WO2020025989A1 - Treatment and diagnosis of breast cancer - Google Patents

Treatment and diagnosis of breast cancer Download PDF

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Publication number
WO2020025989A1
WO2020025989A1 PCT/HU2019/050038 HU2019050038W WO2020025989A1 WO 2020025989 A1 WO2020025989 A1 WO 2020025989A1 HU 2019050038 W HU2019050038 W HU 2019050038W WO 2020025989 A1 WO2020025989 A1 WO 2020025989A1
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Prior art keywords
cadaverine
breast cancer
subject
ldc
level
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PCT/HU2019/050038
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French (fr)
Inventor
Péter BAY
Tünde KOVÁCS
Edit MIKÓ
András VIDA
James J. Goedert
Judit TÓTH
Éva SEBŐ
Original Assignee
Debreceni Egyetem
U.S. National Cancer Institute
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Application filed by Debreceni Egyetem, U.S. National Cancer Institute filed Critical Debreceni Egyetem
Priority to EP19773488.2A priority Critical patent/EP3830300A1/en
Publication of WO2020025989A1 publication Critical patent/WO2020025989A1/en

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    • CCHEMISTRY; METALLURGY
    • C12BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
    • C12QMEASURING OR TESTING PROCESSES INVOLVING ENZYMES, NUCLEIC ACIDS OR MICROORGANISMS; COMPOSITIONS OR TEST PAPERS THEREFOR; PROCESSES OF PREPARING SUCH COMPOSITIONS; CONDITION-RESPONSIVE CONTROL IN MICROBIOLOGICAL OR ENZYMOLOGICAL PROCESSES
    • C12Q1/00Measuring or testing processes involving enzymes, nucleic acids or microorganisms; Compositions therefor; Processes of preparing such compositions
    • C12Q1/68Measuring or testing processes involving enzymes, nucleic acids or microorganisms; Compositions therefor; Processes of preparing such compositions involving nucleic acids
    • C12Q1/6876Nucleic acid products used in the analysis of nucleic acids, e.g. primers or probes
    • C12Q1/6883Nucleic acid products used in the analysis of nucleic acids, e.g. primers or probes for diseases caused by alterations of genetic material
    • C12Q1/6886Nucleic acid products used in the analysis of nucleic acids, e.g. primers or probes for diseases caused by alterations of genetic material for cancer
    • CCHEMISTRY; METALLURGY
    • C12BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
    • C12QMEASURING OR TESTING PROCESSES INVOLVING ENZYMES, NUCLEIC ACIDS OR MICROORGANISMS; COMPOSITIONS OR TEST PAPERS THEREFOR; PROCESSES OF PREPARING SUCH COMPOSITIONS; CONDITION-RESPONSIVE CONTROL IN MICROBIOLOGICAL OR ENZYMOLOGICAL PROCESSES
    • C12Q2600/00Oligonucleotides characterized by their use
    • C12Q2600/112Disease subtyping, staging or classification

Definitions

  • the invention relates to the field of diagnosis and treatment of early stage breast cancer. Specifically, a method is provided for determining whether a subject has early stage breast cancer by measuring the abundance of a bacterium species comprising a DNA sequence coding for a lysine decarboxylase. A method for mitigating breast cancer initiation and/or promotion and/or progression in a subject is also provided.
  • Dysbiosis is often reflected as a loss of diversity of the microbiota (e.g.
  • Cadaverine (CAD; pentane- 1,5 -diamine) is produced by the decarboxylation of lysine that is performed by lysine decarboxylase (LDC) enzymes.
  • LDC lysine decarboxylase
  • Human cells code and express LDC and numerous bacterial species of the human microbiome also express LDC either in a constant (LdcC in the LDC operon) or in an inducible (CadA in the Cad operon) fashion [32, 33].
  • Bacteria use diamines, like cadaverine or putrescine, generated by the decarboxylation of lysine or arginine, to buffer the pH of their environment [28]. The effects of cadaverine on cancer cells and its role in carcinogenesis are not yet characterized in detail.
  • WO2013045826A1 describes that a mixture depleted of cadaverine, putrescine, spermidine and spermine and on the other hand containing agmatine at a concentration higher than that supplied by an average food ration is beneficial in the treatment of pathologies associated with cellular hyperproliferation.
  • the invention prvides a method for determining whether a subject has early stage breast cancer or has an in creased probability of having early stage breast cancer by measuring, in a sample derived from said subject, the level of bacterial cadaverine synthesis.
  • the invention provides a method for determining whether a subject has early stage breast cancer or has an increased probability of having early stage breast cancer by measuring the abundance of a bacterium species comprising a DNA sequence coding for a lysine decarboxylase (LDC), the level of a DNA sequence coding for an LDC of a bacterium species, or the level of a gene product of a DNA sequence coding for an LDC produced by a bacterium species, in a sample derived from the subject, wherein the sample comprises microbiota from the subject and wherein the bacterium species is part of the microbiota of the subject.
  • LDC lysine decarboxylase
  • the invention also provides a method for determining whether a subject is at an increased risk of developing breast cancer, by measuring the abundance of a bacterium species comprising a DNA sequence coding for a lysine decarboxylase (LDC), the level of a DNA sequence coding for an LDC of a bacterium species, or the level of a gene product of a DNA sequence coding for an LDC produced by a bacterium species, in a sample derived from the subject, wherein the sample comprises microbiota from the subject and wherein the bacterium species is part of the microbiota of the subject.
  • the invention also provides cadaverine for use in the treatment or prevention of breast cancer in a subject and cadaverine for use in mitigating cancer initiation and/or promo tion and/or progression in a subject. The invention is further detailed in the following paragraphs.
  • ii) has an increased probability of having early stage breast cancer
  • the level of bacterial cadaverine synthesis is assessed by measuring
  • compared to the corresponding reference value indicates that the subject has early stage breast cancer or an increased probability of having early stage breast or is at an increased risk of developing breast cancer.
  • the breast cancer is stage 0 or 1 breast cancer according to the American Joint Committee on Cancer (AJCC) TNM system.
  • the cancer is stage 0 breast cancer and the test sample is compared to a reference value typical of the absence of stage 0 breast cancer.
  • the cancer is breast cancer stage 1 the test sample is compared to a reference value typical of the absence of stage 1 breast cancer.
  • the DNA sequence coding for LDC is ldcC or cadA.
  • test sample is a feces sample.
  • the bacterium species is selected from Escherichia, Enterobacter and Hafnia. More preferably the bacterium species is selected from Escherichia cob, Enterobacter cloacae and Hafnia alvei.
  • stage 0 breast cancer indicates that the subject has stage 0 breast cancer or an increased probability of having stage 0 breast cancer or is at an increased risk of developing breast cancer.
  • stage 0 breast cancer indicates that the subject has stage 0 breast cancer or an increased probability of having stage 0 breast cancer or is at an increased risk of developing breast cancer.
  • the gene product is LDC protein.
  • the subject is a human, preferably a woman, more preferably a postmenopausal woman.
  • cadaverine for use in the treatment or prevention of breast cancer in a sub ject is provided.
  • cadaverine for use in mitigating cancer initiation and/or promotion and/or progression in a subject is provided.
  • the subject has an increased probability of having early stage breast cancer or is at an increased risk of developing breast cancer. More preferably the subject has early stage breast cancer.
  • the level of a DNA sequence coding for an LDC of a bacterium species, or the level of a gene product of a DNA sequence coding for an LDC produced by a bacterium species, is lower in a test sample comprising microbiota from said subject than the corresponding reference value or the level of cadaverine in a test sample from the subject is lower than the corresponding reference value.
  • the test sample is feces.
  • the bacterium species is selected from Escherichia, Enterobacter and Hafiiia. More preferably the bacterium species is selected from Escherichia coli, Enterobacter cloacae and Hafiiia alvei.
  • the DNA sequence coding for an LDC is cadA or ldcC.
  • the gene product is LDC protein.
  • the invention provides a method for mitigating breast cancer initiation and/or promotion and/or progression in a subject, comprising
  • cadaverine administered to the subject to provide or restore physiological serum concentration of cadaverine if
  • the subject has early stage breast cancer.
  • the test sample is feces.
  • the bacterium species is selected from Escherichia, Enterobacter and Hafnia. More preferably the bacte rium species is selected from Escherichia coli, Enterobacter cloacae and Hafnia alvei.
  • the DNA sequence coding for an LDC is cadA or ldcC.
  • the gene product is LDC protein.
  • a pharmaceutical composition comprising cadaverine and at least one pharmaceutically ac ceptable excipient or carrier.
  • the pharmaceutical composition is for use in mitigating breast cancer initiation and/or promotion and/or progression.
  • the pharmaceutical composition is administered to provide or restore physiological serum concentration of cadaverine in a subject having early stage breast cancer or a lower serum cadaverine level compared to the physiological serum cadaverine.
  • Cadaverine treatment reduces breast cancer aggressiveness in vivo.
  • CAD cadaverine
  • VEH vehicle
  • VEH and CAD-treated mice (A) the number and (B) mass of primary tumors were counted and the (C) number and (D) mass of metastases were measured upon autopsy. (E) Upon autopsy, the infiltration rate of the primary tumor was scored.
  • F-I Primary tumors were formalin-fixed and were embedded into paraffin, then sections were hematoxylin-eosin stained and were scored for (F) mitosis, (G) mitosis/hpf, (H) nuclear pleomorphism.
  • FIG. 1 Cadaverine reduces the proliferation and colony forming ability of breast cancer cells.
  • FIG. 3 Cadaverine treatment reverses EMT (epithelial-mesenchymal transition) of breast cancer cells.
  • A- B In control and cadaverine-treated 4T1 cells
  • FIG. 4 Cadaverine treatment attenuates movement, invasion ability, mitochondrial oxidation and sternness of 4T1 cells.
  • B 4T1 cells were treat ed with cadaverine in the concentration indicated for 48 hours and subsequently invasion capacity of the cells was measured using the Corning matrigel invasion chamber. Cells were counted using the Opera HCS system and invasion index was calculated.
  • OCR Oxygen consumption rate
  • ECAR extra cellular acidification rate
  • FIG. 5 TAARs are seemed to be responsible for the effect of cadaverine.
  • A Patient data was accessed at kmplot.com. Kaplan-Meier plots show the correlation between the mRNA expression of human TAARs and survival in breast cancer.
  • FIG. 6 Cadaverine biosynthesis is suppressed in early stages of breast cancer.
  • A Fluman fecal DNA samples were collected from 48 patients with different stages of breast cancer, and from 48 healthy patients. The abundance of DNA coding for CadA and LdC of the indicated bacterial species were determined in the fecal DNA samples by RT-qPCR. Median values are indicated by a line.
  • FIG. 7 Cadaverine reverts EMT in breast cancer cell lines.
  • Bacterial cadaverine biosynthesis has been found to be suppressed in breast cancer. Bacteria of the human microbiota capable of producing cadaverine may be used as an early indicator of the presence or risk of breast cancer.“Bacterial cadaverine synthesis” refers to the potential of the microbiota to produce cadaverine, prefera bly by the enzymatic decarboxylation of lysine. The level of“bacterial cadaverine synthesis” may depend on the number of bacteria capable of producing cadaverine, e.g the number of bacteria comprising a coding sequence for a lysine decarboxylase enzyme or the rate of expression of the enzyme or the level of activity of the enzyme or the level of the enzyme.
  • Bacteria of the gut capable of producing cadaverine are less abundant in the feces of patients with early stage breast cancer.
  • the concentrations or amounts of LDC DNA, mRNA or protein are lower in the feces sample of an individual with stage 0 or 1 breast cancer than in a control feces sample.
  • The“stage” of a cancer in this description is to be understood as a stage determined using the American Joint Committee on Cancer (AJCC) TNM system staging.
  • AJCC American Joint Committee on Cancer
  • TNM system American Joint Committee on Cancer staging system was used according to the 7th edition.
  • the term“early stage” refers to stage 0 and stage 1, preferably to stage 0 or preferably to stage 1.
  • the invention provides a method for diagnosing breast cancer by measuring the abundance of at least one bacterium species which is capable of producing cadaverine under physiological conditions in the human body, in a test sample derived from the subject, wherein the test sample comprises microbiota of said subject.
  • the term“abundance” or“level” in general is meant as a proportion of a given specimen in a given pool relative to certain similar specimens.
  • the term“abundance” or “level” may refer to a concentration or quantity of the specimen.
  • The“abundance” of a bacterium species may refer to the concentration or the number of cells measured in a sample (e.g. a fecal sample).
  • the term“abun dance of the DNA sequence coding for lysine decarboxylase (LDC) relates to the proportion of the special seg ment of bacterial DNA making up the DNA sequence coding for lysine decarboxylase in a DNA pool or isolate (e.g. total DNA in a sample or a pool of samples).
  • the term“abundance (or level) of the DNA sequence coding for lysine decarboxylase” may relate to the amount of the special segment of bacterial DNA making up the DNA sequence coding for lysine decarboxylase in a sample (test sample or reference sample).
  • the abundance or level of an RNA or protein molecule is defined accordingly, i.e. it relates to the amount of the RNA or protein in the sample.
  • “abundance” may refer to relative abundance, e.g. the abundance of E. coli in a sample of a patient may be calculated based on the abundance of E. coli in a reference sample.
  • Cadaverine is produced by direct decarboxylation of L-lysine catalyzed by lysine decarboxylase.
  • a bacterium is capable of producing cadaverine if the genome of said bacterium comprises a DNA sequence coding for a lysine decarboxylase.
  • a bacterium is capable of producing cadaverine if its genome comprises a cad and/or ldc operon, more particularly cadA and/or ldcC.
  • a bacte rium is capable of producing cadaverine if it expresses a lysine decarboxylase.
  • a bacterium that is capable of producing cadaverine produces cadaverine by the decarboxylation of lysine which is catalyzed by LCD.
  • a bacterium that is capable of producing cadaverine under physiological condi tions in the human body is capable of producing cadaverine in the gastrointestinal system.
  • the bacterium whose abundance is to be measured is a bacterium that is part of the healthy human microbiota, preferably the gut microbiota, preferably the fecal microbiota, more preferably the gut and the fecal microbiota.
  • the DNA sequence coding for a lysine decarboxylase may be a constitutive (e.g. ldcC) or an inducible gene (e.g. cadA) and the expression of the protein may be constitutive or inducible.
  • the capability of a bacterial spe cies/strain/genus to convert lysine to cadaverine under physiological conditions may be tested in vitro. In an appropriate in vitro assay bacterial lysates and lysine are mixed and at the end of the assay cadaverine is detect ed by e.g. mass spectrometry and the lysine/cadaverine ratio is calculated. Lysine carboxylase activity may be measured as described in Inoue et al.
  • A“decreased level of bacterial cadaverine synthesis” in a test sample refers to a decrease of bacterial cadaverine synthesis as compared to a reference level.
  • the (corresponding) reference value of abun dance or quantity or level or concentration may be derived from a plurality of samples from individuals not having early stage breast cancer, preferably not having stage 0 or stage 1 breast cancer, preferably not having cancer and most preferably from healthy individuals.
  • the corresponding reference value of the serum cadaverine concentration may be the physiological serum concentration of cadaverine.
