Delphine Lissa

Cisplatin Resistance Associated with PARP Hyperactivation

Non-small cell lung carcinoma patients are frequently treated with cisplatin (CDDP), most often yielding temporary clinical responses. Here, we show that PARP1 is highly expressed and constitutively hyperactivated in a majority of human CDDP-resistant cancer cells of distinct histologic origin. Cells manifesting elevated intracellular levels of poly(ADP-ribosyl)ated proteins (PAR(high)) responded to pharmacologic PARP inhibitors as well as to PARP1-targeting siRNAs by initiating a DNA damage response that translated into cell death following the activation of the intrinsic pathway of apoptosis. Moreover, PARP1-overexpressing tumor cells and xenografts displayed elevated levels of PAR, which predicted the response to PARP inhibitors in vitro and in vivo more accurately than PARP1 expression itself. Thus, a majority of CDDP-resistant cancer cells appear to develop a dependency to PARP1, becoming susceptible to PARP inhibitor-induced apoptosis.

Functions of BCL-XL at the Interface between Cell Death and Metabolism

The BCL-2 homolog BCL-XL, one of the two protein products of BCL2L1, has originally been characterized for its prominent prosurvival functions. Similar to BCL-2, BCL-XL binds to its multidomain proapoptotic counterparts BAX and BAK, hence preventing the formation of lethal pores in the mitochondrial outer membrane, as well as to multiple BH3-only proteins, thus interrupting apical proapoptotic signals. In addition, BCL-XL has been suggested to exert cytoprotective functions by sequestering a cytosolic pool of the pro-apoptotic transcription factor p53 and by binding to the voltage-dependent anion channel 1 (VDAC1), thereby inhibiting the so-called mitochondrial permeability transition (MPT). Thus, BCL-XL appears to play a prominent role in the regulation of multiple distinct types of cell death, including apoptosis and regulated necrosis. More recently, great attention has been given to the cell death-unrelated functions of BCL-2-like proteins. In particular, BCL-XL has been shown to modulate a number of pathophysiological processes, including—but not limited to—mitochondrial ATP synthesis, protein acetylation, autophagy and mitosis. In this short review article, we will discuss the functions of BCL-XL at the interface between cell death and metabolism.

Preferential killing of p53-deficient cancer cells by reversine.

Reversine is a small synthetic molecule that inhibits multiple mitotic kinases, including MPS1 as well as Aurora kinase A and B (AURKA and AURKB). Here, we investigated the effects of reversine on p53-deficient vs p53-proficient cancer cells. We found that low doses (~0.5 µM) of reversine, which selectively inhibit MPS1 and hence impair the spindle assembly checkpoint, kill human TP53−/− colon carcinoma cells less efficiently than their wild-type counterparts. In sharp contrast, high doses (~5 µM) of reversine induced hyperploidization and apoptosis to a much larger extent in TP53−/− than in TP53+/+ cells. Such a selective cytotoxicity could not be reproduced by the knockdown of MPS1, AURKA and AURKB, neither alone nor in combination, suggesting that it involves multiple (rather than a few) molecular targets of reversine. Videomicroscopy-based cell fate profiling revealed that, in response to high-dose reversine, TP53−/− (but not TP53+/+) cells undergo several consecutive rounds of abortive mitosis, resulting in the generation of hyperpolyploid cells that are prone to succumb to apoptosis upon the activation of mitotic catastrophe. In line with this notion, the depletion of anti-apoptotic proteins of the BCL-2 family sensitized TP53−/− cells to the toxic effects of high-dose reversine. Moreover, the knockdown of BAX or APAF-1, as well as the chemical inhibition of caspases, limited the death of TP53−/− cells in response to high-dose reversine. Altogether, these results suggest that p53-deficient cells are particularly sensitive to the simultaneous inhibition of multiple kinases, including MPS1, as it occurs in response to high-dose reversine.

