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Saeed K, Ojamies P, Pellinen T, Eldfors S, Turkki R, Lundin J, Järvinen P, Nisen H, Taari K, Af Hällström TM, Rannikko A, Mirtti T, Kallioniemi O, Östling P. Clonal heterogeneity influences drug responsiveness in renal cancer assessed by ex vivo drug testing of multiple patient-derived cancer cells. Int J Cancer 2018; 144:1356-1366. [PMID: 30125350 DOI: 10.1002/ijc.31815] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 07/13/2018] [Accepted: 07/26/2018] [Indexed: 12/28/2022]
Abstract
Renal cell cancer (RCC) has become a prototype example of the extensive intratumor heterogeneity and clonal evolution of human cancers. However, there is little direct evidence on how the genetic heterogeneity impacts on drug response profiles of the cancer cells. Our goal was to determine how genomic clonal evolution impacts drug responses. Finding from our study could help to define the challenge that clonal evolution poses on cancer therapy. We established multiple patient-derived cells (PDCs) from different tumor regions of four RCC patients, verified their clonal relationship to each other and to the uncultured tumor tissue by genome sequencing. Furthermore, comprehensive drug-sensitivity testing with 460 oncological drugs was performed on all PDC clones. The PDCs retained many cancer-specific copy number alterations and mutations in driver genes such as VHL, PBRM1, PIK3C2A, KMD5C and TSC2 genes. The drug testing highlighted vulnerability in the PDCs toward approved RCC drugs, such as the mTOR-inhibitor temsirolimus, but also novel sensitivities were uncovered. The individual PDC clones from different tumor regions in a patient showed distinct drug-response profiles, suggesting that genomic heterogeneity contributes to the variability in drug responses. Studies of multiple PDCs from a patient with cancer are informative for elucidating cancer heterogeneity and for the determination on how the genomic evolution is manifested in cancer drug responsiveness. This approach could facilitate tailoring of drugs and drug combinations to individual patients.
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Affiliation(s)
- Khalid Saeed
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Poojitha Ojamies
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Teijo Pellinen
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Samuli Eldfors
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Riku Turkki
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Johan Lundin
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Petrus Järvinen
- Department of Urology, Helsinki University Hospital, Helsinki, Finland
| | - Harry Nisen
- Department of Urology, Helsinki University Hospital, Helsinki, Finland
| | - Kimmo Taari
- Department of Urology, Helsinki University Hospital, Helsinki, Finland
| | - Taija M Af Hällström
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland.,AstraZeneca, Espoo, Finland
| | - Antti Rannikko
- Department of Urology, Helsinki University Hospital, Helsinki, Finland
| | - Tuomas Mirtti
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland.,Department of Pathology, HUSLAB, Helsinki University Hospital, Helsinki, Finland
| | - Olli Kallioniemi
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland.,Department of Oncology and Pathology, Science for Life Laboratory, Karolinska Institutet, Stockholm, Sweden
| | - Päivi Östling
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland.,Department of Oncology and Pathology, Science for Life Laboratory, Karolinska Institutet, Stockholm, Sweden
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Saeed K, Ojamies P, Pellinen T, Eldfors S, Turkki R, Lundin J, Nisen H, Järvinen P, Taari K, Hällström TA, Rannikko A, Mirtti T, Kallioniemi O, Östling P. Abstract 2199: Establishment and high-throughput drug testing of multiple patient-derived cells from each renal cancer; intratumor heterogeneity of drug response and implications for precision medicine. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-2199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Renal cell cancer (RCC) has become a prototype example of the extensive intra-tumor genetic heterogeneity and clonal evolution of human cancers. There is, however, little information on how the genetic heterogeneity will impact on drug responsiveness of the cancer cells. Establishment of multiple patient-derived cells (PDCs) from individual patients may help us to understand genomic clonal evolution pathways in cancer, explore intratumor heterogeneity of drug response across tumors, as well as help to define combinatorial treatments needed to target multiple subclones in a cancer patient. Here, we established several PDCs from different tumor regions of four RCC patients, verified clonal relationships of the PDCs with each others and with the uncultured tumor tissue by genome sequencing. PDCs retained cancer-specific copy number alterations and mutations in driver genes such as VHL, PBRM1, PIK3C2A, KMD5C and TSC2 genes, but also showed differences indicating genetic heterogeneity and clonal evolution, and thus generating a set of natural isogenic variants. Comprehensive drug-sensitivity testing of the PDC clones with 460 oncology drugs was performed. The drug testing analysis identified shared vulnerability of the PDCs towards several approved RCC drugs, such as mTOR-inhibitor (temsirolimus) and multi-kinase-inhibitor (pazopanib). The individual RCC PDC clones from different tumor regions in one patient showed distinct drug response profiles, confirming that genomic heterogeneity contributes to the variability in drug responses. We developed a capability to map drug response evolution on top of genomic evolution in cancer. In conclusion, our study suggested that comparison of drug response profiles among multiple (isogenic) PDC variants from a cancer patient may be informative for i) assessing intratumor heterogeneity in drug response ii) elucidating pharmacogenomic biomarkers among natural isogenic cell variants and iii) identifying drugs and drug combinations that may kill the multiple cancer subclones in a patient. Funding: EU-FP7-Systems Microscopy Network of Excellence, Sigrid Juselius Foundation, Cancer Society of Finland, Academy of Finland, the Magnus Ehrnrooth Foundation, TEKES FiDiPro Fellow Grant and Knut and Alice Wallenberg Foundation.
Citation Format: Khalid Saeed, Poojitha Ojamies, Teijo Pellinen, Samuli Eldfors, Riku Turkki, Johan Lundin, Harry Nisen, Petrus Järvinen, Kimmo Taari, Taija af Hällström, Antti Rannikko, Tuomas Mirtti, Olli Kallioniemi, Päivi Östling. Establishment and high-throughput drug testing of multiple patient-derived cells from each renal cancer; intratumor heterogeneity of drug response and implications for precision medicine [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 2199.
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Affiliation(s)
- Khalid Saeed
- 1Institute for Molecular Medicine Finland, FIMM, University of Helsinki, Helsinki, Finland
| | - Poojitha Ojamies
- 1Institute for Molecular Medicine Finland, FIMM, University of Helsinki, Helsinki, Finland
| | - Teijo Pellinen
- 1Institute for Molecular Medicine Finland, FIMM, University of Helsinki, Helsinki, Finland
| | - Samuli Eldfors
- 1Institute for Molecular Medicine Finland, FIMM, University of Helsinki, Helsinki, Finland
| | - Riku Turkki
- 1Institute for Molecular Medicine Finland, FIMM, University of Helsinki, Helsinki, Finland
| | - Johan Lundin
- 1Institute for Molecular Medicine Finland, FIMM, University of Helsinki, Helsinki, Finland
| | - Harry Nisen
- 2Department of Urology, Helsinki University Hospital, Helsinki, Finland
| | - Petrus Järvinen
- 2Department of Urology, Helsinki University Hospital, Helsinki, Finland
| | - Kimmo Taari
- 2Department of Urology, Helsinki University Hospital, Helsinki, Finland
| | - Taija af Hällström
- 1Institute for Molecular Medicine Finland, FIMM, University of Helsinki, Helsinki, Finland
| | - Antti Rannikko
- 2Department of Urology, Helsinki University Hospital, Helsinki, Finland
| | - Tuomas Mirtti
- 1Institute for Molecular Medicine Finland, FIMM, University of Helsinki, Helsinki, Finland
| | - Olli Kallioniemi
- 3Science for Life Laboratory, Dept of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Päivi Östling
- 3Science for Life Laboratory, Dept of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
