
[Cancer Research 60, 1457-1462, March 1, 2000]
© 2000 American Association for Cancer Research
Overexpression of PTEN/MMAC1 and Decreased Activation of Akt in Human Papillomavirus-infected Laryngeal Papillomas1
Ping Zhang and
Bettie M. Steinberg2
Department of Otolaryngology, Long Island Jewish Medical Center, The Long Island Campus of the Albert Einstein College of Medicine, New Hyde Park, New York 11040
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ABSTRACT
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Laryngeal papillomas are benign, human papillomavirus-induced
hyperplastic tumors of the respiratory tract. They are characterized by
overexpression of the epidermal growth factor receptor, constitutive
activation of mitogen-activated protein kinase, a low proliferative
rate, and defects in differentiation. We have now found that
phosphoinositol 3-kinase (PI 3-K) activity is significantly increased
in papilloma tissue. However, phosphorylated Akt (also known as protein
kinase B), a downstream effector of PI 3-K, is reduced when compared
with normal tissue. The ratio of activated Akt to total Akt is much
lower in papillomas than in normal laryngeal tissue, suggesting
decreased Akt activation. PTEN/MMAC1 is a tumor suppressor that
dephosphorylates phosphatidylinositol 3,4,5-triphosphate, an
intermediate in the PI 3-K/Akt signaling pathway. We have found that
PTEN protein is overexpressed in laryngeal papillomas when compared
with normal laryngeal tissues. On the basis of reverse
transcription-PCR analysis, PTEN mRNA is more abundant
in papillomas, suggesting transcriptional up-regulation. We postulate
that negative regulation of the PI 3-K/Akt pathway by PTEN may modulate
the effects of the hyperactive epidermal growth factor
receptor/mitogen-activated protein kinase pathway, contributing to the
low proliferation and dysfunctional differentiation of laryngeal
papillomas.
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INTRODUCTION
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Laryngeal papillomas are benign squamous epithelial tumors caused
by low-risk
HPVs3
types 6 or 11 (1)
. They are characterized by a
hyperplastic suprabasal epithelium surrounding cords of connective
tissues, with the increase in thickness of the spinous layer
attributable to disruption of normal differentiation rather than high
rates of basal or suprabasal cell proliferation (2)
.
Immunohistochemical (3)
and Western blot analysis have
shown that the EGF receptor is overexpressed, activated MAP kinase and
phosphotyrosine levels are increased, and EGF thresholds for MAP kinase
activation are lower in laryngeal papillomas and cells cultured from
the papillomas (4)
. Moreover, the block to differentiation
can be relieved by removing EGF from the medium of organotypic cultures
of papilloma cells (3)
. Taken together, these data suggest
that alterations in the EGF receptor/MAP kinase signal transduction
pathway contribute significantly to the phenotype of laryngeal
papillomas.
The PI 3-K/Akt pathway is a second signal transduction pathway that
serves as a mediator of effects of insulin and several growth factors,
participating in the regulation of proliferation and differentiation by
the MAP kinase pathway (5
, 6)
. PI 3-K is activated in
response to a variety of growth stimuli that activate receptor tyrosine
kinases, including the insulin receptor and the EGF receptor.
Activation of PI 3-K induces the production of PtdIns
(3,4)P2 and PtdIns
(3,4,5)P3. Both of these lipid second messengers
bind to Akt, presumably altering confirmation and enhancing
phosphorylation on threonine at residue 308 and on serine at residue
473 by other cellular kinases (7)
. Maximal activation
requires phosphorylation at both of these sites. A critical modulator
of the PI 3-K/Akt pathway, PtdIns (3,4,5)P3, also
directly activates the kinase that phosphorylates Akt on threonine 308
(8)
. Activation of Akt through the PI 3-K pathway is
required for cell survival and proliferation when the MAPK pathway is
activated (9
, 10)
. Therefore, we postulated that changes
in this pathway might also occur in papilloma tissues.
