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Xmrk encodes a putative transmembrane glycoprotein of the tyrosine kinase family and is a melanoma-inducing gene in Xiphophorus. We attempted to investigate the biological function of the putative Xmrk receptor by characterizing its signalling properties. Since a potential Iigand for Xmrk has not yet been identified, it has been difficult to analyse the biochemical properlies and biological function of this cell surface protein. In an approach towards such analyses, the Xmrk extracellular domain was replaced by the closely related Iigand-binding domain sequences of the human epidennal growth factor receptor (HER) and the ligand-induced activity of the chimeric HER-Xmrk proteinwas examined. We show that the Xmrk protein is a functional receptor tyrosine kinase, is highly active in malignant melanoma and displays a constitutive autophosphorylation activity possibly due to an activating mutation in its extracellular or transmembrane domain. In the focus formation assay the HER-Xmrk chimera is a potent transfonning protein equivalent to other tyrosine kinase oncoproteins.
Untersuchungen zur Apoptoseregulation durch die Melanom induzierende Rezeptortyrosinkinase Xmrk
(2003)
Überexpression der konstitutiv aktiven Rezeptortyrosinkinase Xmrk im Zahnkarpfen Xiphophorus führt zur Ausbildung maligner Melanome. Expressionsstudien in transgenen Medaka-Fischen haben gezeigt, daß Xmrk allerdings nur in bestimmten Geweben wie Hirn, Epithelien, Auge und Pigmentzellen zur Tumorbildung führt. Zellen, die durch Xmrk transformiert werden können, scheinen somit über entsprechende Komponenten der durch Xmrk induzierten intrazellulären Signaltransduktion verfügen zu müssen. Bisher wurde eine Reihe von Signalproteinen identifiziert, die von Xmrk rekrutiert und aktiviert werden. Dazu gehören die PLC-g, die Adapterproteine Shc und Grb2, die PI3K, die Fyn-Kinase aus der Familie der Src-Kinasen und der Transkriptionsfaktor STAT5. Um die Signaltransduktion von Xmrk in induzierbarer Form untersuchen zu können, wurde eine mit EGF stimulierbare Rezeptorchimäre HER-mrk, deren extrazellulärer Anteil vom humanen EGF-R und deren intrazellulärer Anteil von Xmrk stammt, in der IL-3 abhängigen murinen pro-B-Zellinie Ba/F3 exprimiert. EGF-Stimulation dieser als BaF Hm bezeichneten Zellen führt zu IL-3 unabhängigem Wachstum und zu Langzeitüberleben. Stimulation des aus der gleichen Genfamilie stammenden EGF-Rezeptors hingegen, wird er in Ba/F3 Zellen exprimiert, kann kein Langzeitüberleben vermitteln. Erste Untersuchungen zeigten, daß das durch HER-mrk vermittelte Langzeitüberleben in Ba/F3 Zellen nicht auf einer höheren Rezeptorexpression verglichen mit den EGF-R exprimierenden Zellen beruht. Allerdings korreliert die Rezeptordichte mit der DNA-Syntheseleistung der Ba/F3 Zellen. Durch verschiedene carboxyterminal verkürzte HER-mrk Rezeptormutanten wurde eine unterschiedliche Anzahl von Substratbindungsstellen von Xmrk deletiert. Expression dieser HER-mrk Rezeptormutanten in Ba/F3 Zellen zeigte, daß für die Auslösung der Replikation der DNA keine C-terminale Substratbindungsstelle notwendig ist, während für eine Vollendung der Zellteilung mit Zellvermehrung und für Langzeitüberleben zwei membrannahe Substratbindungsstellen ausreichend sind. Der Vergleich der durch die verschiedenen Rezeptoren induzierten Signalwege bzw. der Substratinteraktionen von HER-mrk, seinen Mutanten und dem EGF-R gab Hinweise auf für die Antiapoptose entscheidende Signalwege. Untersuchungen zur Aktivierung von STAT1, 3 und 5 zeigten, daß HER-mrk zu einer Aktivierung aller drei STAT-Proteine führt, während der EGF-R in Ba/F3 Zellen nur STAT1 und 3, nicht aber STAT5 aktivieren kann. Die HER-mrk Rezeptormutanten zeigten, daß für die Aktivierung von STAT5 durch HER-mrk keine carboxyterminale Substratbindungsstelle notwendig ist, diese aber möglicherweise durch Stabilisierung der Rezeptorbindung seine Aktivierung verstärken. Für die Aktivierung von STAT1 und 3 hingegen sind carboxyterminale Substratbindungsstellen entscheidend. Das für ein antiapoptotisches Protein kodierende STAT5-Zielgen bcl-X wurde als HER-mrk Zielgen identifiziert. Auch die schwächere STAT5 Aktivierung durch die trunkierte HER-mrk Rezeptormutante Hm delta1006 hatte eine bcl-X Transkription zur Folge, während der EGF-R bcl-X nicht induzierte. Untersuchungen weiterer antiapoptotischer Signalwege zeigten, daß die mrk-Kinase sowie ihre Rezeptormutante Hm delta1006 im Gegensatz zum EGF-R auch zu einer Induktion von bcl-2 führen. Da diese Mutante kein Langzeitüberleben vermittelt, ist somit die Induktion der Genexpression antiapoptotischer Proteine wie Bcl-XL und Bcl-2 nicht ausreichend für Antiapoptose. Es bedarf somit der Kombination mehrerer antiapoptotischer Signalwege, um Langzeitüberleben zu sichern. Expression der Rezeptorchimäre HER-mrk in murinen Melanozyten führt bei Stimulation der mrk-Kinase zur Transformation der Zellen. Im Rahmen dieser Arbeit konnte eine starke Induktion von bcl-X nach HER-mrk Stimulation in den Melanozyten nachgewiesen werden. Bei der Untersuchung humaner Melanomzellinien, die in der Expression verschiedener Rezeptortyrosinkinasen oft ein sehr unterschiedliches Muster zeigen, konnte eine konstitutive Aktivität von STAT5 in allen untersuchten Zellinien nachgewiesen werden, während STAT1 und 3 nur eine schwache und inhomogene Basalaktivität aufwiesen. Es zeigt sich folglich ein ähnliches Bild wie im Xiphophorus-Melanom, in dem ausschließlich STAT5 konstitutiv aktiv ist. Die untersuchten humanen Melanomzellinien zeigten durchweg eine Expression von Bcl-XL. Andere Signalwege wie z.B. die Aktivierung der MAPK hingegen zeigten ein heterogenes Muster bei den verschiedenen Zellinien. Erste Experimente in A375 Zellen deuten darauf hin, daß die Expression von dominant negativem STAT5 zur Reduktion der bcl-X Transkription und zur Apoptose der Zellen führt (Wellbrock, unveröffentlicht). Der STAT5/Bcl-XL Signalweg scheint folglich ganz entscheidend für die Antiapoptose von Melanomen zu sein.
