Camilla Engblom

The Intestinal Microbiota Modulates the Anticancer Immune Effects of Cyclophosphamide

The Microbiota Makes for Good Therapy The gut microbiota has been implicated in the development of some cancers, such as colorectal cancer, but—given the important role our intestinal habitants play in metabolism—they may also modulate the efficacy of certain cancer therapeutics. Iida et al. (p. 967) evaluated the impact of the microbiota on the efficacy of an immunotherapy [CpG (the cytosine, guanosine, phosphodiester link) oligonucleotides] and oxaliplatin, a platinum compound used as a chemotherapeutic. Both therapies were reduced in efficacy in tumor-bearing mice that lacked microbiota, with the microbiota important for activating the innate immune response against the tumors. Viaud et al. (p. 971) found a similar effect of the microbiota on tumor-bearing mice treated with cyclophosphamide, but in this case it appeared that the microbiota promoted an adaptive immune response against the tumors. The gut microbiota promote the efficacy of several antineoplastic agents in mice. Cyclophosphamide is one of several clinically important cancer drugs whose therapeutic efficacy is due in part to their ability to stimulate antitumor immune responses. Studying mouse models, we demonstrate that cyclophosphamide alters the composition of microbiota in the small intestine and induces the translocation of selected species of Gram-positive bacteria into secondary lymphoid organs. There, these bacteria stimulate the generation of a specific subset of “pathogenic” T helper 17 (pTH17) cells and memory TH1 immune responses. Tumor-bearing mice that were germ-free or that had been treated with antibiotics to kill Gram-positive bacteria showed a reduction in pTH17 responses, and their tumors were resistant to cyclophosphamide. Adoptive transfer of pTH17 cells partially restored the antitumor efficacy of cyclophosphamide. These results suggest that the gut microbiota help shape the anticancer immune response.

Predicting therapeutic nanomedicine efficacy using a companion magnetic resonance imaging nanoparticle

Magnetic nanoparticles predict the efficacy of drug-loaded polymeric nanoparticles in vivo, helping select for tumors more responsive to nanomedicine. Particle prediction One particle, it seems, can predict the behavior of another. Thankfully, this is not the beginning of a lesson on quantum physics; instead, it is the basis for potentially designing targeted clinical trials in nanomedicine, by knowing if a tumor is likely to respond to a particular therapeutic nanoparticle. Miller et al. hypothesized that if a tumor readily takes up magnetic nanoparticles (MNP), it will also accumulate other nanoparticles carrying a deadly payload. The authors injected MNPs and a fluorescent version of the therapeutic nanoparticles into mice and followed their biodistribution using imaging. Both types of nanoparticles had similar pharmacokinetics and uptake in tumor-associated host cells owing to the enhanced permeability and retention effect. In mice with human tumors, Miller and colleagues found that the tumors with high MNP uptake were significantly more responsive than those with medium or low uptake to nanoparticles delivering chemotherapeutics. Thus, MNPs can be used as companion imaging agents during nanomedicine trials to predict the therapeutic effect of their nanosized counterparts. Therapeutic nanoparticles (TNPs) have shown heterogeneous responses in human clinical trials, raising questions of whether imaging should be used to identify patients with a higher likelihood of NP accumulation and thus therapeutic response. Despite extensive debate about the enhanced permeability and retention (EPR) effect in tumors, it is increasingly clear that EPR is extremely variable; yet, little experimental data exist to predict the clinical utility of EPR and its influence on TNP efficacy. We hypothesized that a 30-nm magnetic NP (MNP) in clinical use could predict colocalization of TNPs by magnetic resonance imaging (MRI). To this end, we performed single-cell resolution imaging of fluorescently labeled MNPs and TNPs and studied their intratumoral distribution in mice. MNPs circulated in the tumor microvasculature and demonstrated sustained uptake into cells of the tumor microenvironment within minutes. MNPs could predictably demonstrate areas of colocalization for a model TNP, poly(d,l-lactic-co-glycolic acid)-b-polyethylene glycol (PLGA-PEG), within the tumor microenvironment with >85% accuracy and circulating within the microvasculature with >95% accuracy, despite their markedly different sizes and compositions. Computational analysis of NP transport enabled predictive modeling of TNP distribution based on imaging data and identified key parameters governing intratumoral NP accumulation and macrophage uptake. Finally, MRI accurately predicted initial treatment response and drug accumulation in a preclinical efficacy study using a paclitaxel-encapsulated NP in tumor-bearing mice. These approaches yield valuable insight into the in vivo kinetics of NP distribution and suggest that clinically relevant imaging modalities and agents can be used to select patients with high EPR for treatment with TNPs.