PTEN/MMAC1/TEP1 is a major new tumor suppressor gene
located on human chromosome 10q23 (11)
. Somatic mutations
of PTEN have been identified in a number of malignancies,
including carcinomas of the breast, prostate, lung, and head and neck
(12, 13, 14, 15, 16)
. Heterozygous disruption of PTEN in
mice leads to tumor formation in multiple tissues, indicating that PTEN
regulates fundamental cellular processes (17)
.
PTEN-knockout mouse embryos display regions of increased
proliferation, and PTEN-deficient immortalized mouse embryo fibroblasts
exhibit decreased sensitivity to cell death, providing in
vivo evidence that PTEN negatively regulates a cell survival
signaling pathway (18)
.
PTEN has homology to tensin, an actin-binding protein localized to
focal adhesion complexes (19)
; to auxilin, a protein
involved in the uncoating of clatherin-coated vesicle
(20)
; and to dual-specificity phosphatases (11
, 21)
. Recombinant PTEN is capable of dephosphorylating both
threonine-and tyrosine-phosphorylated substrates. It also
dephosphorylates lipid second messengers in vitro,
specifically removing the 3-phosphate from PtdIns
(3,4)P2 and PtdIns
(3,4,5)P3 (21
, 22)
.
Overexpression of PTEN suppresses growth and tumorigenicity and induces
G1 cell cycle arrest in human glioblastoma cells,
which is linked to inhibition of the PI 3-K/Akt pathway
(23, 24, 25)
. Overexpression of Akt can rescue cells from
PTEN-dependent death (26)
. Fig. 1
illustrates the EGF receptor/MAP kinase and PI 3-K/Akt pathways.

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Fig. 1. Diagram showing the PI 3-K/Akt pathway, the EGF
receptor/MAP kinase pathway, and a known interaction between the two.
PI-3 Kinase, PI 3-K; MAPK, MAP kinase.
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Studies of PTEN in human tumors have focused on mutation or deletion of
the PTEN gene, and changes in PTEN expression in HPV-induced
benign tumors have not been described. We have analyzed PTEN expression
in laryngeal papilloma tissues by Western blot, RT-PCR and
immunohistochemistry, and analyzed the PTEN-regulated PI 3-K/Akt
pathway. We found activated PI 3-K, overexpression of PTEN, and reduced
activation of Akt. We propose that negative regulation of the PI
3-K/Akt pathway by PTEN may modulate the effects of the highly active
EGF receptor/MAP kinase pathway in laryngeal papillomas, contributing
to the low proliferation rate and dysfunctional differentiation of
these benign tumors.
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MATERIALS AND METHODS
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Tissue Samples
Biopsy specimens were removed during direct laryngoscopy. Normal
tissues were surgical discards of stratified squamous epithelium from
the epiglottis and false vocal fold from patients with no history of
papilloma. A subset of biopsies was from clinically normal tissue
adjacent to papillomas to rule out any systemic difference in signaling
pathways in papilloma patients. Papilloma tissues were removed at the
time of therapeutic laser excision from patients whose lesions had been
assayed previously for HPV presence, typed as either HPV-6 or HPV-11,
as described previously (27)
. Use of these tissue discards
was approved by the Institutional Review Board, and informed consent
was obtained from each subject or subjects guardian.
PI 3-K Assay
Functional kinase assays were done by a modification of the method of
Carpenter et al. (28)
. Tissue lysates
containing 200 µg of protein were immunoprecipitated with
anti-phosphotyrosine (Upstate Biotechnology, Inc., Waltham, MA) and
protein G plus protein A agarose (CalBiochem Corp., San Diego, CA).
Papilloma tissues were sufficiently large to analyze separately,
whereas normal tissues were pooled to achieve protein concentrations
equal to the papilloma extracts. Three normal samples (each a pool of
four normal laryngeal tissues) and five separate papillomas were
analyzed. The lipids L-æ phosphatidyl-L-serine
and L-æ-phosphatidylinositol (Sigma Chemical Co., St. Louis, MO) were
dried under nitrogen in a siliconized tube and then sonicated in 10
mM HEPES (pH 7.4), 0.1 mM
EGTA, and 0.03 ml/100 ml NP40. Reaction mixtures containing 0.5 µCi
of [32 P]ATP per nmol were incubated for 20 min
at 30°C; reactions were stopped by the addition of HCl and extracted
with chloroform-methanol (1:1). Lipids were separated by TLC using the
solvent system n-propyl alcohol:2 M
acetic acid (65:35, v/v). For later experiments, the faster chloroform,
methanol, 2.2 M NH2OH
(9:7:2, v/v/v) solvent system was used. Chromatography plates were
visualized by autoradiography, and films were quantitated by image
analysis (Alpha Innotech Corp., San Leandro, CA).
