Metastatic breast cancer stem cells

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1 Metastatic breast cancer stem cells Christophe GINESTIER, PhD Centre de Recherche en Cancérologie de Marseille Laboratoire d Oncologie Moléculaire Breast Stem Cell Group U168/Inserm/Institut Paoli-Calmettes Marseille

2 Different step of the breast carcinogenesis Normal breast epithelium Preneoplasia Carcinoma in situ Invasive Carcinoma Metastasis Initiation of carcinogenesis Screening and Prevention BRCA1 regulates human mammary stem/progenitor cell fate (Liu, Ginestier et al. PNAS, 28) Diagnostic and Treatment

3 ALDEFLUOR + cells BAAA ALDH DEAB With DEAB Without DEAB 6%

4 ALDEFLUOR+ population and tumorigenicity With DEAB Without DEAB ALDEFLUOR- ALDEFLUOR+ R1 R2 R1 R2 5% to 1% of ALDEFLUOR + population in Breast tumors ALDEFLUOR- 5, cells 5 cells 5 cells ALDEFLUOR+ 5, cells 5 cells 5 cells ALDEFLUOR 5, cells ALDEFLUOR + 5 cells Ginestier et al. Cell stem cell, 27

5 ALDEFLUOR+ population and tumorigenicity ALDEFLUOR - ALDEFLUOR + ALDEFLUOR+ population regenerates heterogeneity of the initial tumor Ginestier et al. Cell stem cell, 27

6 Cancer stem cells and metastasis

7 Cell invasion assay ALDEFLUOR-positive or ALDEFLUOR-negative matrigel DMEM with 1% human serum

8 Cell invasion assay Number of total cells invaded/ 1, cells plated ALDEFLUOR-positive ALDEFLUOR-negative SUM-149 HCC1954 SUM-159 MDAMB 453 MDAMB 436 BRCAMZ 1

9 Intracardiac injections Lentivirus expressing Luciferase R1 R2

10 Intracardiac injections Normalized photon flux , ALDELFUOR-positive 1, ALDEFLUOR-negative 1, Unseparated Weeks Weeks after injections ALDEFLUOR+ (1k) ALDEFLUOR- (1K) Unsorted (1K) Normalized photon flux , ALDELFUOR-positive 5, ALDEFLUOR-negative 5, Unseparated Weeks after injection

11 Invasive Carcinoma Metastasis Anti-CSC therapy Conventional therapy

12 Breast Cancer Stem Cell Gene Expression Signature 8 Breast cell lines 184a1 HCC1954 SUM149 SUM159 MDAMB453 MDAMB231 BrCa-MZ-1 BrCa-MZ-1 SUM149 SKBR7 SKBR7 184a1 SUM159 HCC1954 MDAMB453 MDAMB genes breast cancer stem cell signature 33 genes overexpressed in the ALDEFLUOR-positive populations 184a1 HCC1954 SUM149 SUM159 MDAMB453 MDAMB231 BrCaMZ1 SKBR7 184a1 HCC1954 SUM149 SUM159 MDAMB453 MDAMB231 BrCaMZ1 SKBR7 38 genes overexpressed in the ALDEFLUOR-negative populations

13 Breast Cancer Stem Cell Gene Expression Signature Genes up-regulated in ALDEFLUOR-positive populations Role in stem cell biology Cell Signaling Membrane protein DNA repair/ Chromatin remodeling Unknown NOTCH2 NFYA TPRXL RBM15 PCNX FBXO21 CAMK2B ADRBK1 UGCCL1 CXCR1 CD3LB GIPC3 TAS2R14 RAD51 ARID1B ZFP41 FAM49B PSORS1C2 184a1 HCC1954 SUM149 SUM159 MDAMB453 MDAMB231 BrCa-MZ-1 BrCa-MZ-1 SUM149 SKBR7 SKBR7 184a1 SUM159 HCC1954 MDAMB453 MDAMB231 Genes up-regulated in ALDEFLUOR-negative populations ALG5 HBLD2 GART DC2 COMMD6 UBL5 MRPL41 PDCD1 PDCD5 NACA ATP5S NDUFA2 ATP5J2 IMMP1L CCNL1 PRPF39 LSM3 SFRS7 PRPF4B Cell Signaling Apoptosis Differentiation Oxidative phosphorylation RNA splicing Charafe-Jauffret et al., Cancer Research, 29

14 CXCR1/IL8RA CXCR1 is a receptor for Interleukin-8 involves in the recruitment of leukocytes to sites of inflammation CXCR1 is increased in variety of cancers including breast cancer CXCR1/IL-8 promotes: Tumor cells motility/metastasis Tumor cells proliferation Repertaxin a small molecule inhibitor of IL8 signaling Repertaxin CXCR1/IL8RA CXCR2/IL8RB

