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The Journal of Clinical Endocrinology & Metabolism Vol. 89, No. 5 2434-2441
Copyright © 2004 by The Endocrine Society

Local Aromatase Expression in Human Prostate Is Altered in Malignancy

Stuart J. Ellem, Jacqueline F. Schmitt, John S. Pedersen, Mark Frydenberg and Gail P. Risbridger

Centre for Urological Research (S.J.E., J.F.S., J.S.P., G.P.R.), Monash Institute of Reproduction and Development, Clayton, Victoria 3168, Australia; and Urology Department (M.F.), Monash Medical Centre, Clayton, Victoria 3168, Australia

Address all correspondence and requests for reprints to: Professor Gail P. Risbridger, 27–31 Wright Street, Clayton, Victoria 3168, Australia. E-mail: Gail.Risbridger{at}med.monash.edu.au.


    Abstract
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
Tissue-specific aromatase production is significant in breast cancer and osteoporosis. Prostatic aromatase expression has been equivocal, and any local actions of estrogens are considered secondary to centrally mediated androgen suppression. We examine local aromatase expression and estrogen biosynthesis in the human prostate. Pure samples of stroma and epithelia from biopsy tissues were isolated by laser capture microdissection. Aromatase protein was detected by Western blot analysis, mRNA by RT-PCR, and enzyme activity by tritiated water assay, whereas promoter use was examined by real-time PCR. In nonmalignant prostate tissues, aromatase mRNA expression was absent from epithelium, but did localize to stroma. Presence of protein was confirmed, and expression was driven by promoter PII. Aromatase was expressed and active in LNCaP, PC3, and DU145 cells in addition to microdissected epithelial tumor cells; benign prostate epithelial cells showed no expression or activity. Promoter use in LNCaP and microdissected tumor cells was via PII, whereas PC3 and DU145 cells used promoter I.4. This study demonstrates local estrogen biosynthesis in prostate-induced aromatase gene expression in malignancy and potential alteration of aromatase promoter use with disease progression. These data provide a basis for continued investigation of local estrogen production and its potential role in prostate disease.


    Introduction
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
THE AROMATASE ENZYME catalyzes the reaction for the conversion of androgens to estrogens (1, 2). The aberrant expression of aromatase plays an important role in the development and progression of malignancy, particularly in the breast (3).

Estrogens are recognized as carcinogens by the International Agency for Research on Cancer, and induce tumors in various organs of a number of different species (Ref. 4 and references cited therein). If androgens are locally converted to estrogens, then the synthesis and regulation of estrogen production in the prostate and the subsequent effects on the prostate gland require evaluation.

Human aromatase is encoded by a single copy of the cyp19 gene, localized to chromosome 15q21.2 (5). The complex expression and regulation of aromatase is achieved through the use of multiple exon I that encodes the 5' untranslated region. Each exon I is used in a tissue-specific fashion by alternative splicing and is flanked by its own unique promoter region. Exon I is spliced into exon II at the same splice junction immediately upstream of the start of translation. Therefore, the open reading frame of each transcript, and thus the aromatase protein, is the same irrespective of the site of expression and promoter used. A schematic of the gene is presented in Fig. 1Go.



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FIG. 1. Schematic of the aromatase gene. Stylized overview of the aromatase gene showing exons, multiple exon I, and promoters as well as position and orientation of primers. Dark gray shading, Translated region; light gray shading, untranslated region; spots, common untranslated region; stripes, tissue-specific promoters; black, location and orientation of primers; open boxes, PCR products; dotted lines, splicing.

 
There are conflicting data as to the presence of aromatase in the prostate. Some studies report aromatase expression by RT-PCR or enzymatic activity by biochemical assay (6, 7, 8, 9, 10, 11). In other studies using the same techniques, expression or activity was not detected (12, 13, 14). Data examining aromatase promoter usage in prostate tissue have also been contradictory. A preliminary analysis of alternative exon I use in whole prostate (15) demonstrated use of PII in benign tissue. Another study using a limited number of biopsies from men with benign prostatic hyperplasia (BPH) and prostate cancer (PCa) failed to confirm this result. In two of three biopsies, promoter I.4 was the predominant promoter in benign tissue and, in three of four biopsies from malignant prostate tissue, there was no change in exon I (10).

