Breast Circulating Tumor Cells Research Articles

Epithelial and mesenchymal phenotypes determine the dynamics of circulating breast tumor cells in microfluidic capillaries under chemotherapy-induced stress.

Circulating tumor cells (CTCs) with different epithelial and mesenchymal phenotypes play distinct roles in the metastatic cascade. However, the influence of their phenotypic traits and chemotherapy on their transit and retention within capillaries remains unclear. To explore this, we developed a microfluidic device comprising 216 microchannels of different widths from 5 to 16 μm to mimic capillaries. This platform allowed us to study the behaviors of human breast cancer epithelial MCF-7 and mesenchymal MDA-MB-231 cells through microchannels under chemotherapy-induced stress. Our results revealed that when the cell diameter to microchannel width ratio exceeded 1.2, MCF-7 cells exhibited higher transit percentages than MDA-MB-231 cells under a flow rate of 0.13 mm/s. Tamoxifen (250 nM) reduced the transit percentage of MCF-7 cells, whereas 100 nM paclitaxel decreased transit percentages for both cell types. These differential responses were partially due to altered cell stiffness following drug treatments. When cells were entrapped at microchannel entrances, tamoxifen, paclitaxel, and high-flow stress (0.5 mm/s) induced a reduction in mitochondrial membrane potential (MMP) in MCF-7 cells. Tamoxifen treatment also elevated reactive oxygen species (ROS) levels in MCF-7 cells. Conversely, MMP and ROS levels in entrapped MDA-MB-231 cells remained unaffected. Consequently, the viability and proliferation of entrapped MCF-7 cells declined under these chemical and physical stress conditions. Our findings emphasize that phenotypically distinct CTCs may undergo selective filtration and exhibit varied responses to chemotherapy in capillaries, thereby impacting cancer metastasis outcomes. This highlights the importance of considering both cell phenotype and drug response to improve treatment strategies.

Modeling the novel SERD elacestrant in cultured fulvestrant-refractory HR-positive breast circulating tumor cells

PurposeMetastatic hormone receptor-positive (HR+) breast cancer initially responds to serial courses of endocrine therapy, but ultimately becomes refractory. Elacestrant, a new generation FDA-approved oral selective estrogen receptor degrader (SERD) and antagonist, has demonstrated efficacy in a subset of women with advanced HR+breast cancer, but there are few patient-derived models to characterize its effect in advanced cancers with diverse treatment histories and acquired mutations.MethodsWe analyzed clinical outcomes with elacestrant, compared with endocrine therapy, among women who had previously been treated with a fulvestrant-containing regimen from the recent phase 3 EMERALD Study. We further modeled sensitivity to elacestrant, compared with the currently approved SERD, fulvestrant in patient-derived xenograft (PDX) models and cultured circulating tumor cells (CTCs).ResultsAnalysis of the subset of breast cancer patients enrolled in the EMERALD study who had previously received a fulvestrant-containing regimen indicates that they had better progression-free survival with elacestrant than with standard-of-care endocrine therapy, a finding that was independent estrogen receptor (ESR1) gene mutations. We modeled elacestrant responsiveness using patient-derived xenograft (PDX) models and in ex vivo cultured CTCs derived from patients with HR+breast cancer extensively treated with multiple endocrine therapies, including fulvestrant. Both CTCs and PDX models are refractory to fulvestrant but sensitive to elacestrant, independent of mutations in ESR1 and Phosphatidylinositol-4,5-Bisphosphate 3-Kinase Catalytic Subunit Alpha (PIK3CA) genes.ConclusionElacestrant retains efficacy in breast cancer cells that have acquired resistance to currently available ER targeting therapies. Elacestrant may be an option for patients with HR+/HER2- breast cancer whose disease progressed on fulvestrant in the metastatic setting.Translational Relevance.Serial endocrine therapy is the mainstay of management for metastatic HR+breast cancer, but acquisition of drug resistance highlights the need for better therapies. Elacestrant is a recently FDA-approved novel oral selective estrogen receptor degrader (SERD), with demonstrated efficacy in the EMERALD phase 3 clinical trial of refractory HR+breast cancer. Subgroup analysis of the EMERALD clinical trial identifies clinical benefit with elacestrant in patients who had received prior fulvestrant independent of the mutational status of the ESR1 gene, supporting its potential utility in treating refractory HR+breast cancer. Here, we use pre-clinical models, including ex vivo cultures of circulating tumor cells and patient-derived xenografts, to demonstrate the efficacy of elacestrant in breast cancer cells with acquired resistance to fulvestrant.

