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The overall survival for patients with acute lymphoblastic leukemia (ALL) often is the function of age, in particular in 2019 analysis revealed that 5-year overall survival for patients older than 20 years remains below 35% (American Cancer Society, Cancer Facts &Figures 2019). Importantly, one of the major issues in ALL therapy is the ability of tumor cells to escape the treatment via the establishment of an immunosuppressive environment. The tumor microenvironment has gained tremendous importance in the past decade. This is largely based on the reasoning that, in order to devise better therapeutic strategies for patients, we need to gain better understanding into how malignant cells transform their microenvironment to promote growth, escape immune control and gain therapeutic resistance.
TAM receptors (TAMRs) are engaged in innate immune cells as a feed-back mechanism to terminate the immune response and promote the return to homeostasis (Rothlin et al. 2007). In the context of cancers, aberrant TAMR signaling was mainly explored concerning its pro-oncogenic function (Paolino and Penninger 2016). There are only limited data available suggesting the modulation of cancer immune response via TAMR signaling in highly immunogenic solid tumor models (Paolino et al. 2014; Ubil et al. 2018). So far, however, little is known about their potential indirect immune-modulatory function in hematological malignancies. Taking into account the pronounced importance of TAMR signaling in immune cells combined with the leukemic immune tolerance, the current study focused on the function of TAMR and their ligands in anti-leukemic immunity.
This work uncovers the mechanism of dampening anti-leukemic immune response via TAMR signaling on macrophages using the syngeneic BCR-ABL1 B-ALL mouse model. Using genetic depletion of GAS6 in the host environment or ablation of AXL and/or MERTK receptors in macrophages the bone marrow microenvironment could be rewired in order to achieve an efficient anti-leukemic immune response. In particular, the GAS6/AXL blockade triggers an effective NKand T- cell-dependent anti-leukemic response that results in prolonged survival. This finding specifically tackles the obstacle of inefficient bridging between innate and adaptive immune response typical for hematological malignancies in contrast to solid tumors (E. K. Curran, Godfrey, and Kline 2017).
Besides establishing the vital function of TAMR signaling in anti-leukemic immunity using murine models, the analysis of human blood plasma revealed that age-related immune dysregulation was manifested by significant GAS6 decrease and PROS1 upregulation among elderly donors (>60 y.o.) compared to controls (<25 y.o.). These data are indicative that TAMR signaling likely favors the age-dependent immune system decline, which in turn is associated with a poor survival rate of elderly patients diagnosed with leukemia.
In conclusion, using a preclinical ALL model here it was identified in vivo, that Axl significantly increases upon B-ALL challenge in Mph and NK cells. Therefore, AXL targeting, using the orally bioavailable selective inhibitor Bemcentinib, could serve as a powerful approach to revert early immunosuppression created by leukemia.
Taken together these data propose the AXL receptor as a novel immune checkpoint and attractive candidate for the development of a new therapeutic approach via unleashing the patient’s own immune system to combat leukemic cells.
Cancer is the major cause of death besides cardiovascular disease. Leukaemia represents the most prevalent malignancy in children with a frequency of 30 % and is one of the ten leading types of cancer in adults. Philadelphia Chromosome-positive B-ALL (Ph+ B-ALL) is driven by the cytogenetic aberration of the reciprocal chromosomal translocation t(9;22)(q34;q11) leading to the formation of the Philadelphia chromosome with a BCR-ABL1 fusion gene. This fusion gene encodes a BCR-ABL1 oncoprotein which is characterized by a constitutively enhanced tyrosine kinase activity promoting amplified proliferation, differentiation arrest and resistance to cell death. Ph+ B-ALL is considered the most aggressive ALL subtype with a long-term survival rate in the range of only 30 % despite intensive standard of care including chemotherapy in combination with a tyrosine kinase inhibitor (TKI) followed by allogeneic stem cell transplantation after remission for clinically fit patients.
