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Für die Diagnose und Therapie von Brustkrebs existiert die nationale evidenz- und konsensbasierte S3-Leitlinie. Die klinischen Krebsregister stellen sektor- und facharztübergreifende Diagnose- und Therapiedaten zur Qualitätssicherung bereit. Bislang fehlen jedoch Daten bezüglich patient-reported outcome measures (PROMs). Aufgrund des demographischen Wandels werden Brustkrebserkrankungen vor allem in ländlichen Regionen weiter zunehmen, weshalb Versorgungsstrukturen für alle Patientinnen erreichbar sein sollten. Es wurde ein patientenorientiertes Registerkonzept (Breast Cancer Care for patients with metastatic disease (BRE-4-MED)) für den metastasierten Brustkrebs entwickelt und hinsichtlich vordefinierter Machbarkeitskriterien pilotiert. An der BRE-4-MED-Pilotstudie nahmen 31 Patientinnen (96.8% weiblich) teil. Die bayernweite Erreichbarkeit zu brustkrebsspezifischen Versorgungsstrukturen wurde mithilfe einer Geographic Information System (GIS)-Analyse untersucht. Anhand von Leitlinienempfehlungen und Ergebnissen der BRE-4-MED-Pilotstudie wurden relevante Versorgungsstrukturen identifiziert. Die Ergebnisse der Pilotstudie zeigen, dass die Integration von Primär- und Sekundärdaten aus verschiedenen Quellen in ein zentrales Studienregister machbar ist und die erforderlichen organisatorischen Prozesse (z. B. data linkage mit Krebsregister) funktionieren. Die Ergebnisse der Erreichbarkeitsanalyse verdeutlichen, dass es keine bayernweite Erreichbarkeit zu brustkrebsspezifischen Versorgungsstrukturen gibt. Am stärksten war dieser Zusammenhang in grenznahen Regionen ausgeprägt. Die vorliegende Arbeit zeigt Chancen für eine patientenorientierte, qualitätsgesicherte Brustkrebsversorgung unabhängig vom Wohnort auf.
Breast cancer is the most common cancer among women worldwide and the second most common cause of cancer death in the developed countries. As the current state of the art in first-line drug screenings is highly ineffective, there is an urgent need for novel test systems that allow for reliable predictions of drug sensitivity.
In this study, a tissue engineering approach was used to successfully establish and standardize a 3-dimensional (3D) mamma carcinoma test system that was optimized for the testing of anti-tumour therapies as well as for the investigation of tumour biological issues. This 3D test system is based on the decellularised scaffold of a porcine small intestinal segment and represents the three molecular subsets of oestrogen receptor-positive, HER2/Neu-overexpressing and triple negative breast cancer (TNBC). The characterization of the test system with respect to morphology as well as the expression of markers for epithelial-mesenchymal transition (EMT) and differentiation indicate that the 3D tumour models cultured under static and dynamic conditions reflect tumour relevant features and have a good correlation with in vivo tumour tissue from the corresponding xenograft models. In this respect, the dynamic culture in a flow bioreactor resulted in the generation of tumour models that exhibited best reflection of the morphology of the xenograft material. Furthermore, the proliferation indices of 3D models were significantly reduced compared to 2-dimensional (2D) cell culture and therefore better reflect the in vivo situation. As this more physiological proliferation index prevents an overestimation of the therapeutic effect of cytostatic compounds, this is a crucial advantage of the test system compared to 2D culture. Moreover, it could be shown that the 3D models can recapitulate different tumour stages with respect to tumour cell invasion. The scaffold SISmuc with the preserved basement membrane structure allowed the investigation of invasion over this barrier which tumour cells of epithelial origin have to cross in in vivo conditions during the process of metastasis formation. Additionally, the data obtained from ultrastructural analysis and in situ zymography indicate that the invasion observed is connected to a tumour cell-associated change in the basement membrane in which matrix metalloproteinases (MMPs) are also involved. This features of the model in combination with the mentioned methods of analysis could be used in the future to mechanistically investigate invasive processes and to test anti-metastatic therapy strategies.
