1. Introduction
Breast cancer is a leading cause of death by malignancy in women worldwide. The classification of breast tumors into distinct histological and molecular subtypes has been paramount to orient clinicians in their decision to deliver appropriate treatments to the patients. While hormonotherapy and HER2-targeted therapy are considered as treatments of choice for patients with luminal (Estrogen Receptor-positive) and HER2-amplified breast cancer subtypes, today only few therapies are available for triple-negative breast cancer (TNBC) and for breast tumors that become resistant to treatment [
1,
2]. In the rapidly developing area of precision medicine, with the objective to deliver the right treatment to the right patient, it is of utmost importance to identify new prognostic and predictive biomarkers in order to select patients who need close medical follow up and targeted treatments [
3].
Attention has been drawn since more than 50 years on the microtubule cytoskeleton in the fight against cancer. Mitotic poisons - including taxanes, that bind and stabilize microtubules - have been used in combination with DNA targeting agents for breast cancer chemotherapy. Microtubules are essential components of the cytoskeleton involved in different steps of cell division, migration and intracellular transport of proteins and organelles - all these processes being deregulated in cancer. Microtubules are polarized structures formed by the assembly of tubulin dimers, that rapidly alternate between phases of polymerization and depolymerization at the microtubule ends, in a process called dynamic instability [
4,
5].
The dynamic property of microtubules is crucial to their function. It ensures proper assembly of the mitotic spindle during mitosis and correct attachment of chromosomes to the kinetochores in metaphase to promote equal chromosome segregation during cell division. Microtubule dynamicity is essential for intracellular transport and is also required to establish cell polarity, explore the cytosol and target the cell cortex during migration. Microtubule assembly, dynamics and functions are tightly regulated by a large panel of microtubule-associated and regulatory proteins including MAPs, kinesins and kinases [
6,
7,
8]. Defects in the expression or function of these microtubule-related proteins (designated MT-Rel) may thus provoke major cellular alterations with subsequent consequences on cancer initiation or progression [
9,
10,
11].
In a recent study, we made the assumption that resistance to chemotherapy in breast tumors may result, at least in part, from alterations in the expression levels of MT-Rel genes. We took advantage of large databases containing both molecular and clinical data for breast cancer patients to launch a search for new predictive biomarkers of breast cancer chemoresistance [
12]. To this end, we compared the expression levels of a panel of 280 MT-Rel encoding genes in transcriptomic studies from three independent cohorts of patients with breast tumors classified as sensitive or resistant to chemotherapy. Bioinformatics studies identified a total of 117 MT-Rel genes that were significantly deregulated in sensitive versus resistant breast tumors, among which 17 genes were deregulated in all three cohorts of patients [
12].
In the present study, we investigated whether these 17 predictive MT-Rel genes may be connected and represent a functional network for breast cancer prognosis. To this end, we examined expression levels of these genes and their co-regulation in mammary tumors and adjacent normal tissues. We also evaluated their potential value as prognostic biomarkers of patient survival and the functional consequence of their depletion on cell viability. Finally, we used a Systems Biology method to highlight gene networks potentially associated with important biological functions altered in breast cancer.
4. Discussion
In this study, we have evaluated the prognostic value and functional relevance of a panel of 17 genes encoding MT-Rel proteins that were previously identified as potential predictive biomarkers of chemoresistance. Fourteen MT-Rel genes (KIF4A, ASPM, KIF20A, KIF14, TPX2, KIF18B, KIFC1, AURKB, KIF2C, GTSE1, KIF15, KIF11, RACGAP1, STMN1) were found significantly up-regulated in breast tumors compared with paired adjacent normal tissue, six of them (KIF4A, ASPM, KIF20A, KIF14, TPX2, KIF18B) being overexpressed by more than ten-fold. High expression of each of these genes was associated with poor clinical outcome for the patient - with both reduced overall survival and relapse-free survival - pointing to their potential value as prognostic biomarkers in breast cancer.
In line with our studies, other groups reported that ASPM, KIF20A, TPX2, AURKA and KIF2C are among the top 11 up-regulated hub key genes identified as potential breast cancer prognostic biomarkers [
19]. ASPM and AURKB also recently appeared as key genes up-regulated in TNBC [
20]. Furthermore, a meta-analysis identified KIF20A and ASPM among the top 55 overexpressed genes when comparing tumor and normal samples across the ten most frequent human cancers [
13]. It is to note that the majority (8 out of 14) of up-regulated MT-Rel genes encode kinesins which are molecular motors involved in the intracellular transport of proteins and organelles along microtubules. Kinesins have been recently highlighted as prognostic biomarkers in breast cancer [
21,
22] and a 6-KIFs-based risk score (among which 4 MT-Rel genes KIF4A, KIF15, KIF18B, KIF20A) was reported to accurately predict outcomes [
22].
Among the 17 MT-Rel genes studied here, 3 (MAPT, MTUS1, MAST4) have a different pattern of expression. They are only moderately up-regulated (MAPT) or down-regulated (MTUS1, MAST4) in breast cancer and are not co-regulated with other MT-Rel genes. Low levels of all three genes are associated with malignancy and poor prognosis of breast cancer patients, in line with previous reports for MAPT [
23,
24] and MTUS1 [
15,
16], MAST4 being much less studied.