  • the corresponding reference value is the value derived from measurements of the level of the DNA sequence coding for the (same) LDC of the (same) bacterium species in the same type of samples from individuals not having early stage breast cancer, preferably from healthy individuals. Accordingly, a level or concentration of an LDC protein in a test sample is compared to the characteristic value derived from measurements of the level or concentration of the LDC protein in the same type of samples from individuals not having early stage breast cancer, preferably from healthy individuals.
  • HPMC Human Pan-Microbe Com munities
  • NIH Human Microbiome Project the NIH Human Microbiome Project
  • Integrated reference catalog of the human gut microbiome are well-known to the skilled person, and may be found in e.g. Turnbaugh et al. [71] The hu man microbiome project: exploring the microbial part of our in a changing world. Nature 2007; 449(7164): 804-810, e.g the KEGG database.
  • human microbiota refers to the microbes capable of living in or on the human body.
  • the terms “(human)”“gut microbiota” and“gut microbiome” refer to species of the (human) microbiota living in the (hu man) gastrointestinal tract and the term“fecal microbiota” refers to microbes found in the feces.
  • the term “microbiome” and“microbiota” as used in the description may refer to both the (human) microbiota and (hu man) microbiome and the gut/fecal microbiota and gut/fecal microbiome, preferably to the gut/fecal microbiota and microbiome.
  • Bacteria capable of producing cadaverine may reside in the gut, on the skin or in other tissues, such as breast tissue and in the feces.
  • the abundance of the DNA coding for LdcC and CadA was assessed in human fecal DNA from the experi mental cohort described in the Examples.
  • the abundance of Escherichia coli CadA and also E. coli, Enterobacter cloacae and Hafnia alvelii LdcC DNA in breast cancer patients was decreased compared to healthy individuals (Fig. 6A).
  • Decreased cadA and ldcC abundance was more pronounced in clinical stage 0 patients as compared to the pool of all patients (Fig. 6A).
  • E. coli LdcC protein levels were markedly lower than the levels in the feces of healthy subjects (Fig. 6B).
  • the GEO database has been assessed to study LDC expression in human breast cancer. There was no differ ence in LDC mRNA expression between control and breast cancer cases [39-42] or in LDC expression of the normal breast epithelium and cancer epithelium in patients [42, 43]. Rather as an exception, LDC expression was lower in basal-like breast cancer as compared to control (normal) breast epithelium of non-diseased indi viduals [43, 44].
  • the kmplot.com database was used to assess how expression of LDC in humans affects the outcome of breast cancer. Differences in LDC expression did affect overall survival of the patients, in grade 1 patients high er expression of LDC was associated with significantly longer survival than lower expression of LDC (Fig. 6C). Interestingly, while LDC expression did not affect survival in ER- PR- patients, higher LDC expression corre lated with better survival in ER+ PR+ patients (Fig. 6D). High expression of human LDC prolongs survival in early stage breast cancer patients, supporting the potential anti-cancer properties of cadaverine.
  • cadaverine administered in a dose corresponding to the physiological serum con centration in humans exerted antitumor effects in mice grafted with either human -derived or mouse-derived breast cancer cells.
  • the physiological concentration in humans refers to a reference range measured in healthy (i.e. not having breast cancer) individuals and is considered to be 100-800 nM/1 (in the serum) [34, 35].
  • the invention provides cadaverine for use in the treatment or prevention of breast cancer in a subject, cadaverine for use in mitigating cancer initiation and/or promotion and/or progression in a subject and cadaverine for use in the treatment or prevention of breast cancer in a subject or in mitigating cancer initiation and/or promotion and/or progression in a subject, wherein in said use physiological serum concentration of cadaverine is provided or restored in said subject.
  • physiological serum concentration refers to the serum concentration (or a range of concentrations) measured in healthy subjects.
  • Cadaverine plays a tumor suppressor role in breast cancer, in concentrations corresponding to the human reference range.
  • cadaverine in the concentrations corresponding to its reference con centration, did not have a cytostatic effect on primary fibroblasts, suggesting that these effects are specific for tumor cells.
  • Cadaverine exerts its effects through inhibiting EMT, cellular movement, chemotaxis and metasta sis. It has been also found that cadaverine treatment reduces the aggressivity of breast cancer, as indicated by the decreased rate of mitosis and heterogeneity of nuclear morphology, reduced number of metastases, lower mass and infiltration of the primary tumor. In human patients, rate of mitosis and heterogeneity of nuclear mor phology are part of the Nottingham grading system. Our results suggest that the effect of cadaverine treatment may be detected by the repeated grading of the tumor. Change in nuclear score due to cadaverine treatment is shown on Fig. 1H.
  • Infiltration rate of the primary tumors has been found to be lower after cadaverine treatment (Fig. IE).
  • “low infiltration” class means that the primeary tumor remained in the mammary fat pads without any attachment to muscle tissues.
  • the tumor mass attached to the muscle tissue but did not penetrate to the abdominal wall it was classified as a“medium infiltration” tumor. If the tumor grew into the muscle tissue and totally penetrated the abdominal wall, it was scored as a“high infiltration” tumor.
  • histopathological evaluation may be used to determine infiltration rate, e.g. sample specimen after surgery or biopsy may be used.
  • Breast cancer is considered systemic when the tumor has infiltrated blood or lymphatic vessels.
  • FDG-PET is also suitable to calculate the number of metastases.
  • the dose of cadaverine used in the experiments with mice corresponds to the physiological concentration in the serum of healthy humans.
  • the human dose of cadaverine to be used may be calculated by known standards, e.g. the Guidance for Industry Estimating the Maximum Safe Starting Dose in Initial Clinical Trials for Thera peutics in Adult Healthy Volunteers from the U.S. Department of Health and Human Services Food and Drug Administration Center for Drug Evaluation and Research (CDER).
  • Cadaverin may be administered in a dose of about 50 nmol/kg bodyweight to 500 miho ⁇ /kg bodyweight, preferably about 50 nmol/kg bodyweight to 250 pmol/kg bodyweight, preferably about 50 nmol/kg bodyweight to 100 pmol/kg bodyweight, preferably about 100 nmol/kg bodyweight to 800 nmol/kg bodyweight, or preferably in a dose providing a serum concentration of 50-2000 nM/1 preferably 100-800 nM/1, more preferably 100-500 nM/1 or 50-500 nM/1.
  • cadaverine is administered in a dose restoring physiological serum concentration of cadaverine.
  • physiological serum concentration of cadaverine refers to a reference serum concen tration measured in healthy subjects. Loser et al found the serum concentration of cadaverine to be 0.32 ( ⁇ SEM:0.07) nmol/ml in healthy volunteers.
  • physiological serum concentration of cadaverine refers to a serum concentration of from about 0.15 nmol/ml to about 0.6 nmol/ml.
  • the“physiological serum concentration of cadaverine” refers to a serum concentration of from about 20 nmol/ml to about 0.5 nmol/ml from about 25 nmol/ml to about 0.4 nmol/ml.
  • biogenic amines putrescine and cadaverine show in vitro cytotoxicity at concentrations that can be found in foods www.nature.com/scientific reports (2019) 9: 120) non-observed adverse effect level (NOAEL) for cadaverine was found to be 2.5 mM (equivalent to 255.45 mg/kg), while the lowest observed adverse effect level (LOAEL) found to be 5 mM (equivalent to 510.89 mg/kg).
  • the IC 50 value for cadaverine was 40.72 ⁇ 1.98 mM. The skilled person may calculate a safe dose for cadaverine from these data.
  • Cadaverine may be administered in the form of a pharmaceutical composition, wherein the pharmaceutical composition comprises cadaverine and at least one pharmaceutically acceptable excipient or carrier.
  • the pharmaceutical composition comprises cadaverine and at least one pharmaceutically acceptable excipient or carrier.
  • Cadaverine is a liquid on room temperature, which fumes and attracts CO2 from the air.
  • Cadaverine is soluble in water and alcohol, however, incompatible with acid chlorides, acids, acid anhydrides, strong oxidizing agents, carbon dioxide. These properties must be considered when manufacturing an appropriate dosage form.
  • the term“miti gating” refers to delaying, inhibiting, decreasing any of the processes leading to and playing a role in cancer development, including the processes in which cells change to grow and divide continously, spread and invade other tissues.
  • primary tumor is used in the generally accepted meaning thereof, indicating the original, or first, tumor(s) in the body. Cancer cells from a primary tumor may spread to other parts of the body and form new, or secondary, tumors.
  • Cadaverine teatment (500 nmol/kg) decreased the invasivity of the primary tumors in mice homotopically grafted with 4T1 breast cancer cells (Fig. IE). Histological examination of the primary tumors revealed that cadaverine teatment decreased the rate of mitosis (Fig. 1F-G), the heterogeneity of nuclear morphology (Fig. 1H) and the pathological grade of the tumors. Cadaverine supplementation did not alter the number of primary tumors that grew from the grafted cells (Fig. 1A), but there was a trend towards tumors with lower mass (Fig. IB). In line with that, the number of metastases decreased (Fig.
  • Fig. ID Cadaverine induced a mesenchymal-to-epithelial (MET) transition and reduced invasion.
  • MET mesenchymal-to-epithelial
  • Fig. 3 A Cadaverine treatment changed the fibroblast-like mor phology of the 4T1 cells to a rather cobblestone -like morphology.
  • 3C-E show the changes found in CAD-treated 4T1 cells, primary tumors and their metastases from treated mice.
  • the effects of CAD were most profound on 4T1 cells but the same trend is evident in vivo: expression of EMT markers MMP2, MMP3, Tgfb3, FgFbpl, Erbb3, Erl, Notchl, IgFbp4, Sppl, Krtl4 and DSC2 are decreased, showing the reversal of the epithelial-mesenchymal transition.
  • cadaverine-treated cells were slower in migrating to open areas in scratch as says (Fig. 4A) and also performed worse in Boyden-chamber transmigration tests (Fig. 4B). These data were further supported by the observation that MMP9 expression was suppressed by cadaverine treatment (Fig 4C). Metabolic changes evoked by cadaverine administration were assessed using the Seahorse flux analyzer. Cadaverine treatment reduced glycolytic flux (Fig. 4D) that is a characteristic of breast cancer stroma cells [36]. The“sternness” of 4T1 cells was assessed using the aldefluor assay and a reduction in cancer cell sternness was found (Fig. 4E).
  • cadaverine administration was also investigated on five different established breast cancer cell lines of which four were of human (MD -MBA-231, SKBR3, ZR-75-1 and MCF7), while one was of murine origin (4T1).
  • the cadaverine concentration used corre sponded to the reference concentration of cadaverine in human serum (100-800 nM) [34, 35, 36].
  • cadaverine did not hinder the proliferation of non-transformed primary human skin fibroblasts (Fig. 2A).
  • Fig. 2A We assessed whether slower proliferation could be due to the toxicity of cadaverine to cells.
  • the proportion of the PI positive cells did not increase upon cadaverine treatment (Fig. 2D), nor did the apoptotic fraction in 4T1 cells (Fig. 2C).
  • Cadaverine exerts its beneficial effects through Trace Amino Acid Receptors (TAARs).
  • the trace amino ac id receptor family serves as receptors for cadaverine [37, 38, 39]. Indeed, higher expression of TAAR1, TAAR2, TAAR4, TAAR5 and TAAR9 provided better survival in breast cancer (Fig 5A).
  • TAAR receptors are G protein-dependent receptors [38] we assessed their involvement by treating 4T1 cells with NF449, a Gsa- subunit-selective G-protein antagonist, a treatment that abolished the anti-EMT effect of cadaverine (Fig. 5B).
  • E. coli FdcC levels in the feces of patients having E-cadherin negative breast cancer are lower than in the feces of patients having E-cadherin positive breast cancer.
  • Fig. 8 E-cadherin ex pression in breast cancer has been linked to disease progression, metastasis, aggressiveness of the tumor and reduced overall survival [76]. This finding further supports the tumor suppressive role of cadaverine.
  • a method for diagnosing early stage breast cancer in a human subject comprising measuring the abundance of at least one bacterium species which is capable of producing cadaverine un der physiological conditions in the human body, in a test sample derived from the subject, wherein the test sam ple comprises human microbiota of said subject, and
  • early stage breast cancer refers to stage 0 and stage 1 breast cancer, preferably to stage 0 breast cancer or preferably to stage 1 breast cancer.
  • the method is for diagnosing breast cancer stage 0 according to the American Joint Com mittee on Cancer (AJCC) TNM system and the test sample is compared to a reference value typical of the ab sence of stage 0 breast cancer.
  • the method is for diagnosing breast cancer stage 1 according to the American Joint Committee on Cancer (AJCC) TNM system and the test sample is compared to a reference value typical of the absence of stage 1 breast cancer.
  • the abundance of the bacterium species to be measured is measured by measuring the abundance of the DNA sequence coding for or a gene product of the DNA sequence coding for lysine decar boxylase (LDC).
  • the DNA sequence coding for LDC is a DNA sequence in the ldc operon and/or in the cad operon or the gene product is a gene product of a gene of the ldc operon and/or of the cad operon. More preferably, the DNA sequence in the ldc operon is ldcC and/or the DNA sequence in the cad operon is cadA or the gene of the ldc operon is ldcC and/or the gene of the cad operon is cadA.
  • the gene product is preferably RNA or protein.
  • the protein is preferably LDC, LdcC protein or CadA protein (lysine decarboxylase).
  • the RNA is preferably mRNA.
  • stage 0 is to be diagnosed, DNA or RNA is used, and when stage 1 is to be disagnosed, protein is used.
  • test sample comprising human microbiota of said subject comprises gut microbiota.
  • the at least one bacterium species is select ed from Escherichia, Enterobacter and Hafnia.
  • the at least one bacterium species is selected from Escherichia coli, Enterobacter cloacae and Hafnia alvei.
  • the bacteria to be measured are Escherichia coli, Enterobacter cloacae and Hafnia alvei.
  • the abundance of a DNA se quence coding for LDC or a gene product of thereof is measured, wherein the DNA sequence codes for LdcC protein;
  • the abundance of a DNA sequence coding for LDC or a gene product of thereof is measured, wherein the DNA sequence codes for LdcC protein and/or CadA protein.
  • the test sample may be serum, plasma, whole blood, breast duct fluid, breast tumor tissue or feces.
  • the sample in which the abundance of bacteria is to be measured is preferably feces.
  • the samples to be compared are corresponding samples, e.g. when the abundance of a bacterium species is measured in a feces sample, the reference value is derived from feces.
  • the reference value is a value calculated from samples of individuals not having breast cancer, preferably early stage breast cancer, more preferably stage 0 breast cancer.
  • the reference value is calculated from samples of healthy individuals.
  • the bacterium species capable of producing cadaverine under physiological conditions in the human body is capable of said production in the human gastrointestinal tract.
  • the invention also provides cadaverine for use in the treatment of breast cancer in a patient.
  • a method for treating breast cancer in a patient, comprising administering an effective dose of cadaverine to the patient, is also provided.
  • the treatment decreases the number of metastases in said patient.
  • said treatment decreases the total mass of the primary tumor(s) and/or the total mass of the metastases.
  • said treatment decreases the infiltration rate of the primary tumor(s) into surrounding tissues. More preferably, infiltration of the primary tumor(s) into surrounding tissues (e.g. blood vessel or lymphatic vessels) is prevented.