The role of myeloid cells in cancer therapies

Recent clinical trials have demonstrated the ability to durably control cancer in some patients by manipulating T lymphocytes. These immunotherapies are revolutionizing cancer treatment but benefit only a minority of patients. It is thus a crucial time for clinicians, cancer scientists and immunologists to determine the next steps in shifting cancer treatment towards better cancer control. This Review describes recent advances in our understanding of tumour-associated myeloid cells. These cells remain less studied than T lymphocytes but have attracted particular attention because their presence in tumours is often linked to altered patient survival. Also, experimental studies indicate that myeloid cells modulate key cancer-associated activities, including immune evasion, and affect virtually all types of cancer therapy. Consequently, targeting myeloid cells could overcome limitations of current treatment options.

Tumour-associated macrophages act as a slow-release reservoir of nano-therapeutic Pt(IV) pro-drug

Therapeutic nanoparticles (TNPs) aim to deliver drugs more safely and effectively to cancers, yet clinical results have been unpredictable owing to limited in vivo understanding. Here we use single-cell imaging of intratumoral TNP pharmacokinetics and pharmacodynamics to better comprehend their heterogeneous behaviour. Model TNPs comprising a fluorescent platinum(IV) pro-drug and a clinically tested polymer platform (PLGA-b-PEG) promote long drug circulation and alter accumulation by directing cellular uptake toward tumour-associated macrophages (TAMs). Simultaneous imaging of TNP vehicle, its drug payload and single-cell DNA damage response reveals that TAMs serve as a local drug depot that accumulates significant vehicle from which DNA-damaging Pt payload gradually releases to neighbouring tumour cells. Correspondingly, TAM depletion reduces intratumoral TNP accumulation and efficacy. Thus, nanotherapeutics co-opt TAMs for drug delivery, which has implications for TNP design and for selecting patients into trials.

TLR2/MyD88-Dependent and -Independent Activation of Mast Cell IgE Responses by the Skin Commensal Yeast Malassezia sympodialis

Atopic eczema (AE) is a chronic inflammatory skin disease. Approximately 50% of adult AE patients have allergen-specific IgE reactivity to the skin commensal yeast Malassezia spp. Due to the ruptured skin barrier in AE, it is likely that Malassezia can come into contact with mast cells, which are known to be involved in AE. We therefore hypothesized that Malassezia spp. can activate mast cells. Bone marrow-derived mast cells (BMMCs) were generated from wild type, TLR2, TLR4, and MyD88 gene-deleted mice and cocultured with Malassezia sympodialis extract. We recorded that M. sympodialis induced release of cysteinyl leukotrienes in a dose-dependent manner in nonsensitized and IgE-anti-trinitrophenyl-sensitized BMMCs, respectively, with three times higher levels in the latter type of cells. IgE-sensitized BMMCs also responded by degranulation as assessed by release of β-hexosaminidase, increased MCP-1 production through a MyD88-independent pathway, and activated phosphorylation of the MAPK ERK1/2. Furthermore, M. sympodialis enhanced the degranulation of IgE receptor cross-linked wild-type BMMCs and altered the IL-6 release dose-dependently. This degranulation was independent of TLR2, TLR4, and MyD88, whereas the IL-6 production was dependent on the TLR2/MyD88 pathway and MAPK signaling. In conclusion, M. sympodialis extract can activate nonsensitized and IgE-sensitized mast cells to release inflammatory mediators, to enhance the IgE-mediated degranulation of mast cells, and to modulate MAPK activation and by signaling through the TLR2/MyD88 pathway to modify the IL-6 production of IgE receptor cross-linked mast cells. Collectively, these findings indicate that M. sympodialis can activate mast cells and might thus exacerbate the inflammatory response in AE.

Mast cell degranulation mediates compound 48/80-induced hyperalgesia in mice.

Mast cells mediate allergies, hypersensitivities, host defense, and venom neutralization. An area of recent interest is the contribution of mast cells to inflammatory pain. Here we found that specific, local activation of mast cells produced plantar hyperalgesia in mice. Basic secretagogue compound 48/80 induced plantar mast cell degranulation accompanied by thermal hyperalgesia, tissue edema, and neutrophil influx in the hindpaws of ND4 Swiss mice. Blocking mast cell degranulation, neutrophil extravasation, and histamine signaling abrogated these responses. Compound 48/80 also produced edema, pain, and neutrophil influx in WT C57BL/6 but not in genetically mast cell-deficient C57BL/6-Kit(W-sh)(/)(W-sh) mice. These responses were restored following plantar reconstitution with bone marrow-derived cultured mast cells.

