Activation of the hypoxia pathway in breast cancer tissue and patient survival are inversely associated with tumor ascorbate levels

The transcription factor hypoxia inducible factor (HIF) -1 drives tumor growth and metastasis and is associated with poor prognosis in breast cancer. Ascorbate can moderate HIF-1 activity in vitro and is associated with HIF pathway activation in a number of cancer types, but whether tissue ascorbate...

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Bibliographic Details
Published in:	BMC cancer 2019-04, Vol.19 (1), p.307-307, Article 307
Main Authors:	Campbell, Elizabeth J, Dachs, Gabi U, Morrin, Helen R, Davey, Valerie C, Robinson, Bridget A, Vissers, Margreet C M
Format:	Article
Language:	eng
Subjects:	Antioxidants Ascorbate Ascorbic acid BNIP3 protein Breast cancer Cancer metastasis Cancer patients Cancer research Cancer therapies Carcinoma Cell growth Disease-free survival Endothelial growth factors Ethics Ethnicity Genes Genetic aspects Hydroxylases Hypoxia Hypoxia-inducible factor 1 Invasiveness Medical prognosis Medical research Metastases Metastasis Mortality Necrosis Patient outcomes Patients Prognosis Proteins Survival Transcription factors Tumors Vascular endothelial growth factor Vitamin C Womens health
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Summary:	The transcription factor hypoxia inducible factor (HIF) -1 drives tumor growth and metastasis and is associated with poor prognosis in breast cancer. Ascorbate can moderate HIF-1 activity in vitro and is associated with HIF pathway activation in a number of cancer types, but whether tissue ascorbate levels influence the HIF pathway in breast cancer is unknown. In this study we investigated the association between tumor ascorbate levels and HIF-1 activation and patient survival in human breast cancer. In a retrospective analysis of human breast cancer tissue, we analysed primary tumor and adjacent uninvolved tissue from 52 women with invasive ductal carcinoma. We measured HIF-1α, HIF-1 gene targets CAIX, BNIP-3 and VEGF, and ascorbate content. Patient clinical outcomes were evaluated against these parameters. HIF-1 pathway proteins were upregulated in tumor tissue and increased HIF-1 activation was associated with higher tumor grade and stage, with increased vascular invasion and necrosis, and with decreased disease-free and disease-specific survival. Grade 1 tumors had higher ascorbate levels than did grade 2 or 3 tumors. Higher ascorbate levels were associated with less tumor necrosis, with lower HIF-1 pathway activity and with increased disease-free and disease-specific survival. Our findings indicate that there is a direct correlation between intracellular ascorbate levels, activation of the HIF-1 pathway and patient survival in breast cancer. This is consistent with the known capacity of ascorbate to stimulate the activity of the regulatory HIF hydroxylases and suggests that optimisation of tumor ascorbate could have clinical benefit via modulation of the hypoxic response.
ISSN:	1471-2407 1471-2407