The heterogeneous nature of the prostate is a confounding aspect of the previous studies. Multiple pathologies are commonly present in biopsies from men with benign or malignant disease, such that benign tissue may be observed adjacent to premalignant and/or low- or high-grade tumor. Any analysis of the biopsies or extracts thereof will represent multiple cell types and pathologies. Laser capture microdissection (LCM) directly visualizes tissue sections and permits the rapid isolation of specific cell types (16). Analysis of homogeneous samples procured using this technique provides better comparison between specific cell populations.

To examine aromatase gene expression and cellular localization in human prostate tissues and cell lines, we have used RT-PCR and immunohistochemistry. Enzyme activity was examined by biochemical assay in prostate cell lines. Using LCM, expression of aromatase in pure populations of stroma and epithelium from nonmalignant and malignant tissues was examined. Alternative exon I and promoter use was examined by relative real-time RT-PCR in microdissected human tissues and prostate cell lines.


    Materials and Methods
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
Collection of human tissue samples

For immunohistochemistry, formalin-fixed, paraffin-embedded human prostate, placenta, and breast tissues were obtained from the Melbourne Pathology Archives (Collingwood, Australia). Samples from two placenta, 10 breast cancer, 20 BPH, and 20 PCa patients were collected.

Human prostate samples for RT-PCR, LCM, and Western blot analysis were obtained by needle biopsy from men diagnosed with BPH (n = 12) or PCa (n = 6). Biopsies were collected under sterile conditions during transurethral resection (BPH) or radical prostatectomy (PCa). Biopsies (a minimum of two) were collected from each patient. Samples for LCM were immediately frozen in optimal cutting temperature media; all other samples were snap-frozen in liquid nitrogen. Term placental tissue was kindly provided by the Prince Henry’s Breast Cancer Research Group (Monash Medical Center, Victoria, Australia). All tissues were stored at –70 C until required.

All tissues were obtained in accordance with the requirements and approval of the Committee for Human Ethics and Experimentation at Monash Medical Centre and Monash University.

Culture of human cell lines

Human PCa cell lines DU145, PC3, and LNCaP were obtained from American Type Culture Collection (Rockville, MD). Cells were cultured in DMEM (Life Technologies, Inc., Grand Island, NY) supplemented with 10% heat-inactivated fetal calf serum (CSL Ltd., Parkville, Victoria, Australia), 100 IU/ml penicillin, and 10 µg/ml streptomycin (CSL Ltd.).

A benign prostate epithelial cell (PrEC) line was obtained from Clonetics (Clonetics Limited, BioWhittaker, Walkersville, MD). Cells were cultured per the manufacturer’s instructions and were not used beyond passage 10.

Human placental choriocarcinoma JEG-3 cells were kindly provided by the Department of Obstetrics and Gynaecology (Monash Medical Centre, Clayton, Australia). Cells were cultured in DMEM supplemented with 10% heat-inactivated fetal calf serum, 100 IU/ml penicillin, and 10 µg/ml streptomycin.

All cell cultures were grown in 75-cm2 culture flasks (Falcon; Becton Dickinson and Co., Franklin Lakes, NJ) at 37 C in a humidified incubator with 5% CO2.

LCM of prostate epithelia or stroma

Six-micrometer frozen prostate sections were cut from frozen optimal cutting temperature media blocks at –20 C onto uncoated glass slides cleaned with 100% ethanol. Sections were fixed in 70% ethanol for 3 min, stained with hematoxylin and eosin as previously described (17), dehydrated in graded ethanol washes, and washed in xylene. Sections were air-dried (2–3 min), and microdissection was performed immediately to ensure minimal RNA degradation. Cells were isolated from the slides using the PixCell II LCM System (Arcturus Engineering, Mountain View, CA).