15 Effect of Repertaxin treatment on cancer cells survival Xenotransplantation Repertaxin 4mm 28 days Tumor size % Cancer stem cells Tumor size (mm) Control Repertaxin Docetaxel Repertaxin/Docetaxel Days after injection ALDEFLUOR-positive population (%) Control Repertaxin Docetaxel ertaxin/docetaxel Tumor size (mm) Control Repertaxin Docetaxel Repertaxin/Docetaxel 1, 1, 1 1, 1, 1 Number of cells injected Ginestier et al. JCI, 21

16 IL-8 induces invasion of breast CSC ALDEFLUOR IL HCC1954 MDA-MB-453 SUM159 Charafe-Jauffret et al., Cancer Research, 29

17 Effect of CXCR1 blockade on metastasis formation Ginestier et al. JCI, 21 Normalized Photon Flux SUM159 Control Repertaxin Weeks after injection Control Repertaxin Normalized Photon Flux HCC1954 Control Repertaxin Weeks after injection Control Repertaxin

18 Patient-derived xenograft (PDX) Primary Tumor «Clearing» Dissociation + Matrigel Tumoral growth monitoring b-oestradiol Passages Time from birth (weeks) Human fibroblasts Humanization

19 Xenobank > 2 Primary tumor injections > 5 established PDXs

20 PDX retains histological/molecular features of corresponding primary tumors CRCM 224 PT HES ER PR ERBB2 CRCM 224X HES ER PR ERBB2

21 25% engrafment rate Metastasis-free survival metastasis-free survival LogRank p =.352 p=.352 Grp 1 : N=35, 3-Year survival = 96%, 95%CI = [.88-1] Grp 2 : 1 N=18, 3-Year survival = 66%, 95%CI = [ ] PT non-engrafter PT engrafter Months after Months surgery Proportion of tumor outgrowth Prise (%) p=.5 GRD SBR Grade Days Days after PT implantation III II I Proportion of tumor outgrowth Prise (%) ALDH1 p=.7e-5 ALDH1+ ALDH1+ ALDH1- ALDH LogRank p = Days 1.e-5 Grp 1 : N=29, 5-Year survival = 1%, 95%CI = [1-1] Days after PT implantation Variable Hazard ratio (95% CI) p-value ER.78 [ ],66 PR.67 [ ],45 SBR Grade 2.94 [ ] 4,6E-2 KI [ ],61 ALDH [ ] 3,2E-2 Charafe-Jauffret et al., Submitted

22 PDX model for metastasis study Xenograft removal Lentiviral infection Mammary fat pad implantation GFP + Xenograft removal Mammary fat pad implantation GFP+ Cell sorting Xenograft removal Bioluminescent imaging

23 C V Fo Ce Po Ra Re Ut TD Co Th poumons 11% rein,6% rate,2% uterus 8% tube digestif 14% ganglion 44% pancréas 22% CRCM389X CRCM318X foie 11% uterus 4% cerveau 2% tube digestif 11% os 72% Ce Fo Ut Po Pa Re Ra TD Co TD Fo Co Ra Re Ut Ce Po Pa Gg CRCM341X Metastatic patterns Bone Liver Brain Uterus Digestive tract Lymph node Pancreas Lung Uterus Digestive tract poumons 1% Lung

24 * T412 (5 mice) Lung Mets-enriched 1 75 T318 (3 mice, 1 to come) Lymph node Mets-enriched * * * Bone Genital tract Bone Genital tract GI tract GI tract Liver Liver Lung Lung * * Brain Brain Kidney Kidney Spleen Spleen Heart Lymph Node Heart Lymph Node Pancreas T434 (5 mice, 2 to come) Lung Mets-reduced Adrenal Gland Pancreas Adrenal Gland T389 (6 mice) Lung Mets-enriched Brain Mets-reduced Bone Bone Genital tract Genital tract GI tract GI tract Liver * * Liver Lung Lung * * Brain Brain Kidney * * * Kidney Spleen Spleen Heart Heart Lymph Node Lymph Node Pancreas T341 (7 mice) Liver Mets-enriched Brain Mets-enriched Pancreas Adrenal Gland T226 (3 mice, 2 to come) Liver Mets-enriched Lung Mets-enriched Adrenal Gland 25 Bone Genital tract GI tract Liver Lung Brain ** Kidney Spleen Heart Lymph Node Pancreas Adrenal Gland 25 Bone Genital tract GI tract Liver Lung Brain Kidney Spleen Heart Lymph Node Pancreas Adrenal Gland

25 Daniel BIRNBAUM Emmanuelle CHARAFE-JAUFFRET Marion SALVADOR Simon LAUNAY Rita EL HELOU Julien WICINSKI Olivier CABAUD Emmanuelle JOSSELIN François BERTUCCI Nathalie CERVERA Pascal FINETTI J-F Saunière University of Michigan Max WICHA Gabriela DONTU Suling LIU Hasan KORKAYA Marc DIEBEL Mofitt Cancer center Said Sebti IRIS Stephane Depil Helene Lelièvre Laurence Kraus-Berthier