Abstract LB-364: Mesothelial cells promote ovarian cancer stemness and chemoresistance through osteopontin paracrine signaling

Aims: As mesothelial cells are a major stromal component of the ovarian cancer metastatic microenvironment, in this study we investigated the role of ovarian cancer-associated mesothelial cells (CAMs) on cancer responsiveness to chemotherapy and intrinsic-related cancer stemness properties. Methods: Indirect co-culture system that enables medium exchange between human primary serous-type ovarian cancer cells and primary CAMs isolated from patient ascites was employed, and these co-cultured cancer cells were subsequently grafted subcutaneously to NOD.Cg-Prkdcscid Il2rgtm1Wjl/SzJ (NSG) mice and received serial cisplatin challenges, or checked by Annexin V apoptosis assays and cell viability assays to determine chemosensitivity. In addition, patient derived tumor organoid cultures were compared between the addition of control and its paired primary CAM conditioned medium. In vivo limiting dilution assays and sphere formation assays were utilized to evaluate CAM regulated cancer stemness properties. Finally, a cytokine array on CAM conditioned medium was performed to identify the secreted factors mediating phenotypical changes, and RNA-sequencing analysis of co-cultured cancer cells was conducted to uncover the major events that underlie changed chemo-responsiveness. Results: Cancer cell response to platium-based chemotherapy was inhibited after indirect CAM co-culture or CAM conditioned medium priming, as evidenced both in vivo and in vitro. Organoid formation was drastically enhanced with the supplement of paired CAM conditioned medium, while no tumor organoid was well formed in control medium. These organoids in CAM conditioned medium group are positive for cancer stem cell markers. Correspondingly, CAMs induced a cancer stemness phenotype, as shown by increased tumor formation rate in limiting dilution assays and by strengthened sphere formation abilities in sphere formation assays. Through a cytokine array and functional validations, we pinpointed soluble osteopontin as a key mediator of CAM-responsive cancer stemness and chemoresistance, and it initiates paracrine signaling through the CD44 receptor on cancer cells. RNA-sequencing of ovarian cancer cells primed with CAMs revealed overexpression of multi-drug resistance-related ABC-binding cassette transporters (ABC transporters). Lastly, genetic inhibition of osteopontin in CAMs with shRNA constructs and therapeutic targeting with an anti-osteopontin neutralizing antibody reduced cancer stemness and chemoresistance. Conclusions: We demonstrated that CAMs promote ovarian cancer chemoresistance and tumor formation by establishing a cancer stem cell niche. Importantly, our study identified paracrine osteopontin signaling as a critical mediator of chemoresistance and stemness, and targeting osteopontin from CAMs holds the potential to restore ovarian cancer chemosensitivity.

Citation Format: Jin Qian, Bauer LeSavage, Chenkai Ma, Suchitra Natarajan, Joshua Eggold, Kelsea Hubka, Yiren Xiao, Katherine Fuh, Venkatesh Krishnan, Annika Enejder, Sarah Heilshorn, Oliver Dorigo, Erinn Rankin. Mesothelial cells promote ovarian cancer stemness and chemoresistance through osteopontin paracrine signaling [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr LB-364.

Abstract 5351: FLASH irradiation enhances the therapeutic index of abdominal radiotherapy in mice

Radiation therapy is the most effective cytotoxic cancer therapy available for the treatment of localized tumors. However, radiation-induced toxicity to normal tissues limits the radiation dose and therefore the curative potential of radiotherapy. In particular, the highly radiosensitive intestine greatly limits the use of radiation for patients with intra-abdominal tumor diseases including women with ovarian cancer. Here we sought to investigate the safety and efficacy of FLASH radiation therapy in the treatment of widespread ovarian cancer peritoneal metastases. We performed abdominal irradiation on healthy and ovarian tumor-bearing mice at conventional (CONV, (0.07 Gy/sec)) or FLASH (200 Gy/sec) dose rates and examined gut function by stool counts, DNA damage in crypt cells by γ-H2AX staining, cell death and proliferation by TUNEL/ caspase-3 staining and BrdU immunohistochemistry respectively. We report that ultrahigh dose rate FLASH irradiation causes significantly less radiation-induced intestinal injury in both healthy and tumor-bearing mice compared to CONV dose rate irradiation. Abdominal FLASH reduced the mortality from gastrointestinal syndrome, preserved gut function and epithelial integrity as reflected by their stool counts and FITC-Dextran analysis. In addition, we found decreased cell death and enhanced proliferation of crypt base columnar cells (CBCs) following FLASH irradiation in comparison to CONV irradiation. We also detected reduced number of γ-H2AX foci in crypt cells indicating less DNA damage and/or increased DNA repair after FLASH compared to CONV irradiation. Importantly, FLASH and CONV irradiation have similar efficacy in the reduction of ovarian cancer peritoneal metastases. These findings suggest that FLASH irradiation has biological advantages compared to conventional dose rate irradiation in reducing radiation-induced intestinal injury within the irradiation field and therefore may be an effective strategy to enhance the therapeutic index of radiotherapy for the treatment of abdominal and pelvic tumor disease.