  • surrounding tissues e.g. blood vessel or lymphatic vessels
  • said treatment reverses endothelial-mesenchymal transition in the breast can cer cells.
  • endothelial-mesenchymal transition is indicated and measured by the de creased expression of any one of the following genes in primary tumor tissue or metastasis tissue: MMP2, MMP3, Tgfb3, FgFbpl, Erbb3, Erl, Notchl, IgFbp4, Sppl, Krtl4, DSC2 and combinations thereof.
  • MMP3, Erl the expression of any one of the following genes in primary tumor tissue or metastasis tissue is decreased: MMP3, Erl.
  • said patient is a human, more preferably a woman.
  • cadaverine is administered in a dose providing in the patient a serum concen tration corresponding to the reference physiological serum concentration of cadaverine.
  • cadaverine is administered in a dose that provides about 50 nM/1 to 500 mM/l serum concentration in the patient. More preferably, cadaverine is administered in a dose that provides about 100 to 800 nM/1 serum concentration in the patient.
  • cadaverine is administered in a dose of about 50 nmol/kg to 500 mM/kg, preferably about 100 to 800 nM/kg or in a dose of 0.1 - 1000 mg daily.
  • cadaverine is used to treat early stage breast cancer, in particular stage 0 breast cancer.
  • cadaverine is used as an adjuvant therapy, together with a further anti -cancer treatment.
  • Designed primers, cadaverine and putrescine were from Sigma-Aldrich (St. Louis, MI, USA). Antibodies were from Cell Signaling Technology (Beverly, MA, USA), Abeam (Cambridge, UK) or from Thermo Fisher Scientific (Rockford, USA) unless otherwise stated.
  • 4T1 murine breast cancer cells were maintained in RPMI-1640 (Sigma-Aldrich, R5886) medium containing 10 % FBS, 1 % penicillin/streptomycin, 2 mM L-glutamine and 1 % pyruvate at 37 °C with 5 % C02.
  • MDA-MB-231 and SK-BR-3 human breast cancer cells were maintained in DMEM (Sigma- Aldrich, 1000 mg/1 glucose, D5546) containing 10 % FBS, 1 % penicillin/streptomycin, 2 mM L-glutamine and 10 mM HEPES at 37 °C with 5 % C02.
  • ZR-75-1 human breast cancer cells were maintained in RPMI-1640 (Sigma- Aldrich, R5886) medium con taining 10 % FBS, 1 % penicillin/streptomycin, 2 mM L-glutamine at 37 °C with 5 % C0 2 .
  • MCF-7 human breast cancer cells were maintained in MEM (Sigma-Aldrich, M8042) medium containing 10 % FBS, 1 % penicillin/streptomycin, 2 mM L-glutamine and 10 mM HEPES at 37 °C with 5 % C0 2 .
  • Human primary fibroblast cells were maintained in DMEM (Sigma-Aldrich, 1000 mg/1 glucose, D5546) containing 20 % FBS, 1 % penicillin/streptomycin, 2 mM L-glutamine and 10 mM HEPES at 37 °C with 5 % C0 2 .
  • Cells were seeded in 96-well plates (4T1- 1500 cells/well; MDA-MB-231 and ZR-75-1 - 3000 cells/well; SK-BR-3, MCF-7 and human fibroblast - 5000 cells/well) and were let to attach overnight. Cells were treated with different concentration of cadaverine (Sigma Aldrich, C8561) for 48 hours. After 2 days cells were fixed by the addition of 50 % trichloroacetic acid (TCA, final concentration: 10 %) and the plate was incubated for 1 hour at 4 °C. The plate was then washed 5 times with water and was stained with 0.4 % (w/v) sulphorhodamine B solution in 1 % acetic acid. Unbound dye was removed by washing 5 times with 1 % acetic acid. Bound stain was solubilized with 10 mM Tris base and the absorbance was measured at 540 nm.
  • Cells were seeded in 6-well plates (4T1- 750 cells/well; MDA-MB-231, SKBR-3, ZR-75-1 and MCF-7- 1000 cells/well) in complete medium and were treated with the indicated concentrations of cadaverine for 4 days. At the end of the treatment plates were washed in PBS. Colonies were fixed in 4 % PFA for 30 minutes, dried and stained with the solution of May-Griinwald-Giemsa for 30 minutes. Plates were washed with water and the colonies, containing at least 50 cells, were counted using Image J software.
  • PI uptake cells were seeded in 6-well plates (MDA-MB-231, ZR-75-1 and MCF-7 - 100,000 cells/well; SKBR-3 and human fibroblast - 200,000 cells/well). After 2 days of cadaverine treatment cells were stained with 100 pg/rnl propidium iodide for 30 min at 37 °C. Supernatant was collected in FACS tubes, cells were washed with PBS and collected in the same FACS tubes (trypsin: PBS 1:1) then samples were analyzed by flow cytometry (FACSCalibur, BD Biosciences).
  • ECIS Electric Cell-substrate Impedance Sensing
  • ECIS Electro cell-substrate impedance sensing model ZQ, Applied BioPhysics Inc. (Troy, NY, USA) was used to monitor transcellular electric resistance of control and cadaverine treated cells for 20 hours before the treatment, and total impedance values were measured for additional 48 hours upon the indicated cadaverine treatment. Multifrequency measurements were taken at 62.5, 125, 250, 500, 1000, 2000, 4000, 8000, 16000, 32000, 64000 Hz. The reference well was set to a no-cell control with complete medium.
  • 4T1 cells were grown on coverslips, and treated with the indicated concentration of cadaverine for 48 hours.
  • 5mM NF449 Bio-Techne R&D Systems Kft, 627034-85-9
  • G-protein in hibitor was also added to cadaverine-treated cells.
  • Cells were washed with PBS, fixed with 4% PFA for 15 minutes and permeabilized using 1 % Triton X-100 for 5 minutes. After washing twice with PBS, cells were blocked with 1 % BSA for one hour at room temperature.
  • RNA from cells were prepared using TRIzol reagent (Invitrogen, TR118). 2 pg RNA was reverse transcripted using High Capacity cDNA Reverse Transcription Kit (Applied Biosystems, Foster City, CA, USA, 4368813) according to the manufacturer’s instructions. qPCRBIO SyGreen Lo-ROX Supermix (PCR
  • EMT genes differentially regulated upon cadaverine treatment are listed in Table4. Table 4. List of EMT genes differentially regulated upon cadaverine treatment
  • DH5a Escherichia coli were seeded in liquid LB medium. Cells were incubated at 37°C overnight with gen- tie shaking. E. coli cells were then collected with centrifugation and proteins were isolated using RIPA buffer
  • RIPA buffer 50 mM Tris, 150 mM NaCl, 0.1 % SDS, 1 % TritonX 100, 0.5 % sodium deoxycolate, 1 mM EDTA, 1 mM Na 3 V0 4 , 1 mM NaF, 1 mM PMSF, protease inhibitor coctail
  • Samples were sonicated (Qsonica Q125 Sonicator, Newtown, Connecticut) 3 times for 30 seconds with 50% amplitude.
  • Protein extracts were separated on 8% SDS polyacrylamide gels and transferred onto nitrocellulose mem branes by electroblotting. Then membranes were blocked with 5 % BSA, and incubated with anti-Fysine decar boxylase primary antibody (1: 100, Abeam) for overnight at 4 °C. The membranes were washed with IX TBS- TWEEN and incubated with IgG HRP conjugated secondary antibody (1:2000, Cell Signaling Technology).
  • 4T1 cells were plated in 6-well plates (150,000 cells/well) and were grown overnight. The plates were man ually scratched with sterile 200 m ⁇ pipette tip, followed by washing the cells with complete growth medium. Then cells were treated with 0.1 mM cadaverine in a 37°C thermostat and were monitored every hour for 2 days using JuLi Br Live cell movie analyzer (NanoEnTek Inc., Seoul, Korea).
  • Matrigel invasion assay was carried out on 4T1 cells using Coming BioCoat Matrigel Invasion Chamber (354480). 4T1 cells were seeded in the chambers (50,000 cells/well) in semm free medium, and were grown overnight. Cells were then treated with different concentration of cadaverine (0.1 mM, 0.3 mM, 0.8 mM). The lower chamber contained full 4T1 medium with 100 ng/ml SDFl-alpha (Sigma, SRP4388) as chemoattractant. After 48 hours of cadaverine treatment cells were prepared according to the manufacturer’s instructions and stained with Hematoxylin-Eosin (VWR, 340374T and 341972Q) dye. Cells were then pictured with Opera Phenix High Content Screening System and pictures were analysed using Harmony 4.6 Software. Invasion in dex was calculated from the percentage of invading cells through matrigel membrane and control membrane.
  • 4T1 cells were seeded in 96-well Seahorse assay plates (1500 cells/well) and treated with vehicle and cadaverine for 48 hours. Cells were monitored using XF96 oxymeter (Seahorse Biosciences, North Billerica, MA, USA) to measure the changes in oxygen consumption rate (OCR) and in pH (ECAR) after cadaverine treatment similarly to [27]. Data were normalized to protein content.
  • Lipid peroxidation was measured by detemining the production rate of thiobarbituric acid reactive substrate (TBARS). 4T1 cells were seeded in T75 flasks and allowed to adhere overnight. Cells were exposed to cadaverine for 48 hours, then collected by centrifugation. 8.1 % SDS, 20 % acetic acid, 0.8 % thiobarbituric acid (TBA) and distilled water was added to the pellet and was heated at 96°C for 1 hour in thermoblock. Sam ples were cooled on ice and centrifugated, the absorbance of the supernatant was measured at 540 nm.
  • TBARS thiobarbituric acid reactive substrate
  • the level of the enzyme aldehyde dehydrogenase (ALDH) was determined on 4T1 cells using cadaverine treatment. Cells were seeded on 6 well plates (50000 cells/well) and treated with different concentration of cadaverine (0.1 mM, 0.3 mM, 0.8 mM) for 2 days. Cells were then collected and prepared according to the manu facturer’s instructions. We used SKBR-3 cell line for positive control. Changes in the level of ALDH was measured using flow cytometry and the results were analysed with flowing software 2.5.1.
  • mice Female mice (4 months of age, 20-25g). Animals were bred in the“specific pathogen free” zone of the Animal Facility at the University of Debrecen, and kept in the“minimal disease” zone during the experiments. 4 mice were housed in one cage (standard block shape 365 c 207 c 140 mm, surface 530 cm 2 ; 1284 L Eurostandard Type II. L from Techniplast). Dark/light cycle was 12 h, and temperature was 22 ⁇ 1°C. Mice had ad libitum access to food and water (sterilized tap water). A total of 32 female mice were used in the study, 16 randomly selected control and 16 cadaverine fed mice. The study was performed in two runs at two different occasions, each run comprising of 8 vehicle -treated and 8 cadaverine-treated mice.
  • Tumor was formed in mice by the grafting of 4T1 cells.
  • 4T1 cells were suspended (2xl0 6 /ml) in ice cold PBS-matrigel (1: 1, Sigma- Aldrich) at 1: 1 ratio.
  • 16 female BALB/c mice received 50 pL injections to the ingui nal fat pads below the lower abdominal nipples on both sides (10 5 cells/injection site).
  • Cadaverine stock was prepared in sterilized tap water at lOOx concentration (15 mM) and the stock was stored at -20°C.
  • Cadaverine stock was diluted each day to a working concentration of 150 mM in sterile tap water before the treatment.
  • Animals received a daily oral dose of 100 m1/30 g body weight from cadaverine solution (8 mice) or vehicle (sterilized tap water, 8 mice).
  • researchers administering cadaverine and vehicle solutions were blinded. Treatment was carried out every day during the morning hours between 9am and 11am. Mice were sacrificed on day 14 post grafting.
  • “Low infiltration” class means that primer tumor remained in the mammary fat pads without any attachment to muscle tissues. In case the tumor mass attached to the muscle tissue but did not penetrate the abdominal wall, it classi fied as a“medium infiltration” tumor. If the tumor grew into the muscle tissue and totally penetrated the ab dominal wall, it was scored as a“high infiltration” tumor.
  • Another cohort was used to assess LdcC protein in the feces of healthy volunteers and breast cancer patients.
  • the collection and biobanking of feces was authorized by the Hungarian national authority (ETT).
  • Patients and healthy volunteers meeting the following criteria were excluded from the study according to the corresponding national guideline for fecal transplantation [34]: 1) has previous history of breast cancer or had been operated due to neoplasia, 2) has a disease of unknown origin, 3) has chronic contagious disease, 4) had contagious diar rhea 6 months prior to enrollment, 5) taken antibiotics in the 6 months prior to enrollment, 6) had chemothera py, biological therapy or immunosuppressive therapy 6 months prior to enrollment, 7) used intravenous drugs 12 months prior to enrollment, 8) had piercing, tattooing, acupuncture or other endangering behavior or action 12 months prior to enrollment, 9) exposition to an allergen to which the enrolled individual had been sensitized to, 10) undervent colonoscopy 12 months prior to
  • the kmplot.com database was used to study the link between gene expression levels and breast cancer sur vival in humans.
  • the association of known mutations with breast cancer was retrieved from www.intogen.org/.
  • the sequence of the CadA and LdcC ORFs were retrieved from the KEGG (www.genome.jp/kegg/) database.
  • cacccagcgc atattcaaag aag 23 ⁇ 210> 5
  • NCBI_GEO_Profiles LDC expression in epithelium and stroma of normal breast and invasive breast cancer.
  • NCBI_GEO_Profiles Normal epithelium vs. breast cancer epithelium in patients.
  • CSCs cancer stem cells
  • the Escherichia coli ldcC gene encodes another lysinedecarboxylase, probably a constitutive enzyme. Genes Genet. Syst. (1997) 72, p. 167-172.

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Abstract

The invention relates to the field of diagnosis and treatment of early stage breast cancer. Specifically, a method is provided for determining whether a subject has early stage breast cancer by measuring the abundance of a bacterium species comprising a DNA sequence coding for a lysine decarboxylase. A method for mitigating breast cancer initiation and/or promotion and/or progression in a subject is also provided.

Description

Treatment and diagnosis of breast cancer
FIELD OF THE INVENTION
The invention relates to the field of diagnosis and treatment of early stage breast cancer. Specifically, a method is provided for determining whether a subject has early stage breast cancer by measuring the abundance of a bacterium species comprising a DNA sequence coding for a lysine decarboxylase. A method for mitigating breast cancer initiation and/or promotion and/or progression in a subject is also provided.
BACKGROUND OF THE INVENTION
Microbes that live on the surface or the cavities of the human body affect a large set of pathophysiological processes ranging from metabolic diseases to psychiatric disorders [1-4] or neoplastic dieases [3, 5-7]. The number of directly tumorigenic bacteria is extremely low (-10 species) [8], however, dysbiosis is associated with cancers of the urinary tract [9], cervix [10], skin [11], airways [12], the colon [13], lymphomas [14, 15], prostate [9] and breast cancer [16-23]. Dysbiosis is often reflected as a loss of diversity of the microbiota (e.g.
