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Loss of Lkb1 Provokes Highly Invasive Endometrial Adenocarcinomas

¹ Department of Pathology, ² Simmons Comprehensive Cancer Center, ³ Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, and ⁴ Hamon Center for Therapeutic Oncology Research, University of Texas Southwestern Medical Center, Dallas, Texas; ⁵ Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School; ⁶ Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts; and ⁷ Department of Pathology, M. D. Anderson Cancer Center, Houston, Texas

Requests for reprints: Diego H. Castrillon, University of Texas Southwestern Medical Center, Department of Pathology, 6000 Harry Hines Boulevard, Dallas, TX 75390-9072. Phone: 214-648-4032; Fax: 214-648-7355; E-mail: diego.castrillon{at}utsouthwestern.edu.

Key Words: Endometrial cancer • Lkb1 • invasion • cell polarity

Mutations in the LKB1 tumor suppressor gene result in the Peutz-Jeghers syndrome, an autosomal dominant condition characterized by hamartomatous polyps of the gastrointestinal tract and a dramatically increased risk of epithelial malignancies at other sites, including the female reproductive tract. Here we show that female mice heterozygous for a null Lkb1 allele spontaneously develop highly invasive endometrial adenocarcinomas. To prove that these lesions were indeed due to Lkb1 inactivation, we introduced an adenoviral Cre vector into the uterine lumen of mice harboring a conditional allele of Lkb1. This endometrial-specific deletion of the Lkb1 gene provoked highly invasive and sometimes metastatic endometrial adenocarcinomas closely resembling those observed in Lkb1 heterozygotes. Tumors were extremely well differentiated and histopathologically distinctive and exhibited alterations in AMP-dependent kinase signaling. Although Lkb1 has been implicated in the establishment of cell polarity, and loss of polarity defines most endometrial cancers, Lkb1-driven endometrial cancers paradoxically exhibit (given their highly invasive phenotype) normal cell polarity and apical differentiation. In human endometrial cancers, Lkb1 expression was inversely correlated with tumor grade and stage, arguing that Lkb1 inactivation or down-regulation also contributes to endometrial cancer progression in women. This study shows that Lkb1 plays an important role in the malignant transformation of endometrium and that Lkb1 loss promotes a highly invasive phenotype. [Cancer Res 2008;68(3):759–66]