Multiple myeloma (MM) is a cancer of plasma cells with complex molecular characteristics that evolves from monoclonal gammopathy of undetermined significance, a highly prevalent premalignant condition. MM is the second most frequent hematologic cancer in the United States, and it remains incurable, thereby highlighting the need for new therapeutic approaches, particularly those targeting common molecular pathways involved in disease progression and maintenance, shared across different MM subtypes. Here we report that Wnt/-catenin is one such pathway. We document the involvement of -catenin in cell-cycle regulation, proliferation, and invasion contributing to enhanced proliferative and metastatic properties of MM. The pleiotropic effects of -catenin in MM correlate with its transcriptional function, and we demonstrate regulation of a novel target gene, Aurora kinase A, implicating -catenin in G2/M regulation. -catenin and Aurora kinase A are present in most MM but not in normal plasma cells and are expressed in a pattern that parallels progression from monoclonal gammopathy of undetermined significance to MM. Our data provide evidence for a novel functional link between -catenin and Aurora kinase A, underscoring a critical role of these pathways in MM disease progression. (Blood.
2009;114:2699-2708) IntroductionMultiple myeloma (MM) is a neoplasm of plasma cells that infiltrates the bone marrow (BM). Despite recent advances in its treatment, it remains incurable, with a median survival of 6 years. 1 MM accounts for more than 10% of all hematologic malignancies and is the second most frequent hematologic cancer in the United States. It is typically preceded by an age-progressive condition termed monoclonal gammopathy of undetermined significance (MGUS), which is present in 1% to 10% of adults older than 25 years of age and progresses to malignant MM at a rate of 0.5% to 3% annually. 1,2 This disease is characterized by frequent chromosomal aberrations and mutations in several oncogenes and tumor-suppressor genes. 3,4 The Wnt/-catenin pathway is significant in cancer development because numerous human malignancies such as colorectal, hepatocellular, and breast cancer harbor activating mutations in critical components of this pathway. 5,6 Normally, the Wnt signaling pathway is active during embryogenesis, hematopoietic stem cell growth, cell differentiation, and tissue development. -catenin, a central effector of the Wnt pathway, is involved in both nuclear and cytoplasmic functions. 7,8 In the absence of Wnt ligands, -catenin is targeted by a complex consisting of adenomatous polyposis coli, axin, glycogen synthase kinase-3, and casein kinase 1␣ that phosphorylate and mark it for degradation by the ubiquitinproteasome pathway. 9,10 Upon Wnt stimulation, however, the kinase complex is dissociated, and -catenin is not targeted for destruction. The active form of -catenin translocates to the nucleus and, in association with lymphoid enhancer factor (LEF)/Tcell factor (TCF) proteins, activates transcription...