These authors equally contributed to this study.
Tissue factor pathway inhibitor-2 (TFPI-2) is a potent inhibitor of plasmin which activates matrix metalloproteinases (MMPs) involved in degradation of the extracellular matrix. Its secretion in the tumour microenvironment makes TFPI-2 a potential inhibitor of tumour invasion and metastasis. As demonstrated in aggressive cancers, TFPI-2 is frequently down-regulated in cancer cells, but the mechanisms involved in the inhibition of tumour progression remained unclear. We showed in this study that stable TFPI-2 down-regulation in the National Cancer Institute (NCI)-H460 non-small cell lung cancer cell line using specific micro interfering micro-interfering RNA promoted tumour progression in a nude mice orthotopic model that resulted in an increase in cell invasion. Moreover, TFPI-2 down-regulation enhanced cell adhesion to collagen IV and laminin
Tumour progression is a complex multistep process that depends on an evolving crosstalk between cancer cells and the surrounding stromal tissue. The microenvironment is now recognized as having a pivotal role in promoting cancer initiation, progression and dissemination to form metastases [
TFPI-2 is a 32 kD Kunitz-type serine proteinase inhibitor secreted into the ECM by a wide variety of human cells including endothelial cells, monocytes, fibroblasts, epithelial cells, smooth muscle cells, syncytiotrophoblast cells [
We therefore investigated the impact of stable TFPI-2 inactivation in NCI-H460 non-small lung cancer cells on their behaviour toward lung fibroblast cells. We applied the promising new micro-interfering RNA approach (miRNA) to trigger sequence-specific TFPI-2 RNA degradation and gene silencing. We studied the effects of TFPI-2 inactivation on tumour growth in a nude mice orthotopic model and then invasiveness, proliferation and adhesion properties of cancer cells to ECM proteins and their MMP expression pattern. We also evaluated whether TFPI-2 inactivation in cancer cells might be responsible for regulation of MMP synthesis by pulmonary fibroblasts.
The human non-small cell lung cancer cell line NCI-H460 was obtained from the American Type Culture Collection (LGC Promochem, Molsheim, France). Cells were grown in Roswell Park Institute Medium 1640 medium (Invitrogen, Cergy-Pontoise, France) supplemented with 2 mM L-glutamine, 25 mM sodium bicarbonate, 2 mM glucose, 10 mM 4-(2-hydroxyethyl)-1-piperazi-neethanesulfonic acid (HEPES), 1 mM sodium pyruvate, 100 μg/ml streptomycin, 100 U/ml penicillin and 10% endotoxin-free heat inactivated foetal calf serum (FCS, ATGC Biotechnologie, Noisy le Grand, France). The human fibroblast cell line CCD19-Lu (LGC Promochem) derived from adult normal lung tissue was grown in MEM/Earle's/Glutamax medium supplemented with non-essential amino acids, 25 mM sodium bicarbonate, 1 mM sodium pyru-vate, 100 μg/ml streptomycin, 100 U/ml penicillin and 10% FCS. All cells were cultured in a humidified atmosphere containing 5% CO2 at 37°C.
Two different sequences of pre-miRNA targeting the human TFPI-2 transcripts [
The pcDNA 6.2-GW/EmGFP-miR plasmid (Invitrogen) with blasticidin resistance gene and expressing the EnGFP (emerald green fluorescent protein) was used for the synthesis of pre-miRNA. This pre-miRNA is based on the murine miR-155 sequence [
Confluent NCI-H460 cells were washed with Ca2+ and Mg2+-free Hank's balanced solution and harvested using 0.05% trypsin-0.02% ethylenediaminetetraacetic acid (EDTA). Cell viability was determined by Trypan blue dye exclusion test and ranged between 90% and 95%. For miRNA transfection, 105 cells were seeded in 24-well plates for 24 hrs in RPMI-1640 10% FCS without antibiotics. Purified pcDNA 6.2GW/EmGFP-miR expression vectors (0.8 μg) containing either the TFPI-2 pre-miRNA insert (pcDNA-TFPI-2 pre-miRNA-1, pcDNA-TFPI-2 pre-miRNA-2) or a negative-control mismatch sequence (pcDNA-TFPI-2 pre-miRNA-Neg) were transfected into 75–80% confluency NCI-H460 cells with 2 μl of Lipofectamine 2000 reagent (Invitrogen). Six hours after transfection, the medium was replaced by fresh complete medium containing 10% FCS. After 24 hrs, cells were plated in 6-well plates with selection medium, containing 6 μg/ml blasticidin. Transfection efficacy was checked by fluorescence microscopy 48 hrs after transfec-tion by measuring EmGFP expression. Successfully transfected cell clones were then obtained by 3 weeks culture in the selection medium and TFPI-2 knockdown was assessed by reverse transcriptase real-time PCR and Western blotting.
