Curcumin modulates chronic myelogenous leukemia exosomes composition and affects angiogenic phenotype via exosomal miR-21

Tumor derived exosomes are vesicles which contain proteins and microRNAs that mediate cell-cell communication and are involved in angiogenesis and tumor progression. Curcumin derived from the plant Curcuma longa, shows anticancer effects. Exosomes released by CML cells treated with Curcumin contain a high amount of miR-21 that is shuttled into the endothelial cells in a biologically active form. The treatment of HUVECs with CML Curcu-exosomes reduced RhoB expression and negatively modulated endothelial cells motility. We showed that the addition of CML control exosomes to HUVECs caused an increase in IL8 and VCAM1 levels, but Curcu-exosomes reversed these effects thus attenuating their angiogenic properties. This antiangiogenic effect was confirmed with in vitro and in vivo vascular network formation assays. SWATH analysis of the proteomic profile of Curcu-exosomes revealed that Curcumin treatment deeply changes their molecular properties, in particular, Curcumin induces a release of exosomes depleted in pro-angiogenic proteins and enriched in proteins endowed with anti-angiogenic activity. Among the proteins differential expressed we focused on MARCKS, since it was the most modulated protein and a target of miR-21. Taken together our data indicated that also Curcumin attenuates the exosome's ability to promote the angiogenic phenotype and to modulate the endothelial barrier organization.

Liquid biopsy analysis of ALK alterations from advanced NSCLC patients: The value of exosomal RNA cargo (ExoALK)

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Background: About 5% of NSCLCs present alterations in the ALK gene. Among them the most common is EML4-ALK translocation. The gold standard detection method to treat the patient with ALKi is the tissue, thus, it is mandatory to develop new techniques that allow to detect ALK alterations in liquid biopsy. The purpose of this study is, analyze the feasibility to detect ALK alterations in exosomes (Exo-ALK) derived from NSCLC patients. Methods: We recruit 18 NSCLC patients including EML4-ALK and wild-type patients stage- and time-independent. ALK-positive status is identified by IHQ. The isolation of RNA with the exoRNeasy Kit Serum/Plasma (Qiagen) in UZA and the retrotranscription with ProtoScript II First Strand cDNA Synthesis kit. The ALK alteration present in the exosomes is determined by NGS and bio-informatic analysis in OncoDNA. Samples were provided by the Biobank of the University of Navarra, the UZA Biobank and the University of Naples Federico II. Samples and data were processed following the processes approved by the local Ethical and Scientific Committees. Results: Among analyzed patients, 15 patients were EML4-ALK tissue positive, and 3 were EML4-ALK tissue negative. With our analysis, 9 patients were positive, 7 negative and 2 sample were degraded at the time of analysis. Comparing the results, the 9 positive patients in the exosomes were also positive in the tissue. Moreover, the 2 negative patients were also negative for the translocation in the tissue. However, we were unable to detect 4 positive EML4-ALK patients in the exosomes. Nonetheless, these data show a sensitivity of 69% and a specificity of 100%. No correlation was found comparing treatment-naïve and pretreated patients. Conclusions: Exosomes are raising as a very promising tool to determine the tumor profile due to their stability and their cargo. With further study and a larger number of patients, we demonstrate that exosomes isolation and analysis will be feasible tool, and thus we will reduce the tumor biopsy risks and costs in the clinical practice. Our preliminary results show a good specificity for a proof of concept analysis. These results will be cross-validated and amplified with more patients in the following months.

Second-Line Treatment of Non-Small Cell Lung Cancer: Clinical, Pathological, and Molecular Aspects of Nintedanib

Lung carcinoma is the leading cause of death by cancer in the world. Nowadays, most patients will experience disease progression during or after first-line chemotherapy demonstrating the need for new, effective second-line treatments. The only approved second-line therapies for patients without targetable oncogenic drivers are docetaxel, gemcitabine, pemetrexed, and erlotinib and for patients with target-specific oncogenes afatinib, osimertinib, crizotinib, alectinib, and ceritinib. In recent years, evidence on the role of antiangiogenic agents have been established as important and effective therapeutic targets in non-small cell lung cancer (NSCLC). Nintedanib is a tyrosine kinase inhibitor targeting three angiogenesis-related transmembrane receptors (vascular endothelial growth factor, fibroblast growth factor, and platelet-derived growth factor). Several preclinical and clinical studies have proven the usefulness of nintedanib as an anticancer agent for NSCLC. The most important study was the phase III LUME-Lung 1 trial, which investigated the combination of nintedanib with docetaxel for second-line treatment in advanced NSCLC patients. The significant improvement in overall survival and the manageable safety profile led to the approval of this new treatment in Europe. This review focuses on the preclinical and clinical studies with nintedanib in NSCLC.