Western Blotting
Tissue samples were minced and sonicated in lysis buffer [150
mM NaCl, 20 mM HEPES (pH 7.5), 1 mM
MgCl2, 1 mM
CaCl2, 10 g/100 ml glycerol, 1 g/100 ml NP40,
with freshly added 1 µg/ml pepstatin, 1 µg/ml leupeptin, 0.1
mM phenylmethylsulfonyl fluoride, and 1 mM
NaVO4]. Protein concentrations were determined
by the BCA assay procedure (Pierce), and 20 µg protein from each
sample were loaded on 7.5% SDS-polyacrylamide gels. To achieve
sufficient material, two or more normal tissue biopsies were pooled for
each sample. Proteins were electroblotted to nylon transfer membranes,
blocked with 5 g/100 ml nonfat milk in TTSB [10 mM Tris
(pH 7.5), 100 mM NaCl, and 0.1 g/100 ml Tween 20], and
probed with primary antibody. After incubation with the corresponding
alkaline phosphatase-conjugated second antibody, bound immunoglobulins
were detected using chemiluminescent film exposure. The membranes were
stripped in 2 g/100 ml SDS, 62.5 mM Tris (pH 6.8), and 100
mM ß-mercaptoethanol for 30 min at 65°C, rinsed with
TTSB, and reprobed with subsequent primary antibody.
Primary antibodies used in the study were: PTEN and actin (Santa Cruz
Biotechnology, Inc., Santa Cruz, CA), PI-3K (P85; Transduction
Laboratories, Lexington, KY), and Akt, Akt-thr308p, and Akt-ser473p
(New England BioLabs, Inc., Beverly, MA). All antibodies were used as
described by the manufacturers.
Films were quantitated by densitometry. Results were normalized to
actin intensity on the same blot and expressed as mean ± SE. Statistical significance was determined by a two-tailed
Student t test, with significance set at
P < 0.05.
PTEN mRNA Analysis
PTEN message levels were determined by RT-PCR. Total RNA was
isolated from patient tissue samples with RNA STAT-60 (Tel-Test, Inc.,
Friendswood, TX) and treated with RNase-free DNase. First-strand cDNA
was synthesized from 1.5 µg of total RNA with an oligo(dT)16 primer
and AMV reverse transcriptase (Boehringer Mannheim Biochemicals,
Indianapolis, IN). A total of eight normal biopsies were pooled into
one sample to provide sufficient RNA, and three pools were analyzed.
Papilloma RNAs were analyzed individually. Human
PTEN-specific primers, which generate a 671-bp product, were
described previously (29)
. PTEN cDNA from 150
ng of total RNA was amplified with AmpliTaq Gold (PE Biosystems, Foster
City, CA), starting at 95°C for 9 min, and then 43 cycles at 94°C
for 1 min, 60°C for 1.5 min, followed by a final extension at 60°C
for 10 min. The integrity of each RNA sample and equivalence of RNA
amount were confirmed by using primers to 36B4 cDNA, a
housekeeping gene encoding the human acidic ribosomal phosphoprotein PO
(30)
. The amount of template cDNA was titrated to permit
relative quantitation of PTEN mRNA, with 1:10 and 1:25
dilutions of the cDNA used for 36B4 amplification. PCR
products were detected by ethidium bromide staining of agarose gels.
Negative controls included amplification of RNA that had not been
reverse transcribed to rule out possible product from residual DNA and
omission of template from the reaction.
