The invasion process is highly complex, involving a series of adhesive, degradative, and migratory steps, ultimately allowing metastatic tumor cells to detach themselves from the primary tumor and invade neighboring vessels. During these processes, tumor cells interact with a number of extracellular matrix and basement membrane components, together with endothelial cells of the vessel wall.
7 8 Adhesive interactions between tumor and endothelial cells themselves and between both cell types and extracellular matrix components are therefore critical at both the primary and secondary sites, whereas degradation is essential for migration through the extracellular matrix and basement membrane.
11 12
In most in vitro studies of invasion, investigators have used models that include extracellular matrix and basement membrane components only, correlating in vitro invasion of cell lines with relative metastatic potential in vivo through assessment with animal models.
14 15 Cutaneous melanoma cell lines have also been shown to behave comparatively in such assays.
16 17 However, because cell lines have been used in most work, there have been few published reports of use of STCs of primary tumors, and only limited correlation has been made of invasion with histopathologic details in any tumor type.
19 For both this study and our previous investigation,
19 STCs were used within five passages of being established in culture, with the intention of minimizing the effects of long-term culturing. However, it should be taken into consideration that, because resected tumors may be heterogeneous in their composition, clonal populations cultured may not be representative of the most malignant cellular population of the tumor in vivo.
In the present investigation, to establish whether in vitro invasion could be considered representative of the tumor’s relative metastatic potential in vivo, tumor cell invasion in the assays was compared with predicted invasive potential, by correlating with known prognostic indicators. Results from the control invasion assay (basement membrane alone) confirmed our previous study in which comparable assays were used and in which melanoma cultures invading at a high rate through basement membrane components, in general, were only of epithelioid or mixed cell type.
19 The transendothelial invasion assay seemed to provide a closer correlation. Specifically, only one spindle cell tumor (SOM 295) was able to invade adequately in the transendothelial invasion assay as opposed to three spindle cell tumors (SOM 275, 281, and 295) in the control assay. In contrast, of the tumors with mixed and epithelioid morphologies, with the exception of one case (SOM 262), all six tumors were able to penetrate both barriers. However, it is also of interest that although the aggressive tumors in the transendothelial model tended to have prognostic features more often associated with a poor prognosis, there were some notable exceptions. In particular, SOM 263 was a small choroidal melanoma. It is known that small tumors can behave highly aggressively,
25 despite indicators to the contrary, and it seems that SOM 263, at least in the transendothelial assay is a case in point. Additional follow-up is needed to clarify this point, and because the number of patients studied was small, the better correlations observed with the transendothelial model could be coincidental.
Because the metastatic process involves interactions with endothelial cells as well as extracellular matrix and basement membrane components, we have developed an in vitro model, including both a microvascular endothelial cell layer (of dermal or liver origin) and an artificial basement membrane, to mimic transendothelial invasion. Using fluorescent tagging, it was possible to visualize an intact layer of endothelial cells and thus an effective barrier to invasion
(Fig. 1A) . Cells therefore had to actively migrate between endothelial cells. It is also probable that confluent endothelial cells on the artificial basement membrane would have secreted additional basement membrane proteins, thus increasing the obstacle for the invading cells.
26 In a recent study using a similar system but with bovine aortic endothelial cells (large-vessel endothelial cells) and a series of seven human malignant and nonmalignant cell lines, the investigators observed transmigration of endothelial cells and the subsequent formation of another confluent endothelial monolayer on the lower surface of the membrane.
27 This phenomenon was not observed in our in vitro model and fluorescent tagging of the tumor and endothelial cell populations confirmed that confluent endothelial monolayers were not established on the lower surface of the membrane, possibly due to the use of endothelial cells derived from a different source. Because the microvasculature is generally thought to be the site of tumor cell extravasation
28 29 and because differences have been observed between large- and small-vessel endothelial cells,
30 using microvascular endothelial cells in a transendothelial cell model is possibly more appropriate. Moreover, because uveal melanomas preferentially metastasize to the liver, transendothelial invasion through dermal and liver microvascular endothelial cells may vary. In a preliminary experiment, no differences in the level of invasion were seen between SOM 196B invasion through dermal and liver endothelium. It was therefore hoped that a model using dermal endothelial cells as a barrier to uveal melanoma cells might still be representative of the situation in vivo, and because these cells were more readily available, they were used throughout the study.