Shear stress regulates the migration of suspended breast cancer cells by nuclear lamina protein A/C and large tumor suppressor through yes-associated protein.

Breast cancer is life threatening among women because its migration by hematogenous metastasis, where, besides biochemical cues, breast circulating tumor cells (CTCs) expose to suspension state and shear stress. However, the combined effects of these mechanical factors on CTCs migration were unclear. Here, suspension state and shear stress were loaded to breast tumor cells (BTCs) to mimic two mechanical cues in the mechanical environment of breast CTCs and the mechanobiological mechanism of suspension state and shear stress regulating the migration of (BTCs) was investigated. The migration and nuclear lamina protein A/C (Lamin A/C) accumulation were enhanced in MDA-MB-231 and SK-BR-3 BTCs exposed to shear stress though lower than that of suspended cells with different yes-associated protein (YAP) subcellular localization. Knockdown of LMNA downregulated and upregulated YAP targets in suspended BTCs and BTCs exposed to shear stress, respectively, which inhibited MDA-MB-231 BTCs migration in vitro and in vivo. Large tumor suppressor (LATS) responded to suspension state and shear stress, knockdown of which decreased the migration of MDA-MB-231 BTCs. These findings uncover the mechanobiological mechanism that suspension state and shear stress antagonistically promote BTCs migration by Lamin A/C and LATS through YAP and the potential for targeting YAP in CTCs prognosis. Shear stress regulates suspended breast cancer cells migration by Lamin A/C and LATS through YAP.

Differential Expression of Blood Group Precursor Antigen in Human Breast Cancer Tissue.

There is a pressing need for biomarkers for targeted immunotherapy against breast cancer (BCA), the leading cause of cancer death in women. Previously, a blood group precursor O-core epitope gpCl was found to be highly expressed in breast circulating tumor cells (BCTCs) and BCA cell lines with cancer stem cell (BCSC) features. In this pilot study, the breast tissue distribution of gpC1 was examined using tissue microarrays (TMAs). Notably, gpC1 positive cells were detected in the major histological types of neoplastic breast tissues. Conversely, none of the breast tissues derived from subjects without BCA were gpC1 positive. Thus, gpC1 expression seems to be tumor-specific but not histological type-dependent, reflecting perhaps its characteristics as a conserved epitope of oncofetal blood group precursor antigens.

Integrative Analysis and Machine Learning based Characterization of Single Circulating Tumor Cells.

We collated publicly available single-cell expression profiles of circulating tumor cells (CTCs) and showed that CTCs across cancers lie on a near-perfect continuum of epithelial to mesenchymal (EMT) transition. Integrative analysis of CTC transcriptomes also highlighted the inverse gene expression pattern between PD-L1 and MHC, which is implicated in cancer immunotherapy. We used the CTCs expression profiles in tandem with publicly available peripheral blood mononuclear cell (PBMC) transcriptomes to train a classifier that accurately recognizes CTCs of diverse phenotype. Further, we used this classifier to validate circulating breast tumor cells captured using a newly developed microfluidic system for label-free enrichment of CTCs.

Motion microscopy for label-free detection of circulating breast tumor cells

Circulating tumor cells (CTCs) are cancer cells that have been shed from a primary tumor and circulate in the bloodstream during progression of cancer. They may thus serve as circulating biomarkers that can predict, diagnose and guide therapy. Moreover, phenotypic and genotypic analysis of CTCs can facilitate prospective assessment of mutations and enable personalized treatment. A number of methodologies based on biological and physical differences between circulating tumor and non-tumor cells have been developed over the past few years. However, these methods did not have sufficient sensitivity or specificity. In this work, a remote analysis protocol was designed using motion microscopy that amplifies cellular micro motions in a captured video by re-rendering small motions to generate extreme magnified visuals to detect dynamic motions that are not otherwise visible by naked eye. Intriguingly, motion microscopy demonstrated fluctuations around breast tumor cells, which we referred to herein as cellular trail. Phenomena of cellular trail mostly emerged between 0.5 and 1.5 Hz on amplified video images. Interestingly, cellular trails were associated with cell surface proteins and flow rates rather than mitochondrial activity. Moreover, cellular trails were present only around circulating tumor cells from individuals with breast cancer under conditions of 20–30 μm/s and 0.5–1.5 Hz. Thus, motion microscopy based CTC detection method can offer a valuable supplementary diagnostic tool for assessment of drug efficacy and identifying physical characteristics of tumor cells for further research.

