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Ulevicius J, Jasukaitiene A, Bartkeviciene A, Dambrauskas Z, Gulbinas A, Urboniene D, Paskauskas S. Preoperative Immune Cell Dysregulation Accompanies Ovarian Cancer Patients into the Postoperative Period. Int J Mol Sci 2024; 25:7087. [PMID: 39000195 PMCID: PMC11240929 DOI: 10.3390/ijms25137087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/18/2024] [Accepted: 06/26/2024] [Indexed: 07/16/2024] Open
Abstract
Ovarian cancer (OC) poses a significant global health challenge with high mortality rates, emphasizing the need for improved treatment strategies. The immune system's role in OC progression and treatment response is increasingly recognized, particularly regarding peripheral blood mononuclear cells (PBMCs) and cytokine production. This study aimed to investigate PBMC subpopulations (T and B lymphocytes, natural killer cells, monocytes) and cytokine production, specifically interleukin-1 beta (IL-1β), interleukin-4 (IL-4), interleukin-6 (IL-6), interleukin-10 (IL-10), interleukin-12 (IL-12), and tumor necrosis factor alpha (TNFα), in monocytes of OC patients both preoperatively and during the early postoperative period. Thirteen OC patients and 23 controls were enrolled. Preoperatively, OC patients exhibited changes in PBMC subpopulations, including decreased cytotoxic T cells, increased M2 monocytes, and the disbalance of monocyte cytokine production. These alterations persisted after surgery with subtle additional changes observed in PBMC subpopulations and cytokine expression in monocytes. Considering the pivotal role of these altered cells and cytokines in OC progression, our findings suggest that OC patients experience an enhanced pro-tumorigenic environment, which persists into the early postoperative period. These findings highlight the impact of surgery on the complex interaction between the immune system and OC progression. Further investigation is needed to clarify the underlying mechanisms during this early postoperative period, which may hold potential for interventions aimed at improving OC management.
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Affiliation(s)
- Jonas Ulevicius
- Laboratory of Surgical Gastroenterology, Institute for Digestive Research, Medical Academy, Lithuanian University of Health Sciences, A. Mickeviciaus g. 9, LT-44307 Kaunas, Lithuania
| | - Aldona Jasukaitiene
- Laboratory of Surgical Gastroenterology, Institute for Digestive Research, Medical Academy, Lithuanian University of Health Sciences, A. Mickeviciaus g. 9, LT-44307 Kaunas, Lithuania
| | - Arenida Bartkeviciene
- Laboratory of Surgical Gastroenterology, Institute for Digestive Research, Medical Academy, Lithuanian University of Health Sciences, A. Mickeviciaus g. 9, LT-44307 Kaunas, Lithuania
| | - Zilvinas Dambrauskas
- Laboratory of Surgical Gastroenterology, Institute for Digestive Research, Medical Academy, Lithuanian University of Health Sciences, A. Mickeviciaus g. 9, LT-44307 Kaunas, Lithuania
| | - Antanas Gulbinas
- Laboratory of Surgical Gastroenterology, Institute for Digestive Research, Medical Academy, Lithuanian University of Health Sciences, A. Mickeviciaus g. 9, LT-44307 Kaunas, Lithuania
| | - Daiva Urboniene
- Department of Laboratory Medicine, Medical Academy, Lithuanian University of Health Sciences, A. Mickeviciaus g. 9, LT-44307 Kaunas, Lithuania
| | - Saulius Paskauskas
- Department of Obstetrics and Gynecology, Medical Academy, Lithuanian University of Health Sciences, A. Mickeviciaus g. 9, LT-44307 Kaunas, Lithuania
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Israelsson P, Björk E, Nagaev I, Nagaeva O, Lundin E, Mincheva-Nilsson L, Ottander U. NKG2D-mediated cytotoxicity improves after primary surgery for high-grade serous ovarian cancer. Am J Reprod Immunol 2023; 89:e13647. [PMID: 36335434 PMCID: PMC10077899 DOI: 10.1111/aji.13647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 09/28/2022] [Accepted: 10/26/2022] [Indexed: 11/07/2022] Open
Abstract
PROBLEM Tumors compromise the patients' immune system to promote their own survival. We have previously reported that HGSC exosomes play a central role, downregulating NKG2D cytotoxicity. Primary surgery's effect on tumor exosomes and NKG2D cytotoxicity in HGSC patients has not been studied before. The overall objective of this study was to explore the effect of surgery on the exosome-induced impairment of NKG2D cytotoxicity in HGSC. METHOD OF STUDY Paired pre- and post-operative blood samples were subjected to cell and exosome analyses regarding the NKG2D receptor and ligands, and NKG2D-mediated cytotoxicity. Lymphocytes were phenotyped by immunoflow cytometry. Exosomes, isolated by ultracentrifugation, and characterized by nanoparticle tracking analysis, transmission and immune electron microscopy and western blot were used in functional cytotoxic experiments. HGSC explant culture-derived exosomes, previously studied by us, were used for comparison. RESULTS HGSC exosomes from patients' sera downregulated NKG2D-mediated cytotoxicity in NK cells of healthy donors. In a subgroup of subjects, NKG2D expression on CTLs and NK cells was upregulated after surgery, correlating to a decrease in the concentration of exosomes in postoperative sera. An overall significantly improved NKG2D-mediated cytotoxic response of the HGSC patients' own NK cells in postoperative compared to preoperative samples was noted. CONCLUSIONS Surgical removal of the primary tumor has a beneficial effect, relieving the exosome-mediated suppression of NKG2D cytotoxicity in HGSC patients, thus boostering their ability to combat cancer.
