Open Access Highly Accessed Research article

Gene expression profiling reveals activation of the FA/BRCA pathway in advanced squamous cervical cancer with intrinsic resistance and therapy failure

Ovidiu Balacescu1*, Loredana Balacescu1, Oana Tudoran1, Nicolae Todor1, Meda Rus1, Rares Buiga1, Sergiu Susman2, Bogdan Fetica1, Laura Pop2, Laura Maja1, Simona Visan13, Claudia Ordeanu1, Ioana Berindan-Neagoe12* and Viorica Nagy12

Author Affiliations

1 The Oncology Institute "Prof Dr. Ion Chiricuta", 34-36 Republicii street, 400015 Cluj-Napoca, Romania

2 Iuliu Hatieganu, University of Medicine and Pharmacy, 8 Babes street, 400012 Cluj-Napoca, Romania

3 Faculty of Veterinary Medicine, University of Agricultural Sciences and Veterinary Medicine, 3-5 Calea Manastur street, 400372 Cluj-Napoca, Romania

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BMC Cancer 2014, 14:246  doi:10.1186/1471-2407-14-246

Published: 8 April 2014



Advanced squamous cervical cancer, one of the most commonly diagnosed cancers in women, still remains a major problem in oncology due to treatment failure and distant metastasis. Antitumor therapy failure is due to both intrinsic and acquired resistance; intrinsic resistance is often decisive for treatment response. In this study, we investigated the specific pathways and molecules responsible for baseline therapy failure in locally advanced squamous cervical cancer.


Twenty-one patients with locally advanced squamous cell carcinoma were enrolled in this study. Primary biopsies harvested prior to therapy were analyzed for whole human gene expression (Agilent) based on the patient’s 6 months clinical response. Ingenuity Pathway Analysis was used to investigate the altered molecular function and canonical pathways between the responding and non-responding patients. The microarray results were validated by qRT-PCR and immunohistochemistry. An additional set of 24 formalin-fixed paraffin-embedded cervical cancer samples was used for independent validation of the proteins of interest.


A 2859-gene signature was identified to distinguish between responder and non-responder patients. ‘DNA Replication, Recombination and Repair’ represented one of the most important mechanisms activated in non-responsive cervical tumors, and the ‘Role of BRCA1 in DNA Damage Response’ was predicted to be the most significantly altered canonical pathway involved in intrinsic resistance (p = 1.86E-04, ratio = 0.262). Immunohistological staining confirmed increased expression of BRCA1, BRIP1, FANCD2 and RAD51 in non-responsive compared with responsive advanced squamous cervical cancer, both in the initial set of 21 cervical cancer samples and the second set of 24 samples.


Our findings suggest that FA/BRCA pathway plays an important role in treatment failure in advanced cervical cancer. The assessment of FANCD2, RAD51, BRCA1 and BRIP1 nuclear proteins could provide important information about the patients at risk for treatment failure.

FANCD2; RAD51; BRCA1; BRIP1; Cervical cancer; Microarray; Treatment response