Tumour progression stage-dependent secretion of YB-1 stimulates melanoma cell migration and invasion
(2020)
Secreted factors play an important role in intercellular communication. Therefore, they are not only indispensable for the regulation of various physiological processes but can also decisively advance the development and progression of tumours. In the context of inflammatory disease, Y-box binding protein 1 (YB-1) is actively secreted and the extracellular protein promotes cell proliferation and migration. In malignant melanoma, intracellular YB-1 expression increases during melanoma progression and represents an unfavourable prognostic marker. Here, we show active secretion of YB-1 from melanoma cells as opposed to benign cells of the skin. Intriguingly, YB-1 secretion correlates with the stage of melanoma progression and depends on a calcium- and ATP-dependent non-classical secretory pathway leading to the occurrence of YB-1 in the extracellular space as a free protein. Along with an elevated YB-1 secretion of melanoma cells in the metastatic growth phase, extracellular YB-1 exerts a stimulating effect on melanoma cell migration, invasion, and tumourigenicity. Collectively, these data suggest that secreted YB-1 plays a functional role in melanoma cell biology, stimulating metastasis, and may serve as a novel biomarker in malignant melanoma that reflects tumour aggressiveness.
5.1 Immuntherapie mit vom Tumorstroma abgeleiteten Peptiden Tumore bestehen nicht nur aus Tumorzellen, sondern auch aus der sie umgebenden extrazellulären Matrix (EZM), und Stromazellen wie Fibroblasten (cancer-associated fibroblast; CAF) und Endothelzellen (tumor endothelial cell; TEC). Diese Stromazellen haben durch die Ausschüttung von Zytokinen, proteolytischen Enzymen, Wachstums- und Angiogenesefaktoren einen entscheidenden Einfluss auf die Tumorprogression. Sie unterscheiden sich von den Stromazellen der normalen Gewebe durch die Expression von sogenannten Tumorstroma-assoziierten Antigenen (TSAA). Damit sollten Therapien, die auf TSAA abzielen, universell einsetzbar und weniger anfällig gegenüber Resistenzentwicklungen (immune escape Mechanismen) sein, da Stromazellen im Gegensatz zu neoplastischen Zellen genetisch relativ stabil sind. Für eine Immuntherapie mit vom Tumorstroma abgeleiteten Peptiden wählten wir die TSAA Endoglin und Fap, welche während der Wundheilung und im Tumorstroma induziert werden. Dabei sollte überprüft werden, ob prophylaktische Vakzinierungen in C57Bl/6j Mäusen Peptid-reaktive T-Zellen induzieren können, und das Wachstum von transplantieren Grm1-transgenen Tumoren reduziert werden kann. In der Tat konnten wir sowohl bei Endoglin- als auch bei Fap Peptid vakzinierten Tieren in vivo Peptid-reaktive Lymphozyten im Blut und zu einem geringeren Anteil auch in der Milz nachweisen, welche Peptid-gepulste syngene Milzzellen lysieren konnten. Allerdings konnte in beiden Fällen keine Reduktion des Tumorwachstums gegenüber der Kontrollgruppe beobachtet werden. Bei der Fap-Peptid-vakzinierten Gruppe war das Tumorwachstum gegenüber der Kontrollgruppe sogar gesteigert. Dies könnte darauf hindeuten, dass die Induktion Fap-Peptid-reaktiver T-Zellen tumorpromovierend wirkt. Möglicherweise könnte aber durch eine Modifikation des Vakzinierungsprotokolls bzw. durch eine Kombination mit anderen Immuntherapeutika ein verbessertes Ansprechen auf eine Endoglin bzw. Fap basierte Immuntherapie erzielt werden. 5.2 Immunsuppressive Mechanismen im Grm1-transgenen Melanom-Modell Grm1-transgene Mäuse entwickeln spontan kutane Melanome. Dieses Modell erlaubte es uns in der vorliegenden Arbeit spontane Immunantworten im Laufe der Melanomentstehung zu untersuchen. Hierfür analysierten wir sowohl ex vivo als auch in vitro aus Milz und Lymphknoten gewonnene Lymphozyten von Mäusen, welche keine Tumorläsionen bzw. eine niedrige oder hohe Tumorlast aufwiesen. Dabei konnten wir ex vivo einen Anstieg der Frequenz aktivierter CD4+ und CD8+ Lymphozyten mit zunehmender Tumorlast zeigen. Bei tumortragenden Tieren exprimierten jedoch hauptsächlich CD4+ T-Zellen Aktivierungsmarker nach in vitro Stimulation. Interessanterweise waren diese Zellen tumortragender Tiere auch funktionell beeinträchtigt, was sich in einer verminderten Proliferationskapazität nach in vitro Stimulation zeigte. Weitere Analysen ergaben, dass die erhöhte Frequenz regulatorischer T Zellen bei tumortragenden Tieren ein frühes Ereignis im Laufe der Tumorentstehung ist. Gleichzeitig konnte auch ein starker Anstieg der immunsupprimierenden Zytokine Tgf-β1 und Il-10 sowohl in den Lymphknoten als auch im Tumorgewebe beobachtet werden. Dabei war die Tgf-β1-Expression sowohl im Tumor als auch im tumor-drainierenden Lymphknoten erhöht, während Il-10 im Tumor nur moderat exprimiert wurde, was eine komplexere Regulation der Il-10-Expression nahe legt. Dies bedeutet, dass in Grm1-transgenen Mäusen ähnlich wie auch bei Melanompatienten zelluläre und zytokinabhängige Mechanismen zur Tumorentstehung beitragen und dieses Modell daher geeignet ist, um präklinisch immunmodulierende Therapieansätze zu testen.
