Dietary flavonoid fisetin increases abundance of high-molecular-mass hyaluronan conferring resistance to prostate oncogenesis

Carcinogenesis, Sep 2016

Lall, Rahul K., Syed, Deeba N., Khan, Mohammad Imran, Adhami, Vaqar M., Gong, Yuansheng, Lucey, John A., Mukhtar, Hasan

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Dietary flavonoid fisetin increases abundance of high-molecular-mass hyaluronan conferring resistance to prostate oncogenesis

Carcinogenesis Dietary flavonoid fisetin increases abundance of high-molecular-mass hyaluronan conferring resistance to prostate oncogenesis Rahul K.Lal 1 Deeba N.Syed 1 Mohammad Imran Khan 1 Vaqar M.Adhami 1 Yuansheng Gong 0 John A.Lucey 0 Hasan Mukhta r 0 1 0 Department of Food Science, University of Wisconsin , Madison, WI 53706-1510 , USA 1 Department of Dermatology We and others have shown previously that fisetin, a plant flavonoid, has therapeutic potential against many cancer types. Here, we examined the probable mechanism of its action in prostate cancer (PCa) using a global metabolomics approach. HPLC-ESI-MS analysis of tumor xenografts from fisetin-treated animals identified several metabolic targets with hyaluronan (HA) as the most affected. Efficacy of fisetin on HA was then evaluatinedvitro and alsoin vivo in the transgenic TRAMP mouse model of PCa. Size exclusion chromatography-multiangle laser light scattering (SEC-MALS) was performed to analyze the molar mass (Mw) distribution of HA. Fisetin treatment downregulated intracellular and secreted HA levels both in vitro and in vivo. Fisetin inhibited HA synthesis and degradation enzymes, which led to cessation of HA synthesis and also repressed the degradation of the available high-molecular-mass (HMM)-HA. SEC-MALS analysis of intact HA fragment size revealed that cells and animals have more abundance of HMM-HA and less of low-molecular-mass (LMM)-HA upon fisetin treatment. Elevated HA levels have been shown to be associated with disease progression in certain cancer types. Biological responses triggered by HA mainly depend on the HA polymer length where HMM-HA represses mitogenic signaling and has anti-inflammatory properties whereas LMM-HA promotes proliferation and inflammation. SimilarMlyw, analysis of secreted HA fragment size revealed less HMM-HA is secreted that allowed more HMM-HA to be retained within the cells and tissues. Our findings establish that fisetin is an effective, non-toxic, potent HA synthesis inhibitor, which increases abundance of antiangiogenic HMM-HA and could be used for the management of PCa. Introduction Tumor microenvironment plays a major role during prostate Increased HA levels in various cancers including PCa cor-re cancer (PCa) development. Interactions between the microen-vi late with malignant progression and poor survival. These high ronment and cancer cells are important for migration, met-as HA levels are associated with high expression of HAS and low tasis and survival 1(). A  major component of the extracellular expression of HYALs ( 4–6 ). matrix in the tumor microenvironment is glycosaminoglycan, HA regulates several cellular function7s,8)(. The native, hyaluronan (HA). HA is a non-sulfated, linear polymer co-m high-molecular-mass (HMM)-HA (~107 Da) can be broken down posed of repeating disaccharides of glucuronic acid (GlcUA) and into smaller fragments in response to glycosidase activity and N-acetyl glucosamine units (GlcNAc)2)(. HA is synthesized at environmental parameters such as pH and reactive oxygen the cell surface by the membrane-bound enzyme HA synthase species (ROS) ( 9–12 ). High- and low-molecular-weight forms of (HAS). Three HAS enzymes HAS1, HAS2 and HAS3 are involved HA provoke distinct anti-inflammatory and proinflammatory in the production of HA, whereas HA degradation is controlled effects upon binding to CD44 and can deliver either proliferative by hyaluronidases (HYALs), six of which have been identified3(). or antiproliferative signals in various cell type1s3,(14). Studies Abbreviations have shown that HMM-HA exhibited antiangiogenic effects both in vitro and in vivo ( 2,15 ). In contrary, the lower-molecular-mass (LMM)-HA stimulated cell proliferation and exhibited proinfl-am matory and proangiogenic effects in various studies14( ,16,17 ). In recent years, considerable progress has been made in identifying a specific inhibitor for HA synthesis and such inhi-bi VA) in 2013, whereas PC3 (CRL-1435) and DU145 (HTB-81) cell lines were obtained in 2012. ATCC ensures cell lines authenticity using morphology, karyotyping and PCR-based approaches, which include assays to detect cytochrome C oxidase