Differential Regulation of the EGFR/PI3K/AKT/PTEN Pathway between Low- and High-Grade Gliomas.

Gliomas represent 70% of all central system nervous tumors and are classified according to the degree of malignancy as low- or high-grade. The permanent activation of the EGFR/PI3K/AKT pathway by various genetic or post-translational alterations of EGFR, PI3KCA, and PTEN has been associated with increased proliferation and resistance to apoptosis. The present study aimed to analyze the molecular/genetic changes in the EGFR/PI3K/AKT/PTEN pathway between low-grade and high-grade gliomas in a sample of Colombian patients. A total of 30 samples were tested for PI3K and PTEN mutations, EGFR, PI3K, and AKT gene amplification, AKT, PI3K, BAX, Bcl2 expression levels, and phosphorylation of AKT and PTEN, EGFR and/or PI3K gene amplification was found in 50% of low-grade and 45% of high-grade ones. AKT amplification was found in 25% of the low-grade and 13.6% of the high-grade. The expression of PI3K, AKT, Bcl2, and BAX was increased particularly to a high degree. AKT phosphorylation was found in 66% of low-grade and 31.8% of high-grade. Increased phosphorylation of PTEN was found in 77% low-grade and 66% high-grade. Our results indicate that alterations in the EGFR/PI3K/AKT/PTEN pathway could be important in the initiation and malignant progression of this type of tumor.

1. Introduction

Gliomas are a heterogeneous group of central nervous system (CNS) tumors. According to the World Health Organization (WHO), they are classified into four types: grade I and grade II astrocytoma, which represents an astrocytic tumor, grade III astrocytoma, which consists of an anaplastic tumor, and grade IV astrocytoma); Grade IV is a lethal form of brain cancer that affects adults with poor prognoses. According to the expression of specific markers, it is possible to distinguish subtypes of proneural, neural, mesenchymal, or classical GBM [1,2,3]. However, new ways of classifying have been proposed, including the classic, proneural, and mesenchymal types, since the neural subtype consists of non-tumor cells [4], although 2021 WHO classification better describes the differences between gliomas of adults and pediatrics. The reported worldwide incidence of malignant tumors of the CNS is 3.7 and 2.6/100,000 habitants/year for women and men respectively [5]. GBM are highly aggressive tumors with an average survival of 1 year [6]. The microenvironment plays an important role in the evolution of this type of tumor, towards different functional states that determine the heterogeneity, largely influenced by cellular metabolism, bioenergetic fitness, availability of nutrients, proximity to blood vessels, biochemical gradients, regulation of oxidative phosphorylation (OXPHOS), glycolysis and the response to hypoxia [7] In glioblastoma, pituitary adenylate cyclase-activating polypeptide (PACAP) has been shown to interfere with the hypoxic microenvironment through modulation of hypoxia-inducible factors through inhibition of the PI3K/AKT and MAPK/ERK pathways and has been related to angiogenesis and epithelial-mesenchymal transition (EMT) [8].

Previous studies have demonstrated the important role of diverse cell signaling pathways in the initiation and progression from low- to high-grade gliomas. These pathways include those mediated by p53/MDM2/p14ARF, RB1/CDK4/p16INK4a, and by epidermal growth factor receptor (EGFR)/phosphatidylinositol 3 kinase (PI3K)/protein kinase B (AKT)/phosphatase and tensin homolog (PTEN), which confer increased capacity for proliferation, invasion, and resistance to cell death [9]. The EGFR/PI3K/AKT/PTEN pathway is commonly activated in different tumors by diverse types of alterations (genetic or post-translational) that regulate the metabolic rate and promote cell survival while inhibiting apoptosis [10].

Mutations encoding epidermal growth factor receptor (EGFR) and isocitrate dehydrogenases (IDH1 and IDH2) are the most common GBM mutated metabolic genes. Amplified EGFR involves pathways to control glycolysis and lipogenesis of the glioma [11] and mitochondria and bioenergetic machinery [12].