The Xiphophorus melanoma system is a useful animal model for the study of the genetic basis of tumor formation. The development of hereditary melanomas in interspecific hybrids of Xiphophorus is connected to pigment cell specific overexpression of the mutationally activated receptor tyrosine kinase Xmrk. In purebred fish the oncogenic function of xmrk is suppressed by the molecularly still unidentified locus R. The xmrk oncogene was generated by a gene duplication event from the Xiphophorus egfrb gene and thereby has acquired a new 5’ regulatory sequence, which has probably altered the transcriptional control of the oncogene. So far, the xmrk promoter region was still poorly characterized and the molecular mechanism by which R controls xmrk-induced melanoma formation in Xiphophorus still remained to be elucidated. To test the hypothesis that R controls melanoma development in Xiphophorus on the transcriptional level, the first aim of the thesis was to gain a deeper insight into the transcriptional regulation of the xmrk oncogene. To this end, a quantitative analysis of xmrk transcript levels in different Xiphophorus genotypes carrying either the highly tumorigenic xmrkB or the non-tumorigenic xmrkA allele was performed. I was able to demonstrate that expression of the tumorigenic xmrkB allele is strongly increased in malignant melanomas of R-free backcross hybrids compared to benign lesions, macromelanophore spots, and healthy skin. The expression level of the non-tumorigenic xmrkA allele, in contrast, is not influenced by the presence or absence of R. These findings strongly indicate that differential transcriptional regulation of the xmrk promoter triggers the tumorigenic potential of these xmrk alleles. To functionally characterize the xmrk promoter region, I established a luciferase assay using BAC clones containing the genomic regions where xmrk and egfrb are located for generation of reporter constructs. This approach showed for the first time a melanoma cell specific transcriptional activation of xmrkB by its flanking regions, thereby providing the first functional evidence that the xmrk oncogene is controlled by a pigment cell specific promoter region. Subsequent analysis of different deletion constructs of the xmrkB BAC reporter construct strongly indicated that the regulatory elements responsible for the tumor-inducing overexpression of xmrkB in melanoma cells are located within 67 kb upstream of the xmrk oncogene. Taken together, these data indicate that melanoma formation in Xiphophorus is regulated by a tight transcriptional control of the xmrk oncogene and that the R locus acts through this mechanism. As the identification of the R-encoded gene(s) is necessary to fully understand how melanoma formation in Xiphophorus is regulated, I furthermore searched for alternative R candidate genes in this study. To this end, three genes, which are located in the genomic region where R has been mapped, were evaluated for their potential to be a crucial constituent of the regulator locus R. Among these genes, I identified pdcd4a, the ortholog of the human tumor suppressor gene PDCD4, as promising new candidate, because this gene showed the expression pattern expected from the crucial tumor suppressor gene encoded at the R locus.
The incidence of melanoma and nonmelanoma skin cancer has increased tremendously in recent years. Although novel treatment options have significantly improved patient outcomes, the prognosis for most patients with an advanced disease remains dismal. It is, thus, imperative to understand the molecular mechanisms involved in skin carcinogenesis in order to develop new targeted treatment strategies. Receptor tyrosine kinases (RTK) like the ERBB receptor family, including EGFR/ERBB1, ERBB2/NEU, ERBB3, and ERBB4, are important regulators of skin homeostasis and their dysregulation often results in cancer, which makes them attractive therapeutic targets. Members of the leucine‐rich repeats and immunoglobulin‐like domains protein family (LRIG1‐3) are ERBB regulators and thus potential therapeutic targets to manipulate ERBB receptors. Here, we analyzed the function of LRIG1 during chemically induced skin carcinogenesis in transgenic mice expressing LRIG1 in the skin under the control of the keratin 5 promoter (LRIG1‐TG mice). We observed a significant induction of melanocytic tumor formation in LRIG1‐TG mice and no difference in papilloma incidence between LRIG1‐TG and control mice. Our findings also revealed that LRIG1 affects ERBB signaling via decreased phosphorylation of EGFR and increased activation of the oncoprotein ERBB2 during skin carcinogenesis. The epidermal proliferation rate was significantly decreased during epidermal tumorigenesis under LRIG1 overexpression, and the apoptosis marker cleaved caspase 3 was significantly activated in the epidermis of transgenic LRIG1 mice. Additionally, we detected LRIG1 expression in human cutaneous squamous cell carcinoma and melanoma samples. Therefore, we depleted LRIG1 in human melanoma cells (A375) by CRISPR/Cas9 technology and found that this caused EGFR and ERBB3 downregulation in A375 LRIG1 knockout cells 6 h following stimulation with EGF. In conclusion, our study demonstrated that LRIG1‐TG mice develop melanocytic skin tumors during chemical skin carcinogenesis and a deletion of LRIG1 in human melanoma cells reduces EGFR and ERBB3 expression after EGF stimulation.
