Cancer Stem Cells Extensively and Form New Tumors
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Targeting mammary stem cells for breast cancer prevention Max Wicha M.D. Cancer Stem Cell Hypothesis Cancers Arise from Cells with Dysregulated Self-Renewal Cancers Are “Driven” By Cells With Stem Cell Properties Stem cells as targets for cancer prevention HYPOTHESIES If cancers arise in self-renewing cells then: • Stem/Progenitor cell number may be a cancer risk factor • Targeting tissue stem/progenitor cell self- renewal pathways may reduce cancer risk • Tissue stem cell and self-renewal pathway components may be useful biomarkers for cancer prevention studies characteristics of stem cells • self renewal • differentiation into multiple cell types • types of stem cells embryonic adult • cancer Stem cells and breast carcinogenesis Stem cell Cancer stem cell Quiescent pool of stem cell Early Progenitor Late Progenitor Cancer stem cell DIFFERENTIATION Luminal cells Myoepithelial cells Alveolar cells Reduction mammoplasties “Mammosphere” Suspension culture (Serum-free, EGF, …) Culture Systems Mammospheres Dissociated to single cells Acinar Ductal- acinar Regeneration of the mammary N generation of spheres Mixed Myoepithelial Epithelial structure structure gland in the cleared fat- pad B. Differentiation in C. Differentiation in A. Self- renewal D. Differentiation and in vitro vitro in 2- D culture vitro in 3- D culture self- renewal in vivo (Suspension) (Collagen) (Matrigel ) (NOD/SCID mice) Dontu & Wicha, 2003 Dontu & Wicha, 2003 Weaver & Bissell, 1999 Kuperwasser & Weinberg, 2004 Dontu & Wicha, 2003 Liu & Wicha, 2006 ALDEFLUOR + cells in Normal breast epithelium BAAA ALDH DEAB With DEAB Without DEAB 6% of ALDEFLUOR positive cells in Normal breast epithelium 6% Ginestier et al Cell Stem Cell 2007 ALDEFLUOR+ cells have stem cell properties Culture in suspension With DEAB Without DEAB Only ALDEFLUOR + cells generate mammospheres in suspension ALDEFLUOR+ cells have stem cell properties Without DEAB CK18 SMA ALDEFLUOR+ Luminal cells CK18+ Myoepithelial cells SMA+ ALDEFLUOR- ALDEFLUOR- ALDEFLUOR+ Ginestier, 2007 Models of Tumor Heterogeneity Stochastic model Cancer stem cell model CSC CSC CSC CSC Cancer cells are heterogeneous, Cancer cells are heterogeneous, but most cells can proliferate and only rare cancer stem cells extensively and form new tumors. have the ability to proliferate extensively and form new tumors. Reya et al 2001 Tumor Formation by Human Breast Cancer “Stem Cells” 20,000 200 CD44- CD44+ CD24+ CD24- Cells Cells Al Hajj et al PNAS 2003 Stem Cell Markers • CD44 • CD24 • Aldehyde Dehydrogenase ( Christophe Ginestier) • Oct-4 • Bmi-1 • Nuclear B-Catenin ALDEFLUOR+ population and tumorigenicity With DEAB Without DEAB ALDEFLUOR- ALDEFLUOR+ R1 R2 R1 R2 5% to 10% of ALDEFLUOR + population in Breast tumors ALDEFLUOR- ALDEFLUOR+ 50,000 cells 50,000 cells ALDEFLUOR – ALDEFLUOR + 5000 cells 5000 cells 50,000 cells 500 cells 500 cells 500 cells ALDEFLUOR+ population and tumorigenicity ALDEFLUOR - ALDEFLUOR + ALDEFLUOR+ population regenerates heterogeneity of the initial tumor Overlap between CD44+CD24- and ALDEFLUOR+ Populations Ginestier et al Cell Stem Cell 2007 Breast Cancer