In individuals with mammary carcinoma, the most relevant prognostic predictor of distant organ metastasis and clinical outcome is the status of axillary lymph node metastasis. Metastases form initially in axillary sentinel lymph nodes and progress via connecting lymphatic vessels into postsentinel lymph nodes. However, the mechanisms of consecutive lymph node colonization are unknown. Through the analysis of human mammary carcinomas and their matching axillary lymph nodes, we show here that intrametastatic lymphatic vessels and bulk tumor cell invasion into these vessels highly correlate with formation of postsentinel metastasis. In an in vitro model of tumor bulk invasion, human mammary carcinoma cells caused circular defects in lymphatic endothelial monolayers. These circular defects were highly reminiscent of defects of the lymphovascular walls at sites of tumor invasion in vivo and were primarily generated by the tumor-derived arachidonic acid metabolite 12S-HETE following 15-lipoxygenase-1 (ALOX15) catalysis. Accordingly, pharmacological inhibition and shRNA knockdown of ALOX15 each repressed formation of circular defects in vitro. Importantly, ALOX15 knockdown antagonized formation of lymph node metastasis in xenografted tumors. Furthermore, expression of lipoxygenase in human sentinel lymph node metastases correlated inversely with metastasis-free survival. These results provide evidence that lipoxygenase serves as a mediator of tumor cell invasion into lymphatic vessels and formation of lymph node metastasis in ductal mammary carcinomas.
Dontscho Kerjaschki, Zsuzsanna Bago-Horvath, Margaretha Rudas, Veronika Sexl, Christine Schneckenleithner, Susanne Wolbank, Gregor Bartel, Sigurd Krieger, Romana Kalt, Brigitte Hantusch, Thomas Keller, Katalin Nagy-Bojarszky, Nicole Huttary, Ingrid Raab, Karin Lackner, Katharina Krautgasser, Helga Schachner, Klaus Kaserer, Sandra Rezar, Sybille Madlener, Caroline Vonach, Agnes Davidovits, Hitonari Nosaka, Monika Hämmerle, Katharina Viola, Helmut Dolznig, Martin Schreiber, Alexander Nader, Wolfgang Mikulits, Michael Gnant, Satoshi Hirakawa, Michael Detmar, Kari Alitalo, Sebastian Nijman, Felix Offner, Thorsten J. Maier, Dieter Steinhilber, Georg Krupitza