Pigment cells and neuronal cells both are derived from the neural crest. Here, we describe the Pit-Oct-Unc (POU) domain transcription factor Brn3a, normally involved in neuronal development, to be frequently expressed in melanoma, but not in melanocytes and nevi. RNAi-mediated silencing of Brn3a strongly reduced the viability of melanoma cell lines and decreased tumour growth in vivo. In melanoma cell lines, inhibition of Brn3a caused DNA double-strand breaks as evidenced by Mre11/Rad50-containing nuclear foci. Activated DNA damage signalling caused stabilization of the tumour suppressor p53, which resulted in cell cycle arrest and apoptosis. When Brn3a was ectopically expressed in primary melanocytes and fibroblasts, anchorage-independent growth was increased. In tumourigenic melanocytes and fibroblasts, Brn3a accelerated tumour growth in vivo. Furthermore, Brn3a cooperated with proliferation pathways such as oncogenic BRAF, by reducing oncogene-induced senescence in non-malignant melanocytes. Together, these results identify Brn3a as a new factor in melanoma that is essential for melanoma cell survival and that promotes melanocytic transformation and tumourigenesis.
Inhibition of RAF/MEK/ERK signaling is beneficial for many patients with BRAFV600E–mutated melanoma. However, primary and secondary resistances restrict long-lasting therapy success. Combination therapies are therefore urgently needed. Here, we evaluate the cellular effect of combining a MEK inhibitor with a genotoxic apoptosis inducer. Strikingly, we observed that an activated MAPK pathway promotes in several melanoma cell lines the pro-apoptotic response to genotoxic stress, and MEK inhibition reduces intrinsic apoptosis. This goes along with MEK inhibitor induced increased RAS and P-AKT levels. The protective effect of the MEK inhibitor depends on PI3K signaling, which prevents the induction of pro-apoptotic PUMA that mediates apoptosis after DNA damage. We could show that the MEK inhibitor dependent feedback loop is enabled by several factors, including EGF receptor and members of the SPRED family. The simultaneous knockdown of SPRED1 and SPRED2 mimicked the effects of MEK inhibitor such as PUMA repression and protection from apoptosis. Our data demonstrate that MEK inhibition of BRAFV600E-positive melanoma cells can protect from genotoxic stress, thereby achieving the opposite of the intended anti-tumorigenic effect of the combination of MEK inhibitor with inducers of intrinsic apoptosis.
T-Zellimmunantworten werden normalerweise durch folgenden Weg initiiert: unreife dendritische Zellen nehmen Antigen in der Peripherie auf, wandern in die sekundären lymphatischen Organe, wobei sie auf ihrem Weg sowohl reifen als auch das Antigen prozessieren. In den sekundären lymphatischen Organen angekommen, präsentieren sie als reife dendritische Zellen den T-Zellen die Antigene in Form von Peptiden zusammen mit kostimulierenden Molekülen. Dadurch rufen sie eine spezifische T-Zellantwort hervor. In der vorliegenden Arbeit wurde untersucht, ob nicht Situationen herbeigeführt werden können, die ein T-Zell priming außerhalb der sekundären lymphatischen Organe erlauben. Dazu wurden ein murines Modell, bei dem das Zytokin Lymphotoxin-alpha spezifisch am Tumor angereichert wurde, und ein humanes Modell, bei dem reife, antigenbeladene DC intradermal appliziert wurden, untersucht. Im murinen Modell zeigte sich, dass die gerichtete Anreicherung von Lymphotoxin-alpha am Tumor zu dessen Zerstörung führte, welche durch T-Zellen vermittelt wurde, und mit der Induktion eines tertiären lymphatischen Gewebes am Tumor assoziiert war. Dieses tertiäre lymphatische Gewebe war durch die Kompartimentalisierung von T- und B-Zellen und der Präsenz von high endothelial venules charakterisiert und besaß zudem mit dendritischen Zellen und naïven T-Zellen alle Voraussetzungen für ein in loco priming. Dementsprechend konnte in der Folge der gerichteten Lymphotoxin-alpa Therapie im Tumor ein Anstieg am T-Zellinfiltrat, welches sich oligoklonal zusammensetzte, beobachtet werden. In vitro Experimente verdeutlichte die Tumorspezifität der Therapie-induzierten T-Zellantwort, da die T-Zellen auf ein Tumorantigen mit der Ausschüttung von Interferon gamma reagierten und die Tumorzellen lysierten. Im humanen Modell wurden Hautbiopsien von Melanompatienten untersucht, denen im Rahmen einer klinischen Studie autologe, in vitro generierte und antigenbeladene DC intradermal appliziert wurden. Die Patienten erlaubten die Entnahme von Hautbiopsien aus den Injektionsstellen für wissenschaftliche Untersuchungen. Eine Induktion bzw. Verstärkung einer spezifischen T-Zellantwort durch die Vakzinierung mit antigenbeladenen dendritischen Zellen konnte bereits in zahlreichen Arbeiten und auch in dem in dieser Arbeit untersuchten Patientenkollektiv gezeigt werden. Bei der Analyse der Injektionsstellen zeigt sich, dass ein großer Teil der injizierten dendritischen Zellen in der Vakzinierungsstelle verharren und dass diese unabhängig von einer Beladung mit Antigen zu einer Induktion von high endothelial venules Charakteristika