed a significant accumulation of pancreatic proteases such as chymotrypsin B, anionic trypsin and pancreatic elastase in animals lacking UBR1. Furthermore, an up-regulation of ER-stress proteins and inflammation related proteins was observed. Phenotypic characterisation revealed in UBR1 knockout animals significantly increased lipase levels, a significantly increased histological score and significantly increased elastase activity 8h after the onset of pancreatitis. In isolated pancreatic acini of UBR1 knockout animals we found a significant increase in intracellular elastase activation upon supramaximal CCK stimulation, which was associated with a significant rise in the rate of necrosis explaining the more severe phenotype in the UBR1 knock-out animals. A TUNEL assay showed that there was more apoptosis in wild type compared to UBR1 knockout mice. Another set of experiments was designed to identify physiologically important substrates of UBR1. Inhibition of such substrates might then in turn allow reversion or prevention of the severe form of pancreatitis in UBR1 knockout mice. However, using the trypsin specific and reversible inhibitor S-124 it was shown that impaired trypsin degradation and thereby prolonged activation of this protease did not critically influence the phenotype. Calcium analysis after physiological stimulation revealed an increase of pathological Ca2+ signalling events, i.e. significant decrease of spike number and significant increase of spike duration. Of the candidates potentially influencing Ca2+ signalling RGS4 turned out to be of particular importance. Pre-incubation of pancreatic acini of UBR1 knockout animals with a specific RGS4 inhibitor (CCG-4986, 10 µM) normalized Ca2+ patterns, did not affect trypsin activity itself but prevented Ca2+-triggered premature trypsin activation and thus acinar disintegration. In summary, using lymphoblasts samples of JBS patients we were able to deduce a protein panel which could be developed as a possible diagnostic tool for confirmation of JBS syndrome. Furthermore, using UBR1 knockout mice in an experimental model we were able to elucidate the vital function of UBR1 and its direct substrate RGS4 in the defense against pathologic pancreatic damage thereby manifesting JBS as an inflammatory disorder due to an inadequate UBR1 mediated defense.
In acinar cells, cellular organelles like zymogene granule, mitochondria, endoplasmic reticulum and lysosome functions in coordinate way in order to synthesize and secrets large amounts of digestive enzyme. Dysfunction of this organelle, results into enzyme activation within acinar cell; ultimately, acute pancreatitis. While previous studies reported that mitochondrial function is disrupt but mechanism of clearance of these mitochondria remains unknown during pancreatitis. Here we reported that PINK1 and Parkin mediated pathway is activated during pancreatitis and clears dysfunctional mitochondria in-vivo. PINK1 or Parkin deficient acinar cell had energy crisis, decreased ATP production and altered acinar cell fate in-vitro. Inhibiting clearance of dysfunctional mitochondria aggravates experimental pancreatitis severity and delays regeneration/recovery of exocrine tissue after disease via PARIS-PGC-1α pathway. While an attempt to explore therapeutic target of PARIS-PGC-1α pathway by treatment of SRT1720 rescued experimental pancreatitis. Together, PINK1 and Parkin, restricts exocrine pancreatic damage in pancreatitis and accelerates tissue recovery after disease.
Acute pancreatitis is a common clinical inflammatory disease with variable severity from mild, self-limiting attacks to a severe lethal attack with a high mortality. In most of the cases, acute pancreatitis is either caused by gallstone obstruction or excessive alcohol consumption. Clinical symptoms include elevated levels (minimum 3 times than normal) of pancreatic enzymes such as amylase or lipase in serum. It is generally believed that earliest event in acute pancreatitis occur in acinar cells which includes premature protease activation and cytoplasmic vacuole formation. Premature trypsinogen activation has been considered as chief culprit as it can activate other proteases in a cascade like manner in acinar cells. Trypsin activity takes place in a biphasic curve with elevated levels at 1 h and 8 h in the initial stages up to 24 h in caerulein induced pancreatitis in mice. It has been shown that cytoplasmic vacuoles observed in pancreatitis are of autophagic nature. The role of autophagy for the disease onset and its role in trypsinogen is much of a debate. Hence, we studied the relation between autophagosome formation and trypsinogen activation in first 12h of pancreatitis. Although autophagosomes were found to be co-localised with trypsin in vivo, this was found to be a late event occuring only by 4 h. Substrate specific trypsin activity and western blotting from both sub-cellular fractions over the time course of pancreatitis and multiple fractions prepared from 1 h caerulein induced pancreatic tissue revealed that trypsin activity observed at 1 h occured in a zymogen enriched fraction. In line simultaneous confocal imaging of trypsin activity and autophagosome formation in hyperstimulated acini isolated from GFP-LC3 mice showed that both processes are independent and take place in parallel. Furthermore, protease inhibition by gabexate mesilate did not prevent autophagosome formation indicating that trypsinogen activation is not a prerequisite for vacuole formation. Even though, autophagosomes and active trypsin were found to be co-localised around 30 minutes to some degree upon cholecystokinin hyperstimulation, the earliest trypsin activation started to appear by 15 minutes and was independent of autophagosomes. The earliest active trypsin was found to be co-localised along with the cis-Golgi complex suggesting that the Golgi apparatus and its pre-condensed zymogen granules are the compartment responsible for the trypsinogen activation. 2) Protease activation in pancreatic acinar cells considered as the early hallmark event in the acute pancreatitis. However, the disease is aggravated by the infiltration of the leukocytes. Activated proteases mediate acinar cell injury and hereby cause the release of chemokines, which in turn attract inflammatory cells. Transmigrated inflammatory cells cause systemic damage that deteriorates the condition of the disease. Neutrophil elastase has been reported to be involved in the dissociation of cell-cell contact at adherens junctions by the extracellular cleavage of E-cadherin. This subsequently leads to transmigration of leukocytes into the epithelial tissue during the initial phase of experimental pancreatitis and aggravates the disease condition. On the other hand, pancreatic elastase substantially contributes to acinar cell necrosis. In this study, ZD0892, an orally bioavailable dual inhibitor against both elastases was tested for its efficacy to ameliorate severity in acute pancreatitis. ZD0892 orally fed mice showed increased survival compared to the control group in the taurocholate model of severe pancreatitis. In the initial stages of pancreatitis up to 24 h, the severity markers were found to be significantly lower in the inhibitor treated group. Treatment of mice with ZD0892 did not impede the defensive property of the leukocytes such as phagocytosis or oxidative burst. In caerulein induced pancreatitis, a mild form of acute pancreatitis, in rats, the local damage measured as serum amylase and lipase, wet dry ratio, and pancreatic myeloperoxidase levels were significantly lower in the inhibitor group. Systemic inflammatory parameters such as myeloperoxidase activity in lung was found to be significantly lower in the inhibitor fed rats. Inhibitor feeding resulted in lesser elastolytic activity compared to control group indicating that extracellular matrix was less damaged. Prophylactic treatment of pancreatitis with an orally available inhibitor with a dual specificity against pancreatic elastase and PMN-elastase was shown to ameliorate both local and systemic damage. Hence, in overall, ZD0892 treatment is proved to be beneficial to the mice and rats in experimental pancreatitis and should be considered for treatment in humans as the substance has been already studied in phase I and II trails for other indications.