Alterations in this pathway include (1) the amplification or mutations of oncogenes such as EGFR, PI3K, and AKT [13]; (2) the mutations on tumor suppressor genes such as PTEN [14]; (3) post-translational modification such as phosphorylation of AKT, that increases its kinase activity, or phosphorylation of PTEN that inhibits its phosphatase activity [13,15,16,17]. In the present paper, we analyzed mutations in PI3K (exons 9 and 20) and the PTEN (exons 5 and 6); gene amplification of EGFR, PI3K, and AKT; expression levels of AKT, PI3K, apoptotic proteins (pro-apoptotic BAX and anti-apoptotic Bcl2), and phosphorylation of AKT (S473) and PTEN (S380), in a sample of low- and high-grade gliomas from Colombian patients. Our results demonstrate the differential regulation of the PI3K/AKT/PTEN pathway in high- and low-grade gliomas, which could be of great importance for diagnosing and treating these types of tumors.

2. Materials and Methods

2.1. Patients and Specimens

The study was approved by the ethics committee of the medical school of the National University of Colombia according to act 10–2010, the written informed consent of all the participants involved was obtained following the rules of the Declaration of Helsinki. A total of 30 samples were collected from patients with a diagnosis of glioma attending the Neuro-Oncology Service of the Colombian National Cancer Institute, in some cases, healthy brain tissue peripheral to the tumor was obtained from these same patients and used as controls, patients treated with drugs before surgery were excluded, the histological analysis and classification of the gliomas were performed by a neuropathologist from the national institute of cancerology, taking into account 2007 WHO classification; each specimen was immediately frozen in liquid nitrogen after surgery and store until use.

2.2. DNA, ARN, and Protein Isolation

A total of 50 mg of each tumor sample was used for DNA, RNA, and protein isolation by using TRIZOL® following the manufacturer’s instructions (Invitrogen, Carlsbad, CA, USA). For RNA, the aqueous phase was quantified by spectrophotometry, and 40 μg of isolated RNA was used to isolate mRNA by using a capture mRNA kit (Roche, Mannheim, Germany). Briefly, total RNA was hybridized with oligo-dT marked with biotin and immobilized streptavidin. These tubes served as the basis for cDNA generation by reverse transcription (RT-PCR).

For DNA, the intermediate phase was mixed with phenol-chloroform-isoamyl alcohol (25:24:1) and centrifuged at 2.420 RCF for 1 min. The following aqueous phase was mixed with a solution of alcohol chloroform 1-isoamyl (24:1) and centrifuged at 2.420 RCF for 1 min. Finally, the aqueous phase was precipitated at −20 °C for 2 h with Isopropanol, 50 μg/mL glycogen, 0.5 M ammonium acetate, followed by centrifugation at 2.420 RCF for 20 min at 4 °C. The precipitate was washed with 70% ethanol and centrifuged at 2.420 RCF for 20 min at 4 °C. Finally, the precipitate was evaporated at 95 °C for 5 min and solubilized in HPLC water.

For the isolation of proteins, a solution of protease inhibitors (sodium fluoride 5 mM, trypsin inhibitor 50 μg/mL, Benzamidine 5 mM, PMSF 1 Mm, sodium vanadate 1 mM) was mixed with lysis buffer (NP40 0.5%, HEPES 1M, pH 7.4 10 Mm, EDTA 0.5 M, pH 8.0 2 mM) in a 1:1 ratio. To preserve the phosphorylation of the serine/threonine and tyrosine phosphatases of interest, a cocktail of four phosphatase inhibitors with broad specificity, which included sodium fluoride, sodium orthovanadate, sodium pyrophosphate, and β-glycerophosphate was added (Halt™ Phosphatase Inhibitor Cocktail-Thermo Scientific-Rockford, 61105 Waltham, MA, USA). Between 50 and 100 mg of sample tissue was transferred to a glass tube in ice. Samples were then homogenized with a micro homogenized at 1.075 RCF with the mixture of protease inhibitors and lysis buffer for 30 min. The samples were then transferred to an Eppendorf tube and sonicated for 4 min, 3 times, at intervals of 10 min. Finally, samples were centrifuged at 2.420 RCF for 10 min at 4 °C and the aqueous phase was transferred to a clean tube and stored at −70 °C. Protein quantification was achieved by using a NanoDropT1000 spectrophotometer (Thermo Scientific, Wilmington, DE, USA).

