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Background  Amplifications at 6p22.3 are prevalent in advanced stage bladder cancer (TCC). Previous studies have identified  SOX4 ,  CDKAL , and  E2F3  as targets of this amplification and therefore potential oncogenes, but the more telomeric  DEK  gene too has been reported as overexpressed and amplified. We have therefore investigated whether the intermediate region harboring the oncogene candidate  ID4  is also part of the amplicon.    Results  Expression of  E2F3 ,  DEK , and  ID4  was investigated by real-time RT-PCR in 28 TCC compared to 6 normal bladder tissues and in 15 TCC cell lines compared to cultured normal urothelial cells. Expression of  E2F3  as well as  DEK  increased on average in tumor vs. normal tissues (3-fold and 2.5-fold, resp.), but only the increase for  E2F3  was statistically significant (p = 0.039). ID4 overexpression was observed in selected specimens. Each of the three genes was overexpressed in several cell lines, up to 150-fold ( ID4 ), 30-fold ( E2F3 ), and 9-fold ( DEK ), but these increases were not correlated to each other. Instead, moderate ( DEK ) to excellent ( ID4 ) correlations were observed with copy number increases of microsatellites near each gene. Microsatellite copy number increases were highly heterogeneous across the investigated several Mb region revealing at least three subregions of amplification.    Conclusion  Extending previous reports, our data indicate that the 6p22.3 amplicon in TCC is highly heterogeneous and targets several genes in a variable fashion. Among these, expression of  E2F3  and  DEK  appear to be generally increased in TCC, with additional increases caused by amplifications. In contrast, over-expression of  ID4 , which is normally predominantly expressed in testes and brain, appears to depend more strictly on gene amplification. Accordingly, the effect of amplifications at 6p22.3 in bladder cancer is expected to be non-uniform, thereby contributing to the highly variable biological and clinical behavior of advanced stage tumors.  ID4  is a potential oncogene in a small subset of bladder cancers.

Amplification and overexpression of the ID4 gene at 6p22.3 in bladder cancer