Nuclear-Biased DUSP6 Expression is Associated with Cancer Spreading Including Brain Metastasis in Triple-Negative Breast Cancer.

DUSP6 is a dual-specificity phosphatase (DUSP) involved in breast cancer progression, recurrence, and metastasis. DUSP6 is predominantly cytoplasmic in HER2+ primary breast cancer cells, but the expression and subcellular localization of DUSPs, especially DUSP6, in HER2-positive circulating tumor cells (CTCs) is unknown. Here we used the DEPArray system to identify and isolate CTCs from metastatic triple negative breast cancer (TNBC) patients and performed single-cell NanoString analysis to quantify cancer pathway gene expression in HER2-positive and HER2-negative CTC populations. All TNBC patients contained HER2-positive CTCs. HER2-positive CTCs were associated with increased ERK1/ERK2 expression, which are direct DUSP6 targets. DUSP6 protein expression was predominantly nuclear in breast CTCs and the brain metastases but not pleura or lung metastases of TNBC patients. Therefore, nuclear DUSP6 may play a role in the association with cancer spreading in TNBC patients, including brain metastasis.

AMPK-Akt Double-Negative Feedback Loop in Breast Cancer Cells Regulates Their Adaptation to Matrix Deprivation.

Cell detachment from the extracellular matrix triggers anoikis. Disseminated tumor cells must adapt to survive matrix deprivation, while still retaining the ability to attach at secondary sites and reinitiate cell division. In this study, we elucidate mechanisms that enable reversible matrix attachment by breast cancer cells. Matrix deprival triggered AMPK activity and concomitantly inhibited AKT activity by upregulating the Akt phosphatase PHLPP2. The resultant pAMPKhigh/pAktlow state was critical for cell survival in suspension, as PHLPP2 silencing also increased anoikis while impairing autophagy and metastasis. In contrast, matrix reattachment led to Akt-mediated AMPK inactivation via PP2C-α-mediated restoration of the pAkthigh/pAMPKlow state. Clinical specimens of primary and metastatic breast cancer displayed an Akt-associated gene expression signature, whereas circulating breast tumor cells displayed an elevated AMPK-dependent gene expression signature. Our work establishes a double-negative feedback loop between Akt and AMPK to control the switch between matrix-attached and matrix-detached states needed to coordinate cell growth and survival during metastasis.Significance: These findings reveal a molecular switch that regulates cancer cell survival during metastatic dissemination, with the potential to identify targets to prevent metastasis in breast cancer. Cancer Res; 78(6); 1497-510. ©2018 AACR.

Mechanical ventilation promotes lung metastasis in experimental 4T1 breast cancer lung-metastasized models.

Background/purposeThe aim of this study was to test the hypothesis that mechanical ventilation (MV) during cancer surgery induces lung stroma/tissue milieu changes, creating a favorable microenvironment for postoperative lung metastatic tumor establishment.Materials and methodsIn Protocol A, female BALB/c mice were divided into an MV group and a control (no MV) group, both of which were anesthetized and subjected to intravenous injection of green fluorescent protein (GFP)-labeled mouse mammary carcinoma cell line (4T1) cells. After 24 h, the lung tissue was removed and the number of GFP-labeled 4T1 cells was calculated. In Protocol B, the clinically relevant mouse model of spontaneous breast cancer lung metastasis was used with surgical resection of the primary tumor to investigate the MV event that dictates postoperative lung metastasis. Female BALB/c mice were inoculated in the mammary fat pad with 4T1 cells. After 14-d growth, mice were anesthetized and divided into an MV group and a control (no MV) group during surgical procedures (mastectomy). Metastatic tumor burden was assessed two weeks after mastectomy by both macroscopic metastatic nodule count, hematoxylin–eosin histology, immunohistochemistry for the macrophage marker (CD68), and epithelial cell adhesion molecule (EpCAM).ResultsMV was associated with a significant increase in the number of circulating breast tumor cells (GFP-labeled 4T1 cells) remaining in the microvasculature of the lung (P<0.01). Immunohistochemical results showed increased infiltration of CD68-positive macrophages within injured lung parenchyma and metastatic tumor as well as increased expression of EpCAM in metastatic nodules. Postoperative metastases were more prevalent in the mechanically ventilated mice group compared to the non-ventilated group (P<0.05).ConclusionMV-induced lung metastasis occurs by attracting circulating tumor cells to the site of the lung injury and by accelerating the proliferation of preexisting micro-metastases in the lung. These observations indicate that the metastasis-enhancing effect of MV should be considered in general anesthesia during cancer surgery.