The efficacy of chemotherapy has long been mainly attributed to tumour cell toxicity while immune modulating effects have been overlooked, especially in light of known immunosuppressive properties. Accumulative evidence, however, emphasizes the ability of chemotherapeutic agents, including TKIs, to normalise or re-educate a dysfunctional tumour microenvironment (TME) resulting in enhanced anti-tumour immunity. One of the underlying mechanisms of immune modulation is the induction of immunogenic cell death (ICD). ICD is an anti-tumour agent-induced cell death modality determined by the capacity to convert cancer cells into anti-cancer vaccines. The induction of ICD relies on the release of damage-associated molecular patterns (DAMPs) from dying tumour cells succumbing to ICD. Translocation of CALR to the cell surface, extracellular secretion of ATP and release of HMGB1 from the nucleus are key hallmarks of ICD that mediate anti-tumour immunity upon binding to antigen presenting cells resulting in a tumour antigen-specific immune response. Besides these molecular determinants, ICD is functionally defined by the inhibition of tumour growth in a vaccination assay in which mice are injected with tumour cells exposed to the potential ICD inducer in-vitro and then re-challenged with live tumour cells of the same cancer type. Both molecular and functional criteria determine the gold standard approach to assess ICD. By increasing the immunogenicity of cancer cells, ICD contributes to the restoration of immunosurveillance as an essential feature of tumour rejection, which is clinically reflected by improved therapeutic efficacy and disease outcome in patients. Therefore, identifying novel ICD inducers is an objective of interest in the context of cancer therapy.
In respect of these considerations, the aim addressed in the present work is the examination of the second-generation TKI Nilotinib for the ability to induce ICD. The thesis is set in the context of the group's research on the role of Gas6/TAM signalling within the TME regarding the pathogenesis of acute leukaemia. In in-vivo experiments of our research group it has been consistently observed that the use of Nilotinib enhances the anti-leukaemic immunity mediated by a deletion of Gas6. Against the background of increasing importance of chemotherapeutic agents as potent modulators of a dysregulated TME, it was hypothesized that Nilotinib may synergize with a Gas6-deficient environment by inducing ICD in Ph+ B-ALL cells.
In growth inhibition and Annexin V/Propidium iodide cell death assays Nilotinib was shown to induce cell death in concentration-dependent manner that occurs bimodally in terms of cell death modality ranging between apoptosis and necrosis. By ICD marker analysis, comprising flow-cytometric detection of CALR exposure, chemoluminescence-based ATP measurement and immunoblotting for HMGB1, it was found that Nilotinib-induced cell death is not accompanied by CALR exposure and ATP secretion, but is associated with the release of HMGB1. In macrophages co-culture experiments with Nilotinib-treated leukaemic cells, no relevant shift in terms of macrophages activation and polarisation was observed in either a juxtacrine or paracrine setup. In consistency with the results obtained in the in-vitro experiments, Nilotinib was not potent to elicit a protective immune response in mice within a vaccination assay.
Conclusively, Nilotinib was identified to not qualify as bona fide ICD inducer. The role of Nilotinib-induced cell death and HMGB1 release are proposed as objective for further investigation concerning the synergistic interplay between Nilotinib and a Gas6-deficient environment. Efforts addressing exploration and optimisation of the immunological potential of chemotherapeutic agents are a promising approach aimed at providing cancer patients with the best possible treatment in future.