I gene (COI analysis) to rule out interspecies c-on tamination and short tandem repeat DNA profiling to rule out intra-spe cies contamination as tabulated inSupplementary Table  7, available at Carcinogenesis Online. Cell lines were immediately resuscitated upon receipt and frozen in aliquots in liquid nitrogen. Once thawed, early-pas sage cells were cultured within 3 months from a frozen vial of the same batch of cells. Cells were routinely tested to ensure there was no m-yco plasma contamination (MycoAlert Mycoplasma Detection Kit, Lonza). RWPE1, NB11 and NB26 cells were cultured in human keratinocyte growth supplement from Thermo-Fisher Scientific (Grand Island, NE), supplemented with HKGS and 1% penicillin–streptomycin. PC3 and DU145 cells were cultured in RPMI 1640 from Gibco (Carlsbad, CA), with 10% fetal bovine serum and 1% penicillin–streptomycin. The cells were then inc-u bated at 37°C with 5% C O2in a humid environment. For time-dependent studies, cells (70% confluent) were treated with fisetin dissolved in d-ime thyl sulfoxide (DMSO) (0–40μ M) for specified time points at 37°C in media and harvested for further studies. BrdU cell proliferation assay The BrdU assay from Cell Signaling (Danvers, MA) was used as per the ma-n ufacturer’s instructions to measure cell proliferation. Absorbance was read at 450nm using a Synergy 2 multidetection microplate reader (BioTek, VT). HPLC–ESI–MS analysis Materials Aqueous and organic metabolites were isolated from control and fisetintor would not only help elucidate the function of HA, but also treated tumor xenograft tissues using a methanol/water and dichlorom-eth can be used for treatment of diseases with elevated HA levels ane/water extraction as described previously36(). Metabolite extracts ( 18–22 ). 4-Methylumbelliferone (4-MU) is one of the well-known (10 µl) were then diluted to 5µ0l  with 0.1% formic acid in water. Untargeted and potent HA synthesis inhibitor, and its role has been explored metabolomics using HPLC–ESI–MS was performed with a 10 µl injection on extensively in various cancers1( 9,21–26 ), but the IC50 of 4-MU to an Agilent 6210 ESI-TOF mass spectrometer with Agilent 1200 series HPLC inhibit HA synthesis in prostate and other cancers is as high as (Santa Clara, CA). Solvents were 0.1% formic acid in water (A) and 0.1%-for 400 µM (~70 µg/ml) ( 19,22 ). Therefore, identifying non-toxic inhib-i mic acid in acetonitrile (B). The HPLC column was an Agilent Zorbax SB C18 tors that effectively suppress HAS levels and its production will 1.8 µm, 2.1 mm i.d. × 50 mm length (Santa Clara, CA). Metabolites were g-ra be important. Generally considered as non-toxic, dietary fl-avo dient-eluted at a flow rate of 0.m25l/min starting at 2% B with a m1in hold, noids act as key modulators of signaling pathways and are the-re ramping to 50% B at 35min, then to 95% B at 40min, returning to 2% B at 42 min and re-equilibrating at 2% B for 1m8in. Electrospray was performed fore considered desirable chemopreventive agents27(,28). Fisetin, in positive-ion (+) mode at 3.6kV and fragmentor at 130V. Metabolite dete-c found in many fruits and vegetables, belongs to the flavonol -sub tion was performed over the m/z range 50–1700 by summing 10013 trangroup of flavonoids and has shown potential against PC2a9(–34). sients/scan (0.89 scans/s). Blank injections (10µl ) of 20% MeOH and 0.08% In this study, we identified HA as a unique target of fisetin in formic acid in water were made between sample injections. PCa cells, tumor xenografts and TRAMP mouse model. We utilized Raw data acquired using HPLC–ESI–MS system were processed by SEC-MALS for a quick, accurate and quantitative determination Xcalibur software that provides an appropriate format for further data of different molecular masses of HA bothin vitro and in vivo. analysis. The structured data files were then uploaded on XCMS Online (, a high-quality cloud-based platform linked with METLIN h(ttps://, to facilitate metabolite Materials and methods identification using a repository of metabolite and tandem mass spe-c trometry information of known compounds. TRAMP animals were obtained as described previously 3( 5 ). Housing and care of the animals was approved by the University of Wisconsin’s Research Animal Resource Committee in accordance with the NIH Guidelines for the Care and Use of Laboratory Animals. Fisetin was purchased from Sigma Chemical Co. (St Louis, MO). Antibodies In vivo tumor xenograft model were obtained from Cell Signaling Technology (Danvers, MA), Abcam Seven- to eight-week-old athymicn(u/nu) male nude mice (Harlan) were (Cambridge, MA) and