Total mRNA was extracted from 106 cells using the Dynabeads mRNA Direct Kit (Invitrogen) according to the manufacturer's instructions. Total mRNA was then reverse transcribed for 1 hr at 42°C in incubation buffer containing 250 μM of each deoxynucleotide triphosphate, 5 μM oligo (dT)20, 24 units RNase inhibitor, and 20 units of avian myeloblastosis virus reverse transcriptase (Roche Diagnostics, Meylan, France).
The amounts of TFPI-2, MMP-1, -2, -3, -7, -9, -13, -14 and EMMPRIN transcripts within cells were assessed by real-time PCR using the icycler iQ detection system (Bio-Rad, Ivry sur Seine, France). PCR was performed in a total reaction volume of 25 μl containing cDNA obtained from mRNA of 2 × 104 cells, 2-fold dilution of Platinum Quantitative PCR SuperMix-UDG (Invitrogen), 0.32 μM of each primer (Eurogentech, Angers, France,
Oligonucleotide sequences used for real-time PCR
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| TFPI-2 | Forward: AACGCCAACAATTTCTACACCT Reverse: TACTTTTCTGTGGACCCCTCAC | 109 | 67 | 35 |
| MMP-1 | Forward: CTGCTGCTGTTCTGGGGT Reverse: GCCACTATTTCTCCGCTTTTC | 147 | 65 | 40 |
| MMP-2 | Forward: GGCCCTGTCACTCCTGAGAT Reverse: CAGTCCGCCAAATGAACCGG | 105 | 67 | 34 |
| MMP-3 | Forward: ATCCCGAAGTGGAGGAAAAC Reverse: GCCTGGAGAATGTGAGTGGA | 139 | 65 | 40 |
| MMP-7 | Forward: CCGCATATTACAGTGGATCG Reverse: GCCAATCATGATGTCAGCAG | 111 | 60 | 40 |
| MMP-9 | Forward: AGACCGGTGAGCTGGATAG Reverse: GTGATGTTGTGGTGGTGCC | 121 | 69 | 45 |
| MMP-13 | Forward: AGCATGGCGACTTCTACCC Reverse: CATCAAAATGGGCATCTCCT | 96 | 65 | 40 |
| MMP-14 | Forward: CGAGGGGAGATGTTTGTCTT Reverse: TCGTAGGCAGTGTTGATGGA | 131 | 65 | 40 |
| EMMPRIN | Forward: TGCTGGTCTGCAAGTCAGAG Reverse: GCGAGGAACTCACGAAGAAC | 123 | 65 | 40 |
| β-actine | Forward: GCCCTAGACTTCGAGCAAGA Reverse: AGGAAGGAAGGCTGAAGAG | 143 | 62 | 25 |
Transfected cells (miRNA-1 and -2, miRNA-Neg clones and parental NCI-H460) were grown in complete medium to 70–80% confluency in 6-well plates. Cells were eliminated by trypsinization and proteins from the ECM were solubilized in TNC buffer (50 mM Tris-HCl pH 7.5, 0.15 M NaCl, 10 mM CaCl2 and 0.05% Brij 35) and then centrifuged at 15,000 × g for 5 min. Total protein concentrations of the supernatants were measured using the Lowry method (Total Protein Kit, Sigma Aldrich, Saint Quentin Fallavier, France). Proteins (3 μg) were separated on 12% SDS-PAGE and transferred onto a nitrocellulose membrane. Membranes were then saturated for 2 hrs at room temperature in TNT buffer (10 mM Tris-HCl and 150 mM NaCl pH 7.4, 0.1% Tween-20) with 5% non-fat dried milk, incubated overnight at 4°C with polyclonal rabbit anti-TFPI-2 antibody (generous gift of W. Kisiel) diluted 1/3000 in TNT buffer with 5% non-fat milk and for 1h with peroxidase-labelled anti-rabbit IgG (Sigma Aldrich) after washing with TNT buffer. Following exposure for 1 min. to the Chemiluminescence Reagent Plus (Perkin Elmer Biosystems, Courtaboeuf, France), membranes were drained, wrapped in a plastic bag and exposed to autoradiography film (Sigma Aldrich) for 10 min. in the dark.