[17]). In colon carcinogenesis, microbes probably promote the malignancy. However, the majority of the afore mentioned cancers are located distantly from larger depots of microbes, hence, suggesting indirect induction or promotion mechanisms. Indeed, bacterial metabolites emerge as“endocrine” agents that are produced by the microbiome, are absorbed into the circulation, and exert their biological effects distantly
Cadaverine (CAD; pentane- 1,5 -diamine) is produced by the decarboxylation of lysine that is performed by lysine decarboxylase (LDC) enzymes. Human cells code and express LDC and numerous bacterial species of the human microbiome also express LDC either in a constant (LdcC in the LDC operon) or in an inducible (CadA in the Cad operon) fashion [32, 33]. Bacteria use diamines, like cadaverine or putrescine, generated by the decarboxylation of lysine or arginine, to buffer the pH of their environment [28]. The effects of cadaverine on cancer cells and its role in carcinogenesis are not yet characterized in detail.
Loser et al. [35, 36] found that cadaverine concentrations in the pancreatic tissue of patients with pancreatic cancer were elevated. Depierre et al. [62] also found that the excretion (in urine) of cadaverine was increased versus controls in lung cancer. US20170016901A1 describes that elevated levels of polyamines (among them cadaverine) may indicate the presence of breast cancer. EP3064940 also shows that the concentration of cadaverine measured in the saliva of breast cancer patients is higher than that of the controls.
WO2013045826A1 describes that a mixture depleted of cadaverine, putrescine, spermidine and spermine and on the other hand containing agmatine at a concentration higher than that supplied by an average food ration is beneficial in the treatment of pathologies associated with cellular hyperproliferation.
Breast cancer is among the most common cancers worldwide. Early detection may be a clue for efficient therapy without irreversible damages.
BRIEF DESCRIPTION OF THE INVENTION
The invention prvides a method for determining whether a subject has early stage breast cancer or has an in creased probability of having early stage breast cancer by measuring, in a sample derived from said subject, the level of bacterial cadaverine synthesis. The invention provides a method for determining whether a subject has early stage breast cancer or has an increased probability of having early stage breast cancer by measuring the abundance of a bacterium species comprising a DNA sequence coding for a lysine decarboxylase (LDC), the level of a DNA sequence coding for an LDC of a bacterium species, or the level of a gene product of a DNA sequence coding for an LDC produced by a bacterium species, in a sample derived from the subject, wherein the sample comprises microbiota from the subject and wherein the bacterium species is part of the microbiota of the subject.
The invention also provides a method for determining whether a subject is at an increased risk of developing breast cancer, by measuring the abundance of a bacterium species comprising a DNA sequence coding for a lysine decarboxylase (LDC), the level of a DNA sequence coding for an LDC of a bacterium species, or the level of a gene product of a DNA sequence coding for an LDC produced by a bacterium species, in a sample derived from the subject, wherein the sample comprises microbiota from the subject and wherein the bacterium species is part of the microbiota of the subject. The invention also provides cadaverine for use in the treatment or prevention of breast cancer in a subject and cadaverine for use in mitigating cancer initiation and/or promo tion and/or progression in a subject. The invention is further detailed in the following paragraphs.
A method for determining whether a subject
i) has early stage breast cancer or
ii) has an increased probability of having early stage breast cancer or
iii) is at an increased risk of developing breast cancer,
the method comprising
assessing, in a test sample from the subject, the level of bacterial cadaverine synthesis, the sample comprising microbiota from the subject or
measuring the level of cadaverine in a test sample from the subject
wherein
a decreased level of bacterial cadaverine synthesis or
a decreased level of cadaverine, respectively,
indicates that the subject has early stage breast cancer or an increased probability of having early stage breast cancer or is at an increased risk of developing breast cancer.
Preferably, the level of bacterial cadaverine synthesis is assessed by measuring
the abundance of a bacterium species comprising a DNA sequence coding for a lysine decarboxylase (LDC) or
the level of a DNA sequence coding for an LDC of a bacterium species, or
the level of a gene product of a DNA sequence coding for an LDC produced by a bacterium species, wherein
a lower abundance of the bacterium species in the test sample or
a lower level of the DNA sequence coding for an LDC of a bacterium species, or
a lower level of the gene product of a DNA sequence coding for an LDC produced by a bacterium spe cies, respectively,
compared to the corresponding reference value indicates that the subject has early stage breast cancer or an increased probability of having early stage breast or is at an increased risk of developing breast cancer.
Preferably the breast cancer is stage 0 or 1 breast cancer according to the American Joint Committee on Cancer (AJCC) TNM system. Preferably, the cancer is stage 0 breast cancer and the test sample is compared to a reference value typical of the absence of stage 0 breast cancer. Alternatively, the cancer is breast cancer stage 1 the test sample is compared to a reference value typical of the absence of stage 1 breast cancer.
Preferably the DNA sequence coding for LDC is ldcC or cadA.
Preferably the test sample is a feces sample.
Preferably the bacterium species is selected from Escherichia, Enterobacter and Hafnia. More preferably the bacterium species is selected from Escherichia cob, Enterobacter cloacae and Hafnia alvei.
In a preferred embodiment
a lower abundance of the bacterium species in the test sample or
a lower level of the DNA sequence coding for an LDC of a bacterium species
compared to the corresponding reference value
indicates that the subject has stage 0 breast cancer or an increased probability of having stage 0 breast cancer or is at an increased risk of developing breast cancer.
In a more preferred embodiment a lower level of the DNA sequence coding for an LDC of a bacterium spe cies
compared to the corresponding reference value
indicates that the subject has stage 0 breast cancer or an increased probability of having stage 0 breast cancer or is at an increased risk of developing breast cancer.
In a preferred embodiment
a lower level of the gene product of a DNA sequence coding for an LDC produced by a bacterium species compared to the corresponding reference value
indicates that the subject has stage 1 breast cancer or an increased probability of having stage 1 breast cancer or is at an increased risk cancer of developing breast cancer. Preferably the gene product is LDC protein.
Preferably the subject is a human, preferably a woman, more preferably a postmenopausal woman.
In another aspect of the invention cadaverine for use in the treatment or prevention of breast cancer in a sub ject is provided.
Also cadaverine for use in mitigating cancer initiation and/or promotion and/or progression in a subject is provided.
Preferably the subject
has early stage breast cancer or
has an increased probability of having early stage breast cancer or is at an increased risk of developing breast cancer. More preferably the subject has early stage breast cancer.
Preferably prior to said use
the abundance of a bacterium species comprising a DNA sequence coding for LDC,
the level of a DNA sequence coding for an LDC of a bacterium species, or the level of a gene product of a DNA sequence coding for an LDC produced by a bacterium species, is lower in a test sample comprising microbiota from said subject than the corresponding reference value or the level of cadaverine in a test sample from the subject is lower than the corresponding reference value..
In a preferred embodiment the cadaverine for use is for use in
decreasing the infiltration rate of primary tumor(s) into surrounding tissues and/or
decreasing the number of metastases and/or
decreasing the total mass of the primary tumor(s) and/or
decreasing the total mass of the metastases.
Preferably the test sample is feces. Preferably the bacterium species is selected from Escherichia, Enterobacter and Hafiiia. More preferably the bacterium species is selected from Escherichia coli, Enterobacter cloacae and Hafiiia alvei. Preferably the DNA sequence coding for an LDC is cadA or ldcC. Preferably the gene product is LDC protein.
In another aspect the invention provides a method for mitigating breast cancer initiation and/or promotion and/or progression in a subject, comprising
measuring in a test sample comprising microbiota from said subject
the abundance of a bacterium species comprising a DNA sequence coding for a lysine decarboxylase (LDC) or
the level of a DNA sequence coding for an LDC of a bacterium species, or
the level of a gene product of a DNA sequence coding for an LDC produced by a bacterium species, or measuring the level of cadaverine in a test sample from said subject,
administering cadaverine to the subject to provide or restore physiological serum concentration of cadaverine if
the abundance of the bacterium species comprising a DNA sequence coding for LDC or
the level of the DNA sequence coding for an LDC of a bacterium species or
the level of the gene product of a DNA sequence coding for an LDC produced by a bacterium species, or the level of cadaverine, respectively,
is lower than the corresponding reference value, and
monitoring the presence of breast cancer in the subject and/or the serum cadaverine level of said subject, and if necessary, administering another anticancer therapy together or without the administration of cadaverine.
In a preferred embodiment the subject has early stage breast cancer. Preferably the test sample is feces. Pref erably the bacterium species is selected from Escherichia, Enterobacter and Hafnia. More preferably the bacte rium species is selected from Escherichia coli, Enterobacter cloacae and Hafnia alvei. Preferably the DNA sequence coding for an LDC is cadA or ldcC. Preferably the gene product is LDC protein.
In another aspect a pharmaceutical composition comprising cadaverine and at least one pharmaceutically ac ceptable excipient or carrier is provided. Preferably the pharmaceutical composition is for use in mitigating breast cancer initiation and/or promotion and/or progression. Preferably the the pharmaceutical composition is administered to provide or restore physiological serum concentration of cadaverine in a subject having early stage breast cancer or a lower serum cadaverine level compared to the physiological serum cadaverine. BRIEF DESCRIPTION OF THE DRAWINGS
Figure 1. Cadaverine treatment reduces breast cancer aggressiveness in vivo. Female Balb/c mice were grafted with 4T1 cells as described in the Examples and were treated with cadaverine (CAD, 500 nmol/kg q.d. p.o.) or vehicle (VEH, CTL) (n=16/16) for 16 days before sacrifice. For pathological measurements 6 samples from VEH group and 8 samples from cadaverine group were analysed. In VEH and CAD-treated mice (A) the number and (B) mass of primary tumors were counted and the (C) number and (D) mass of metastases were measured upon autopsy. (E) Upon autopsy, the infiltration rate of the primary tumor was scored. Significant level (p=0.002) was calculated using Fisher's exact test with 2x3 Contingency Table. (F-I) Primary tumors were formalin-fixed and were embedded into paraffin, then sections were hematoxylin-eosin stained and were scored for (F) mitosis, (G) mitosis/hpf, (H) nuclear pleomorphism.
Data is plotted as mean ± SEM. In box-whiskers charts (panels B and D) middle lines indicate the median, while squares sign the mean of data. A-D: two-tailed Student t-test. * and ** indicate p<0.05 and p<0.01, re spectively.
Figure 2. Cadaverine reduces the proliferation and colony forming ability of breast cancer cells. (A) 4T1 (n=6 in octuplicates), MDA-MB-231 (n=3 in octuplicates), SKBR-3 (n=3 in octuplicates), ZR-75-1 (n=3 in octuplicates) and MCF-7 (n=3 in octuplicates) breast cancer cells and primary fibroblasts cells were treated with cadaverine in the concentrations indicated for 48 hours then total protein concentrations were determined in SRB (sulphorhodamine B) assay. Values are expressed as fold changes, where 1.0 means protein content in the control cells (indicated by a dotted line). (B) 4T1, MDA-MB-231, SKBR-3, ZR-75-1 and MCF-7 (n=3 for each in one replicate) cells were treated with cadaverine in the concentrations indicated for 4 days. Colonies were then stained according to May-Griinwald-Giemsa and counted using Image J software (n=3). (C) 4T1 cells (n=3 in triplicates) were treated with cadaverine in the concentrations indicated in the examples for 48 hours. Cells were stained with Annexin-FITC-PI Apoptosis Kit and analyzed by flow cytometry (n=4). (D) 4T1 (n=3 in triplicates), MDA-MB-231 (n=4 in triplicates), SKBR-3(n=4 in triplicates), ZR-75-1 (n=3 in triplicates) and MCF-7 (n=3 in triplicates) were treated with cadaverine in the concentrations indicated in the examples for 48 hours. Dead cells were stained with propidium iodide (PI) and analyzed by flow cytometry. Data is plotted as mean ± SEM.
Figure 3. Cadaverine treatment reverses EMT (epithelial-mesenchymal transition) of breast cancer cells. (A- B) In control and cadaverine-treated 4T1 cells (A) total cellular impedance was measured by ECIS (electric cell- substrate impedance sensing) (n=2 in duplicate) (p=0.0484 at 36 hrs and 0.0487 at 40 hrs) and (B) morphology of the actin cytoskeleton (representative picture of control and 0.1 mM cadaverin-treated cells) was assessed after Texas Red-X Phallodin+To-Pro-3 staining (n=2 in triplicates), ratio (%) of epithelial and mesenchymal cells was shown on bar chart. Significance was calculated using Chi-square test in Microsoft Excel (p<0.001 between control and 0.1 mM cadaverine, p<0.001 between control and 0.3 mM cadaverine, p<0.001 between control and 0.8 mM cadaverine). (C-E) Expression of a set of genes involved in EMT were assessed by RT- qPCR in (C) 4T1 cells (n=3), (D) primary tumors (n=16/16) and in (E) metastases (n=16/16). All data is ex pressed as fold change. The line that equals to 1 (no change) indicates the average of the control samples. Data is plotted as mean ± SEM. On panel A significance was calculated using One-way Anova. On panels C-E sig- nificance was calculated using two-sample student t-test, (two-tailed), while on panel B One-way Anova was used to calculate differences. *, ** and *** p<0.05, p<0.01 or p<0.001 respectively.
Figure 4. Cadaverine treatment attenuates movement, invasion ability, mitochondrial oxidation and sternness of 4T1 cells. (A) 4T1 cells were treated with cadaverine in the concentration indicated for 48 hours after scratching a 4T1 cell layer. Subsequent closure of the wound was assessed by the JULI-Br live cell analyzer system (n=2). Significance was calculated using two-sample student t-test (two-tailed). (B) 4T1 cells were treat ed with cadaverine in the concentration indicated for 48 hours and subsequently invasion capacity of the cells was measured using the Corning matrigel invasion chamber. Cells were counted using the Opera HCS system and invasion index was calculated. (p=0.003 both between control and 0.1 mM cadaverine, and control and 0.3 mM cadaverine, p= 4.14 x 10 4 between control and 0.8 mM cadaverine). (C) 4T1 cells were treated with vehicle and cadaverine for 48 hours, then cells were stained for MMP9 and nucleus (DAPI) and sections were analysed by confocal microscopy using a Leica SP8 confocal system. MMP9 content was calculated from the total cellu lar fluorescence masured by the Image J software (p=0.001 between both control and 0.3 mM cadaverine and control and 0.8 mM cadaverine). (D) 4T1 cells were treated with vehicle and cadaverine for 48 hours (n=3 in 24 replicates), then cells were subjected to a Seahorse XF96 analysis. Oxygen consumption rate (OCR) and extra cellular acidification rate (ECAR) were measured and plotted (pOCR=0.006 between control and 0.1 mM cadaverine, pOCR p<0.001 between control and 0.3 mM cadaverine, pOCR=1.8 x 10 5 between control and 0.8 mM cadaverine). (E) 4T1 cells were treated with vehicle and cadaverine in the concentration indicated for 48 hours (n=3 in triplicates), then cells were subjected to an Aldefluor assay (p=0.035 between control and 0.3mM cadaverine). Data is plotted as mean ± SEM. Significance was calculated using One-way Anova. *, ** and *** indicate p<0.05, p<0.01 and p<0.001, respectively.
