PITX1 is a regulator of TERT expression in prostate cancer with prognostic power

Affiliation
Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital
Poos, Alexandra M.;
Affiliation
Department of Pathology, University Medical Center Hamburg-Eppendorf
Schroeder, Cornelia;
GND
1229361200
Affiliation
Institute for Infectious Diseases and Infection Control (IIMK), Jena University Hospital
Jaishankar, Neeraja;
GND
1144642825
Affiliation
Institute for Infectious Diseases and Infection Control (IIMK), Jena University Hospital
Röll, Daniela;
GND
138688125
Affiliation
Institute for Infectious Diseases and Infection Control (IIMK), Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany; neeraja.jaishankar@uni-jena.de (N.J.); daniela.roell@med.uni-jena.de (D.R.); marcus.oswald@web.de (M.O.)
Oswald, Marcus;
Affiliation
Department of Pathology, University Medical Center Hamburg-Eppendorf
Meiners, Jan;
Affiliation
Division of Chromatin Networks, German Cancer Research Center (DKFZ) and BioQuant Center
Braun, Delia M.;
Affiliation
Division of Chromatin Networks, German Cancer Research Center (DKFZ) and BioQuant Center
Knotz, Caroline;
ORCID
0000-0002-7152-2709
Affiliation
Division of Chromatin Networks, German Cancer Research Center (DKFZ) and BioQuant Center
Frank, Lukas;
Affiliation
VIROQUANT CellNetworks RNAi Screening Facility and Research Group High-Content Analysis of the Cell (HiCell)
Gunkel, Manuel;
Affiliation
Biomedical Computer Vision Group, BioQuant Center and IPMB, Heidelberg University
Spilger, Roman;
Affiliation
Biomedical Computer Vision Group, BioQuant Center and IPMB, Heidelberg University
Wollmann, Thomas;
Affiliation
Department of Pathology, University Medical Center Hamburg-Eppendorf
Polonski, Adam;
Affiliation
Department of Pathology, University Medical Center Hamburg-Eppendorf
Makrypidi-Fraune, Georgia;
Affiliation
Department of Pathology, University Medical Center Hamburg-Eppendorf
Fraune, Christoph;
Affiliation
Martini-Clinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf
Graefen, Markus;
Affiliation
Division of Chromatin Networks, German Cancer Research Center (DKFZ) and BioQuant Center
Chung, Inn;
GND
1247778037
ORCID
0000-0002-6633-480X
Affiliation
Institute of Human Genetics, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany; alexander.stenzel@med.uni-jena.de (A.S.); aria.baniahmad@med.uni-jena.de (A.B.)
Stenzel, Alexander;
Affiliation
VIROQUANT CellNetworks RNAi Screening Facility and Research Group High-Content Analysis of the Cell (HiCell)
Erfle, Holger;
Affiliation
Biomedical Computer Vision Group, BioQuant Center and IPMB
Rohr, Karl;
GND
112808337X
ORCID
0000-0003-1085-9161
Affiliation
Institute of Human Genetics, Jena University Hospital
Baniahmad, Aria;
Affiliation
Department of Pathology, University Medical Center Hamburg-Eppendorf
Sauter, Guido;
ORCID
0000-0001-9951-9395
Affiliation
Division of Chromatin Networks, German Cancer Research Center (DKFZ) and BioQuant Center
Rippe, Karsten;
ORCID
0000-0003-0158-4258
Affiliation
Department of Pathology, University Medical Center Hamburg-Eppendorf
Simon, Ronald;
Affiliation
Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany; a.poos@dkfz-heidelberg.de
Koenig, Rainer

Simple Summary Most prostate cancer is of an indolent form and is curable. However, some prostate cancer belongs to rather aggressive subtypes leading to metastasis and death, and immediate therapy is mandatory. However, for these, the therapeutic options are highly invasive, such as radical prostatectomy, radiation or brachytherapy. Hence, a precise diagnosis of these tumor subtypes is needed, and the thus far applied diagnostic means are insufficient for this. Besides this, for their endless cell divisions, prostate cancer cells need the enzyme telomerase to elongate their telomeres (chromatin endings). In this study, we developed a gene regulatory model based on large data from transcription profiles from prostate cancer and chromatin-immuno-precipitation studies. We identified the developmental regulator PITX1 regulating telomerase. Besides observing experimental evidence of PITX1′s functional role in telomerase regulation, we also found PITX1 serving as a prognostic marker, as concluded from an analysis of more than 15,000 prostate cancer samples. Abstract The current risk stratification in prostate cancer (PCa) is frequently insufficient to adequately predict disease development and outcome. One hallmark of cancer is telomere maintenance. For telomere maintenance, PCa cells exclusively employ telomerase, making it essential for this cancer entity. However, TERT, the catalytic protein component of the reverse transcriptase telomerase, itself does not suit as a prognostic marker for prostate cancer as it is rather low expressed. We investigated if, instead of TERT , transcription factors regulating TERT may suit as prognostic markers. To identify transcription factors regulating TERT , we developed and applied a new gene regulatory modeling strategy to a comprehensive transcriptome dataset of 445 primary PCa. Six transcription factors were predicted as TERT regulators, and most prominently, the developmental morphogenic factor PITX1. PITX1 expression positively correlated with telomere staining intensity in PCa tumor samples. Functional assays and chromatin immune-precipitation showed that PITX1 activates TERT expression in PCa cells. Clinically, we observed that PITX1 is an excellent prognostic marker, as concluded from an analysis of more than 15,000 PCa samples. PITX1 expression in tumor samples associated with (i) increased Ki67 expression indicating increased tumor growth, (ii) a worse prognosis, and (iii) correlated with telomere length.

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