부산대학교 도서관

Clear cell ovarian cancer histotypes exhibit metabolic features associated with resistance to hypoxia and glucose deprivation-induced cell death. This metabolic characteristic suggests that clear cell ovarian cancers activate survival mechanisms not typical of other epithelial ovarian cancers. Here we demonstrate that microtubule-associated protein 1 light chain 3A (LC3A), a marker of autophagy, is related to hypoxia and poor prognosis in clear cell ovarian cancer. In 485 ovarian tumours, we found that LC3A was significantly associated with poor progression-free (p = 0.0232), disease-specific (p = 0.0011) and overall patient survival (p = 0.0013) in clear cell ovarian cancer patients, but not in other subtypes examined. LC3A was an independent prognostic marker of reduced disease-specific [hazard ratio (HR): 2.55 (95% CI 1.21-5.37); p = 0.014] and overall survival [HR: 1.95 (95% CI 1.00-3.77); p = 0.049] in patients with clear cell ovarian carcinoma. We also found a strong link between autophagy and hypoxia as LC3A staining revealed a significant positive association with the hypoxia-related proteins carbonic anhydrase-IX and HIF-1[alpha]. The functional link between hypoxia and autophagy was demonstrated using clear cell and high-grade serous cell lines that were subjected to hypoxia or hypoxia + glucose deprivation. Clear cell carcinoma lines displayed greater autophagy induction and were subsequently more sensitive to inhibition of autophagy under hypoxia compared to the high-grade serous lines. Together, our findings indicate that hypoxia-induced autophagy may be crucial to the clinical pathology of clear cell ovarian cancer and is a potential explanation for histological subtype differences in patient disease progression and outcomes. Copyright [c] 2012 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd. Article Note: No conflicts of interest were declared. CAPTION(S): Supplementary materials and methods Table S1. Follow-up and survival characteristics by subtype. Figure S1. Clear cell carcinoma cells and high-grade serous carcinoma cells cultured under hypoxia for 16 h do not show additional accumulation of LC3-II as compared to cells cultured under normoxia. Figure S2. Clear cell carcinoma cells and high-grade serous carcinoma cells have minimal detectable LC3-II in the absence of HCQ after being cultured for 3 days under normoxia, hypoxia or hypoxia + glucose deprivation. Figure S3. Stabilization of HIF-1[alpha] in ovarian carcinoma cells after being cultured under hypoxia.