führte. Waren die dendritischen Zellen mit Antigen beladen, so führte dies zu einem stärkeren T-Zellinfiltrat in den Injektionsstellen, wobei sowohl naïve als auch central memory T-Zellen nachgewiesen wurde. Diese Zellen wurden vermutlich durch die Überexpression der DC CK1 und SDF1 Chemokinen in den Injektionsstellen, die chemotaktisch auf T-Zellen wirken, angezogen. Das Infiltrat in den Injektionsstellen war oligoklonal und wies tumorspezifische T-Zellen auf. Nachdem diese T-Zellklone im Blut der Patienten vor der Vakzinierung nicht nachweisbar waren, müssen sie zumindest in den Injektionsstellen expandiert sein. Interessanterweise konnte einer dieser Klone in Metastasen nachgewiesen werden, die nach der Vakzinierung dem Patienten entfernt wurden. In beiden Modellen wurde also durch die Manipulation des Mikromilieus, d.h. Lymphotoxin-alpa Anreicherung am Tumor bzw. Injektion von reifen dendritischen Zellen in die Haut, Strukturen wie z.B. high endothelial venules induziert, die ein in loco priming ermöglichen sollten. Dementsprechend riefen diese Veränderungen ein Tumorantigen-spezifisches Infiltrat hervor. Diese Ergebnisse deuten darauf hin, dass T-Zell priming auch außerhalb sekundärer lymphatischer Organe erfolgen kann. Prinzipiell scheint also nur der Kontakt von reifen, antigenbeladenen dendritischen Zellen mit den entsprechenden antigenspezifischen, naïven T-Zellen entscheiden zu sein. Die Möglichkeit des in vitro primings bekräftigt diese These. In vivo erfolgt dieses Aufeinandertreffen normalerweise in den sekundären lymphatischen Organen, doch konnte in der vorliegenden Arbeit gezeigt werden, dass Veränderungen des Mikromilieus diesen Kontakt auch in anderen Geweben ermöglicht.
Background
Therapeutic vaccination directed to induce an anti-tumoral T-cell response is a field of extensive investigation in the treatment of melanoma. However, many vaccination trials in melanoma failed to demonstrate a correlation between the vaccine-specific immune response and therapy outcome. This has been mainly attributed to immune escape by antigen loss, rendering us in the need of new vaccination targets.
Patients and methods
This phase-II trial investigated a peptide vaccination against survivin, an oncogenic inhibitor-of-apoptosis protein crucial for the survival of tumor cells, in HLA-A1/-A2/-B35-positive patients with treatment-refractory stage-IV metastatic melanoma. The study endpoints were survivin-specific T-cell reactivity (SSTR), safety, response, and survival (OS).
Results
Sixty-one patients (ITT) received vaccination therapy using three different regimens. 55 patients (PP) were evaluable for response and survival, and 41/55 for SSTR. Patients achieving progression arrest (CR + PR + SD) more often showed SSTRs than patients with disease progression (p = 0.0008). Patients presenting SSTRs revealed a prolonged OS (median 19.6 vs. 8.6 months; p = 0.0077); multivariate analysis demonstrated SSTR as an independent predictor of survival (p = 0.013). The induction of SSTRs was associated with gender (female vs. male; p = 0.014) and disease stage (M1a/b vs. M1c; p = 0.010), but not with patient age, HLA type, performance status, or vaccination regimen.
Conclusion
Survivin-specific T-cell reactivities strongly correlate with tumor response and patient survival, indicating that vaccination with survivin-derived peptides is a promising treatment strategy in melanoma.
Background
Therapeutic vaccination directed to induce an anti-tumoral T-cell response is a field of extensive investigation in the treatment of melanoma. However, many vaccination trials in melanoma failed to demonstrate a correlation between the vaccine-specific immune response and therapy outcome. This has been mainly attributed to immune escape by antigen loss, rendering us in the need of new vaccination targets.
Patients and methods
This phase-II trial investigated a peptide vaccination against survivin, an oncogenic inhibitor-of-apoptosis protein crucial for the survival of tumor cells, in HLA-A1/-A2/-B35-positive patients with treatment-refractory stage-IV metastatic melanoma. The study endpoints were survivin-specific T-cell reactivity (SSTR), safety, response, and survival (OS).
Results
Sixty-one patients (ITT) received vaccination therapy using three different regimens. 55 patients (PP) were evaluable for response and survival, and 41/55 for SSTR. Patients achieving progression arrest (CR + PR + SD) more often showed SSTRs than patients with disease progression (p = 0.0008). Patients presenting SSTRs revealed a prolonged OS (median 19.6 vs. 8.6 months; p = 0.0077); multivariate analysis demonstrated SSTR as an independent predictor of survival (p = 0.013). The induction of SSTRs was associated with gender (female vs. male; p = 0.014) and disease stage (M1a/b vs. M1c; p = 0.010), but not with patient age, HLA type, performance status, or vaccination regimen.
Conclusion
Survivin-specific T-cell reactivities strongly correlate with tumor response and patient survival, indicating that vaccination with survivin-derived peptides is a promising treatment strategy in melanoma.