Hemodynamic shear flow regulates biophysical characteristics and functions of circulating breast tumor cells reminiscent of brain metastasis.

Tumor cells disseminate to distant organs mainly through blood circulation, where they experience considerable levels of fluid shear flow. However, its influence on circulating tumor cells remains less understood. This study elucidates the effects of hemodynamic shear flow on biophysical properties and functions of breast circulating tumor cells with metastatic preference to brain. Only a small subpopulation of tumor cells are able to survive in shear flow with enhanced anti-apoptosis ability. Compared to untreated cells, surviving tumor cells spread more on soft substrates that mimic brain tissue but less on stiff substrates. They exhibit much lower expression of F-actin and cell stiffness but generate significantly higher cellular contractility. In addition, hemodynamic shear flow upregulates the stemness genes and considerably changes the expression of the genes related to brain metastasis. The enhanced cell spreading on soft substrates, reduced stiffness, elevated cellular contractility, and upregulation of the stemness and brain metastasis genes in tumor cells after shear flow treatment may be related to breast cancer metastasis in soft brain tissues. Our findings thus provide the first piece of evidence that hemodynamic shear flow regulates biophysical properties and functions of circulating tumor cells that are associated with brain metastasis, suggesting that tumor cells surviving in blood shear flow may better reflect the characteristics of organ preference in metastasis.

In vitro selections of mammaglobin A and mammaglobin B aptamers for the recognition of circulating breast tumor cells

Mammaglobin B (MGB2) and mammaglobin A (MGB1) are proteins expressed in metastatic breast cancers. The early detection of circulating tumor cells (CTCs) in breast cancer patients is crucial to decrease mortality rate. Herein, novel aptamers were successfully selected and characterized against MGB2 and MGB1 proteins using a hybrid SELEX approach. The potential use of the selected aptamers in breast CTC detection was studied using spiked breast cancer cells in whole blood lysate. The results obtained from this study showed that the selected aptamers (MAMB1 and MAMA2) bind to their target breast cancer cell lines with high affinity (low nanomolar Kd values) and specificity. They also bind to their free recombinant target proteins and show minimal non-specific binding to normal and other cancer cell lines. Additionally, they were able to distinguish a low number of breast cancer cells spiked in whole blood lysate containing normal blood cells. The results obtained in this study indicate the great potential for the use of aptamers to detect MGB1 and MGB2 protein biomarkers, expressed on the surface of breast CTCs.

Proteolytically Stable Cyclic Decapeptide for Breast Cancer Cell Targeting.

Starting with a previously reported linear breast cancer targeting decapeptide WxEAAYQkFL, here we report the synthesis of a novel cyclic peptide analogue cyclic WXEAAYQkFL. The N- to C-terminus amide cyclized peptide with one d-amino acid (k) displayed higher uptake by breast cancer cells, with minimal uptake by the noncancerous cells compared to the linear peptide with two d-amino acids (x and k), and was stable toward proteolytic degradation. When immobilized on gold microcantilever surface, the cyclic peptide was able to capture breast cancer cells specifically and sense samples with ≥25 cancer cells/mL. Animal studies using mice carrying orthotopic breast MDA-MB-231 tumors showed that the cyclic peptide preferentially accumulates in tumor (2 h after injection) and is rapidly cleared from all other organs except kidneys and liver. The study highlights the discovery of a novel proteolytically stable cyclic peptide that can be used for targeted drug delivery or for enumerating circulating breast tumor cells.

