Since FoxM1 is re-activated during benign and malignant transformations, this protein was extensively studied in various tumor cell lines as well as in tumor tissues obtained from cancer patients. Microarray analysis of human solid tumors demonstrated that FoxM1 is one of the most common overexpressed genes.
63 FoxM1 was overexpressed in human non-small cell lung cancers (NSCLC), head and neck squamous carcinomas, hepatocellular carcinomas (HCC), intrahepatic cholangiocarcinomas, colon carcinomas, basal cell carcinomas, infiltrating ductal breast carcinomas, anaplastic astrocytomas, glioblastomas, pancreatic carcinomas, gastric cancer, acute myeloid leukemia and other human tumors and human neoplastic cell lines.
10,22,28,49,64–68 Our previous studies have demonstrated that elevated levels of FoxM1 correlated with high proliferation rates in human prostate adenocarcinomas
19 and NSCLC.
22 Positive correlation was also found between FoxM1 overexpression and increased angiogenesis in human glioblastomas.
69 In breast cancer patient samples, FoxM1 levels strongly associated with expression of estrogen receptor alpha.
70 FoxM1 was overexpressed in HCC from patients that responded poorly to treatment.
64To study the role of FoxM1 during carcinogenesis, various genetic mouse models were generated (). We previously developed a transgenic
Rosa26-Foxm1 mouse line in which FoxM1b levels were increased in all cell types.
44 Ubiquitous overexpression of FoxM1b elevated proliferation of lung tumor cells and increased the number and size of lung tumors induced by tobacco smoke derived carcinogen 3-methylcholanthrene (MCA) and promoted by butylated hydroxytoluene (BHT).
71 Likewise, an increase in the number and size of colorectal tumors was found in
Rosa26-Foxm1 mice treated with azoxymethane (AOM) and dextran sodium sulfate (DSS).
66 FoxM1b transgene cooperated with SV 40 T Antigen to accelerate initiation and progression of prostate adenocarcinomas in
Rosa26-Foxm1/TRAMP and
Rosa26-Foxm1/LADY double transgenic mice.
19 Deletion of FoxM1 from all cell types in
Mx-Cre/Foxm1fl/fl mice decreased urethane-mediated lung tumorigenesis
22 and delayed the growth and progression of hepatocellular carcinoma (HCC) induced by DEN/phenobarbital treatment.
72 Although these studies suggested a critical role for FoxM1 in lung, prostate, colon and liver tumorigenesis, specific requirements for the FoxM1 in different cell populations were not addressed.
| Table 3Transgenic mouse models showing the role of FoxM1 in tumorigenesis |
To dissect cell-autonomous roles of FoxM1 in cancer lesions, selective targeting of this transcription factor was performed in vivo. Hepatocyte-specific overexpression of FoxM1b in TTR-FoxM1b transgenic mice was insufficient to induce HCC.
73 After DEN/phenobarbital treatment TTR-FoxM1b livers showed increased proliferation of hepatocytes in preneoplastic regions, but no effect on progression of HCC was found.
73 In our recent studies, specific expression of activated FoxM1b mutant protein in respiratory epithelial cells (SPC-rtTA/TetO-FoxM1b ΔN mice) caused epithelial hyperplasia but was insufficient to induce lung adenocarcinomas.
74 These studies demonstrated that FoxM1b might require a “second hit” to transform differentiated hepatocytes or lung epithelial cells into malignant phenotype. The fact that simultaneous overexpression of FoxM1b-ΔN and activated K-Ras accelerated lung tumor growth in vivo
74 provides a direct support for this concept.
FoxM1 was found to be required for growth and expansion of HCC and epithelial tumors. Mice with hepatocyte-specific FoxM1 deletion (Albumin-Cre
Foxm1fl/fl) displayed diminished proliferation of tumor cells and decreased formation of HCC after DEN/Phenobarbital induction.
28 Likewise, reduced growth of colorectal tumors was found in Villin-Cre
Foxm1fl/fl mice treated with AOM/DSS.
66 Our recent studies demonstrated that deletion of
FoxM1 from lung epithelial cells (
SPC-rtTA/tetO-Cre/Foxm1fl/fl transgenic mice) prior to the tumor initiation with urethane or MCA/BHT caused a striking reduction in the number and size of lung adenomas.
75 Decreased lung tumorigenesis in
SPC-rtTA/tetO-Cre/Foxm1fl/fl mice was associated with diminished proliferation of tumor cells and reduced expression of
Topoisomerase-2α (
TOPO-2α), a critical regulator of tumor cell proliferation. We also demonstrated that FoxM1 directly bound to and induced transcription of the mouse
TOPO-2α promoter region, indicating that
TOPO-2α is a direct target of FoxM1 in lung tumor cells.
75 Interestingly, a deletion of FoxM1 in preexisting lung tumors dramatically reduced tumor growth in the lung,
75 indicating that FoxM1 is a promising target for antitumor therapy in cancer patients.
Lung cancer lesions contain not only tumor cells, but also diverse stromal and inflammatory cells, that create a tumor promoting microenvironment. Vascular endothelial cells provide essential support to the tumor microenvironment, directly contributing to proliferation and progression of tumor cells. Recently, we used mice with endothelial cell-specific FoxM1 deletion (
Tie2-Cre/Foxm1fl/fl) to study the role of FoxM1 in tumor-associated blood vessels. Surprisingly, numbers and sizes of lung tumors were increased in
Tie2-Cre/Foxm1fl/fl mice treated with urethane or MCA/BHT.
79 Thus, FoxM1 may function as a tumor suppressor in tumor-associated blood vessels. In addition, perivascular infiltration by inflammatory cells was elevated and numbers of inflammatory cells in BAL fluid were increased in
Tie2-Cre/Foxm1fl/fl lungs. FoxM1 was shown to be a direct transcriptional activator of endothelial-specific genes, such as VEGF receptor-2 (
Flk-1) and
FoxF1 transcription factor, both of which are critical for lung inflammation.
79 Moreover, FoxM1 was directly bound to the promoter region of
Sfrp1 gene, a known inhibitor of canonical Wnt/β-catenin signaling. As a consequence of decreased
Sfrp1 expression in FoxM1-deficient endothelium,
Tie2-Cre/Foxm1fl/fl tumors displayed increased canonical Wnt signaling as was demonstrated by activation of TOPGAL transgene,
79 a known reporter for Wnt/β-catenin signaling. Taken together, these in vivo studies suggest that endothelial-specific expression of FoxM1 limits lung inflammation and canonical Wnt signaling in lung epithelial cells, thereby restricting lung tumorigenesis.