Die Dissertation befasst sich mit Daten zum frühinvasiven kolorektalen Karzinom aus der Westpfalz in einem Zeitraum von 6 Jahren (2010 – 2016). In diesem Zeitraum sind 11% (n=130) frühinvasive kolorektale Karzinome aufgetreten. Davon besitzen 11% (n=14) Lymphknotenmetastasen. Beim pT1 Kolonkarzinom (n=92) treten Lymphknotenmetastasen in 13% (n=12) und beim pT1 Rektumkarzinom (n=38) in 5% (n=2) auf. Zur Risikostratifizierung werden pT1 kolorektale Karzinome in Low-Risk (sm1, G1, G2) und High-Risk (sm3, G3, G4) Karzinome eingeteilt. 84% (n=109) der pT1 kolorektalen Karzinome sind gut (G1) und mäßig differenziert (G2) und 35% (n=46) besitzen eine Submucosaeindringtiefe von sm1. 15% der G1 und G2 (n=11 von 73) pT1 Kolonkarzinome und 6% der G1 und G2 (n=2 von 36) pT1 Rektumkarzinome sind nodal positiv. Ein positiver nodaler Status ist in 12% (n=4 von 33) bei pT1sm1 Kolonkarzinomen aufgetreten. Ähnliches gilt für pT1sm1 Rektumkarzinome mit 8% (n=1 von 13). Weder im sm3 Stadium noch beim G3 pT1 Rektumkarzinom ist ein no-dal positiver Status vorgekommen. Dies zeigt, dass die Einteilung in Low- und High-Risk Karzinome nach der S3–Leitlinie zu überdenken ist. Ein positiver Lymphknoten-status tritt auch bei Low-Risk Karzinomen auf und verschlechtert das onkologische Outcome signifikant. Die Überlebensraten verdeutlichen diese Erkenntnis. Frühinvasi-ve kolorektale Karzinome besitzen eine ähnliche 5 Jahres-Überlebensrate von 81% wie fortgeschrittene neoadjuvant behandelte ypT1 kolorektale Karzinome. Das Gleiche gilt für nodal negative pT1 Karzinome (83%) im Vergleich mit fortgeschrittenen nodal negativen ypT0 und ypT1 Karzinomen (81%). Auch nodal positive pT1 Karzinome und fortgeschrittene nodal positive ypT0 und ypT1 Karzinome haben ähnliche Überle-bensraten (66% versus 67%). Auch dieser Vergleich zeigt, dass frühinvasive kolorekta-le Karzinome unterschätzt werden. Zur Optimierung des onkologischen Outcomes ist eine systemische Therapie bei frühinvasiven kolorektalen Karzinomen - auch ohne Lymphknotenmetastasen - zur Verbesserung des Überlebens nach 5 Jahren zu erwägen. Diese Thematik bietet einen Ansatzpunkt für weitere Studien um eine konkrete Aussa-ge über die Signifikanz einer neo-oder adjuvanten Therapie bei frühinvasiven kolorek-talen Karzinomen zu ermöglichen. Ein angepasstes multimodales Therapiekonzept sowie eine adäquate Nachsorge erscheinen bei frühinvasiven kolorektalen Karzinomen unabdingbar.
Für die Funktion und das Überleben von Zellen ist die Aufrechterhaltung und Regulation der Redoxhomöostase durch Produktion und Elimination von radikalen Sauerstoffspezies (ROS) von entscheidender Bedeutung. In Tumorzellen finden sich höhere basale ROS-Level als in gesunden Zellen, was jedoch trotz des vermehrten oxidativen Stresses nicht zur Zelltodinduktion führt, da kompensatorisch antioxidative Mechanismen ebenfalls gesteigert sind. Vor allem zwei antioxidative Systeme sind hauptsächlich bei der Elimination von ROS involviert: das Glutathion (GSH)-System und das Thioredoxin (TRX)-System. Hierbei spielt eine beständige Regeneration von GSH, als auch von TRX, eine wichtige Rolle, da diese bei der Reduktion von Sauerstoffradikalen verbraucht werden. Im hepatozellulären Karzinom (HCC) ist die gestörte Redoxhomöostase mit gesteigerten ROS Leveln ein wichtiger Faktor in der Karzinogenese. Das HCC wird oft erst im fortgeschrittenen, nicht mehr kurativen Stadium diagnostiziert und ist resistent gegenüber nahezu allen Formen von Chemotherapien. Dies verdeutlich die immense Bedeutung der Erforschung der teilweise unverstandenen Tumorgenese, aber auch die Notwendigkeit für die Entwicklung von neuen Therapien.