Interferon alpha (IFNα) is approved for adjuvant treatment of stage III melanoma in Europe and the US. Its clinical efficacy, however, is restricted to a subpopulation of patients while side effects occur in most of treated patients. Thus, the identification of predictive biomarkers would be highly beneficial to improve the benefit to risk ratio. In this regard, STAT3 is important for signaling of the IFNα receptor. Moreover, the STAT3 single-nucleotide polymorphism (SNP) rs4796793 has recently been reported to be associated with IFNα sensitivity in metastatic renal cell carcinoma. To translate this notion to melanoma, we scrutinized the impact of rs4796793 functionally and clinically in this cancer. Interestingly, melanoma cells carrying the minor allele of rs4796793 were the most sensitive to IFNα in vitro. However, we did not detect a correlation between SNP genotype and STAT3 mRNA expression for either melanoma cells or for peripheral blood lymphocytes. Next, we analyzed the impact of rs4796793 on the clinical outcome of 259 stage III melanoma patients of which one-third had received adjuvant IFNα treatment. These analyses did not reveal a significant association between the STAT3 rs4796793 SNP and patients' progression free or overall survival when IFNα treated and untreated patients were compared. In conclusion, STAT3 rs4796793 SNP is no predictive marker for the efficacy of adjuvant IFNα treatment in melanoma patients.
Skin Tumors in Childhood
(2011)
Background:
Dermatologists, paediatricians, and general practitioners are often consulted by worried parents for the evaluation of a cutaneous tumor.
Methods:
Selective literature review.
Results:
Only 1-2% of skin tumors excised in children turn out to be malignant when examined histologically. Warning signs of malignancy include rapid growth, firm consistency, diameter exceeding 3 cm, ulceration, a non-movable mass, and presence in the neonatal period. The more common malignant skin tumors in adults-basal cell carcinoma, cutaneous squamous cell carcinoma, and melanoma-are very rare in childhood. Congenital melanocytic nevi and sebaceous nevi bear a lower malignant potential than previously believed; nevertheless, their excision is often indicated. A Spitz nevus can mimic a melanoma both clinically and histologically. Some benign skin tumors of childhood tend to regress spontaneously within a few years but may cause complications at particular locations and when multiple. For infantile hemangiomas requiring systemic treatment because of imminent obstruction or ulceration, propranolol seems to have a far more favorable risk-benefit ratio than corticosteroids.
Conclusion:
Physicians need specialized knowledge in order to decide whether a skin tumor in a child should be excised, non-surgically treated, or further evaluated, or whether it can be safely left untreated because of the likelihood of spontaneous remission.
Peroxiredoxin 6 (PRDX6) is a bifunctional enzyme comprising a peroxidase and a Ca2+-independent phospholipase (iPLA2) activity. This renders the enzyme capable of detoxifying reactive oxygen species (ROS) and of catalyzing the liberation of arachidonic acid (AA) from cellular membranes. Released AA can be further metabolized to bioactive lipids including eicosanoids, which are involved in inflammation, cell growth, differentiation, invasion and proliferation. Human melanoma cells are often characterized by imbalances in both ROS and lipid levels, which can be generated by oncogenic signaling, altered metabolism or UV irradiation.
In previous studies, a comparative proteome analysis of the Xiphophorus fish melanoma model revealed a strong upregulation of Prdx6 in benign and malignant lesions compared to healthy skin. As the Xiphophorus melanoma model displays in many respects molecular characteristics that are similar to human melanoma, I investigated the functional role of PRDX6 in human melanoma cells.
The first part of the study deals with the regulation of PRDX6 in melanocytes and human melanoma cells. I could demonstrate that the protein level of PRDX6 was strongly enhanced by the induction of the EGFR orthologue Xmrk from the Xiphophorus fish as well as the human EGFR. The upregulation of PRDX6 was further shown to be mediated in a PI3K-dependent and ROS-independent manner.
The main part of the thesis comprises the investigation of the functional role of PRDX6 in human melanoma cells as well as the analysis of the underlying mechanism. I could show that knockdown of PRDX6 enhanced the oxidative stress response and led to decreased proliferation of melanoma cells. This cell growth effect was mainly mediated by the iPLA2 activity of PRDX6. Under conditions of strongly enhanced oxidative stress, the peroxidase activity became also important for cellular proliferation. Furthermore, the anti-proliferative effect in cells with lowered PRDX6 levels was the result of reduced cellular AA content and the decrease in the activation of SRC family proteins. Similarly, supplementation with AA led to regeneration of SRC family kinase activity and to an improvement in the reduced proliferation after knockdown of PRDX6. Since AA can be further processed into the prostaglandin PGE2, which has a pro-tumorigenic function in some cancer types, I further examined whether this eicosanoid is involved in the proliferative function of PRDX6. In contrast to AA, PGE2 was not consistently required for melanoma proliferation.
In summary, I could demonstrate that PRDX6 plays a major role in AA-dependent lipid signaling in melanoma cells and thereby regulates proliferation. Interestingly, the proliferation relevant iPLA2 activity can be pharmacologically targeted, and melanoma cell growth was clearly blocked by the inhibitor BEL. Thus, I could identify the phospholipase activity of PRDX6 as a new therapeutically interesting target for melanoma treatment.