The use of the transendothelial assay could provide an additional experimental system for the investigation of uveal melanoma invasion. For its effective use, the transendothelial model must be able to differentiate reliably between aggressive and nonaggressive melanomas in a manner consistent with their actual invasive capability. Few studies of transendothelial cell invasion cells have been published, but existing evidence suggests invasive abilities in a transendothelial cell invasion model correlates with metastatic potential in vivo,
27 although in such studies, correlation with clinical outcome was not feasible. Because primary tumors have been used in this investigation, it was possible to make some limited comparisons with the outcome of individual patients. Survival data were limited to an average of 12 months, however, and correlation with long-term survival for tumors was not possible. Nonetheless in agreement with published data, it is of interest that one tumor (SOM 196B) had been resected 41 months earlier, and the patient is known to be alive and disease free. Once in culture, this tumor invaded well, without the inclusion of an endothelial cell layer in the standard invasion assay. Yet invasion was significantly reduced (
P < 0.05) in the transendothelial cell invasion assay, with only 15% of the invading tumor population capable of overcoming both basement membrane and endothelial cell barriers. This may suggest that for SOM 196B the actual number of tumor cells in the total tumor population capable of overcoming both barriers is relatively small. In common with this tumor, other tumors, such as SOM 277, invaded well through the basement membrane, yet invasion was significantly decreased (
P < 0.05) for most melanomas when an endothelial cell layer was included.
It is widely understood that the metastatic process is highly inefficient.
31 Only a small percentage of cells in the primary neoplasm acquire the phenotype necessary to facilitate successful extravasation. Furthermore, once tumor cells have disseminated, only a fraction reach the secondary site and continue growth to become eventual metastatic foci. In vivo studies have shown that only 0.01% of tumor cells that enter the circulation progress to form metastatic colonies.
32 More recently, it has been suggested that growth of metastatic tumor cells into macroscopic tumors is primarily because of the microenvironment in which they are located, in agreement with Paget’s original seed-and-soil hypothesis.
33 34 Thus, in the initial stages of metastasis, a metastatic cell differs from a nonmetastatic cell, by its propensity to extravasate. In previous invasion assays, tumor cells have been considered to be invasive if they are capable of overcoming basement membrane barriers alone. In contrast, in the transendothelial model, we have considered cells to be invasive if they are able to overcome both the endothelial cell and basement membrane barriers together. Levels of invasion in the transendothelial model varied between tumors. Most tumors, were less effective at penetrating both the endothelial and basement membrane barriers (
P < 0.05; SOM 196B, 262, 275, 277, 280, 281, 282, 290, and 295). For these melanomas, invasion may compare to some extent, with the estimated level of 0.01% of tumor cells forming metastatic colonies. For other tumors (SOM 263 and 296), almost the entire invading cellular population was capable of overcoming both barriers (
P > 0.05). These melanomas may therefore equate to highly aggressive tumors in vivo, with more than 0.01% of tumor cells able to penetrate basement membrane and endothelial barriers.
The transendothelial model considers only invasion through basement membrane and endothelial layers, and metastasis itself is a highly complex procedure. Many factors influence the establishment of metastases and thus although tumor cells may be capable of overcoming both barriers, aspects such as survival in the bloodstream and proliferation in the target organ cannot be assessed by such a model. Of additional note, it has now been reported that mosaic vessels may exist that are lined with both tumor and endothelial cells.
35 Aggressive uveal melanomas have also demonstrated the formation of vascular channels in vitro and in vivo, composed of tumor cells only.
36 Therefore, in uveal melanoma, metastatic progression may be far more complicated than previously thought and may use a number of mechanisms of extravasation.
This study has shown a closer association of transendothelial cell invasion in vitro with known prognostic markers and, as such, may more reliably distinguish between melanomas invading at high and low levels than previous invasion assays using basement membrane alone. (Most spindle cell tumors were incapable of penetrating both endothelial and basement membrane barriers, whereas in comparison, only one of the mixed and epithelioid tumors was unable to penetrate both of these barriers.) The transendothelial assay is too impractical to be of prognostic value but was a useful experimental system in which to study differences in invasion and the mechanisms involved in both aggressive and nonaggressive tumors. Long-term clinical follow-up is necessary to further correlate in vitro transendothelial invasion in this model with clinical outcome, but it is possible that this system is a more representative model of invasion than previous in vitro models.
The authors thank Robin Farr for assistance with photographic and poster work.