In der hier dargestellten experimentellen Arbeit gingen wir deshalb der Frage nach, ob die alleinige Inhibierung der antioxidativen Schutzmechanismen durch sog. ROS Modulatoren ausreicht, um eine Zelltodinduktion in humanen HCC-Zelllinien herbeizuführen und damit eine potenzielle neue Therapiestrategie aufzuzeigen.
Wir konnten zeigen, dass die simultane Inhibierung dieser zwei antioxidativen Hauptmechanismen im HCC durch die Kombination von Auranofin (TXR-Inhibitor) mit Buthionine-Sulfoximin (BSO, Glutathion-Inhibitor) und Erastin (indirekter Glutathion-Inhibitor) mit BSO zur ROS-abhängigen Zelltodinduktion im HCC in vitro führt. Interessant ist, dass die gesteigerten ROS-Level jedoch nicht den Zelltod im HCC induzierten, wenn nur eines der beiden antioxidativen Systeme inhibiert wurde. Offenbar ist die Tumorzelle in der Lage durch Hochregulierung anderer antioxidativer Systeme das induzierte ROS zu neutralisieren. Unsere Untersuchungen zum Wirkmechanismus der Zelltodinduktion durch die Kombinationsbehandlungen Auranofin + BSO bzw. Erastin + BSO identifizierten unerwarteterweise eine Caspasen-unabhängige, nicht-apoptotische Zelltodform, die sog Ferroptose, welche durch ROS-Produktion und Lipidperoxidierung charakterisiert ist.
Weitere Experimente konnten untermauern, dass mit der Induktion der Ferroptose durch die selektive ROS-Modulation die Apoptoseresistenz der HCC Zellen umgangen werden kann.
Mechanistisch kann diese erstmals 2012 beschriebene eisenabhängige Zelltodform, Ferroptose, durch zwei verschiedene Signalwege induziert werden: Erstens durch den kanonischen Pfad, bei welchem die Inhibierung der Glutathionperoxidase 4 (GPX4), einem Protein, welches die Zellmembran vor Lipidperoxidation schützt, eine zentrale Rolle spielt, und zweitens durch den nicht-kanonischen Pfad, welcher durch eine Anhäufung von zweiwertigem Eisen u. a. durch Aktivierung von Hämoxygenasen (HO), vermittelt durch den Transkriptionsfaktor Nuclear factor erythroid 2-related factor 2 (Nrf2), gekennzeichnet ist. Wir konnten feststellen, dass in unseren Kombinationsbehandlungen beide Pfade involviert sind und eine Herunterregulierung von GPX4 als auch eine Akkumulation von Nrf2 und Hämoxygenase-1 (HO-1) besteht.
Zusammenfassend konnte unsere Arbeit zeigen, dass mittels pharmakologischer Adressierung zweier antioxidativer Systeme die Therapieresistenz der HCC-Zellen umgangen werden kann, und dass die Induktion der Ferroptose zukünftig eine vielversprechende Therapieoption im HCC darstellen könnte.
Colorectal cancer (CRC) has the third highest incidence and the fourth highest mortality rate worldwide and represents a substantial health care burden and affects the life of millions of people. CRC is a genetic disease caused by the stepwise accumulation of genetic alterations. The initiating event in colorectal carcinogenesis is the aberrant activation of the WNT pathway, but other pathways are also commonly deregulated, including the PI3K/AKT pathway. A number of previous studies using genetically engineered mouse models aimed at dissecting the exact role of PI3K/AKT pathway in CRC, but have yielded in rather conflicting results. Despite the inconsistent results, these studies already put forward the idea that PI3K/AKT signaling in combination with other genetic events might substantially contribute to tumor progression. Since the PI3K/AKT pathway is frequently activated in CRC, it represents an ideal candidate for therapeutic intervention. Although extensive efforts had led to the development of numerous inhibitors targeting the PI3K/AKT pathway, the diversity of genetic alterations can challenge the identification of the most effective therapeutic targets. Therefore, the discovery of shared tumor-promoting mechanisms downstream of these genetic alterations might unravel new biomarkers and druggable targets. The aim of this study was to elucidate the precise role of PI3K/AKT pathway during the course of colorectal carcinogenesis and to decipher novel protumorigenic molecular mechanisms downstream of PI3K/AKT activation that can be used for therapeutic intervention.
