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Correlation of NRF2 and progesterone receptor and its effects on ovarian cancer biology

Authors Czogalla B, Kahaly M, Mayr D, Schmoeckel E, Niesler B, Hester A, Zeder-Göß C, Kolben T, Burges A, Mahner S, Jeschke U, Trillsch F

Received 26 March 2019

Accepted for publication 27 June 2019

Published 14 August 2019 Volume 2019:11 Pages 7673—7684

DOI https://doi.org/10.2147/CMAR.S210004

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Melinda Thomas

Peer reviewer comments 2

Editor who approved publication: Dr Xueqiong Zhu


Bastian Czogalla,1 Maja Kahaly,1 Doris Mayr,2 Elisa Schmoeckel,2 Beate Niesler,3 Anna Hester,1 Christine Zeder-Göß,1 Thomas Kolben,1 Alexander Burges,1 Sven Mahner,1 Udo Jeschke,1 Fabian Trillsch1

1Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany; 2Faculty of Medicine, Institute of Pathology, Lmu Munich, Munich, Germany; 3Department of Human Molecular Genetics, Institute of Human Genetics, University of Heidelberg, Heidelberg, Germany

Purpose: This study aimed to investigate the potential prognostic impact of nuclear factor erythroid 2-related factor 2 (NRF2) and progesterone receptor A (PRA)/progesterone receptor B (PRB) in ovarian cancer patients which might be the rationale for putative new treatment strategies.
Patients and methods: The presence of NRF2 and PRA/PRB was investigated in 156 ovarian cancer samples using immunohistochemistry (IHC). Staining of NRF2 and PRA/PRB was rated using the semi-quantitative immunoreactive score (IR score, Remmele’s score) and correlated to clinical and pathological data. NRF2 and PRA/PRB expression were compared with respect to the overall survival (OS).
Results: NRF2 staining was different in both, the cytoplasm and nucleus between the histological subtypes (p=0.001 and p=0.02, respectively). There was a significant difference in the PRA expression comparing all histological subtypes (p=0.02). Histological subtypes showed no significant differences in the PRB expression. A strong correlation of cytoplasmic NRF2 and PRA expression was detected (cc=0.247, p=0.003) as well as of cytoplasmic NRF2 and PRB expression (cc=0.25, p=0.003), confirmed by immunofluorescence double staining. Cytoplasmic NRF2 expression was associated with a longer OS (median 50.6 vs 32.5 months; p=0.1) as it was seen for PRA expression (median 63.4 vs 33.1 months; p=0.08), although not statistically significant. In addition, high PRB expression (median 80.4 vs 32.5 months; p=0.04) and concurrent expression of cytoplasmic NRF2 and PRA were associated with a significantly longer OS (median 109.7 vs 30.6 months; p=0.02). The same relationship was also noted for NRF2 and PRB with improved OS for patients expressing both cytoplasmic NRF2 and PRB (median 153.5 vs 30.6 months; p=0.009). Silencing of NFE2L2 induced higher mRNA expression of PGR in the cancer cell line OVCAR3 (p>0.05) confirming genetic interactions of NRF2 and PR.
Conclusion: In this study, the combination of cytoplasmic NRF2 and high PRA/PRB expression was demonstrated to be associated with improved overall survival in ovarian cancer patients. Further understanding of interactions within the NRF2/AKR1C1/PR pathway could open new additional therapeutic approaches.

Keywords: nuclear factor erythroid 2-related factor 2, progesterone receptor, ovarian cancer, immunohistochemistry


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