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Affiliation(s)
- Pernilla Israelsson
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden.,Department of Clinical Microbiology, Infection and Immunology, Umeå University, Umeå, Sweden.,Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Emma Björk
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden.,Department of Clinical Microbiology, Infection and Immunology, Umeå University, Umeå, Sweden
| | - Ivan Nagaev
- Department of Clinical Microbiology, Infection and Immunology, Umeå University, Umeå, Sweden
| | - Olga Nagaeva
- Department of Clinical Microbiology, Infection and Immunology, Umeå University, Umeå, Sweden
| | - Eva Lundin
- Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
| | - Lucia Mincheva-Nilsson
- Department of Clinical Microbiology, Infection and Immunology, Umeå University, Umeå, Sweden
| | - Ulrika Ottander
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
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De Bruyn C, Ceusters J, Landolfo C, Baert T, Thirion G, Claes S, Vankerckhoven A, Wouters R, Schols D, Timmerman D, Vergote I, Coosemans A. Neo-Adjuvant Chemotherapy Reduces, and Surgery Increases Immunosuppression in First-Line Treatment for Ovarian Cancer. Cancers (Basel) 2021; 13:5899. [PMID: 34885008 PMCID: PMC8656504 DOI: 10.3390/cancers13235899] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/11/2021] [Accepted: 11/18/2021] [Indexed: 12/14/2022] Open
Abstract
In monotherapy, immunotherapy has a poor success rate in ovarian cancer. Upgrading to a successful combinatorial immunotherapy treatment implies knowledge of the immune changes that are induced by chemotherapy and surgery. METHODOLOGY Patients with a new d ovarian cancer diagnosis underwent longitudinal blood samples at different time points during primary treatment. RESULTS Ninety patients were included in the study (33% primary debulking surgery (PDS) with adjuvant chemotherapy (ACT), 61% neo-adjuvant chemotherapy (NACT) with interval debulking surgery (IDS), and 6% debulking surgery only). Reductions in immunosuppression were observed after NACT, but surgery reverted this effect. The immune-related proteins showed a pronounced decrease in immune stimulation and immunosuppression when primary treatment was completed. NACT with IDS leads to a transient amelioration of the immune microenvironment compared to PDS with ACT. CONCLUSION The implementation of immunotherapy in the primary treatment schedule of ovarian cancer cannot be induced blindly. Carboplatin-paclitaxel seems to ameliorate the hostile immune microenvironment in ovarian cancer, which is less pronounced at the end of primary treatment. This prospective study during primary therapy for ovarian cancer that also looks at the evolution of immune-related proteins provides us with an insight into the temporary windows of opportunity in which to introduce immunotherapy during primary treatment.
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Affiliation(s)
- Christine De Bruyn
- Laboratory of Tumor Immunology and Immunotherapy, ImmunOvar Research Group, Department of Oncology, Leuven Cancer Institute, Katholieke Universiteit Leuven, 3000 Leuven, Belgium; (C.D.B.); (J.C.); (C.L.); (T.B.); (G.T.); (A.V.); (R.W.)
