Epithelial Na, K-ATPase expression is down-regulated in canine prostate cancer; a possible consequence of metabolic transformation in the process of prostate malignancy
© Mobasheri et al; licensee BioMed Central Ltd. 2003
Received: 25 November 2002
Accepted: 13 June 2003
Published: 13 June 2003
An important physiological function of the normal prostate gland is the synthesis and secretion of a citrate rich prostatic fluid. In prostate cancer, citrate production levels are reduced as a result of altered cellular metabolism and bioenergetics. Na, K-ATPase is essential for citrate production since the inward Na+ gradients it generates are utilized for the Na+ dependent uptake of aspartate, a major substrate for citrate synthesis. The objective of this study was to compare the expression of previously identified Na, K-ATPase isoforms in normal canine prostate, benign prostatic hyperplasia (BPH) and prostatic adenocarcinoma (PCa) using immunohistochemistry in order to determine whether reduced citrate levels in PCa are also accompanied by changes in Na, K-ATPase expression.
Expression of Na, K-ATPase α1 and β1 isoforms was observed in the lateral and basolateral plasma membrane domains of prostatic epithelial cells in normal and BPH prostates. Canine kidney was used as positive control for expression of Na, K-ATPase α1 and γ isoforms. The α1 isoform was detected in abundance in prostatic epithelial cells but there was no evidence of α2, α3 or γ subunit expression. In advanced PCa, Na, K-ATPase α1 isoform expression was significantly lower compared to normal and BPH glands. The abundant basolateral immunostaining observed in normal and BPH tissue was significantly attenuated in PCa.
The loss of epithelial structure and function and the transformation of normal epithelial cells to malignant cells in the canine prostate have important implications for cellular metabolism and are accompanied by a down regulation of Na, K-ATPase.
The principal physiological function of the prostate gland is the synthesis, accumulation and secretion of the anion citrate . Citrate may be used as an important energy source for spermatozoa, or involved as a buffer or chelator of cations in seminal fluid . Na+ dependent uptake of aspartate from plasma is achieved by two kinetically distinct Na+-dependent transport systems to create a high cytosolic aspartate concentration . Aspartate provides the intra-mitochondrial source of oxaloacetate while glucose provides the source of acetyl-CoA for citrate biosynthesis . Ouabain-sensitive Na, K-ATPase-mediated transport is critical for aspartate uptake, citrate production and prostatic fluid formation since the inward Na+ gradients generated by Na, K-ATPase are utilized for the Na+ dependent uptake of aspartate. Na+ and K+ also represent a large component of prostatic fluid osmolarity  and their levels are finely regulated by plasma membrane transport systems that have yet to be identified. Furthermore, androgen activation of Na, K-ATPase serves as a metabolic pacemaker in the prostate [6, 7] exerting transcriptional control over the expression of Na, K-ATPase subunits, which play a critical role in the biogenesis of Na, K-ATPase in prostate cancer [8, 9]. In normal prostate, citrate concentrations in prostatic fluid range from 40 to 150 mM. In prostate cancer however, citrate production levels are significantly reduced as a result of altered cellular metabolism and bioenergetics .
Na, K-ATPase is an important regulator of intracellular electrolyte levels in almost all mammalian cells [10, 11]. It is a Mg2+-dependent P-type transport pump responsible for maintaining the low intracellular Na+:K+ ratio that is essential for cell homeostasis and physiological function. It catalyzes the active uptake of K+ and extrusion of Na+ at the expense of hydrolyzing ATP with a stoichiometry of 3Na+ for 2K+. The active form of Na, K-ATPase is an integral membrane protein complex primarily composed of two non-covalently attached subunits; a 110-kDa catalytic α subunit and a 45–55-kDa glycosylated β subunit. The α subunit has binding sites for Na+, K+, ATP and cardiac glycosides (digitalis and ouabain) . Four α isoforms encoded by different genes have been identified which are ~85% identical at the protein level [13, 14]. The β subunit is a complex type II glycoprotein with a short cytoplasmic NH2 terminus, a single transmembrane domain and a large globular COOH ectodomain containing three disulfide bridges and sites for N-linked glycosylation.
Renal Na, K-ATPase consists of an additional small component known as the γ subunit [15, 16]. The γ subunit is a member of the FXYD family of small ion transport regulators  and is believed to be responsible for fine regulation of Na+ transport in the nephron by modulating the transport function of renal Na, K-ATPase [18, 19].
We have previously shown that human and rat prostatic epithelial cells express the α1, β1 and β2 isoforms of Na, K-ATPase [20, 11]. Despite the importance of Na, K-ATPase function for citrate production there is no information about its expression patterns in hyperplastic or neoplastic prostate. The objective of this study was to determine the localization of Na, K-ATPase and to compare expression of Na, K-ATPase isoforms in normal canine prostate, benign prostatic hyperplasia (BPH) and prostatic adenocarcinoma (PCa) in order to determine whether reduced citrate levels in PCa are also accompanied by changes in Na, K-ATPase expression.