Pathogen-free male BALB/c nude mice 4 weeks old (Charles River laboratories, Lyon, France) were acclimatized for 2 weeks before starting the study in a sterile environment. All animals were handled and cared in accordance with the national and institutional guidelines. Protocols were conducted under the supervision of an authorized investigator with the approval of the institutional ethic committee where experiments are performed (CIPA, TAAM-UPS44 Orléans, France). Mice were maintained in sterilized filter-stopped cages throughout the experimentation. They were examined daily and monitored for signs of distress, decreased physical activity and weight.
Before implantation, confluent miRNA-1 and -2 and miRNA-Neg NCI-H460 cells were harvested using 0.05% trypsin and 0.02% EDTA and washed twice in FCS-free medium. Cells were then resuspended in RPMI-1640 containing 10 mM EDTA (Sigma Aldrich) added immediately before implantation. Trypan Blue dye exclusion test was used to assess cell viability >95% for implantation.
The intrabronchial tumoral cell implantation procedure was derived from that previously described [
Cell migration was assessed using a model based on the Boyden chamber (8 μm pore size, BD Biosciences). Briefly, transfected cells were harvested by trypsinisation, then washed with phosphate-buffered saline (PBS) and 2 × 105 cells were suspended in 400 μl of serum-free medium and seeded on the upper chamber of the inserts. The lower chamber of a 24-well cell culture plate was filled with 600 μl of culture medium containing 10% FCS used as chemoattractant. Plates were incubated for 48 hrs at 37°C in a humidified atmosphere containing 5% CO2. The cells remaining in the insert were removed by aspiration and wiping with cotton swabs. Migrated cells on the lower surface of the filter and adhering to the plate were detached by 0.05% trypsin-0.02% EDTA and counted in a Malassez chamber. The results were expressed as the percentage of migrating cells ± S.E.M.
To study the cell invasion through the basement membrane components, cell culture inserts were coated with a thin layer of 0.8 mg/ml Matrigel™ (BD Biosciences) according to the manufacturer's instructions.
Tumour cells (1.25 ± 104) were seeded in 24-well plates and cultured in 700 μl complete medium containing 10% FCS. After 24, 48, 72 and 96 hrs of culture, 140 μl of MTS (3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2H-tetrazolium, inner salt) and an electron coupling agent, phenazine ethosulphate (CellTiter 96® AQueousOne Solution, Promega, Charbonnières les Bains, France) were added. Cells were incubated for 1 hr at 37°C in a humidified atmosphere containing 5% CO2 and absorbance was then measured on an ELISA plate reader (Thermomax Molecular Devices, St Grégoire, France) at a wavelength of 490 nm.
Adhesion of stably pre-miRNA-transfected NCI-H460 cells to laminin, vitronectin, fibronectin and collagen I and IV was studied using the ‘CytoMatrix SCREEN Kit’ (AbCys, Paris, France) according to the manufacturer's instructions. Cells were serum-starved overnight, detached with 0.05% trypsin-0.02% EDTA and allowed to express novel integrins in the shaking incubator at 37°C in 5% CO2 for 2 hrs in complete medium containing 1% bovine serum albumin (BSA). After counting cells in the presence of Trypan blue using a Malassez chamber, 5 × 104 viable cells in 100 μl complete medium with 1% BSA were plated in triplicate on ECM protein-coated wells, or on wells coated with BSA used as control, for 2 hrs at 37°C in a humidified CO2 atmosphere. Cells were then rinsed three times with PBS containing Ca2+ and Mg2+ and adhering cells were fixed and stained in 100 μl of 0.2% crystal violet in 10% ethanol over 5 min. of gentle shaking at room temperature. Relative attachment of cells was determined using absorbance readings at 570 nm in a microplate reader (Thermomax Molecular Devices). Readings measured with BSA for each cell type were subtracted from ECM protein readings.
