Management of melanoma is a growing and challenging public health issue requiring novel and multidisciplinary approaches to achieve more efficient prevention and therapeutic benefits. The aim of this article is to show the critical role of APE/Ref-1 on melanomagenesis and progression. APE/Ref-1 serves as a redox-sensitive node of convergence of various signals as well as a DNA-repair enzyme, and its activation protects melanocytes and melanoma cells from chronic oxidative stress and promotes cell survival via mediation of downstream pathways. APE/Ref-1 is a strong candidate as a potential drug-treatable target for the prevention and treatment of human melanoma. Lead compounds exhibiting inhibitory effects on APE/Ref-1 are also reviewed. We anticipate potential clinical benefit in the future through inhibition of APE/Ref-1 and/or Ref-1-mediated signaling.

Ultraviolet (UV) light exposure accounts for only 40-50% of the attributable risk for cutaneous melanoma (CM); also classical UV-induced lesions are rare in melanomas (especially among CM with NRAS or BRAF mutations). It is therefore likely that an additional environmental factor exists as familial and genetic factors play a role in less than 5%. A large amount of (largely forgotten) epidemiologic data indicates that heavy metal exposure is strongly associated with the development of CM. Also, epidemiologic studies of patients with joint replacement indicate a marked subsequent time-related increase in melanoma in patients with metal-on-metal hip arthroplasties. In these patients chromium and cobalt levels rise to 10x normal and stay elevated at levels two- to threefold normal for at least 10 years. Chromium is widely used in industry for its anticorrosive and steel-strengthening properties and is widespread in everyday materials. Our hypothesis is therefore that chromium, alone or in conjunction with UV, plays a major role in the pathogenesis of CM. We have incubated human neonatal melanocytes for more than 10 weeks in the presence of a wide range and concentrations of metals without effect except by hexavalent chromium Cr(VI)and to a lesser degree Co²(+). After prolonged culture, chromium-incubated cells produced foci and when replated secondary colonies formed. We have just begun to study this phenomenon in more detail and studies without and with different wavelengths of UV will be explored. Of interest is that aneuploidy (a universal chromosomal change in cutaneous melanoma) in lymphocytes in patients with hip-on-hip metal prostheses has been demonstrated by others.

Resveratrol has demonstrated preventive and therapeutic activities in a variety of tumors. However, the mechanistic basis of its pharmacological effects on human melanoma has not been well defined. Our results demonstrated that resveratrol significantly inhibited melanoma anchorage-independent growth, and even at high doses no distinct apoptosis or cell cycle arrest was observed. It is noteworthy that c83-2c (metastatic) and wm3211 (radial growth phase) melanoma cells became more dendritic shaped with resveratrol treatment. Major histocompatibility complex (MHC) class I antigen and Fas/CD95 constitutive surface expression levels were, respectively, increased by 2.7- and 1.6-fold of control in c83-2c cells. Resveratrol reduced both activator protein-1 (AP-1) DNA binding and transcriptional activities, and supershift assay revealed that AP-1 composition was shifted from c-Jun/JunD/Fra-1 to JunD/Fra-1/Fra-2, with markedly increased JunD, Fra-1, and Fra-2 protein expression levels in the nucleus. Furthermore, we overexpressed Fra-2 in human melanoma cells by using a Fra-2 expression construct and both AP-1 transcriptional activity and 12-O-tetradecanoylphorbol-induced transcriptional transactivation were reduced significantly, whereas MHC class I antigen and Fas/CD95 levels were elevated to 2.0 and 1.8 times of control, respectively. Addition of H(2)O(2) (10 muM) partially reversed the inhibition of colony proliferation; however, no effects on either MHC class I antigen or Fas expression was evident. Although H(2)O(2) restored participation of c-Jun in AP-1 complexes, H(2)O(2) addition did not affect the induction of Fra-1 and Fra-2 by resveratrol nor the morphological changes. We propose that alterations in AP-1 transcription signaling, mediated by changes in AP-1 dimeric composition and reduced intracellular reactive oxygen species levels, substantially contribute to the phenotypic changes induced by resveratrol.