Specific cell types microdissected include stroma (from both BPH and PCa; not adjacent to or near epithelial or tumor cells), benign epithelia, and high-grade tumor cells (Gleason grade 4+; identified morphologically and later confirmed by a pathologist). Cells collected for each sample type varied from approximately 2,500 (tumor cells) to approximately 10,000 (stroma). Specific cell types were microdissected using a 7.5- to 30-µm laser aperture with power between 25 and 35 mW and a pulse duration of 5 msec.

Sections used for LCM sample preparation were used once only. A minimum of three samples was prepared for each cell type from each patient examined.

RNA purification and RT-PCR

Total RNA was extracted from prostate and placental tissues, prostate cell lines, and LCM cells using the TRIzol reagent according to the manufacturer’s protocol (Life Technologies, Rockville, MD). Whole tissues were homogenized in TRIzol, whereas cell lines and microdissected cells were lysed directly in TRIzol reagent. The protocol for microdissected cells was modified after phase separation by pooling the supernatant of five samples and by adding 5 µg of linear acrylamide (Ambion, Austin, TX).

Potential genomic DNA contamination was removed by digestion in a 20-µl solution containing 2 U deoxyribonuclease (DNase) I (Ambion), 1x DNase I reaction buffer (Ambion), and 10 µl of extracted RNA (to a maximum of 2 µg). DNase was subsequently removed by phenol:chloroform purification, and RNA was stored at –70 C.

Total RNA from prostate cell lines, whole placenta, whole prostate (3 µg), or from microdissected cells (100 ng) was reverse-transcribed using Superscript II reverse transcriptase (Roche Diagnostics, Basel, Switzerland) according to the manufacturer’s protocol.

PCR primers for 18S were 18SF (5'-TCA AGA ACG AAA GTC GGA GGT TCG-3') and 18SR (5'-GTC TGT GAT GCC CTT AGA TGT CC-3'). Aromatase coding sequence primers were CDSF (5'-CAC AAT CAT TAC AGC TCT CGA TTC G-3'), CDSR (5'-CGT CGT GTC ATG CTG GAC AC-3'), and CDSD (5'-CGG GCT ATG TGG ACG TGT TG-3'). Primers specific for aromatase exon I were modified from those used by Agarwal et al. (18) and were I.1 (5'-GCT GAA CAC GTG GAG GCA AAC-3'), I.2 (5'-CCT CTG AGG TCA AGG AAC AC-3'), I.3 (5'-CAA GAT GAT AAG GTT CTA TCA GAC C-3'), I.4 (5'-AAC GTG ACC AAC TGG AGC CTG-3'), PII (5'-CTC TGA AGC AAC AGG AGC TAT AGA T-3'), and EX2R (5'-CAT CAC CAG CAT CGT GCC TG-3'). Specific exon I was detected using exon I-specific sense primers and the EX2R primer. The position and orientation of the aromatase primers are depicted in Fig. 1Go.

PCRs were prepared on ice for each sample as follows: 2 mM MgCl2 (PerkinElmer, Boston, MA) 1x PCR buffer (PerkinElmer), 0.25 mM each deoxy (d)ATP, dCTP, dGTP, deoxythymidine triphosphate (PerkinElmer), 0.5 pmol each of forward and reverse primers, 0.02 U/µl Taq DNA polymerase, and 1 µl of cDNA (5% of reverse transcriptase reaction). Reaction volume was made up to 25 µl with nuclease-free H2O. PCRs consisted of 95 C for 5 min followed by 30 (18S) or 40 (Aromatase CDS and exon I) cycles of 95 C for 30 sec, 60 C (18S), 56 C (Aromatase CDS) or 54 C (Aromatase exon I) for 30 sec, and 72 C for 30 sec with a final incubation of 72 C for 10 min.

