Epithelial-mesenchymal transition and stem cell markers in patients with HER2-positive metastatic breast cancer

Antonio Giordano, Hui Gao, Simone Anfossi, Evan Cohen, Michal Mego, Bang Ning Lee, Sanda Tin, Michele De Laurentiis, Charla A. Parker, Ricardo H. Alvarez, Vicente Valero, Naoto T. Ueno, Sabino De Placido, Sendurai A. Mani, Francisco J. Esteva, Massimo Cristofanilli, James M. Reuben*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

181 Scopus citations


Currently, there is extensive information about circulating tumor cells (CTC) and their prognostic value; however, little is known about other characteristics of these cells. In this prospective study, we assessed the gene transcripts of epithelial-to-mesenchymal transition - inducing transcription factors (EMT-TF) and cancer stem cell (CSC) features in patients with HER2 + metastatic breast cancer (MBC). Epithelial cells were enriched from peripheral blood mononuclear cells (PBMC) using antibody-coated anti-CD326 antibody (CD326+) magnetic beads, and the residual CD326- PBMCs were further depleted of leukocytes using anti-CD45 antibody-coated magnetic beads (CD326-CD45-). RNA was extracted from all cell fractions, reverse transcribed to cDNA, and subjected to quantitative reverse transcription PCR to detect EMT-TFs (TWIST1, SNAIL1, ZEB1, and TG2) as a measure of CTCs undergoing EMT (EMT-CTCs). In addition, PBMCs were analyzed using multiparameter flow cytometry for ALDH activity and CSCs that express CD24, CD44, and CD133. Twenty-eight patients were included in this study. At least one EMT-TF mRNA was elevated in the CTCs of 88.2% of patients and in the CD326-CD45- cell fraction of 60.7% of patients. The CD326-CD45- fraction of patients with elevated SNAIL1 and ZEB1 transcripts also had a higher percentage of ALDH+//CD133 + cells in their blood than did patients with normal SNAIL1 and ZEB1 expression (P = 0.038). Our data indicate that patients with HER2+ MBCs have EMT-CTCs. Moreover, an enrichment of CSCs was found in CD326 -CD45- cells. Additional studies are needed to determine whether EMT-CTCs and CSCs have prognostic value in patients with HER2 + MBCs treated with trastuzumab-based therapy.

Original languageEnglish (US)
Pages (from-to)2526-2534
Number of pages9
JournalMolecular cancer therapeutics
Issue number11
StatePublished - Nov 2012

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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