A melatonina e seus metabólitos como marcadores prognósticos em neoplasias mamárias humanas
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2017-10-31
Autores
Castro, Tialfi Bergamin de
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Universidade Estadual Paulista (Unesp)
Resumo
O câncer de mama é a principal causa de mortes relacionadas ao câncer em mulheres e pesquisas têm sido focadas em identificar e validar biomarcadores que podem ser utilizados para confirmar o diagnóstico e determinar o prognóstico. Mudanças no ritmo circadiano podem contribuir para o desenvolvimento do câncer e sendo assim, a melatonina, um hormônio sintetizado pela glândula pineal à noite, na ausência de luz e seus metabolitos AFMK e AMK são sugeridos como potenciais biomarcadores. A melatonina pode atuar através do receptor MT1 regulando cinases e a expressão de genes específicos relacionados a proliferação, angiogênese, diferenciação celular e transporte de glicose. A expressão elevada de GLUT1 (Glucose Transporter-1) está associada ao prognóstico ruim no câncer. Os objetivos deste estudo foram comparar os níveis de melatonina, AFMK e AMK em mulheres recentemente diagnosticadas com câncer de mama, mulheres em quimioterapia adjuvante, enfermeiras que trabalham à noite em comparação com mulheres saudáveis e hábitos normais e avaliou-se a expressão do receptor MT1 e GLUT1 em tumores de mama e correlacionou com os subtipos moleculares, características patológicas e prognóstico. Foi coletado sangue de 53 mulheres com câncer de mama sendo 47 sem tratamento e 6 em quimioterapia adjuvante, 19 mulheres saudáveis sendo 1 O enfermeiras de turno noturno e 9 mulheres de hábitos normais. Os compostos foram quantificados por espectrometria de massas. Para a expressão de MT1 e GLUT1 foi realizada imunohistoquímica em 42 tumores de mama. Os resultados mostraram que mulheres com câncer de mama tiveram níveis menores de melatonina em comparação com mulheres de hábitos normais (p< 0.01 ), níveis ainda mais baixos em enfermeiras que trabalham no período noturno e em pacientes em quimioterapia adjuvante (p<0.01). Não houve diferença significativa nos níveis de AFMK e AMK entre os grupos (p>0.05). Além disso, pacientes com metástase apresentaram níveis elevados de melatonina e AFMK (p=0.02 e p=0.01, respectivamente) e altos níveis de AFMK estavam presentes quando linfonodos estavam acometidos (p=0.04), pacientes com tumores maiores que 20mm e que dormem com luz à noite (p=0.02 e p=0.007, respectivamente). Na análise imunohistoquímica, alta expressão do MT1 foi associada ao subtipo Luminal A, melhor prognóstico (p<0.05) e em tumores RE+ (p=0.002), enquanto que a expressão elevada de GLUT1 foi associada ao triplonegativo, pior prognóstico (p<0.05), tumores maiores que 20mm 9p=0.004) e baixa em tumores RE+ (p=0.003). Em conclusão, nossos resultados mostram menores níveis de melatonina em pacientes com câncer de mama e apontam para o benefício da suplementação de melatonina como proteção para mulheres que trabalham à noite o que poderia reduzir o risco de desenvolvimento de câncer de mama. Os resultados da imunohistoquímica indicam que o MT1 e o GLUT1 podem ser utilizados como marcadores prognósticos e são potenciais alvos para o tratamento do câncer de mama. De acordo com os resultados podese concluir que a quebra do ciclo circadiano e, portanto, alterações nos níveis de melatonina e a expressão de MT1 e GLUT1 podem estar relacionadas com o risco de desenvolvimento e prognóstico do câncer de mama.
