Journal of Molecular Medicine

, Volume 96, Issue 10, pp 1025–1037 | Cite as

Low cleaved caspase-7 levels indicate unfavourable outcome across all breast cancers

  • Andreas U. Lindner
  • Federico Lucantoni
  • Damir Varešlija
  • Alexa Resler
  • Brona M. Murphy
  • William M. Gallagher
  • Arnold D. K. Hill
  • Leonie S. Young
  • Jochen H. M. PrehnEmail author
Original Article


Elevated levels of the anti-apoptotic BCL2 protein associate with favourable outcome in breast cancer. We investigated whether executioner caspase activation downstream of mitochondrial apoptosis was associated with, or independent, of BCL2’s prognostic signature in breast cancer. Levels of pro- and anti-apoptotic BCL2 family proteins were quantified in triple negative breast cancer (TNBC) samples and utilised to calculate BCL2 profiles of 845 breast cancer patients. Biomarkers including single apoptosis proteins and network-enriched apoptosis system signatures were evaluated using uni- and multi-variate Cox-models. In both TNBC and non-TNBC breast cancer, the anti-apoptotic BCL2 protein was particularly abundant when compared to other solid tumours. High BCL2 protein levels were prognostic of favourable outcome across all breast cancers (HR 0.4, 95% CI 0.2–0.6, Wald p < 0.0001). Although BCL2 and cleaved caspase-7 levels were negatively correlated, levels of cleaved caspase-7 were also associated with favourable outcome (HR 0.4, 95% CI 0.3–0.7, Wald p = 0.001). A combination of low BCL2 and low cleaved caspase-7 protein levels was highly prognostic of unfavourable outcome across all breast cancers (HR 11.29, 95% CI 2.20–58.23, Wald p = 0.01). A combination of BCL2 and cleaved caspase-7 levels is a promising prognostic biomarker in breast cancer patients.

Key message

  • BCL2 levels are elevated in breast cancer where they are marker of good prognosis.

  • BCL2 and active caspase levels correlate negatively; yet, active caspases indicate good outcome.

  • Low BCL2 and low caspase-7 are highly prognostic of unfavourable outcome across all breast cancers.

  • BCL2 levels indicate molecular subtype and tumour proliferation status in breast cancer.


Breast cancer BCL-2 proteins Apoptosis Cell death Caspases Systems biology 



arbitrary unit


analysis of variance


antagonist/killer 1 (BAK1)


associated X, apoptosis regulator (BCL2L4)


B-cell lymphoma 2


B-cell lymphoma-extra large (BCL2L1)


Bcl-2 interacting mediator of cell death (BCL2L11)


BCL2 homology 3rd domain


confidence interval


disease-free survival


oestrogen receptor 1 (ESR1)


Receptor tyrosine-protein kinase erbB-2 (ERBB2)


hazard ratio


inhibitor of apoptosis




myeloid cell leukaemia sequence 1 (BCL2L3)


mitochondrial outer membrane permeabilisation


nanomolar (10−9 mol/L)


horbol-12-Myristate-13-Acetate-Induced protein 1 (PMAIP1)


overall survival


probability value


50-gene signature


proportional hazards assumption


progesterone receptor (PGR)


phosphatidylinositol-4,5-Bisphosphate 3-Kinase Catalytic Subunit


p53 upregulated modulator of apoptosis (BBC3)


reverse protein phase array


The Cancer Genome Atlas


triple negative breast cancer


tumour/lymph node/metastasis staging system

Tukey HSD

Tukey Honest significant differences post-hoc test


voltage-dependent anion channel 2

Wald p

Wald test probability value



We are grateful to the patients and their families who participated in this study. We thank Ciaran de Chaumont and Lance Hudson for technical assistance, Ramphul Eimear, Dr. Róisín M. Dwyer and Prof. Michael J. Kerin for sharing of samples, and Dr. Triona Ni Chonghaile for critical review of the manuscript. The results published here are in part based upon data generated by the TCGA Research Network: which we also gratefully acknowledge.

Authors’ contributions

A.U.L., F.L. and D.V. generated data. A.U.L. and A.R. performed data analysis. D.V., B.M.M., A.D.K.H. and L.S.Y. acquired clinical data and provided material. J.H.M.P. and W.M.G. conceived this study and provided funding. J.H.M.P. and L.S.Y. supervised the study. A.U.L. and J.H.M.P. wrote the manuscript. All authors read, reviewed and approved the final manuscript.


Funding support was provided by the Irish Cancer Society Collaborative Cancer Research Centre grant, BREAST-PREDICT (to J.H.M.P. and W.M.G.) and a Science Foundation Ireland Investigator Award to J.H.M.P. (13/IA/1881).

Compliance with ethical standards

Informed consents were collected following ethical approval from Beaumont Hospital Medical Research Ethics Committee.

Conflict of interest

AUL and JHMP filed a patent application at the EPO (Appl.No. EP20120166187 and EP20130728324), USPTO (Appl. No. 14/397697) and WIPO (Appl. No. PCT/EP2013/059051). The other authors declare no further conflict of interest.

Ethics approval and consent to participate

For the BREAST-PREDICT cohort, informed consents were collected following ethical approval from Beaumont Hospital Medical Research Ethics Committee.

Supplementary material

109_2018_1675_MOESM1_ESM.xlsx (270 kb)
ESM 1 (XLSX 270 kb)
109_2018_1675_MOESM2_ESM.pdf (42.9 mb)
Fig. S1 (PDF 43956 kb)
109_2018_1675_MOESM3_ESM.pdf (624 kb)
Fig. S2 (PDF 623 kb)
109_2018_1675_MOESM4_ESM.pdf (607 kb)
Fig. S3 (PDF 606 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Andreas U. Lindner
    • 1
    • 2
  • Federico Lucantoni
    • 1
    • 2
  • Damir Varešlija
    • 3
  • Alexa Resler
    • 1
    • 2
  • Brona M. Murphy
    • 1
    • 2
  • William M. Gallagher
    • 4
  • Arnold D. K. Hill
    • 3
  • Leonie S. Young
    • 3
  • Jochen H. M. Prehn
    • 1
    • 2
    Email author
  1. 1.RCSI Centre for Systems MedicineRoyal College of Surgeons in IrelandDublin 2Ireland
  2. 2.Department of Physiology and Medical PhysicsRoyal College of Surgeons in IrelandDublin 2Ireland
  3. 3.Department of SurgeryRoyal College of Surgeons in IrelandDublin 2Ireland
  4. 4.Cancer Biology and Therapeutics Laboratory, School of Biomolecular and Biomedical Science, Conway InstituteUniversity College DublinDublin 4Ireland

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