Figure 5. TAARs are seemed to be responsible for the effect of cadaverine. (A) Patient data was accessed at kmplot.com. Kaplan-Meier plots show the correlation between the mRNA expression of human TAARs and survival in breast cancer. (B) 4T1 cells were treated with, 100 nM cadaverine (48 hours) or 100 nM cadaverine (48 hours) in combination with 5 mM NF449 G protein inhibitor (last 48 hours of cadaverine treatment), cells were stained with Texas Red-X Phallodin- and To-Pro-3 then cells were assessed by confocal microscopy (n=2 in triplicates). Ratio (%) of epithelial and mesenchymal cells was shown on bar chart (cells were treated with cadaverine in the indicated concentrations in combination with 5 mM NF449G protein inhibitor). Data is plotted as mean ± SEM.
Figure 6. Cadaverine biosynthesis is suppressed in early stages of breast cancer. (A) Fluman fecal DNA samples were collected from 48 patients with different stages of breast cancer, and from 48 healthy patients. The abundance of DNA coding for CadA and LdC of the indicated bacterial species were determined in the fecal DNA samples by RT-qPCR. Median values are indicated by a line. (B) Fluman fecal samples were collected from stage 1 breast cancer patients (n=7) and from healthy (control) subjects (n=3). The E. coli LdcC protein level was determined using Western blot. Flereby we show a representative image. Band intensity was normal ized to total protein content assessed by ponceau-S staining of whole blots. Box chart of LDC protein expres sion from fecal samples. The middle line indicates the median, while squares sign the mean of data. Data was normalized to the mean of control samples. Blots were routinely cut as the representative blot. (C-D) Patient data was accessed at kmplot.com. Kaplan-Meier plots the correlation between the mRNA expression of human LDC and survival in breast cancer. Graphs show the correlation between LDC and disease survival in different forms and stages of the disease. Those arrays were also included where ER status was deducted from gene ex pression data. ** indicates statistically significant difference between control and stage 1 breast cancer treated groups at p<0.01. Significance was calculated using two-sample student t-test.
Figure 7. Cadaverine reverts EMT in breast cancer cell lines. (A-B) In control and cadaverine-treated (A) MDA-MB-231 (n=l in triplicates) and (B) SKBR-3 (n=l in triplicates) breast cancer cells morphology of the actin cytoskeleton was assessed after Texas Red-X Phallodin+To-Pro-3 staining. Ratio (%) of epithelial and mesenchymal cells was shown on bar charts. Significance was calculated using Chi-square test in Microsoft Excel.
Figure 8. Fecal E. coli LdcC expression was determined from total fecal extracts by Western blotting (n=29/5) from breast cancer patients. LdcC signal was normalized for total protein (Amido black signal from the membrane).
DETAILED DESCRIPTION OF THE INVENTION
Bacterial cadaverine biosynthesis has been found to be suppressed in breast cancer. Bacteria of the human microbiota capable of producing cadaverine may be used as an early indicator of the presence or risk of breast cancer.“Bacterial cadaverine synthesis” refers to the potential of the microbiota to produce cadaverine, prefera bly by the enzymatic decarboxylation of lysine. The level of“bacterial cadaverine synthesis” may depend on the number of bacteria capable of producing cadaverine, e.g the number of bacteria comprising a coding sequence for a lysine decarboxylase enzyme or the rate of expression of the enzyme or the level of activity of the enzyme or the level of the enzyme. Bacteria of the gut capable of producing cadaverine are less abundant in the feces of patients with early stage breast cancer. For example, the concentrations or amounts of LDC DNA, mRNA or protein are lower in the feces sample of an individual with stage 0 or 1 breast cancer than in a control feces sample. The“stage” of a cancer in this description is to be understood as a stage determined using the American Joint Committee on Cancer (AJCC) TNM system staging. American Joint Committee on Cancer (AJCC) (TNM system) staging system was used according to the 7th edition. The term“early stage” refers to stage 0 and stage 1, preferably to stage 0 or preferably to stage 1. Accordingly, the invention provides a method for diagnosing breast cancer by measuring the abundance of at least one bacterium species which is capable of producing cadaverine under physiological conditions in the human body, in a test sample derived from the subject, wherein the test sample comprises microbiota of said subject. The term“abundance” or“level” in general is meant as a proportion of a given specimen in a given pool relative to certain similar specimens. The term“abundance” or “level” may refer to a concentration or quantity of the specimen. The“abundance” of a bacterium species may refer to the concentration or the number of cells measured in a sample (e.g. a fecal sample). The term“abun dance of the DNA sequence coding for lysine decarboxylase (LDC) relates to the proportion of the special seg ment of bacterial DNA making up the DNA sequence coding for lysine decarboxylase in a DNA pool or isolate (e.g. total DNA in a sample or a pool of samples). The term“abundance (or level) of the DNA sequence coding for lysine decarboxylase” may relate to the amount of the special segment of bacterial DNA making up the DNA sequence coding for lysine decarboxylase in a sample (test sample or reference sample). The abundance or level of an RNA or protein molecule is defined accordingly, i.e. it relates to the amount of the RNA or protein in the sample. In the context of the specification,“abundance” may refer to relative abundance, e.g. the abundance of E. coli in a sample of a patient may be calculated based on the abundance of E. coli in a reference sample. Cadaverine is produced by direct decarboxylation of L-lysine catalyzed by lysine decarboxylase. In the context of the invention a bacterium is capable of producing cadaverine if the genome of said bacterium comprises a DNA sequence coding for a lysine decarboxylase. Particularly, a bacterium is capable of producing cadaverine if its genome comprises a cad and/or ldc operon, more particularly cadA and/or ldcC. More particularly, a bacte rium is capable of producing cadaverine if it expresses a lysine decarboxylase. In the context of the invention a bacterium that is capable of producing cadaverine produces cadaverine by the decarboxylation of lysine which is catalyzed by LCD. Preferably, a bacterium that is capable of producing cadaverine under physiological condi tions in the human body, is capable of producing cadaverine in the gastrointestinal system. The bacterium whose abundance is to be measured is a bacterium that is part of the healthy human microbiota, preferably the gut microbiota, preferably the fecal microbiota, more preferably the gut and the fecal microbiota.
The DNA sequence coding for a lysine decarboxylase may be a constitutive (e.g. ldcC) or an inducible gene (e.g. cadA) and the expression of the protein may be constitutive or inducible. The capability of a bacterial spe cies/strain/genus to convert lysine to cadaverine under physiological conditions may be tested in vitro. In an appropriate in vitro assay bacterial lysates and lysine are mixed and at the end of the assay cadaverine is detect ed by e.g. mass spectrometry and the lysine/cadaverine ratio is calculated. Lysine carboxylase activity may be measured as described in Inoue et al. Although culturing (gut) microbes has its challenges, the skilled person will find guidance in e.g. Sommer [68]; Lagier et al. [69]; Browne et al [70]; Yamamoto et al. [70]. To mimic the natural growing conditions of the gut microbiota, one might use specialized testing conditions, e.g the i- screen platform by TNO (The Netherlands Organization for Applied Scientific Research). To determine whether a bacterium species is (capable of) coexisting with a human subject or is capable to grow in the gut, one might consult and search sequence databases such as those of the NIH Human Microbiome Project (https://commonfund. nih.gov/hmp; httt>s://t>ortal.hmt>dacc.org/ as of 19 July 2018) or the Human Pan-Microbe Communities (http://www.hpmcd.org/ as of 19 July 2018). It is also possible to sequence and compare a charac teristic genetic portion of a bacterium of interest with reference samples of healthy humans. The methods for measuring the (relative) quantity of bacteria, DNA, RNA or protein are well known to the skilled person and include e.g. quantitative real time PCR assays, (faecal) immunochemical tests, Western blot, turbidimetry, anti body and mass spectrometry-based assays, RT -coupled new generation sequencing. Guidance is also found in the Examples, and in e.g. Liang et al [63]; Wong SH, et al. [64] ; E. Nabizadeh et al. [65]; Goedert et al. [66]; Xie et al. [67]. A“decreased level of bacterial cadaverine synthesis” in a test sample refers to a decrease of bacterial cadaverine synthesis as compared to a reference level. The (corresponding) reference value of abun dance or quantity or level or concentration may be derived from a plurality of samples from individuals not having early stage breast cancer, preferably not having stage 0 or stage 1 breast cancer, preferably not having cancer and most preferably from healthy individuals. E.g. the corresponding reference value of the serum cadaverine concentration may be the physiological serum concentration of cadaverine. Likewise, in the case of the level of a DNA sequence coding for an LDC of a bacterium species, the corresponding reference value is the value derived from measurements of the level of the DNA sequence coding for the (same) LDC of the (same) bacterium species in the same type of samples from individuals not having early stage breast cancer, preferably from healthy individuals. Accordingly, a level or concentration of an LDC protein in a test sample is compared to the characteristic value derived from measurements of the level or concentration of the LDC protein in the same type of samples from individuals not having early stage breast cancer, preferably from healthy individuals.
It is also possible to search appropriate databases for bacteria known to be present in the human body, pref erably in the human gastrointestinal tract, preferably in the intestine, wherein a DNA sequence coding for a LDC was annoted. Accordingly, a screening method is provided, wherein bacteria suitable to indicate the pres ence of early stage breast cancer may be screened for. In the screening method an appropriate database is searched for bacteria wherein a DNA sequence coding for a LDC has been annoted. By measuring the abun dance of such bacteria in healthy individuals and early stage breast cancer patients, bacteria suitable to indicate the presence of early stage breast cancer may be identified. Such databases (e.g. the Human Pan-Microbe Com munities (HPMC) database, the NIH Human Microbiome Project, the Integrated reference catalog of the human gut microbiome) are well-known to the skilled person, and may be found in e.g. Turnbaugh et al. [71] The hu man microbiome project: exploring the microbial part of ourselves in a changing world. Nature 2007; 449(7164): 804-810, e.g the KEGG database.
The term“human microbiota” refers to the microbes capable of living in or on the human body. The terms “(human)”“gut microbiota” and“gut microbiome” refer to species of the (human) microbiota living in the (hu man) gastrointestinal tract and the term“fecal microbiota” refers to microbes found in the feces. The term “microbiome” and“microbiota” as used in the description may refer to both the (human) microbiota and (hu man) microbiome and the gut/fecal microbiota and gut/fecal microbiome, preferably to the gut/fecal microbiota and microbiome. Bacteria capable of producing cadaverine may reside in the gut, on the skin or in other tissues, such as breast tissue and in the feces.
The abundance of the DNA coding for LdcC and CadA was assessed in human fecal DNA from the experi mental cohort described in the Examples. The abundance of Escherichia coli CadA and also E. coli, Enterobacter cloacae and Hafnia alvelii LdcC DNA in breast cancer patients was decreased compared to healthy individuals (Fig. 6A). Decreased cadA and ldcC abundance was more pronounced in clinical stage 0 patients as compared to the pool of all patients (Fig. 6A). In the feces of stage 1 patients E. coli LdcC protein levels were markedly lower than the levels in the feces of healthy subjects (Fig. 6B).
The GEO database has been assessed to study LDC expression in human breast cancer. There was no differ ence in LDC mRNA expression between control and breast cancer cases [39-42] or in LDC expression of the normal breast epithelium and cancer epithelium in patients [42, 43]. Rather as an exception, LDC expression was lower in basal-like breast cancer as compared to control (normal) breast epithelium of non-diseased indi viduals [43, 44].
The kmplot.com database was used to assess how expression of LDC in humans affects the outcome of breast cancer. Differences in LDC expression did affect overall survival of the patients, in grade 1 patients high er expression of LDC was associated with significantly longer survival than lower expression of LDC (Fig. 6C). Interestingly, while LDC expression did not affect survival in ER- PR- patients, higher LDC expression corre lated with better survival in ER+ PR+ patients (Fig. 6D). High expression of human LDC prolongs survival in early stage breast cancer patients, supporting the potential anti-cancer properties of cadaverine.
It has been also found that cadaverine administered in a dose corresponding to the physiological serum con centration in humans exerted antitumor effects in mice grafted with either human -derived or mouse-derived breast cancer cells. The physiological concentration in humans refers to a reference range measured in healthy (i.e. not having breast cancer) individuals and is considered to be 100-800 nM/1 (in the serum) [34, 35]. There fore, the invention provides cadaverine for use in the treatment or prevention of breast cancer in a subject, cadaverine for use in mitigating cancer initiation and/or promotion and/or progression in a subject and cadaverine for use in the treatment or prevention of breast cancer in a subject or in mitigating cancer initiation and/or promotion and/or progression in a subject, wherein in said use physiological serum concentration of cadaverine is provided or restored in said subject. In the context of said use or said cadaverine for use the term “physiological serum concentration” refers to the serum concentration (or a range of concentrations) measured in healthy subjects. Cadaverine plays a tumor suppressor role in breast cancer, in concentrations corresponding to the human reference range. Moreover, cadaverine, in the concentrations corresponding to its reference con centration, did not have a cytostatic effect on primary fibroblasts, suggesting that these effects are specific for tumor cells. Cadaverine exerts its effects through inhibiting EMT, cellular movement, chemotaxis and metasta sis. It has been also found that cadaverine treatment reduces the aggressivity of breast cancer, as indicated by the decreased rate of mitosis and heterogeneity of nuclear morphology, reduced number of metastases, lower mass and infiltration of the primary tumor. In human patients, rate of mitosis and heterogeneity of nuclear mor phology are part of the Nottingham grading system. Our results suggest that the effect of cadaverine treatment may be detected by the repeated grading of the tumor. Change in nuclear score due to cadaverine treatment is shown on Fig. 1H.
Infiltration rate of the primary tumors has been found to be lower after cadaverine treatment (Fig. IE). In our experiments“low infiltration” class means that the primeary tumor remained in the mammary fat pads without any attachment to muscle tissues. In case the tumor mass attached to the muscle tissue but did not penetrate to the abdominal wall, it was classified as a“medium infiltration” tumor. If the tumor grew into the muscle tissue and totally penetrated the abdominal wall, it was scored as a“high infiltration” tumor. In the clinics, histopathological evaluation may be used to determine infiltration rate, e.g. sample specimen after surgery or biopsy may be used. Breast cancer is considered systemic when the tumor has infiltrated blood or lymphatic vessels.
Besides the total mass of the primary tumor(s), also the total mass of the metastases decreased after cadaverine treatment in our experiments. In human patients, e.g. FDG-PET may be used to follow such changes. FDG-PET is also suitable to calculate the number of metastases.
The dose of cadaverine used in the experiments with mice corresponds to the physiological concentration in the serum of healthy humans. The human dose of cadaverine to be used may be calculated by known standards, e.g. the Guidance for Industry Estimating the Maximum Safe Starting Dose in Initial Clinical Trials for Thera peutics in Adult Healthy Volunteers from the U.S. Department of Health and Human Services Food and Drug Administration Center for Drug Evaluation and Research (CDER). Cadaverin may be administered in a dose of about 50 nmol/kg bodyweight to 500 mihoΐ/kg bodyweight, preferably about 50 nmol/kg bodyweight to 250 pmol/kg bodyweight, preferably about 50 nmol/kg bodyweight to 100 pmol/kg bodyweight, preferably about 100 nmol/kg bodyweight to 800 nmol/kg bodyweight, or preferably in a dose providing a serum concentration of 50-2000 nM/1 preferably 100-800 nM/1, more preferably 100-500 nM/1 or 50-500 nM/1.