2.3. Mutations Analysis

For DNA sequencing, primers for PI3K and PTEN were designed using Primer 3 and Blast programs (Table 1). The final concentrations of the primers were obtained in PCR Buffer 1X (10 mM Tris-HCl, 50 mM KCl, 0.1% Triton X-100), using 1.5 mM MgCl2 (for PTEN exon 5 and PI3KCA exon 20), 2 mM MgCl2 (for exon 6 of PTEN) and 2.5 mM MgCl2 (for exon 9 of PI3KCA), dNTPs 0.2 mM, 0.8 mM of each primer, and 1U Taq polymerase for each reaction. The final volume was 25 μL. PCR amplification products were as follows: PTEN exon 5 (518 bp) and exon 6 (274 bp); PI3K exon 9 (487 bp) and exon 20 (525 bp). Subsequently, PCR products were purified using the Wizard PCR Preps DNA Purification System (Promega, Madison, WI, USA), following the manufacturer’s recommendations. DNA sequencing was performed in 5′–3′ and 3′–5′ directions, by using an ABI-3730xl system (Applied Biosystems, Foster City, CA, USA). Finch TV and Gene Runner were used for sequencing analysis. Sequences were compared to Gene Bank reference sequences: PTEN exon 5 (NC 000010 Region, 69576-69814) and exon 6 (NC 000010 Region, 88681-88822); PI3K exon 9 (NC 000003 Region, 69688-69812) and exon 20 (NC 000003 Region, 85572-85842).

Table 1

Sequence of primers for mutational analysis of PI3K and PTEN genes.

Primer Exon 9 PI3KCA	Forward 5′ CCA CAA ATA TCA ATT TAC AAC CAT TG 3’Reverse 5′ GAT TGG TTC TTT CCT GTC TCT G 3′
Primer Exon 20A PI3KCA	Forward 5′ CCA CAA ATA TCA ATT TAC AAC CAT TG 3′Reverse 5′ GAT TGG TTC TTT CCT GTC TCT G 3′
Primer Exon 20B PI3KCA	Forward 5′ GGG GAT TTT TGT TTT GTT TTG 3′Reverse 5′ TTG CAT ACA TTC GAA AGA CC 3′
Primer Exon 5 PTEN	Forward 5′ AAA AAG GAA AGG AGA AGG ACC 3′Reverse 5′ CCT GAA TAA AAT GGG GGA AA 3′
Primer Exon 6 PTEN	Forward 5′ TGT TCC AAT ACA TGG AAG GAT 3′Reverse 5′ ACG ACC CAG TTA CCA TAG CA 3′

2.4. Analysis of Gene Amplification of EGFR, PI3K, and AKT

Primers and TaqMan probes (Applied Biosystems, Foster City, CA, USA) were designed using Prime Express TM software (Applied Biosystems, Foster City, CA, USA) (Supplementary Table S1). The final concentrations used were: 1X Master mix, primers 50 nm, 50 nm probe, and sample, of DNA, each sample was performed in triplicate. PCR conditions were: 1 cycle of 95 °C for 10 min followed by 40 cycles of 95 °C for 15 s and 61 °C for about 1 min. A standard curve was performed for the reference gene (beta-actin), using base 10 dilutions of lymphocytic DNA (15 ng to 15 pg) to calculate the efficiency of the reaction. Gene amplification was determined by using the ΔΔCT comparative method on tumoral and control tissues and having beta-actin as an endogenous control.

