Abstract
Resistance to platinum-based chemotherapy develops in the majority of patients with epithelial ovarian cancer (EOC). Platinum compounds form electrophilic intermediates that mediate DNA cross-linking and induce double-strand DNA breaks. Because the cellular response to electrophilic xenobiotics is partly mediated by Keap1-Nrf2 pathway, we evaluated the presence of Kelch-like ECH-associated protein 1 (Keap1) mutations and NF-E2-related factor 2 (Nrf2) pathway activation in EOC and correlated these with platinum resistance and clinical outcome. Nrf2 immunohistochemistry revealed nuclear localization (a surrogate of pathway activation) in over half of EOC patient specimens examined, with more common occurrence in the clear cell EOC subtype. Quantitative real-time PCR revealed that Nrf2 target genes were upregulated in tumors with nuclear positivity for Nrf2. Microarray analysis also showed upregulation of Nrf2 target genes in clear cell EOCs compared with other EOC subtypes. In addition, Keap1 sequence analysis revealed genetic mutations in 29% of clear cell samples and 8% of nonclear cell tumors. RNAi-mediated knockdown of Keap1 was associated with Nrf2 pathway activation and resistance to carboplatin in vitro. Importantly, patients with evidence of Nrf2 pathway activation had fewer complete clinical responses to platinum-based therapy, were enriched for platinum resistance, and had shorter median overall survival compared with those who did not show evidence of Nrf2 pathway activation. Our findings identify Keap1 mutations in EOC and they suggest a previously unrecognized role for the Keap1-Nrf2 pathway in mediating chemotherapeutic responses in this disease.
Publication types
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Research Support, Non-U.S. Gov't
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Research Support, U.S. Gov't, Non-P.H.S.
MeSH terms
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Adenocarcinoma, Clear Cell / drug therapy
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Adenocarcinoma, Clear Cell / genetics
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Adenocarcinoma, Clear Cell / mortality
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Adenocarcinoma, Clear Cell / pathology
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Antineoplastic Agents, Alkylating / pharmacology
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Antineoplastic Agents, Alkylating / therapeutic use
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Carboplatin / pharmacology
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Carcinoma / drug therapy
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Carcinoma / genetics*
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Carcinoma / mortality
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Carcinoma / pathology
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Cell Line, Tumor / drug effects
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DNA Mutational Analysis
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DNA, Neoplasm / drug effects
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DNA, Neoplasm / genetics
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Drug Resistance, Neoplasm / genetics
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Female
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Gene Expression Profiling
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Humans
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Intracellular Signaling Peptides and Proteins / antagonists & inhibitors
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Intracellular Signaling Peptides and Proteins / genetics
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Intracellular Signaling Peptides and Proteins / physiology*
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Kaplan-Meier Estimate
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Kelch-Like ECH-Associated Protein 1
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NF-E2-Related Factor 2 / genetics
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NF-E2-Related Factor 2 / physiology*
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Neoplasm Proteins / antagonists & inhibitors
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Neoplasm Proteins / genetics
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Neoplasm Proteins / physiology*
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Organoplatinum Compounds / pharmacology
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Organoplatinum Compounds / therapeutic use
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Ovarian Neoplasms / drug therapy
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Ovarian Neoplasms / genetics*
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Ovarian Neoplasms / mortality
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Ovarian Neoplasms / pathology
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Proportional Hazards Models
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RNA Interference
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RNA, Small Interfering / pharmacology
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Sequence Analysis, DNA
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Signal Transduction / genetics
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Signal Transduction / physiology*
Substances
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Antineoplastic Agents, Alkylating
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DNA, Neoplasm
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Intracellular Signaling Peptides and Proteins
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KEAP1 protein, human
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Kelch-Like ECH-Associated Protein 1
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NF-E2-Related Factor 2
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NFE2L2 protein, human
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Neoplasm Proteins
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Organoplatinum Compounds
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RNA, Small Interfering
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Carboplatin