In a preferred embodiment cadaverine is administered in a dose restoring physiological serum concentration of cadaverine. The term“physiological serum concentration of cadaverine” refers to a reference serum concen tration measured in healthy subjects. Loser et al found the serum concentration of cadaverine to be 0.32 (±SEM:0.07) nmol/ml in healthy volunteers. In an embodiment “physiological serum concentration of cadaverine” refers to a serum concentration of from about 0.15 nmol/ml to about 0.6 nmol/ml. In a preferred embodiment the“physiological serum concentration of cadaverine” refers to a serum concentration of from about 20 nmol/ml to about 0.5 nmol/ml from about 25 nmol/ml to about 0.4 nmol/ml. In a study by the Europe an Food Safety Authority (Scientific opinion on risk based control of biogenic amine formation in fermented foods EFSA Journal 2011;9(10):2393), cumulative daily exposure to cadaverine was found to be between 52.5 and 100.8 mg/day in European countries. In an in vitro cytotoxicity study on human cells (del Rio et al. The biogenic amines putrescine and cadaverine show in vitro cytotoxicity at concentrations that can be found in foods www.nature.com/scientific reports (2019) 9: 120) non-observed adverse effect level (NOAEL) for cadaverine was found to be 2.5 mM (equivalent to 255.45 mg/kg), while the lowest observed adverse effect level (LOAEL) found to be 5 mM (equivalent to 510.89 mg/kg). The IC50 value for cadaverine was 40.72 ± 1.98 mM. The skilled person may calculate a safe dose for cadaverine from these data.
Cadaverine may be administered in the form of a pharmaceutical composition, wherein the pharmaceutical composition comprises cadaverine and at least one pharmaceutically acceptable excipient or carrier. Cadaverine is a liquid on room temperature, which fumes and attracts CO2 from the air. Cadaverine is soluble in water and alcohol, however, incompatible with acid chlorides, acids, acid anhydrides, strong oxidizing agents, carbon dioxide. These properties must be considered when manufacturing an appropriate dosage form.The term“miti gating” refers to delaying, inhibiting, decreasing any of the processes leading to and playing a role in cancer development, including the processes in which cells change to grow and divide continously, spread and invade other tissues.
The term“primary tumor” is used in the generally accepted meaning thereof, indicating the original, or first, tumor(s) in the body. Cancer cells from a primary tumor may spread to other parts of the body and form new, or secondary, tumors.
Cadaverine teatment (500 nmol/kg) decreased the invasivity of the primary tumors in mice homotopically grafted with 4T1 breast cancer cells (Fig. IE). Histological examination of the primary tumors revealed that cadaverine teatment decreased the rate of mitosis (Fig. 1F-G), the heterogeneity of nuclear morphology (Fig. 1H) and the pathological grade of the tumors. Cadaverine supplementation did not alter the number of primary tumors that grew from the grafted cells (Fig. 1A), but there was a trend towards tumors with lower mass (Fig. IB). In line with that, the number of metastases decreased (Fig. 1C) and, as with the primary tumors, there was a trend for smaller tumors in the cadaverine-teated mice (Fig. ID). Cadaverine induced a mesenchymal-to-epithelial (MET) transition and reduced invasion. Better adherence of mesenchymal-like cancer cells was found in the ECIS (electric cell-substrate impedance sensing) system, in which 0.1 mM cadaverine increased resistance (Fig. 3 A). Cadaverine treatment changed the fibroblast-like mor phology of the 4T1 cells to a rather cobblestone -like morphology (Fig. 3B) that is characteristic for epithelial cells [27], as shown by phallodin-Texas Red staining to visualize the arrangement of the actin cytoskeleton. Treatment of MDA-MB-231, SKBR-3 and ZR-75-1 breast cancer cell lines with cadaverine led to similar mor phological changes. RT-qPCR screen on EMT genes revealed differential expression of genes after cadaverine treatment (Table 4). MMP2, MMP3 and MMP9 and support movement; Tgfb3, FgFbpl, Erbb3 and Erl support proliferation; while Krtl4, Notchl, CDH1, IgFbp4 and Sppl support cell adhesion (Fig. 3D-E). Fig. 3C-E show the changes found in CAD-treated 4T1 cells, primary tumors and their metastases from treated mice. The effects of CAD were most profound on 4T1 cells but the same trend is evident in vivo: expression of EMT markers MMP2, MMP3, Tgfb3, FgFbpl, Erbb3, Erl, Notchl, IgFbp4, Sppl, Krtl4 and DSC2 are decreased, showing the reversal of the epithelial-mesenchymal transition.
In line with these observations, cadaverine-treated cells were slower in migrating to open areas in scratch as says (Fig. 4A) and also performed worse in Boyden-chamber transmigration tests (Fig. 4B). These data were further supported by the observation that MMP9 expression was suppressed by cadaverine treatment (Fig 4C). Metabolic changes evoked by cadaverine administration were assessed using the Seahorse flux analyzer. Cadaverine treatment reduced glycolytic flux (Fig. 4D) that is a characteristic of breast cancer stroma cells [36]. The“sternness” of 4T1 cells was assessed using the aldefluor assay and a reduction in cancer cell sternness was found (Fig. 4E).
The influence of cadaverine administration on the proliferation of cultured breast cancer cell lines was also investigated on five different established breast cancer cell lines of which four were of human (MD -MBA-231, SKBR3, ZR-75-1 and MCF7), while one was of murine origin (4T1). The cadaverine concentration used corre sponded to the reference concentration of cadaverine in human serum (100-800 nM) [34, 35, 36]. Cadaverine slowed proliferation of 4T1, MDA-MB-231 and SKBR-3 cells as measured in SRB assay (Fig. 2A) or in colony forming assays (Fig. 2B). Importantly, the same concentrations of cadaverine did not hinder the proliferation of non-transformed primary human skin fibroblasts (Fig. 2A). We assessed whether slower proliferation could be due to the toxicity of cadaverine to cells. The proportion of the PI positive cells did not increase upon cadaverine treatment (Fig. 2D), nor did the apoptotic fraction in 4T1 cells (Fig. 2C).
Cadaverine exerts its beneficial effects through Trace Amino Acid Receptors (TAARs). The trace amino ac id receptor family serves as receptors for cadaverine [37, 38, 39]. Indeed, higher expression of TAAR1, TAAR2, TAAR4, TAAR5 and TAAR9 provided better survival in breast cancer (Fig 5A). As TAAR receptors are G protein-dependent receptors [38] we assessed their involvement by treating 4T1 cells with NF449, a Gsa- subunit-selective G-protein antagonist, a treatment that abolished the anti-EMT effect of cadaverine (Fig. 5B).
Interestingly, it was found that E. coli FdcC levels in the feces of patients having E-cadherin negative breast cancer are lower than in the feces of patients having E-cadherin positive breast cancer. (Fig. 8) E-cadherin ex pression in breast cancer has been linked to disease progression, metastasis, aggressiveness of the tumor and reduced overall survival [76]. This finding further supports the tumor suppressive role of cadaverine. Some aspects of the invention are summerized below:
1. A method for diagnosing early stage breast cancer in a human subject is provided, comprising measuring the abundance of at least one bacterium species which is capable of producing cadaverine un der physiological conditions in the human body, in a test sample derived from the subject, wherein the test sam ple comprises human microbiota of said subject, and
wherein a decrease in the abundance of the at least one species in the test sample compared to a reference value of abundance of the at least one bacterium species typical of the absence of early stage breast cancer, is indicative of early stage breast cancer in said subject. In the context of the description, early stage breast cancer refers to stage 0 and stage 1 breast cancer, preferably to stage 0 breast cancer or preferably to stage 1 breast cancer.
2. Preferably, the method is for diagnosing breast cancer stage 0 according to the American Joint Com mittee on Cancer (AJCC) TNM system and the test sample is compared to a reference value typical of the ab sence of stage 0 breast cancer. Preferably, the method is for diagnosing breast cancer stage 1 according to the American Joint Committee on Cancer (AJCC) TNM system and the test sample is compared to a reference value typical of the absence of stage 1 breast cancer.
3. Preferably, the abundance of the bacterium species to be measured is measured by measuring the abundance of the DNA sequence coding for or a gene product of the DNA sequence coding for lysine decar boxylase (LDC). Preferably, the DNA sequence coding for LDC is a DNA sequence in the ldc operon and/or in the cad operon or the gene product is a gene product of a gene of the ldc operon and/or of the cad operon. More preferably, the DNA sequence in the ldc operon is ldcC and/or the DNA sequence in the cad operon is cadA or the gene of the ldc operon is ldcC and/or the gene of the cad operon is cadA. The gene product is preferably RNA or protein. The protein is preferably LDC, LdcC protein or CadA protein (lysine decarboxylase). The RNA is preferably mRNA. Preferably, when stage 0 is to be diagnosed, DNA or RNA is used, and when stage 1 is to be disagnosed, protein is used.
4. The method according to any one of points 1 to 3, wherein the test sample comprising human microbiota of said subject comprises gut microbiota.
5. The method according to any one of points 1 to 4, wherein the at least one bacterium species is select ed from Escherichia, Enterobacter and Hafnia. Preferably, the at least one bacterium species is selected from Escherichia coli, Enterobacter cloacae and Hafnia alvei. In preferred embodiments the bacteria to be measured are Escherichia coli, Enterobacter cloacae and Hafnia alvei.
Preferably, when measuring the abundance of E. cloacae and/or H. alvei, the abundance of a DNA se quence coding for LDC or a gene product of thereof is measured, wherein the DNA sequence codes for LdcC protein; when measuring the abundance of E. coli, the abundance of a DNA sequence coding for LDC or a gene product of thereof is measured, wherein the DNA sequence codes for LdcC protein and/or CadA protein.
The test sample may be serum, plasma, whole blood, breast duct fluid, breast tumor tissue or feces. The sample in which the abundance of bacteria is to be measured is preferably feces. The samples to be compared are corresponding samples, e.g. when the abundance of a bacterium species is measured in a feces sample, the reference value is derived from feces. The reference value is a value calculated from samples of individuals not having breast cancer, preferably early stage breast cancer, more preferably stage 0 breast cancer. Preferably, the reference value is calculated from samples of healthy individuals.
Preferably the bacterium species capable of producing cadaverine under physiological conditions in the human body is capable of said production in the human gastrointestinal tract.
The invention also provides cadaverine for use in the treatment of breast cancer in a patient. A method for treating breast cancer in a patient, comprising administering an effective dose of cadaverine to the patient, is also provided.
In an embodiment, the treatment decreases the number of metastases in said patient.
In yet other embodiments, said treatment decreases the total mass of the primary tumor(s) and/or the total mass of the metastases.
Preferably, said treatment decreases the infiltration rate of the primary tumor(s) into surrounding tissues. More preferably, infiltration of the primary tumor(s) into surrounding tissues (e.g. blood vessel or lymphatic vessels) is prevented.
In preferred embodiments said treatment reverses endothelial-mesenchymal transition in the breast can cer cells. In preferred embodiments endothelial-mesenchymal transition is indicated and measured by the de creased expression of any one of the following genes in primary tumor tissue or metastasis tissue: MMP2, MMP3, Tgfb3, FgFbpl, Erbb3, Erl, Notchl, IgFbp4, Sppl, Krtl4, DSC2 and combinations thereof. In pre ferred embodiments the expression of any one of the following genes in primary tumor tissue or metastasis tissue is decreased: MMP3, Erl.
Preferably, said patient is a human, more preferably a woman.
In preferred embodiments, cadaverine is administered in a dose providing in the patient a serum concen tration corresponding to the reference physiological serum concentration of cadaverine. Preferably, cadaverine is administered in a dose that provides about 50 nM/1 to 500 mM/l serum concentration in the patient. More preferably, cadaverine is administered in a dose that provides about 100 to 800 nM/1 serum concentration in the patient. In preferred embodiments, cadaverine is administered in a dose of about 50 nmol/kg to 500 mM/kg, preferably about 100 to 800 nM/kg or in a dose of 0.1 - 1000 mg daily.
Preferably, cadaverine is used to treat early stage breast cancer, in particular stage 0 breast cancer. Pref erably, cadaverine is used as an adjuvant therapy, together with a further anti -cancer treatment.
EXAMPLES
Materials and methods
Chemicals
Designed primers, cadaverine and putrescine were from Sigma-Aldrich (St. Louis, MI, USA). Antibodies were from Cell Signaling Technology (Beverly, MA, USA), Abeam (Cambridge, UK) or from Thermo Fisher Scientific (Rockford, USA) unless otherwise stated.
Cell culture
4T1 murine breast cancer cells were maintained in RPMI-1640 (Sigma-Aldrich, R5886) medium containing 10 % FBS, 1 % penicillin/streptomycin, 2 mM L-glutamine and 1 % pyruvate at 37 °C with 5 % C02.
MDA-MB-231 and SK-BR-3 human breast cancer cells were maintained in DMEM (Sigma- Aldrich, 1000 mg/1 glucose, D5546) containing 10 % FBS, 1 % penicillin/streptomycin, 2 mM L-glutamine and 10 mM HEPES at 37 °C with 5 % C02.
ZR-75-1 human breast cancer cells were maintained in RPMI-1640 (Sigma- Aldrich, R5886) medium con taining 10 % FBS, 1 % penicillin/streptomycin, 2 mM L-glutamine at 37 °C with 5 % C02.
MCF-7 human breast cancer cells were maintained in MEM (Sigma-Aldrich, M8042) medium containing 10 % FBS, 1 % penicillin/streptomycin, 2 mM L-glutamine and 10 mM HEPES at 37 °C with 5 % C02.
Human primary fibroblast cells were maintained in DMEM (Sigma-Aldrich, 1000 mg/1 glucose, D5546) containing 20 % FBS, 1 % penicillin/streptomycin, 2 mM L-glutamine and 10 mM HEPES at 37 °C with 5 % C02.
Sulphorhodamine B assay
Cells were seeded in 96-well plates (4T1- 1500 cells/well; MDA-MB-231 and ZR-75-1 - 3000 cells/well; SK-BR-3, MCF-7 and human fibroblast - 5000 cells/well) and were let to attach overnight. Cells were treated with different concentration of cadaverine (Sigma Aldrich, C8561) for 48 hours. After 2 days cells were fixed by the addition of 50 % trichloroacetic acid (TCA, final concentration: 10 %) and the plate was incubated for 1 hour at 4 °C. The plate was then washed 5 times with water and was stained with 0.4 % (w/v) sulphorhodamine B solution in 1 % acetic acid. Unbound dye was removed by washing 5 times with 1 % acetic acid. Bound stain was solubilized with 10 mM Tris base and the absorbance was measured at 540 nm.
Colony formation assay
Cells were seeded in 6-well plates (4T1- 750 cells/well; MDA-MB-231, SKBR-3, ZR-75-1 and MCF-7- 1000 cells/well) in complete medium and were treated with the indicated concentrations of cadaverine for 4 days. At the end of the treatment plates were washed in PBS. Colonies were fixed in 4 % PFA for 30 minutes, dried and stained with the solution of May-Griinwald-Giemsa for 30 minutes. Plates were washed with water and the colonies, containing at least 50 cells, were counted using Image J software.