Real-time PCR was carried out using the Roche LightCycler and SYBR Green protocol (Roche Diagnostics). Individual reactions were prepared in capillary cuvettes (Roche Diagnostics) according to the manufacturer’s instructions. cDNA was diluted a minimum of 20-fold before use. All LightCycler PCRs were run for 45 cycles with the aforementioned annealing temperatures. The aromatase coding sequence was used to generate a standard curve to enable the relative quantitation of each promoter. Promoter levels were expressed as a percentage of total aromatase expression.

All real-time experiments were performed a minimum of three times, with each sample run in triplicate (n = 9).

Southern transfer and autoradiography

PCR products were separated by agarose gel electrophoresis and were then alkaline-capillary-blotted onto Hybond N+ membrane (Amersham Life Science, Little Chalfont, Buckinghamshire, UK) as previously described (19).

The CDSD oligonucleotide was radioactively 5' end-labeled using [{gamma}-32P]ATP and T4 polynucleotide kinase (Roche Molecular Biochemicals, Castle Hill, New South Wales, Australia). After successive washes in 0.2x saline sodium citrate/0.1% sodium dodecyl sulfate (SDS) and 0.1x saline sodium citrate/0.1% SDS, the membrane was exposed to XOMAT AR film (Eastman Kodak, Rochester, NY) for up to 48 h at room temperature and developed.

Immunohistochemical staining for aromatase protein

Two antiaromatase antibodies were examined; a monoclonal antibody kindly provided by Dr. Nigel P. Groome (20) and a polyclonal antibody purchased from Dr. Y. Osawa and colleagues (21).

Sections were dewaxed and rehydrated in graded ethanol washes. For antigen retrieval, sections were placed in either a 5% citrate solution (Groome) or Target Retrieval Solution (Osawa; Dako, Carpinteria, CA) then heated to 90 C in a 1350-W microwave, maintained for 5 min, and cooled for an additional 20 min. Sections were treated with 6% H2O2 for 30 min to block endogenous peroxidase activity and incubated in CAS blocking solution (Zymed Laboratories, San Francisco, CA) for 1 h at room temperature.

The sections were incubated overnight at 4 C in either a 1:10 (Groome) or 1:200 (Osawa) dilution of primary antibody. Control sections were incubated in a matched dilution of mouse IgG (Groome), primary antibody preincubated with immunizing peptide (10x excess concentration) (Groome) or normal rabbit serum (Osawa). After washes in 1x PBS, sections were incubated for 1 h in a 1:250 dilution of either biotinylated horse antimouse IgG (Groome; Vector Laboratories, Burlingame, CA) or biotinylated goat antirabbit IgG (Osawa; Vector Laboratories). All sections were then washed in PBS, incubated for 1 h with the Vectastain Elite ABC kit (Vector Laboratories), and color-reacted with 3,3'-diaminobenzidine tetrahydrochloride (DAB Liquid Substrate Kit, Zymed Laboratories). The reactions were stopped in water and sections were counterstained with Mayer’s hematoxylin (Sigma Diagnostics, St. Louis, MO), dehydrated, cleared, and mounted.

Tritiated water release assay

Aromatase activity was measured by the rate of formation of 3HOH from [1]3H-androstenedione (25.9 Ci/µl) using a modified version of the procedure originally described by Ackerman et al. (22). Cell lines were cultured in 12-well plates until approximately 60% confluent. After being starved in serum-free media for 24 h, cultures were incubated for 6 h in serum-free media (1 ml per well) containing 60 pmol of [1]3H-androstenedione. Media were subsequently collected and, after the addition of trichloroacetic acid, steroids were extracted with chloroform and adsorbed with dextran-coated charcoal. The specific activity of aromatase was expressed as the rate of formation of 3HOH per mg protein per 6 h. Protein was assayed using the Bio-Rad DC protein assay (Bio-Rad, Hercules, CA).