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Malani D, Kumar A, Yadav B, Kontro M, Potdar S, Brück O, Kytölä S, Saarela J, Eldfors S, Ojamies P, Riikka K, Majumder MM, Västrik I, Ellonen P, Kankainen M, Suvela M, Knappila S, Parson A, Palva A, Mattila P, Kulesskiy1 E, Turunen L, Laamanen K, Lehtinen E, Mikkonen P, Nurmi M, Timonen S, Murumägi A, Gjersten BT, Mustjoki S, Aittokallio T, Wennerberg K, Anders S, Wolf M, Heckman C, Porkka K, Kallioniemi O. Abstract 3899: Discovery and clinical implementation of individualized therapies in acute myeloid leukemia based on ex vivo drug sensitivity testing and multi-omics profiling. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-3899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Acute myeloid leukemia (AML) is a heterogeneous disease characterized by multiple molecular subtypes and lack of effective targeted therapies. Here, we performed extensive molecular profiling and ex vivo drug testing with 515 approved and emerging cancer drugs on 164 AML patient samples. The aim was to i) assign individualized treatment options to advanced AML patients in real time, ii) explore drug response patterns across the molecular subtypes of AML and iii) identify opportunities to repurpose existing and emerging cancer drugs.
Bone marrow samples (n=164) from 129 consecutive AML patients and 17 healthy donors were studied from the Helsinki University Hospital and the Haukeland University Hospital, Bergen. Mononuclear cells were resuspended either in mononuclear cell medium (MCM) or stroma conditioned medium (CM) and tested for drug sensitivity and resistance as previously described (PMID: 24056683) and studied by exome and transcriptome sequencing. The study protocol allowed us to return data to the clinician for consideration of novel treatment options. For the meta-analysis of associations between drug responses and molecular and clinical parameters, Wilcoxon signed ranked test and logistic regression were applied.
Clustering of all patient samples based on ex vivo drug response patterns in both media types identified 7 distinct functional groups of AML. For example, a subgroup of samples was highly resistant to chemotherapeutics and all targeted drugs except BCL-2 inhibitors. The differences in drug responses in the two media types highlighted the importance of assay conditions for ex vivo drug testing. Strong clustering of several drugs in the same drug classes was often observed as well as clustering across different classes, for example between BET (JQ1, I-BET151, birabresib) and MEK (trametinib, cobimetinib) inhibitors. About 24 percent of the FLT3 negative AML patients manifested strong ex vivo sensitivity to glucocorticoids, highlighting a potential drug repositioning opportunity in this subset of AML patients. Overall, we identified 320 significant associations between drugs and mutated driver genes including association between NPM1 mutation and sensitivity to JAK inhibitors.
Altogether, targeted treatment opportunities were clinically tested in 25 occasions in chemorefractory AML patients. The tailored clinical therapy led to transient complete remission or leukemia free state in 36% (9/25) of these cases.
In conclusion, we discovered and clinically implemented individualized therapeutic options for AML patients, which resulted in a 36% clinical responses in a non-randomized proof-of-concept study. The associations identified between ex-vivo drug response and driver mutations provided novel drug repositioning opportunities in specific molecular subtypes.
Citation Format: Disha Malani, Ashwini Kumar, Bhagwan Yadav, Mika Kontro, Swapnil Potdar, Oscar Brück, Sari Kytölä, Jani Saarela, Samuli Eldfors, Poojitha Ojamies, Karjalainen Riikka, Muntasir Mamun Majumder, Imre Västrik, Pekka Ellonen, Matti Kankainen, Minna Suvela, Siv Knappila, Alun Parson, Aino Palva, Pirkko Mattila, Evgeny Kulesskiy1, Laura Turunen, Karoliina Laamanen, Elina Lehtinen, Piia Mikkonen, Maria Nurmi, Sanna Timonen, Astrid Murumägi, Bjorn Tore Gjersten, Satu Mustjoki, Tero Aittokallio, Krister Wennerberg, Simon Anders, Maija Wolf, Caroline Heckman, Kimmo Porkka, Olli Kallioniemi. Discovery and clinical implementation of individualized therapies in acute myeloid leukemia based on ex vivo drug sensitivity testing and multi-omics profiling [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 3899.