To obtain a better insight into the role of the PI3K/AKT pathway during colorectal carcinogenesis, mice expressing an oncogenic variant of AKT1 (AktE17K) specifically in the intestinal epithelial cells (IEC) were used. At the age of 6 months untreated AktE17K mice showed clearly perturbed intestinal homeostasis, but no tumor formation. To induce colonic tumorigenesis, AktE17K mice were subjected to treatment with the colonic carcinogen azoxymethane (AOM). In response to AOM, AktE17K mice developed invasive but non-metastatic tumors, which showed strong nuclear accumulation of TP53. To investigate the role of PI3K/AKT signaling specifically in CRC progression, AktE17K mice were crossed to TP53-deficient mice (Tp53ΔIEC). Unlike AktE17K mice, untreated Tp53ΔIEC; AktE17K, developed highly invasive small
intestinal tumors by the age of 6 months. To investigate the role of AKT hyperactivation in colonic tumor progression, Tp53ΔIEC; AktE17K mice were subjected to AOM treatment. AKT hyperactivation significantly enhanced tumor progression and induced metastatic dissemination.
To get a better insight how AKT signaling can promote tumor progression, whole tumor tissues from AOM-treated Tp53ΔIEC and Tp53ΔIEC; AktE17K mice were subjected to next generation mRNA sequencing and phospho-proteomic analysis by mass spectrometry. Both analyses indicated that AKT hyperactivation expands the inflammatory tumor microenvironment and upregulates pathways associated with invasion and metastasis. Importantly, Gene Set Enrichment Analysis revealed that AOM-induced colon tumors of Tp53ΔIEC; AktE17K animals, are highly similar in their gene expression profile to the CMS4 subtype of human CRC, which is associated with worse overall- and relapse-free survival. Gene expression analysis also suggested elevated NOTCH signaling in the Tp53ΔIEC; AktE17K tumors. Interestingly, while the expression of Notch3 mRNA was increased in the tumors of Tp53ΔIEC; AktE17K mice, the expression of the other NOTCH receptors was unaffected by AKT hyperactivation. In vitro experiments using TP53-deficient mouse tumor organoids with hyperactive AKT signaling confirmed the direct, tumor cell-intrinsic link between AKT activation and increased Notch3 expression. Moreover, inhibition of EZH2 mimicked the effect of AKT hyperactivation on Notch3 expression, suggesting that AKT regulates Notch3 via an epigenetic mechanism.
Knock-down of Notch3 in TP53-deficient mouse tumor organoids with hyperactive AKT signaling resulted in differential regulation of several pathways with potential role in invasion and metastasis and in cell death and survival. Subsequent in vivo experiments confirmed the role of NOTCH3 signaling in CRC progression. Treatment of AOM-induced Tp53ΔIEC; AktE17K mice with a NOTCH3 antagonistic antibody or the γ-secretase inhibitor DAPT significantly reduced invasion and metastasis. Importantly, NOTCH3 expression was also found to be associated with human CRC progression, suggesting that NOTCH3 represent a valid target for the treatment of CRC. This work, using genetically engineered mouse models and advanced in vitro techniques, has demonstrated a strong tumor promoting role for PI3K/AKT signaling in CRC progression and has identified NOTCH3 signaling as a potential therapeutic target downstream of the PI3K/AKT pathway.
