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Original Studies |
Cattedra di Endocrinologia, Dipartimento di Medicina Sperimentale e Clinica (F.A., E.C., S.F.), and Cattedra di Farmacologia, Facoltà di Farmacia (D.R.), Università di Catanzaro, 88100 Catanzaro; and Oncologia Sperimentale, Istituto Nazionale Tumori (P.V.), Milan, Italy; and Institut de Recherches Scientifiques sur le Cancer, Centre National de Recherches Scientifiques (J.-A.D., R.W., H.G.S.), 94802 Villejuif; and Institut Gustave Roussy (M.S., B.C.), 94805 Villejuif, France
Address all correspondence and requests for reprints to: Sebastiano Filetti, M.D., Cattedra di Endocrinologia, Dipartimento di Medicina Sperimentale e Clinica, Via T. Campanella, 88100 Catanzaro, Italy. E-mail: filetti{at}tin.it
| Abstract |
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| Introduction |
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Radioiodine represents a major diagnostic and therapeutic tool for the management of differentiated thyroid cancer (DTC) patients to ablate residual, recurrent, or metastatic tumors (5), and the presence and functional integrity of the NIS are prerequisites for iodine concentration by malignant cells. In the present study we examined the expression of the NIS gene in a series of different histotypes of thyroid carcinomas, both primary tumors and metastases.
| Subjects and Methods |
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Forty-one thyroid tumors, collected at the Institut Gustave
Roussy (Villejuif, France) and at the Thyroid Center (University of
Catania, Italy), were examined. Tissues obtained at surgery were
immediately frozen and stored in liquid nitrogen until analysis. Tumors
were histologically classified according to WHO recommendations (6).
The clinical and pathological features of the patients studied are
shown in Table 1
. Follow-up of thyroid
cancer patients included thyroglobulin (Tg) measurements and total body
131I scan (TBS) using either 7.418.5 megabecquerels (25
mCi) or a high dose of radioiodine (3.7 gigabecquerels; 100 mCi), as
previously reported (7). We also included some primary cancer tissues
from patients who had metastases (with or without 3.7 gigabecquerels
131I uptake at TBS) during the follow-up.
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Total RNA was extracted from fresh-frozen tissues using the RNA Btm technique (Bioprobe Systems, Richmond, CA) following the manufacturers instructions, as previously described (8). The tumor tissues used for RNA isolation in this study were microdissected by a pathologist to exclude contamination of surrounding normal thyroid cells.
Complementary DNA (cDNA) was synthesized from 1 µg total RNA according to the protocol of the manufacturer (Boehringer Mannheim, Milan, Italy). The mixture was incubated at 25 C for 10 min and at 42 C for 60 min, heated to 99 C for 5 min, and then stored at -20 C. PCR amplification was performed using 5 µL cDNA, as previously described (9). Briefly, samples were subjected to 41 cycles of amplification, and PCR conditions were as follows: for the NIS and thyroid peroxidase (TPO) genes, denaturation at 94 C (1 min), annealing at 62 C (1 min), and extension at 72 C (1 min) for 40 cycles; for the Tg gene, denaturation at 94 C (1 min), annealing at 57 C (1 min), and extension at 72 C (1 min) for 40 cycles; the last cycle was 72 C for 7 min (1 cycle). Ten of 50 µL of the amplification products were then run on 1.5% Tris-borate-ethylenediamine tetraacetate agarose gel containing ethidium bromide and analyzed to confirm a positive or a negative outcome.
Primer oligonucleotides for the NIS gene were: 5' primer, 5'-TCTCTCAGTCAACGCCTCT-3'; and 3' primer, 5'-ATCCAGGATGGCCACTTCTT-3'. The amplification yielded a 299-bp DNA product corresponding to fragment 18012099 according to the published sequence of the NIS gene (4).
Primer oligonucleotides for the Tg gene were: 5' primer, 5'-AGGGAAACGGCCTTTCTGAA-3'; and 3' primer, 5'-GTGGAGAAGACGACGATTTC-3'. The amplification yielded a 408-bp DNA product corresponding to fragment 152560 according to the published sequence of the gene (10).
Primer oligonucleotides for the TPO gene were: 5' primer, 5'-ACTGCACACGCTGTGGCTGC-3'; and 3' primer, 5'-TGCAGTTTGGCTGGTCTTGC-3'. The amplification yielded a 434-bp DNA product corresponding to fragment 12991733 according to the published sequence of the gene (11).
The Tg and the TPO primers spanned exon-intron junctions of the genes to exclude the possibility of genomic DNA contamination. For the same purpose, amplification of the NIS gene was performed after including a mock RT sample (by omitting the reverse transcriptase in the cDNA synthesis reaction), because the exon-intron organization of the NIS gene was published after these experiments were performed (12). All primers were obtained from Genosys (Cambridge, UK).
