Breast cancer is the most prevalent cancer in the world and is the leading cause of cancer related death in women (411,000 annual deaths represent 14% of female cancer deaths) [
1,
2]. Breast cancer is also the most frequent cancer of women (23% of all cancers) [
1]. Routine screening and early detection have reduced the incidence of breast cancer, but despite optimal treatment, about 30% of women with recurrent disease develop distant metastases [
3]. Although multiple chemotherapeutic strategies are currently in use for the treatment of breast cancer [
4], active treatment of patients is determined by multiple factors such as the hormone-dependency of the cancer [
5], activation of specific oncogenes [
6], invasiveness and metastases [
7], subsequent drug resistance [
8-
10] and the risk of potential toxicities with repeated therapy [
4,
11]. Many patients are also subjected to combination drugs, as no single agent offers a clear survival advantage over another [
4]. In addition, reliable biomarkers correlating response to chemotherapy and survival have not been clearly defined [
12]. As such, there is a clinical need for breast cancer therapeutics which potently target malignant cells resultant with identifiable biomarkers, independent of the type of breast cancer profile presented by the patient.
We have recently reported that the non-pathogenic, tumor suppressive human Adeno-Associated Virus Type 2 (AAV2) induced apoptosis in both low and high-grade Human Papillomavirus (HPV) positive cervical cancer cell lines but not in normal keratinocytes [
13]. AAV2 induced cell death correlated with the expression of AAV2 non-structural Rep proteins and culminated in DNA laddering and caspase-3 activation/cleavage [
13], both established hallmarks of apoptosis [
14]. Since AAV2 induced apoptosis also coincided with increased S phase entry in HPV/AAV2 co-infected cells, our studies further suggested that coordinate manipulation of both cell-cycle and apoptosis pathways by AAV2 has the potential to suppress growth and proliferation of cervical cancer cells [
13]. Our work further provides a molecular platform supporting earlier studies which suggested that AAV2 seropositivity is negatively correlated with the development of cervical cancer [
15].
AAV2 has been shown to suppress DNA replication and oncogenicity [
16] of a number of viruses including adenovirus [
17], herpesvirus [
18], pox virus [
19] and human papillomavirus (HPV) [
20]. The AAV2 encoded non-structural Rep78 protein has been shown to inhibit
in vitro cellular transformation mediated by papillomaviruses [
21-
24] and has been mapped to the ability of its Rep proteins to downregulate transcription from the papillomavirus early promoters [
23,
25,
26]. Rep78 also antagonizes expression and activity of cellular tumor suppressors abrogated by adenovirus infections, such as p53 [
27], pRb [
28] as well as cell cycle modulators such as E2F [
29], thereby curbing cell growth and proliferation. A recent report also demonstrated the ability of AAV2 to induce a moderate degree of caspase activation during adenovirus coinfection [
30]. In animal models, AAV2 was shown to suppress the growth of adenovirus and herpesvirus induced tumors [
31,
32]. The tumor suppressive functions of AAV2 are not restricted to virus-virus interactions as AAV2 also suppressed cells in culture transformed by activated oncogenes [
33], selectively killed carcinogen-treated cells [
19,
34] and targeted uncontrolled cellular proliferation rates by implementing cell cycle blocks, growth arrest and differentiation [
35-
40]. These studies and our published report [
13] cumulatively led us to hypothesize that AAV2 also has the potential to mediate death of breast cancer cells.
In the current study, we investigated the ability of AAV2 to infect and induce apoptosis in a variety of human breast cancer derived cell lines, representing a range of breast cancer types graded upon hormone dependency and aggressiveness: the luminal MCF-7 (ERα-positive) are weakly invasive and do not normally metastasize to bone [
41]; MDA-MB-468 (ERα-negative) are weakly invasive and non-metastatic and were derived from human breast adenocarcinoma [
42]; and MDA-MB-231 (ERα-negative) are highly invasive, basal cell line [
43] derived from metastatic (pleural effusion), infiltrating ductal breast carcinoma [
44]. The MDA-MB-231 cell line is highly metastatic which forms tumors when injected into the mammary fat pads of immunocompromised mice [
44]. As controls, we used primary normal human breast epithelial cells (nHMECs) isolated and cultured from breast tissue samples from patients undergoing breast reduction surgery. AAV2 infection induced caspase-independent apoptosis in the MCF-7 and caspase-dependent apoptosis in the MDA-MB-468 and MDA-MB-231 cell lines. In contrast, normal human mammary epithelial cells (nHMECs) were unaffected upon infection with AAV2. Cell death of breast cancer cells coincided with active AAV2 genome replication and differential expression of AAV2 non-structural Rep proteins: Rep78, Rep68 and/or Rep40 but not Rep52. AAV2 induced cell death of the MCF-7 and MDA-MB-231 lines was characterized by an increase in the number of cells with S phase DNA content whereas apoptotic MDA-MB-468 lines infected with AAV2 were increasingly arrested in the G2 phase of the cell cycle. Decreased cell viability in all three cell lines infected with AAV2 was characterized by upregulated expression of c-Myc and Ki-67, both proteins which are markers of proliferation and c-Myc is also a pro-apoptotic protein. Our results portray activation of distinct cell cycle and apoptosis pathways which culminate in cell death of all three breast cancer derived lines. Since the choice of specific therapeutics for the treatment of breast cancer is often determined by the aggressiveness of the cancer presented by individual patients, our studies suggest that AAV2 could have universal applicability for derivation of common yet novel therapeutics for a range of breast cancer types.