Aromatase Inhibitor Exemestane has Antiproliferative Effects on Human Mesothelioma Cells Daniela Stoppoloni, BSc, Luisa Salvatori, BSc, Annamaria Biroccio,

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Aromatase Inhibitor Exemestane has Antiproliferative Effects on Human Mesothelioma Cells Daniela Stoppoloni, BSc, Luisa Salvatori, BSc, Annamaria Biroccio, BSc, Carmen D'Angelo, BSc, Paola Muti, MD, Alessandra Verdina, BSc, Ada Sacchi, BSc, Bruno Vincenzi, MD, Alfonso Baldi, MD, Rossella Galati, BSc Journal of Thoracic Oncology Volume 6, Issue 3, Pages 583-591 (March 2011) DOI: 10.1097/JTO.0b013e31820cdd6f Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 1 Aromatase and estrogen receptors are expressed in human mesothelioma cells. A, Using gel electrophoresis with Western blot, CYP19A1 expression is shown in five representative malignant mesothelioma (MM) cell lines. Breast cancer cell line MCF-7 with known expression of CYP19A1, positive control. MPP89, Ist-Mes2, NCI-H2452, MSTO-211H, and Ist-Mes1 MM cell lines as noted. B, Using electrophoresis and Western blot, ERα expression is shown in five representative MM cell lines and MCF-7, positive control with known high expression of Erα. The classical 67 KDa ERα, as well as a 46 KDa variant, occurs in MCF-7and MM cell lines. C, Using electrophoresis with Western blot, expression of ERβ is shown in MM cell lines and MCF7, positive control. Bottom, actin loading controls. Multiple signals were achieved by stripping and reprobing the same blot. D, Reverse transcription polymerase chain reaction (RT-PCR) amplification for assay of aromatase mRNA from MCF7and MM cells. mRNA CYP indicates aromatase gene expression versus GAPDH. The standard deviation expresses the result of three different quantization. Note that the same representative MM cancer cell lines were used for RT-PCR and for Western immunoblots. Journal of Thoracic Oncology 2011 6, 583-591DOI: (10.1097/JTO.0b013e31820cdd6f) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 2 Aromatase activity occurs in human malignant mesothelioma (MM) cells. A, Aromatase activity in MM cells was measured by production of estradiol after treatment with testosterone. The greatest increment in the production of estradiol occurred after 48 hours treatment with 10 nmol/L testosterone and prostaglandin-E2 (PGE2) in all MM cell lines. Testosterone in combination with epidermal growth factor (EGF) induced a statistically significant increase in aromatase activity in MPP89, Ist-Mes2 and Ist-Mes1. Estradiol standards were provided by the manufacturer, and controls included cells grown but not treated with testosterone. Values were reported as means ± SD of three independent experiments, and asterisks indicate significant difference (p < 0.05) of the treatment with EGF or PGE2 versus testosterone calculated by Student's t test. B, Effect of cytokines in MM cell lines was measured by CYP19A1 mRNA level after treatment with cytomix at 1, 2, and 3 hours. Levels of CYP19A1 mRNA were compared with that in MM cells not treated with cytomix. Values were reported as means ± SD of three independent experiments, and p value indicates significant difference (p < 0.05) of the treatment with cytokines versus control calculated by Student's t test. C, Effect of cytokines in MM cell lines was measured by production of estradiol after treatment with cytomix at 3 hours. Aromatase activity in MM cells was measured by production of estradiol after treatment with cytomix at 3 hours. See text for details. Values were reported as means ± SD of three independent experiments, and p values indicate significant difference (p < 0.05) of the treatment with cytokines versus control calculated by Student's t test. Journal of Thoracic Oncology 2011 6, 583-591DOI: (10.1097/JTO.0b013e31820cdd6f) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 3 Aromatase expression by immunohistochemistry is present in most archival malignant mesothelioma (MM) tumor specimens. A, Immunohistochemical staining of aromatase in human pleural mesothelioma. 1 = strong cytoplasmic expression (original magnification, ×200); 2 = negative staining (original magnification, ×200). B, Correlation between aromatase expression and histotype. C, Survival and pathological and immunohistochemical parameters in patients with MM in an univariate analysis. Journal of Thoracic Oncology 2011 6, 583-591DOI: (10.1097/JTO.0b013e31820cdd6f) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 4 Kaplan-Meier survival plot for aromatase. Journal of Thoracic Oncology 2011 6, 583-591DOI: (10.1097/JTO.0b013e31820cdd6f) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 5 Aromatase inhibitor, exemestane, blocks growth of malignant mesothelioma (MM) cell in vitro. A, Exemestane reduces growth of MPP89, Ist-Mes1, and Ist-Mes2 cell lines in vitro. Both cell lines were treated with exemestane for 48 hours (72 hours after seeding the cells in flask) at concentrations ranging from 2.8 × 10−4 to 2.8 × 10−1mM. B, Effect of exemestane on the cell cycle in MM cell lines. Cell cycle analysis after propidium iodide staining was performed by flow cytometry in MPP89 (white histograms), Ist-Mes1 (gray histograms), and Ist-Mes2 (black histograms) cells untreated or treated with exemestane at the dose of 2.8 × 10−1 mM for 48 hours. The percentages of cells in the different phases of cell cycle was reported inside the relative histogram. A representative out of three independent experiments is shown. C, Effect of exemestane (Exe) on caspase-3, poly(ADP-ribose) polymerase (PARP), Bcl-xL, and phosphorylation of Akt (p-Akt). The cells were cultured in complete medium for 24 hours and then treated with exemestane (2.8 × 10−1 mM) for 48 hours. Western blot of total lysates indicates that the addition of exemestane activates caspase pathways and PARP cleavage and significantly decreases p-Akt and Bcl-xL. Ist-Mes2 has no detectable basal p-Akt. Journal of Thoracic Oncology 2011 6, 583-591DOI: (10.1097/JTO.0b013e31820cdd6f) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions