Kristin Nieman

Adipocytes promote ovarian cancer metastasis and provide energy for rapid tumor growth

Intra-abdominal tumors, such as ovarian cancer, have a clear predilection for metastasis to the omentum, an organ primarily composed of adipocytes. Currently, it is unclear why tumor cells preferentially home to and proliferate in the omentum, yet omental metastases typically represent the largest tumor in the abdominal cavities of women with ovarian cancer. We show here that primary human omental adipocytes promote homing, migration and invasion of ovarian cancer cells, and that adipokines including interleukin-8 (IL-8) mediate these activities. Adipocyte–ovarian cancer cell coculture led to the direct transfer of lipids from adipocytes to ovarian cancer cells and promoted in vitro and in vivo tumor growth. Furthermore, coculture induced lipolysis in adipocytes and β-oxidation in cancer cells, suggesting adipocytes act as an energy source for the cancer cells. A protein array identified upregulation of fatty acid–binding protein 4 (FABP4, also known as aP2) in omental metastases as compared to primary ovarian tumors, and FABP4 expression was detected in ovarian cancer cells at the adipocyte-tumor cell interface. FABP4 deficiency substantially impaired metastatic tumor growth in mice, indicating that FABP4 has a key role in ovarian cancer metastasis. These data indicate adipocytes provide fatty acids for rapid tumor growth, identifying lipid metabolism and transport as new targets for the treatment of cancers where adipocytes are a major component of the microenvironment.

Adipose tissue and adipocytes support tumorigenesis and metastasis.

Adipose tissue influences tumor development in two major ways. First, obese individuals have a higher risk of developing certain cancers (endometrial, esophageal, and renal cell cancer). However, the risk of developing other cancers (melanoma, rectal, and ovarian) is not altered by body mass. In obesity, hypertrophied adipose tissue depots are characterized by a state of low grade inflammation. In this activated state, adipocytes and inflammatory cells secrete adipokines and cytokines which are known to promote tumor development. In addition, the adipocyte mediated conversion of androgens to estrogen specifically contributes to the development of endometrial cancer, which shows the greatest relative risk (6.3-fold) increase between lean and obese individuals. Second, many tumor types (gastric, breast, colon, renal, and ovarian) grow in the anatomical vicinity of adipose tissue. During their interaction with cancer cells, adipocytes dedifferentiate into pre-adipocytes or are reprogrammed into cancer-associated adipocytes (CAA). CAA secrete adipokines which stimulate the adhesion, migration, and invasion of tumor cells. Cancer cells and CAA also engage in a dynamic exchange of metabolites. Specifically, CAA release fatty acids through lipolysis which are then transferred to cancer cells and used for energy production through β-oxidation. The abundant availability of lipids from adipocytes in the tumor microenvironment, supports tumor progression and uncontrolled growth. Given that adipocytes are a major source of adipokines and energy for the cancer cell, understanding the mechanisms of metabolic symbiosis between cancer cells and adipocytes, should reveal new therapeutic possibilities. This article is part of a Special Issue entitled Lipid Metabolism in Cancer.

The First Line of Intra-abdominal Metastatic Attack: Breaching the Mesothelial Cell Layer

Iwanicki and colleagues reveal that ovarian cancer spheroids clear mesothelial cells which cover the surface of the abdominal cavity using myosin-generated force.

Adipocyte-induced CD36 expression drives ovarian cancer progression and metastasis

Ovarian cancer (OvCa) is characterized by widespread and rapid metastasis in the peritoneal cavity. Visceral adipocytes promote this process by providing fatty acids (FAs) for tumour growth. However, the exact mechanism of FA transfer from adipocytes to cancer cells remains unknown. This study shows that OvCa cells co-cultured with primary human omental adipocytes express high levels of the FA receptor, CD36, in the plasma membrane, thereby facilitating exogenous FA uptake. Depriving OvCa cells of adipocyte-derived FAs using CD36 inhibitors and short hairpin RNA knockdown prevented development of the adipocyte-induced malignant phenotype. Specifically, inhibition of CD36 attenuated adipocyte-induced cholesterol and lipid droplet accumulation and reduced intracellular reactive oxygen species (ROS) content. Metabolic analysis suggested that CD36 plays an essential role in the bioenergetic adaptation of OvCa cells in the adipocyte-rich microenvironment and governs their metabolic plasticity. Furthermore, the absence of CD36 affected cellular processes that play a causal role in peritoneal dissemination, including adhesion, invasion, migration and anchorage independent growth. Intraperitoneal injection of CD36-deficient cells or treatment with an anti-CD36 monoclonal antibody reduced tumour burden in mouse xenografts. Moreover, a matched cohort of primary and metastatic human ovarian tumours showed upregulation of CD36 in the metastatic tissues, a finding confirmed in three public gene expression data sets. These results suggest that omental adipocytes reprogram tumour metabolism through the upregulation of CD36 in OvCa cells. Targeting the stromal-tumour metabolic interface via CD36 inhibition may prove to be an effective treatment strategy against OvCa metastasis.