Identification of cell surface integrins was performed by using the fluorimetric Alpha/Beta Integrin-Mediated Cell Adhesion Assay Combo Kit (Chemicon Millipore, Saint Quentin en Yvelines, France). Briefly, 3 × 106 tumour cells (miRNA-Neg, miRNA-1b or miRNA-2b NCI-H460 clones) were seeded in medium complemented with 1% BSA and incubated overnight at 37°C in 5% CO2. Cells were then detached with 0.05% to 0.02% EDTA and washed twice in Hank's Buffered Salt Solution (HBSS) (without Ca2+ and Mg2+). After centrifugation at 800 × g, the pellet was resuspended in 2 ml medium supplemented with 1% BSA and the cells were incubated rocking for 2 hrs at 37°C in 5% CO2. The cells were then spun down and the pellet was resuspended in 2 ml Assay Buffer. 100 μl of the cell suspension in Assay Buffer were distributed in a microtitre plate coated with anti-human Integrin mouse monoclonal antibodies and incubated for 2 hrs at 37°C in 5% CO2. The unbound cells were washed away and adhering cells were lysed and detected with the patental CyQuant GR dye (Molecular Probes, Invitrogen, Carlsbad, CA, USA), which binds to nucleic acids, by reading fluorescence with a Wallac 1420 Victor2 apparatus (excitation: 485 nm; emission: 535 nm). Results are expressed in relative fluorescence units.
The measurement of 10 signal transduction pathways in the tumour cell clones was performed with the Cignal Finder™ Cancer 10-Pathway Reporter Array (SA Biosciences, TEBU, Le Perry en Yvelines, France). Briefly, 5 × 104 NCI-H460 miRNA-Neg, miRNA-1b or miRNA-2b cells were reverse-transfected with SureFECT reagent directly in a 96-well plate containing a mixture of a pathway-focused transcription factor-responsive. Each of the 10-pathway reporter assays contains an inducible transcription factor responsive firefly luciferase reporter and constitutively expressing
Tumour cells (miRNA-Neg, miRNA-1b or miRNA-2b NCI-H460 clones) were grown in complete medium to confluency. Cells were then washed twice with HBSS medium without Ca2+ and Mg2+ and cultured with serum-free medium supplemented with 1% Nutridoma® (Roche Diagnostics) for 24 hrs at 37°C. The conditioned medium was collected, centrifuged at 1600 × g for 10 min. and concentrated 10-fold (Amicon concentrator, Millipore, Saint Quentin en Yvelines, France). Fibroblast cells seeded overnight in 6-well plates (106 cells) in complete medium with 10% FCS were washed twice with PBS, and fresh concentrated conditioned medium equivalent to 107 tumour cells (ratio 10:1) was then applied for 24 hrs. A control condition was assayed by using non-conditioned medium complemented with 1% Nutridoma® and concentrated 10-fold. Twenty-four hours later, fibroblast cells were lysed, total mRNA was extracted and the amounts of MMP-1, -2, -3, -7, -9, -13, -14 and EMMPRIN transcripts assessed by reverse transcription and real-time PCR. MMP-1, -3 and -7 protein expression was evaluated by immunofluorescence assay.
Tumour cells or fibroblasts were seeded in 8-well chamber slides (LabTek, Dominique Dutscher, Issy les Moulineaux, France) 24 hrs prior to immuno-fluorescence staining in complete medium with 10% FCS or with fresh concentrated conditioned medium from tumour cells. Cells were then washed twice with PBS and fixed in 4% paraformaldehyde solution for 10 min. at room temperature. After two washings in PBS, slides were blocked with a fresh saturation solution (PBS/BSA 2%) for 1 hr and then incubated at room temperature with primary antibodies,
Data were expressed as means ± S.E.M., statistical analysis was carried out using Student's t-test (two tailed) and
NCI-H460 cells from a human non-small cell lung cancer were stably transfected with two recombinant plasmids encoding pre-miRNA,
To examine miRNA-induced gene down-regulation, total mRNA and protein from the ECM of NCI-H460, miRNA-Neg, miRNA-1a and -1b, and miRNA-2a and -2b cells were extracted. Although the miRNA-Neg and miRNA-1a clones exhibited no interference effect, significant inhibition of TFPI-2 transcripts was achieved in the miRNA-1b, -2a and -2b cell clones as demonstrated by RT and real-time PCR, with 91%, 73% and 93.5% inhibition, respectively, compared to parental NCI-H460 cells (
TFPI-2 silencing in lung cancer cells by micro-RNA interference. (A) TFPI-2 transcript levels were quantified using real-time RT-PCR in non-small lung cancer cells stably transfected with recombinant plasmids containing miRNA inserts that target TFPI-2 mRNA in parental NCI-H460. The copy number of TFPI-2 transcripts was first normalized to 106 copies of β-actin mRNA and the percentage of TFPI-2 mRNA inhibition in miRNA clones was compared to parental NCI-H460. Data are presented as means ± S.E.M. from four independent mRNA extractions and real-time RT-PCR performed in triplicate. (B) TFPI-2 protein expression in ECM from NCI-H460 non-small lung cancer cells and miRNA clones by immunoblotting using a rabbit polyclonal antibody against TFPI-2. (C) Immunofluorescence staining of parental NCI-H460 cells and miRNA-1b and -2b clones using a rabbit polyclonal antibody against TFPI-2 (original magnification, ×40).