Thus, differential regulation of all 17 MT-Rel genes in breast tumors (14 being overexpressed and 3 down-regulated) is associated with both poor prognosis and better response to chemotherapy [
12], a finding that may appear counter-intuitive. Our group has addressed this question in a previous study of the MTUS1 gene. We showed that depletion of MTUS1-encoded protein ATIP3 - a microtubule stabilizer - leads to increased microtubule dynamicity [
16], mitotic spindle defects [
17], centrosome amplification and multipolar spindle formation [
12]. As a consequence, MTUS1/ATIP3 deficient cells are prone to aneuploidy, which is both a recognized source of tumor aggressiveness and a source of vulnerability to taxane-based chemotherapy. Indeed, in aneuploid cells, low levels of taxanes induce excessive mitotic abnormalities which increase aneuploidy up to a threshold which is no more manageable by the cell and induces cell death [
25]. Based on these findings, we reasoned that coordinated de-regulation of subsets of the 17 MT-Rel genes may alter microtubule dynamics and promote aneuploidy, leading to increased vulnerability of breast tumors to chemotherapy or new adapted therapies.
Noticeably, 8 out of the 17 MT-Rel genes (MAPT, MTUS1, STMN1, KIF2C, KIF18B, GTSE1, ASPM, KIFC1) are involved in the regulation of microtubule dynamics and stability. Genes that are underexpressed (MAPT, MTUS1) encode microtubule stabilizers (Tau and ATIP3 proteins, respectively) [
15,
16,
17,
26] whereas genes that are overexpressed (STMN1, KIF2C, KIF18B) encode proteins that either destabilize [
27] or depolymerize [
28,
29,
30,
31] microtubules, respectively. Other overexpressed genes (GTSE1, ASPM, KIFC1) indirectly control microtubule dynamics. The microtubule plus-end binding protein GTSE1 inhibits KIF2C and its overexpression increases spindle microtubule dynamics [
32,
33], as does the minus-end binding protein ASPM by interacting with citron kinase (CIT) [
34] whereas in interphase ASPM interacts with katanin to promote severing and disassembly of dynamic microtubules [
35]. Finally, the molecular motor KIFC1 (also called HSET) binds to, and disrupts, microtubule plus ends, thereby inducing catastrophe and increasing microtubule dynamic instability [
36]. Globally, the emerging picture is an imbalance favoring microtubule destabilization, likely driven by the upregulation of genes encoding microtubule destabilizing or depolymerizing proteins and down-regulation of those encoding microtubule stabilizers, with a net tendency to increase microtubule dynamics in cancer cells. This in turn, alters the proper organization and shape of the cytoskeleton, leading to cellular abnormalities.
To further highlight cellular abnormalities driven by de-regulation of the 17 MT-Rel genes, we undertook a Systems Biology approach that extends beyond the 17 genes and takes into account differential gene expression. These studies allowed to draw a functional gene network that comprises 41 genes (including 2 protein complexes) and 87 edges contributing to major biological functions altered in breast tumors. Probing GO terms in public databases revealed that all 14 up-regulated MT-Rel genes are connected into 3 major functional sub-networks specifying different steps of mitosis, namely prometaphase/metaphase (control of mitotic spindle organization and integrity), anaphase (equal separation of chromosomes in each daughter cell) and cytokinesis (completion of division into two daughter cells). Defects in mitotic spindle assembly, chromosome segregation or cytokinesis likely result from altered microtubule dynamics. These defects are major drivers of aneuploidy due to improper chromosome attachment to the spindle in metaphase, chromosome lagging in anaphase and/or multinucleated cells due to cytokinesis failure. To our surprise, despite the presence of 8 kinesins and 8 proteins regulating microtubule dynamics in the network, pathways involved in cell migration were not significantly highlighted in our study. Although the GO term "microtubule motor activity" (GO:0003777 with p-value of 9.175e-17) reached considerable significance, the genes associated with this GO term exhibited minimal connectivity within our network. Consequently, the intracellular transport pathway would not add significant insights in terms of Systems Biology perspective. These findings further underscore the profound impact of mitotic pathways within this gene network.
By combining gene expression, prognostic studies, functional data and Systems Biology methods, our study points to important genes to target in breast cancer. We identify here 3 champions, namely AURKB, TPX2 and KIF4A. These are highly up-regulated and/or essential genes, contributing as hubs to several functional sub-networks in deregulated breast cancer. AURKB encodes the mitotic kinase Aurora B, that phosphorylates components at the kinetochore - where chromosomes attach microtubules - and regulates the microtubule depolymerizing activity of KIF2C [
37,
38]. TPX2 (Targeting Protein for Xlp2) is both a substrate and a regulator of Aurora kinase A (AURKA) that also phosphorylates a wide range of substrates in mitosis and controls the depolymerizing activity of KIF2A kinesin at the spindle pole [
17,
39]. Both Aurora kinases and their substrates KIF2A and KIF2C are actionable proteins and specific inhibitors have been developed in the past years [
40,
41,
42]. Targeting Aurora kinase has been extensively explored and several clinical trials have been performed - or are still ongoing - to evaluate the efficiency and the safety of Aurora kinase inhibition in cancer patients.
Author Contributions
Conceptualization, S.R-F, V.S and C.N.; software, G.G. O.C and V.S.; investigation, S.R-F, M.M, G.G, M.H, H.M and V.S.; supervision, V.S. and C.N.; writing—original draft preparation, S.R-F, G.G, V.S, C.N.; writing-review and editing, S.R-F., M.M, G.G., V.S. and C.N.; funding acquisition, M.M, H.M, M.H, O.C., V.S and C.N. All authors have read and agreed to the published version of the manuscript.