High-grade Serous Ovarian Cancer Cell Research Articles

Enhanced amphiregulin exposure promotes modulation of the high grade serous ovarian cancer tumor immune microenvironment

High grade serous ovarian cancer (HGSOC) is a lethal gynecologic malignancy in which chemoresistant recurrence rates remain high. Furthermore, HGSOC patients have demonstrated overall low response rates to clinically available immunotherapies. Amphiregulin (AREG), a low affinity epidermal growth factor receptor ligand is known to be significantly upregulated in HGSOC patient tumors following neoadjuvant chemotherapy exposure. While much is known about AREG’s role in oncogenesis and classical immunity, it is function in tumor immunology has been comparatively understudied. Therefore, the objective of this present study was to elucidate how increased AREG exposure impacts the ovarian tumor immune microenvironment (OTIME). Using NanoString IO 360 and protein analysis, it was revealed that treatment with recombinant AREG led to prominent upregulation of genes associated with ovarian pathogenesis and immune evasion (CXCL8, CXCL1, CXCL2) along with increased STAT3 activation in HGSOC cells. In vitro co-culture assays consisting of HGSOC cells and peripheral blood mononuclear cells (PBMCs) stimulated with recombinant AREG (rAREG) led to significantly enhanced tumor cell viability. Moreover, PBMCs stimulated with rAREG exhibited significantly lower levels of IFNy and IL-2. In vivo rAREG treatment promoted significant reductions in circulating levels of IL-2 and IL-5. Intratumoral analysis of rAREG treated mice revealed a significant reduction in CD8+ T cells coupled with an upregulation of PD-L1. Finally, combinatorial treatment with an AREG neutralizing antibody and carboplatin led to a synergistic reduction of cell viability in HGSOC cell lines OVCAR8 and PEA2. Overall, this study demonstrates AREG’s ability to modulate cytotoxic responses within the OTIME and highlights its role as a novel HGSOC immune target.

NB compounds are potent and efficacious FOXM1 inhibitors in high-grade serous ovarian cancer cells

BackgroundGenetic studies implicate the oncogenic transcription factor Forkhead Box M1 (FOXM1) as a potential therapeutic target in high-grade serous ovarian cancer (HGSOC). We evaluated the activity of different FOXM1 inhibitors in HGSOC cell models.ResultsWe treated HGSOC and fallopian tube epithelial (FTE) cells with a panel of previously reported FOXM1 inhibitors. Based on drug potency, efficacy, and selectivity, determined through cell viability assays, we focused on two compounds, NB-73 and NB-115 (NB compounds), for further investigation. NB compounds potently and selectively inhibited FOXM1 with lesser effects on other FOX family members. NB compounds decreased FOXM1 expression via targeting the FOXM1 protein by promoting its proteasome-mediated degradation, and effectively suppressed FOXM1 gene targets at both the protein and mRNA level. At the cellular level, NB compounds promoted apoptotic cell death. Importantly, while inhibition of apoptosis using a pan-caspase inhibitor rescued HGSOC cells from NB compound-induced cell death, it did not rescue FOXM1 protein degradation, supporting that FOXM1 protein loss from NB compound treatment is specific and not a general consequence of cytotoxicity. Drug washout studies indicated that FOXM1 reduction was retained for at least 72 h post-treatment, suggesting that NB compounds exhibit long-lasting effects in HGSOC cells. NB compounds effectively suppressed both two-dimensional and three-dimensional HGSOC cell colony formation at sub-micromolar concentrations. Finally, NB compounds exhibited synergistic activity with carboplatin in HGSOC cells.ConclusionsNB compounds are potent, selective, and efficacious inhibitors of FOXM1 in HGSOC cells and are worthy of further investigation as HGSOC therapeutics.