Development Luminal Myoepithelial Normal duct Hyperplasia In situ carcinoma Invasive carcinoma Aldefluor + cells are invasive and metastatic U (-) (+) HCC1954HCC1954 (100k) 500 100,000 ALDELFUOR-positive 450 100,00 ALDEFLUOR-negative 400 350 100,000 Unseparated 300 Positive E 250 Negative 200 Unsorted 150 100 50 Normalized Flux Photon Normalized Photon Flux Photon Normalized 0 1 2 3 4 5 6 7 8 F WeeksWeeks after after injection injection B 600 MDAMDAMB453-MB-453 (100k) K 500 500 450 100,000 ALDELFUOR-positive 400 400 100,00 ALDEFLUOR-negative 350 300 300 100,000 Unseparated 250 Positive G 200 200 Negative 150 Unsorted 100 100 Relative invasion rate Normalized Flux Photon 50 Normalized Photon Flux Photon Normalized 0 0 L 1 2 3 4 1 2 3 4 5 ALDEFLUOR + + + + + + - - - - - - Weeks after injection BrCa-MZ-01 MDA-MB-453 SUM159 Weeks after injection C H IL8 - - - + + + - - - + + + SUM159SUM159 (100k) HCC1954 MDA-MB-453 SUM159 30 A 100,000 ALDELFUOR-positive 25 100,00 ALDEFLUOR-negative 20 100,000 Unseparated Positive 15 Negative Unsorted I M 10 5 Normalized Flux Photon Normalized Photon Flux Photon Normalized 0 1 2 3 4 5 Weeks after after injection injection D J Cancer Stem Cells: Implications For Metastasis TDC only No Metastases CSC=Cancer Stem Cell TDC=Terminally Differentiated Cell NO CSC 1o Tumor CSC with FULL malignant potential Metastases in months to few years TDC TDC Subsequently to other sites TDC CSC TDC TDC TDC CSC with PARTIAL malignant potential Dormancy followed by Metastases after many years: Secondary Oncogenic “Hits” and/or Changes in Microenvironment Carcinogenesis Stem cell regulation Dysregulation Cancer TUMOR Microenvironment Stem Cell Generation Tumor Microenviornment and the “CSC Niche” • The Microenvironment (“Stem cell niche”) contains fibroblasts, endothelial cells, inflammatory cells and mesenchymal stem cells recruited from bone marrow. • The Microenvironment plays an important role in normal mammary development as well as tumor growth and metastasis. > Bone marrow derived mesenchymal stem cells are recruited to murine breast carcinomas (Karnoub 2007). • Cytokines regulate breast cancer stem cells. > IL6 increases breast cancer stem cells (Sanson 2008). > IL8/CXCR1 axis regulates breast cancer stem cells (Charafe-Jaffret Cancer Research 2009) Effects of Cytokines on breast cancer stem/progenitor cell population A 14 12 10 positive - 8 6 4 SUM159 cells (%) ALDEFLOUR-positive cells (%) ALDEFLOUR 2 0 Co- Control 2 ug/ml 1 ug/ml 10 ng/ml 10 ng/ml 100 ng/ml 100 ng/ml Co- 100 ng/ml culture N.T. CXCL12 ug/ml CXCL51 ug/ml CXCL610 ng/ml CXCL710 ng/ml IL6 100IL8 ng/ml culture CXCL1 CXCL5 CXCL6 CXCL7 IL6 IL8 SUM159 B 16 12 positive - 8 4 SUM159 cells (%) ALDEFLOUR ALDEFLOUR-positive cells (% cells ALDEFLOUR-positive 0 10 ug/ml SUM159SUM159 ControlN.T. 100100 ug/ml ug/ml 5050 ug/ml ug/ml 2020 ug/ml ug/ml 100100 ug/ml ug/ml 10 ug/ml anti-IL8 alonealone anti-CXCL5anti-CXCL5 anti-CXCL6anti-CXCL6 anti-CXCL7anti-CXCL7 anti-IL6anti-IL6 anti-IL8 Co-culture Model of cytokine networks between MSC and breast cancer cells CXCL7 Bulk Tumor Mesenchymal Cells Cells ALDH- CXCR2 ALDH+ ALDH- IL-6R ALDH- gp130 IL-6 CXCL1 CXCL5 CXCL6 IL-8 IL-6 CXCR1 IL-6R gp130 Stem cell self Cancer