Citation Format: Suchitra Natarajan, Karen Levy, Jinghui Wang, Stephanie Chow, Joshua Eggold, Phoebe Loo, Rakesh Manjappa, Frederick M. Lartey, Emil Schüler, Lawrie Skinner, Marjan Rafat, Ryan Ko, Anna Kim, Duaa Al Rawi, Rie von Eyben, Oliver Dorigo, Kerriann M. Casey, Edward E. Graves, Karl Bush, Amy S. Yu, Albert C. Koong, Peter G. Maxim, Billy W. Loo, Erinn B. Rankin. FLASH irradiation enhances the therapeutic index of abdominal radiotherapy in mice [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5351.

Abstract A23: Ultrarapid total abdominal FLASH irradiation in a preclinical model of ovarian cancer

Introduction: Ultrahigh dose-rate irradiation (FLASH RT) is rapidly emerging as new strategy to enhance the therapeutic index of radiotherapy by protecting normal tissues from radiation-induced toxicity while maintaining tumor control. In mice, FLASH has been shown to protect the lung, skin, and brain against radiation-induced toxicity. A recent study has utilized FLASH radiotherapy in preclinical models of lung cancer to demonstrate that FLASH RT radiotherapy achieves similar tumor control to conventional RT. While these findings identify an important role for FLASH RT in the protection of multiple tissues, the role of FLASH in enhancing the therapeutic index of abdominal and pelvic tumors located near the highly radiosensitive intestine is not known. For this purpose, we have developed an experimental platform using a clinical linear accelerator that enables total abdominal FLASH RT where rapid delivery of a single fraction of high-dose radiotherapy is performed in less than one second (200 Gy/sec).

Methods: For the tumor model, ID8 cells were injected intraperitoneally into female mice. Radiation was delivered 10 days post-ID8 injection. Tumor burden was assessed at 28 days following tumor injection. Flow cytometry was used to profile infiltrating immune cells. Normal tissue toxicity was assessed through survival, total body weight, solid stool production, complete blood count, and histologic analysis.

Results: In ID8 tumor-bearing mice, 14 Gy FLASH promotes GI function with a 2-fold increase in solid stool production at 5 days post-TAI. Both modalities extended median overall survival in the ID8 model by 5 days and reduced tumor burden by 50% relative to unirradiated controls. Irradiated cohorts also demonstrated an increase in the number of proliferating CD8+ and CD4+ T cells present in the ascites.

Conclusion: We demonstrate that FLASH RT protects the gastrointestinal (GI) tract from lethal radiation-induced toxicity, improves epithelial integrity and GI function, enhances crypt survival, and provides efficient tumor control in a preclinical model of ovarian peritoneal metastasis. Here we present the first data supporting the potential for tumor control and GI protection using FLASH-TAI in a syngeneic orthotopic preclinical model of ovarian cancer.

Citation Format: Karen Levy, Jinghui Wang, Joshua Eggold, Suchitra Natarajan, Peter Maxim, Bill Loo, Erinn Rankin. Ultrarapid total abdominal FLASH irradiation in a preclinical model of ovarian cancer [abstract]. In: Proceedings of the AACR Special Conference on Advances in Ovarian Cancer Research; 2019 Sep 13-16, 2019; Atlanta, GA. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(13_Suppl):Abstract nr A23.

