Abstract. Ovarian cancer ranks the most lethal among gynecologic neoplasms in women. To develop potential biomarkers for diagnosis, we have identified five novel genes (CYP39A1, GTF2A1, FOXD4L4, EBP, and HAAO) that are hypermethylated in ovarian tumors, compared with the non-malignant normal ovarian surface epithelia, using the quantitative methylation-specific polymerase chain reactions. Interestingly enough, multivariate Cox regression analysis has identified hypermethylation of CYP39A1 correlated with an increase rate of relapsing (P=0.032, hazard ratio >1).Concordant hypermethylation in at least three loci was observed in 50 out of 55 (91%) of ovarian tumors examined. The test sensitivity and specificity were assessed to be 96 and 67% for CYP39A1; 95 and 88% for GTF2A1; 93 and 67% for FOXD4L4; 81 and 67% for EBP; 89 and 82% for HAAO, respectively. Our data have identified, for the first time, GTF2A1 alone, or GTF2A1 plus HAAO are excellent candidate biomarkers for detecting this disease. Moreover, the known functions of these gene products further implicate dysregulated transcriptional control, cholesterol metabolism, or synthesis of quinolinic acids, may play important roles in attributing to ovarian neoplasm. Molecular therapies, by reversing the aberrant epigenomes using inhibitory agents or by abrogating the upstream signaling pathways that convey the epigenomic perturbations, may be developed into promising treatment regimens.
IntroductionOvarian cancer remains the most lethal malignancy of the female reproductive tract, and is ranked as the fourth leading cause of cancer death in women (1). While there are over 20,000 new cases diagnosed annually, approximately 15,000 deaths are reported in the United States each year (1). Typically, ovarian cancer is asymptomatic in the early stages and hence three-fourths of women are diagnosed after the disease has metastasized beyond the primary site which frequently causes poor prognostic outcomes. Investigation of early molecular events resulting in ovarian cancer has been hampered by the lack of identifiable precursor lesions as well as poor biomarkers for laboratorial tests. Currently, the only clinically accepted biomarker is CA125, which is found elevated in the serum of the majority of ovarian cancers (reviewed in ref.2). Although CA125 has high clinical sensitivity, its use for early ONCOLOGY REPORTS 22: 853-861, 2009 Abbreviations: DAC, 5-aza-2'-deoxycytidine; nOSE, normal ovarian surface epithelia; qMSP, quantitative methylation-specific polymerase chain reactions; qRT-PCR, quantitative reverse transcription followed by polymerase chain reactions; TSA, trichostatin A