- Department of Obstetrics and Gynecology, University Hospital Antwerp, 2650 Edegem, Belgium
- Department of Obstetrics and Gynecology, Leuven Cancer Institute, University Hospitals Leuven, 3000 Leuven, Belgium; (D.T.); (I.V.)
| | - Jolien Ceusters
- Laboratory of Tumor Immunology and Immunotherapy, ImmunOvar Research Group, Department of Oncology, Leuven Cancer Institute, Katholieke Universiteit Leuven, 3000 Leuven, Belgium; (C.D.B.); (J.C.); (C.L.); (T.B.); (G.T.); (A.V.); (R.W.)
| | - Chiara Landolfo
- Laboratory of Tumor Immunology and Immunotherapy, ImmunOvar Research Group, Department of Oncology, Leuven Cancer Institute, Katholieke Universiteit Leuven, 3000 Leuven, Belgium; (C.D.B.); (J.C.); (C.L.); (T.B.); (G.T.); (A.V.); (R.W.)
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00168 Rome, Italy
- Department of Development and Regeneration, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
- Queen Charlotte’s and Chelsea Hospital, Imperial College, London W12 0HS, UK
| | - Thaïs Baert
- Laboratory of Tumor Immunology and Immunotherapy, ImmunOvar Research Group, Department of Oncology, Leuven Cancer Institute, Katholieke Universiteit Leuven, 3000 Leuven, Belgium; (C.D.B.); (J.C.); (C.L.); (T.B.); (G.T.); (A.V.); (R.W.)
- Department of Obstetrics and Gynecology, Leuven Cancer Institute, University Hospitals Leuven, 3000 Leuven, Belgium; (D.T.); (I.V.)
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen Mitte, 45136 Essen, Germany
| | - Gitte Thirion
- Laboratory of Tumor Immunology and Immunotherapy, ImmunOvar Research Group, Department of Oncology, Leuven Cancer Institute, Katholieke Universiteit Leuven, 3000 Leuven, Belgium; (C.D.B.); (J.C.); (C.L.); (T.B.); (G.T.); (A.V.); (R.W.)
- Department of Obstetrics and Gynecology, Leuven Cancer Institute, University Hospitals Leuven, 3000 Leuven, Belgium; (D.T.); (I.V.)
| | - Sandra Claes
- Laboratory of Virology and Chemotherapy (Rega Institute), Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit Leuven, 3000 Leuven, Belgium; (S.C.); (D.S.)
| | - Ann Vankerckhoven
- Laboratory of Tumor Immunology and Immunotherapy, ImmunOvar Research Group, Department of Oncology, Leuven Cancer Institute, Katholieke Universiteit Leuven, 3000 Leuven, Belgium; (C.D.B.); (J.C.); (C.L.); (T.B.); (G.T.); (A.V.); (R.W.)
| | - Roxanne Wouters
- Laboratory of Tumor Immunology and Immunotherapy, ImmunOvar Research Group, Department of Oncology, Leuven Cancer Institute, Katholieke Universiteit Leuven, 3000 Leuven, Belgium; (C.D.B.); (J.C.); (C.L.); (T.B.); (G.T.); (A.V.); (R.W.)
- Oncoinvent AS, 0484 Oslo, Norway
| | - Dominique Schols
- Laboratory of Virology and Chemotherapy (Rega Institute), Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit Leuven, 3000 Leuven, Belgium; (S.C.); (D.S.)
| | - Dirk Timmerman
- Department of Obstetrics and Gynecology, Leuven Cancer Institute, University Hospitals Leuven, 3000 Leuven, Belgium; (D.T.); (I.V.)
- Department of Development and Regeneration, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
| | - Ignace Vergote
- Department of Obstetrics and Gynecology, Leuven Cancer Institute, University Hospitals Leuven, 3000 Leuven, Belgium; (D.T.); (I.V.)
- Department of Oncology, Gynaecological Oncology, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
| | - An Coosemans
- Laboratory of Tumor Immunology and Immunotherapy, ImmunOvar Research Group, Department of Oncology, Leuven Cancer Institute, Katholieke Universiteit Leuven, 3000 Leuven, Belgium; (C.D.B.); (J.C.); (C.L.); (T.B.); (G.T.); (A.V.); (R.W.)