Abstract TMIM-081: THE HYPOXIC TUMOR-MESOTHELIAL NICHE PROMOTES OVARIAN CANCER METASTASIS THROUGH COLLAGEN REMODELING

High grade serous ovarian cancer (HGSOC) is a leading cause of cancer related deaths among women. The primary cause of morbidity and mortality in HGSOC patients is metastasis to organs within the peritoneal cavity. Mesothelial cells line the surface of peritoneal organs and are a key stromal cell in HGSOC metastatic niche. However, the mechanisms by which mesothelial cells promote ovarian cancer peritoneal metastasis remain largely unknown. Here we demonstrate that tumor associated mesothelial cells promote tumor invasion by increasing collagen deposition and remodeling. Mechanistically, we demonstrate the tumor-mesothelial niche is hypoxic where both tumor cells and mesothelial cells express the hypoxia inducible factors HIF-1 and HIF-2 and their downstream target gene lysyl oxidase (LOX). LOX is an enzyme that crosslinks collagen fibrils to promote collagen remodeling. In tumor-mesothelial co-culture experiments, we demonstrate that hypoxia enhances extracellular fibrillar collagen deposition by mesothelial cells. Conditioned media from hypoxic tumor-mesothelial co-cultures promotes collagen remodeling and HGSOC tumor cell invasion. Genetic inactivation of either HIF-1 and HIF-2 or LOX reduces the hypoxic induction of collagen remodeling and tumor cell invasion. Importantly, pharmacologic inhibition of HIF-1 and HIF-2 with digoxin reduces the colonization of disseminated HGSOC cells to the omentum, the preferential migration site of peritoneal cancer metastasis. Moreover, pharmacologic inhibition of LOX with BAPN (beta-aminopropionitrile) is sufficient to inhibit metastatic tumor burden and collagen remodeling at metastatic sites in preclinical models of HGSOC metastasis. These data reveal a novel role for mesothelial cells in the production of type I collagen and collagen remodeling in the HGSOC metastatic microenvironment. Furthermore, these studies demonstrate a role for the HIF/LOX signaling axis in the HGSOC tumor-mesothelial niche that can be therapeutically targeted to inhibit collagen remodeling and ovarian cancer metastatic progression.

Citation Format: Suchitra Natarajan, Katie Foreman, Michaela Soriano, Hussein Shehade, Daniel Fregoso, Joshua Eggold, Ninna S. Rosen, Sarah Heilshorn, Adam J. Krieg, Venkatesh Krishnan, Oliver Dorigo, Subarna Sinha, Katherine C. Fuh, Erinn B. Rankin. THE HYPOXIC TUMOR-MESOTHELIAL NICHE PROMOTES OVARIAN CANCER METASTASIS THROUGH COLLAGEN REMODELING [abstract]. In: Proceedings of the 12th Biennial Ovarian Cancer Research Symposium; Sep 13-15, 2018; Seattle, WA. Philadelphia (PA): AACR; Clin Cancer Res 2019;25(22 Suppl):Abstract nr TMIM-081.

Abstract AP25: TOTAL ABDOMINAL ULTRA-RAPID FLASH IRRADIATION DEMONSTRATES DECREASED GASTROINTESTINAL TOXICITY COMPARED TO CONVENTIONAL TOTAL ABDOMINAL IRRADIATION IN MICE

OBJECTIVE: Ovarian cancer is the most common cause of gynecologic cancer-related death in the United States. The majority of patients diagnosed with ovarian cancer present with stage III or IV disease in which the tumor has disseminated beyond the ovaries and pelvic organs to the peritoneum and mesothelial lining of abdominal organs. Despite advances in ovarian cancer treatments including maximal cytoreductive surgery, chemotherapy and checkpoint-blockade immunotherapy, recurrence is common and prognosis remains poor. Ovarian cancer is a radiosensitive tumor; however, use of total abdominal irradiation (TAI) has fallen out of favor in the past 15 years due to high toxicity, particularly of the gastrointestinal (GI) tract. In prior studies, ultra-rapid FLASH radiation spares normal tissues, such as the lung and skin, from toxic effects of radiation. This suggests that FLASH may be an effective strategy to reduce complications of radiotherapy while maintaining antitumor control. We developed a FLASH irradiation system for mice using a linear accelerator that generates 16 MeV electrons at a high beam current and delivers large doses of radiation in a single beam in <500ms. Conventional radiotherapy delivers a dose-rate of 3-4 Gy/minute, while FLASH radiotherapy delivers a dose-rate of >40 Gy/second. Our objective is to develop a method for delivering TAI using FLASH and assess toxicity.

METHODS: Female C57BL/6 mice received TAI using FLASH and conventional (CONV) radiation in increasing doses: 8.5 Gy, 10.5 Gy and 12 Gy. Normal tissue toxicity was determined by measuring total body weights, stool counts, histological analysis, and survival.