2.5. Expression Level of AKT, PI3K, Bcl-2, and Bax

Reverse transcription was performed using SuperScript III first-Strand Synthesis System (Invitrogen, Carlsbad, CA, USA) to obtain cDNA according to the manufacturer’s recommendations. The primers were designed for each cDNA (Supplementary Table S2). A real-time PCR was performed using the SYBR Green detection system (Roche, Mannheim, Germany). The final concentrations used were: 1X master mix, 0.2 mM of each primer, and cDNA 2 μL. The conditions of each PCR were an initial cycle 95 °C for 10 min, followed by 45 amplification cycles each of 95 °C for 10 s followed by 56 °C for AKT, 60 °C for actin, BAX, and Bcl-2 and 62 °C for PI3K, and a final 72 °C extension cycle. The cycling of the melting curve was 95 °C for 1 s, 65 °C for 1 min, and 95 °C continuous. The expression levels of AKT, PI3K, Bcl-2, and BAX in each of the samples were determined by calculating ΔΔCt. Beta-actin was used as endogenous control.

2.6. Immunoblotting for AKT and PTEN Phosphorylation

A total of 50 μg of protein from each sample and the molecular marker was run in a 12% SDS-PAGE using Laemmli buffer. Electrophoresis was carried out 100 V/1 hin in a mini electrophoresis BioRad Protean® II (BioRad, Hercules, CA, USA) using a 12%, SDS-PAGE gel. Proteins were transferred onto nitrocellulose membranes using Mini Trans-Blot (BioRad, Hercules, CA, USA). The transfer was carried out for 1 h at 100 V. The membrane was subsequently incubated in blocking buffer (5% skim milk in TBS with 0.1% Tween-20 (TBS-T) for 1 h. Nitrocellulose membranes were incubated overnight at 4 °C with primary antibodies for phosphorylated PTEN (Phospho PTEN (Ser380) antibody Cell Signaling 9551, Danvers, MA, USA), total AKT (Anti Akt total rabbit Cell Signaling 4691, Danvers, MA, USA), and phosphorylated AKT (Anti fosfo Akt rabbit (Ser473) Cell Signaling, 4060, Danvers, MA, USA). The bound antibody was visualized by incubating the membrane with a specific secondary antibody (anti-rabbit IgG HRP linked 1:4000; Cell Signaling 7074, Danvers, MA, USA) in blocking buffer for 1 h at room temperature, and development was performed using chemiluminescence with ECL (Thermo Fisher, Waltham, MA, USA). The data analysis was performed using the Image-J software. As positive controls, we used protein extracted from the CAD cell line (neuroblastoma) treated with IGF-1.

2.7. Statistical Analysis

Statistical analyzes between low- and high-grade gliomas were performed using Student’s t-test and multivariate analysis with SPSS 6.0 software (Statistical Package for Social Sciences). The level of significance was p < 0.05.

3. Results

3.1. Characteristics of the Samples

The sample included in the present study were 8 low-grade (2 grades I and 6 grade II; 50% men and 50% women), and 22 high-grade (13 were grade IV or GBM; 23% women and 76.92% men) gliomas (Table 2).

Table 2

Frequencies of characteristics of the population with high- and low-grade gliomas. GG: ganglioglioma; AP: Pilocytic Astrocytoma; EPM: Ependymoma; ODG: Oligodendroglioma; OA: Oligoastrocytoma; AA: Anaplastic Astrocytoma; OAA: Anaplastic oligoastrocytoma; ODA: Oligodendroglioma anaplastic; EPMA: Ependymoma anaplastic; GM: glioblastoma multiforme.

		n(%)	Female (%)	Male (%)	Age (Range)	Type
LOW GRADE	GRADE I	2(6.6%)	1(50%)	1(50%)	5–40	1GG	1AP
	GRADE II	6(20%)	3(50%)	3(50%)	20–56	2EPM	2ODG	2OA
HIGH GRADE	GRADE III	9(30%)	2(22.2%)	7(77.7%)	30–56	3AA	3OAA	1ODA	2EPMA
	GRADE IV	13 (43.3%)	3 (23%)	10 (76.92%)	20–58	13GM

3.2. Mutation Analysis of PI3KCA and PTEN Genes

Mutation analysis of the catalytic subunit of PI3K (PI3KCA: exons 9 and 20) and PTEN (exons 5 and 6) was analyzed by PCR amplification followed by Sanger sequencing by using specific primers (Table 1). No mutations were found in the exons analyzed.

