Ewing tumors (ET) comprise the second most common type of bone-associated sarcomas in children and adolescents and are characterized by oncogenic EWS/FLI1 fusion proteins and early metastasis. Using comprehensive microarray analyses and RNA interference this study identified the six-transmembrane epithelial antigen of the prostate 1 (STEAP1) - a membrane-bound mesenchymal stem cell marker of unknown function - as a highly expressed protein in ET compared to benign tissues and shows its regulation by EWS/FLI1. Knockdown of STEAP1 reduced proliferation, anchorage-independent colony-formation as well as invasiveness of ET cells in vitro and decreased tumor growth and metastasis of ET xenografts in vivo. Moreover, transcriptome and proteome analyses as well as functional studies revealed that STEAP1 expression correlates with oxidative stress responses and elevated levels of reactive oxygen species (ROS) that in turn are able to regulate redox-sensitive and pro-invasive genes via interferon-independent activation of signal transducer and activator of transcription (STAT1). As compelling evidence suggests that elevated levels of intracellular oxidative stress can on the one hand contribute to enhanced aggressiveness of numerous cancers, but on the other hand can increase the susceptibility of cancer cells toward chemotherapeutics and radiotherapy, membranous and cytoplasmic STEAP1 expression was analyzed in 114 primary pre-chemotherapy ET by immunohistochemistry and compared with clinical parameters and patient outcome. This analysis showed that 87.7% of the samples displayed detectable STEAP1 expression. High membranous and cytoplasmic STEAP1 expression was found in 53.5% and 25.4%, respectively, without correlation of both parameters. Especially combined high membranous and cytoplasmic STEAP1 expression, but also exclusive membranous STEAP1 immunoreactivity correlated with improved overall survival (p = 0.021). Accordingly, low membranous STEAP1 expression was identified as an independent risk factor in multivariate analysis (HR 2.65, p = 0.036), whereas very high STEAP1 expression was associated with excellent overall survival and an increased susceptibility of ET cell lines toward chemotherapy. In synopsis, these data suggest that STEAP1 is associated with the invasive behavior and oxidative stress phenotype of ET and point to a hitherto unanticipated oncogenic function of STEAP1 in ET. In addition, this study proves that high membranous STEAP1 expression can predict improved patient outcome, possibly caused by enhanced ROS-mediated chemosensitivity, and thus may help to define a specific sub-group of ET patients, who might benefit from adapted conventional therapy regimens and targeted delivery of ROS-dependent therapeutics to their STEAP1 expressing tumor cells.
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