miRNA-Neg, miRNA-1b and -2b NCI-H460 cell suspensions containing a 99mTc-labelled tin colloid used as tracer were implanted intrabronchially with a catheter inserted into the trachea. The catheter position into the right main bronchus was checked using X-ray imaging and the punctual deposition of cells into the lung assessed by scintigraphy. Only one mouse died immediately after surgery and another one died during experimentation due to tumour progression. When cells were orthotopically implanted with 10 mM EDTA, lung tumours were obtained in 95% of mice after a 4-week period. Tumours were located in the lower and middle parts of the lung as demonstrated by tomography scanning (
Impact of TFPI-2 silencing on tumour progression in a nude mice orthotopic model. The intrabronchial implantation of cells was performed with a 1.9 Fr × 50 cm blunt-ended catheter that was inserted and advanced into the right main bronchus. Position of the catheter was monitored using X-ray imaging. Tumour cell suspension (7.5 × 105 miRNA-Neg, miRNA-1b and -2b tumour cells in 25 μl) containing a 99mTc-labelled tin colloid and 10 mM EDTA was slowly injected into the right lobe. The scintigraphic assessment of the cell deposition into lung was then performed. Tumour progression was monitored using computed tomography scanning imaging over a 4-week period. Twenty minutes prior imaging, 100 mg/kg D-luciferin was injected i.p. to anesthetized mice. Lung tumour (T) volumes were measured on axial transverse sections. Each scanning image is representative of results obtained in nine animals per group. Tumour volume results are mean ± S.E.M. (
The migratory ability of miRNA-1b and -2b NCI-H460 clones through insert filters of 8 μm pore size was significantly increased 1.7-fold (
Lung cancer cell migration, invasion, proliferation and adhesion to ECM proteins. (A) Cell migration and invasion were evaluated by modified Boyden chamber assay using culture inserts (8 μm pore size) coated with a thin layer of Matrigel (0.8 mg/ml) for invasion and uncoated inserts for migration. Cells (2 × 105) were seeded in the upper chamber of the inserts and allowed to migrate for 48 hrs to the lower chamber containing culture medium with 10% FCS used as chemoattractant. Results from six experiments (means ± S.E.M.) are expressed as the percentage of migrating miRNA-1b and -2b cells compared with miRNA-Neg cells (*
Growth of miRNA clones and miRNA-Neg cells seeded at low density was then measured every 24 hrs over 96 hrs. As shown in
To explore further the mechanisms by which TFPI-2 is able to regulate cell invasion, we investigated whether cell attachment to different ECM components was affected when this serine protease inhibitor was down-regulated. The results showed increased adhesion to fibronectin, vitronectin, laminin and collagen IV with both miRNA-1b and -2b clones compared to miRNA-Neg cells (
To investigate whether the expression of integrins on cell surface could mediate cell-matrix adhesion and thus invasion process, we determined the integrin profiles of cells using various α and β subunit antibodies. Our data clearly demonstrated that down-regulation of TFPI-2 could promote expression of α1 subunit (
Characterization of cell surface integrins affected by TFPI-2 down-regulation in non-small lung cancer cells. (A) α integrin and (B) β integrin-mediated cell adhesion of tumour cells (3 × 106) transfected with pre-miRNA targeting TFP-2. The fluorescence of CyQuant GR dye evaluating tumour cells adhering to anti-human monoclonal antibody was measured at 535 nm and expressed in relative fluorescence units. Results represent the mean ± S.E.M. of two experiments performed in duplicate. (*
Levels of MMP-1, -2, -3, -7, -9, -13, -14 and EMMPRIN transcripts were quantified in miRNA-Neg, miRNA-1b and -2b clones using RT and real-time PCR (