Abstract P1-01-04: Comprehensive genomic characterization of circulating tumor cells (CTCs) in metastatic breast cancer (MBC) sheds light on the biology of blood-borne metastasis

Abstract Background: CTCs offer a relatively non-invasive source of metastatic tissue for molecular analysis. To elucidate the underlying biology of blood-borne metastasis, we profiled CTCs from MBC patients (pts). Methods: CTCs were isolated by IE/FACS (immunomagnetic enrichment/fluorescence-activated cell sorting). Expression of 64 cancer-related genes in CTCs was analyzed via microfluidic-based multiplex QPCR. Genome-wide copy number (CN) analysis by array comparative genomic hybridization (ACGH) was performed on CTCs isolated from the same tumor-enriched blood samples. The Illumina platform was utilized for next generation sequencing and data was analyzed using NantOmics analysis pipeline and Nexus 8.0 software. Mutations were confirmed by Sanger sequencing or by digital droplet PCR. Results: Expression profiles of CTCs from 105 MBC pts clustered away from those of blood, indicating high-purity isolation of CTCs by IE/FACS. In addition to EPCAM, tumor-related genes, e.g., CCND1, MUC1, and TTF3 were upregulated in CTCs. Approximately 70% of the CTC samples were considered ER-positive, of which 47% were ER+HER2+, and 22% ER+HER2-. Among the ER+HER2- samples, about two-thirds (68%) had low proliferative (MKI67) status. HER2-positive and triple-negative CTCs accounted for 27% and 30% of the samples, respectively. Furthermore, 30% of the samples were assigned to luminal A, 6% to luminal B, 13% to Her2-enriched, 33% to basal-like, and 12% to normal-like subtypes. Expression profiling of CTCs in 74 serial blood samples from 28 pts showed fluctuations in expression at the gene-level, while subtype calls were mostly consistent across time points. CTCs from 49 of the 105 pts analyzed by ACGH revealed numerous genomic aberrations such as 1q/8q gains and 8p/16q losses, consistent with breast cancer origin. CN profiles grouped into three major clusters: CTCs exhibiting low genomic instability, 8q gain, and 1q gain/11q loss. ERBB2 and CCND1 were upregulated in CTCs showing increased genomic alterations. Changes in ER (n=102) and HER2 (n=130) status between CTCs and matched primary tumors (PT) were observed in 27% and 23% of the pts, respectively, indicating that biomarker status may change during disease progression. Comparative analysis of CN data from low-pass whole genome sequencing (WGS) of CTCs vs. matched PTs (n=7 pairs) demonstrated clonal-relatedness as well as some genetic divergence. WGS (38x) and whole exome sequencing (140x) analysis of CTCs from an index pt diagnosed with invasive lobular carcinoma detected numerous genomic aberrations, including a copy loss and a frameshift mutation in E-cadherin (CDH1). Interestingly, analysis of CN and mutation data revealed that CTCs were more closely related to the lymph node metastases than to the PT. Single-cell sequencing of CTCs revealed uniformity in genome-wide CN alterations, while cell-to-cell heterogeneity was observed only when single-cell expression profiles were analyzed. Conclusions: Comprehensive molecular characterization provided novel insights into the biology of breast CTCs. Further CTC profiling may open avenues for discovery and development of novel biomarkers for personalized medicine and strategies to prevent metastasis. Citation Format: Magbanua MJ, Hauranieh L, Roy R, Wolf D, Benz S, Vaske C, Pendyala P, Sosa E, Scott J, Lee JS, Ordonez A, Ho B, Solanki T, VantVeer L, Rugo H, Park J. Comprehensive genomic characterization of circulating tumor cells (CTCs) in metastatic breast cancer (MBC) sheds light on the biology of blood-borne metastasis [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-01-04.

Abstract P1-01-18: A multiplexed immunofluorescence identifies phenotypic heterogeneity of circulating tumor cells in breast cancer