Immunohistochemistry
Serial frozen sections were fixed in cold acetone and incubated with
either anti-PTEN or anti-PTEN preincubated at 4°C overnight with PTEN
peptide (Santa Cruz Biotechnology) to block the antigen recognition
site, used as a negative control. Detection was performed with the
Vectastain ABC kit (Vector Laboratories, Burlingame, CA), using
diaminobenzidine as substrate. Sections were then lightly
counterstained with hematoxylin.
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RESULTS
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PI 3-K Activity Is Elevated in Laryngeal Papillomas
We reported recently that laryngeal papilloma tissues contain high
levels of tyrosine-phosphorylated proteins and increased activation of
the EGF receptor/MAP kinase pathway (4)
. We therefore
asked whether PI 3-Kinase activity was also elevated in the papilloma
tissues. Fig. 2A
shows one such assay. The levels of PI 3-K activity were
elevated in the papilloma extracts (mean, 5.1 ± 2.1
fold higher than the normal tissue extracts). This difference was
significant (P = 0.025), supporting the
hypothesis that multiple signal transduction pathways may be elevated
in laryngeal papillomas.

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Fig. 2. PI 3-K activity and protein abundance in extracts from
laryngeal papillomas and normal laryngeal tissues. A,
TLC of products from a lipid kinase assay. The position of
PtdIns-3-phosphate (PIP) is shown. Ori,
origin. B, Western blot showing protein levels in
extracts. Actin levels on the same blot were used to correct for any
difference in protein content in the extracts. PI3K, PI
3-K.
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The PI 3-K assays were done using equal amounts of protein from the two
types of tissues, not by adding equal amounts of total PI 3-K. To
determine whether total PI 3-K levels were elevated in papilloma cells,
Western blot analysis of both types of tissues was done (Fig. 2B)
. There was no elevation of total PI 3-K in the papilloma
tissues. In fact, the levels were somewhat lower in papillomas relative
to normal tissues (0.45 ± 0.13, compared with
1.0 ± 0.6), although this difference was not
significant. Clearly, the fraction of PI 3-K that was activated was
greater in papillomas than in uninfected tissues, consistent with the
high level of tyrosine phosphorylation in these benign tumors.
Decreased Activation of Akt in Laryngeal Papillomas
Akt is a downstream mediator of PI 3-K, activated by PtdIns
(3,4,5)P3 (8)
. We therefore analyzed
the relative levels of activated Akt by Western blot, using antibodies
specific for either serine- or threonine-phosphorylated Akt and an
antibody that recognized all Akt forms (Fig. 3)
. The amount of Ser-473-P Akt in papilloma tissue relative to normal
tissue was 0.52 ± 0.06 to 1.0 ± 0.02.
This difference was marginally not significant (P = 0.06). However, the relative amount of Thr-308-P Akt was
significantly reduced (P = 0.01), with a
papilloma:normal tissue ratio of 0.2 ± 0.06 to
1.0 ± 0.2. These results were clearly discordant with
the enhanced PI 3-K activity in papilloma tissues.

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Fig. 3. Western blots of phosphorylated and total Akt in extracts
from papillomas and normal tissues. Antibodies specific for Akt
phosphorylated on serine 473, on threonine 308, and total Akt were used
sequentially on the same blot, followed by anti-actin to correct for
differences in protein content in the extracts.
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The fraction of Akt that is active in any given tissue is a function of
both the amount of phosphorylated Akt and the total Akt level. There
was slightly more total Akt in papillomas (1.4 ± 0.2
fold higher than normal tissue). Although this difference was not
significant, it further suggested that activation of Akt in papilloma
tissues was suppressed. When the ratios of phosphorylated Akt to total
Akt were calculated for papilloma tissues relative to normal tissues,
there was a clear reduction in the fraction of Akt that was
phosphorylated in papillomas (Fig. 4)
. The differences were highly significant for both phosphorylation
sites (P = 0.02 for serine phosphorylation and
P = 0.01 for threonine phosphorylation).

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Fig. 4. Fraction of total Akt that was phosphorylated on either
serine 473 or threonine 308 in papilloma tissues, relative to levels in
normal laryngeal epithelium. The low relative abundance of either
phosphorylated form in papillomas was significantly different from
normal tissue (P = 0.02 and 0.01,
respectively). Bars, SE.
