Abstract
Cholangiocarcinoma (CCA) is an aggressive cancer with high resistance to chemotherapeutics. CCA is enriched in cancer stem cells, which correlate with aggressiveness and prognosis. FXR, a member of the metabolic nuclear receptor family, is markedly down-regulated in human CCA. Our aim was to evaluate, in primary cultures of human intrahepatic CCA (iCCA), the effects of the FXR agonist obeticholic acid (OCA), a semisynthetic bile acid derivative, on their cancerogenic potential. Primary human iCCA cell cultures were prepared from surgical specimens of mucinous or mixed iCCA subtypes. Increasing concentrations (0–2.5 μM) of OCA were added to culture media and, after 3–10 days, effects on proliferation (MTS assay, cell population doubling time), apoptosis (annexin V-FITC/propidium iodide), cell migration and invasion (wound healing response and Matrigel invasion assay), and cancerogenic potential (spheroid formation, clonogenic assay, colony formation capacity) were evaluated. Results: FXR gene expression was downregulated (RT-qPCR) in iCCA cells vs normal human biliary tree stem cells (p < 0.05) and in mucinous iCCA vs mixed iCCA cells (p < 0.05) but was upregulated by addition of OCA. OCA significantly (p < 0.05) inhibited proliferation of both mucinous and mixed iCCA cells, starting at a concentration as low as 0.05 μM. Also, CDCA (but not UDCA) inhibited cell proliferation, although to a much lower extent than OCA, consistent with its different affinity for FXR. OCA significantly induced apoptosis of both iCCA subtypes and decreased their in vitro cancerogenic potential, as evaluated by impairment of colony and spheroid formation capacity and delayed wound healing and Matrigel invasion. In general, these effects were more evident in mixed than mucinous iCCA cells. When tested together with Gemcitabine and Cisplatin, OCA potentiated the anti-proliferative and pro-apoptotic effects of these chemotherapeutics, but mainly in mixed iCCA cells. OCA abolished the capacity of both mucinous and mixed iCCA cells to form colonies when administered together with Gemcitabine and Cisplatin. In subcutaneous xenografts of mixed iCCA cells, OCA alone or combined with Gemcitabine or Cisplatin markedly reduced the tumor size after 5 weeks of treatment by inducing necrosis of tumor mass and inhibiting cell proliferation. In conclusion, FXR is down-regulated in iCCA cells, and its activation by OCA results in anti-cancerogenic effects against mucinous and mixed iCCA cells, both in vitro and in vivo. The effects of OCA predominated in mixed iCCA cells, consistent with the lower aggressiveness and the higher FXR expression in this CCA subtype. These results, showing the FXR-mediated capacity of OCA to inhibit cholangiocarcinogenesis, represent the basis for testing OCA in clinical trials of CCA patients.
Highlights
Intrahepatic cholangiocarcinoma is a cancer with both a poor prognosis and increasing incidence worldwide [1]. iCCA includes two different histological subtypes: the large bile duct type iCCAs, and the small bile duct type iCCAs, where areas of hepatocytic differentiation and neoplastic ductular reaction are present within the tumor mass [2]
Other than the typical features associated with chemoresistance, e.g. high expression of MDR proteins, which characterize this tumor, we have recently demonstrated that cancer stem cells (CSC) are highly represented in iCCAs in association with cells expressing epithelial/mesenchymal transition (EMT) traits [3]
Obeticholic acid inhibits the cancerogenic potential of human cholangiocarcinoma combinations
Summary
Intrahepatic cholangiocarcinoma (iCCA) is a cancer with both a poor prognosis and increasing incidence worldwide [1]. iCCA includes two different histological subtypes: the large bile duct type (mucinous) iCCAs, and the small bile duct type (mixed) iCCAs, where areas of hepatocytic differentiation and neoplastic ductular reaction are present within the tumor mass [2]. Other than the typical features associated with chemoresistance, e.g. high expression of MDR proteins, which characterize this tumor, we have recently demonstrated that cancer stem cells (CSC) are highly represented in iCCAs in association with cells expressing epithelial/mesenchymal transition (EMT) traits [3]. These features have been associated with aggressiveness, chemo-resistance and a dismal prognosis of iCCA [3]. The proliferation of hepatocytes and intestinal cells and the differentiation of stem cells into adult cells of the hepatocyte or intestinal lineages have been recently demonstrated to be directly regulated by FXR [8, 10, 11]
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