Abstract Introduction: Circulating Tumor Cells (CTCs) have attracted significant attention as a new class of "liquid biopsy", enabling longitudinal and non-invasive disease monitoring to capture an overall snapshot of individual disease. Primary breast tumors are highly heterogeneous due to their genetic instability. Thus, the presence of heterogeneous populations of CTCs is expected. A number of attempts have been made to address CTC's phenotypic heterogeneity using different methods and approaches. For comprehensive understanding of distinct CTC phenotypes, transcriptomic and cell surface marker studies using single cell analysis separated CTCs into different subgroups with epithelial-, mesenchymal-, and stem-like signatures. These studies concluded that the prevalence of stem-like CTCs is associated with poor prognosis. Immunofluorescence is an ideal approach to understand the heterogeneity of 3 - 4 markers in a large number of distinct CTCs; however, such approach does not address the presence of overlapping phenotypic signatures. The collection method of CTCs adds another layer of complexity since the most commonly adopted CTC enumeration strategy relies on affinity-based selection using antibody against EpCAM, which, although abundantly expressed on epithelial cancer cells, automatically eliminates a large fraction of non-epithelial CTCs. To better understand the whole landscape of this heterogeneous disease, the use of marker-independent unbiased methods to collect CTCs is critical to obtain the overall landscape of phenotypic heterogeneity. Aim: We aimed to investigate the heterogeneity of breast CTCs on a single cell level using size exclusion- based enrichment principal. Methods: Whole blood was collected from metastatic breast cancer patients under IRB approved protocol. CTCs were isolated on porous membrane (8 µm) under negative pressure (ISET®) from 10 mL of blood. CTCs were fixed on the porous membrane and used for multiplexed immunofluorescence to investigate the expression of epithelial (CK and EPCAM), mesenchymal (Vimentin, Snail and TWIST), and stem-like markers (CD44, ALDH1, and CD133) on CTCs. Results: CTCs were isolated on ISET filter from all subtypes, Stage IV patients. CTCs were identified based on their morphological and phenotypical characteristics with our CTC criteria of size of nucleus ≥16 µm, triple negative for α-smooth muscle actin, fibroblast associated protein, and CD45. The CTCs were further characterized based on their mesenchymal and stem-like signatures to understand their heterogeneity. Conclusions: Multiplex immunofluorescence staining of CTCs collected using the size-based enrichment approach enabled us to identify the heterogeneity of CTCs. The phenotypic heterogeneity represents a corner stone for future studies to identify a subset of CTCs that may be associated with breast cancer patient prognosis. Citation Format: Kamal M, Zhang R, Walker M, Squires R, Talbert B, Dooley W, Razaq W, Tanaka T. A multiplexed immunofluorescence identifies phenotypic heterogeneity of circulating tumor cells in breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-01-18.

Circulating tumor cells in breast cancer: applications in personalized medicine.

Recent technological advancements in rare cell analysis have facilitated the detection of circulating tumor cells (CTCs) in the blood of patients diagnosed with breast and other types of cancers. Numerous clinical studies involving the enumeration of CTCs in breast cancer patients have unequivocally demonstrated the prognostic value of these cells. Evidence from recent molecular studies indicates that CTCs may be potential surrogate markers for systemic disease. As such, real-time assessment of therapeutic biomarkers in breast CTCs, such as the estrogen receptor(ER) and the human epidermal growth factor receptor 2 (HER2), may have a tremendous impact in guiding-targeted cancer therapy. In this review, we discuss the clinical implications of CTC detection and its potential utility for personalized medicine in breast cancer.

Abstract B03: A small-molecule antagonist of CX3CR1 impairs homing and colonization of breast cancer cells in the skeleton

Abstract Therapeutic approaches aimed to prevent breast cancer cells from spreading to distant sites are commonly neglected, based on the indication that dissemination from primary tumors can occur early. However, mounting evidence indicates that cancer cells recirculating from established bone lesions could further seed and colonize both skeleton and soft-tissue organs, thus precipitating metastatic dissemination and accelerating disease progression. We have previously shown that breast circulating tumor cells (CTCs) rely on the chemokine receptor CX3CR1 for lodging to the skeleton. Here, we show that this receptor is overexpressed by all four main subtypes of breast adenocarcinoma and also abundantly detected in bone metastatic lesions from breast cancer patients. We have recently synthesized JMS-17-2, a novel small molecule inhibitor of CX3CR1. We tested this compound in pre-clinical animal models of metastases in which human breast cancer cells, labeled with fluorescent and bioluminescent markers, are converted into CTCs by direct grafting in the arterial blood circulation. Pre-incubating cancer cells with JMS-17-2 or treating animals with this compound (10 mg/Kg, i.p.) were equally effective in dramatically decreasing the number of breast CTCs that lodged to the skeleton. These disseminated tumor cells (DTCs) were detected 24 hours after grafting and enumerated by multispectral fluorescence microscopy of sequential bone tissue sections spanning the entire width of tibiae and femora. Notably, when animals were examined at two weeks after grafting, JMS-17-2 completely prevented metastases, indicating that the reduction in number of DTCs directly translates to an impaired tumor growth in the long term. Finally, JMS-17-2 was administered to animals harboring a limited number of small metastases in bone and soft-tissues and monitored by bioluminescence imaging for three weeks before sacrifice. Animals treated with the CX3CR1 antagonist remained at an oligometastatic stage whereas control animals showed a sharp increase in the number of metastatic lesions and overall tumor burden. The work presented here should generate a conceptual shift in the treatment strategies for breast cancer patients, paving the way to approaches aimed to counteract the seeding of additional lesions from existing metastases. We also introduce JMS-17-2 as the first CX3CR1 antagonist and lead compound of a class of potentially new drugs with a novel mechanism of action that could be added to the arsenal of therapies currently used to treat advanced breast adenocarcinoma. Citation Format: Fei Shen, Yun Zhang, Danielle Jernigan, Jie Yan, Fernando Garcia, Olimpia Meucci, Joseph Salvino, Alessandro Fatatis. A small-molecule antagonist of CX3CR1 impairs homing and colonization of breast cancer cells in the skeleton. [abstract]. In: Proceedings of the AACR Special Conference on Advances in Breast Cancer Research; Oct 17-20, 2015; Bellevue, WA. Philadelphia (PA): AACR; Mol Cancer Res 2016;14(2_Suppl):Abstract nr B03.

