A novel polymorphic repeat in the upstream regulatory region of the estrogen-induced gene EIG121 is not associated with the risk of developing breast or endometrial cancer
© The Author(s) 2016
Received: 7 February 2016
Accepted: 11 May 2016
Published: 26 May 2016
The estrogen-induced gene 121 (EIG121) has been associated with breast and endometrial cancers, but its mechanism of action remains unknown. In a genome-wide search for tandem repeats, we found that EIG121 contains a short tandem repeat (STR) in its upstream regulatory region which has the potential to alter gene expression. The presence of this STR has not previously been analysed in relation to breast or endometrial cancer risk.
In this study, the lengths of this STR were determined by PCR, fragment analysis and sequencing using DNA from 223 breast cancer patients, 204 endometrial cancer patients and 220 healthy controls to determine if they were associated with the risk of developing breast or endometrial cancer. We found this repeat to be highly variable with the number of copies of the AG motif ranging from 27 to 72 and having a bimodal distribution. No statistically significant association was identified between the length of this STR and the risk of developing breast or endometrial cancer or age at diagnosis.
The STR in the upstream regulatory region of EIG121 is highly polymorphic, but is not associated with the risk of developing breast or endometrial cancer in the cohorts analysed here. While this polymorphic STR in the regulatory region of EIG121 appears to have no impact on the risk of developing breast or endometrial cancer, its association with disease recurrence or overall survival remains to be determined.
The recent emphasis on high-throughput assays in the search to find genetic variants responsible for familial cancer risk has failed to account for a significant proportion of cases. Instead, the use of genome-wide association studies and next-generation sequencing has revealed variants that account for a small portion of heritability and has now resulted in the phrase “missing heritability” to explain that which remains unaccounted for [1, 2]. Another form of genetic variation that has been over-looked, largely due to their inability to be analysed on a large scale, is that of variable tandem repeats (TRs) which are common throughout the human genome and highly mutable . TRs may be drivers of phenotypic variation as they are known to be the cause of several neurological disorders and are associated with complex diseases such as diabetes and cancer .
In a recent study we identified short tandem repeats (STRs) in the upstream regulatory region of genes that are candidates for conferring cancer risk . One such STR is a dinucleotide AG repeat upstream of the estrogen-induced gene, EIG121 (also known as KIAA1324). In endometrial cancer cases, EIG121 is highly induced by estrogen in the endometrium and differentially expressed in endometrial cancer types [5, 6]. Studies suggest that EIG121, a transmembrane protein, has an important cellular function, as it is highly conserved across species and confers survival upon cells that have been starved of nutrients or exposed to cytotoxic chemotherapeutics . Our analysis from publicly-available datasets, using the Oncomine™ Platform (http://www.oncomine.com), shows EIG121 to be over-expressed in breast cancer compared to other cancer types (Additional file 1: Table S1; ) and compared to normal breast tissue (Additional file 2: Table S2; [9, 10]).
Breast and endometrial cancers are estrogen-driven malignancies, and in both diseases, higher expression of estrogen-induced genes is associated with tumours that tend to be low-grade and less aggressive [5, 11] suggesting involvement of these genes in cancer risk and/or development. As EIG121 has already been associated with estrogen levels and cancer, we analysed the variability of this newly identified STR in a series of breast and endometrial cancer cases and in a healthy control population to determine if there was any association between its length and the risk of developing these estrogen-driven cancers.
Demographic characteristics of the participants used in this study
Breast cancer (n = 223)
Endometrial cancer (n = 204)
Healthy controls (n = 220)
Age (at ascertainment; in years)
Age (at diagnosis; in years)
BMI (in kg/m2)a
Underweight (BMI < 18.5)
n = 1
n = 1
Normal (18.5 ≤ BMI < 25)
n = 37
n = 58
Overweight (25 ≤ BMI < 30)
n = 56
n = 91
Obese (BMI ≥ 30)
n = 94
n = 70
n = 16
n = 0
The STR (a dinucleotide AG repeat) situated 518 bp upstream of the transcription start site for EIG121 was genotyped by polymerase chain reaction (PCR) and fragment analysis using forward (5′-aggctaatccaggagaatctcttg-3′) and reverse (5′-aggctaatccaggagaatctcttg-3′) primers designed to amplify a 232 bp length fragment. PCR was performed with Platinum Taq DNA Polymerase High Fidelity (Invitrogen), an annealing temperature of 61 °C and 1.5 mM MgSO4. Fragment analysis was conducted on the ABI3730 DNA Analyzer (Applied Biosystems (AB)) after denaturation in the presence of HiDi Formamide (AB) and GeneScan 600 LIZ Size Standard (AB). The resulting electropherograms were analysed using Peak Scanner v1.0 software (AB). Sanger sequencing  on at least 10 % of each sample cohort, using the same primer sequences as described above, confirmed STR lengths. A line of best fit was generated to correct lengths obtained from fragment analysis as described by Pasqualotto and co-workers .