Dot blot
For dot blot hybridization of both normal and tumor thyroid tissue total RNAs with the labeled 12046 NIS rat probe, we used the technique previously described (8). The 12046 NIS rat probe was obtained by EcoRI-HindIII digestion of the full-length rat NIS cDNA (3). A murine actin probe (13) was used to ascertain equal RNA loading.
| Results |
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Normal thyroid tissues obtained from peritumoral thyroid areas
showed, after amplification, a band of 408 bp representing the Tg
transcript, a 434-bp band representing the TPO transcript, and a 299-bp
band representing the NIS transcript (data not shown). Figure 1
shows the results in some of the tumors
examined. All tumoral tissues except one anaplastic carcinoma presented
the Tg and TPO transcripts, indicating the integrity of the mRNA and
cDNA used in the experiments. Five of 19 papillary thyroid cancer
tissues (no. 4, 6, 11, 14, and 15, Table 1
) did not express the NIS
transcript, suggesting that a reduction of iodide trapping in these
tumors may be a consequence of the loss of NIS expression. The NIS
transcript was not detected in one of five follicular thyroid cancers
(no. 22, Table 1
). In the two anaplastic tumors, NIS symporter mRNA was
only barely detected in one case.
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Dot blot analysis of NIS mRNA
In two cases (no. 17 and 18, Table 1
) we evaluated by dot blot
analysis the relative abundance of NIS mRNA in the nonmalignant thyroid
tissue, the primary papillary tumor and its lymph node metastases. A
slight, but not significant, decrease in NIS gene expression was
observed in the primary cancer of one patient (no. 17) compared with
that in the normal adjacent thyroid tissue. In contrast, in both
patients, NIS gene expression was significantly reduced in the
metastatic tissue (3- to 5-fold) compared to that in either normal or
primary cancer tissues (Fig. 2
). A murine
actin probe (13) was used to ascertain equal RNA loading (Fig. 2
).
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| Discussion |
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The functional integrity of the iodine transport system in thyroid cancer cells is essential to assure an uptake of radioiodine high enough to detect and eradicate the neoplastic thyroid tissue. In the present study the expression of the NIS gene was investigated by RT-PCR in a series of thyroid tumors of different histotypes. Considering the limitations of RT-PCR as a quantitative method, we could evaluate only the presence or absence of NIS transcript in our series of tumors. In 24 differentiated carcinomas, we found a loss of expression of the iodide symporter gene in 6 primary thyroid tumors. On the contrary, all 24 tumors expressed both Tg and TPO genes. Molecular mechanisms may differently affect the expression of the NIS, Tg, TSH receptor, and TPO genes, or a different pattern of sensitivity may occur after oncogenic transformation. The absence of the NIS function, by reducing iodide uptake, may confer to these tumor cells a proliferative advantage due to the loss of the iodine autoregulation process (15). The absence of NIS mRNA signal, however, is not restricted to the malignant phenotype, because we found one cold benign follicular adenoma carrying this defect.
In our small series, four of eight DTC patients with distant metastases and negative posttherapeutic TBS presented with a lack of NIS gene expression in the primary cancer (no. 6, 11, 14, and 22). At least in these cases, therefore, the absence of NIS appears intrinsic to the primary transformed thyroid cell and not acquired in the metastatic tissues through a further dedifferentiation during the tumor progression process. If these data are confirmed in a larger unselected series of DTC patients, this finding may have a clinical impact. When the loss of NIS gene expression is found in the primary tumor, the tumor cells will not pick up 131I, and in the case of elevated serum Tg levels, 131I TBS performed even with a high dose will be negative. In such cases, alternative tools to detect metastases, such as octreoscan (16), positron emission tomography scan (17), or conventional imaging modalities, may be used. In cases with negative TBS in the presence of NIS expression in the neoplastic tissue, other mechanisms are responsible for the failure to concentrate radioiodine. Among these mechanisms, a defect (intrinsic and/or acquired) in the iodide symporter protein structure or activation or an alteration in iodide organification may be involved. The function of the iodide symporter system, in fact, may require the full expression of the mature iodide transporter protein in the cellular plasma membrane.
On the contrary, a decrease in NIS gene expression in lymph node metastases compared to those in both normal thyroid tissues and primary tumor was detected. This result may be a consequence of cancer progression and malignant metastatic cell dedifferentiation. In conclusion, as the iodide symporter system plays a critical role in thyroid tumorigenesis, analysis of its mRNA expression may offer useful information for the management of and therapeutic approach to DTC patients, especially in the presence of metastases.
| Acknowledgments |
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| Footnotes |
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Received December 23, 1997.
Revised March 19, 1998.
Accepted April 7, 1998.
| References |
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