Abstract LB-C08: Exploring glycan markers for immunotyping and precision-targeting of breast circulating tumor cells (CTCs)

Abstract Recognition of abnormal glycosylation in virtually every cancer type has raised great interest in exploration of the tumor glycome for biomarker discovery. Identifying glycan markers of circulating tumor cells (CTCs) represents a new development in tumor biomarker discovery. The aim of this study was to establish an experimental approach to enable rapid screening of CTCs for glycan marker identification and characterization. We applied carbohydrate microarrays and a high-speed fiber-optic array scanning technology (FASTcell) to explore potential glycan markers of breast CTCs (bCTCs) and targeting antibodies. An anti-tumor monoclonal antibody, HAE3-C1 (C1), was identified as a key immunological probe in this study. In our carbohydrate microarray analysis, C1 was found to be highly specific for an O-glycan cryptic epitope, gpC1. Using FASTcell technology, we established a procedure to quantify expression levels of gpC1 in tumor cells. In blood samples from five Stage IV metastatic breast cancer patients, the gpC1 positive CTCs were detected in all subjects; approximately 40% of bCTCs were strongly gpC1 positive. Interestingly, the CTCs from a triple-negative breast cancer patient with multiple sites of metastasis were predominantly gpC1 positive (92.5%, 37/40 CTCs). Taken together, we present here a practical approach to examine rare cell expression of glycan markers. Using this approach, we identified an O-core glyco-determinant gpC1 as a potential immunological target of bCTCs. Given its bCTC-expression profile, this target warrants an extended investigation in a larger cohort of breast cancer patients. Citation Format: Lidia C. Sambucetti, Xiaohe Liu, Ben Hsieh, Richard Bruce, George Somlo, Jiaoti Huang, Denong Wang. Exploring glycan markers for immunotyping and precision-targeting of breast circulating tumor cells (CTCs). [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2015 Nov 5-9; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2015;14(12 Suppl 2):Abstract nr LB-C08.

Exploring Glycan Markers for Immunotyping and Precision-targeting of Breast Circulating Tumor Cells

Recognition of abnormal glycosylation in virtually every cancer type has raised great interest in exploration of the tumor glycome for biomarker discovery. Identifying glycan markers of circulating tumor cells (CTCs) represents a new development in tumor biomarker discovery. The aim of this study was to establish an experimental approach to enable rapid screening of CTCs for glycan marker identification and characterization. We applied carbohydrate microarrays and a high-speed fiber-optic array scanning technology (FAST scan) to explore potential glycan markers of breast CTCs (bCTCs) and targeting antibodies. An anti-tumor monoclonal antibody, HAE3-C1 (C1), was identified as a key immunological probe in this study. In our carbohydrate microarray analysis, C1 was found to be highly specific for an O-glycan cryptic epitope, gp(C1). Using FAST-scan technology, we established a procedure to quantify expression levels of gp(C1) in tumor cells. In blood samples from five stage IV metastatic breast cancer patients, the gp(C1) positive CTCs were detected in all subjects; ∼40% of bCTCs were strongly gp(C1) positive. Interestingly, CTCs from a triple-negative breast cancer patient with multiple sites of metastasis were predominantly gp(C1) positive (92.5%, 37/40 CTCs). Together we present here a practical approach to examine rare cell expression of glycan markers. Using this approach, we identified an O-core glyco-determinant gp(C1) as a potential immunological target of bCTCs. Given its bCTC-expression profile, this target warrants an extended investigation in a larger cohort of breast cancer patients.