Samples were run in triplicate, with experiments repeated a minimum of three times (n = 9).

SDS-PAGE and Western immunoblotting

Total cellular protein was extracted from whole tissue samples (human placenta and BPH) and prostate cell lines by homogenization in the presence of 0.15 M NaCl, 1% Nonidet P-40, 0.25 mM Na-deoxycholate, 1% SDS, 0.05 M Tris, and Complete Cocktail Inhibitor (Roche Molecular Biochemicals). Cellular debris was removed by centrifugation. Protein extracts (5 µg placenta, 60 µg all other samples) were separated on denaturing 12.5% SDS-PAGE gels in a Mini-Proten 3 Gel Tank (Bio-Rad) at 120 V for 2 h in the presence of 25 mM Tris, 250 mM glycine (pH 8.3), and 0.1% SDS and were blotted onto Immobilon P transfer membranes (Millipore, Bedford, MA) as previously described (23). Membranes were blocked for 4 h at room temperature using 5% nonfat milk powder dissolved in Tris-buffered saline (pH 7.4) containing 0.1% Tween 20 (TBST) and incubated overnight at 4 C in aromatase antiserum (diluted 1:4000 or 1:400 in TBST containing 1% nonfat milk powder and 5% normal goat serum for Groome and Osawa antibodies, respectively), TBST with 1% nonfat milk powder, and 5% normal goat serum (antibody control) or antibody preincubated with immunizing peptide (10x excess concentration; Groome only).

Membranes were then incubated for 1 h at room temperature in horseradish peroxidase-conjugated goat antimouse (diluted 1:15,000 in TBST with 1% nonfat milk powder; Groome; Dako) or horseradish peroxidase-conjugated goat antirabbit (diluted 1:10,000 in TBST with 1% nonfat milk powder; Osawa; Dako) antisera. Bound antibody was visualized on XOMAT AR film (Eastman Kodak) using the ECL Plus Western blotting detection system (Amersham Life Science).


    Results
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
RT-PCR examination of RNA from human prostate cell lines (Fig 2AGo) and biopsy specimens from men diagnosed with BPH and PCa (Fig. 2BGo) consistently demonstrated the presence of the aromatase coding sequence. mRNA for the aromatase gene was detected in the placental control tissue but was not present in a primary PrEC line. In contrast to nonmalignant epithelial cells, aromatase mRNA was expressed in all of the human prostate tumor cell lines, i.e. LNCaP, DU145, and PC3 (Fig. 2AGo). Aromatase mRNA was reliably and consistently detected in all human prostate biopsy specimens (18 of 18, both BPH and PCa; nine BPH shown), and confirmed by Southern hybridization, autoradiography (Fig. 2BGo), and sequencing (data not shown). Although aromatase mRNA was readily detectable in the tumor cell lines and patient biopsies, low expression levels were noted, particularly in patient tissues.



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FIG. 2. Detection of aromatase in patient biopsies and prostate cell lines. Aromatase mRNA was found to be present in all prostate tumor cell lines, but not the benign PrEC line as detected by RT-PCR (A). Aromatase coding sequence was detected in needle biopsies from all 18 human patients tissues examined (BPH and PCa; nine BPH shown) (B). Results in A and B were confirmed by Southern hybridization (CDSD) as shown. Positive placental, negative reverse transcriptase negative (flanking each respective sample), and water controls are presented.

 
The detection of aromatase protein was performed by immunohistochemical localization using two specific antibodies as has been previously described (20, 21); the results presented were obtained using the Groome antibody. Figure 3Go shows the immunolocalization of aromatase protein in placenta (Fig. 3Go, A, D, and E), but not in breast (Fig. 3BGo) or prostate (Fig. 3CGo) specimens. The localization of immunoreactivity for aromatase to the syncytiotrophoblasts within the placenta using the Groome monoclonal antibody was identical with results obtained using the polyclonal antibody from Osawa and colleagues (data not shown). Both antibodies failed to detect aromatase protein in either breast or prostate tissues (Fig. 3Go, B and C). In contrast, Western blot analysis detected protein in placenta, whole prostate, and all prostate tumor cell lines but not PrECs (Fig. 3FGo). Controls run without primary antibody (not shown) or with excess antigenic peptide (Fig. 3GGo; placenta only) were clear.



