HIF-2A Promotes Dissemination of Plasma Cells in Multiple Myeloma by Regulating CXCL12/CXCR4 and CCR1 Kate Vandyke1,2,3, Mara N
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Published OnlineFirst August 30, 2017; DOI: 10.1158/0008-5472.CAN-17-0115 Cancer Molecular and Cellular Pathobiology Research HIF-2a Promotes Dissemination of Plasma Cells in Multiple Myeloma by Regulating CXCL12/CXCR4 and CCR1 Kate Vandyke1,2,3, Mara N. Zeissig1,2, Duncan R. Hewett1,2, Sally K. Martin1,2, Krzysztof M. Mrozik1,2, Chee Man Cheong1,2, Peter Diamond1, L. Bik To3,4, Stan Gronthos2,5, Daniel J. Peet6, Peter I. Croucher7,8, and Andrew C.W. Zannettino1,2,3,9 Abstract Disease progression and relapse in multiple myeloma is chemokine receptor CCR1 in multiple myeloma PCs. CCR1 dependent on the ability of the multiple myeloma plasma activation potently induces multiple myeloma PC migration cells (PC) to reenter the circulation and disseminate through- toward CCL3 while abrogating the multiple myeloma PC out the bone marrow. Increased bone marrow hypoxia is migratory response to CXCL12. In addition, increased CCR1 associated with increased recirculation of multiple myeloma expression by multiple myeloma PCs conferred poor prognosis PCs. Accordingly, we hypothesized that during chronic hyp- in newly diagnosed multiple myeloma patients and was asso- oxia, activation of HIF-2a may overcome the bone marrow ciated with an increase in circulating multiple myeloma PCs in retention signal provided by stromal-derived CXCL12, thereby these patients. Taken together, our results suggest a role for enabling dissemination of multiple myeloma PCs. Here we hypoxia-mediated CCR1 upregulation in driving the egress of demonstrate that HIF-2a upregulates multiple myeloma PC multiple myeloma PCs from the bone marrow. Targeting CXCL12 expression, decreasing migration toward CXCL12 and CCR1 may represent a novel strategy to prevent dissemination reducing adhesion to mesenchymal stromal cells in vitro.We and overt relapse in multiple myeloma. Cancer Res; 77(20); 5452–63. also found that HIF-2a strongly induced expression of the Ó2017 AACR. Introduction development of the asymptomatic precursor disease monoclonal gammopathy of undetermined significance (MGUS; ref. 2). In a Multiple myeloma is an incurable hematologic cancer that is small proportion of MGUS patients (1% per year), intrinsic responsible for an estimated 80,000 deaths worldwide, each year genetic changes, coupled with extrinsic factors, lead to the pro- (1). Multiple myeloma is characterized by the clonal proliferation liferation of the multiple myeloma PCs and their dissemination to of malignant plasma cells (PC) within the bone marrow. While, in sites throughout the skeleton (3). Ultimately, multiple myeloma some cases, malignant PCs establish at a single site, forming a PC proliferation and dissemination results in hypercalcemia, solitary plasmacytoma, in the majority of cases, the transformed renal insufficiency, anemia, and osteolytic bone disease, features PC will disseminate throughout the bone marrow, leading to the characteristic of progressive disease (4). Dissemination and repopulation throughout the bone marrow 1Myeloma Research Laboratory, Adelaide Medical School, Faculty of Health and is key, not only during multiple myeloma disease progression, but Medical Sciences, University of Adelaide, Adelaide, Australia. 2Cancer Theme, also in the outgrowth of resistant multiple myeloma PCs during South Australian Health and Medical Research Institute, Adelaide, Australia. 3SA relapse following therapy. Evidence suggest that in most, if not all Pathology, Adelaide, Australia. 4Haematology and Bone Marrow Transplant multiple myeloma patients, malignant PCs continually migrate 5 Unit, Royal Adelaide Hospital, Adelaide, Australia. Mesenchymal Stem Cell and repopulate multiple sites throughout the bone marrow (2). Laboratory, Adelaide Medical School, Faculty of Health and Medical Sciences, Circulating multiple myeloma PCs are observed in over two- University of Adelaide, Adelaide, Australia. 6School of Biological Sciences, Faculty of Sciences, University of Adelaide, Adelaide, Australia. 7Bone Biology thirds of newly diagnosed multiple myeloma patients and are Division, Garvan Institute of Medical Research, Sydney, Australia. 8St Vincent's a predictor of response to therapy, with increased numbers of Clinical School, Faculty of Medicine, University of New South Wales, Sydney, circulating multiple myeloma PCs representing an independent Australia. 