Abstract. Osteosarcoma is the most common primary bone malignancy in pediatric and adolescent populations. Recurrence and metastatic potential can be due to a subpopulation of cells with stem cell-like characteristics, such as tumor-initiating cells (TICs), which maintain the capacity to regenerate entire tumors. Targeting the TICs in osteosarcoma is a promising avenue for the development of new therapies for this devastating disease. TICs are usually quiescent with a low protein turnover, decreased metabolism, and downregulation of proteasome activity. Recently, cancer cells with low proteasome activity have been identified as TICs in several types of cancer. We stably infected two osteosarcoma cell lines, MG-63 and U2-OS, with an expression vector for a fusion protein between the green fluorescent protein, ZsGreen, and the C-terminal degron of the murine ornithine decarboxylase to monitor the 26S proteasome activity in living cells. We separated the osteosarcoma cells with low proteasome activity using fluorescence-activated cell sorting (FACS) and verified whether these ZsGreen + cells had TIC-like properties. The ZsGreen + cells showed enhanced sphere formation capacity and underwent asymmetric divisions into ZsGreen + and ZsGreen -cells, whereas ZsGreen -cells underwent only symmetric divisions into ZsGreen -cells. Moreover, the ZsGreen + cells were more chemo-and radioresistant. Thus, the present study demonstrated that chemoradiation-resistant TICs can be visualized by this system and suggested the rationale for further study of osteosarcoma stem cells.
IntroductionOsteosarcoma is the most common primary bone malignancy in children and young adults. Osteosarcoma occurs in the long bones of the limbs, particularly in the distal femur and proximal tibia. Osteosarcoma is a locally aggressive tumor and tends to produce early distant metastases, particularly to the lung. Before 1970, amputation was the only treatment for osteosarcoma patients and 80% patients died of metastatic disease (1). Since the 1970s, the combination of limb-sparing surgery and conventional chemotherapy agents, including methotrexate (MTX), cisplatin (CDDP), and doxorubicin, has been used to treat osteosarcoma. However, the 5-year patient survival has plateaued at ~60-70% (2).Tumors are organized into a hierarchy of heterogeneous cell populations. Recurrence and metastatic potential may be due to a subpopulation of cells with stem cell-like characteristics, such as cancer stem cells (CSCs) or tumor-initiating cells (TICs), which maintain the capacity to regenerate entire tumors (3). Targeting the TICs in osteosarcoma may be a promising avenue to explore for the development of new therapies for this devastating disease.Increasing evidence of the existence of TICs in patients with osteosarcoma has been reported. Identification of osteosarcoma TICs has been performed using CD133 (4,5), side populations (6,7), PKH26 (8), ALDH1 (9,10), and the promoter reporter assays of hTERT (11)