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FIG. 3. Detection of aromatase protein. Immunohistochemical analysis of aromatase protein in human placental tissue sections revealed strong cytoplasmic staining in syncytiotrophoblasts with adjacent cytotrophoblasts clear (A). No evident staining was observed in breast (B) or prostate (C) sections. Matched IgG and preadsorption-negative controls for the placenta (D and E), breast and prostate (not shown) were clear. Aromatase protein was detected in cellular extracts from placenta, whole prostate (BPH), and all but one of the PrEC lines by Western blot analysis (F). Controls lacking primary antibody (not shown) or with excess antigenic peptide (G) were clear. Western blots were repeated three times. Data presented were obtained using the Groome antibody.

 
Aromatase activity was measured by tritiated water release assay (see Fig. 6Go). The control JEG-3 cells demonstrated a high activity of 41.79 ± 1.25 pmol/mg protein·6 h that is comparable to levels previously reported (24, 25, 26). In the prostate lines, activity was significant (P < 0.001) and highest in DU145 and PC3 cells, being 734.9 ± 77.7 and 318.3 ± 59.8 fmol/mg protein·6 h, respectively. Comparatively, the activity measured in LNCaP cells was low, 26.7 ± 6.0 fmol/mg protein·6 h, but was still significantly above background (P < 0.01). PrECs consistently demonstrated no measurable activity.



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FIG. 6. Aromatase enzyme activity. Aromatase enzyme activity was measured by tritiated water release assay. Activities recorded were JEG-3: 41,792 ± 1252; PrEC: no activity detected; LNCaP: 26.7 ± 6.0; DU145: 734.9 ± 77.7; and PC3: 318.3 ± 59.8 fmol/mg protein·6 h, respectively. Data are the mean ± SD of average values from three independent assays performed in triplicate. **, P < 0.01; ***, P < 0.001: statistical significance above background was measured by the Student’s t test.

 
Additional analysis of aromatase expression and promoter use was performed on placental tissue and prostate cell lines by relative real-time PCR. As previously reported, placental aromatase predominantly used promoter I.1, I.2 (to a lesser extent) with trace levels of I.3, I.4, and PII present (Fig. 4Go). In contrast, the androgen-responsive LNCaP prostate tumor cells used PII as well as I.4 and, to a lesser extent, I.3 (Fig. 4Go). Promoter use in the androgen-independent PC3 and DU145 differed to that of LNCaP cells with predominant use of promoter I.4 with I.3 also being detectable. PII was undetectable in these cells.



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FIG. 4. Aromatase promoter use in prostate cell lines. Promoter use in placenta and prostate cell lines was determined by relative real-time PCR; use of each promoter is expressed as a percentage of total aromatase expression. The placental control shows use of all promoters examined, predominantly I.1. Androgen-responsive LNCaP cells used promoters I.4, PII, and, to a lesser extent, I.3. Androgen-independent DU145 and PC3 cells principally used promoter I.4 and small levels of I.3. Data are the mean ± SD of average values from three independent experiments performed in triplicate.

 
LCM was performed on human prostate biopsy specimens to study aromatase expression and promoter use in stromal and epithelial cells. Microdissected samples of isolated stroma (isolated from either BPH or PCa sections; not adjacent to malignant foci or benign epithelium), benign epithelia, and malignant epithelia (Gleason grade 4+) were obtained from five patients (3 PCa, 2BPH). Using relative real-time PCR, aromatase mRNA was detected in stroma from both PCa and BPH tissues, in malignant epithelia, but not in benign epithelia (Fig. 5AGo). In contrast to the observations in the tumor cell lines, promoter PII was exclusively used in the microdissected stromal tissue of all five patients studied (Fig. 5BGo), with identical expression in samples isolated from either BPH or PCa sections. After the onset of aromatase expression in the malignant epithelia, a different promoter use to stroma was observed, and it now included promoters I.4 and I.3 in addition to PII (Fig. 5CGo).