Detection of cell death
For the detection of cell death we used simple propidium iodide (PI, Biotium, Fremont, CA, 40016) uptake assays, while to differentiate between apoptosis and necrosis we used an Annexin V+PI double staining assay kit (Invitrogen, Oregon, USA, V13242).
For PI uptake cells were seeded in 6-well plates (MDA-MB-231, ZR-75-1 and MCF-7 - 100,000 cells/well; SKBR-3 and human fibroblast - 200,000 cells/well). After 2 days of cadaverine treatment cells were stained with 100 pg/rnl propidium iodide for 30 min at 37 °C. Supernatant was collected in FACS tubes, cells were washed with PBS and collected in the same FACS tubes (trypsin: PBS 1:1) then samples were analyzed by flow cytometry (FACSCalibur, BD Biosciences).
4T1 cells were seeded in 6-well plates (50,000 cells/well) and treated with the indicated cadaverine concen trations for 2 days. Cells were harvested in FACS tubes, washed once with cold PBS and stained with 100 pg/rnl PI solution and 5 pi FITC Annexin V (Component A) according to the instructions of the apoptosis kit. The number of apoptotic cells was measured with flow cytometry. Electric Cell-substrate Impedance Sensing (ECIS)
4T1 cells were seeded on type 8W10E arrays (20,000 cells/well) then treated with 0.1 mM cadaverine. ECIS (Electric cell-substrate impedance sensing) model ZQ, Applied BioPhysics Inc. (Troy, NY, USA) was used to monitor transcellular electric resistance of control and cadaverine treated cells for 20 hours before the treatment, and total impedance values were measured for additional 48 hours upon the indicated cadaverine treatment. Multifrequency measurements were taken at 62.5, 125, 250, 500, 1000, 2000, 4000, 8000, 16000, 32000, 64000 Hz. The reference well was set to a no-cell control with complete medium.
Immunocytochemistry
4T1 cells were grown on coverslips, and treated with the indicated concentration of cadaverine for 48 hours. To investigate the effect of TAARs, 5mM NF449 (Bio-Techne R&D Systems Kft, 627034-85-9) G-protein in hibitor was also added to cadaverine-treated cells. Cells were washed with PBS, fixed with 4% PFA for 15 minutes and permeabilized using 1 % Triton X-100 for 5 minutes. After washing twice with PBS, cells were blocked with 1 % BSA for one hour at room temperature. For direct labelling of the actin cytoskeleton, fixed cells were incubated with TexasRed-X Phalloidin (1:150; Thermo Fisher Scientific) for an hour, followed by several washing steps with PBS. For visualizing MMP9 protein in 4T1 cells, mMMP9 primary antibody (1:1000, Abeam) was applied overnight on cells in a humid chamber at 4°C. Subsequently, primary antibody was visualized by a goat anti -rabbit secondary antibody (1:500, Thermo Fisher Scientific). Cell nuclei were visualized with TO-PRO-3 iodide (1:1000, Thermo Fisher Scientific), or DAPI (1:10, Thermo Fisher Scien tific). Coverslips were rinsed and mounted in Mowiol/Dabco solution. Confocal images were acquired with Feica SP8 confocal microscope and FAS AF v3.1.3 software. Intensity was calculated using Image J software. Materials used in immunocytochemistry assays are summarized in Table 1.
Table 1 Fist of antibodies used for Western blot /Immunocytochemistry
Figure imgf000017_0001
Bacterial FdcC and CadA quantitation
The human DNA library was published in Goedert, J.J., et al. Investigation of the association between the fecal microbiota and breast cancer in postmenopausal women: a population -based case-control pilot study. J Natl Cancer Inst. 107, djvl47. (2015) [17]. For the determination of the abundance of lysine decarboxylase in human samples 10 ng of DNA was used for qPCR reactions. Primers are listed in Table 2. The amplicons were subsequently sequenced using the same primers as listed in Table 2. Table 2 Primers for the determination of the abundance of Cad A and LdcC using RT-qPCR
Figure imgf000018_0001
mRNA isolation and quantitation, EMT screening
Total RNA from cells were prepared using TRIzol reagent (Invitrogen, TR118). 2 pg RNA was reverse transcripted using High Capacity cDNA Reverse Transcription Kit (Applied Biosystems, Foster City, CA, USA, 4368813) according to the manufacturer’s instructions. qPCRBIO SyGreen Lo-ROX Supermix (PCR
Biosystems Ltd, London, UK, PB20.11 -05) was used for the qPCR reactions, the expression level of the genes was detected with Light-Cycler 480 Detection System (Roche Applied Science). Geometric mean of 36B4 and cyclophyllin or GAPDH was used for normalization. Primers used in RT-qPCR reactions are listed in Table 3.
Table 3. Primers used in the RT-qPCR reactions
Figure imgf000018_0002
Figure imgf000019_0001
EMT genes differentially regulated upon cadaverine treatment are listed in Table4. Table 4. List of EMT genes differentially regulated upon cadaverine treatment
Figure imgf000019_0002
Table 5. Significant changes in gene expression of 4T1 cells and tumor samples
Figure imgf000019_0003
Figure imgf000020_0001
V alidation of E. coli LdcC antibody
DH5a Escherichia coli were seeded in liquid LB medium. Cells were incubated at 37°C overnight with gen- tie shaking. E. coli cells were then collected with centrifugation and proteins were isolated using RIPA buffer
(50 inM Tris, 150 inM NaCl, 0.1 % SDS, 1 % TritonX 100, 0.5 % sodium deoxycholate, 1 mM EDTA, 1 inM Na3V04, 1 mM NaF, 1 mM PMSF, protease inhibitor coctail). Cell wall and membrane were dismpted using ultrasound sonicator (Branson Ultrasonic Sonifier S-250A, Thermo Fisher Scientific) 3 times for 30 seconds at 50 % amplitude. Samples were analyzed by SDS -PAGE followed by Western blotting.
Fecal sample preparation
RIPA buffer (50 mM Tris, 150 mM NaCl, 0.1 % SDS, 1 % TritonX 100, 0.5 % sodium deoxycolate, 1 mM EDTA, 1 mM Na3V04, 1 mM NaF, 1 mM PMSF, protease inhibitor coctail) was used to lyse cells of fecal sam ples. Samples were sonicated (Qsonica Q125 Sonicator, Newtown, Connecticut) 3 times for 30 seconds with 50% amplitude. After centrifugation, 25 mΐ 5 X SDS sample buffer (50 % glycerol, 10 % SDS, 310 mM Tris HC1, pH 6.8, 100 mM DTT, 0.01 % bromophenol blue) and 8 mΐ b-mercaptoethanol were added to every 100 mΐ supernatant. Samples were heated 10 minutes at 96 °C and kept on ice until loading.
SDS-PAGE and Western blotting
Protein extracts were separated on 8% SDS polyacrylamide gels and transferred onto nitrocellulose mem branes by electroblotting. Then membranes were blocked with 5 % BSA, and incubated with anti-Fysine decar boxylase primary antibody (1: 100, Abeam) for overnight at 4 °C. The membranes were washed with IX TBS- TWEEN and incubated with IgG HRP conjugated secondary antibody (1:2000, Cell Signaling Technology).
Bands were visualized by enhanced chemiluminescence reaction (SuperSignal West Pico Solutions, Thermo Fisher Scientific, 34578) using Chemidock Touch system. Densitometry was performed using the Image J soft- ware. Primary and secondary antibodies, used in this study, are listed in Table 1.
Scratch assay
4T1 cells were plated in 6-well plates (150,000 cells/well) and were grown overnight. The plates were man ually scratched with sterile 200 mΐ pipette tip, followed by washing the cells with complete growth medium. Then cells were treated with 0.1 mM cadaverine in a 37°C thermostat and were monitored every hour for 2 days using JuLi Br Live cell movie analyzer (NanoEnTek Inc., Seoul, Korea).
Invasion
Matrigel invasion assay was carried out on 4T1 cells using Coming BioCoat Matrigel Invasion Chamber (354480). 4T1 cells were seeded in the chambers (50,000 cells/well) in semm free medium, and were grown overnight. Cells were then treated with different concentration of cadaverine (0.1 mM, 0.3 mM, 0.8 mM). The lower chamber contained full 4T1 medium with 100 ng/ml SDFl-alpha (Sigma, SRP4388) as chemoattractant. After 48 hours of cadaverine treatment cells were prepared according to the manufacturer’s instructions and stained with Hematoxylin-Eosin (VWR, 340374T and 341972Q) dye. Cells were then pictured with Opera Phenix High Content Screening System and pictures were analysed using Harmony 4.6 Software. Invasion in dex was calculated from the percentage of invading cells through matrigel membrane and control membrane.
Figure imgf000021_0001
Seahorse flux analysis
4T1 cells were seeded in 96-well Seahorse assay plates (1500 cells/well) and treated with vehicle and cadaverine for 48 hours. Cells were monitored using XF96 oxymeter (Seahorse Biosciences, North Billerica, MA, USA) to measure the changes in oxygen consumption rate (OCR) and in pH (ECAR) after cadaverine treatment similarly to [27]. Data were normalized to protein content.
Determination of lipid peroxidation (TB ARS)
Lipid peroxidation was measured by detemining the production rate of thiobarbituric acid reactive substrate (TBARS). 4T1 cells were seeded in T75 flasks and allowed to adhere overnight. Cells were exposed to cadaverine for 48 hours, then collected by centrifugation. 8.1 % SDS, 20 % acetic acid, 0.8 % thiobarbituric acid (TBA) and distilled water was added to the pellet and was heated at 96°C for 1 hour in thermoblock. Sam ples were cooled on ice and centrifugated, the absorbance of the supernatant was measured at 540 nm. In control and cadaverine-treated (A) MDA-MB-231 (n=l in triplicates) and (B) SKBR-3 (n=l in triplicates) breast cancer cells morphology of the actin cytoskeleton was assessed after Texas Red-X Phallodin+To-Pro-3 staining. Ratio (%) of epithelial and mesenchymal cells was shown on bar charts. Significance was calculated using Chi-square test in Microsoft Excel. No changes in lipid oxidation were detected.
Aldefluor assay
The level of the enzyme aldehyde dehydrogenase (ALDH) was determined on 4T1 cells using cadaverine treatment. Cells were seeded on 6 well plates (50000 cells/well) and treated with different concentration of cadaverine (0.1 mM, 0.3 mM, 0.8 mM) for 2 days. Cells were then collected and prepared according to the manu facturer’s instructions. We used SKBR-3 cell line for positive control. Changes in the level of ALDH was mesured using flow cytometry and the results were analysed with flowing software 2.5.1.
Animal study
Animal experiments were approved by the Institutional Animal Care and Use Committee at the University of Debrecen and the National Board for Animal Experimentation (1/2015/DEMAB) and were carried out ac cording to the NIH guidelines (Guide for the care and use of laboratory animals) and applicable national laws. Animal studies are reported in compliance with the ARRIVE guidelines [72, 73].
We used BALB/c female mice (4 months of age, 20-25g). Animals were bred in the“specific pathogen free” zone of the Animal Facility at the University of Debrecen, and kept in the“minimal disease” zone during the experiments. 4 mice were housed in one cage (standard block shape 365 c 207 c 140 mm, surface 530 cm2; 1284 L Eurostandard Type II. L from Techniplast). Dark/light cycle was 12 h, and temperature was 22 ± 1°C. Mice had ad libitum access to food and water (sterilized tap water). A total of 32 female mice were used in the study, 16 randomly selected control and 16 cadaverine fed mice. The study was performed in two runs at two different occasions, each run comprising of 8 vehicle -treated and 8 cadaverine-treated mice.
Tumor was formed in mice by the grafting of 4T1 cells. 4T1 cells were suspended (2xl06/ml) in ice cold PBS-matrigel (1: 1, Sigma- Aldrich) at 1: 1 ratio. 16 female BALB/c mice received 50 pL injections to the ingui nal fat pads below the lower abdominal nipples on both sides (105 cells/injection site).
Animals received daily oral cadaverine treatment. Cadaverine stock was prepared in sterilized tap water at lOOx concentration (15 mM) and the stock was stored at -20°C. Cadaverine stock was diluted each day to a working concentration of 150 mM in sterile tap water before the treatment. Animals received a daily oral dose of 100 m1/30 g body weight from cadaverine solution (8 mice) or vehicle (sterilized tap water, 8 mice). Researchers administering cadaverine and vehicle solutions were blinded. Treatment was carried out every day during the morning hours between 9am and 11am. Mice were sacrificed on day 14 post grafting.
During autopsy primary tumors were scored based on their infiltration rate into surrounding tissues.“Low infiltration” class means that primer tumor remained in the mammary fat pads without any attachment to muscle tissues. In case the tumor mass attached to the muscle tissue but did not penetrate the abdominal wall, it classi fied as a“medium infiltration” tumor. If the tumor grew into the muscle tissue and totally penetrated the ab dominal wall, it was scored as a“high infiltration” tumor.
Both primary and metastatic tumor masses were removed from mice and were measured on analytical bal ance in pre weighed Eppendorf tubes.
Human studies
We assessed the abundance of the bacterial DNA coding for lysine decarboxylase in human fecal DNA samples. The human fecal samples were collected from healthy women and breast cancer patients by collabora tors at the National Cancer Institute (NCI), Kaiser Permanente Colorado (KPCO), the Institute for Genome Sciences at the University of Maryland School of Medicine, and RTI International. The study protocol and all study materials were approved by the Institutional Review Boards at KPCO, NCI, and RTI International (IRB number 11CN235). The primary study results were published in [17]. Fecal samples from 46 breast cancer pa- tients (stage 0-3) and 48 control subjects (table 6., cohort 1). All females.
Table 6. Cohort 1
Figure imgf000023_0001
Another cohort was used to assess LdcC protein in the feces of healthy volunteers and breast cancer patients. The collection and biobanking of feces was authorized by the Hungarian national authority (ETT). Patients and healthy volunteers meeting the following criteria were excluded from the study according to the corresponding national guideline for fecal transplantation [34]: 1) has previous history of breast cancer or had been operated due to neoplasia, 2) has a disease of unknown origin, 3) has chronic contagious disease, 4) had contagious diar rhea 6 months prior to enrollment, 5) taken antibiotics in the 6 months prior to enrollment, 6) had chemothera py, biological therapy or immunosuppressive therapy 6 months prior to enrollment, 7) used intravenous drugs 12 months prior to enrollment, 8) had piercing, tattooing, acupuncture or other endangering behavior or action 12 months prior to enrollment, 9) exposition to an allergen to which the enrolled individual had been sensitized to, 10) undervent colonoscopy 12 months prior to enrollment. First morning feces was sampled; samples were frozen and deposited in the biobank two hours after defecation. Samples were stored at -70°C until subsequent use.
E-cadherin expression and E. coli LDcC expression
Fecal protein was prepared from the feces of E-cadherin positive (n=29) and negative (n=5) breast cancer cases. Protein was separated using SDS-PAGE. Proteins were transferred to nitrocellulose membrane and was probed for E. coli LdcC protein. Signal was developed using ECL that was normalized for total protein meas ured by amido black-staining of the membrane. E-cadherin expression was assessed by routine immunohisto- chemistry.
Database screening
The kmplot.com database was used to study the link between gene expression levels and breast cancer sur vival in humans. The association of known mutations with breast cancer was retrieved from www.intogen.org/. The sequence of the CadA and LdcC ORFs were retrieved from the KEGG (www.genome.jp/kegg/) database. We assessed the NCBI GEO Profiles with the term“LDC and breast cancer” in June 2018.