We demonstrated previously that c-Jun, JunB and c-Fos RNA were dysregulated in metastatic melanoma cells compared with normal human melanocytes. The purpose of this study was to evaluate the distribution in composition of AP-1 dimers in human melanoma pathogenesis. We investigated AP-1 dimer pairing in radial growth phase-like (RGP) (w3211) and vertical growth phase-like (VGP) (w1205) human melanoma cells and metastatic cell lines (cloned from patients, c83-2c, c81-46A, A375, respectively) compared with melanocytes using electrophoretic mobility shift assay (EMSA), Western blot and transfection analyses. There are progressive variations in AP-1 composition in different melanoma cell lines compared with normal melanocytes, in which c-Jun, JunD and FosB were involved in AP-1 complexes. In w3211, c-Jun, JunD and Fra-1 were involved in AP-1 binding, while in w1205, overall AP-1 binding activity was decreased significantly and supershift binding was detected only with JunD antibodies. In metastatic c81-46A and A375 cells, only JunD was involved in AP-1 binding activity, but in a third (c83-2c) c-Jun, JunD and Fra-1 were present. Western blot evaluation detected c-Jun in melanocytes and w3211, but this component was decreased significantly or was not detectable in w1205, c81-46A and A375 cells. In contrast, JunD protein was elevated in c81-46A and c83-2c cells compared with melanocytes and RGP and VGP cell lines. Normal melanocytes and c83-2c cells (which have c-Jun involved in AP-1 binding), transfected with c-Jun antisense and treated with cisplatin, showed higher viability compared with untransfected cells, while in c81-46A cells (in which only JunD is detectable) no change in cell viability was observed following treatment with cisplatin and c-jun antisense transfection. A dominant-negative c-Jun mutant (TAM67) significantly increased the soft agar colony formation of w3211 and c83-2c cells. These results suggest that components of AP-1, especially c-Jun, may offer a new target for the prevention or treatment of human melanoma progression.

Apurinic/apyrimidinic endonuclease-1/redox factor-1 (APE/Ref-1) is a multifunctional protein involved in DNA base excision repair and redox regulation of many transcription factors. In different melanoma cell lines, we found that both nucleus and cytoplasm exhibited higher levels of Ref-1 compared with normal melanocytes. Similar increases of Ref-1 expression, detected by immunohistofluorescence, were also evident in nevi and malignant melanoma biopsies compared with normal skin, which were predominantly localized in the nucleus. Using recombinant adenovirus Adref-1, encoding full-length Ref-1, we transiently overexpressed APE/Ref-1 in human melanocytes, which protected these cells from UVB-induced apoptosis and increased foci formation in culture. Ref-1 overexpression also protected melanoma cells from cisplatin- or H2O2-induced apoptosis, whereas increased apoptosis was observed with Ref-1 antisense construct infection. These observations suggested that intracellular Ref-1 levels played an important role in sensitization of melanoma cells to apoptosis. Electrophoretic mobility shift assay results showed that in both cultured primary and metastatic melanomas DNA-binding activities of activator protein-1 and nuclear factor-kappaB were significantly diminished or shifted when anti-APE/Ref-1 antibody was added to deplete APE/Ref-1 from the binding complexes. Induced nuclear factor-kappaB transcriptional activities were also evident after Ref-1 overexpression. Furthermore, using three-dimensional molecular structure modeling and virtual screening, we found that resveratrol, a natural compound found in fruits and vegetables, docks into a druggable pocket of Ref-1 protein. In vitro studies revealed that resveratrol inhibited, in a dose-dependent manner, Ref-1-activated activator protein-1 DNA-binding activities as well as Ref-1 endonuclease activities and rendered melanoma cells more sensitive to dacarbazine treatment.