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Affiliation(s)
- Disha Malani
- 1Inst. for Molec. Medicine Finland (FIMM), Helsinki, Finland
| | - Ashwini Kumar
- 1Inst. for Molec. Medicine Finland (FIMM), Helsinki, Finland
| | - Bhagwan Yadav
- 2Hematology Research Unit Helsinki, Helsinki, Finland
| | - Mika Kontro
- 2Hematology Research Unit Helsinki, Helsinki, Finland
| | - Swapnil Potdar
- 1Inst. for Molec. Medicine Finland (FIMM), Helsinki, Finland
| | - Oscar Brück
- 2Hematology Research Unit Helsinki, Helsinki, Finland
| | - Sari Kytölä
- 2Hematology Research Unit Helsinki, Helsinki, Finland
| | - Jani Saarela
- 1Inst. for Molec. Medicine Finland (FIMM), Helsinki, Finland
| | - Samuli Eldfors
- 1Inst. for Molec. Medicine Finland (FIMM), Helsinki, Finland
| | | | | | | | - Imre Västrik
- 1Inst. for Molec. Medicine Finland (FIMM), Helsinki, Finland
| | - Pekka Ellonen
- 1Inst. for Molec. Medicine Finland (FIMM), Helsinki, Finland
| | - Matti Kankainen
- 1Inst. for Molec. Medicine Finland (FIMM), Helsinki, Finland
| | - Minna Suvela
- 1Inst. for Molec. Medicine Finland (FIMM), Helsinki, Finland
| | - Siv Knappila
- 1Inst. for Molec. Medicine Finland (FIMM), Helsinki, Finland
| | - Alun Parson
- 1Inst. for Molec. Medicine Finland (FIMM), Helsinki, Finland
| | - Aino Palva
- 1Inst. for Molec. Medicine Finland (FIMM), Helsinki, Finland
| | - Pirkko Mattila
- 1Inst. for Molec. Medicine Finland (FIMM), Helsinki, Finland
| | | | - Laura Turunen
- 1Inst. for Molec. Medicine Finland (FIMM), Helsinki, Finland
| | | | - Elina Lehtinen
- 1Inst. for Molec. Medicine Finland (FIMM), Helsinki, Finland
| | - Piia Mikkonen
- 1Inst. for Molec. Medicine Finland (FIMM), Helsinki, Finland
| | - Maria Nurmi
- 1Inst. for Molec. Medicine Finland (FIMM), Helsinki, Finland
| | - Sanna Timonen
- 1Inst. for Molec. Medicine Finland (FIMM), Helsinki, Finland
| | - Astrid Murumägi
- 1Inst. for Molec. Medicine Finland (FIMM), Helsinki, Finland
| | | | - Satu Mustjoki
- 2Hematology Research Unit Helsinki, Helsinki, Finland
| | | | | | - Simon Anders
- 4Center for Molecular Biology of University of Heidelberg (ZMBH), Heidelberg, Germany
| | - Maija Wolf
- 1Inst. for Molec. Medicine Finland (FIMM), Helsinki, Finland
| | | | - Kimmo Porkka
- 2Hematology Research Unit Helsinki, Helsinki, Finland
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Saeed K, Ojamies P, Pellinen T, Rahkama V, Eldfors S, Paavolainen L, Turkki R, Horvath P, Lundin J, Nisen H, af Hällström T, Rannikko A, Mirtti T, Kallioniemi O, Östling P. Precision systems medicine in urological Tumors – Molecular profiling and functional testing. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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5
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Malani D, Murumägi A, Yadav B, Kontro M, Eldfors S, Kumar A, Karjalainen R, Majumder MM, Ojamies P, Pemovska T, Wennerberg K, Heckman C, Porkka K, Wolf M, Aittokallio T, Kallioniemi O. Enhanced sensitivity to glucocorticoids in cytarabine-resistant AML. Leukemia 2016; 31:1187-1195. [PMID: 27833094 PMCID: PMC5420795 DOI: 10.1038/leu.2016.314] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 09/22/2016] [Accepted: 09/26/2016] [Indexed: 12/20/2022]
Abstract