3.3. Amplification Level of EGFR, PI3K, and AKT Genes between Low- and High-Grade Gliomas

Relative levels of EGFR, PI3K, and AKT were analyzed using specific TaqMan probes. Amplification of EGFR was found in 12.5% of lo-grade and in 31.8% of high-grade gliomas (p = 0.099); PI3K was amplified in 50% of low-grade and 40.9% of high-grade gliomas (p = 0.36), and amplification of AKT was found in 25% of low-grade and 13.6% of high-grade gliomas (p = 0.64) (Figure 1).

Figure 1

Relative Amplification of EGFR, PI3K, and AKT in low and high gliomas. Gene amplification analysis was performed for EGFR; PI3K, and AKT. An increase in EGRF was observed in high-grade gliomas and PI3k/AKT in low-grade gliomas, however, no statistically significant differences in copy number were observed. Each sample was analyzed in triplicate. A standard curve was performed for the reference gene (beta-actin). Gene amplification was determined by using the ΔΔCT comparative method having beta-actin as an endogenous control. Asterisks and circles show the samples with the highest level of expression in each group.

3.4. Changes in the Expression Levels of AKT, PI3K, BAX, and BCL2 between Low- and High-Grade Gliomas

Expression analysis of AKT, PI3K, BAX, and BCL2 genes was performed by RT-PCR and SYBR Green dye, using beta-actin as endogenous control. The PI3K and AKT genes are key elements that regulate an important cell survival pathway. There was a tendency to increase the expression of AKT in high-grade gliomas (low-grade 12.5% vs. high-grade 32% gliomas; (p = 0.511); while expression of PI3K was particularly high in low-grade gliomas (low-grade 60% vs. high-grade 50% gliomas; (p = 0.680). The BCL2 gene family are important regulators of mitochondrial homeostasis and therefore of the decision of cell death/survival. The pro-apoptotic member of the BCL2 family, BAX, showed a similarly low level of expression between low- and high-grade gliomas (p = 0.471); while there is an increase in the expression of the anti-apoptotic family member, BCL2, in low-grade gliomas (low-grade 50% vs. high-grade 32% gliomas; (p = 0.574) (Figure 2).

Figure 2

Levels expression in low- and high-grade gliomas. Relative expression levels of AKT, PI3K, BAX, and BCL2 were analyzed by RT-PCR. There was a tendency to increase the expression of AKT in high-grade gliomas, while the expression of PI3K was increased in both low- and high-grade gliomas. Pro-apoptotic BAX showed a low level of expression both in low- and high-grade gliomas, while there is a clear increase in the expression of the anti-apoptotic BCL2 in both glioma grades, however, no statistically significant differences were observed. Asterisks and circles show the samples with the highest level of expression in each group.

3.5. Changes in the Level of Phosphorylation of AKT and PTEN between Low- and High-Grade Gliomas

AKT is a key kinase involved in cell survival. Phosphorylation of AKT at serine 473 (Ser 473) is important for its full cell survival function. PTEN is a phosphatase important for the negative regulation of the PI3K/AKT pathway, and its phosphorylation at serine 380 (Ser 380) causes inhibition of PTEN function. We found that there is an increase in the phosphorylation status of AKT (activation) and PTEN (inhibition) in high-grade gliomas as compared to low-grade gliomas (Figure 3), suggesting that these changes could be important for the activation of the PI3K/AKT pathway and malignant progression of gliomas.

Figure 3

Phosphorylation of AKT and PTEN in Low- and High-grade gliomas are presented in relative optical densities (O.R.D). Analysis of protein expression using western blotting of total AKT phosphorylated AKT (Phospho AKT), phosphorylated PTEN (Phospho PTEN). Showed are examples of low-grade (T14, T17, T25, T10, T27) and high-grade (T9, T18, T13, T16, T28, T19, T24, T26, and T30) tumors. Normal cerebral tissue was used as a control of expression. An increase in the level of phosphorylation of AKT (p = 0.32) and PTEN (p = 0.06) was observed between low- and high-grade gliomas, however, no statistically significant differences were observed. Asterisks show the samples with the highest level of phosphorylation of each group.