The results of this study reveal that the α1 and β1 subunits are the dominant Na, K-ATPase isoforms expressed in the basolateral membranes of epithelial cells in normal and BPH canine prostate. The α2, α3 and γ subunits of Na, K-ATPase are not expressed in this tissue. Immunohistochemical and image analyses performed in this study suggest that Na, K-ATPase expression is significantly reduced in canine PCa. The cause of this down-regulation is not known at present but it may be associated with the loss of epithelial polarity and function in prostate cancer. It may also be related to the reduced citrate production and secretion that accompanies neoplastic development in the prostate . There is, however, an argument against the latter scenario: unlike the human prostate, the canine counterpart does not produce huge quantities of citrate (L.C. Costello, personal communication). Therefore, the down-regulation of Na, K-ATPase could be intricately involved in a series of other metabolic changes that occur during the progression of prostate malignancy, or it could merely be a consequence of such changes, which has little effect in the process of neoplastic transformation.
Androgen ablation therapy is often used to treat advanced prostate cancer – a treatment that is successful until the malignant growth evolves resistance to this and becomes androgen-independent . Previous studies have indicated that the β-subunit of Na, K-ATPase is down-regulated in the prolonged presence of a synthetic androgen at a transcriptional level, resulting in a reduction of functional Na+, K+-ATPase in androgen-dependant prostate cell-lines . Studies have also shown that voltage activated sodium channel (VASC) activity and expression is altered in prostate cancer cell lines  and VASC protein expression has been shown to enhance the invasive, metastatic properties of rat and human prostate cancer cells . Taken together, these results suggest that neoplastic development in the prostate is accompanied by changes in cell homeostasis and expression levels of ion transporters including Na, K-ATPase and VASC. Whether Na, K-ATPase expression is also reduced in human PCa remains to be determined.
Normal (2 prostates), BPH (2 prostates) and PCa (3 prostates) were dissected from the cadaver of canines following euthanasia. Normal and BPH tissue was obtained from animals euthanased for non-related clinical reasons. Canine kidneys were used as positive controls for expression of Na, K-ATPase γ subunit. All the procedures were carried out in accordance with current local guidelines. Tissues were fixed for 48 hrs in neutral buffered formalin before being embedded in paraffin wax. The sections of prostate tissue were histologically and morphologically analyzed using established histpathological criteria (i.e. cellular and nuclear pleomorphisms as evidence of dysplastic and neoplastic alterations ) by two independent veterinary pathologists and were categorized into normal, BPH, well differentiated (low grade) and poorly differentiated (high grade) adenocarcinomas.
All chemicals and secondary antibodies used were purchased from Sigma Biosciences (Poole, Dorset, UK). Fast-Red alkaline phosphatase precipitating agent was purchased from Sigma/Aldrich (Poole, Dorset, UK).
Isoform specific antibodies used to detect the isoforms of Na, K-ATPase in canine prostatic tissue by immunohistochemical analysis.
D. M. Fambrough
Pan α (monoclonal)
known α isoforms
Pan α (monoclonal)
known α isoforms
Image analysis was carried out using Scion Image for Windows (version 4.0.2 http://www.scioncorp.com/) based on NIH Image for Macintosh. Sections used for image analysis were only exposed to the Fast-Red precipitating agent and not counterstained with hematoxylin.
The results are expressed as the means +/-SD of a representative experiment performed in triplicate. The means were compared using student's t-test assuming equal variances. p < 0.05 was considered statistically significant.
Note added in proof
In a very recent study of Na, K-ATPase α and β subunit expression in bladder tumours, human urothelial cancer tissue microarrays have been successfully used to demonstrate that the mean protein expression for both α and β subunits of Na, K-ATPase is reduced in invasive bladder tumours compared to benign and dysplastic tissue . These recent findings partially confirm our results in canine prostate cancer. The authors have suggested that Na, K-ATPase α and β subunit expression levels may be useful predictors of clinical outcomes.
Research grants from the Pet Plan Charitable Trust (Grant no. 02–11) and the Wellcome Trust (U.K.) supported this work. We wish to thank the pathologists of the Department of Veterinary Pathology at the University of Liverpool for supplying tissues and original histopathological interpretations. We are particularly grateful to Dr M. Takahashi and Dr M.W. McEnery for the pan α specific monoclonal mAb 9A7. We express our gratitude to Dr. D.M. Fambrough (Johns Hopkins University), Dr. K.J. Sweadner (Harvard University), Dr. S.J.D. Karlish (Weizmann Institute of Science, Rehovot, Israel) and Dr. M.J. Caplan (Yale University School of Medicine) for their continued generosity in provision of antibodies. We would also like to acknowledge Dr. D. Alvarez de la Rosa (Yale University School of Medicine) for critical comments on the manuscript and Dr. L.C. Costello (University of Maryland) for useful discussions and invaluable advice.
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