Garima Sinha

Mesenchymal Stem Cell–Derived Exosomes Stimulate Cycling Quiescence and Early Breast Cancer Dormancy in Bone Marrow

Dormant breast cancers resurge as metastatic disease after a long dormancy period in the bone marrow, where cancer cells interact with mesenchymal stem cells (MSC). However, the nature of early interactions between breast cancer cells and MSCs in the bone marrow microenvironment that facilitate adaptation to a quiescent state remains poorly understood. Here, we report that breast cancer cells prime MSC to release exosomes containing distinct miRNA contents, such as miR-222/223, which in turn promotes quiescence in a subset of cancer cells and confers drug resistance. Building on these results, we developed a novel, nontoxic therapeutic strategy to target dormant breast cancer cells based on systemic administration of MSC loaded with antagomiR-222/223. In an immunodeficient mouse model of dormant breast cancer, this therapy sensitized breast cancer cells to carboplatin-based therapy and increased host survival. Overall, our findings illuminate the nature of the regulatory interactions between breast cancer cells and MSCs in the evolution of tumor dormancy and resurgence in the micrometastatic microenvironment of the bone marrow. Cancer Res; 76(19); 5832-44. ©2016 AACR.

A review of stem cell translation and potential confounds by cancer stem cells.

Mesenchymal stem cells (MSCs) are multipotent cells found in both fetal and adult tissues. MSCs show promise for cellular therapy for several disorders such as those associated with inflammation. In adults, MSCs primarily reside in the bone marrow (BM) and adipose tissues. In BM, MSCs are found at low frequency around blood vessels and trabecula. MSCs are attractive candidates for regenerative medicine given their ease in harvesting and expansion and their unique ability to bypass the immune system in an allogeneic host. Additionally, MSCs exert pathotropism by their ability to migrate to diseased regions. Despite the “attractive” properties of MSCs, their translation to patients requires indepth research. “Off-the-shelf” MSCs are proposed for use in an allogeneic host. Thus, the transplanted MSCs, when placed in a foreign host, could receive cue from the microenvironment for cellular transformation. An important problem with the use of MSCs involves their ability to facilitate the support of breast and other cancers as carcinoma-associated fibroblasts. MSCs could show distinct effect on each subset of cancer cells. This could lead to untoward effect during MSC therapy since the MSCs would be able to interact with undiagnosed cancer cells, which might be in a dormant state. Based on these arguments, further preclinical research is needed to ensure patient safety with MSC therapy. Here, we discuss the basic biology of MSCs, discuss current applications, and provide evidence why it is important to understand MSC biology in the context of diseased microenvironment for safe application.

The bone marrow niche in support of breast cancer dormancy.

Despite the success in detecting breast cancer (BC) early and, with aggressive therapeutic intervention, BC remains a clinical problem. The bone marrow (BM) is a favorable metastatic site for breast cancer cells (BCCs). In BM, the survival of BCCs is partly achieved by the supporting microenvironment, including the presence of immune suppressive cells such as mesenchymal stem cells (MSCs). The heterogeneity of BCCs brings up the question of how each subset interacts with the BM microenvironment. The cancer stem cells (CSCs) survive in the BM as cycling quiescence cells and, forming gap junctional intercellular communication (GJIC) with the hematopoietic supporting stromal cells and MSCs. This type of communication has been identified close to the endosteum. Additionally, dormancy can occur by soluble mediators such as cytokines and also by the exchange of exosomes. These latter mechanisms are reviewed in the context of metastasis of BC to the BM for transition as dormant cells. The article also discusses how immune cells such as macrophages and regulatory T-cells facilitate BC dormancy. The challenges of studying BC dormancy in 2-dimensional (2-D) system are also incorporated by proposing 3-D system by engineering methods to recapitulate the BM microenvironment.

Evaluation of a developmental hierarchy for breast cancer cells to assess risk-based patient selection for targeted treatment

This study proposes that a novel developmental hierarchy of breast cancer (BC) cells (BCCs) could predict treatment response and outcome. The continued challenge to treat BC requires stratification of BCCs into distinct subsets. This would provide insights on how BCCs evade treatment and adapt dormancy for decades. We selected three subsets, based on the relative expression of octamer-binding transcription factor 4 A (Oct4A) and then analysed each with Affymetrix gene chip. Oct4A is a stem cell gene and would separate subsets based on maturation. Data analyses and gene validation identified three membrane proteins, TMEM98, GPR64 and FAT4. BCCs from cell lines and blood from BC patients were analysed for these three membrane proteins by flow cytometry, along with known markers of cancer stem cells (CSCs), CD44, CD24 and Oct4, aldehyde dehydrogenase 1 (ALDH1) activity and telomere length. A novel working hierarchy of BCCs was established with the most immature subset as CSCs. This group was further subdivided into long- and short-term CSCs. Analyses of 20 post-treatment blood indicated that circulating CSCs and early BC progenitors may be associated with recurrence or early death. These results suggest that the novel hierarchy may predict treatment response and prognosis.

