The clinical relevance of circulating, cell-free and exosomal micrornas as biomarkers for gynecological tumors

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1 Department of Tumor Biology The clinical relevance of circulating, cell-free and exosomal micrornas as biomarkers for gynecological tumors cfdna Copenhagen April 6-7, 2017 Heidi Schwarzenbach, PhD

2 Tumor cells release their nucleic acids into the blood circulation Schwarzenbach et al., Nat Rev Cancer 2011

3 Postoperative tumor rest contributes to the increased serum levels of circulating DNA in ovarian cancer patients Wimberger Schwarzenbach, Int J Cancer, 2011

4 Cell-free DNA circulates as nucleosomes in the blood of breast cancer patients Roth Schwarzenbach, BMC Cancer 2011

5 The elevated serum levels of circulating nucleosomes in breast cancer patients are caused by caspases 3 and 7 which are involved in the apoptosis of tumor cells Apoptosis DNA Fragmentation Roth Schwarzenbach, BMC Cancer 2011 DNases

6 Increased serum levels of circulating protease activities in breast cancer patients at advanced tumor stages or with metastasis Roth Schwarzenbach, BMC Cancer 2011

7 Association of increased serum levels of circulating protease activities with disseminated tumor cells in bone marrow of ovarian cancer patients Wimberger, Schwarzenbach, Int J Cancer, 2011 Degradation of the extracellular matrix by proteases supports the dissemination of tumor cells.

8 MicroRNAs Non-coding RNA molecules of ~22 nucleotides Binding to hundreds of different mrnas resulting in the regulation of various signal pathways Apoptosis, cell differentiation, neural development, tumorigenesis, metastasis Frequent location in fragile chromosomal regions exhibiting amplifications, deletions or translocations Translational inhibition mrna-degradation protein expression Degraded mrnas

9 microrna expression profile in the plasma of breast cancer patients Breast cancer patients vs. healthy women micrornas Median fold change P-Values mir-27a mir mir-130a mir Stückrath Schwarzenbach, Oncotarget 2015

10 Increased plasma levels of mir-130a in HER2-positive and lymph node-negative breast cancer patients, and their effect on cell proliferation p=0.006 p=0.001 p=0.027 p=0.001 Stückrath Schwarzenbach, Oncotarget 2015

11 Decreased serum levels of mir-155 in metastatic breast cancer patients and their epigenetic regulation p= mir-155 expression Treatment of breast cancer cells with the demethylation agent 5-aza-desoxycytidine and the histone deacetylase inhibitor TSA increased the expression of mir-155, but TSA could not further stimulate the 5-aza-desoxycytidine mediated upregulation of mir-155. Eichelser Schwarzenbach, Clin Chem 2013

12 Serum PTEN-targeting mir-214 discriminates malignant from benign breast tumors (n = 53) (n = 32) (n = 102) MiR-214 targets the tumor suppressor PTEN which controls the phosphoinositide 3-kinase signaling pathway The upregulated, preoperative levels of mir-214 significantly decreases in the postoperative serum. Schwarzenbach et al. Breast Cancer Res Treat. 2012

13 Increased serum levels of mir-21, mir-210 and mir-373 in HER2-positive breast cancer patients undergoing neoadjuvant therapy combined with either trastuzumab or lapatinib before after Neoadjuvant Therapy mir-21 mir-21 Relative microrna levels mir-210 mir-373 mir-210 mir-373 Healthy Breast Cancer Healthy Beast Cancer Müller Schwarzenbach, Breast Cancer Res Treat 2014

14 Changes in the serum levels of mir-21, mir-210 and mir-373 in HER2- positive breast cancer patients undergoing neoadjuvant therapy combined with either trastuzumab or lapatinib Relative microrna levels mir-21 mir-210 mir-373 before after Neoadjuvant Therapy before after Neoadjuvant Therapy before after Neoadjuvant Therapy Müller Schwarzenbach, Breast Cancer Res Treat 2014

15 Higher serum levels of cell-free mir-21 are associated with a shorter overall survival of HER2-positive breast cancer patients before and after neoadjuvant therapy Survival Probability Survival Probability Time (months) Time (months) Müller Schwarzenbach, Breast Cancer Res Treat 2014

16 Elevated serum concentrations of cell-free mir-429 are associated with FIGO stages, tumor rest and tumor marker CA125 values in ovarian cancer patients p= p=0.001 p=0.005 p=0.03 r= FIGO I: Tumor limited to the ovaries FIGO II: Tumor involves ovaries with pelvic extension FIGO III: Tumor involves ovaries with peritoneal metastasis outside the pelvis FIGO: IV: Distant metastasis Meng Schwarzenbach, Brit. J. Cancer 2015

17 Higher serum levels of circulating, cell-free mir-429 predict poor overall survival in ovarian cancer patients p=0.011 Survival Probability below median above median Time (months) Meng Schwarzenbach, Brit. J. Cancer 2015

18 Mechanisms of release of micrornas into the blood circulation Cell-free micrornas incorporated in apoptotic bodies Schwarzenbach et al., Nat. Rev. Clin. Oncol. 2014

