Genes Highly Expressed in Normal Cervical Epithelium

To determine cervical tissue specific expression, we first investigated the expression of the 107 genes using expression data available at the National Center for Biotechnology Information (NCBI) Unigene database and the National Cancer Institute (NCI) Cancer Genome Anatomy Project (CGAP) SAGE Anatomical Viewer. Based on CGAP information, only four of the 107 genes were unique to cervical tissue: carcinoembryonic antigen-related cell adhesion molecule 7 (CEACAM7), keratin 6A (KRT6A), small proline-rich protein 3 (SPRR3) and S100 calcium binding protein A7 (S100A7). These genes were further investigated for expression by RT-PCR in 20 different tissue types and three normal cervical specimens (Figure 2). CEACAM7 was found to be expressed in colon, larynx, pancreas and two of the three normal cervical specimens. KRT6A expression was detected in placenta, thymus, tongue, prostate, larynx, colon, skin and in all three of the normal cervical specimens. SPRR3 was found strongly expressed in placenta, thymus, colon, tongue, larynx and all three of the normal cervical cases. S100A7 showed expression in placenta, thymus, and tongue and in all three of the normal cervical specimens. All four genes were prominently expressed in the cervical epithelium but this combination of genes was not expressed in the tissues examined (Figure 2).

Disrupted Gene Expression in CIN III

All tags were assessed for altered expression in CIN III. Four hundred and seventy-six tag show greater than two fold increase in CIN III and are expressed at greater than 15 tpm (see Additional file 1) while 315 tags were decreased in CIN III (see Additional file 2).

We determined if the expression of the 107 unique tags, that were highly expressed in normal cervical libraries (> 500 TPM), were disrupted in CIN III. Comparison of expression levels in N1, N2 to the CIN III libraries using the Z-test revealed five differentially expressed genes (Table 2). Annexin 2 (ANXA2), galectin 7 (LGALS7) and connexin 43 (GJA1) exhibited decreased expression in CIN III (Z < -1.96) while aquaporin 3 (AQP3) and ribosomal-like protein 37 (RPL37) increased in expression (Z > 1.96). Real-time PCR was performed on a panel of 6 new cervical specimens, three each of normal and CIN III for all five of these genes (Figure 3). Expression results were normalized to housekeeping gene ACTB and 18S (Figure 3A and 3B, respectively). Decrease in expression of ANXA2, LGALS7 and GJA1 in CIN III was confirmed while increase in expression of AQP3 and RPL37 were not.

					Z_Scorea
Tag	N1 tpm	N2 tpm	C1 tpm	C2 tpm	N1 vs C2	N1 vs C1	N2 vs C2	N2 vs C1	Gene Symbol
TTTGCTTTTGTTTTGTT					-4.7	-3.1	-5.1	-3.5	AQP3
CAATAAATGTTCTGGTT	5063	3272	6362	6064	-3.5	-4.6	-10.8	-12	RPL37
TGTTCTGGAGAGTGTTC	741	1310	504	513	2.4	2.6	6.9	7.3	GJA1
TAAACCTGCTGTGCGGG	682	2220	446	425	2.9	2.7	12.9	13.4	LGALS7
CTTCCAGCTAACAGGTC	1644	1754	1298	887	5.6	2.4	6.3	3.2	ANXA2

^a Z > 1.96; reduced expression in CIN III, Z < -1.96; increased expression in CIN III.

Viral (HPV 16) tags in L-SAGE libraries

Assessing Highly Expressed Tags by Functional Group

Of the 107 highly expressed tags (>500 tpm), 47 were expressed at extremely high levels (>10³ tpm) including genes frequently used as controls in expression analysis, GAPDH and ACTB. High expression of 20 genes in normal cervical tissue was reported in a previous study [3]. Fifteen of these genes are encompassed by our list of 107 high expressers. The most highly expressed tags expressed at >10⁴ tpm (GTGGCCACGGCCACAGC and TACCTGCAGAATAATAA) mapped to the genes S100A9 and S100A8, respectively. Both genes belong to the calcium binding protein family. These findings are in agreement with a previous report of high S100A8 and S100A9 levels in cervical tissue [3]. Although the function of these genes is not well understood, genes within this family have been proposed to participate in a variety of cellular process including cell cycle, wound healing and cell differentiation [9].

Assigning the 103 highly expressed genes to one of eleven broad functional groups allowed for an assessment of those cellular processes represented by the most abundant transcripts. These cellular processes include calcium binding proteins, cell cycle or cell death, cytoskeleton, immune functioning, keratinization, membrane proteins, mitochondrial, protein processing, translation (ribosomal proteins), translation (non ribosomal proteins) with a small fraction of tags mapping to other functional groups or to genes with no known function (Figure 4A). The 41 ribosomal genes account for the greatest proportion of highly expressed genes at 28% and 31% (normal and CIN III, respectively). In contrast, only five calcium binding genes account for the second largest functional subgroup of highly expressed tags, 18% and 19% (normal and CIN III, respectively).