ATF3 characterizes aggressive drug-tolerant persister cells in HGSOC

High-grade serous ovarian cancer (HGSOC) represents the most common and lethal subtype of ovarian cancer. Despite initial response to platinum-based standard therapy, patients commonly suffer from relapse that likely originates from drug-tolerant persister (DTP) cells. We generated isogenic clones of treatment-naïve and cisplatin-tolerant persister HGSOC cells. In addition, single-cell RNA sequencing of barcoded cells was performed in a xenograft model with HGSOC cell lines after platinum-based therapy. Published single-cell RNA-sequencing data from neo-adjuvant and non-treated HGSOC patients and patient data from TCGA were analyzed. DTP-derived cells exhibited morphological alterations and upregulation of epithelial-mesenchymal transition (EMT) markers. An aggressive subpopulation of DTP-derived cells showed high expression of the stress marker ATF3. Knockdown of ATF3 enhanced the sensitivity of aggressive DTP-derived cells to cisplatin-induced cell death, implying a role for ATF3 stress response in promoting a drug tolerant persister cell state. Furthermore, single cell lineage tracing to detect transcriptional changes in a HGSOC cell line-derived xenograft relapse model showed that cells derived from relapsed solid tumors express increased levels of EMT and multiple endoplasmic reticulum (ER) stress markers, including ATF3. Single cell RNA sequencing of epithelial cells from four HGSOC patients also identified a small cell population resembling DTP cells in all samples. Moreover, analysis of TCGA data from 259 HGSOC patients revealed a significant progression-free survival advantage for patients with low expression of the ATF3-associated partial EMT genes. These findings suggest that increased ATF3 expression together with partial EMT promote the development of aggressive DTP, and thereby relapse in HGSOC patients.

MicroRNA Expression Profiles in Human Samples and Cell Lines Revealed Nine miRNAs Associated with Cisplatin Resistance in High-Grade Serous Ovarian Cancer.

Metastasis and drug resistance are major contributors to cancer-related fatalities worldwide. In ovarian cancer (OC), a staggering 70% develop resistance to the front-line therapy, cisplatin. Despite proposed mechanisms, the molecular events driving cisplatin resistance remain unclear. Dysregulated microRNAs (miRNAs) play a role in OC initiation, progression, and chemoresistance, yet few studies have compared miRNA expression in OC samples and cell lines. This study aimed to identify key miRNAs involved in the cisplatin resistance of high-grade-serous-ovarian-cancer (HGSOC), the most common gynecological malignancy. MiRNA expression profiles were conducted on RNA isolated from formalin-fixed-paraffin-embedded human ovarian tumor samples and HGSOC cell lines. Nine miRNAs were identified in both sample types. Targeting these with oligonucleotide miRNA inhibitors (OMIs) reduced proliferation by more than 50% for miR-203a, miR-96-5p, miR-10a-5p, miR-141-3p, miR-200c-3p, miR-182-5p, miR-183-5p, and miR-1206. OMIs significantly reduced migration for miR-183-5p, miR-203a, miR-296-5p, and miR-1206. Molecular pathway analysis revealed that the nine miRNAs regulate pathways associated with proliferation, invasion, and chemoresistance through PTEN, ZEB1, FOXO1, and SNAI2. High expression of miR-1206, miR-10a-5p, miR-141-3p, and miR-96-5p correlated with poor prognosis in OC patients according to the KM plotter database. These nine miRNAs could be used as targets for therapy and as markers of cisplatin response.

Abstract 278: Investigating the functional role of cancer-associated fibroblasts in the emergence of drug-tolerant persisters in ovarian cancer

Abstract Chemoresistance remains a major clinical challenge for the treatment of high-grade serous ovarian cancer (HGSC), the most lethal gynecologic malignancy. The majority of patients who initially respond to first-line platinum/taxane-based chemotherapy eventually relapse with chemoresistant disease, leading to poor survival outcomes. It is increasingly recognized that cancer cells can enter a reversible drug-tolerant persister (DTP) state through non-genetic mechanisms to evade chemotherapy-induced cytotoxicity prior to the development of chemoresistance. However, how environmental signals and extracellular factors from the tumor microenvironment drive the process remains poorly understood. Cancer-associated fibroblasts (CAFs) are a functionally heterogeneous population of activated fibroblasts. CAFs play a critical role in shaping the tumor microenvironment and tumor behaviors, including promoting tumor growth and mediating therapy resistance. Here, we demonstrated that HGSC cell lines co-cultured with patient-derived FAP-high CAFs, a subpopulation of CAFs previously identified in our lab to be tumor-promoting, significantly increase the formation of DTPs upon prolonged carboplatin treatment compared to the mono-cultured condition. Interestingly, the extracellular matrix (ECM) organization signature is enriched in FAP-high CAFs compared to their FAP-low counterparts, and we found that ECM deposited by FAP-high CAFs also facilitates the emergence of DTPs in HGSC cells. Future work will focus on elucidating the mechanisms by which FAP-high CAFs and the associated ECM promote DTP formation in HGSC cells through transcriptomic and proteomic profiling. This will aid the identification of potential therapeutic vulnerabilities to target cancer cells in the DTP state in FAP-high HGSC patients. Citation Format: Angel S. Ng, Ngoc Bui, Laurie Ailles. Investigating the functional role of cancer-associated fibroblasts in the emergence of drug-tolerant persisters in ovarian cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 278.