Synergistic interaction between cisplatin and PARP inhibitors in non-small cell lung cancer

The antineoplastic agent cis-diammineplatinum(II) dichloride (cisplatin, CDDP) is part of the poorly effective standard treatment of non-small cell lung carcinoma (NSCLC). Here, we report a novel strategy to improve the efficacy of CDDP. In conditions in which CDDP alone or either of two PARP inhibitors, PJ34 hydrochloride hydrate or CEP 8983, used as standalone treatments were inefficient in killing NSCLC cells, the combination of CDDP plus PJ34 or that of CDDP plus CEP 8983 were found to kill a substantial fraction of the cells. This cytotoxic synergy could be recapitulated by combining CDDP and the siRNA-mediated depletion of the principal PARP isoform, PARP1, indicating that it is mediated by on-target effects of PJ34 or CEP 8983. CDDP and PARP inhibitors synergized in inducing DNA damage foci, mitochondrial membrane permeabilization leading to cytochrome c release, and dissipation of the inner transmembrane potential, caspase activation, plasma membrane rupture and loss of clonogenic potential in NSCLC cells. Collectively, our results indicate that CDDP can be advantageously combined with PARP inhibitors to kill several NSCLC cell lines, independently from their p53 status. Combined treatment with CDDP and PARP inhibitors elicits the intrinsic pathway of apoptosis.

Immunosurveillance against tetraploidization-induced colon tumorigenesis.

Circumstantial evidence suggests that colon carcinogenesis can ensue the transient tetraploidization of (pre-)malignant cells. In line with this notion, the tumor suppressors APC and TP53, both of which are frequently inactivated in colon cancer, inhibit tetraploidization in vitro and in vivo. Here, we show that—contrarily to their wild-type counterparts—Tp53−/− colonocytes are susceptible to drug-induced or spontaneous tetraploidization in vitro. Colon organoids generated from tetraploid Tp53−/− cells exhibit a close-to-normal morphology as compared to their diploid Tp53−/− counterparts, yet the colonocytes constituting these organoids are characterized by an increased cell size and an elevated expression of the immunostimulatory protein calreticulin on the cell surface. The subcutaneous injection of tetraploid Tp53−/− colon organoids led to the generation of proliferating tumors in immunodeficient, but not immunocompetent, mice. Thus, tetraploid Tp53−/− colonocytes fail to survive in immunocompetent mice and develop neoplastic lesions in immunocompromised settings only. These results suggest that tetraploidy is particularly oncogenic in the context of deficient immunosurveillance.

Whole-genome duplication increases tumor cell sensitivity to MPS1 inhibition

Several lines of evidence indicate that whole-genome duplication resulting in tetraploidy facilitates carcinogenesis by providing an intermediate and metastable state more prone to generate oncogenic aneuploidy. Here, we report a novel strategy to preferentially kill tetraploid cells based on the abrogation of the spindle assembly checkpoint (SAC) via the targeting of TTK protein kinase (better known as monopolar spindle 1, MPS1). The pharmacological inhibition as well as the knockdown of MPS1 kills more efficiently tetraploid cells than their diploid counterparts. By using time-lapse videomicroscopy, we show that tetraploid cells do not survive the aborted mitosis due to SAC abrogation upon MPS1 depletion. On the contrary diploid cells are able to survive up to at least two more cell cycles upon the same treatment. This effect might reflect the enhanced difficulty of cells with whole-genome doubling to tolerate a further increase in ploidy and/or an elevated level of chromosome instability in the absence of SAC functions. We further show that MPS1-inhibited tetraploid cells promote mitotic catastrophe executed by the intrinsic pathway of apoptosis, as indicated by the loss of mitochondrial potential, the release of the pro-apoptotic cytochrome c from mitochondria, and the activation of caspases. Altogether, our results suggest that MPS1 inhibition could be used as a therapeutic strategy for targeting tetraploid cancer cells.

