'Near-patient models for the assessment of tumor aggressiveness & therapy response

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1 'Near-patient models for the assessment of tumor aggressiveness & therapy response Gabri van der Pluijm Leiden University Medical Centre Leiden, dept. Urology, The Netherlands

2 Outline Clinical problem of urological cancers Near-patient disease models Tumor progression (functional studies) Development of novel therapy

3 Clinical Problem of Prostate Cancer - most frequent cancer in men - second leading cause of cancer death in males - after prostatectomy or radiotherapy of the primary tumor, a subset of T1-T3 organ confined cancers progress towards incurable metastasis Serum PSA Death 20-30% Surgical therapy, radiotherapy (T 1 -T 3 stage) Androgen deprivation therapy (ADT) Castration resistance Metastasis Castration resistance 70-80% time 5 10 years months

4 Stage: T1-3 The problem! Bone metastases 20-30% Bone marrow MICRO-metastasis Bone MACRO-metastasis Mechanism(s)? Novel Therapy?

5 Cancer Cells Molecular Profiling BioMedical Imaging -Novel Imaging Agents -Improved Detection of MRD -Companion diagnostics Clinical Problem Lethal Metastasis (MRD) Therapy Resistance Intra-Tumor Heterogeneity Functional Studies Near-patient Models as Pathway to the Clinic Supportive Stroma Primary tumor Metastasis Molecular Profiling Novel Therapy Drug Respositioning Nanodrug Delivery

6 Anatomical osteotropisms Bone Metastases Red marrow distribution

7 Major Aim 1) better identify newly diagnosed cancer patients with ostensible localized disease that are at risk of disease progression. 2) select novel, effective inhibitors of perturbed, key pathways and predict an individualised therapy response in patients (personalised medicine). Near-patient prostate cancer models for the assessment of disease prognosis and therapy response. (Period )

8 Near-patient models patient Isolated human cancer cells Established human cancer cell lines with optical imaging reporter tumor IN VIVO IN VITRO IN VIVO IN VIVO EX VIVO Zebrafish 2D Cultures Spheroid/Organoid Xenografting in immunodeficient mice Patient-derived Xenografting (PDX) Tumor Slice cultures

9 Bladder cancer orthotopic in vivo xenograft model Preclinical model using bioluminescent imaging of orthotopically inoculated UM-UC-3luc2 cells 2*10 6 human UM-UC- 3luc2 cells Total tumor burden (photons/second) 5,0E+09 4,5E+09 4,0E+09 3,5E+09 3,0E+09 2,5E+09 2,0E+09 1,5E+09 1,0E+09 5,0E+08 0,0E+00 4,0E+08 3,5E+08 3,0E+08 2,5E+08 2,0E+08 1,5E+08 1,0E+08 5,0E+07 0,0E days after inoculation bladder lymph node lung Nude BalbC mouse L days M N O Van der Horst et al European Urology 2011

10 Kinetics of Bone Metastasis (PC-3M-Pro4luc2) ventral dorsal

11 Seed & Soil in real time Cell Number in Tibial Bone Metastasis Stem-like prostate cancer cells

12 ALDH high subpopulation & cancer stem/progenitors Clonogenicity Migration # single colonies/plate *** *** ALDH low ALDH hi # Migrated Cells/Field *** ALDEFLUOR Assay 0 PC-3M-Pro4 C4-2B 0 ALDH low ALDH hi Tumorigenicity Bone Metastasis ALDH hi ALDH low ALDH low Differentiated Epithelial Phenotype ALDHhigh Mesenchymal Phenotype Stem/progenitor cells (a2 hi, CD44 hi,av hi,ck5 + ) days days van den Hoogen et al.cancer Res; (2010), Clin Exp Metastasis 2011

13 Strategy for quantification of tumor dissemination in zebrafish

14 Prostate Cancer Stem-like Cells are identified as Metastasis-initiating Cells in the Zebrafish Model 6dpi ALDH hi 6dpi ALDH low Zoni et al. Cancer Res. (2015)

15 human cancer xenograft model for studying metastatic onset 2dpf CHT 4dpi MDA-MB-231/B1 UMUC-3 PC-3M-Pro4 Prostate cancer Bladder cancer invasive cancers less aggressive cancers Zoni E. et al. Cancer Res Jun 1;75(11): Drabsch Y, et al. Breast Cancer Res Nov 7;15(6):R106. Mercatali L et al. Int J Mol Sci Aug 22;17(8).