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PTEN Is Overexpressed in Laryngeal Papillomas
The inconsistency between elevated PI 3-K activity and reduced Akt
phosphorylation suggested that signaling downstream of PI 3-K might be
blocked. Ramaswamy et al. (25)
reported
recently that PTEN, the phosphatase that dephosphorylates PtdIns
(3,4,5)P3, is linked to inhibition of the PI
3-K/Akt pathway. We therefore analyzed three normal samples (each a
pool of two separate biopsies from different patients) and 10
papillomas from different patients for PTEN protein levels. Fig. 5A
shows one such assay. PTEN was consistently overexpressed
in papillomas. When the PTEN signals were normalized to actin levels
(Fig. 5B)
, the PTEN levels were 3.3 ± 0.6
fold higher in papilloma tissue than in normal tissues, which was
statistically significant (P = 0.01). These
results provided an explanation for the lower levels of phosphorylation
of Akt in papilloma tissues.

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Fig. 5. Expression of PTEN in normal and papilloma tissues.
A, extracts from both types of tissues were analyzed by
Western blot. B, densitometric analysis of PTEN levels
in papilloma tissues compared with normal laryngeal tissues, corrected
for differences in protein loading with antibody to actin.
Bars, SE.
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PTEN RNA Levels Are Increased in Papilloma Cells
PTEN levels are down-regulated in several ways in malignancies,
including reduction in either transcription or translation
(31)
. We therefore asked whether the elevation of PTEN
protein in papillomas reflected differences in steady-state mRNA level.
RT-PCR results were consistent with an increase in PTEN
message in papilloma cells (Fig. 6)
. Each of the eight papilloma samples generated product that could be
visualized on an ethidium bromide-stained gel, albeit at different
levels. However, the PCR product from eight pooled normal tissue RNAs
was below detectable levels. This did not reflect insufficient RNA,
because the 36B4 product level was equal to the papillomas.
Reamplification of the initial PCR products did demonstrate the
presence of PTEN transcripts in normal tissue RNA, but at
very low abundance (data not shown). Two additional pooled normal
samples were equally low in abundance, only visible on reamplification
(data not shown). The negative control, amplifying RNA without reverse
transcription, showed no DNA contamination and confirmed that we were
measuring differences in PTEN RNA abundance. Thus, we
conclude that at least part of the increase in PTEN protein in
laryngeal papillomas is attributable to an increase in PTEN
mRNA levels.

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Fig. 6. RT-PCR analysis of PTEN mRNA in normal laryngeal
epithelium and papillomas. M, molecular weight marker.
N, amplified cDNA from pooled normal tissues.
Papillomas, amplified cDNA from seven separate papilloma
samples. Con, control amplification of RNA from
papillomas, omitting reverse transcription.
H2O, control amplification with
no sample added. Amplification of 36B4 RNA was used to assure
equivalent amounts of cDNA in each amplification reaction.
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PTEN Distribution Is Different in Normal and Papilloma Tissues
We then asked whether all cells within a papilloma overexpressed PTEN,
or whether the expression varied within the tissue (Fig. 7)
. Normal tissue showed faint staining for PTEN in the cytoplasm and
slightly stronger in the suprabasal layers of the tissue (Fig. 7, A and B)
, suggesting that PTEN might be regulated
coordinately with differentiation. In contrast, papilloma tissues
showed strong staining throughout the epithelium (Fig. 7, D and E)
. The stronger staining was consistent with our
Western blot results. Most striking was the presence of PTEN in the
nuclei of many of the papilloma cells, as well as in the cytoplasm.
Recently, Sano et al. (32)
reported PTEN
nuclear staining in a subset of neurons and endothelial cells, ruling
out the likelihood that nuclear staining in papillomas was artifactual.
These results suggest that PTEN is not only overexpressed in
papillomas, but that it might also have additional effects on
regulation of growth and differentiation beyond reducing Akt
activation. We confirmed that the staining patterns were specific for
PTEN, because preabsorption of antibody with PTEN peptide nearly
abolished all staining (Fig. 7, C and F)
.