Santa Cruz Biotechnology (Dallas, TX), and a list xenografted as described previously3(0). We selected unique PCa cells is provided in Supplementary Table  1, available atCarcinogenesis Online. NB11 and NB26 for determining thein vivo effects of fisetin due to their Quantitative PCR (qPCR) primers were synthesized and obtained from DNA ability to form rapid and reproducible tumors. After injected, 12 animals synthesis laboratory at the University of Wisconsin Biotechnology Center. were then randomly divided into 2 groups with 6 animals each. The The sequences of oligonucleotides used are listed iSnupplementary Table 2, first group of animals received 30μ l i.p. injection of phosphate-buffered available atCarcinogenesis Online. Commercially available HA oligos (HA60K-1 saline (PBS)/DMSO (1:1) and served as control. The animals of second and HA200K-1) were purchased from Lifecore Biomedical (Chaska, MN). group received i.p. injection of fisetin (40mg/kg ~ 1 mg/animal) in 30 μl of PBS/DMSO (1:1) twice weekly. Tumor sizes were measured twice weekly Animals as described previously 3(0). All animals were sacrificed when tumors reached a volume of 1200mm 3 in the control group. Samples were co-l lected and stored at −20°C until further analysis. Spontaneous PCa progression (TRAMP) model Eight-week-old transgenic TRAMP micen(  =  27) were randomly divided Cell culture into two groups for five different time points from 8–12–16–20–24 weeks. Non-tumorogenic RWPE1 (CRL-11609), tumorogenic NB11 (CRL-2851) and Each time point/group contained three animals, respectively. The first NB26 (CRL-2852) cell lines were directly obtained from ATCC (Manassas, group of TRAMP (n = 15) animals received 50 µl PBS/DMSO (1:1) and served as the control. The second groupn(  =  12) received fisetin (1mg/animal) series with a Superose 12 and 10/300 GL column (GE Healthcare, Pittsburgh, dissolved in 50 µl PBS/DMSO (1:1) thrice weekly, beginning at 8 weeks of PA) attached to a Waters HPLC system (Waters Corporation, Milford, MA). age and continued until the animals were 12, 16, 20 and 24 weeks old, A solution containing 2m0M imidazole and 50 mM NaCl at pH 7.0 was used respectively. Throughout the experiment, the animals had access to chow as an eluting buffer. All the samples were filtered through a 0μ.2m2 filter. dietad libitum. Sample injection volume was 100 μl, and nominal flow rate was 0.m5l/min. Animals in all groups were observed weekly for body weight, tumor The chromatography system consisted of columns, a ultraviolet det-ec progression by abdominal palpation and survival. At the termination of tor (model 2998; Waters Corporation, Milford, MA) operating at 2n8m0, a the experiment at their respective time points, blood samples were c-ol DAWN-DSP MALS photometer Wyatt Technology, Santa Barbara, CA) fitted lected by the ‘mandibular bleed’ and serum was separated and stored at with a helium-neon laserλ( = 632.8 nm) and a K-5 flow cell, and a differe-n −20°C until further analysis. The prostate was excised under a dissecting tial refractometer (DRI) detector (model 2414; Waters Corporation, Milford, microscope and snap frozen in liquid nitrogen for further analysis. MA). The electronic outputs of the ultraviolet, DRI and MALS were sent to a Dell computer. The data were processed with ASTRA (version 4.0) software. Western blotting The DRI response factor was measured by injecting a series of known NaCl After treatment with fisetin (4μ0M , 48 h), whole cell lysates were prepared concentrations into the detector with the syringe pump. This response -fac and western blot analysis was performed as described previously29(). tor was obtained from the slope of the linear plot between NaCl con-cen Densitometric measurements of the bands were done with image analysis tration and DRI response. The factor to correct the Rayleigh ratio to 90° software using the Biorad ChemiDoc MP imaging system. for instrument geometry was obtained by measuring the LS intensity of filtered (0.025μ  m) HPLC quality toluene at 90°. The responses to LS inte-n HA ELISA sity of the photodiodes arrayed around the scattering cell were normalized to the diode at 90° with a bovine serum albumin (BSA) sample (monomeric BSA with a nominal molecular weight of 6k6Da). Human and Mouse HA ELISA kit were obtained from TSZ ELISA (Waltham, MA) and R&D systems (Minneapolis, MN). These immunoassays have been shown to accurately quantitate HA. Both kits are solid-phase ELISA Statistical analysis designed to measure at least 3k5Da HA in biological samples. HA levels in mouse serum and human PCa cells treated with or without fisetin (μ40M  , 