Effects of TFPI-2 down-regulation on metalloproteinase and EMMPRIN in non-small lung cancer cells. (A) MMP and EMMPRIN transcript levels were quantified using real-time RT-PCR in lung cancer cells stably transfected with miRNA-1b and -2b targeting TFPI-2 mRNA and in miRNA-Neg clone cells. The copy numbers of each transcript were normalized to 106 copies of β-actin. Results represent the mean ± S.E.M. from four independent mRNA extractions and real-time RT-PCR performed in triplicate. (*
To determine whether various signalling pathways were activated in TFPI-2 down-regulated non-small lung cancer cells, we measured the activities of 10 signal transduction pathways involved in cancer biology using a dual-luciferase reporter assay. As shown in
Identification of signal transduction pathway involved when TFPI-2 is down-regulated in lung cancer cells. Using a luciferase pathway reporter array, the firefly luciferase activity of inducible transcription factor-responsive construct transfected in miRNA clones was measured and related to
In order to examine the effects of soluble factors produced by tumour cells expressing (or not) TFPI-2 on metalloproteinases and EMMPRIN synthesis by fibroblast cells, conditioned serum-free media were obtained from miRNA-Neg, miRNA-1b and -2b clones. Fresh conditioned media equivalent to 107 tumour cells were applied to 106 fibroblasts for 24 hrs. Controls were performed by incubating fibroblasts with non-conditioned medium concentrated 10-fold. MMP-1, -2, -3, -7, -9, -13, -14 and EMMPRIN transcript levels in fibroblast cells, quantified by RT and real-time PCR, were not affected when cells were incubated with concentrated conditioned medium from miRNA-Neg compared to concentrated medium used as control (
Metalloproteinase and EMMPRIN in fibroblasts cultured with conditioned media from non-small lung cancer cells inactivated for TFPI-2. (A) Normal fibroblasts (106 cells) were grown for 24 hrs in a fresh concentrated conditioned medium from 107 miRNA-1b, -2b, or miRNA-Neg clones. The copy number of each transcript was determined and normalized to 106 copies of β-actin. Data are presented as means ± S.E.M. from four independent mRNA extractions and real-time RT-PCR performed in triplicate. *
The relationship between TFPI-2 down-regulation, frequently associated with epigenetic changes and tumour aggressiveness, has been well documented in a wide variety of cancers [
We showed in this study that TFPI-2 transcripts could be significantly down-regulated in human non-small cell lung cancer cells using artificial microRNA technology. Consistent with this mRNA degradation, both Western blotting and immunofluores-cence assays demonstrated a strong decrease in TFPI-2 protein, mainly when more than 90% of mRNA transcripts were inhibited. The stable targeting and degradation of complementary transcripts by artificial miRNA is a highly specific approach for effective gene silencing [
Our results demonstrated that stable TFPI-2 knockdown, as we previously demonstrated with transient RNA interference [
The tumour microenvironment is important for tumour progression, mainly
In conclusion, the present study provides evidence that inactivation of TFPI-2 synthesis might promote tumour invasion by a mechanism dependent on regulation of MMP-1, -2, -3, -7 and of ERK signalling pathway. Moreover, soluble factors produced by lung cancer cells may contribute to MMP synthesis by fibroblasts from the microenvironment, thus enhancing tumour progression and formation of metastases.
We are grateful to Walter Kisiel (Department of Pathology, University of New Mexico, Health Sciences Center, Albuquerque, NM, USA) for kindly providing the anti-TFPI-2 rabbit polyclonal antibody. We thank Alain Le Pape for hepful discussion on this work. We also particularly thank Julien Sobilo, Maryline Lemée, Stéphanie Rétif and Sophie Hamard for excellent technical assistance and Doreen Raine for editing the English text. This study was supported by the ‘Ligue Contre le Cancer’ and the ‘Région Centre’ (THERICAPT project).