Colorectal cancer (CRC) has the third highest incidence and the fourth highest mortality rate worldwide and represents a substantial health care burden and affects the life of millions of people. CRC is a genetic disease caused by the stepwise accumulation of genetic alterations. The initiating event in colorectal carcinogenesis is the aberrant activation of the WNT pathway, but other pathways are also commonly deregulated, including the PI3K/AKT pathway. A number of previous studies using genetically engineered mouse models aimed at dissecting the exact role of PI3K/AKT pathway in CRC, but have yielded in rather conflicting results. Despite the inconsistent results, these studies already put forward the idea that PI3K/AKT signaling in combination with other genetic events might substantially contribute to tumor progression.
Since the PI3K/AKT pathway is frequently activated in CRC, it represents an ideal candidate for therapeutic intervention. Although extensive efforts had led to the development of numerous inhibitors targeting the PI3K/AKT pathway, the diversity of genetic alterations can challenge the identification of the most effective therapeutic targets. Therefore, the discovery of shared tumor-promoting mechanisms downstream of these genetic alterations might unravel new biomarkers and druggable targets. The aim of this study was to elucidate the precise role of PI3K/AKT pathway during the course of colorectal carcinogenesis and to decipher novel pro-tumorigenic molecular mechanisms downstream of PI3K/AKT activation that can be used for therapeutic intervention.
To obtain a better insight into the role of the PI3K/AKT pathway during colorectal carcinogenesis, mice expressing an oncogenic variant of AKT1 (AktE17K) specifically in the intestinal epithelial cells (IEC) were used. At the age of 6 months untreated AktE17K mice showed clearly perturbed intestinal homeostasis, but no tumor formation. To induce colonic tumorigenesis, AktE17K mice were subjected to treatment with the colonic carcinogen azoxymethane (AOM). In response to AOM, AktE17K mice developed invasive but nonmetastatic tumors, which showed strong nuclear accumulation of TP53. To investigate the role of PI3K/AKT signaling specifically in CRC progression, AktE17K mice were crossed to TP53- deficient mice (Tp53ΔIEC). Unlike AktE17K mice, untreated Tp53ΔIECAktE17K, developed highly invasive small intestinal tumors by the age of 6 months. To investigate the role of AKT hyperactivation in colonic tumor progression, Tp53ΔIECAktE17K mice were subjected to AOM treatment. AKT hyperactivation significantly enhanced tumor progression and induced metastatic dissemination.
To get a better insight how AKT signaling can promote tumor progression, whole tumor tissues from AOM-treated Tp53ΔIEC and Tp53ΔIECAktE17K mice were subjected to next generation mRNA sequencing and phospho-proteomic analysis by mass spectrometry. Both analyses indicated that AKT hyperactivation expands the inflammatory tumor microenvironment and upregulates pathways associated with invasion and metastasis. Importantly, Gene Set Enrichment Analysis revealed that AOM-induced colon tumors of Tp53ΔIECAktE17K animals, are highly similar in their gene expression profile to the CMS4 subtype of human CRC, which is associated with worse overall- and relapse-free survival7 . Gene expression analysis also suggested elevated NOTCH signaling in the Tp53ΔIECAktE17K tumors. Interestingly, while the expression of Notch3 mRNA was increased in the tumors of Tp53ΔIECAktE17K mice, the expression of the other NOTCH receptors was unaffected by AKT hyperactivation. In vitro experiments using TP53-deficient mouse tumor organoids with hyperactive AKT signaling confirmed the direct, tumor cell-intrinsic link between AKT activation and increased Notch3 expression. Moreover, inhibition of EZH2 mimicked the effect of AKT hyperactivation on Notch3 expression, suggesting that AKT regulates Notch3 via an epigenetic mechanism.