48 h) were measured according to the manufacturer’s protocol. Microsoft Excel software was used to calculate the mean and standard error of the mean (SEM). For the HPLC–ESI–MS metabolomics study, a l-ib eralP value of 0.1 was considered significant. Two-tailed, Studentt-’stest RNA isolation and qPCR analysis was used to assess statistical significance. Data points in all the rest of studies represent mean ± SEM, andP values < 0.05 were considered Total RNA was extracted from cells and animal tissues using RNeasy kit significant. (Qiagen, Germantown, MD), and reverse transcribed with iScript Reverse transcription supermix kit (Biorad, Hercules, CA). cDNA was amplified in triplicate using gene-specific primers S(upplementary Table  2, avail- Results able atCarcinogenesis Online). Threshold cycleC(T) values obtained from the instrument’s software were used to calculate the fold change of the Identification of HA as a unique target of fisetin respective mRNAs. ΔCT was calculated by subtracting thCeT value of the in PCa housekeeping gene from that of the mRNA of interestΔ.ΔCT for each mRNA was then calculated by subtracting thCeTvalue of the control from the experimental value. Fold change was calculated by the formul−aΔΔC2T (30). To identify new biomarkers in PCa, we designed a comprehen sive metabolic profiling of fisetin-treated NB11/NB26 tumor xenografts. NB11 and NB26 cells are unique tumorogenic PCa cells derived from non-tumorgenic RWPE1 cells upon exposure Intracellular ROS assay to N-methyl-N-nitrosourea 3( 7 ). We selected these unique PCa The OxiSelect™ Intracellular ROS Assay Kit obtained from Cell Biolabs Inc. cells, NB11 and NB26, for determining thien vivo effects of fise(San Diego, CA) provides a cell-based assay for measuring primarily hydr-o tin due to their ability to form rapid and reproducible tumors. gen peroxide, along with hydroxyl, peroxyl and other ROS levels within a Aqueous and organic extracts were isolated from the tissue cell. Cells treated with or without fisetinμ(M40)  for specified times were samples and analyzed using HPLC–ESI–MS in both positive and processed as per the manufacturer’s instructions. Hydrogen peroxide was negative scan modes. The total ion chromatogram resulted in used as a positive control in the assay. Fluorescence was evaluated on a excellent separation between the two tissue groupns =( 6). The Synergy H1 (BioTek) multimode microplate reader at 480/53n0m (excita- XCMS online analysis of the total ion chromatogram revealed tion/emission) using Gen5 2.0 software (BioTek). a list of newly identified metabolites. The quasimolecular ions Immunofluorescence analysis were confirmed and the exact masses of the monoisotopic molecular weights were used to search the METLIN database. gNrBa1f1t, aNnBd26T,RPACM3PanadniDmUa1l4s5licdeelslswterreeaitnecduwbaitthedfiwseittihnH(4μA0M a,n2t4ibho),dxyenaso-per Total metabolites identified were 2086, out of which 1203 were protocol as described previously3(0). After rinsing in PBS tween 20 (PBST), downregulated and 883 were upregulated between vehicle c-on slides were incubated with fluorescent-conjugated secondary antibody trol and fisetin-treated NB11 xenografts. Similarly, a total of 2203 at 1:500 dilution in blocking buffer. Slides were then rinsed in PBST, and metabolites were identified in control versus fisetin-treated sections were mounted with ProLong Gold Antifade reagent containing NB26 xenografts, out of which 1654 were downregulated and 549 4′,6-diamidino-2-phenylindole (Invitrogen) and left in dark overnight. were upregulated S(upplementary Figure 1 and Supplementary Slides were imaged with the Andor Revolution XD spinning-disk confocal Table 8, available atCarcinogenesis Online). microscope using a ×20/×40/1.4 NA oil objective with identical exposures To obtain a comprehensive global metabolic signature and gains for each antibody stained. for this discovery-based approach, we considered a liberal SEC-MALS analysis P value of 0.1 as significant for this data set. Among identified metabolites, an m/z of 776.25 stood out as a single metabolite Cells with or without fisetin treatment were collected over time and pooled HA (Figure 1A). The relative intensity of the identified HA peak in order to isolate enough HA to be detected in Size exclusion chroma-tog (retention time  =  2546.73min) exhibited a significant decrease raphy-multiangle laser light scattering (SEC-MALS) analysis. HA was- iso lated using the PEGNAC HA size protocol (available online). This method in fisetin-treated NB26 xenograftsFi(gure  1B) and plotted as sequentially removes proteins, nucleic acids and