Abstract IA30: Metabolic symbiosis: The contribution of adipocytes to visceral metastasis

Many tumor types (gastric, breast, colon, renal, and ovarian) grow in the anatomical vicinity of adipose tissue and are known to reprogram adjacent normal adipocytes into cancer-associated adipocytes (CAA). Clinical observations indicate that the most common, as well as the largest, site of ovarian cancer (OvCa) metastasis is the omentum, a large fat pad (20x12x3cm) positioned in front of the bowel. The omentum, which is primarily composed of adipocytes, provides energy storage and functions as an endocrine organ. Because cancer cell behavior is highly dependent on the microenvironment, and adipocytes are a major source of energy-dense fatty acids, we hypothesized that adipocytes promote OvCa omental metastasis and growth via altered lipid metabolism. To investigate this hypothesis, primary human visceral adipocytes were cultured from omental tissue specimens collected from patients who underwent surgical procedures for benign conditions. The rate of β-oxidation was assessed by a radioisotopic assay using 3H-palmitate. Sections of human serous ovarian carcinomas and corresponding omental metastases were utilized for immunohistochemistry, RT-PCR, and a reverse-phase protein array. Homozygous fatty acid binding protein 4 (FAPB4)-null mice or wild-type (WT) animals were inoculated orthotopically or intraperitoneally with mouse OvCa cells. Adipocytes were found to promote the invasion, migration, and proliferation of OvCa cells. The homing of OvCa towards adipocytes in vitro, or to the mouse omentum in vivo, was reduced by using inhibitory antibodies against interleukin (IL)-6,IL-8, or their receptors. Co-culture of OvCa cells with adipocytes resulted in cytoplasmic lipid accumulation in OvCa cells, which was a consequence of direct lipid transfer from the adipocytes. Co-injection of SKOV3ip1 OvCa cells with adipocytes enhanced tumor growth in mice, when compared to the injection of SKOV3ip1 cells alone. Moreover, lipolysis was activated in co-cultured adipocytes as evidenced by the secretion of free fatty acids and glycerol. FABP4 was found to be highly expressed in omental metastatic tissues as compared to the respective primary OvCa tumor tissue. When mouse OvCa cells were injected under the ovarian bursa of FABP4 knock-out mice the number of metastases was significantly lower than in WT mice. Treatment with a FABP4 inhibitor also induced apoptosis and inhibited migration and invasion of OvCa cells. The fatty acid translocase (FAT/CD36) was identified as the fatty acid transporter responsible for lipid accumulation in cancer cells co-cultured with adipocytes. Our results suggest that adipocytes advance the progression of OvCa through two major mechanisms: (1) They promote metastasis to the omentum via the secretion of cytokines, and (2) They support cancer cell proliferation by activating lipolysis, thereby mobilizing energy-dense fatty acids which are utilized by the cancer cells in an energy-yielding β-oxidation pathway through a FABP4 and FAT/CD36 dependent mechanism. By better understanding these mechanisms and, more generally, the biology of adipocytes in the tumor microenvironment, we will be able to identify metabolic targets and, ultimately, introduce new compounds for the treatment of cancer. Citation Format: Kristin Nieman, Andras Ladanyi, Ernst Lengyel. Metabolic symbiosis: The contribution of adipocytes to visceral metastasis. [abstract]. In: Proceedings of the AACR Special Conference on Tumor Invasion and Metastasis; Jan 20-23, 2013; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2013;73(3 Suppl):Abstract nr IA30.

Abstract 5185: Ovarian cancer cells induce fibronectin production in the peritoneal microenvironment through a TGFβRI-dependent mechanism which promotes the early steps of metastasis

Proceedings: AACR 103rd Annual Meeting 2012‐‐ Mar 31‐Apr 4, 2012; Chicago, IL The high mortality rate that results from ovarian cancer (OvCa) is caused by the wide dissemination of cancer cells within the abdominal cavity. OvCa cells metastasize to the peritoneum, which is covered by a single layer of mesothelial cells, and invade into the underlying stroma, composed of extracellular matrices (ECM) including fibronectin (FN) and stromal cells such as fibroblasts. We hypothesize that cancer cells stimulate stromal cells to produce and secrete FN, initiating the metastatic niche. A 3D model of the human peritoneal surface (in vitro), pieces of human omentum (ex vivo), and a mouse xenograft model (in vivo) of OvCa were used to investigate the early effects of cancer cells on the host microenvironment. FN expression was investigated in human normal and tumor tissues using tissue microarrays, reverse-phase protein arrays, and preserved tissues. The different model systems and tissues were examined utilizing a number of techniques including; immunohistochemistry, immunofluorescence, ECM extraction, real-time quantitative PCR, and immunoblotting. Our results reveal that FN is overexpressed in the stroma of more than 90% of OvCa metastatic tissues examined. Moreover, total FN expression levels are significantly greater in omental metastases as compared to patient-matched primary tumor tissues. Additionally, the EDA+ fragment of FN is upregulated in OvCa metastases when compared to normal omental tissue. Cancer cell adhesion and proliferation are increased on omental metastases-derived ECM as compared to normal omental-derived ECM, which are significantly inhibited when the interaction between FN and its receptor, integrin α5β1 is blocked. Using the in vitro 3D model, we found that mesothelial cells and fibroblasts are the source of FN, and multiple peritoneal cancer cells induce FN production. Knocking-down FN in mesothelial cells (in vitro), sections of human omentum (ex vivo), and mouse peritoneum (in vivo) perturbs OvCa cell adhesion, invasion, and proliferation. Likewise, treatment with ATN-161, which antagonizes the interaction between FN and its receptor, integrin α5β1, also reduces OvCa cell adhesion, invasion, and proliferation in the 3D omental model (in vitro), and OvCa metastasis in the xenograft model (in vivo). OvCa cells increase phosphorylation and nuclear localization of Smad2/3 in mesothelial cells upon co-culture, and inhibition of Smad 3 as well as TGFβRI in mesothelial cells resulted in decreased FN production. Moreover, Rac 1 activity is increased upon co-culture of OvCa and mesothelial cells, and subsequent inhibition of Rac 1 in mesothelial cells lead to a decrease in FN production. Taken together, we show that abdominally metastasizing cancer cells induce FN production in the microenvironment and inhibition of this response may prevent the first steps of peritoneal metastasis. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 5185. doi:1538-7445.AM2012-5185