The relative expression levels of the functional groups do not change greatly between the normal and CIN III libraries however the keratin and immune related functional groups show slight decrease from 12% and 17% in CIN III to 9% and 14% in normal tissue (keratin and immune groups, respectively).

All tags expressed at or greater than 15 tpm in Normal and CIN III libraries (2,814 and 3,279 respectively) were also evaluated according functional group using Onto-Express (see Additional File 3) [10]. The most represented groups included DNA dependent transcription regulators and transcription in both the Normal and CIN III libraries.

Cervical Tissue Gene Signature

Four of the 103 unique genes we found to be abundantly expressed in normal cervical tissue were documented to have limited or no expression in other tissues according to the web resources NCBI UniGene [11] and NCI CGAP SAGE Anatomical Viewer [12, 13] (Figure 1B). These genes (CEACAM7, SPRR3, S100A7 and KRT6A) are our candidates for an expression signature unique to normal cervical tissue and were further investigated in a panel of 20 different tissue types and three new normal cervical specimens. We found that all four of these genes were not abundantly expressed simultaneously in any of the 20 tissues examined (Figure 2). Placenta, thymus and tongue were found to express a combination of three genes (S100A7, SPRR3 and KRT6A), while colon expressed another combination (CEACAM7, SPRR3 and KRT6A). KRT6A and SPRR3 expression was observed in larynx tissue with only minimal expression detected for S100A7 and CEACAM7. In contrast, two of the cervical cases strongly expressed all four genes investigated while only the third showed very low CEACAM7 expression. Significantly, our study is the first to document CEACAM7 expression in cervix. The data suggest that abundant expression of CEACAM7 and S100A7 collectively, are unique to cervical tissue and have the potential to serve as useful biomarkers in identifying origins of metastatic disease.

It is interesting to note that decreased expression of three of the genes is linked to abnormal growth and organization of epithelium. For example, CEACAM7 is a member of the carcinoembryonic antigen family of genes and expression has been documented in highly differentiated normal colon epithelium and the apical surface of normal ductal pancreas epithelium, while loss of expression has been reported in colon hyperplastic polyps [14]. Another member of this gene family, CEACAM1, is shown to have no or very low expression in cervical carcinoma [15]. Decreased expression of KRT6A and S100A7 have been associated with breast, lung and ovarian cancer [16–20]. SPRR3 belongs to the class of small proline rich genes which are expressed in differentiated keratinocytes and has previously been shown to be highly expressed in normal cervical tissue [21].

Genes Altered in Expression in CIN III

The 107 highly expressed unique tags in the normal libraries were assessed for expression changes in CIN III. Two genes showed increased expression (AQP3 and RPL37) while three genes declined in transcript counts in the CIN III libraries (ANXA2, GJA1 and LGALS7). All five were evaluated by real-time PCR in a new cervical tissue panel. Results for ANXA2, LGALS7 and GJA1 confirmed L-SAGE findings.

Panel results for GJA1 are in agreement with those reported by King et al. in that GJA1 expression was detected in normal cervical epithelium while reduced expression was observed in CIN III lesions investigated [22]. It has been suggested that this pattern may be a consequence of epithelial disorganization and not causative in dysplasia development [23, 24].

The high expression of LGALS7 in normal cervical epithelium contrasted by the low expression seen in the CIN III lesions in the tissue panel we report here is similar to those expression patterns seen in studies of other normal tissue types compared to their respective carcinomas including cornea and larynx [25]. LGALS7 expression has been hypothesized in all stratified epithelium tissue types and has been experimentally detected in human cornea, heart, larynx, tongue, skin, thymus and thyroid [26–28]. Though, LGALS7 has been investigated in the context of cell line models, it is interesting to note that expression of this gene in cervical epithelium has not been previously reported [26–28]. LGALS7 is one of fifteen members of the B-galactoside-binding lectin family, some of which have been shown to influence cell growth, cell cycle, apoptosis and cell migration via their predicted role in homeostasis, however, the role of LGALS7 in cancer is unclear [27, 29]. Support for the pro-apoptotic function of LGALS7 was reported by Kuwabara et al. and Bernard et al. who identified cells more sensitive to apoptosis when LGALS7 expression was high in the epithelium derived cells [28, 30, 31]. In contrast, Demers et al. showed an increase in LGALS7 expression in lymphoma cells and suggested a positive role in cell growth and dispersal through induced matrix metalloproteinase 9 (MMP9) expression [32]. We did not observe a statistically significant change in MMP9 in the four libraries investigated. This variance in expression suggests multiple roles for LGALS7 that may be tissue-type dependent.