isolate HA from cells, a function of relative abundance (fold change  =  76.09) in both media, tissues or any biological samples. Separation of HA molecular fr-ag fisetin-treated xenograft groupFsi(gure 1C). We next performed ments was carried out by SEC-MALS on a Superose 6, 10/300 GL column in immunofluorescence staining for HA in NB11 and NB26 tumor tissues and observed that fisetin-treated animals exhibited retention of more HA inside the cell with increasing doses significantly decreased HA expression as compared with the (Supplementary Figure  4A, available atCarcinogenesis Online). untreated controlsFi(gure 1D and Supplementary 2, available at Also, fisetin treatment (40µM , 48 h) significantly decreased cell Carcinogenesis Online). proliferation in NB11 and NB26 cellsSu(pplementary Figure 4B, available atCarcinogenesis Online). Fisetin was able to decrease Fisetin decreases intracellular and extracellular HA both intracellular and extracellular HA levels signifying HA as a abundance in PCa cells potential target of fisetin in PCa. We performed immunofluorescence staining for HA in NB11, NB26, PC3 and DU145 PCa cells treated with or without fisetin Fisetin decreases HA levels that are associated (40 µM, 48 h). Fluorescence intensity in all four cell types suggested with inhibition of disease progression in TRAMP that fisetin-treated cells showed significantly decreased HA mouse model expression as compared with the untreated controlFsig(ure 2A The in vitro results of NB11/NB26 cells prompted us to look for si-m and Supplementary Figure 3, available atCarcinogenesis Online). ilar effects of fisetin in another mouse model of PCa. The TRAMP Next, we evaluated intracellular and extracellular HA upo n- fise model is a spontaneous PCa progression model that closely tin treatment (40µ M, 48 h) using a solid-phase sandwich human mirrors the pathogenesis of human PCa 3( 8,39 ). Compared with HA ELISA assay. Our data showed that intracellular HA levels vehicle-treated animals, fisetin-treated animals of 24 weeks significantly decreased in fisetin-treated PCa celFlisg u(re  2B). exhibited decreased hyperplasia S(upplementary Figure  5A, Similarly, secreted HA levels in the fisetin-treated group were available atCarcinogenesis Online) in the prostate. We found no significantly lower than the untreated contFrioglu(re 2C). significant change in body weight of the animals between the It was further noted that PCa cells secrete more HA in the vehicle- and fisetin-treated groups as shownSu( pplementary media and retain less HA within the cellFi(gure 2B, Figure 2C). Figure 5B, available atCarcinogenesis Online), indicating that fis-e PC3 and NB26 cells treated with or without fisetin (5–µ4M0 ) tin is not associated with any significant adverse side effects. We showed a similar decrease in secreted HA levels in a dose- also observed less palpable tumors in fisetin-treated animals dependent manner. We found that fisetin decreases HA levels when compared with the vehicle-treated controls. Many of the secreted in the media in a dose-dependent manner and enables fisetin-treated animals had well-differentiated adenocarcinoma with no evidence of poorly differentiated carcinoma with cell types F(igure 4B and Supplementary Figure 4C, available at disease progression (Supplementary Figure  5C, available at Carcinogenesis Online). Carcinogenesis Online). qPCR analysis of PCa tumors of TRAMP tissues revealed a Next, we performed immunofluorescence staining for HA in similar significant decrease in HAS2 and HAS3 mRNA levels in TRAMP prostate tissues and compared HA expression intensity fisetin-treated mice as compared with the vehicle-treated c-on among control and fisetin-treated groups. Fluorescence in-ten trols with increasing weeks of disease progressionFi(gure  4C). sity showed that the vehicle-treated control animals dem- on Previous studies have shown that native HA can be broken strated increased expression with disease progression that down into smaller fragments either via enzymatic (via HYALs) was significantly reduced in fisetin-treated animalFsig(ure 3A, or non-enzymatic catabolism (via ROS). Since fisetin decreases Figure  3B). Next, we evaluated the effect of fisetin on secreted enzymatic catabolism via reduction in HYAL levelsFi(gure  4A, HA levels in TRAMP mouse serum using a mouse HA ELISA. Our Figure 4B) both in vitro/in vivo, we investigated the role of nonresults revealed that serum HA levels increased with disease enzymatic catabolism in fisetin-treated cells by measuring ROS progression and fisetin-treated animals showed significantly levels in both PC3 and