We sought to identify drugs that could counteract cytarabine resistance in acute myeloid leukemia (AML) by generating eight resistant variants from MOLM-13 and SHI-1 AML cell lines by long-term drug treatment. These cells were compared with 66 ex vivo chemorefractory samples from cytarabine-treated AML patients. The models and patient cells were subjected to genomic and transcriptomic profiling and high-throughput testing with 250 emerging and clinical oncology compounds. Genomic profiling uncovered deletion of the deoxycytidine kinase (DCK) gene in both MOLM-13- and SHI-1-derived cytarabine-resistant variants and in an AML patient sample. Cytarabine-resistant SHI-1 variants and a subset of chemorefractory AML patient samples showed increased sensitivity to glucocorticoids that are often used in treatment of lymphoid leukemia but not AML. Paired samples taken from AML patients before treatment and at relapse also showed acquisition of glucocorticoid sensitivity. Enhanced glucocorticoid sensitivity was only seen in AML patient samples that were negative for the FLT3 mutation (P=0.0006). Our study shows that development of cytarabine resistance is associated with increased sensitivity to glucocorticoids in a subset of AML, suggesting a new therapeutic strategy that should be explored in a clinical trial of chemorefractory AML patients carrying wild-type FLT3.
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Affiliation(s)
- D Malani
- Institute for Molecular Medicine Finland, FIMM, University of Helsinki, Helsinki, Finland
| | - A Murumägi
- Institute for Molecular Medicine Finland, FIMM, University of Helsinki, Helsinki, Finland
| | - B Yadav
- Institute for Molecular Medicine Finland, FIMM, University of Helsinki, Helsinki, Finland
| | - M Kontro
- Hematology Research Unit Helsinki, Department of Hematology, University of Helsinki and Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
| | - S Eldfors
- Institute for Molecular Medicine Finland, FIMM, University of Helsinki, Helsinki, Finland
| | - A Kumar
- Institute for Molecular Medicine Finland, FIMM, University of Helsinki, Helsinki, Finland
| | - R Karjalainen
- Institute for Molecular Medicine Finland, FIMM, University of Helsinki, Helsinki, Finland
| | - M M Majumder
- Institute for Molecular Medicine Finland, FIMM, University of Helsinki, Helsinki, Finland
| | - P Ojamies
- Institute for Molecular Medicine Finland, FIMM, University of Helsinki, Helsinki, Finland
| | - T Pemovska
- Institute for Molecular Medicine Finland, FIMM, University of Helsinki, Helsinki, Finland
| | - K Wennerberg
- Institute for Molecular Medicine Finland, FIMM, University of Helsinki, Helsinki, Finland
| | - C Heckman
- Institute for Molecular Medicine Finland, FIMM, University of Helsinki, Helsinki, Finland
| | - K Porkka
- Hematology Research Unit Helsinki, Department of Hematology, University of Helsinki and Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
| | - M Wolf
- Institute for Molecular Medicine Finland, FIMM, University of Helsinki, Helsinki, Finland
| | - T Aittokallio
- Institute for Molecular Medicine Finland, FIMM, University of Helsinki, Helsinki, Finland.,Department of Mathematics and Statistics, University of Turku, Turku, Finland
| | - O Kallioniemi
- Institute for Molecular Medicine Finland, FIMM, University of Helsinki, Helsinki, Finland.,Science for Life Laboratory, Department of Oncology and Pathology, Karolinska Institutet, Solna, Sweden
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