VEGFR-3 and Its Ligand VEGF-C Are Associated with Angiogenesis in Breast Cancer Reija Valtola, Petri Salven, Päivi Heikkilä, Jussi Taipale, Heikki Joensuu,

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VEGFR-3 and Its Ligand VEGF-C Are Associated with Angiogenesis in Breast Cancer Reija Valtola, Petri Salven, Päivi Heikkilä, Jussi Taipale, Heikki Joensuu, Marko Rehn, Taina Pihlajaniemi, Herbert Weich, Robert deWaal, Kari Alitalo The American Journal of Pathology Volume 154, Issue 5, Pages 1381-1390 (May 1999) DOI: 10.1016/S0002-9440(10)65392-8 Copyright © 1999 American Society for Investigative Pathology Terms and Conditions

Figure 1 Immunostaining for VEGFR-3 (A), PAL-E (B), and collagen XVIII (C) in adjacent sections of histologically normal breast tissue. Careful examination of the staining patters shows that most of the weakly VEGFR-3 positive vessels are also stained for PAL-E and collagen XVIII (black arrows). One of the vessels, indicated by green arrows, is stained for VEGFR-3 but not for the PAL-E and only very weakly for collagen XVIII and therefore presumably lymphatic. In a benign fibroadenoma, numerous VEGFR-3 positive vessels can be observed (arrows in D). Magnifications, ×400. The American Journal of Pathology 1999 154, 1381-1390DOI: (10.1016/S0002-9440(10)65392-8) Copyright © 1999 American Society for Investigative Pathology Terms and Conditions

Figure 2 Immunohistochemical characterization of VEGFR-3 expressing vessels in intraductal carcinoma. In adjacent sections (A, B), VEGFR-3 and PAL-E decorate a similar pattern of necklace vessels (arrowheads) around the duct filled with carcinoma cells. In double staining for VEGFR-3 and Ki-67, several nucleae of the tumor cells inside the ducts are strongly positive for Ki-67 (A, inset, green arrows) as are several endothelial cell nucleae of the necklace vessels (red arrow). Some distance away, an apparently quiescent, VEGFR-3 positive vessel with a Ki-67 negative nucleus is marked with a black arrow. Another set of adjacent sections was compared with staining for VEGFR-3 (C), laminin (D), collagen XVIII (E), and SMA (F). Double staining for PAL-E and VEGFR-3 (G) and comparison with adjacent section stained for VEGFR-3 only (H). The vessels adjacent to the affected ducts are double-positive (arrowheads), whereas a VEGFR-3 positive vessel is present a short distance away from the affected duct in the interductal stroma (arrows). Note that basal lamina is positive for PAL-E in the double staining procedure. Magnification, ×400 (A, B); ×320 (C, D, E, F); ×480 (G, H). The American Journal of Pathology 1999 154, 1381-1390DOI: (10.1016/S0002-9440(10)65392-8) Copyright © 1999 American Society for Investigative Pathology Terms and Conditions

Figure 3 Analysis of anti-VEGF-C antibodies by immunoprecipitation. Metabolically labeled conditioned medium of 293 T cells transfected with expression vectors for VEGF-C or VEGF-D was precipitated with the indicated antibodies (α-) or receptor bodies (-Ig) detailed in the materials and methods and analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and autoradiography. Note the lack of precipitation of VEGF-D by the anti-VEGF-C antibodies. Note also that the VEGFR-3-Ig precipitates both 29/31 kd and 21.5 kd forms of VEGF-C, which are not recognized by VEGFR-1-Ig. The American Journal of Pathology 1999 154, 1381-1390DOI: (10.1016/S0002-9440(10)65392-8) Copyright © 1999 American Society for Investigative Pathology Terms and Conditions

Figure 4 Comparison of VEGF-C (A, B) and VEGFR (C-F) stainings in intraductal carcinoma. Note the expression of VEGF-C in all (A) or part (B) of the carcinoma in situ cells. Negative control using anti-VEGF-C antibodies blocked with a 10-fold molar excess of the VEGF-C protein gave no staining of the carcinoma cells (inset in B). C and D show sections adjacent to A stained for VEGFR-2 and VEGFR-3, respectively. Note that the necklace vessels are positive for both VEGFR-2 and VEGFR-3 in the vicinity of VEGF-C expressing carcinoma cells. E and F show a similar comparison for VEGFR-1 and VEGFR-3, respectively. Note that the staining for VEGFR-3 appears more discontinuous. Magnification, ×300 (<label;A, C, D>); ×400 (B); ×350 (E, F). The American Journal of Pathology 1999 154, 1381-1390DOI: (10.1016/S0002-9440(10)65392-8) Copyright © 1999 American Society for Investigative Pathology Terms and Conditions

Figure 5 VEGFR-3 in invasive ductal (A-C) and lobular (D) breast cancer. The intratumoral VEGFR-3 positive vessels (A) surround tumor cell clusters in ductal breast carcinoma and are predominantly positive for PAL-E (black arrows in B). Also an invasive growth pattern is associated with VEGFR-3 positive vessels (C), whereas no staining is observed using anti-VEGFR-3 antibodies blocked with a 10-fold molar excess of the VEGFR-3 protein (inset in C). Occasionally, invasion of the carcinoma cells into the VEGFR-3 positive vessels could be observed (D). Magnification, ×200. The American Journal of Pathology 1999 154, 1381-1390DOI: (10.1016/S0002-9440(10)65392-8) Copyright © 1999 American Society for Investigative Pathology Terms and Conditions