Knock-down of Notch3 in TP53-deficient mouse tumor organoids with hyperactive AKT signaling resulted in differential regulation of several pathways with potential role in invasion and metastasis and in cell death and survival. Subsequent in vivo experiments confirmed the role of NOTCH3 signaling in CRC progression. Treatment of AOM-induced Tp53ΔIECAkt E17K mice with a NOTCH3 antagonistic antibody or the γ-secretase inhibitor DAPT significantly reduced invasion and metastasis. Importantly, NOTCH3 expression was also found to be associated with human CRC progression, suggesting that NOTCH3 represent a valid target for the treatment of CRC. This work, using genetically engineered mouse models and advanced in vitro techniques, has demonstrated a strong tumor promoting role for PI3K/AKT signaling in CRC progression and has identified NOTCH3 signaling as a potential therapeutic target downstream of the PI3K/AKT pathway.
Standard cancer therapy research targets tumor cells while not considering the damage on the tumor microenvironment (TME) and its associated implications in impairing therapy response. Employing patients-derived organoids (PDOs) and matched stroma cells or a novel murine preclinical rectal cancer model of local radiotherapy, it was demonstrated that tumor cells-derived IL-1α polarizes cancer-associated fibroblasts towards an inflammatory (iCAFs) phenotype. While numerous studies in different tumor entities highlighted the molecular heterogeneity of CAFs, so far there are no clear findings on their functional heterogeneity and relevance in therapy resistance and response. The present study molecularly characterized iCAFs subpopulation among RCA patients as well as the preclinical mouse model and importantly unraveled the detailed molecular mechanism underlying their contribution to impair therapy response. Mechanistically, iCAFs were demonstrated to be characterized by an upregulation of nitric oxide synthase (iNOS) which triggered accumulation of reactive nitrogen species (RNS) and subsequently an oxidative DNA damage response (DDR). Such a baseline IL-1α-driven DNA damage further sensitized iCAFs to a p53-mediated therapy induced senescence (TIS) causing extensive extracellular matrix (ECM) changes and induction of senescence associated secretory phenotype (SASP) that favored tumor progression and hindered tumor cell death. Moreover, iCAFs reversibility and repolarization into more quiescent like phenotype was demonstrated upon IL-1 signaling inhibition by anakinra, a recombinant IL-1 receptor antagonist (IL1RA). Accordingly, treating mice with anakinra or specific deletion of Il1r1 in CAFs sensitized stroma-rich resistant tumors to chemoradiotherapy (CRT). Similarly, targeting CAFs senescence by senotherapy (venetoclax chemical) or employing Trp53 deficient mice reverted therapy resistance among non-responsive tumors in vivo by reducing ECM deposition and consequently favoring CD8+ T cells intratumoral infiltration posttherapy. Importantly, rectal cancer patients that do not completely respond to neoadjuvant therapy displayed an iCAFs senescence program post-CRT. Moreover, these patients presented a baseline increased CAFs content, a dominant iCAFs signature that correlated with poorer disease-free survival (DFS) and a significantly reduced circulating IL1RA serum levels. While reduced pretherapeutic IL1RN gene expression predicted poor prognosis among RCA patients, IL1RA serum levels were associated with rs4251961 (T/C) single nucleotide polymorphism (SNP) in the IL1RN gene. Finally, functional validation assays revealed that conditioned media of PDOs drove inflammatory polarization of fibroblasts and consequently rendered them sensitive to RNS-mediated DNA damage and TIS. Collectively, the study highlighted a crucial and novel role of a CAFs subset, iCAFs, in therapy resistance among RCA patients, shedding light on their functional relevance by identifying IL-1 signaling as an appealing target for their repolarization and successful targeting. Therefore, it makes sense to combine the newly demonstrated and thoroughly proven therapeutic approach of targeting IL-1 signaling in combination with conventional CRT and possibly immunotherapy. This might have a major impact on RCA therapy and be of immense relevance for other stroma-rich tumors.