In silico pathway analysis in cervical carcinoma reveals potential new targets for treatment

An in silico pathway analysis was performed in order to improve current knowledge on the molecular drivers of cervical cancer and detect potential targets for treatment. Three publicly available Affymetrix gene expression data-sets (GSE5787, GSE7803, GSE9750) were retrieved, vouching for a total of 9 cervical cancer cell lines (CCCLs), 39 normal cervical samples, 7 CIN3 samples and 111 cervical cancer samples (CCSs). Predication analysis of microarrays was performed in the Affymetrix sets to identify cervical cancer biomarkers. To select cancer cell-specific genes the CCSs were compared to the CCCLs. Validated genes were submitted to a gene set enrichment analysis (GSEA) and Expression2Kinases (E2K). In the CCSs a total of 1,547 probe sets were identified that were overexpressed (FDR < 0.1). Comparing to CCCLs 560 probe sets (481 unique genes) had a cancer cell-specific expression profile, and 315 of these genes (65%) were validated. GSEA identified 5 cancer hallmarks enriched in CCSs (P < 0.01 and FDR < 0.25) showing that deregulation of the cell cycle is a major component of cervical cancer biology. E2K identified a protein-protein interaction (PPI) network of 162 nodes (including 20 drugable kinases) and 1626 edges. This PPI-network consists of 5 signaling modules associated with MYC signaling (Module 1), cell cycle deregulation (Module 2), TGFβ-signaling (Module 3), MAPK signaling (Module 4) and chromatin modeling (Module 5). Potential targets for treatment which could be identified were CDK1, CDK2, ABL1, ATM, AKT1, MAPK1, MAPK3 among others. The present study identified important driver pathways in cervical carcinogenesis which should be assessed for their potential therapeutic drugability.

Exosomes genetic cargo in lung cancer: a truly Pandora's box

Lung cancer is a highly lethal disease. Targeted therapies have been developed in last years, however survival rates are not improving due to the delay in the diagnosis, making biomarkers one of the most interesting fields of study in cancer. Liquid biopsy has raised as an alternative to tissue biopsy due to improvements in analytical techniques for circulating tumor cells (CTCs), cell free DNA and exosomes. Among all, exosomes have raised as one of the most promising tools to understand the tumor due to their stability in the blood and their similarity to the cells of origin. In the last years, different alterations have been described inside the exosomes derived from non-small cell lung cancer (NSCLC) cells mirroring the processes inside these tumoral cells, such as EGFR mutation, translocations or microRNA (miRNA) deregulation. All these studies have opened the window to a new world of possibilities in the study of tumor biomarkers.

Exosomal miRNA Analysis in Non-small Cell Lung Cancer (NSCLC) Patients' Plasma Through qPCR: A Feasible Liquid Biopsy Tool

The discovery of alterations in the EGFR and ALK genes, amongst others, in NSCLC has driven the development of targeted-drug therapy using selective tyrosine kinase inhibitors (TKIs). To optimize the use of these TKIs, the discovery of new biomarkers for early detection and disease progression is mandatory. These plasma-isolated exosomes can be used as a non-invasive and repeatable way for the detection and follow-up of these biomarkers. One ml of plasma from 12 NSCLC patients, with different mutations and treatments (and 6 healthy donors as controls), were used as exosome sources. After RNAse treatment, in order to degrade circulating miRNAs, the exosomes were isolated with a commercial kit and resuspended in specific buffers for further analysis. The exosomes were characterized by western blotting for ALIX and TSG101 and by transmission electron microscopy (TEM) analysis, the standard techniques to obtain biochemical and dimensional data of these nanovesicles. Total RNA extraction was performed with a high yield commercial kit. Due to the limited miRNA-content in exosomes, we decided to perform retro-transcription PCR using an individual assay for each selected miRNA. A panel of miRNAs (30b, 30c, 103, 122, 195, 203, 221, 222), all correlated with NSCLC disease, were analyzed taking advantage of the remarkable sensitivity and specificity of Real-Time PCR analysis; mir-1228-3p was used as endogenous control and data were processed according to the formula 2(-) (ΔΔct) (13). Control values were used as baseline and results are shown in logarithmic scale.

