Modelling genetic and clinical heterogeneity in epithelial ovarian cancers

The biology underlying early-stage epithelial ovarian cancer (EOC) development is poorly understood. Identifying biomarkers associated with early-stage disease could have a significant impact on reducing mortality. Here, we describe establishment of a threedimensional (3D) in vitro genetic model of EOC initiation and early-stage neoplastic progression. Normal primary ovarian epithelial (POE) cells, immortalized using hTERT (immortalised ovarian epithelial [IOE] cells), were partially transformed by overexpressing the CMYC oncogene (IOE ^CMYC cells). Subsequent expression of mutant alleles of KRAS (KRAS ^G12V) or BRAF (BRAF ^V600E) created double-mutant lines (IOE ^CMYC.KRAS and IOE ^CMYC.BRAF). The transformed phenotype of IOE ^CMYC cells was further enhanced in concert with KRAS ^G12V/BRAF ^V600E expression, as in vitro analyses indicated that IOE ^CMYC cells had undergone morphological and phenotypic changes characteristic of neoplastic progression. When cultured as 3D spheroids, IOE cells underwent growth arrest, reminiscent of nonproliferative, unstimulated POE in vivo. In contrast, IOSE ^{CMYC+BRAF/KRAS} cells formed highly proliferative, poly-aggregate spheroid structures, showing increased expression of the Wilms tumour 1 tumourigenic marker and MIB1 proliferation marker. Transcriptomic analyses identified different gene expression profiles between the different cell lines and novel candidate genes (e.g. RGS4, CTGF and THBS1) that are somatically altered in EOCs. Gene expression signatures were compared with signatures from primary EOCs; tumours with IOE ^CMYC 'like' signatures were more likely to be high grade (P 5 0.018); tumours with BRAF signatures were associated with improved relapse-free survival (P 5 0.003). In conclusion, we have established in vitro 3D models of early-stage EOCs, which reflect genetic and phenotypic heterogeneity of the disease. Molecular genetic characteristics of these models correlated with molecular and clinical features of primary EOCs.