Abstract 4447: ZC3H18: A novel regulator of NAD+ metabolism in high-grade serous ovarian cancer

Abstract ZC3H18 is a multifunctional regulator of gene expression that is lost in a subset of high-grade serous ovarian cancers (HGSOC). Our prior studies have established that the loss of ZC3H18 diminishes BRCA1 levels, leading to the disruption of homologous recombination DNA repair (HR) and heightened sensitivity of HGSOC cells to PARP inhibitors. Here we show an additional facet to ZC3H18's impact, showing that its loss also induces a reprogramming of energy metabolism in HGSOC. Our findings demonstrate that the depletion of ZC3H18 results in reduced mRNA and protein levels of the NAD+-biosynthetic enzyme, NMNAT1, in HGSOC cells. Mechanistic studies uncovered that ZC3H18 occupies the NMNAT1 promoter, facilitating NMNAT1 transcription by recruiting CDK12 onto the promoter. Consistent with this mechanism, loss of ZC3H18 led to a reduction in CDK12 levels on the NMNAT1 promoter, diminishing NMNAT1 abundance and subsequently causing a decline in cellular NAD levels. These observations unveil a previously unknown role for ZC3H18 in HGSOC, shedding light on its involvement in the regulation of energy metabolism. Importantly, our findings provide valuable insights into potential therapeutic pathways that leverage the metabolic changes linked to ZC3H18 deficiency. Citation Format: Benjamin Wilson, Natalie Wilson, Xianfeng Chen, Shuwen Zhang, Chen Wang, Larry M. Karnitz, Scott H. Kaufmann, Arun Kanakkanthara. ZC3H18: A novel regulator of NAD+ metabolism in high-grade serous ovarian cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4447.

Abstract 2881: Comparing the effects of proton and photon therapy on promoting cancer aggressiveness in ovarian cancer and glioblastoma

Abstract Ovarian cancer is the 12th most common cancer among women in the United States and the 5th leading cause of cancer-related death for women. About 80% of the patients are diagnosed at stages III or IV, classified as High-Grade Serous Ovarian Cancer (HGSOC). HGSOC is highly aggressive, exhibiting an 80% recurrence rate within 24 months after cancer treatment. Brain and nervous system cancer ranks as the 10th leading cause of cancer-related death in the U.S., with Glioblastoma Multiforme (GBM) accounting for 47.7% of all brain cancer cases. GBM is the most aggressive primary brain cancer, with a 90% recurrence rate and a 4% 2-year survival rate. Patients with these cancers encounter limited treatment options, and the recurrence of cancer exacerbates these challenges. Therefore, a deeper understanding of the factors contributing to cancer treatment-induced aggressiveness is greatly needed. In our study, we first examined the treatment efficacy of proton and photon radiation by conducting apoptosis assays. Our findings demonstrate that proton radiation is significantly more effective at eliminating both HGSOC and GBM cells compared to photon radiation. Subsequently, we assessed the level of cancer aggressiveness in the surviving cells after radiation exposure by measuring stemness and epithelial-mesenchymal transition (EMT) levels. While proton radiation proved to be more effective in eliminating a greater number of cancer cells, we hypothesize that both proton and photon irradiation promote cancer aggressiveness in the surviving cells of HGSOC and GBM. To assess the stemness and EMT level of cancer cells following radiation, we integrated a SORE6-GFP reporter to identify the cancer stem cell population expressing SOX2/OCT4 and a 3’ UTR-ZEB1-GFP reporter to detect the cell population with mesenchymal traits. Cells transduced with the reporters were treated with 0, 1, 2, 4, and 8 Gy of 250 MeV proton and 6 MeV photon beams, and at 72 hours post-radiation, GFP levels were measured via flow cytometry. Our data demonstrated a dose-dependent increase in stemness and EMT levels in live cells after both types of radiation. Furthermore, cancer cells exposed to radiation were harvested at 72 hours and 240 hours post-radiation for RT-qPCR analysis. Our preliminary data indicate an upregulation of stemness genes including POU5F1 and SOX2, as well as EMT transcription factor genes ZEB1, SNAI1, and TWIST1 in response to both types of radiation in most cell lines. These findings indicate that both proton and photon radiation therapies promote cancer aggressiveness in the surviving cancer cells. Citation Format: Yeonkyu Jung, Ann Morcos, Aaron Keniston, Ashley Antonissen, Sharon Asariah, Antonella Bertucci, Marcelo Vazquez, Juli Unternaehrer. Comparing the effects of proton and photon therapy on promoting cancer aggressiveness in ovarian cancer and glioblastoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2881.