Breast cancer is the Jeading cause of cancer-related deaths in women and researches has been focused on identify and validate biomarkers that can be used to confirm the diagnosis and determine the prognosis. Changes in circadian rhythm may contribute to the development of cancer and thus melatonin, a hormone synthesized by the pineal gland at night, in the absence of light and its metabolites AFMK and AMK are suggested as potential biomarkers. Melatonin can act through the MT1 receptor by regulating kinases and the expression of specific genes related to proliferation, angiogenesis, ce/1 differentiation and glucose transport. High GLUT1 (Glucose Transporter-1) expression is associated with poor prognosis in cancer. The objectives of this study were to compare the leveis of melatonin, AFMK and AMK in women newly diagnosed with breast cancer, women on adjuvant chemotherapy, health nurses which work at night compared to healthy women and normal habits and the expression of MT1 receptor and GLUT1 in breast tumors and correlated with molecular subtypes, pathological features and prognosis. Blood from 53 women with breast cancer was colletcted, 47 of them without treatment and 6 in adjuvant chemotherapy, 19 healthy women, 1 O of them night shift nurses and 9 women of normal habits. Compounds were quantified by mass spectrometry. For the expression of MT1 and GLUT1, immunohistochemistry was performed in 42 breast tumors. The results showed that women with breast cancer had lower leveis of melatonin compared to normal women (p <0.01), even Jower leveis in nurses working at night and in adjuvant chemotherapy (p <0.01). There was no significant difference in AFMK and AMK leveis between groups (p> 0.05). ln addition, patients with metastasis had high leveis of melatonin and AFMK (p = 0.02 and p = 0.01, respectively) and high leveis of AFMK were present when lymph nades were affected (p = 0.04), patients with tumors larger than 20mm and who sleep with light at night (p = 0.02 and p = 0.007, respectively). ln the immunohistochemical analysis, high MT1 expression was associated with the Luminal A subtype, with a better prognosis (p <O.OS) and in ER + tumors (p = 0.002), whereas high GLUT1 expression was associated with tripie negative, worse prognosis (p<0.05), tumors greaterthan 20mm (p= 0.004) and low in ER + tumors (p = 0.003). ln conclusion, our results show Jower leveis of melatonin in breast cancer patients and point to the benefit of melatonin supplementation as protection for women who work at night which could reduce the risk of developing breast cancer. The results of immunohistochemistry indicate that MT1 and GLUT1 can be used as prognostic markers and are potential targets for the treatment of breast cancer. According to the results it can be concluded that the breakdown of the circadian cyc/e and, therefore, changes in melatonin leveis and the expression of MT1 and GLUT1 may be related to the risk of development and prognosis of breast cancer
Breast cancer is the Jeading cause of cancer-related deaths in women and researches has been focused on identify and validate biomarkers that can be used to confirm the diagnosis and determine the prognosis. Changes in circadian rhythm may contribute to the development of cancer and thus melatonin, a hormone synthesized by the pineal gland at night, in the absence of light and its metabolites AFMK and AMK are suggested as potential biomarkers. Melatonin can act through the MT1 receptor by regulating kinases and the expression of specific genes related to proliferation, angiogenesis, ce/1 differentiation and glucose transport. High GLUT1 (Glucose Transporter-1) expression is associated with poor prognosis in cancer. The objectives of this study were to compare the leveis of melatonin, AFMK and AMK in women newly diagnosed with breast cancer, women on adjuvant chemotherapy, health nurses which work at night compared to healthy women and normal habits and the expression of MT1 receptor and GLUT1 in breast tumors and correlated with molecular subtypes, pathological features and prognosis. Blood from 53 women with breast cancer was colletcted, 47 of them without treatment and 6 in adjuvant chemotherapy, 19 healthy women, 1 O of them night shift nurses and 9 women of normal habits. Compounds were quantified by mass spectrometry. For the expression of MT1 and GLUT1, immunohistochemistry was performed in 42 breast tumors. The results showed that women with breast cancer had lower leveis of melatonin compared to normal women (p <0.01), even Jower leveis in nurses working at night and in adjuvant chemotherapy (p <0.01). There was no significant difference in AFMK and AMK leveis between groups (p> 0.05). ln addition, patients with metastasis had high leveis of melatonin and AFMK (p = 0.02 and p = 0.01, respectively) and high leveis of AFMK were present when lymph nades were affected (p = 0.04), patients with tumors larger than 20mm and who sleep with light at night (p = 0.02 and p = 0.007, respectively). ln the immunohistochemical analysis, high MT1 expression was associated with the Luminal A subtype, with a better prognosis (p <O.OS) and in ER + tumors (p = 0.002), whereas high GLUT1 expression was associated with tripie negative, worse prognosis (p<0.05), tumors greaterthan 20mm (p= 0.004) and low in ER + tumors (p = 0.003). ln conclusion, our results show Jower leveis of melatonin in breast cancer patients and point to the benefit of melatonin supplementation as protection for women who work at night which could reduce the risk of developing breast cancer. The results of immunohistochemistry indicate that MT1 and GLUT1 can be used as prognostic markers and are potential targets for the treatment of breast cancer. According to the results it can be concluded that the breakdown of the circadian cyc/e and, therefore, changes in melatonin leveis and the expression of MT1 and GLUT1 may be related to the risk of development and prognosis of breast cancer
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Palavras-chave
Câncer, Câncer de mama, Melatonina, AFMK, AMK, MT1, GLUT1, Breast cancer, Melatonin