4. Discussion

In the present study, we aim to analyze the differential molecular/genetic changes in the EGFR/PI3K/AKT/PTEN pathway and the BCL2 family members BAX and BCL2 between low- and high-grade gliomas. The study of genetic alterations associated with the progression of gliomas may highlight possible therapeutic targets that could improve the survival of this devastating pathology. We found in general that gliomas use the activation of the PI3K/AKT pathway, through different mechanisms, from the early stages to its malignant progression to high-grade tumors.

We analyzed a sample of gliomas, that included low- and high-grade gliomas (30% vs. 70% respectively); low-grade gliomas were equally frequent in men and women (50%), while high-grade gliomas were more frequent in men than in women (77.30% vs. 22.64%), as previously described in other populations [18,19,20].

Diverse alterations in the PI3K Class 1A family of proteins have been previously associated with diverse types of cancers [13,21], including gliomas, in which mutations in the catalytic subunit of PI3K (PI3KCA: exons 9 and 20) and mutations in PTEN (exons 5 and 6) are frequently found [22,23]. Although we did not find mutations in PI3KCA nor PTEN in the exons analyzed in the present sample, we cannot exclude the presence of mutations in additional exons, as has been previously described [23,24].

We found amplification of EGFR (12.5% in low-grade and 31.8% in high-grade gliomas: 7.7% in GBM), PI3K (50% and 45% of low- and high-grade gliomas, respectively) and AKT (25% in low-grade and 13,6% in high-grade gliomas). Previous studies have demonstrated either a trend similar to the present results [25,26,27,28,29] or the absence of amplification [22,30,31]. These contradictory results may arise from differences in the techniques used to evaluate the amplification status, as some have used FISH analysis, while others, such as ours, used RT-PCR.

Gene amplification does not directly mean increased activation of the signaling pathway involved and therefore it is important to analyze the expression and level of activation or inhibition of downstream targets such as AKT, PI3K, and PTEN. We found increased expression of AKT (12.5% in low-grade and 32% in high-grade gliomas) and increased expression of PI3K (62% in low-grade and 50% in high-grade gliomas). Activation of AKT (phosphorylation at Ser432) was found in 31.8% of low-grade and 66% of high-grade gliomas, while inhibition of PTEN (phosphorylation at Ser380) was found in 77.2% and 66% of low- and high-grade gliomas. These observations demonstrate that in the samples analyzed, the PI3K/AKT pathway is clearly activated and, therefore, could play an important role in the early stages of carcinogenesis and later to progression to more aggressive forms. Our observations are similar to previous reports [13,14,15,24,26,32,33,34,35].

In addition, there was not a clear increase in the expression of BAX while the expression of BCL2 was elevated (50% in low-grade and in 32% in high-grade gliomas). The decision of a cell to death or survival largely relies on the balance of pro and anti-apoptotic signals [36]. Currently, advances in genomics and molecular classification provide a lot of biological information that could be of great clinical relevance in the prediction, treatment, and prognosis of this type of tumor in different populations [2,3]. The present results showed that the BCL2 family of proteins balance towards an anti-apoptotic signal related to the higher expression of BCL2 and the increase in the relation BCL2/BAX, as has been previously reported [37,38,39,40,41,42]. We hope that our findings can contribute to the improvement inn therapies, survival, and quality of life of patients with this type of tumor.

5. Conclusions

Our results show that the EGFR/PI3K/AKT/PTEN pathway intervenes in the carcinogenic process of gliomas and could be important for the initiation and progression to high-grade tumors such as GBM. Currently, the EGFR/PI3K/AKT/PTEN pathway is one of the main pathways for the diagnosis and treatment of this type of tumor.