The mechanisms that enable cells to regulate their gene expression and thus their metabolism, proliferation or cellular behaviour are not only important to understand the basic biology of a living cell, but are also of crucial interest in cancerogenesis. Highly interwoven and tightly regulated pathways are the basis of a robust but also flexible regulatory network. Interference with these pathways can be either causative for tumorigenesis or can modify its outcome. The receptor tyrosine kinase (RTK) and RAS dependent pathways leading to AKT or ERK1/2 activation are of particular interest in melanoma. These signaling modules are commonly activated by different mutations that can be found in various pathway components like NRAS, BRAF or PTEN. The first part of this work deals with the diverse and versatile functions of the ERK1/2 pathway feedbackregulator MKP2 in different cellular, melanoma relevant settings. In addition, a functional role of the AP1-complex member FOSL1, an ERK1/2 transcriptional target being implicated in the regulation of proliferation, is demonstrated. Secondly, aspects of direct pharmacological inhibition of the ERK1/2 pathway with regard to the induction of apoptosis have been analysed. Due to the high frequency of melanoma related mutations occurring in the RAS/RAF/MEK/ERK pathway (e.g. NRASQ61K, BRAFV600E), inhibition of this signaling cascade is deemed to be a promising therapeutic strategy for the treatment of malignant melanoma. However, although in clinical trials mono-therapeutic treatment with MEK- or RAF inhibitors was successful in the short run, it failed to show satisfactory long-lasting effects. Hence, combination therapies using a MAPK pathway inhibitor and an additional therapy are currently under investigation. I was able to demonstrate that inhibition of MEK using the highly specific inhibitor PD184352 can have a protective effect on melanoma cells with regard to their susceptibility towards the apoptosis inducing agent cisplatin. Single application of cisplatin led to strong DNA damage and the induction of caspase-dependent apoptosis. Additional administration of the MEK inhibitor, however, strongly reduced the apoptosis inducing effect of cisplatin in several melanoma cell lines, These cells displayed an increased activation of the serine/threonine kinase AKT after MEK inhibition. This AKT activation concomitantly led to the phosphorylation of FOXO transcription factors, attenuating the cisplatin induced expression of the BH3-only protein PUMA. PUMA in turn was important to mediate the apoptosis machinery after cisplatin treatment. My results also indicate a participation of RTKs, in particular EGFR, in mediating MEK inhibitor induced activation of AKT. These results demonstrate that inhibition of the RAS/RAF/MEK/ERK signaling pathway in melanoma cell lines does not necessilary have favourable effects in a cytotoxic co-treatment situation. Instead, it can even enhance melanoma survival under pro-apoptotic conditions.
Ras genes are among the most commonly mutated genes in human cancer; yet our understanding of their oncogenic activity at the molecular mechanistic level is incomplete. To identify downstream events that mediate ras-induced cellular transformation in vivo, we analyzed global microRNA expression in three different models of Ras-induction and tumor formation in zebrafish. Six microRNAs were found increased in Ras-induced melanoma, glioma and in an inducible model of ubiquitous Ras expression. The upregulation of the microRNAs depended on the activation of the ERK and AKT pathways and to a lesser extent, on mTOR signaling. Two Ras-induced microRNAs (miR-146a and 193a) target Jmjd6, inducing downregulation of its mRNA and protein levels at the onset of Ras expression during melanoma development. However, at later stages of melanoma progression, jmjd6 levels were found elevated. The dynamic of Jmjd6 levels during progression of melanoma in the zebrafish model suggests that upregulation of the microRNAs targeting Jmjd6 may be part of an anti-cancer response. Indeed, triple transgenic fish engineered to express a microRNA-resistant Jmjd6 from the onset of melanoma have increased tumor burden, higher infiltration of leukocytes and shorter melanoma-free survival. Increased JMJD6 expression is found in several human cancers, including melanoma, suggesting that the up-regulation of Jmjd6 is a critical event in tumor progression.
The following link has been created to allow review of record GSE37015: http://www.ncbi.nlm.nih.gov/geo/query/acc.cgi?token=jjcrbiuicyyqgpc&acc=GSE37015.
The Ras/RAF/MEK/ERK cascade is a central cellular signal transduction pathway involved in cell proliferation, differentiation, and survival where RAF kinases are pivotal kinases implicated in cancer. The development of specific irreversible kinase inhibitors is a rewarding but difficult aim. CI-1033 was developed to irreversibly inhibit erbB receptor tyrosine kinases by reacting to the Cys113 residue (p38alpha MAP kinase numbering) of the kinase domain. In this study we tried a similar approach to target the RAF oncoproteins which posses a similar cysteine at position 108 in the hinge region between the small n-lobe and the large c-lobe of the kinase domain. A novel synthetic approach including a lyophilization step allowed us the synthesis of a diphenyl urea compound with an epoxide moiety (compound 1). Compound 1 possessed inhibitory activity in vitro. However our time kinetics experiments and mass spectroscopic studies clearly indicate that compound 1 does not react covalently with the cysteine residue in the hinge region. Moreover, in cell culture experiments, a strong activation of the RAF signaling pathway was observed, an effect which is known from several other RAF kinase inhibitors and is here reported for the first time for a diphenyl urea compound, to which the clinically used unspecific kinase inhibitor BAY 43-9006 (Sorafinib, Nexavar) belongs. Although activation was apparently independent on B- and C-RAF hetero-oligomerization in vitro, in vivo experiments support such a mechanism as the activation did not occur in starved knockout cells lacking either B-RAF or C-RAF. Furthermore, we developed a mathematical model of the Ras/RAF/MEK/ERK cascade demonstrating how stimuli induce different signal patterns and thereby different cellular responses, depending on cell type and the ratio between B-RAF and C-RAF. Based on biochemical data for activation and dephosphorylation, we set up differential equations for a dynamical model of the Ras/RAF/MEK/ERK cascade. We find a different signaling pattern and response result for B-RAF (strong activation, sustained signal) and C-RAF (steep activation, transient signal). We further support the significance of such differential modulatory signaling by showing different RAF isoform expression in various cell lines and experimental testing of the predicted kinase activities in B-RAF, C-RAF as well as mutated versions. Additionally the effect of the tumor suppressor DiRas3 (also known as Noey2 or ARHI) on RAF signaling was studied. I could show that DiRas3 down-regulates the mitogenic pathway by inhibition of MEK, a basis for a refined model of the Ras/RAF/MEK/ERK cascade.
