ENPP3 expressed by HER2-positive breast cancer cells is associated with good prognosis by restraining epithelial-to-mesenchymal phenotype

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Abstract Background Ectonucleotide pyrophosphatase/phosphodiesterase 3 (ENPP3/CD203c) is largely studied as a marker of mast cells and basophils. By depleting extracellular ATP, it prevents excessive activation of mast cells and basophils, hence reducing inflammation and allergic reactions. Recent findings have also shown that Enpp3 can deplete cGAMP, another molecule involved in STING activation and IFN-mediated pro-inflammation. Little is still known regarding the role of Enpp3 in non-immune cells although a few reports have described its expression in healthy tissues and tumors. Methods In silico analysis were performed to investigate the expression levels and the prognostic value of Enpp3 in breast cancer, together with ovarian, prostate and colon carcinoma. ENPP3 expression was evaluated in formalin-fixed, paraffin-embedded tumor samples of breast cancer patients by immunohistochemistry, and in mouse mammary cancer cell lines by western blots. Cells were treated with EGFR ligands to stimulate the EGFR/HER2 axis. A mouse-derived mammary cancer cell line was engineered by CRISPR/Cas9 to introduce a GFP sequence under the control of the Enpp3 promoter. GFP-positive and - negative cells were sorted and analyzed by gene expression profiling to identify genes and pathways associated with Enpp3 expression. Finally, wild type and Enpp3 knockout cells were injected in the fat pad of Wsh mice, which do not have mast cells, to evaluate the growth of the tumors which were further analyzed by immunohistochemistry. Results We provide evidence that HER2-positive cells express higher levels of ENPP3 in samples of breast cancer patients. Moreover, in vitro models confirmed that HER2 expression and EGFR stimulation result in up-regulation of Enpp3. We identified pathways that can concur to Enpp3 expression and showed that i n vivo the absence of Enpp3 promotes tumor growth and development of tumors with a marked epithelial-to-mesenchymal phenotype. Finally, in a small cohort of HER2-positive breast cancer patients, we found that ENPP3 expression correlates with increased relapse-free survival. Conclusions Despite its potential immunosuppressive role, our findings support the notion that ENPP3 expression is promoted by HER2 in breast cancer, and that it is endowed with a positive prognostic value.

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