RESULTS: Seven cohorts of mice were analyzed: five unirradiated controls, eight received 8.5Gy, five received 10.5Gy and five received 12 Gy of either TAI-FLASH or TAI-CONV. Stool counts were unchanged from controls in TAI-FLASH mice 5 days post-irradiation at all doses. In the TAI-CONV cohort, a 50% stool quantity decrease was noted after 8.5Gy and a 63% stool quantity decrease was noted after 12Gy at 5 days post-TAI. Histological analysis of the duodenum post-irradiation demonstrated that TAI-FLASH has a protective effect on the mucosal architecture. Weights remained unchanged across all groups. The survival analysis was most notable for all of the TAI-CONV mice having died by day 9 whereas all of the TAI-FLASH mice survived.

CONCLUSIONS: These data demonstrate FLASH protects against death from TAI and improves the epithelial integrity of the lower GI tract following TAI compared to conventional radiation in a preclinical model. Our discovery that FLASH is a safe strategy to deliver effective doses of total abdominal radiation potentially identifies a new opportunity to utilize TAI-FLASH for treatment of ovarian peritoneal metastases.

Citation Format: Karen Levy MD, Joshua Eggold BA, Marjan Rafat PhD, Emil Schuler PhD, Hussein Shehade PhD, Daniel Fregoso BS, Jose Vilches-Moure DVM PhD, Albert Koong MD PhD, Peter Maxim PhD MSc, Billy W Loo MD PhD, Erinn Rankin PhD. TOTAL ABDOMINAL ULTRA-RAPID FLASH IRRADIATION DEMONSTRATES DECREASED GASTROINTESTINAL TOXICITY COMPARED TO CONVENTIONAL TOTAL ABDOMINAL IRRADIATION IN MICE [abstract]. In: Proceedings of the 12th Biennial Ovarian Cancer Research Symposium; Sep 13-15, 2018; Seattle, WA. Philadelphia (PA): AACR; Clin Cancer Res 2019;25(22 Suppl):Abstract nr AP25.

SV40 utilizes ATM kinase activity to prevent non-homologous end joining of broken viral DNA replication products

Simian virus 40 (SV40) and cellular DNA replication rely on host ATM and ATR DNA damage signaling kinases to facilitate DNA repair and elicit cell cycle arrest following DNA damage. During SV40 DNA replication, ATM kinase activity prevents concatemerization of the viral genome whereas ATR activity prevents accumulation of aberrant genomes resulting from breakage of a moving replication fork as it converges with a stalled fork. However, the repair pathways that ATM and ATR orchestrate to prevent these aberrant SV40 DNA replication products are unclear. Using two-dimensional gel electrophoresis and Southern blotting, we show that ATR kinase activity, but not DNA-PK_cs kinase activity, facilitates some aspects of double strand break (DSB) repair when ATM is inhibited during SV40 infection. To clarify which repair factors associate with viral DNA replication centers, we examined the localization of DSB repair proteins in response to SV40 infection. Under normal conditions, viral replication centers exclusively associate with homology-directed repair (HDR) and do not colocalize with non-homologous end joining (NHEJ) factors. Following ATM inhibition, but not ATR inhibition, activated DNA-PK_cs and KU70/80 accumulate at the viral replication centers while CtIP and BLM, proteins that initiate 5′ to 3′ end resection during HDR, become undetectable. Similar to what has been observed during cellular DSB repair in S phase, these data suggest that ATM kinase influences DSB repair pathway choice by preventing the recruitment of NHEJ factors to replicating viral DNA. These data may explain how ATM prevents concatemerization of the viral genome and promotes viral propagation. We suggest that inhibitors of DNA damage signaling and DNA repair could be used during infection to disrupt productive viral DNA replication.

Viruses from both Polyomaviridae and Papillomaviridae families share several characteristics. These include common modes of DNA replication and an accumulation of DNA damage signaling and repair proteins at replicating viral DNA. Several DNA repair proteins, with unknown functions during viral DNA replication, associate with the viral replication centers of the polyomavirus simian virus 40 (SV40). In this study we examined the mechanisms that regulate and recruit DNA repair machinery to replicating viral DNA during permissive SV40 infection. We found that the virus deploys DNA repair to broken viral DNA using cellular DNA damage signaling pathways. Our results shed light on why both Polyomaviridae and Papillomaviridae DNA replication elicits DNA damage signaling and repair. As no effective treatments currently exist for the Polyomaviridae family, our data identify pathways that might be therapeutically targeted to inhibit productive viral replication. Additionally, we categorize distinct functions for DNA repair and damage signaling pathways during viral replication. The results provide insights into how viruses exploit cellular processes to overwhelm the cell and propagate.