Heterogeneity of macrophage infiltration and therapeutic response in lung carcinoma revealed by 3D organ imaging

Involvement of the immune system in tumour progression is at the forefront of cancer research. Analysis of the tumour immune microenvironment has yielded a wealth of information on tumour biology, and alterations in some immune subtypes, such as tumour-associated macrophages (TAM), can be strong prognostic indicators. Here, we use optical tissue clearing and a TAM-targeting injectable fluorescent nanoparticle (NP) to examine three-dimensional TAM composition, tumour-to-tumour heterogeneity, response to colony-stimulating factor 1 receptor (CSF-1R) blockade and nanoparticle-based drug delivery in murine pulmonary carcinoma. The method allows for rapid tumour volume assessment and spatial information on TAM infiltration at the cellular level in entire lungs. This method reveals that TAM density was heterogeneous across tumours in the same animal, overall TAM density is different among separate pulmonary tumour models, nanotherapeutic drug delivery correlated with TAM heterogeneity, and successful response to CSF-1R blockade is characterized by enhanced TAM penetration throughout and within tumours.

Radiation therapy primes tumors for nanotherapeutic delivery via macrophage-mediated vascular bursts

Radiation therapy enhances nanotherapeutic drug delivery in a tumor-associated macrophage–dependent fashion. Culling cancer by vacating the vasculature Although it is important for blood vessels to maintain barrier function under most conditions, in cancer therapy, vascular permeability enhances drug delivery to tumors. Miller et al. used intravital microscopy and computational modeling to show that a single, low dose of radiation therapy could induce transient, dynamic, and localized vascular “bursting”—increased permeability, coinciding with extravasation of fluid, cells, and nanoparticles from blood vessels in tumors. Along with vascular bursting, radiation enlarged blood vessel volume and the number of tumor-associated macrophages in mouse xenografts and patient tumor biopsies. These tumor-associated macrophages took up drug-laden nanoparticles, inducing greater drug delivery to tumors. This study demonstrates an alternative strategy for improving targeted nanotherapy delivery by modifying the local tumor microenvironment rather than the nanoparticle itself. Efficient delivery of therapeutic nanoparticles (TNPs) to tumors is critical in improving efficacy, yet strategies that universally maximize tumoral targeting by TNP modification have been difficult to achieve in the clinic. Instead of focusing on TNP optimization, we show that the tumor microenvironment itself can be therapeutically primed to facilitate accumulation of multiple clinically relevant TNPs. Building on the recent finding that tumor-associated macrophages (TAM) can serve as nanoparticle drug depots, we demonstrate that local tumor irradiation substantially increases TAM relative to tumor cells and, thus, TNP delivery. High-resolution intravital imaging reveals that after radiation, TAM primarily accumulate adjacent to microvasculature, elicit dynamic bursts of extravasation, and subsequently enhance drug uptake in neighboring tumor cells. TAM depletion eliminates otherwise beneficial radiation effects on TNP accumulation and efficacy, and controls with unencapsulated drug show that radiation effects are more pronounced with TNPs. Priming with combined radiation and cyclophosphamide enhances vascular bursting and tumoral TNP concentration, in some cases leading to a sixfold increase of TNP accumulation in the tumor, reaching 6% of the injected dose per gram of tissue. Radiation therapy alters tumors for enhanced TNP delivery in a TAM-dependent fashion, and these observations have implications for the design of next-generation tumor-targeted nanomaterials and clinical trials for adjuvant strategies.

Osteoblasts remotely supply lung tumors with cancer-promoting SiglecFhigh neutrophils