9Centre for Cancer Biology, University of South Australia, Adelaide, indicator of poor prognosis and rapid progression (5–8). Australia. The homing of multiple myeloma PCs from the peripheral Note: Supplementary data for this article are available at Cancer Research circulation to the bone marrow is critically dependent on the Online (http://cancerres.aacrjournals.org/). chemokine (C-X-C motif) ligand CXCL12 (also known as stromal Corresponding Author: Andrew C.W. Zannettino, Myeloma Research Labora- cell–derived factor-1; SDF-1), the ligand for CXCR4. CXCL12 is tory, Adelaide Medical School, Faculty of Health and Medical Sciences, University highly expressed by bone marrow mesenchymal stromal cells of Adelaide, North Terrace, Adelaide, SA 5000, Australia. Phone: 618-812-8490; (BMSC; refs. 9, 10) and acts as potent attractor for the homing of Fax: 618-8222-3139; E-mail: [email protected] both normal and malignant PCs into the bone marrow (11, 12). doi: 10.1158/0008-5472.CAN-17-0115 In addition, CXCL12 is crucial in the subsequent retention of Ó2017 American Association for Cancer Research. multiple myeloma PCs in the bone marrow, stimulating increased 5452 Cancer Res; 77(20) October 15, 2017 Downloaded from cancerres.aacrjournals.org on September 24, 2021. © 2017 American Association for Cancer Research. Published OnlineFirst August 30, 2017; DOI: 10.1158/0008-5472.CAN-17-0115 CCR1, CXCL12, and Hypoxia in MM Dissemination adhesion of multiple myeloma PCs to bone marrow stromal cells marrow aspirates isolated from the posterior iliac crest of healthy and promoting multiple myeloma PC survival and resistance to adult human donors and were used at passage 6. Survival was therapeutics (13, 14). calculated from the date of bone marrow or blood collection until While the mechanisms involved in multiple myeloma PC death, by any cause. Patients who were lost to follow up were homing to the bone marrow are relatively well characterized, the censored at the date of last contact. mechanisms responsible for driving multiple myeloma PCs egress from the bone marrow remain to be elucidated. Emerging data Cell culture suggest that the elevated bone marrow hypoxia observed in Unless otherwise specified, all cell culture reagents were multiple myeloma (15–17) is a potential microenvironmental sourced from Sigma-Aldrich and all media were supplemented stimulus that drives multiple myeloma PC dissemination (18). with 2 mol/L L-glutamine, 100 U/mL penicillin, 100 mg/mL Recent studies suggest bone marrow hypoxia strongly correlates streptomycin, 1 mmol/L sodium pyruvate, and 10 mmol/L with both tumor burden and numbers of circulating multiple HEPES buffer. BMSCs were maintained as described previously myeloma PCs in mouse models of multiple myeloma, suggesting (21). HMCLs RPMI-8226, LP-1, and U266 were obtained from the that hypoxic multiple myeloma PCs may be preferentially mobi- ATCC between 2000 and 2003; STR authentication was not lized to the peripheral blood (18). This may, at least in part, be due conducted on these lines as they were obtained directly from the to decreased adhesion and a reduced chemotactic response to ATCC. OPM2 cells were provided by Prof. Andrew Spencer bone marrow stromal cells under hypoxia (18). A similar asso- (Monash University, Melbourne, Australia) in 2004; this cell line ciation between tumor hypoxia and increased metastasis has also was authenticated in 2016 using STR analysis performed by the been seen in patients with solid tumors and in animal models of Molecular Genetics Laboratory, SA Pathology, using an metastasis (17). AmpFLSTR Identifiler PCR Amplification Kit (Thermo Fisher Exposure to hypoxia induces gene expression through the Scientific). HMCLs were last mycoplasma tested in May 2016 stabilization and increased expression of the hypoxia-inducible using a MycoAlert Mycoplasma Detection Kit (Lonza). HMCLs transcription factors HIF-1a and HIF-2a (17). Our previous were maintained in RPMI1640 medium with 10% FCS (Thermo studies suggest that HIF-2a plays a critical role in multiple Fisher Scientific) and supplements. All experiments were con- myeloma disease progression, through binding to the promoter ducted within 4 weeks of thawing of cells. Cell lines were routinely and driving expression of CXCL12 (15). In addition to being cultured in a humidified environment with 5% carbon dioxide at highly expressed by bone marrow stromal cells, CXCL12 is highly 37C. Hypoxic culture conditions (<1% oxygen) were established expressed by multiple myeloma PCs (19) and multiple myeloma using an anaerobic sachet (Oxoid). Where indicated, cells were PC–derived CXCL12 plays an important role in driving osteolysis treated with the CCR1 inhibitor BX471 (Sigma Aldrich) in (19, 20) and angiogenesis (15) in myeloma patients. 0.0004% DMSO, or 0.0004% DMSO alone, or with recombinant In the studies presented here, we investigated whether upre- human (rh)CXCL12 (100 ng/mL; R&D Systems) or rhCCL3 gulation of CXCL12 expression in multiple myeloma PCs, in (100 ng/mL; PeproTech). Generation of RPMI-8226 and LP-1 response to HIF-2a expression, abrogates the chemoattraction cell lines overexpressing CXCL12, HIF-1a, or HIF-2a is described