NB26 cells. Increase in ROS levels can lower serum HA levels as compared with the respective controls breakdown the native HMM-HA into smaller-molecular-weight (Figure 3C). fragments. Our data show that fisetin increased ROS levels-sig nificantly in both PC3 and NB26 cellFsi(gure 4D). Fisetin reduces HA synthesis and degradation enzyme levels in vitro and in vivo Fisetin increases abundance of HMM-HA in PCa cells Previous studies indicate that elevated HAS and HYAL levels In non-diseased conditions, native HA is present as HMM-HA are responsible for the high turnover (both synthesis and d-eg (Mw ~107 Da), whereas in diseased condition, it gets broken radation) of HA in advanced disease state and may cooperate down into LMM-HA. HMM-HA is known to have antiangiogenic together in cancerous growth. To determine whether fisetin properties; however, LMM-HA has shown to be proangiogenic. has any effect on HA synthesis and degradation, we evaluated Since the biological functions of HA is size dependent, we first mRNA levels of HAS and HYAL enzymes in NB11 and NB26 evaluated the molar mass distribution profile of HA fragments cells with or without fisetin treatment (µ4M0 ) for 6h. Fisetin- in normal versus cancerous cells. Intracellular HA was- col treated cells exhibited a significant decrease in HAS and HYAL lected from normal RWPE1 and PCa PC3 cells by employing the mRNA levels (Figure 4A). The change in transcriptional levels of PEGNAC HA size protocol. The isolated HA was then used for HAS and HYALs were reflected in protein expression that were SEC-MALS analysis to identify and compare the molar mass of markedly reduced upon fisetin treatment between the two HA fragment in both cell types. The molar mass versus elution volume chromatograms of SEC-MALS analysis and theMw of respectively. We measured the HA fragment sizes in vehicleHA fragments showed that normal RWPE1 cells predominantly versus fisetin-treated animals. The light-scattering MALS data exhibited higher levels of HMM-HA fragment cluster and no in vehicle-treated TRAMP animals showed a decreased abu-n detectable LMM-HA cluster. In PC3 cells, we observed lower-lev dance of HMM-HA fragment cluster with increased abundance els of HMM-HA fragment cluster and higher levels of LMM-HA of proangiogenic LMM-HA fragment clusters. Interestingly, in (Figure  5A, Supplementary Table  3, available atCarcinogenesis fisetin-treated animals, we observed increased abundance of Online) that could contribute to the pro-oncogenic nature of antiangiogenic HMM-HA fragment clusters and lower ab-un cancer cells. dance of LMM-HA fragment clustersF(igure 6A, Supplementary Next, we determined the effect of fisetin on molecular mass Table 5, available atCarcinogenesis Online). Studies have shown profile of HA fragments in PCa cells. Intracellular and extr-acel that increased HMM-HA levels are directly associated with re-sist lular HA with or without fisetin treatment were isolated from ance to oncogenesis 1( 5,40,41 ). These results suggest a novel role PC3 cells/culture media and analyzed using SEC-MALS. We of fisetin in increasing the abundance of intracellular HMM-HA, observed an increased abundance of intracellular HMM-HA which is associated with resistance to PCa progression. fragment cluster in fisetin-treated cells when compared with Serum analysis of vehicle-treated TRAMP animals revealed the untreated control cells. Even the intracellular LMM-HAhigher secretion of antiangiogenic HMM-HA and lower sec-re fragments in fisetin-treated cells were found to have comp-ar tion of LMM-HA fragment clusters. Notably, serum analysis of atively higherMw than the untreated control celFlisgu(re  5B, fisetin-treated animals showed lower secretion of antian-gio Supplementary Table  4, available at Carcinogenesis Online). genic HMM-HA and higher secretion of proangiogenic LMM-HA Interestingly, we observed that PC3 cells release more HMM-HA fragment clustersF(igure  6B, Supplementary Table  6, available in the media, whereas no detectable HMM-HA was secreted in at Carcinogenesis Online). Taken together, these findings clearly media of fisetin-treated cells suggesting retention of antian-gio show that fisetin inhibits the development of PCa in TRAMP genic HMM-HA fragments within the cells. mouse model. Fisetin increases abundance of HMM-HA conferring resistance to prostate oncogenesis in TRAMP mouse model Our study demonstrates that fisetin, which is found in many TRAMP (n  =  15) and TRAMP + fisetin (n  =  12) animals were fruits and vegetables, is a potent HA synthesis inhibitor and selected randomly, and vehicle or fisetin was administered