Immune modulation by a cellular network of mesenchymal stem cells and breast cancer cell subsets: Implication for cancer therapy

The immune modulatory properties of mesenchymal stem cells (MSCs) are mostly controlled by the particular microenvironment. Cancer stem cells (CSCs), which can initiate a clinical tumor, have been the subject of intense research. This review article discusses investigative studies of the roles of MSCs on cancer biology including on CSCs, and the potential as drug delivery to tumors. An understanding of how MSCs behave in the tumor microenvironment to facilitate the survival of tumor cells would be crucial to identify drug targets. More importantly, since CSCs survive for decades in dormancy for later resurgence, studies are presented to show how MSCs could be involved in maintaining dormancy. Although the mechanism by which CSCs survive is complex, this article focus on the cellular involvement of MSCs with regard to immune responses. We discuss the immunomodulatory mechanisms of MSC-CSC interaction in the context of therapeutic outcomes in oncology. We also discuss immunotherapy as a potential to circumventing this immune modulation.

Is reduction of tumor burden sufficient for the 21st century

Currently, animal models are used to test the efficacy of tumor treatment. A significant reduction of tumor mass is lauded as great improvement. As we begin the 21st century, one wonders if this is sufficient and acceptable for cancer treatment. Although the presence of cancer stem cell (CSCs) is not a new phenomenon, their role in the initiation of the tumor for clinical resurgence is mostly ignored when testing drugs. The current treatment then poses a major limitation to aggressively target the cells most responsible for tumor initiation and resurgence. The review does not trivialize the problem since it is acknowledged that the tumors and cells within the tissue microenvironment would interact through complex mechanisms. It is quite possible that the interaction by CSCs and the microenvironment will vary, depending on the tissue, e.g., bone marrow versus brain. Research studies are needed to investigate if CSCs from the same organ differ after migrating to other tissues. If so, this will pose an economic dilemma for targeted drug development. It will not be feasible to develop drugs for each organ. Besides, the cost, there could be problems to effectively deliver the drugs to all organs, problems to assess drug distribution to particular tissues and toxicity for specific drugs. If multiple drugs are required to eradicate CSCs in different tissues, there is a problem of possible untoward effect for the simultaneous delivery of multiple drugs to a single cancer patient. As new drugs are developed, the investigators will need to pay attention for dedifferentiation of non-CSCs to CSCs. The metabolic pathways will have to be given equal attention as the stem cells genes since their pathways might show major differences rather than the stem cells genes, which are shared by the normal stem cells.

Secretome within the bone marrow microenvironment: A basis for mesenchymal stem cell treatment and role in cancer dormancy

The secretome produced by cells within the bone marrow is significant to homeostasis. The bone marrow, a well-studied organ, has multiple niches with distinct roles for supporting stem cell functions. Thus, an understanding of mediators involved in the regulation of stem cells could serve as a model for clinical problems and solutions such as tissue repair and regeneration. The exosome secretome of bone marrow stem cells is a developing area of research with respect to the regenerative potential by bone marrow cell, particularly the mesenchymal stem cells. The bone marrow niche regulates endogenous processes such as hematopoiesis but could also support the survival of tumors such as facilitating the cancer stem cells to exist in dormancy for decades. The bone marrow-derived secretome will be critical to future development of therapeutic strategies for oncologic diseases, in addition to regenerative medicine. This article discusses the importance for parallel studies to determine how the same secretome may compromise safety during the use of stem cells in regenerative medicine.

Cancer Stem Cells: Issues with In Vitro Expansion and Model Systems

Despite tremendous progress, breast cancer (BC) still remains a clinical issue. Reports have confirmed the presence of a subset of BC cells (BCCs) with self-renewal ability, which are referred as cancer stem cells (CSCs). The CSCs can remain dormant for decades following either incomplete removal of the primary tumor or through resisting current chemo-, radio- and endocrine treatments. The biology of breast CSCs is poorly understood. These cells can persist either by completely withdrawing from the cell cycle or by continuing to proliferate at a slower rate. Therefore, developing methods to characterize breast CSCs may help develop innovative-targeted therapies to control or eliminate the resistant cells. Traditional in vitro studies for breast CSCs usually use two-dimensional (2-D) monolayer cultures. Moreover, in order to mimic the architectural features of the in vivo environment, most recent reports use thee-dimensional (3-D) culture systems to address some of the limitations of the 2-D monolayer culture. This chapter discusses the current methodologies used for cancer stem cells (CSCs). The methods are also discussed in the context of specific applications.

