Purpose: This study was designed to provide a comprehensive assessment on the role of h1,6-branched oligosaccharides in the metastasis and outcome of breast carcinoma. Generation of these structures on N-glycans is initiated by h1,6-N-acetylglucosaminyltransferase V and used by both myeloid cells and cancer cells in systemic migration.Experimental Design: Tissue microarrays of >700 tumors (>400 patients; 30-year follow-up data) were stained through lectin histochemistry with leukocytic phytohemagglutinin (LPHA), a selective marker for h1,6-branched oligosaccharides. Node-negative and node-positive primary tumors and patient-matched lymph node metastases were scored by blinded observers. Results: Metastases stained at significantly greater intensities than did the patient-matched primary tumors (P < 0.0001), demonstrating for the first time that the abundance of h1,6-branched oligosaccharides was directly associated with breast carcinoma nodal metastasis. Multivariate analyses revealed that h1,6-branched oligosaccharides in primary tumors were a predictor of poor outcome, most notably in node-negative tumors, where an LPHA staining score of 3+ gave a risk factor of 3.3, independent of tumor size, nuclear grade, or patient age (P = 0.007).
Conclusions:The data firmly establish a role for h1,6-N-acetylglucosaminyltransferase V activity and h1,6-branched oligosaccharides in breast carcinoma metastasis, and reemphasize the involvement, although poorly understood, of aberrant glycosylation in tumor progression.h1,6-N-acetylglucosaminyltransferase V (GnT-V, E.C.2.4.1.155) is a key enzyme in the production of tri-or tetra-antennary glycans, and catalyzes the transfer of N-acetylglucosamine to a-1,6-mannose in the pentasaccharide core of acceptor glycans (1-3). This forms a h1,6 branch point, whose branches typically consist of polylactosamine antennae, carriers of the fucosyl-based antigens, Lewis x and Lewis a . These are used by both normal leukocytes and tumor cells in selectin binding (4-9). h1,6 branching also affects numerous cellular pathways for adhesion, motility, angiogenesis, and apoptosis (see Discussion). Thus, the h1,6 branch point represents a potential rate-limiting step in systemic migration. This branch point can be identified through lectin histochemistry with the plant lectin, leukocytic phytohemagglutinin (LPHA), which exhibits high specificity for h1,6 branching on N-glycans (10, 11) and can be used in formalin-fixed, paraffin-embedded tissues (12). LPHA binding to histologic sections of melanomas was resistant to the strong oxidative bleaching procedures necessary to decolorize melanin (12), indicating the h1,6 branches were stable to oxidation, a major cause of antigen loss on long-term storage of paraffin-embedded tissues (13). LPHA binding was markedly reduced when histologic sections of renal cell carcinomas, melanomas, and breast carcinomas were preincubated with glycosidase F, indicating that the h1,6 branch points were associated with N-glycans (asparagine linked) in these tissues ...