Exosomes isolation and characterization in serum is feasible in non-small cell lung cancer patients: critical analysis of evidence and potential role in clinical practice

Exosomes are nano-sized vesicles of endolysosomal origin, released by several cytotypes in physiological and pathological conditions. Tumor derived exosomes, interacting with other cells of the tumor microenvironment, modulate tumor progression, angiogenic switch, metastasis, and immune escape. Recently, extracellular vesicles were proposed as excellent biomarkers for disease monitoring and prognosis in cancer patients. Non-small cell lung cancer (NSCLC) has a poor 5-year survival rate due to the delay in the detection of the disease. The majority of patients are diagnosed in an advanced disease stage. Exosomes might be promising beneficial tools as biomarker candidates in the scenario of NSCLC, since they contain both, proteins and miRNAs. The clinical case reported in this manuscript is a proof of concept revealing that NSCLC exosomes and sorted miRNAs might constitute, in a near future, novel biomarkers. This review summarizes the role of exosomes in NSCLC, focusing on the importance of exosomal microRNAs in lung cancer diagnosis and prognosis.

BRAF mutations in non-small cell lung cancer: has finally Janus opened the door?

B-Raf mutations occur in about 1-2% of non-small cell lung cancers (NSCLC). These mutations generate a permanent activation of the mitogen activated protein kinase (MAPK) pathway, which promotes tumor growth and proliferation. In the present review, we discuss B-Raf mutation epidemiology, diagnostic methods to detect B-Raf mutations, the role of B-Raf as a driver mutation and a potential therapeutic target in NSCLC. The results of clinical trials involving B-Raf or MAPK pathway inhibitors for the treatment of NSCLC are also discussed. Clinical trials evaluating B-Raf inhibitors in BRAF mutated NSCLC patients have shown promising results, and larger prospective studies are warranted to validate these findings. Enrollment of these patients in clinical trials is an interesting strategy to offer a potentially more effective and less toxic targeted therapy.

The potential of neurotrophic tyrosine kinase (NTRK) inhibitors for treating lung cancer

INTRODUCTION

Molecular alterations in neurotrophic tyrosine kinase (NTRK) genes have been identified in several solid tumors including lung cancer. Pre-clinical and clinical evidence suggested their potential role as oncogenic drivers and predictive biomarkers for targeted inhibition, leading to the clinical development of a new class of compounds blocking the NTRK molecular pathway, which are currently undner early clinical investigation.

AREA COVERED

This review describes the biology of the NTRK pathway and its molecular alterations in lung cancer. It focuses on the pre-clinical and clinical development of emerging NTRK inhibitors, which have shown very promising activity in early phase I studies.

EXPERT OPINION

Among the several NTRK-inhibitors, entrectinib and LOXO-101 are those in more advanced stage of clinical development. Both agents have shown encouraging activity along with a tolerable safety profile in patients with different solid tumors harboring NTRK-fusions, emerging as new promising therapeutic options for molecularly selected patients with advanced Trk-driven lung cancers. Results from ongoing phase II basket trials are eagerly awaited.

Abstract 3382: Exosomes analysis in non-small cell lung cancer: looking for a clinical application

BACKGROUND

Cancer cells produce a heterogeneous mixture of vesicular, organelle-like structures (microvesicles or MVs) into their surroundings including blood and body fluid. In particular exosomes are biological nanovescicles (40-100 nm) that are formed by the inward budding of multivescicular bodies (MVB), as a component of the endocytic pathway. They are released from different cell types under both normal and pathological conditions. Exosomal content is composed by proteins, DNA, mRNA and microRNA (miRNA) that are transferred to distant site and mediate inter-cellular communication.

PURPOSE OF THE STUDY

The aim of this pilot study is to investigate whether exosomes isolation from clinical samples (plasma from NSCLC patients) is feasible. Furthermore we have analyzed a panel of 7 miRNA related to NSCLC.

EXPERIMENTAL DESIGN AND METHODS

The study population was selected among lung cancer patients diagnosed with NSCLC, histotype adenocarcinoma, in the Oncology department of Antwerp University Hospital. A total of 12 patients participated in the project. Six blood samples from healthy volunteers were also collected. After obtaining the informed consent, blood samples (10 ml) were stored in the UZA-tumor biobank. Clinical data were also collected from patients’ medical records.

Exosomes were isolated by means of both Density Gradient (DG) centrifugation and the Total Exosome Isolation kit (from plasma) (Invitrogen) according to manufacturers’ instructions. The Total exosome RNA and protein isolation kit (Invitrogen) was used for proteins recovery from exosome. Extracted proteins are used for western blot analysis aimed at the identification of specific exosome protein markers: CD63, ALIX and TSG101. Nanoparticle Tracking Analysis (NTA) was performed by means of the NanoSight NS500 instrument. In order to visualize the isolated exosomes a TEM (Transmission Electron Microscopy) analysis was performed.