Statistical analyses were performed using the Stata 11.1 software package (StataCorp LP, College Station, TX, USA) and involved non-parametric Mann–Whitney U tests, Cox proportional hazard regression, Pearson’s Chi squared and Fisher’s exact tests. The significance levels of all tests were set at p value < 0.05 (two-sided) and corrected for multiple comparisons using the Bonferroni method.
Hazard ratios (HR), 95 % confidence intervals (CI) and p values for breast and endometrial cancer analysis in relation to EIG121 STR lengths
HR (95 % CI)
HR (95 % CI)
Both allele lengths with cancer risk
Mann–Whitney U test
Both allele lengths with age at diagnosis
Cox proportional hazard regression
Both allele lengths with age at diagnosis (BMI considered)
Cox proportional hazard regression
Allelic analysis (S/L)
Pearson’s Chi squared test
Genotypic analysis (SS/SL/LL)
Fisher’s exact test
In conclusion, the AG dinucleotide repeat in the upstream regulatory region of EIG121 is a highly polymorphic STR, making it a variable genetic element with the potential to influence the expression of EIG121 and subsequently impact disease risk and/or severity. No statistically significant association was identified between the length of this dinucleotide repeat and the age at diagnosis or risk of developing breast or endometrial cancer in the cohorts analysed. Hence, while this STR in the regulatory region of EIG121 is highly polymorphic, it is unlikely to be associated with the risk of developing breast or endometrial cancer. We cannot exclude its involvement in recurrence or overall survival as this information was not available for this study.
KAB provided the concept, designed the study, performed the experiments and analysis, and wrote the manuscript. EGH and JA assisted with statistical analysis and manuscript development. KAAK and NAB assisted with the study design, interpretation of results and manuscript development. RJS assisted with the concept and study design, interpretation of results and manuscript development. All authors read and approved the final manuscript.
This work was supported by an Australian Postgraduate Award (K.A. Bolton) and a National Health and Medical Research Centre Training (post-doctoral) Fellowship and Cancer Institute NSW Career Development Fellowship (N.A. Bowden). We wish to thank the breast cancer patients (Hunter Area Pathology Service, HAPS), endometrial cancer patients (John Hunter Hospital, JHH) and healthy controls (Hunter Community Study, HCS) who kindly consented to the use of their DNA for research. We wish to thank Dr. Michelle Wong-Brown for helping to source the breast cancer samples from HAPS; Dr. Katie Ashton, Dr. Anthony Proietto and Dr. Geoffrey Otton for sourcing and collecting the endometrial cancer samples from JHH; and Mr. Mark McEvoy and Mr. Stephen Hancock for sourcing samples and clinical data for the HCS cohort.
Availability of supporting data
The authors declare that they have no competing interests.