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FIG. 5. Aromatase expression and promoter use in LCM samples. Aromatase message was detected in isolated stromal cells, malignant epithelial cells, but not in benign epithelial cells by RT-PCR (A). 18S control for RNA is shown. Examination of promoter use in microdissected samples by relative real-time PCR revealed exclusive use of PII by stromal cells (B) and use of promoters PII, I.4, and I.3 by tumor cells (C). Data are the mean ± SD of average values from three independent experiments performed in triplicate.

 
Specificity of promoter PCR products was confirmed by agarose gel electrophoresis, Southern transfer, autoradiography, and sequencing (data not shown).


    Discussion
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
The effects of estrogenic suppression on the hypothalamic-pituitary-gonadal axis are well known (27), and although the evidence for direct effects of estrogen on the prostate are equivocal, our data demonstrate local estrogen synthesis by the gland that is altered in malignancy. In the breast, local synthesis of estrogen via the aromatase enzyme is considered an important event in malignancy. Our results show a low level of aromatase activity and, therefore, the ability of human prostate cell lines to convert testosterone to estrogen (Fig. 6Go). Most significantly, the levels we have observed are within the range that has been reported for the breast. These data provide additional evidence for a direct intraprostatic effect of estrogen on the prostate gland.

In breast cancer, aromatase and its aberrant expression are significant (28, 29, 30). After the induction of malignancy in this system, there is a shift in promoter usage from promoter I.4 to PII or I.3. Subsequently, aromatase expression increases at the tumor site, and the resultant elevated local estrogen levels produce a positive feedback loop that drives tumor cell proliferation (31). Aromatase inhibitors have successfully been used to treat breast cancer, and it has been postulated that they may replace tamoxifen as the first therapeutic option (32, 33, 34). We have demonstrated that analogous changes in promoter usage occur in prostate malignancy, potentially associated with the progression to androgen independence. As shown in the cell lines, this change from PII to promoter I.4 would result in altered regulation and is consistent with the role cytokines are believed to play once prostate tumor cells reach an androgen-independent state. PII is responsive to cAMP and factors such as prostaglandin E2 (35), dexamethasone, and phorbol esters (36). Alternately, promoter I.4 is induced by TGFß (37), IL-6, IL-11, oncostatin M, and leukemia inhibitory factor (38). These factors are recognized to be involved in carcinogenesis in many tissue types, including PCa. Therefore, one of the mechanisms through which factors such as TGFß, the ILs, and leukemia inhibitory factor could mediate tumorigenic actions in PCa may be through an induction of estrogen production in epithelia. Although the alternate promoter use seen in the androgen-independent cell lines would imply that androgens are directly or indirectly involved in the regulation of these promoters, subsequent experiments on cells cultured with and without testosterone failed to show any significant change (data not shown).

Additional parallels between the prostate and breast were noted after the examination of aromatase activity in malignant tissues. Both the presence of the aromatase enzyme and its activity was detected in prostate epithelial tumor cell lines but not in a benign epithelial cell line. This confirms that local conversion of testosterone to estrogen occurs in prostate tumor cells, and, given the aberrant promoter regulation observed in these tissues, this would potentially result in elevated local estrogen levels at the tumor site. Although the activity measured in the prostate tumor cell lines was low overall, all levels detected were within the activity range that has been reported in breast tumors [(2.5 fmol/mg protein·h up to 2.6 pmol/mg protein·h; (39, 40, 41)].