A bona fide portrayal of tumor growth Bone has a well-established role in advanced cancer. It provides a supportive microenvironment for the growth of metastatic cells that escape the primary tumor, which ultimately leads to loss of bone mass. Engblom et al. show that bone may also contribute to early-stage tumorigenesis through a mechanism that leads to an increase in bone mass (see the Perspective by Zhang and Lyden). In mouse models of lung adenocarcinoma, primary tumor cells remotely activated bone-resident cells called osteoblasts, which have a bone-building function. The activated osteoblasts in turn triggered production of a certain type of neutrophil that infiltrates the primary tumor and promotes its growth. Patients with early-stage lung cancer were also found to have an increase in bone density, consistent with the findings in mice. Science, this issue p. eaal5081; see also p. 1127 Systemic cross-talk between tumor and bone can boost the growth of early-stage lung cancer in mice. INTRODUCTION Myeloid cells have emerged as key regulators of cancer growth because of their abundance in the tumor stroma in a broad range of cancers, their association with clinical outcome, and their ability to modulate tumor progression. Most tumor-infiltrating myeloid cells derive from circulating precursors, which are produced in distant tissues, and some tumors amplify myeloid cell activity by skewing hematopoiesis toward the myeloid lineage or increasing myeloid cell populations in the periphery. For example, patients across diverse cancer types can present with elevated levels of myeloid progenitor cells in peripheral blood. Additionally, increased numbers of circulating myeloid cells, such as neutrophils, often correlate with poorer clinical outcome. It is therefore important to consider host changes that occur away from the tumor stroma to more fully understand the biological processes underlying tumor growth. RATIONALE The bone marrow is a tissue of particular interest as it is the main production site for hematopoietic cells corresponding to all circulating blood lineages in the adult. The marrow contains resident cell components, such as osteoblasts, which not only participate in bone maintenance but also regulate hematopoiesis and immune cell fate. However, our understanding of bone dynamics in the context of cancer (growing at sites distant from the local bone microenvironment) and related immune responses remains limited. To address this knowledge gap, we explored whether a common solid cancer—lung adenocarcinoma—remotely affects bone tissue and how this might shape tumor-associated hematopoietic responses and tumor growth. RESULTS We show in different mouse models and in cancer patients (n = 70) that lung adenocarcinomas increase bone stromal activity even in the absence of local metastasis. Animal studies further reveal that the cancer-induced bone phenotype involves bone-resident osteocalcin-expressing (Ocn+) osteoblastic cells. Ocn+ cells affect distant tumor progression because experimentally reducing the number of these cells limits lung tumor growth. Also, Ocn+ cells are required for full-fledged tumor infiltration by a distinct subset of neutrophils that are defined by their high expression of the lectin SiglecF (sialic acid–binding immunoglobulin-like lectin F). Compared to other neutrophils, SiglecFhigh cells express genes associated with cancer-promoting processes, including angiogenesis, myeloid cell differentiation and recruitment, extracellular matrix remodeling, suppression of T cell responses, and tumor cell proliferation and growth. Additionally, SiglecFhigh neutrophils have increased reactive oxygen species production, promote macrophage differentiation, and boost tumor progression in vivo. We further report that the soluble receptor for advanced glycation end products (sRAGE) is up-regulated in the circulation of tumor-bearing mice and fosters osteoblastic activity and osteoblast-dependent neutrophil maturation in vitro. CONCLUSION This study identifies systemic cross-talk between lung tumors and bones: Lung tumors can remotely activate Ocn+ osteoblastic cells in bones even in the absence of local metastasis. In turn, these Ocn+ cells supply tumors with SiglecFhigh neutrophils, which foster cancer progression. The findings bear scientific and therapeutic importance because they reveal contributions of the host systemic environment to tumor growth and they position Ocn+ cells, SiglecFhigh neutrophils, and sRAGE as candidate clinical biomarkers and possible intervention points for anticancer therapy. Systemic cross-talk between lung tumors and bones. Lung adenocarcinomas can remotely activate Ocn+ osteoblastic cells in bones even in the absence of local metastasis. In turn, these osteoblasts supply tumors with SiglecFhigh neutrophils, which exhibit cancer-promoting functions (left). By contrast, the bone marrow in steady state only produces SiglecFlow neutrophils (right). Bone marrow–derived myeloid cells can accumulate within tumors and foster cancer outgrowth. Local immune-neoplastic interactions have been intensively investigated, but the contribution of the systemic host environment to tumor growth remains poorly understood. Here, we show in mice and cancer patients (n = 70) that lung adenocarcinomas increase bone stromal activity in the absence of bone metastasis. Animal studies reveal that the cancer-induced bone phenotype involves bone-resident osteocalcin-expressing (Ocn+) osteoblastic cells. These cells promote cancer by remotely supplying a distinct subset of tumor-infiltrating SiglecFhigh neutrophils, which exhibit cancer-promoting properties. Experimentally reducing Ocn+ cell numbers suppresses the neutrophil response and lung tumor outgrowth. These observations posit osteoblasts as remote regulators of lung cancer and identify SiglecFhigh neutrophils as myeloid cell effectors of the osteoblast-driven protumoral response.

Sex education in Swedish schools as described by young women

Objectives To investigate sex education in Swedish schools regarding content, satisfaction, and suggested improvements, as described by teenagers and young adults. Methods Waiting-room survey conducted among 225 female patients (aged 13–25) at youth and student health clinics in one large-, and one medium-sized Swedish city. Results Most participants (97%, n = 218) had received sex education in school, of varying content and quality. Sixty percent thought basic body development was sufficiently covered. Insufficiently covered topics included sexual assault (96%), sexual harassment (94%), pornography (90%), abortion (81%), emergency contraception (80%), fertility (80%), and pregnancy (59%). Thirty percent received no information about chlamydia, and almost half reported that condyloma and human papillomavirus had not been addressed. The youngest respondents (13–19 years) were significantly more likely to have been told about emergency contraception, homosexuality, bisexuality, and transsexuality. Nearly half (46%) considered ‘acceptable’ the knowledge gained from sex education provided at school whereas more than a third considered it ‘poor’ or ‘very poor’. Suggested improvements included more information, more discussion, greater emphasis on sexual diversity, and more knowledgeable teachers. Conclusions Content and quality of sex education varied greatly. Most respondents thought many topics were insufficiently covered, sex education should be more extensive, and teachers better educated.