Patient-reported tolerability of adverse events in phase 1 trials

Background Phase I experts recommend revisiting dose-limiting toxicity (DLT) definition to include chronic and cumulative toxicities induced by new molecularly targeted therapies. Patient’s assessment of late toxicities’ tolerability is, however, unknown. Materials and methods A prospective survey on adverse events (AEs) tolerability on 23 National Cancer InstituteCommon Terminology Criteria for Adverse Event, Version 4 (NCI-CTCAE.v4) items was conducted at Gustave Roussy’s Phase I department. Patients’ maximum tolerability duration was recorded at baseline, during trial and at trial completion. Results were compared with the corresponding physicians’ survey. Results 52 patients enrolled in 27 Phase I trials between May 2014 and November 2015 completed 102 forms. At baseline, the most feared G2/G3 AEs were haematuria (74%), vomiting (71%) and hyperglycemia (64%)/dry mouth (94%), hyperglycemia (92%) and vomiting (92%). At trial completion, the most feared G2/G3 AEs were personality change (83.3%), haematuria (82%) and fever (80%)/dry mouth, fever and dizziness (100% each). Tolerability score did not differ over time. More previous treatments and occurrence of severe AEs were associated with better tolerability at study completion (p=0.0234 and p=0.0153, respectively, in multivariate analysis). Patient’s tolerability differed from physician’s assessment. Conclusion AEs considered intolerable by patients are toxicities that directly impact their quality of life and differ from those feared by physicians or included in DLT definition. Patient-reported tolerability of AEs may help in optimising drug development.

Abstract 726: Ultrasensitive quantification of promoter methylation in cell-free circulating DNA for early detection of lung cancer

Lung cancer is the leading cause of cancer-related deaths worldwide. Early detection of lung cancer using Low Dose Computed Tomography (LDCT) screening has been shown to decrease the mortality rate. However, most nodules found are deemed to be benign upon further invasive testing. Thus, complementary minimally-invasive tests are being sought that will help discriminate malignant from benign nodules. Molecular biomarkers are increasingly becoming part of routine clinical practice for the diagnosis, prognosis or prediction of treatment response, with improved disease management and survival outcome. Cell-free circulating DNA (cfDNA) in body fluids, including serum, plasma and urine, has recently emerged as a surrogate for tumor DNA. In addition to providing a minimally-invasive source of tumor DNA, cfDNA reflects molecular alterations and tumor heterogeneity. Epigenetic changes, including DNA methylation, occur early in carcinogenesis. Cancer cells are characterized both by global hypomethylation and hypermethylation of CpG islands in gene promoter regions. Analysis of tumor-specific DNA methylation in cfDNA is a promising strategy for applying epigenetic biomarkers to the detection of cancers at an early-stage. In a prior genome-wide analysis of DNA methylation, we identified a locus methylated de novo in fresh frozen tumor tissues resected from stage I lung cancer patients, that had high discriminatory power to distinguish tumor from non-tumor tissues in multiple patient cohorts. High promoter methylation was also associated with shorter cancer-specific survival. The present study aims at evaluating the diagnostic significance of promoter methylation in cfDNA, and the prognostic value in formalin-fixed paraffin-embedded (FFPE) tissues. We developed a methylation-specific droplet digital PCR (ddPCR) assay to quantify rare methylation events. DNA was subjected to bisulfite treatment to convert unmethylated cytosine residues to uracil. We designed specific primers and probe containing 7 CpGs to only amplify the methylated promoter. Experimental conditions were first optimized using fully methylated and unmethylated control DNAs, DNA extracted from lung cancer cell lines, germline cells and lung tissues (paired tumor and non-tumor). The ddPCR assay has a limit of detection of 30 haploid genomes equivalent of methylated promoter DNA, and a limit of quantification of a single methylated allele present at 0.2% (i.e., 1 methylated copy among 500 unmethylated copies). We demonstrated the assay linearity, reproducibility and specificity for the methylated locus. Differences in methylation levels between tumors and adjacent tissues were also observed. We have thus established a robust and ultrasensitive method for standardized determination of promoter methylation status in cfDNA. We are currently evaluating its potential value for noninvasive diagnosis and prognosis of lung cancer patients. Citation Format: Delphine Lissa. Ultrasensitive quantification of promoter methylation in cell-free circulating DNA for early detection of lung cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 726. doi:10.1158/1538-7445.AM2017-726