Pharmacologic regulation of AMPK in breast cancer affects cytoskeletal properties involved with microtentacle formation and re-attachment.

The presence of tumor cells in the circulation is associated with a higher risk of metastasis in patients with breast cancer. Circulating breast tumor cells use tubulin-based structures known as microtentacles (McTNs) to re-attach to endothelial cells and arrest in distant organs. McTN formation is dependent on the opposing cytoskeletal forces of stable microtubules and the actin network. AMP-activated protein kinase (AMPK) is a cellular metabolic regulator that can alter actin and microtubule organization in epithelial cells. We report that AMPK can regulate the cytoskeleton of breast cancer cells in both attached and suspended conditions. We tested the effects of AMPK on microtubule stability and the actin-severing protein, cofilin. AMPK inhibition with compound c increased both microtubule stability and cofilin activation, which also resulted in higher McTN formation and re-attachment. Conversely, AMPK activation with A-769662 decreased microtubule stability and cofilin activation with concurrent decreases in McTN formation and cell re-attachment. This data shows for the first time that AMPK shifts the balance of cytoskeletal forces in suspended breast cancer cells, which affect their ability to form McTNs and re-attach. These results support a model where AMPK activators may be used therapeutically to reduce the metastatic efficiency of breast tumor cells.

Abstract 4116: A small-molecule antagonist of CX3CR1 impairs homing and colonization of breast cancer cells in the skeleton

Abstract Therapeutic approaches aimed to prevent breast cancer cells from spreading to distant sites are commonly neglected, based on the indication that dissemination from primary tumors can occur early. However, mounting evidence indicates that cancer cells recirculating from established bone lesions could further seed and colonize both skeleton and soft-tissue organs, thus precipitating metastatic dissemination and accelerating disease progression. We have previously shown that breast circulating tumor cells (CTCs) rely on the chemokine receptor CX3CR1 for lodging to the skeleton. Here, we show that this receptor is overexpressed by all four main subtypes of breast adenocarcinoma and also abundantly detected in bone metastatic lesions from breast cancer patients. We have recently synthesized JMS-17-2, a novel small molecule inhibitor of CX3CR1. We tested this compound in pre-clinical animal models of metastases in which human breast cancer cells, labeled with fluorescent and bioluminescent markers, are converted into CTCs by direct grafting in the arterial blood circulation. Pre-incubating cancer cells with JMS-17-2 or treating animals with this compound (10 mg/Kg, i.p.) were equally effective in dramatically decreasing the number of breast CTCs that lodged to the skeleton. These disseminated tumor cells (DTCs) were detected 24 hours after grafting and enumerated by multispectral fluorescence microscopy of sequential bone tissue sections spanning the entire width of tibiae and femora. Notably, when animals were examined at two weeks after grafting, JMS-17-2 completely prevented metastases, indicating that the reduction in number of DTCs directly translates to an impaired tumor growth in the long term. Finally, JMS-17-2 was administered to animals harboring a limited number of small metastases in bone and soft-tissues and monitored by bioluminescence imaging for three weeks before sacrifice. Animals treated with the CX3CR1 antagonist remained at an oligometastatic stage whereas control animals showed a sharp increase in the number of metastatic lesions and overall tumor burden. The work presented here should generate a conceptual shift in the treatment strategies for breast cancer patients, paving the way to approaches aimed to counteract the seeding of additional lesions from existing metastases. We also introduce JMS-17-2 as the first CX3CR1 antagonist and lead compound of a class of potentially new drugs with a novel mechanism of action that could be added to the arsenal of therapies currently used to treat advanced breast adenocarcinoma. Citation Format: Fei Shen, Yun Zhang, Danielle Jernigan, Jie Yan, Fernando Garcia, Olimpia Meucci, Joseph Salvino, Alessandro Fatatis. A small-molecule antagonist of CX3CR1 impairs homing and colonization of breast cancer cells in the skeleton. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 4116. doi:10.1158/1538-7445.AM2015-4116