Ethics approval was obtained from the Human Research Ethics Committee, University of Newcastle (H-2009-0265; H-050-065) and the Hunter New England Human Research Ethics Committee, Hunter New England Health Service (09/05/20/5.01; 05/03/09/3.14), Newcastle, NSW, Australia.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
- Brookes KJ. The VNTR in complex disorders: the forgotten polymorphisms? A functional way forward? Genomics. 2013;101(5):273–81.View ArticlePubMedGoogle Scholar
- Hannan AJ. Tandem repeat polymorphisms: modulators of disease susceptibility and candidates for ‘missing heritability’. Trends Genet. 2010;26(2):59–65.View ArticlePubMedGoogle Scholar
- Press MO, Carlson KD, Queitsch C. The overdue promise of short tandem repeat variation for heritability. Trends Genet. 2014;30(11):504–12.View ArticlePubMedPubMed CentralGoogle Scholar
- Bolton KA, Ross JP, Grice DM, Bowden NA, Holliday EG, Avery-Kiejda KA, Scott RJ. STaRRRT: a table of short tandem repeats in regulatory regions of the human genome. BMC Genom. 2013;14(1):795.View ArticleGoogle Scholar
- Westin SN, Broaddus RR, Deng L, McCampbell A, Lu KH, Lacour RA, Milam MR, Urbauer DL, Mueller P, Pickar JH, et al. Molecular clustering of endometrial carcinoma based on estrogen-induced gene expression. Cancer Biol Ther. 2009;8(22):2126–35.View ArticlePubMedPubMed CentralGoogle Scholar
- Deng L, Broaddus RR, McCampbell A, Shipley GL, Loose DS, Stancel GM, Pickar JH, Davies PJ. Identification of a novel estrogen-regulated gene, EIG121, induced by hormone replacement therapy and differentially expressed in type I and type II endometrial cancer. Clin Cancer Res. 2005;11(23):8258–64.View ArticlePubMedGoogle Scholar
- Deng L, Feng J, Broaddus RR. The novel estrogen-induced gene EIG121 regulates autophagy and promotes cell survival under stress. Cell Death Dis. 2010;1(1):e32.View ArticlePubMedPubMed CentralGoogle Scholar
- Yu K, Ganesan K, Tan LK, Laban M, Wu J, Zhao XD, Li H, Leung CH, Zhu Y, Wei CL, et al. A precisely regulated gene expression cassette potently modulates metastasis and survival in multiple solid cancers. PLoS Genet. 2008;4(7):e1000129.View ArticlePubMedPubMed CentralGoogle Scholar
- Curtis C, Shah SP, Chin SF, Turashvili G, Rueda OM, Dunning MJ, Speed D, Lynch AG, Samarajiwa S, Yuan Y, et al. The genomic and transcriptomic architecture of 2,000 breast tumours reveals novel subgroups. Nature. 2012;486(7403):346–52.PubMedPubMed CentralGoogle Scholar
- Finak G, Bertos N, Pepin F, Sadekova S, Souleimanova M, Zhao H, Chen H, Omeroglu G, Meterissian S, Omeroglu A, et al. Stromal gene expression predicts clinical outcome in breast cancer. Nat Med. 2008;14(5):518–27.View ArticlePubMedGoogle Scholar
- Oh DS, Troester MA, Usary J, Hu Z, He X, Fan C, Wu J, Carey LA, Perou CM. Estrogen-regulated genes predict survival in hormone receptor-positive breast cancers. J Clin Oncol. 2006;24(11):1656–64.View ArticlePubMedGoogle Scholar
- Wong MW, Nordfors C, Mossman D, Pecenpetelovska G, Avery-Kiejda KA, Talseth-Palmer B, Bowden NA, Scott RJ. BRIP1, PALB2, and RAD51C mutation analysis reveals their relative importance as genetic susceptibility factors for breast cancer. Breast Cancer Res Treat. 2011;127(3):853–9.View ArticlePubMedGoogle Scholar
- Ashton KA, Proietto A, Otton G, Symonds I, McEvoy M, Attia J, Gilbert M, Hamann U, Scott RJ. The influence of the Cyclin D1 870 G>A polymorphism as an endometrial cancer risk factor. BMC Cancer. 2008;8:272.View ArticlePubMedPubMed CentralGoogle Scholar
- McEvoy M, Smith W, D’Este C, Duke J, Peel R, Schofield P, Scott R, Byles J, Henry D, Ewald B, et al. Cohort profile: the hunter community study. Int J Epidemiol. 2010;39(6):1452–63.View ArticlePubMedGoogle Scholar
- Pasqualotto AC, Denning DW, Anderson MJ. A cautionary tale: lack of consistency in allele sizes between two laboratories for a published multilocus microsatellite typing system. J Clin Microbiol. 2007;45(2):522–8.View ArticlePubMedPubMed CentralGoogle Scholar