Statistical analysis
We used two tailed Student’s t-test for the comparison of two groups unless stated otherwise. Fold data for human fecal DNA assessment were log2 transformed to achieve normal distribution. For multiple comparisons one-way analysis of variance test (ANOVA) was used followed by Tukey’s honestly significance (HSD) post- hoc test. Data is presented as average ± SEM unless stated otherwise. Texas Red-X Phalloidin-labelled fluores cent pictures were analysed using Cell Profiler 2.0 followed by Advanced Cell Classifier 3.0. Statistical analysis was done using Origin 8.6 software unless stated otherwise. Sequence Listing Free Text <223 > Escherichia coli LdcC forward primer <223 > Escherichia coli LdcC reverse primer <223> Escherichia coli CadA forward primer <223 > Escherichia coli CadA reverse primer <223 > Enterobacter cloacae LdcC forward primer <223 > Enterobacter cloacae LdcC reverse primer <223 > Hafnia alvei LdcC forward primer <223 > Hafnia alvei LdcC reverse primer <223 > MMP2 Murine forward primer
<223 > MMP2 Murine reverse primer
<223 > MMP3 Murine forward primer
<223 > MMP3 Murine reverse primer
<223 > MMP9 Murine forward primer
<223 > MMP9 Murine reverse primer
<223> Krtl5 Murine forward primer
<223> Krt 15 Murine reverse primer
<223 > Sppl Murine forward primer
<223 > Sppl Murine reverse primer
<223 > FgfBpl Murine forward primer
<223 > FgfBpl Murine reverse primer
<223 > Notch 1 Murine forward primer
<223 > Notch 1 Murine reverse primer
<223> Tgfb3 Murine forward primer
<223> Tgfb3 Murine reverse primer
<223 > Erbb3 Murine forward primer
<223 > Erbb3 Murine reverse primer
<223> Erl Murine forward primer
<223> Erl Murine reverse primer
<223 > IgfBp4 Murine forward primer
<223 > IgfBp4 Murine reverse primer
<223> 36B4 Murine forward primer
<223> 36B4 Murine reverse primer
<223 > CyclophillinA Murin forward primer <223 > CyclophillinA Murin reverse primer <223 > GAPDH Murine forward primer <223 > GAPDH Murine reverse primer
<223> T A AR7d Murine forward primer <223> T A AR7d Murine reverse primer
<223> TAAR8b Murine forward primer
<223> TAAR8b Murine reverse primer
SEQUENCE LISTING
<110> Debreceni Egyetem
<120> Treatment and diagnosis of breast cancer
<130> 124391/KOH
<160> 40
<170> Patentln version 3.5
<210> 1
<211> 23
<212> DNA
<213> Artificial Sequence
<220>
<223> Escherichia coli LdcC forward primer
<400> 1
cggcccttat aacctgctgt ttc 23 <210> 2
<211> 23
<212> DNA
<213> Artificial Sequence
<220>
<223> Escherichia coli LdcC reverse primer
<400> 2
ccttgtgcca gatcctgaat acg 23 <210> 3
<211> 23
<212> DNA
<213> Artificial Sequence
<220>
<223> Escherichia coli CadA forward primer
<400> 3
gtctgtgcgg cgttattttt gac
Figure imgf000025_0001
<210> 4
<211> 23
<212> DNA
<213> Artificial Sequence <220>
<223> Escherichia coli CadA reverse primer
<400> 4
cacccagcgc atattcaaag aag 23 <210> 5
<211> 23
<212> DNA
<213> Artificial Sequence
<220>
<223> Enterobacter cloacae LdcC forward primer
<400> 5
atatgatctg aacctgcggg tga 23 <210> 6
<211> 23
<212> DNA
<213> Artificial Sequence
<220>
<223> Enterobacter cloacae LdcC reverse primer
<400> 6
aggttctcca gctcaacggt ttc 23 <210> 7
<211> 23
<212> DNA
<213> Artificial Sequence
<220>
<223> Hafnia alvei LdcC forward primer
<400> 7
ggtgaactgg gttctctgct tga 23 <210> 8
<211> 23
<212> DNA
<213> Artificial Sequence
<220>
<223> Hafnia alvei LdcC reverse primer
<400> 8
agcgggtgct gagtacatac caa
Figure imgf000026_0001
<210> 9
<211> 20 <212> DNA
<213> Artificial Sequence
<220>
<223> MMP2 Murine forward primer
<400> 9
tgggggagat tctcactttg 20
<210> 10
<211> 20
<212> DNA
<213> Artificial Sequence
<220>
<223> MMP2 Murine reverse primer
<400> 10
catcactggg accagtgtct 20
<210> 11
<211> 23
<212> DNA
<213> Artificial Sequence
<220>
<223> MMP3 Murine forward primer
<400> 11
tgggactcta ccactcagcc aag 23
<210> 12
<211> 23
<212> DNA
<213> Artificial Sequence
<220>
<223> MMP3 Murine reverse primer
<400> 12
tgcacattgg tgatgtctca ggt 23
<210> 13
<211> 20
<212> DNA
<213> Artificial Sequence
<220>
<223> MMP9 Murine forward primer
<400> 13
cattcgcgtg gataaggagt 20 <210> 14
<211> 20
<212> DNA
<213> Artificial Sequence
<220>
<223> MMP9 Murine reverse primer
<400> 14
acctggttca cctcatggtc 20
<210> 15
<211> 23
<212> DNA
<213> Artificial Sequence
<220>
<223> Krtl5 Murine forward primer
<400> 15
gaagaggcca acactgaact gga 23
<210> 16
<211> 23
<212> DNA
<213> Artificial Sequence
<220>
<223> Krtl4 Murine reverse primer
<400> 16
aggctctgct ccgtctcaaa ctt 23
<210> 17
<211> 23
<212> DNA
<213> Artificial Sequence
<220>
<223> Sppl Murine forward primer
<400> 17
gattggcagt gatttgcttt tgc 23
<210> 18
<211> 23
<212> DNA
<213> Artificial Sequence
<220>
<223> Sppl Murine reverse primer <400> 18
ttctgcttct gagatgggtc agg 23
<210> 19
<211> 23
<212> DNA
<213> Artificial Sequence
<220>
<223> FgfBpl Murine forward primer
<400> 19
caaggtccaa gaagctgtct cca 23
<210> 20
<211> 23
<212> DNA
<213> Artificial Sequence
<220>
<223> FgfBpl Murine reverse primer
<400> 20
agctccaaga ttccccacag aac 23
<210> 21
<211> 23
<212> DNA
<213> Artificial Sequence
<220>
<223> Notchl Murine forward primer
<400> 21
ccttcacctg tctgtgtcca cct 23
<210> 22
<211> 23
<212> DNA
<213> Artificial Sequence
<220>
<223> Notchl Murine reverse primer
<400> 22
tcacagtggt actgcgtgtt ggt 23
<210> 23
<211> 23
<212> DNA
<213> Artificial Sequence <220>
<223> Tgfb3 Murine forward primer
<400> 23
ggcgtctcaa gaagcaaaag gat 23
<210> 24
<211> 23
<212> DNA
<213> Artificial Sequence
<220>
<223> Tgfb3 Murine reverse primer
<400> 24
ccttaggttc gtggacccat ttc 23
<210> 25
<211> 23
<212> DNA
<213> Artificial Sequence
<220>
<223> Erbb3 Murine forward primer
<400> 25
tacttgcctc tgggctctct cct 23
<210> 26
<211> 23
<212> DNA
<213> Artificial Sequence
<220>
<223> Erbb3 Murine reverse primer
<400> 26
cacctggact tgactcggtg act 23
<210> 27
<211> 23
<212> DNA
<213> Artificial Sequence
<220>
<223> Erl Murine forward primer
<400> 27
gaccatgacc cttcacacca aag 23
<210> 28
<211> 23 <212> DNA
<213> Artificial Sequence
<220>
<223> Erl Murine reverse primer
<400> 28
ctcggggtag ttgaacacag tgg 23
<210> 29
<211> 23
<212> DNA
<213> Artificial Sequence
<220>
<223> IgfBp4 Murine forward primer
<400> 29
caagatgaag atcgtgggga cac 23
<210> 30
<211> 23
<212> DNA
<213> Artificial Sequence
<220>
<223> IgfBp4 Murine reverse primer
<400> 30
cagtttggaa tggggatgat gaa 23
<210> 31
<211> 21
<212> DNA
<213> Artificial Sequence
<220>
<223> 36B4 Murine forward primer
<400> 31
agattcggga tatgctgttg g 21
<210> 32
<211> 21
<212> DNA
<213> Artificial Sequence
<220>
<223> 36B4 Murine reverse primer
<400> 32
aaagcctgga agaaggaggt c 21 <210> 33
<211> 21
<212> DNA
<213> Artificial Sequence
<220>
<223> CyclophillinA Murin forward primer
<400> 33
tggagagcac caagacagac a 21
<210> 34
<211> 19
<212> DNA
<213> Artificial Sequence
<220>
<223> CyclophillinA Murine reverse primer
<400> 34
tgccggagtc gacaatgat 19
<210> 35
<211> 23
<212> DNA
<213> Artificial Sequence
<220>
<223> GAPDH Murine forward primer
<400> 35
caaggtcatc catgacaact ttg 23
<210> 36
<211> 20
<212> DNA
<213> Artificial Sequence
<220>
<223> GAPDH Murine reverse primer
<400> 36
ggccatccac agtcttctgg 20
<210> 37
<211> 23
<212> DNA
<213> Artificial Sequence
<220>
<223> TAAR7d Murine forward primer <400> 37
attgatgcct tccttgggtt cat 23 <210> 38
<211> 23
<212> DNA
<213> Artificial Sequence
<220>
<223> TAAR7d Murine reverse primer
<400> 38
caggaaacag gttggtggtt gag 23 <210> 39
<211> 23
<212> DNA
<213> Artificial Sequence
<220>
<223> TAAR8b Murine forward primer
<400> 39
actcttctgc cctccacctg tgc 23 <210> 40
<211> 23
<212> DNA
<213> Artificial Sequence
<220>
<223> TAAR8b Murine reverse primer
<400> 40
ttgacaacga tttggcagcc ccc 23
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Claims

1. A method for determining whether a subject
i) has early stage breast cancer or
ii) has an increased probability of having early stage breast cancer or
iii) is at an increased risk of developing breast cancer,
the method comprising
assessing, in a test sample from the subject, the level of bacterial cadaverine synthesis, the sample comprising microbiota from the subject or
measuring, in a test sample from the subject, the level of cadaverine
wherein
a decreased level of bacterial cadaverine synthesis or
a decreased level of cadaverine, respectively,
indicates that the subject has early stage breast cancer or an increased probability of having early stage breast cancer or is at an increased risk of developing breast cancer.
2. The method according to claim 1
wherein the level of bacterial cadaverine synthesis is assessed by measuring
the abundance of a bacterium species comprising a DNA sequence coding for a lysine decarboxylase (LDC) or
the level of a DNA sequence coding for an LDC of a bacterium species, or
the level of a gene product of a DNA sequence coding for an LDC produced by a bacterium species, wherein
a lower abundance of the bacterium species in the test sample or
a lower level of the DNA sequence coding for an LDC of a bacterium species, or
a lower level of the gene product of a DNA sequence coding for an LDC produced by a bacterium species, respectively,
compared to the corresponding reference value
indicates that the subject has early stage breast cancer or an increased probability of having early stage breast or is at an increased risk of developing breast cancer.
3. The method according to claim 1 or 2, wherein the breast cancer is stage 0 or 1 breast cancer according to the American Joint Committee on Cancer (AJCC) TNM system.
4. The method according to any one of the preceding claims, wherein the DNA sequence coding for LDC is ldcC or cadA.
5. The method according to any one of the preceding claims, wherein the test sample is a feces sample.
6. The method according to any one of the preceding claims, wherein the bacterium species is selected from Escherichia, Enterobacter and Hafnia.
7. The method according to claim 6, wherein the bacterium species is selected from Escherichia coli,
Enterobacter cloacae and Hafnia alvei.
8. The method according to any one of the preceding claims, wherein
a lower abundance of the bacterium species in the test sample or
a lower level of the DNA sequence coding for an LDC of a bacterium species
compared to the corresponding reference value
indicates that the subject has stage 0 breast cancer or an increased probability of having stage 0 breast cancer or the subject is at an increased risk of developing breast cancer.
9. The method according to any one of claims 1 to 7, wherein
a lower level of the gene product of a DNA sequence coding for an LDC produced by a bacterium species compared to a reference sample
indicates that the subject has stage 1 breast cancer or an increased probability of having stage 1 breast cancer.
10. The method according to claim 9, wherein the gene product is LDC protein.
11. The method according to any one of the preceding claims, wherein the subject is a postmenopausal woman.
12. Cadaverine for use in the treatment or prevention of breast cancer in a subject.
13. Cadaverine for use in mitigating cancer initiation and/or promotion and/or progression in a subject.
14. Cadaverine for use according to claim 12 or 13, wherein the subject
has early stage breast cancer or
has an increased probability of having early stage breast cancer or
is at an increased risk of developing breast cancer.
15. Cadaverine for use according to any one of claims 12 to 14, wherein prior to said use
the abundance of a bacterium species comprising a DNA sequence coding for LDC or
the level of a DNA sequence coding for an LDC of a bacterium species or
the level of a gene product of a DNA sequence coding for an LDC produced by a bacterium species is lower in a test sample from the subject comprising microbiota from said subject than the corresponding refer ence value, or
the level of cadaverine in a test sample from the subject is lower than the corresponding reference value.
16. Cadaverine for use according to any one of claims 11 to 15, for use in
decreasing the infiltration rate of primary tumor(s) into surrounding tissues and/or
decreasing the number of metastases and/or
decreasing the total mass of the primary tumor(s) and/or
decreasing the total mass of the metastases.
17. Cadaverine for use according to any one of claims 12 to 16, wherein cadaverine is administered to pro vide or restore physiological serum concentration of cadaverine in said subject.
18. A method for mitigating breast cancer initiation and/or promotion and/or progression in a subject, com prising
measuring in a test sample from said subject, wherein the test sample comprises microbiota from said subject, the abundance of a bacterium species comprising a DNA sequence coding for a lysine decarboxylase (LDC), the level of a DNA sequence coding for an LDC of a bacterium species, or the level of a gene product of a DNA sequence coding for an LDC produced by a bacterium species, or measuring, in a test sample from said subject, the level of cadaverine,
administering cadaverine to the subject to provide or restore physiological serum concentration of cadaverine if the abundance of the bacterium species comprising a DNA sequence coding for LDC or
the level of the DNA sequence coding for an LDC of a bacterium species or
the level of the gene product of a DNA sequence coding for an LDC produced by a bacterium species or the level of cadaverine, respectively,
is lower than the corresponding reference value, and
monitoring the presence of breast cancer in the subject.
19. A pharmaceutical composition comprising cadaverine and at least one pharmaceutically acceptable ex cipient or carrier.
20. The pharmaceutical composition according to claim 19 for use in mitigating breast cancer initiation and/or promotion and/or progression.
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