Tumor Biology

, Volume 37, Issue 10, pp 13279–13286 | Cite as

The inflammatory microenvironment in epithelial ovarian cancer: a role for TLR4 and MyD88 and related proteins

  • Zheng Li
  • Matthew S. Block
  • Robert A. Vierkant
  • Zachary C. Fogarty
  • Stacey J. Winham
  • Daniel W. Visscher
  • Kimberly R. Kalli
  • Chen Wang
  • Ellen L. Goode
Original Article


The tumor-associated inflammatory microenvironment may play a pivotal role in epithelial ovarian cancer (EOC) carcinogenesis and outcomes, but a detailed profile in patient-derived tumors is needed. Here, we investigated the expression of TLR4- and MyD88-associated markers in tumors from over 500 EOC patients using immunohistochemical staining. We demonstrate that high expression of TLR4 and MyD88 predicts poorer overall survival in patients with EOC; most likely, this is due to their association with serous histology and features of high tumor burden and aggressiveness, including stage, grade, and ascites at surgery. Combined TLR4 and MyD88 expression appears to serve as an independent risk factor for shortened survival time, even after covariate adjustment (both moderate HR 1.1 [95 % CI 0.7–1.8], both strong HR 2.1 [95 % CI 1.1–3.8], both weak as referent; p = 0.027). We reveal that in EOC tissues with elevated expression of both TLR4 and MyD88 and activated NF-κB signaling pathway, expression of hsp60, hsp70, beta 2 defensin, and HMGB1 are also enriched. In total, these results suggest that activation of TLR4/MyD88/NF-κB signaling by endogenous ligands may contribute to an inflammatory microenvironment that drives a more aggressive phenotype with poorer clinical outcome in EOC patients.


Epithelial ovarian cancer Toll-like receptor four (TLR4) Myeloid differentiation primary response gene eighty-eight (MyD88) Endogenous ligands NF-κB signaling pathway 



This work was supported by the Mayo Clinic SPORE in Ovarian Cancer, P50 CA136393, and R01 CA122443.

Compliance with ethical standards

We declare that all experiments were performed in accordance with the current law of USA. The study was approved by the Institutional Review Board (IRB) of Mayo Clinic in Rochester. Patients provided written informed consent and permission for active follow-up.

Conflicts of interest

The authors declare that they have no conflict of interest

Supplementary material

13277_2016_5163_MOESM1_ESM.xlsx (54 kb)
ESM 1 (XLSX 53 kb)
13277_2016_5163_Fig3_ESM.gif (348 kb)
Supplemental Figure 1

Representative images for endogenous ligands, TLR4, and MyD88 Scoring was based on the intensities of nuclear and cytoplasmic staining in the majority of cells. In order to conserve figure space, markers are shown grouped by the scoring scheme used in final analyses; in some instances, this represents combination of score categories: none/weak v moderate/strong (hsp60); none/weak v moderate (gp96, beta 2 defensin); none v weak/moderate (fibrinogen, heparan sulfate); none v weak v moderate (hsp70, HMGB1); and none/weak v moderate v strong (TLR4 and MyD88). (GIF 347 kb)

13277_2016_5163_MOESM2_ESM.tif (91.1 mb)
High Resolution Image (TIFF 93301 kb)
13277_2016_5163_Fig4_ESM.gif (316 kb)
Supplemental Figure 2

Representative images for NF-κB signaling pathway and target gene In order to conserve figure space, markers are shown grouped by the scoring scheme used in final analyses; in some instances, this represents combination of score categories: none v weak v moderate intensity of nuclear and cytoplasmic staining in the majority of cells (IKKβ, IκBα, p50, MMP9); none v weak/moderate intensity of nuclear and cytoplasmic staining in the majority of cells (phospho-IκBα); and <10 % v > =10 % of positive cells in nuclei (phospho-p65). (GIF 316 kb)

13277_2016_5163_MOESM3_ESM.tif (457 kb)
High Resolution Image (TIFF 457 kb)


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Copyright information

© International Society of Oncology and BioMarkers (ISOBM) 2016

Authors and Affiliations

  • Zheng Li
    • 1
    • 2
  • Matthew S. Block
    • 3
  • Robert A. Vierkant
    • 1
  • Zachary C. Fogarty
    • 1
  • Stacey J. Winham
    • 1
  • Daniel W. Visscher
    • 4
  • Kimberly R. Kalli
    • 3
  • Chen Wang
    • 1
  • Ellen L. Goode
    • 1
  1. 1.Department of Health Sciences ResearchMayo ClinicRochesterUSA
  2. 2.Department of Gynecologic OncologyThe Third Affiliated Hospital of Kunming Medical University (Yunnan Tumor Hospital)KunmingChina
  3. 3.Department of Medical OncologyMayo ClinicRochesterUSA
  4. 4.Department of Laboratory MedicineMayo ClinicRochesterUSA

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