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Shen J, Liu T, Lv J, Xu S. Identification of an Immune-Related Prognostic Gene CLEC5A Based on Immune Microenvironment and Risk Modeling of Ovarian Cancer. Front Cell Dev Biol 2021; 9:746932. [PMID: 34712666 PMCID: PMC8547616 DOI: 10.3389/fcell.2021.746932] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 09/16/2021] [Indexed: 12/31/2022] Open
Abstract
Objective: To understand the immune characteristics of the ovarian cancer (OC) microenvironment and explore the differences of immune-related molecules and cells to establish an effective risk model and identify the molecules that significantly affected the immune response of OC, to help guide the diagnosis. Methods: First, we calculate the TMEscore which reflects the immune microenvironment, and then analyze the molecular differences between patients with different immune characteristics, and determine the prognostic genes. Then, the risk model was established by least absolute shrinkage and selection operator (LASSO) analysis and combined with clinical data into a nomogram for diagnosis and prediction. Subsequently, the potential gene CLEC5A influencing the immune response of OC was identified from the prognostic genes by integrative immune-stromal analysis. The genomic alteration was explored based on copy number variant (CNV) and somatic mutation data. Results: TMEscore was a prognostic indicator of OC. The prognosis of patients with high TMEscore was better. The risk model based on immune characteristics was a reliable index to predict the prognosis of patients, and the nomogram could comprehensively evaluate the prognosis of patients. Besides, CLEC5A was closely related to the abundance of immune cells, immune response, and the expression of immune checkpoints in the OC microenvironment. OC cells with high expression of CLEC5A increased the polarization of M2 macrophages. CLEC5A expression was significantly associated with TTN and CDK12 mutations and affected the copy number of tumor progression and immune-related genes. Conclusion: The study of immune characteristics in the OC microenvironment and the risk model can reveal the factors affecting the prognosis and guide the clinical hierarchical treatment. CLEC5A can be used as a potential key gene affecting the immune microenvironment remodeling of OC, which provides a new perspective for improving the effect of OC immunotherapy.
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Affiliation(s)
- Jiacheng Shen
- Department of Gynecology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Tingwei Liu
- Department of Gynecology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jia Lv
- Department of Obstetrics and Gynecology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shaohua Xu
- Department of Gynecology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
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Szulc-Kielbik I, Kielbik M, Nowak M, Klink M. The implication of IL-6 in the invasiveness and chemoresistance of ovarian cancer cells. Systematic review of its potential role as a biomarker in ovarian cancer patients. Biochim Biophys Acta Rev Cancer 2021; 1876:188639. [PMID: 34695534 DOI: 10.1016/j.bbcan.2021.188639] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/23/2021] [Accepted: 10/18/2021] [Indexed: 12/12/2022]
Abstract
Interleukin 6 (IL-6) is a pleiotropic cytokine that is strongly implicated in the development and progression of ovarian cancer. The most recognized actions of IL-6 in ovarian cancer (OC) cells are the induction of cell proliferation and inhibition of cell apoptosis. Equally important is its ability to enhance the migratory and invasive potential of OC cells. Moreover, the increased expression and secretion of this cytokine positively correlates with OC cell chemoresistance. Elevated concentrations of IL-6 are observed in the serum and ascites of ovarian cancer patients. Thus, its level is discussed in the literature as a potential biomarker that can help to discriminate malignant and nonmalignant ovarian tumors and allow for the prediction of the chemotherapy response. The importance of IL-6 in ovarian cancer is proved by the fact that this cytokine is a potential target to anti-cancer therapy. This review is divided into two parts. The first summarizes the general biological activity of IL-6, and overviews its impact on OC cells, as well as discusses the current proposition of IL-6 inclusion in combination of anti-OC therapy. The second part is a systematic review of IL-6 as a possible biomarker in ovarian cancer patients.
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Affiliation(s)
- Izabela Szulc-Kielbik
- Institute of Medical Biology, Polish Academy of Sciences, 106 Lodowa Str., 93-232 Lodz, Poland.
| | - Michal Kielbik
- Institute of Medical Biology, Polish Academy of Sciences, 106 Lodowa Str., 93-232 Lodz, Poland.
| | - Marek Nowak
- Dept. of Operative Gynecology and Gynecologic Oncology, Polish Mother's Memorial Hospital - Research Institute, 281/289 Rzgowska Str., Lodz, Poland; Dept. of Operative and Endoscopic Gynecology, Medical University of Lodz, 4 Kosciuszki Str., 90-419 Lodz, Poland.
| | - Magdalena Klink
- Institute of Medical Biology, Polish Academy of Sciences, 106 Lodowa Str., 93-232 Lodz, Poland.