can be developed for management of PCa. We and others have beginning at 8 weeks of age and continued until 24 weeks old, previously reported that fisetin is an effective proapoptotic Discussion agent with anti-invasive and antiangiogenic propertie2s9(–34). advantage when compared with 4-MU bothin vitro and in vivo The inhibition of HA synthesis by fisetin is significant cons-id PCa models. ering the fact that targeting the HA pathway with other agents Accumulation of HA is associated with progression of va-ri has met with limited success. Only 4-MU has been found to ous cancers including PCa. Nevertheless, there are inconsistent be the most promising till date 1( 9 ). d-Mannose has shown views regarding the significance and relevance of HA secreted in promise in vitro although at very high concentrations ofm20M serum. Studies in breast cancer have shown that the total serum (42). Similarly, a curcumin analogue was shown to inhibit HA HA levels reflect disease progression44(), whereas other studies export from fibroblasts at 5µM  (43); however, antitumor acti-v have shown that the serum HA level does not have any progn-os ity of both these agents has not been evaluated at these doses. tic significance with disease4( 5 ). Our results suggest that fisetin Sulfated HA has been reported to display antitumor activity significantly decreases both cellular and secreted HA levelins in by blocking HA signaling, but its oral bioavailability and- evi vitro/in vivo and shows promise in prevention of other cancers dence in experimental in vivo models has not yet been evalu- that are associated with increased HA levels. ated ( 18 ). 4-MU, which is a known HA synthesis inhibitor, is The concept of HA present inside the cells has met with a effective at high concentrations. The 5I0Cof 4-MU is 400  µM, lot of skepticism. Several studies have addressed this question, whereas fisetin inhibits HA synthesis at 4µ0M , a 10-fold lower but the actual mechanism of intracellular HA uptake remains dose. The in vitro IC50 dose of fisetin translates to 4m0g/kg body elusive. HA is a large molecule synthesized in the plasma me mweight (~1mg/day) in vivo, which is less than the dose required brane; hence, the existence of intracellular HA seems less pl-au in humans (1.5–2 g/day) as dietary supplement. At these low sible. However, evidence for intracellular HA has continued to doses, fisetin exhibits no detectable toxicity as revealed by grow over the years, and it is now clear that HA can get into the xenograft and TRAMP studies. We observed that fisetinm(1g/ cells to be catabolized and perhaps perform a number of impo-r animal/day) significantly reduced tumor growth and delayed tant cellular functions. HA internalization is tightly regulated progression of PCa in the TRAMP mouse model. Fisetin acts as and appears to occur simultaneously with increased HA synt-he a potent HA synthesis inhibitor and exhibits significant dose sis during cell migration and proliferatio4n6(–52). It seems that normal removal of HA from the matrix occurs via CD44 along replaced by newly formed HA every 24h ( 53 ). Importantly, the with HYAL2 activation. HA binds to CD44 and other specific cell presence of ROS is known to enhance HA turnover5( 4–56 ). Our surface receptors and gets internalized. Increased HYAL2 results results show that fisetin treatment significantly inhibits both in a cleavage of HMM-HA into smaller fragments, and CD44 is HAS and HYAL enzymes and halts the synthesis of new HA then released and recycled back to the cell surface. Most of the and also prevents the degradation of previously synthesized intracellular HA translocated into the cytoplasm or nucleus isHA. Fisetin treatment increased ROS levelins vitro but did not primarily low molecular weight (<3k0Da). Our results showed enhance HA turnover in PCa cells. that fisetin treatment significantly decreased hyaluronidase HA is a ‘dynamic’ molecule with a constant turnover in protein levels, especially HYAL1 and HYAL2. Interestingly, we many tissues via rapid metabolism leading to HA fragments of still found HA internalization within the cells even in absence of various sizes: HMM-HA, LMM-HA and o-HA. The innumerable HYAL2. As observed by others also5(0), treatment of cells with oncogenic functions of HA mainly depend on its molecular size the monoclonal antibody to the HA receptor CD44 increased ( 2,5,9,11,13,14,57 ). In this study, we used SEC-MALS analysis to endosomal HA that was significantly decreased upon fisetin accurately measure the molecular distribution of HA size f-rag treatment S( upplementary Figure  6, available atCarcinogenesis