The third gene investigated, ANXA2, is known to be highly expressed in epithelial cells and is localized to the plasma membrane and endosome. It has been suggested to function in linking membrane to membrane and membrane to cytoskeleton [33]. The decrease in expression we observe suggests that the loss of ANXA2 may be a causative factor in disorganisation of the epithelial architecture, which is characteristic of cervical neoplastic lesions. ANXA2 is also known to bind with S100A10 and participates in transport channel function across the plasma membrane [33]. Interestingly, the ANXA2 binding site on S100A10 also binds NS3, a viral protein from the bluetongue virus, and therefore directly competes with ANXA2. The S100A10 protein has also been shown inhibit Hepatitis B virus polymerase (HBV pol) activity [34]. It is plausible that a S100A10-ANXA2 complex may have a role in HPV infection or viral lifecycle. S100A10 expression was high and consistent in Normal and CIN III libraries whereas ANXA2 decreased in the CIN III libraries.

The above real-time PCR results were normalized to the widely accepted housekeeping gene ACTB (Figure 3A). For comparison we also normalized the genes to a second housekeeping gene 18S (Figure 3B). Briefly, results for GJA1 and LGALS7 were in agreement to those when normalizing to ACTB, however ANXA2 was shown to be increased in CIN III as expected by the SAGE data. but this does not concur with the QPCR results when normalized to ACTB. One possible explanation is that on average, the ACTB cycle threshold was >1.3 Ct lower in the CIN III cases indicating an increase in ACTB expression in CIN III lesions. Any Ct decrease less than this in the genes investigated would appear as a decrease in gene expression in CIN III when normalized to ACTB but and increase when normalized to 18S.

The real-time PCR results for AQP3 and RPL37 did not concur with L-SAGE data and may be due to interindividual differences rather than a representation of changes present in CIN lesions or cancer. It is interesting to note that RPL37 overexpression in prostate cancer, colon cancer cell lines and clinical specimens have been reported [35, 36]. Our L-SAGE results also suggest a similar pattern in cervical neoplasia. Results for these genes when normalized to 18S showed an increase in expression in only CIN III A (see Additional file 3).

Wong et al investigated gene expression in invasive cervical carcinoma by DNA microarray [37]. We investigated this publicly available data through NCBI GEO [38]. Briefly, in this data, GJA1 showed a small decrease in expression in invasive disease while LGALS7 was detected in only four of the 26 specimens, three of which were normal tissue. Moderate AQP3 expression was detected in the majority of cases including the control group. Expression of ANXA2 and RPL37 was not assessed in the microarray study.

Human L-SAGE Tags Map to the HPV Genome

HPV is an established etiological factor in cervical cancer [2]. There are over 100 known strains of HPV, however HPV 16 and HPV 18 are considered to be the frequent high risk types owing to higher rates of persistent infection, higher rates of progression to cervical neoplasia, and shorter median progression times than other HPV strains [2]. HPV 16 is the most common strain and can be detected in approximately 60% of cervical cancers, while HPV 18 infection occurs in approximately 10–20%. Uncontrolled expression of E6 and E7 genes from strains 16 or 18 are considered to be essential for oncogenic transformation and function through inhibition of host cell tumour suppressors p53 and the retinoblastoma protein (Rb) [2].

This is the first study to mine human SAGE libraries for viral transcripts. Overall, CIN III library C2 (2,548 tpm) possessed a greater number of tag counts from the more prevalent HPV 16 strain when compared to C1 (320 tpm) (Table 3). HPV 18 tags were not found in any library and no viral tags were detected in the normal libraries. With the exception of two tags, the viral tags expressed in cervical SAGE did not map to known human genes or expressed sequences. The exceptions, CATGCACGCTTTTTAATTACA and CATGTGTATGTATTAAAAATA, mapped to a single human EST isolated from a uterine tumour (EST BF909200). The full length EST sequence is 97% identical with the HPV 16 genome, more specifically the E5 gene, and therefore was likely amplified from HPV sequences in the original lesion.

Tags mapping to the E5 gene accounted for the greatest proportion of HPV tags mapping to known transcripts in both C1 and C2 (93% and 52%, respectively). E5 is considered to be one of three HPV 16 oncogenes (E5, E6 and E7) and is highly expressed in basal cells of premalignant cervical lesions [39]. This expression declines as cells differentiate and move toward the apical face of the epithelium whereas E6 and E7 expression increases [39]. E5 is detected throughout all epithelium layers in high grade lesions such as CIN III. In contrast, expression is restricted to layers closest to the basal cells in low grade lesions, implying that E5 expression may be limited to undifferentiated basal cells [40, 41]. The high expression of E5 we observe in the CIN III libraries and the absence of HPV 16 genes in the normal libraries is in concordance with such studies.