Although estrogens can regulate androgen levels indirectly via the hypothalamic-pituitary-gonadal axis (27), mounting evidence indicates that they can also act directly on the prostate gland. Two estrogen receptor (ER) subtypes have been localized to the prostate; ER{alpha} predominantly in stroma and also in epithelia (42, 43, 44) and ERß solely in epithelia (45). At maturity, estrogens administered in combination with a constant level of androgens cause metaplastic growth of the prostate, whereas estrogens alone are directly growth inhibititory in vitro (46, 47, 48). Additionally, exposure to high levels of estrogens during the neonatal period results in permanent alterations in prostate growth as well as predisposing the gland to hyperplasia and severe dysplasia similar to the human pathology, prostatic intraepithelial neoplasia (43, 49). Understanding the role of estrogen in the prostate is further complicated by data demonstrating that low levels of estrogen can induce proliferation, both during development and at maturity (50, 51).

Collectively, these reports emphasize the importance of estrogens in the prostate, and we have conclusively demonstrated that the gland also has the capacity to locally synthesize estrogens, something that has been a matter of contention to date. A major confounding aspect of previous studies may be the heterogeneity of the gland itself because needle biopsies from tissues from men with benign disease will contain tumor cells, and vice versa. Ergo, any conclusion drawn from the examination of such samples will not be definitive. The heterogeneity of the gland, in addition to low levels of aromatase expression, are the likely reasons for the discrepancies in the literature and the difficulty in generating reliable and reproducible results. We have overcome these inherent problems by using LCM to analyze patient samples in conjunction with a number of different human prostate cell lines, and this study is the first to examine aromatase expression in homogeneous prostate samples prepared directly from patient tissues.

The action of estrogen in prostatic stroma and epithelia is principally mediated through ER{alpha}, other than ERß, which, to date, has no apparent role (52). Not only have we detected aromatase expression in 100% (18 of 18; BPH and PCa) of patient biopsies examined, but in samples prepared by LCM we have found that aromatase expression is localized to the stroma of benign tissues, with expression also being detected in malignant epithelia. These data are consistent with previously reported data examining the influence of ER{alpha} in the prostate. The predominant localization of ER{alpha} to stroma implies that estrogen action on the epithelium primarily involves paracrine events, whereas in malignancy, the switch to aromatase expression in epithelia suggests that autocrine or intracrine events may elicit estrogen-mediated responses. The continued expression of ER{alpha} and its role in PCa requires additional investigation. Alternately, estrogen produced in the epithelium may act via nonreceptor-mediated events or through other steroid receptors like the androgen receptor. In the latter instance, it is noteworthy that mutations in the androgen receptor detected in LNCaP cells (53) and in tumors (54) permit its activation by estrogenic compounds.

Our results confirm local aromatase gene expression in benign prostate, further supporting a role for estrogen in this organ. We have also demonstrated an induction of expression with malignancy that is similar to that occurring in breast cancer, and a level of aromatase activity in tumor cells that is within the range reported in breast tumors. The key differences between prostate and breast tumors with regard to aromatase expression and regulation need to be further examined if potential therapeutic targets are to be identified. These data provide a basis for the development of novel tissue-specific inhibitors, or selective aromatase modulators, as new possibilities for the treatment of prostate cancer.


    Acknowledgments
 
We thank Professor N. Groome and Dr. P. Saunders for the monoclonal aromatase antibody, Dr. W. Boon for assistance with tritiated water assays, and Drs. E. Ball and S. McPherson for assistance reviewing the manuscript.


    Footnotes
 
This work was supported by National Health and Medical Research Council program grant funding (to G.P.R.).

Abbreviations: BPH, Benign prostatic hyperplasia; d, deoxy; DNase, deoxyribonuclease; ER, estrogen receptor; LCM, laser capture microdissection; PCa, prostate cancer; PrEC, prostate epithelial cell (line); SDS, sodium dodecyl sulfate; TBST, Tris-buffered saline with Tween 20.

Received May 30, 2003.

Accepted February 1, 2004.


    References
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 

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