Regulatory T cells (Tregs) prevent autoimmunity but limit antitumor immunity. The canonical NF-\(\kappa\)B signaling pathway both activates immunity and promotes thymic Treg development. Here, we report that mature Tregs continue to require NF-\(\kappa\)B signaling through I\(\kappa\)B-kinase \(\beta\) (IKK\(\beta\)) after thymic egress. Mice lacking IKK\(\beta\) in mature Tregs developed scurfy-like immunopathology due to death of peripheral FoxP3\(^+\) Tregs. Also, pharmacological IKK\(\beta\) inhibition reduced Treg numbers in the circulation by ~50% and downregulated FoxP3 and CD25 expression and STAT5 phosphorylation. In contrast, activated cytotoxic T lymphocytes (CTLs) were resistant to IKK\(\beta\) inhibition because other pathways, in particular nuclear factor of activated T cells (NFATc1) signaling, sustained their survival and expansion. In a melanoma mouse model, IKK\(\beta\) inhibition after CTL cross-priming improved the antitumor response and delayed tumor growth. In conclusion, prolonged IKK\(\beta\) inhibition decimates circulating Tregs and improves CTL responses when commenced after tumor vaccination, indicating that IKK\(\beta\) represents a druggable checkpoint.
Melanoma is the most aggressive skin cancer with very limited treatment options. Upon appearance of metastases chemotherapeutics are used to either kill or slow down the growth of cancer cells by inducing apoptosis or senescence, respectively. With melanomas originating from melanocytes, it is vital to elucidate the mechanisms that distinguish senescence induction from proliferation and tumourigenicity. Xmrk (Xiphophorus melanoma receptor kinase), the fish orthologue of the human epidermal growth factor receptor (EGFR), causes highly aggressive melanoma in fish. Using an inducible variant, HERmrk, I showed that high receptor levels result in melanocyte senescence, whereas low and medium expression allows for cell proliferation and tumourigenicity. Mechanistically, HERmrk leads to increased reactive oxygen species (ROS) levels, which trigger a DNA damage response. Consequently, multinucleated, senescent cells develop by both endomitosis and fusion. Furthermore, oncogenic N‐RAS (N-‐RAS61K) induces a similar multinucleated phenotype in melanocytes. In addition, I found that both overexpression of C‐MYC and the knockdown of miz‐1 (Myc‐interacting zinc finger protein 1) diminished HERmrk‐induced senescence entry. C‐MYC prevent ROS induction, DNA damage and senescence, while acting synergistically with HERmrk in conveying tumourigenic features to melanocytes. Further analyses identified cystathionase (CTH) as a novel target gene of Myc and Miz-1 crucial for senescence prevention. CTH encodes an enzyme involved in the synthesis of cysteine from methionine, thereby allowing for increased ROS detoxification. Even though senescence was thought to be irreversible and hence tumour protective, I demonstrated that prolonged expression of the melanoma oncogene N‐RAS61K in pigment cells overcomes initial OIS by triggering the emergence of tumour‐initiating, mononucleated stem‐like cells from multinucleated senescent cells. This progeny is dedifferentiated, highly proliferative, anoikis‐resistant and induces fast‐growing, metastatic tumours upon transplantation into nude mice. Our data demonstrate that induction of OIS is not only a cellular failsafe mechanism, but also carries the potential to provide a source for highly aggressive, tumour‐initiating cells.
Simple Summary
In melanoma patients treated with dabrafenib and trametinib, dose reductions and treatment discontinuations related to adverse events (AE) occur frequently. However, the associations between patient characteristics, AE, and exposure are unclear. Our prospective study analyzed serum (hydroxy-)dabrafenib and trametinib exposure and investigated its association with toxicity and patient characteristics. Additionally, the feasibility of at-home sampling of capillary blood was assessed, and a model to convert capillary blood concentrations to serum concentrations was developed. (Hydroxy-)dabrafenib or trametinib exposure was not associated with age, sex, body mass index, or AE. Co-medication with P-glycoprotein inducers was associated with lower trough concentrations of trametinib but not (hydroxy-)dabrafenib. The applicability of the self-sampling of capillary blood was demonstrated. Our conversion model was adequate for estimating serum exposure from micro-samples. The monitoring of dabrafenib and trametinib may be useful for dose modification and can be optimized by at-home sampling and our new conversion model.
Abstract
Patients treated with dabrafenib and trametinib for BRAF\(^{V600}\)-mutant melanoma often experience dose reductions and treatment discontinuations. Current knowledge about the associations between patient characteristics, adverse events (AE), and exposure is inconclusive. Our study included 27 patients (including 18 patients for micro-sampling). Dabrafenib and trametinib exposure was prospectively analyzed, and the relevant patient characteristics and AE were reported. Their association with the observed concentrations and Bayesian estimates of the pharmacokinetic (PK) parameters of (hydroxy-)dabrafenib and trametinib were investigated. Further, the feasibility of at-home sampling of capillary blood was assessed. A population pharmacokinetic (popPK) model-informed conversion model was developed to derive serum PK parameters from self-sampled capillary blood. Results showed that (hydroxy-)dabrafenib or trametinib exposure was not associated with age, sex, body mass index, or toxicity. Co-medication with P-glycoprotein inducers was associated with significantly lower trough concentrations of trametinib (p = 0.027) but not (hydroxy-)dabrafenib. Self-sampling of capillary blood was feasible for use in routine care. Our conversion model was adequate for estimating serum PK parameters from micro-samples. Findings do not support a general recommendation for monitoring dabrafenib and trametinib but suggest that monitoring can facilitate making decisions about dosage adjustments. To this end, micro-sampling and the newly developed conversion model may be useful for estimating precise PK parameters.