ments in all biological samples. Although large molecules of Online). We suggest a novel concept that HA internalization in HA promote tissue integrity and quiescence, the generation of fisetin-treated cells occurs via CD44 alone and is independent of breakdown products enhances signal transduction, contributing polymer digestion by HYAL2 activation. This significant finding to the pro-oncogenic behavior of cancer cells. Previous studies represents the mechanistic aspect of HA internalization upon (15,40,41) have revealed that cancer resistance in naked mole rat fisetin treatment. derives from the abundant production of HMM-HA. In contrary, HAS enzymes synthesize HA, whereas the HYALs degrade it LMM-HA has been proven to play a crucial role in breast cancer into smaller fragments. This constant HA turnover is important and seems to be a more promising molecular biomarker than for the maintenance of tissue homeostasis, and ~30% of HA is total HA for detecting breast cancer metastas5i7s).( Our in vivo results showed that during PCa progression in TRAMP animals, states, which undergoes breakdown with progression of disease there is increased pool of HMM-HA that further breaks down into and larger pool of proangiogenic LMM-HA accumulates. Fisetin LMM-HA. This suggests higher activity of HYAL enzymes leading reduces the larger pool of LMM-HA and increases the abundance to higher degradation with disease progression. Increased ROS of HMM-HA, which mimics the HA fragment profile of the nonlevels in diseased state may also contribute to the breakdown diseased state. The precise mechanism underlying the actual of HMM-HA into smaller fragments. Upon fisetin treatment, we role of fisetin and its ability to directly or indirectly restructure observed an increase in accumulation of HMM-HA botihn vitro/in the smaller HA fragments into larger fragments though very vivo. This increase of HMM-HA fragments in presence of fisetin promising requires further exploration. mimics the HA fragment profile of the non-diseased state that In summary, our study demonstrates fisetin, as a non-toxic, unveils a novel effect of fisetin. This effect is because fisetin -sig orally bioavailable, potent HA synthesis inhibitor in PCa. Fisetin nificantly decreases both HAS and HYAL levels. In this condition, treatment enables accumulation of a larger pool of ant-ian the HA synthesis process is halted and no new HMM-HA is pr-o giogenic HMM-HA and lowers level of proangiogenic LMM-HA, duced. At the same time with reduced activity of HYALs upon which leads to reduction of HA signaling. The dose of fisetin fisetin treatment, there seems to be very little or no degradationused in our in vivo studies was comparable with those in human of the preexisting HMM-HA. Fisetin treatment induces ROS l-ev use as a dietary supplement. Hence, by inhibiting HA synthesis, els, but surprisingly, increased ROS levels do not seem to cont-rib fisetin displays significant potential for prevention and tr-eat ute toward HA degradation as evidenced by larger accumulation ment of PCa in preclinical models. of HMM-HA upon fisetin treatmentin vitro. Hence, the HMM-HA stays intact within the cells and tissues upon fisetin treatment. Supplementary material Another possible reason for this phenomenon could be fis-e tin’s ability to directly or indirectly catalyze and reassembleSupplementary Tables 1–9 and Figures 1–6 can be found at the LMW-HA fragments into HMW-HA fragments. Interestingly, SEC-MALS analysis of commercially available HA oligos (HA-60K and HA-200K) incubated with fisetin revealed an increase in the Funding molecular weight of the starting HA oligos in a cell-free- sys United States Public Health Service Grants (RO1 CA160867 to H.M.). tem (Supplementary Table 9, available atCarcinogenesis Online). These preliminary data open up newer promising avenues and suggest fisetin probably possesses the potential to reassemble Acknowledgements the smaller HA fragments to larger ones. On the basis of our We gratefully acknowledge Cleveland Clinic for using their findings, antiangiogenic HMM-HA is increased in non-diseased HA isolation protocol (available online NHLBI # PO1HL107147). We thank the CORE resource facility at UW-Madison for helping in 24 . Piccioni , F. et al. 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Lall, Rahul K., Syed, Deeba N., Khan, Mohammad Imran, Adhami, Vaqar M., Gong, Yuansheng, Lucey, John A., Mukhtar, Hasan. Dietary flavonoid fisetin increases abundance of high-molecular-mass hyaluronan conferring resistance to prostate oncogenesis, Carcinogenesis, 2016, 918-928, DOI: 10.1093/carcin/bgw071