Zur bisherigen Basisdiagnostik bei klinischem Verdacht eines PCa wird den aktuellen Leitlinien zufolge, neben einer fundierten Anamnese und körperlicher Untersuchung, die Bestimmung des PSA-Wertes gezählt. Seit nun mehr als zwei Jahrzehnten hat sich die PSA-Bestimmung zur Früherkennung, aber auch der Überwachung von Patienten mit bereits diagnostiziertem PCa bewährt. Ob die Bestimmung des PSA-Wertes die PCa-spezifische Mortalität adäquat widerspiegelt, wird allerdings in zahlreichen Expertenkreisen weiterhin kontrovers diskutiert. Anlässlich dessen soll die Erforschung neuer Biomarker dazu dienen, das Risiko eines aggressiven PCa gezielter zu erfassen und behandeln zu können. Die Arbeitsgruppe von Tsaur et al. hat in vorausgegangenen Studien auf das vielversprechende Potential von sE-Cadherin als möglichen Biomarker beim PCa hingewiesen [92]. Basierend darauf wurde in der vorliegenden Arbeit untersucht, wie sich das Serumprotein sE-Cadherin auf PCa-Zelllinien vor allem in Hinblick auf die Metastasierung des PCa am in vitro Modell auswirkt. Die Experimente erfolgten an den beiden Androgen-resistenten Zellen PC3 und DU145 sowie der Androgen-sensitiven Zelllinie LNCaP nach Behandlung mit sE-Cadherin. Unbehandelte Zellen dienten jeweils als Kontrolle. Die ersten Versuche beschäftigten sich damit, eine Arbeitskonzentration des sE-Cadherins zu etablieren, welche nachfolgend für alle weiteren Versuche genutzt werden konnte. Die Arbeitskonzentration von sE-Cadherin wurde auf 5 µg/ml festgelegt. Mithilfe des MTT-Assays wurde nachfolgend das Zellwachstum untersucht. Auswirkungen von sE-Cadherin auf den Zellzyklus der genannten PCa-Zelllinien wurden mithilfe der fluoreszenzaktivierten Zellanalyse (FACS) nach erfolgter Zell-Synchronisation evaluiert. Der Einfluss von sE-Cadherin auf die einzelnen Schritte der Metastasierung wurde durch Migrations- und Invasions- sowie Adhäsions-Versuchen an Zellmatrixproteinen (immobilisiertes Kollagen und Fibronektin) untersucht. Mithilfe der Durchflusszytometrie konnte die Beeinflussung von sE-Cadherin auf die Integrinoberflächenprofile analysiert werden. Zur Evaluation relevanter Signalwege erfolgten Western-Blot-Versuche, in denen der Expressionsstatus von Integrin-assoziierten Signalproteinen untersucht wurde. Blockade-Studien dienten der Überprüfung der funktionellen Relevanz einzelner Integrine. Die Behandlung der PCa-Zellen mit sE-Cadherin in der Konzentration von 5 µg/ml führte zur signifikanten Abnahme des Tumorwachstums. Die Zellzyklus-Analyse zeigte einen vermehrten Zell-Arrest in der G0/G1-Phase sowie Abnahme der S-Phase. Des Weiteren führte die sE-Cadherin-Applikation bei allen drei PCa-Zelllinien zur Abnahme der Adhäsionsfähigkeit an Kollagen und Fibronektin. Im Gegensatz dazu konnte gleichzeitig eine Erhöhung der chemotaktischen Bewegung beobachtet werden. Unter der sE-Cadherin-Behandlung kam es zur signifikanten Veränderung der Oberflächenprofile der Integrin-Subtypen α3 und β1. Dessen physiologische Relevanz konnte in Blockadestudien überprüft werden. Es zeigte sich, dass beide Subtypen, jedoch insbesondere β1, in die Adhäsion und Chemotaxis involviert sind. Abschließend kann in Zusammenschau der Experimente und dessen Resultate geschlussfolgert werden, dass sE-Cadherin maßgeblich das Metastasierungspotenzial der verschiedenen Prostatakarzinomzellen steigert, indem es das Zellwachstum stagnieren lässt und gleichzeitig das Herablösen der Tumorzellen von der extrazellulären Matrix sowie den Anschluss an das Blut-/Lymphabflusssystem erleichtert.