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du Bois A, Baert T, Vergote I. Role of Neoadjuvant Chemotherapy in Advanced Epithelial Ovarian Cancer. J Clin Oncol 2019; 37:2398-2405. [DOI: 10.1200/jco.19.00022] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
| | - Thaïs Baert
- Kliniken Essen-Mitte, Essen, Germany
- Katholieke Universiteit Leuven, Leuven, Belgium
| | - Ignace Vergote
- Katholieke Universiteit Leuven, Leuven, Belgium
- Universitaire Ziekenhuizen Leuven, Leuven, Belgium
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Veskimäe K, Scaravilli M, Niininen W, Karvonen H, Jaatinen S, Nykter M, Visakorpi T, Mäenpää J, Ungureanu D, Staff S. Expression Analysis of Platinum Sensitive and Resistant Epithelial Ovarian Cancer Patient Samples Reveals New Candidates for Targeted Therapies. Transl Oncol 2018; 11:1160-1170. [PMID: 30056367 PMCID: PMC6079561 DOI: 10.1016/j.tranon.2018.07.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/09/2018] [Accepted: 07/10/2018] [Indexed: 12/21/2022] Open
Abstract
Ovarian cancer has the highest mortality rate of all gynecologic malignancies. Identification of new biomarkers is highly needed due to its late diagnosis and high recurrence rate. The objective of this study was to identify mechanisms of therapy resistance and potential biomarkers by analyzing mRNA and protein expression from samples derived from patients with platinum-sensitive and -resistant ovarian cancer (total cohort n = 53). The data revealed new candidates for targeted therapies, such as GREB1 and ROR2. We showed that the development of platinum resistance correlated with upregulation of ROR2, whereas GREB1 was downregulated. Moreover, we demonstrated that high levels of ROR2 in platinum-resistant samples were associated with upregulation of Wnt5a, STAT3 and NF-kB levels, suggesting that a crosstalk between the non-canonical Wnt5a-ROR2 and STAT3/NF-kB signaling pathways. Upregulation of ROR2, Wnt5a, STAT3 and NF-kB was further detected in a platinum-resistant cell-line model. The results of the present study provided insight into molecular mechanisms associated with platinum resistance that could be further investigated to improve treatment strategies in this clinically challenging gynecological cancer.
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Affiliation(s)
- K Veskimäe
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland.
| | - M Scaravilli
- BioMediTech Institute, University of Tampere, Tampere, Finland.; Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - W Niininen
- BioMediTech Institute, University of Tampere, Tampere, Finland.; Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - H Karvonen
- BioMediTech Institute, University of Tampere, Tampere, Finland.; Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - S Jaatinen
- BioMediTech Institute, University of Tampere, Tampere, Finland.; Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - M Nykter
- BioMediTech Institute, University of Tampere, Tampere, Finland.; Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - T Visakorpi
- BioMediTech Institute, University of Tampere, Tampere, Finland.; Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland; Fimlab Laboratories, Tampere University Hospital, Tampere, Finland
| | - J Mäenpää
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - D Ungureanu
- BioMediTech Institute, University of Tampere, Tampere, Finland.; Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - S Staff
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland; BioMediTech Institute, University of Tampere, Tampere, Finland
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Expression Analysis of Platinum Sensitive and Resistant Epithelial Ovarian Cancer Patient Samples Reveals New Candidates for Targeted Therapies. Transl Oncol 2018. [PMID: 30056367 DOI: 10.1016/j.tranon.2018.07.010] [] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Ovarian cancer has the highest mortality rate of all gynecologic malignancies. Identification of new biomarkers is highly needed due to its late diagnosis and high recurrence rate. The objective of this study was to identify mechanisms of therapy resistance and potential biomarkers by analyzing mRNA and protein expression from samples derived from patients with platinum-sensitive and -resistant ovarian cancer (total cohort n = 53). The data revealed new candidates for targeted therapies, such as GREB1 and ROR2. We showed that the development of platinum resistance correlated with upregulation of ROR2, whereas GREB1 was downregulated. Moreover, we demonstrated that high levels of ROR2 in platinum-resistant samples were associated with upregulation of Wnt5a, STAT3 and NF-kB levels, suggesting that a crosstalk between the non-canonical Wnt5a-ROR2 and STAT3/NF-kB signaling pathways. Upregulation of ROR2, Wnt5a, STAT3 and NF-kB was further detected in a platinum-resistant cell-line model. The results of the present study provided insight into molecular mechanisms associated with platinum resistance that could be further investigated to improve treatment strategies in this clinically challenging gynecological cancer.
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