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Fig. 7. Immunohistochemical detection of PTEN in tissues.
A and B, normal laryngeal tissue, showing
low levels of cytoplasmic PTEN. D and E,
papilloma tissue, showing both cytoplasmic and nuclear PTEN staining
throughout the epithelium. Higher magnification of papilloma tissue
(E) clearly shows nuclear PTEN in a fraction of cells in
the basal layer. C and F, negative
controls for normal and papilloma tissue, with antibody preadsorbed
with PTEN peptide prior to staining papilloma tissue. Tissues were
lightly counterstained with hematoxylin after immunohistochemical
detection of PTEN. Bar, 100 µm.
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Correlation between PTEN and PI 3-K Levels
There was variation in PTEN levels in the different tissue samples,
with papilloma tissues ranging from 1.9 to 5.8 fold higher than the
normal tissue. We had previously noted some variation in PI 3-K levels.
We therefore analyzed the relationship between PI 3-K levels and PTEN
levels. There was a correlation (r = 0.98)
between PI 3-K and PTEN protein level in papillomas (Fig. 8)
. We were also able to analyze four samples for correlation between
relative PI 3-K activity and PTEN level. This analysis, even with the
small sample size, showed a similar correlation, with
r = 0.93 (data not shown). Because of the
need to pool multiple normal tissues for analysis, we were not able to
do the same correlation analysis for the normal tissues. We do not yet
know the mechanism for the coordinate increase in expression of both
proteins or the apparent relationship between PI 3-K activity and PTEN
abundance.

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Fig. 8. Correlation of abundance of PI 3-K and PTEN in papilloma
tissues. Six separate papilloma biopsies were analyzed by Western
blots, and protein levels were quantitated by densitometry and
normalized to actin on the same blots. There was a clear positive
correlation (r = 0.98) between PI 3-K and
PTEN levels in these tissues.
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DISCUSSION
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This study analyzed the abundance and distribution of the tumor
suppressor PTEN in laryngeal papilloma tissues and the PI 3-K/Akt
pathway it regulates. We found that both PTEN and the signaling pathway
were altered when compared with normal laryngeal epithelium. PTEN
protein was consistently overexpressed in papillomas, with differences
in both abundance and distribution.
The suprabasal distribution of PTEN in normal tissue is consistent with
the role of PTEN as a negative regulator of the PI 3-K/Akt pathway.
Activation of that pathway is important in induction of cell
proliferation, and the upper layers of the epithelium are terminally
differentiated and not proliferating. We reported previously that
papilloma tissues show a lower percentage of proliferating basal cells
than normal tissue (2)
. Similarly, cultured papilloma
cells proliferate more slowly than uninfected cells (3)
.
The presence of elevated levels of PTEN in basal cells could explain
the lower proliferative rate of these benign tumors.
The identification of endogenous PTEN substrates has been essential for
a better understanding of its intracellular role in papilloma tissues.
PTEN is a phosphatase, capable of dephosphorylating both threonine- and
tyrosine-phosphorylated substrates and also targeting the lipid second
messenger PtdIns (3,4,5)P3 in vitro
(21
, 22) and in vivo (17)
. PtdIns
(3,4,5)P3 is the product of PI 3-K. PI 3-K can be
activated by many extracellular stimuli, including EGF,
platelet-derived growth factor, and insulin, phosphorylating the
hydroxyl group at position 3 on the inositol ring of phosphoinositides.
Its lipid products bind to multiple signaling molecules that initiate
secondary signaling cascades that regulate many diverse physiological
functions, such as trafficking, adhesion, actin arrangement, cell
growth, and cell survival (6)
. Our data show that PI 3-K
activity was 2.57.8 times higher in papillomas. This elevation in
activity could be attributable to the overexpression of the EGF
receptor and increased activity of the EGF receptor/MAP kinase pathway
seen in papillomas (3
, 4)
. Although the small size of the
biopsy samples precluded assaying both pathways in the same samples, we
have consistently seen over overexpression of the EGF receptor and
constitutive activation of MAP kinase in papilloma tissues.