16 Development of Novel Therapy for Urological Malignancies Drug discovery & development Drug repositioning/repurposing Nanodrug delivery Targeting chemotherapy resistance Companion diagnostics

17 Oncological Epithelial Plasticity Sessile, Epithelial phenotype Pharmacological compounds MET EMT Invasive, Mesenchymal Phenotype Therapy resistance Stem/progenitor properties Angiogenesis Survival

18 OCD155 inhibits Bone Metastasis in Prostate Cancer (PC-3M-Pro4 luciferase expressing, day 35) dorsal ventral Vehicle OCD155 (5mg/kg/d)

19 Drug Repurposing/Repositioning Safety profile and clinical properties are well studied and understood, Considerably reduction of failure in later stages of clinical development Antibiotic (Salinomycin) Anti-depressant (Penfluoridol)

20 Anti-tumorigenic & anti-metastatic properties of salinomycin In vitro Zebrafish model Preclinical mouse model Migration Vehicle Sali ventral dorsal ventral dorsal vehicle 0.1 µm 1 µm Salinomycin (µm) vehicle Salinomycin Clonogenicity vehicle Salino mycin vehicle 0.1 µm 1 µm Salinomycin (µm) vehicle Salinomycin

21 patient-tumor slices cultured ex vivo Patient-derived Tumor material Treat tumor pieces with compound Fix, embed, cut, stain & analyze,

22 Patient-derived prostate cancer slices cultured ex vivo Vehicle Salinomycin(10µM) Cytokeratin-8 DAPI Cytokeratin-8 DAPI

23 Dissemination and metastasis of bladder cancer cells Injection site Extravasation

24 10uM 1uM 0.1uM Vehicle Treatment with salinomycin of bladder cancer cells 2 dpi 4 dpi

25 Salinomycin in ex vivo cultured tumor slices from urothelial carcinoma Control Sali 0.1uM Sali 1uM Sali 10uM Pancytokeratin ( DAPI PCNA Collagen

26 Cationic Amphipilic Drugs Acta Psychiatr Scand May;117(5): Lower incidence of cancer in schizophrenia patients Cationic Amphiphilic Drugs (CADs) often used as anti-depressants/psychotics Known to induce lysosomal cell-death Catts VS et al 2008, Mortensen PB 1989, Dalton et al 2006, Petersen et al. 2013

27 Bladder cancer orthotopic in vivo xenograft model Day 0 Inoculation UMUC3 luc2 cells Day 3 BLI Treatment penfluridole /vehicle Day 9 BLI Treatment penfluridole/ vehicle Day 13 BLI Day 16 BLI Day 20 BLI histology Nude BalbC mouse vehicle penfluridole 100µM Lungs Kidney and ureter Uterus and ovaries Liver Spleen

28 High grade papillary urothelial cell carcinoma with invasion in stroma. (Non muscle invasive) Day 3 Day 7 vehicle 10uM penfluridol 50uM penfluridol Pancytokeratin DAPI Collagen

29 Sunmary & Conclusions Each disease model has specific intrinsic limitations lack of functioning immune system (PDX, xenografting) lack of cellular and extracellular stroma (cell cultures, organoids) species differences (mice, zebrafish..) etc. weaknesses can be exploited for the study of mechanisms of tumor progression & the identification of novel therapeutic targets! Clinical validation of preclinical findings in human tissues facilitates clinical translation

30 Acknowledgements LUMC dept. Urology Geertje van der Horst Marjan van de Merbel Jeroen Buijs Eugenio Zoni Jan Kroon Federico La Manna Maaike van der Mark Rob Bevers Rob Pelger IRST-Meldola, Italy Laura Mercatali Toni Ibrahim EMC, Rotterdam, The Netherlands Dept. of Pathology Ellen Zwarthoff Dept. Urology Wytske van Weerden Chris Bangma Radboud MC Dept. Exp. Urology Onno van Hooij Tilly Aalders Jack Schalken Univ. of Utrecht Dept. Pharmaceutics Gert Storm Bart Metselaar Univ. of Berne Dept. Urology Switzerland Janine Hensel Marianna de Julio George Thalmann Marco Cecchini IBL, Leiden, The Netherlands Institute of Biology Lanpeng Chen Ewa Snaar-Jagalska