The validation of the 3D models as a test system with respect to the predictability of therapeutic effects was achieved by the clinically relevant targeted therapy with the monoclonal antibody trastuzumab which induces therapeutic response only in patients with HER2/Neu-overexpressing mamma carcinomas due to its specificity for HER2. While neither in 2D nor in 3D models of all molecular subsets a clear reduction of cell viability or an increase in apoptosis could be observed, a distinct increase in antibody-dependent cell-mediated cytotoxicity (ADCC) was detected only in the HER2/NEU-overexpressing 3D model with the help of an ADCC reporter gene assay that had been adapted for the application in the 3D model in the here presented work. This correlates with the clinical observations and underlines the relevance of ADCC as a mechanism of action (MOA) of trastuzumab. In order to measure the effects of ADCC on the tumour cells in a direct way without the indirect measurement via a reporter gene, the introduction of an immunological component into the models was required. This was achieved by the integration of peripheral blood mononuclear cells (PBMCs), thereby allowing the measurement of the induction of tumour cell apoptosis in the HER2/Neu-overexpressing model. Hence, in this study an immunocompetent model could be established that holds the potential for further testing of therapies from the emergent field of cancer immunotherapies.
Subsequently, the established test system was used for the investigation of scientific issues from different areas of application. By the comparison of the sensitivity of the 2D and 3D model of TNBC towards the water-insoluble compound curcumin that was applied in a novel nanoformulation or in a DMSO-based formulation, the 3D test system was successfully applied for the evaluation of an innovative formulation strategy for poorly soluble drugs in order to achieve cancer therapy-relevant concentrations. Moreover, due to the lack of targeted therapies for TNBC, the TNBC model was applied for testing novel treatment strategies. On the one hand, therapy with the WEE1 kinase inhibitor MK 1775 was evaluated as a single agent as well as in combination with the chemotherapeutic agent doxorubicin. This therapy approach did not reveal any distinct benefits in the 3D test system in contrast to testing in 2D culture. On the other hand, a novel therapy approach from the field of cellular immunotherapies was successfully applied in the TNBC 3D model. The treatment with T cells that express a chimeric antigen receptor (CAR) against ROR1 revealed in the static as well as in the dynamic model a migration of T cells into the tumour tissue, an enhanced proliferation of T cells as well as an efficient lysis of the tumour cells via apoptosis and therefore a specific anti-cancer effect of CAR-transduced T cells compared to control T cells. These results illustrate that the therapeutic application of CAR T cells is a promising strategy for the treatment of solid tumours like TNBC and that the here presented 3D models are suitable for the evaluation and optimization of cellular immunotherapies.
In the last part of this work, the 3D models were expanded by components of the tumour stroma for future applications. By coculture with fibroblasts, the natural structures of the intestinal scaffold comprising crypts and villi were remodelled and the tumour cells formed tumour-like structures together with the fibroblasts. This tissue model displayed a strong correlation with xenograft models with respect to morphology, marker expression as well as the activation of dermal fibroblasts towards a cancer-associated fibroblast (CAF) phenotype. For the integration of adipocytes which are an essential component of the breast stroma, a coculture with human adipose-derived stromal/stem cells (hASCs) which could be successfully differentiated along the adipose lineage in 3D static as well as dynamic models was established. These models are suitable especially for the mechanistic analysis of the reciprocal interaction between tumour cells and adipocytes due to the complex differentiation process.
Taken together, in this study a human 3D mamma carcinoma test system for application in the preclinical development and testing of anti-tumour therapies as well as in basic research in the field of tumour biology was successfully established. With the help of this modular test system, relevant data can be obtained concerning the efficacy of therapies in tumours of different molecular subsets and different tumour stages as well as for the optimization of novel therapy strategies like immunotherapies. In the future this can contribute to improve the preclinical screening and thereby to reduce the high attrition rates in pharmaceutical industry as well as the amount of animal experiments.