19 Elevated serum levels of exosomes in ovarian cancer patients Ovarian Cancer Western Blot Mucin1 CD63 CD9 Schwarzenbach, Expert Rev Mol Diagn. 2015

20 Exosomes visualized by FISH Cell nucleus was stained by DAPI Exosomes were stained by Exo-Red

21 Predominant circulation of exosomal micrornas in the blood of breast cancer patients Relative microrna concentrations p=0.021 mir-101 mir-372 mir-373 Eichelser Schwarzenbach, Oncotarget, 2014

22 Increased levels of exosomal mir-373 in the serum of estrogen receptor-negative breast cancer patients Relative mir-373 concentrations p=0.006 p=0.001 Cell-free p=0.001 p=0.021 Exosomal 70kDa 70kDa Downregulation of the estrogen receptor by mir-373. plasmid mir-373 Basal empty mir-373 mimic inhibitor ER HSC70 Eichelser Schwarzenbach, Oncotarget, 2014

23 mir-373 inhibits the apoptosis of MCF-7 cells mediated by camptothecin Control mir-373 +Camptothecin mir-373 +Camptothecin MCF-7 cells transfected with mir-373 and treated with the topoisomerase I inhibitor camptothecin. Camptothecin, which is used in cancer chemotherapy, induces apoptosis. Eichelser Schwarzenbach, Oncotarget, 2014

24 Diagnostic relevance of exosomal mir-373, mir-200a, mir-200b and mir-200c in the serum of ovarian cancer patients Relative exosomal mirna concentrations p=0.003 p=0.004 p=0.033 p=0.004 mir-373 mir-200a mir-200b mir-200c The serum levels of exosomal mir-373 and mir-200a are upregulated in lymph node-negative (N0) and -positive (N1) patients. The serum levels of exosomal mir-200b and mir-200c differentiate between lymph node-negative (N0) and -positive (N1) patients. Meng Schwarzenbach, Oncotarget 2016

25 Relative exosomal mirna concentrations Diagnostic relevance of exosomal mir-373, mir-200a, mir- 200b and mir-200c in the serum of ovarian cancer patients **** *** * ** ** *** *** mir-373 mir-200a mir-200b mir-200c * *** *** *** * p ** p=0.002 *** The serum levels of exosomal mir- 373 and mir-200a are increased in all FIGO stages. The serum levels of exosomal mir- 200b and mir-200c differentiate between FIGO I-III and FIGO IV. FIGO I: Tumor limited to the ovaries FIGO II: Tumor involves ovaries with pelvic extension FIGO III: Tumor involves ovaries with peritoneal metastasis outside the pelvis FIGO: IV: Distant metastasis

26 The serum levels of exosomal mir-200b and mir-200c correlate with the tumor marker CA125 values in ovarian cancer patients mir-200a r=0.203 p=0.076 mir-200b r=0.438 mir-200c r= a 200b 200c Meng Schwarzenbach, Oncotarget 2016

27 Higher serum levels of exosomal mir-200b and mir-200c predict poor overall survival in ovarian cancer patients mir-200a mir-200b mir-200c Survival Probability p=0.22 below median above median Survival Probability p=0.007 below median above median Survival Probability p=0.017 below median above median Time (months) Time (months) Time (months) Meng Schwarzenbach, Oncotarget 2016

28 Conclusion Deregulation of cell-free and exosomal micrornas in the blood of breast and ovarian cancer patients. Diagnostic and prognostic relevance of cell-free and exosomal micrornas in the blood of breast and ovarian cancer patients. Changes in the serum levels of cell-free micrornas in HER2- positive breast cancer patients undergoing neoadjuvant therapy Predominant circulation of micrornas in exosomes in the blood of breast cancer patients. Correlations of serum concentrations of micrornas with tumor marker CA125, tumor stage, tumor rest and receptor status. Associations of micrornas with apoptosis and proliferation in cancer cell lines.

29 Conclusion A promising new class of potential liquid biomarkers. Extraction of micrornas from exosomes derived from blood plasma and serum in real-time. Screening of these micrornas provides information about the deregulated signaling pathways that can be blocked by a targeted therapy. Quantification of micrornas can facilitate decisions in the treatment of cancer patients. Schwarzenbach, Exp Rev Diagn 2014

30 Acknowledgments Dr. Carina Roth Dr. Xiaodan Meng Dr. Isabel Stückrath Dr. Corinna Eichelser Bettina Steinbach Prof. Klaus Pantel (University Medical Center Hamburg-Eppendorf, Germany) Prof. Dr. Volkmar Müller (University Medical Center Hamburg-Eppendorf, Germany) Prof. Dr. Wolfgang Janni (Heinrich Heine University, Düsseldorf, Germany) Erich und Gertrud Roggenbuck-Stiftung zur Förderung der Krebsforschung Dr. Brigitte Rack (Ludwig Maximilians University of Munich, Germany)

31 Thanks for your attention A long way to cure cancer Hamburg, Germany