We do not know whether the elevated PTEN levels in papillomas are
directly caused by HPV infection. HPV proteins can alter transcription
of multiple cellular proteins (33, 34, 35)
and could possibly
enhance PTEN transcription by elevating amounts of a
limiting transcription factor. Conversely, increased PTEN could reflect
the hyperplastic state of the papilloma tissues. The fact that PTEN and
PI 3-K levels correlated in papillomas suggests a potential coordinated
regulation of these proteins, thus maintaining a type of homeostatic
balance of proteins within the PI 3-K/Akt pathway. Alternatively, PTEN
levels could actually be regulated by PI 3-K activity, not simply
protein level, because the limited number of papilloma samples we were
able to analyze suggested a correlation between PI 3-K activity and
PTEN abundance. Because the PI 3-K in papillomas was highly activated,
increase in protein abundance would result in increased active protein.
These possibilities must be studied further to determine whether one or
more are correct.
Akt is a crucial downstream target for PI 3-K activity. Both PtdIns
(3,4,5)P3 and PtdIns
(3,4)P2 take part in Akt activation, with PtdIns
(3,4,5)P3 playing a dual role by binding to the
PH domain at the NH2-terminal end of Akt to allow
phosphorylation by the upstream kinase and also directly activating the
upstream kinase (8
, 36)
. Phosphorylation of Akt at Thr-308
and Ser-473 has been proposed to be essential for its activation
(37
, 38)
. Our results with phospho-specific Akt antibodies
showed that both of these sites were underphosphorylated in papillomas
compared with normal tissue. Akt is a serine/threonine kinase that
phosphorylates multiple substrates, resulting in a variety of
biological effects, including glycogen synthesis, GLUT-4 translocation,
cell cycle regulation, differentiation, and suppression of apoptosis
(reviewed in Ref. 39
). Thus, reduction in active Akt by
PTEN could have multiple effects in papilloma cells.
Overexpression of PTEN could affect regulation of papilloma cells by
other pathways as well as by reducing activated AKT. The
NH2 terminus of PTEN is homologous to the
cytoskeletal protein tensin. A role for PTEN as a molecule regulating
the connection between the cytoskeleton and intracellular signaling
pathways has been proposed (11
, 12
, 21)
. Studies with
glioblastoma cells reported that PTEN inhibited cell migration,
spreading, and focal adhesions by inhibiting integrin and growth
factor-mediated MAP kinase signaling pathways by targeting focal
adhesion kinase, Shc, and its interaction with the adapter protein
growth factor receptor binding protein 2, without affecting c-Jun
NH2-terminal kinase or Akt signaling, (40
, 41)
. We reported previously (42)
that the actin
cytoskeleton structure was altered in papilloma cells, suggesting that
multiple different signaling processes regulated by PTEN are altered in
these cells. The presence of PTEN in the nuclei of papilloma cells
(Fig. 7)
and endothelial cells and neurons (32)
suggests
that PTEN may also have a nuclear function, at least in some tissues.
We are now beginning to investigate the interactive role of PTEN with
these various pathways and the regulation of PTEN expression in
HPV-infected cells, using cells derived from laryngeal papillomas.
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FOOTNOTES
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The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked advertisement in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
1 Supported by Grant P50DC 00203 from the National
Institute on Deafness and Other Communication Disorders and a grant
from the Helen and Irving Schneider Family Foundation. 
2 To whom requests for reprints should be
addressed, at Department of Otolaryngology, Long Island Jewish Medical
Center, 27005 76th Avenue, New Hyde Park, NY 11040.
Phone: (718) 470-7553; Fax: (718) 347-2320; E-mail: bsteinbe{at}lij.edu 
3 The abbreviations used are: HPV, human
papillomavirus; EGF, epidermal growth factor; PI 3-K,
phosphatidylinositol 3-kinase; PtdIns (3,4,5)P3,
phosphoinositol 3,4,5-trisphosphate; PtdIns (3,4)P2,
phosphoinositol 3,4-bisphosphate; MAP, mitogen-activated protein;
RT-PCR, reverse transcription-PCR. 
Received 6/29/99.
Accepted 12/30/99.
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