Recently, it was shown that MDA-MB-231 breast cancer cells express very high levels of the A2BAR as the sole adenosine receptor subtype, and stimulation of the A2BAR in MDA-MB-231 cells triggers an unusual inhibitory signal on ERK1/2 phosphorylation. The ERK1/2 pathway is reported to be associated with the control of growth, proliferation and differentiation of cells and as such might serve as a promising target for tumor treatment. The present study investigated signaling mechanisms involved in linking A2BAR to ERK1/2 phosphorylation in MDA-MB-231 cells. The A2BAR mediated reduction of ERK1/2 phosphorylation and of proliferation of MDA-MB-231 cell is in good agreement with previous results from (Dubey et al., 2005). These observations provide support to the hypothesis that activation of A2BAR could attenuate the growth of some types of cancer cell and argue against a stimulation of proliferation resulting from the activation of A2BAR as discussed by (Fernandez-Gallardo et al., 2016). AC activation by forskolin has recently been shown to enhance the activity of the chemotherapeutic agent doxorubicin in TNBC cells via a mechanism dependent on the PKA-mediated inhibition of ERK1/2 phosphorylation. Furthermore, forskolin also increased the sensitivity of MDA-MB-231 and MDA-MB-468 triple negative breast cancer cells to 5-fluorouracil and taxol (Illiano et al., 2018), and sustains the evidence of anticancer activity mediated by cAMP/PKA-mediated ERK1/2 inhibition. Similar to these studies, a reduced amount of pERK1/2 was also observed after stimulation of AC with FSK, application of cAMP-AM or inhibition of PDE-4. The inhibition of ERK1/2 phosphorylation was mimicked by UTP and abolished with the PLC inhibitor U73122 or by chelating intracellular Ca2+ with BAPTA-AM. These results point to an important role for both cAMP and Ca2+ signaling in the pathway leading to a decrease in ERK1/2 phosphorylation. This study encourages the idea that A2BAR could be used as target in cancer therapy. But A2BAR did not only stimulate signaling cascades associated with cell survival and proliferation reduction, but also key phases relevant in angiogenesis like Ca2+ mobilization (Kohn et al., 1995). Whereas the potency toward AC and Ca2+ are similar for the diverse agonists, the potency to promote ERK1/2 reduction is much higher. Interestingly, the proliferation of MDA-MB-231 cells is inhibited by low nanomolar agonist concentration which is inactive in Ca2+ mobilization. This means that it is certainly possible to reduce the proliferation without promoting angiogenesis. LUF6210 is particularly interesting when considering that it preferentially stimulates a reduction in ERK1/2 phosphorylation over Ca2+ and therefore may not promote angiogenesis. LUF6210 is therapeutically appealing as adjuvant in treatment of cancer. Given that stimulation of AC can activate a reduction of ERK1/2 phosphorylation and proliferation in cancer cells, agonist bias toward Gs-AC-PKA-mediated ERK1/2 inhibition represent a potential therapy of various malignancies. The fact that the reduction of ERK1/2 phosphorylation followed by reduced proliferation observed in MDA-MB-231 cells were mediated by the activation of the A2BAR illustrates the importance of this receptor subtype in cancer. A2BARs must be considered as a key factor in cancer treatment and deserve attention for the development of new therapeutic strategies.
LASP1 reguliert die Genexpression und Sekretion von Matrix-Metalloproteasen in Brustkrebszellen
(2016)
Migration und Tumorzellinvasion erfordern die vorhergehende Degradation der umliegenden Extrazellulärmartrix (EZM). Dieser Umbauprozess erfolgt primär durch proteolytische Endopeptidasen, sog. Matrix-Metalloproteasen (MMPs). Damit diese ihre funktionelle Aktivität ausüben können, müssen sie zunächst rekrutiert und mit Hilfe podosomaler bzw. invadopodialer Strukturen in die EZM sezerniert werden.
Das LIM und SH3 Domänen Protein 1 (LASP1), ein neu in Podosomen von Makrophagen identifiziertes regulatorisches Gerüstprotein, beeinflusst, neben Größe, Anzahl und Beständigkeit von Podosomen, in hohem Maße die Matrixdegradationskapazität der Zelle.
Auch in invasiven Brustkrebszellen wurde eine Lokalisation von LASP1 an Invadopodien, den Podosomen-äquivalenten Strukturen, detektiert.
Das primäre Ziel der vorliegenden Arbeit war daher die funktionelle Charakterisierung von LASP1 in Invadopodien. Unter Etablierung eines Matrix-Degradations-Assays konnte gezeigt werden, dass eine Herunterregulation von LASP1 auch in der humanen Brustkrebszelllinie MDA-MB-231, die zuvor schon für Makrophagen gezeigte Matrixdegradation nachhaltig beeinträchtig.
Durch Analyse und Verifikation von zugänglichen Mikroarraydaten mittels qRT-PCR und Western Blot konnte ferner belegt werden, dass LASP1 in den Brustkrebszellen die Genexpression und Proteintranslation von MMP1, -3 und -9 positiv moduliert und somit das gesamt-invasive Potential der Zelle steigert. Darüber hinaus deuten Zymogramme und die Analyse des konditionierten Mediums darauf hin, dass LASP1 als Strukturprotein die vesikuläre Sekretion der inaktiven Zymogene (proMMPs) in die EZM fördert. Demzufolge modifiziert LASP1 während der Krebsprogression die zelluläre Mikroumgebung zugunsten einer erhöhten Metastasierungsrate.
Die neu identifizierte regulatorische Funktion von LASP1 auf die Transkription sowie Sekretion von Matrix-Metalloproteasen erklärt die in früheren Arbeiten beobachtete Korrelation zwischen einer erhöhten LASP1 Konzentration im Gewebe und dem vermehrten Auftreten von Metastasen, und damit einhergehend, schlechteren Überleben der Patientinnen.