The total exosome RNA and protein isolation kit (Invitrogen) was used to extract small-RNA from exosomal samples. The analysis of 7 miRNAs (miR-30b, -30c, -103, -122, -195, -221, -222) was performed on the LightCycler 480 (Roche) and the fold change was calculated according to the formula 2ααCq. miR-1228 was used has endogenous control to normalize the reaction.

RESULTS

• ALIX protein is a reliable protein marker for exosome identification

• TEM analysis have shown that exosomes can be isolated in NSCLC plasma samples

• 7 selected miRNAs are strongly deregulated in our clinical samples and seem related to staging

• miR30b and -30c might be related to squamous cell carcinoma histotype

CONCLUSION

The analysis of exosomes in NSCLC could represent a noninvasive test for patients’ management. With this pilot study we have demonstrated that exosome analysis and exosomal miRNA profiling is feasible. Due to the small sample size we cannot make significant statistic conclusion. Further analyses in a larger series are needed.

Citation Format: Christian D. Rolfo, Marta Castiglia, Marco Giallombardo, Jorge Chacartegui, Nele Van Der Steen, Inge Mertens, Marc Peeters, Antonio Russo, Patrick Pauwels. Exosomes analysis in non-small cell lung cancer: looking for a clinical application. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 3382. doi:10.1158/1538-7445.AM2015-3382

Nintedanib in non-small cell lung cancer: from preclinical to approval

Angiogenesis is a driving force of a tumor’s development. Targeting this process is an attractive option, as this is a feature shared by most of the solid tumors. A lot of antiangiogenic drugs have been developed following this path, including bevacizumab, sorafenib, sunitinib, vandetanib, ramucirumab, motesanib and many others. The latest drug of this class to be approved for patients with non-small cell lung cancer (NSCLC) was nintedanib, a triple angiokinase inhibitor. This molecule targets vascular endothelial growth factor (VEGF), platelet derived growth factor (PDGF) and fibroblast growth factor (FGF) pathways, avoiding the tumor’s switch to normal escape mechanisms. The pharmacokinetic, pharmacodynamic and toxicity profiles of nintedanib have been tested in several studies. These trials revealed it to be very interesting, as this agent did not lead to the classical adverse events of other tyrosine kinase inhibitors. A phase III clinical trial that recently concluded provided us with relevant information in patients with NSCLC of adenocarcinoma histology. Here we present a short overview of the tumor angiogenesis pathways and antiangiogenic drugs. In particular, we will focus on nintedanib, from the preclinical studies to the latest phase III clinical trial that allowed this new agent to be approved by the European Medicines Agency as a second-line treatment option in association with docetaxel for NSCLC patients with adenocarcinoma histology.

Looking into the "Garden of the Hesperides": new drugs for hepatocellular carcinoma

Advanced hepatocellular carcinoma remains an entity that is hard to approach therapeutically and has shown disappointing results in terms of survival. For many years, the only accepted option for this setting was the use of a multikinase inhibitor, sorafenib. Nevertheless, through the years, a deeper knowledge has arisen about how pathogenic pathways correlate with hepatocellular carcinoma. In this review, we provide an update of the most recent data regarding new agents under investigation and new possible targets for future treatments.

Exosomal shuttling of miR-126 in endothelial cells modulates adhesive and migratory abilities of chronic myelogenous leukemia cells

BACKGROUND

Recent findings indicate that exosomes released from cancer cells contain microRNAs (miRNAs) that may be delivered to cells of tumor microenvironment.

RESULTS

To elucidate whether miRNAs secreted from chronic myelogenous leukemia cells (CML) are shuttled into endothelial cells thus affecting their phenotype, we first analysed miRNAs content in LAMA84 exosomes. Among the 124 miRNAs identified in LAMA84 exosomes, we focused our attention on miR-126 which was found to be over-overexpressed in exosomes compared with producing parental cells. Transfection of LAMA84 with Cy3-labelled miR-126 and co-culture of leukemia cells with endothelial cells (EC) confirmed that miR-126 is shuttled into HUVECs. The treatment of HUVECs with LAMA84 exosomes for 24 hours reduced CXCL12 and VCAM1 expression, both at the mRNA and protein level, and negatively modulated LAMA84 motility and cells adhesion. Transfection in HUVECs of miR-126 inhibitor reversed the decrease of CXCL12 and restored the motility and adhesion of LAMA84 cells while the over-expression of miR-126, showed opposite effects.

CONCLUSION

Our results show that the miR-126 shuttled by exosomes is biologically active in the target cells, and support the hypothesis that exosomal miRNAs have an important role in tumor-endothelial crosstalk occurring in the bone marrow microenvironment, potentially affecting disease progression.