renewal Stem Cell S. Liu Canc. Res. 2011 Regulation of CSC’s by cytokine loops in the tumor microenviornment Korkaya & Wicha JCI, 121(10):3804-09, 2011 Diet ,exercise and breast cancer risk Neilson H K et al. Cancer Epidemiol Biomarkers Prev 2009;18:11-27 Fas-Ligand IL-8 IL-8 Fas-Ligand IL-8 IL-8 Chemotherapy Fas CXCR1 Fas FADD PI3-K FADD FAK PTEN AKT Apoptosis Self- FOXO3a IL-8 IL-8 β-catenin IL-8 Renewal GSK3β β-catenin Wnt pathway IL-8 TCF targets, Fas-Ligand Self-renewal Fas-Ligand A Cancer stem cell Bystander effect Bulk tumor cells Repertaxin Fas-Ligand Fas-Ligand Chemotherapy Fas Fas CXCR1 FADD FADD FAK FOXO3a Apoptosis Apoptosis IL-8 IL-8 AKT Death IL-8 FOXO3a IL-8 Fas-Ligand Fas-Ligand Fas-Ligand Cancer stem cell Bystander effect Bulk tumor cells B Stem Cell Equilibria miR-93 EMT MET Differentiation TGF-b Il6 Quiescent Cycling Vimentin + Vimentin - Epcam (ESA) - Epcam (ESA) + p53 p53 p21 p21 CD44+/CD24- Aldefluor + E Cadherin - E Cadherin + 44+/24- Highly Tumorigenic Aldefluor+ Recapitulation of Tumors Via CSC Metastasis Breast Tumor Micrometastasis Macrometastasis Vasculature Aldefluor + Invasive Edge of Tumor Time CD44+/CD24- Distal Healthy Organ Necrotic Distal Colonized Organ Zone EMT MET Strategic Approach to Preventive Therapeutics Genetic Estimated Toxicity Background Lifetime Risk I N C R E A S E S A N C R E I NUTRITION E S A N C R E I BOTANICAL Sporadic <10% BASED Haplotype-SNP 10%-40% I1307K PHARMACEUTICAL Familial Syndrome >40% BASED (BRCA) Kakalara Self Renewal and Differientiation Pathways In Breast Stem Cells ER- stem cells SC SC SC Her2 Self renewal SC Notch Bmi-1 BRCA-1 Hedgehog PTEN ER+ Progenitor cells Differentiation Myoepithelial cells Alveolar epithelial cells Ductal epithelial cells A Conceptual Link Between Hereditary & Sporatic Breast Cancers Wnt Wnt IL-8 IL-8 IL-8 IL-8 LRP CXCR1 Repertaxin HH PI3-K HH PTCH Frizzled Perifosine HH FAK DSH GSK3β AKT FU SMO PTEN Cyclopamine β-catenin RTKs Src HER2 SUFU β-catenin GLI TCF Trastuzumab GLI Bmi-1 STAT3 NOTCH HES DSL HER2 DSL NICD STAT3 Anti-DLL4 γ-secretase JAK3 gp130 IL-6R GSI CXCR2 IL6 IL6 IL6 Cancer stem cell Breast Tumor Monoclonal Abs IL-8 CXCL7 IL-6 IL-6R gp130 Targeting Self-Renewal Pathways in CSC’S Mesenchymal Cells Broccoli could stop breast cancer spreading by targeting stem cells Broccoli contains sulforaphane, which seemed to kill off cancer stem cells in tests Figure 2. A Primary Mammospheres B Mammosphere Size 120.0 MCF7 0 µM 0.5 µM 1 µM 5 µM 100.0 SUM1… SF SF SF SF 80.0 MCF7 ** 60.0 ** ** ** 40.0 **** Sphere formation Sphere formation 20.0 SUM159 normalized to control (%) 0.0 0 0.5 1 5 Concentration of SF (µM) C 2nd Passage 3rd Passage 120.0 140.0 MCF7 MCF7 100.0 SUM159 120.0 SUM159 100.0 80.0 ** 80.0 * 60.0 ** 60.0 * 40.0 ** ** 40.0 Sphere formation Sphere formation 20.0 ** Sphere formation 20.0 ** ** ** normalized to control (%) 0.0 normalized to control (%) 0.0 0 0.5 1 5 0 0.5 1 5 Li CCR 2010 Concentration of SF (µM) Concentration of SF (µM) Figure 3. A P=0.003 4 P=0.008 3.5 3 2.5 2 positive cells positive - 1.5 1 0.5 % ALDH % 0 0 1 5 B Concentration of SF (µm Control 1 µM SF 5 µM SF 3.01% 1.47% 0.49% B A 25 ) 500 1st Generation 1st Generation 3 400 Control 20 50 mg/kg SF 300 P=0.018