An increase in sample size and inclusion of mild and moderate stages of cervical intraepithelial neoplasia will aid in quantifying the relationship between viral gene expression and disease. This will also assist in further elucidating genes important in early lesion transcriptome events. A comparison of such events with those seen in later stages will help to identify genes important in the molecular pathogenesis of the disease.

Sample selection

The specimens were collected immediately prior to the LEEP (Loop electrosurgical excision procedure) cone biopsy targeting a small portion of the affected epithelium. These specimens were collected with patient consent at the Vancouver General Hospital Women's Clinic at Vancouver Hospital & Health Science Centre. Cases were assessed by cervical cancer pathologists at Vancouver Hospital and Health Science Centre and were selected without prior knowledge of HPV status. Specimens N1 and N2 in this study were observed to be normal squamous epithelia whereas C1 and C2 were identified as high grade dysplasia or CIN III. Detailed information on specimen pathology based on the LEEP cone specimens can be found in Additional file 4. All samples were stored immediately in RNA later and stored at -80°C. Three cases each of CIN III (CIN III A, CIN III B and CIN III C) and normal cervical tissue (NA, NB and NC) which were used for target validation through real-time PCR were also collected, assessed and stored in the same manner.

L-SAGE Library Construction and Sequence Tag Analysis

The biopsies were individually homogenised in Lysis Binding buffer (100 mM Tris-HCl, pH7.5, 500 mM LiCl, 10 mM EDTA, pH 8.0, 1% LiDS, 5 mM dithiothreitol). Long SAGE libraries were constructed according to the L-SAGE kit manual (Invitrogen, Ontario, Canada). Sequencing was performed at the BC Cancer Agency Michael Smith Genome Sciences Centre. L-SAGE employs 21 basepair sequence tags, reducing the ambiguity in tag-to-gene mapping that is sometimes encountered in classic SAGE libraries which use 14 basepair sequence tags.

Data Analysis

Tags were mapped using the February 12, 2006 version of SAGE Genie [13], and raw tag counts excluding duplicate ditags were normalized to tags per million (tpm). A Z-test analysis, standard for SAGE data analysis, was performed as previously established by Kal et al. for comparison of one SAGE library to another using an established cut-off of 1.96 on the absolute Z-score to determine statistically significant differences in expression levels between normal and CIN III [42].

Reverse Transcriptase PCR

For validation of cervical tissue gene signature, human Multiple Tissue cDNA Panel I and II (Clontech, Mississauga, Ontario) and total RNA for human larynx, skin, stomach and tongue (Stratagene, Cedar Creek, Texas) were used. Five-hundred nanograms from larynx, skin, stomach and tongue was used to generate cDNA. Final concentrations of PCR reagents for cervical tissue signature were 0.5 μM primer, 2 mM MgCl₂, 0.2 mM dNTP, 1× PCR buffer (Invitrogen), 0.5 U Taq polymerase and 1 μL of cDNA (annealing temperatures: 55°C (ACTB, CEACAM7), 60°C (KRT6A), 65°C (SPRR3 and S100A7). Total RNA for the panel of six cervical specimens used for validation of genes was isolated using Trizol (Invitrogen) and cDNA was generated using the High Capacity TaqMan Reverse Transcription Reagents, according to the manufacturer's instructions (Applied Biosystems, Foster City, CA).

Expression of genes selected by data analysis were analyzed by real-time PCR using TaqMan^® Gene Expression Assays on the ABI 7500 Real-Time PCR System (Applied Biosystems, Foster City, CA), according to manufacturer's instructions. Samples were run in duplicate and normalized against an beta-actin (ACTB) endogenous control (HuACTB, Applied Biosytems). Assay IDs include AQP3, Hs00185020_m1; GAL7, Hs00170104_m1; RPL37, Hs02340038_g1; and GJA-1, Hs00748445_s1. The relative quantification of these target genes in CIN III (CIN III A, CIN III B and CIN III C) samples compared to normal tissue (NA, NB and NC) samples was performed using the established 2^-ΔΔCt method, (Applied Biosystems, Relative Quantitation Of Gene Expression, ABI PRISM 7700 Sequence Detection System: User Bulletin #2). The cycle threshold (Ct) value of the target gene was normalized to ACTB by subtracting the Ct value for ACTB from that of the target gene (ΔCt gene = Ct gene - Ct ACTB). This number was then averaged from the three normal cases (ave ΔCt normal). The mean fold change of each gene between normal and CIN III was calculated using the following equation: 2 ^{-(ΔCt gene - ave ΔCt normal)}. The relative quantification values were then plotted, one indicating no change with respect to normal cervical tissue.

HPV Tag-to-Gene Mapping

Viral genomic sequence files (viral1.genomic.fna and HPV11.txt) were downloaded from public repositories and processed into 21 bp SAGE tags at every Nla III site in both orientations using custom Perl scripts [43, 44].