Abstract P1-06-07: Msi1 in maintaining breast cancer stem cell involves the AKT/PI3K pathway

Musashi1 (Msi1) was originally described in neural stem cells in a role influencing neural differentiation in the Numb/Notch pathway. Due to its role in neural stem cells, there has been much interest in the role of Msi1 in the breast cancer (BC) stem cell population. In this vein, with we have demonstrated a possible feedback loop between the stem cell marker OCT4 and Msi1, in addition to other stem cell-associated genes. Flow cytometry analyses demonstrated that the subset of BC cells (BCCs) that we previously identified as those with high Oct4 was also enriched for Msi1. Msi1 knockdown BCCs showed decreased doubling time and with limited ability to be passaged, indicating the loss of the self-renewal subset needed for cell passaging. These in vitro findings were consistent with the inability of the Msi1 knockdown BCCs to undergo serial passages in vivo. We therefore examined the Msi1 knockdown BCCs for intracellular proteins that could explain the reduced cell growth and the reduced initiating cells. We selected the AKT/PI3K pathway due to its recent connection to the maintenance of BC stem cells. Msi1 knockdown repressed several molecules within the AKT/PI3K pathway: PTEN, AKT, and PI3K. There were no significant differences found however, in the apoptotic factors, BCL-2 and Caspase-3. Upon further investigation, we observed increases in molecules that are linked to decreased cell proliferation and senescence, p16, p53 and p21. Since Msi1 is an RNA binding protein, it is possible that its loss could leave RNAs for binding to miRNAs and this might be partly responsible for the decrease in key intracellular molecules needed for the survival and proliferation of the Msi1 knockdown BCCs. Further studies are needed to investigate how miRNAs and Msi1 interact to maintain the survival of BCCs. Finally, Msi1 KD positively affects the expression of the immune checkpoint inhibitor PD-1L, suggesting increased PD-1L expression in cells that are not of the CSC phenotype. The studies may identify Msi1 or its associated molecules as a potential therapeutic intervention for BC. Citation Format: Nahas GR, Sinha GA, Sherman LS, Walker ND, Rameshwar P. Msi1 in maintaining breast cancer stem cell involves the AKT/PI3K pathway. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-06-07.

Abstract 2537: Role of N-cadherin in connexin 43 mediated gap junctional formation between dormant breast cancer cells and bone marrow mesenchymal and stromal cells

Breast cancer (BC) remains a clinical problem. This is partly due to the existence of dormant BC cells (BCCs) in the bone marrow (BM) that could resurge decades after cancer remission. Cancer stem cells (CSCs) establish themselves in cycling quiescence within the BM microenvironment by forming gap junctional intercellular communication (GJIC) with mesenchymal stem cells (MSCs) and the hematopoietic supporting stroma. MiRNAs can be exchanged between the CSCs and other BM cells through the gap junction to impart cycling quiescence of the CSCs. Although the CSCs express several members of the connexin (Cx) family of proteins, GJIC between CSCs and BM cells requires Cx43. Preventing the formation of GJIC between CSCs and endogenous BM cells enhanced cycle of the BCCs with enhanced chemosensitivity. Since Cx43 is also involved in hematopoietic regulation, in order to identify targets to reverse dormancy, this study investigated the molecular mechanisms by which Cx43 is regulated, including the role of N-cadherin as a facilitator of GJIC between CSCs and BM cells. CSCs are epithelial-mesenchymal cells (EMT) and therefore express N-cadherin. In other studies Cx43 has been shown to interact with N-cadherin to facilitate the movement of Cx43 to the cell membrane. To this end, we hypothesize that the intracellular complex formed by N-cadherin and Cx43 in CSCs is regulated by the chemokine CXCL-12. MDA-MB-231, MDA-MB-468 and T47D were stimulated with different levels of CXCL12. At different times, the expression of N-cadherin was studied by real time PCR, confocal microscopy and flow cytometry. The results showed CXCL12 regulated both N-cadherin and Cx43. However, the outcome on their expression depended on the invasiveness of the tumor. Direct interaction between N-cadherin and Cx43 was demonstrated by time-line tracking for co-localization, molecular modeling and immunoprecipitation. In summary, this study showed that co-localization of N-cadherin and Cx43 is controlled by low level of CXC12. Ongoing studies are investigating how these findings affect GJIC between CSCs and BM stroma/MSCs. Citation Format: Garima Sinha. Role of N-cadherin in connexin 43 mediated gap junctional formation between dormant breast cancer cells and bone marrow mesenchymal and stromal cells. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 2537.