Abstract 4538: Brigatinib induces synergy with PARP inhibitors through dual inhibition of FAK and EphA2 in high-grade serous ovarian carcinoma

Abstract PARP inhibitors (PARPis) have now become a standard of care for high-grade serous ovarian cancer (HGSOC), especially for those with defects in homologous recombination (HR) DNA repair. However, the innate and acquired PARPi resistance in HGSOC poses a significant concern, necessitating the exploration of novel treatment options and strategies. Here we investigated the potential of combining brigatinib—a second-generation anaplastic lymphoma kinase (ALK) inhibitor approved for treating lung cancer—with PARPis as way to enhance PARPi activity in HGSOC. Clonogenic cell survival assays revealed that brigatinib synergizes with PARPis in HR-proficient and -deficient HGSOC cell lines. In subsequent proteomics approaches and cell-based confirmatory studies, we found that brigatnib suppressed tyrosine kinases FAK and EphA2 with reduction in downstream signaling. Follow-up pharmacologic and gene-silencing techniques demonstrated that dual FAK and EphA2 inhibition additively reduces PI3K/Akt and MAPK/ERK cell survival signaling to levels conferring PARPi sensitivity. Additionally, the efficacy of this therapeutic approach on tumor size reduction was assessed in HGSOC patient-derived xenograft (PDX) models, with combination treatment inducing tumor regression more effectively than either agent alone. Overall, our studies unveil a beneficial ALK-independent effect of brigatinib that may offer new avenues for considering its repurposing as a HGSOC therapy. Citation Format: Julie R. Duffield, Xiaonan Hou, Iman K. McKeon-Makki, Amelia M. Huehls, Benjamin W. Wilson, Anjali Prasad, Xinyan Wu, Scott H. Kaufmann, Larry M. Karnitz, John J. Weroha, Arun Kanakkanthara. Brigatinib induces synergy with PARP inhibitors through dual inhibition of FAK and EphA2 in high-grade serous ovarian carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4538.

Abstract 2989: MicroRNA profiling in human samples and cell lines uncovers eight key players in the cisplain resistance of HGSOC

Abstract Metastasis and drug resistance remain significant contributors to cancer-related mortality globally. In ovarian cancer, a substantial 70% of cases develop resistance to the front-line therapy, cisplatin. Despite numerous proposed mechanisms for cisplatin resistance, the complete molecular events leading to this phenomenon in ovarian cancer remain incompletely understood. Mounting evidence suggests that dysregulation of microRNAs (miRNAs) plays a pivotal role in carcinogenesis, including the development of drug resistance. While various miRNAs have been identified in ovarian cancer samples and cell lines, few studies have compared miRNA expression in human paraffin ovarian samples and cisplatin-resistant high-grade serous ovarian cancer (HGSOC), the most prevalent and malignant of gynecological malignancies. This study aimed to identify key miRNAs implicated in cisplatin resistance. We performed miRNA expression profiles in RNA isolated from human paraffin ovarian tumors and ovarian cancers cell lines. Eight miRNAs were commonly increased in paraffin samples and cisplatin resistant ovarian cancer cells. Targeting these miRNAs with inhibitors significantly reduced cell proliferation by more than 50% for miR-203a, miR-96-5p, miR-10a-5p, miR-141-3p, miR-200c-3p, and miR-182-5p, and to a lesser extent, miR-296-5p and miR-1206. Inhibitors demonstrated a reduction in cell migration for all targets except miR-200c-3p and miR-10a-5p. Analysis of online databases, literature reports, and molecular pathway construction revealed that these eight miRNAs regulate key molecular pathways associated with cell proliferation, primarily through PTEN regulation in cisplatin-resistant HGSOC cells. Interrogation of the KM plotter patient database revealed that high expression of miR-1206, miR-10a, miR-141, and miR-96 correlates with a poor prognosis in ovarian cancer patients. These findings position these eight miRNAs as potential therapeutic targets and markers for cisplatin response in ovarian cancer therapy. Citation Format: Mariela Rivera-Serrano, Marienid Flores, Jose Rolon, Victor Reyes, Fatma Valiyeva, Pablo E. Vivas-Mejia. MicroRNA profiling in human samples and cell lines uncovers eight key players in the cisplain resistance of HGSOC [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2989.

Abstract 182: Cyclooxygenase-2 blockade is crucial to restore natural killer cell activity before anti-CTLA-4 therapy against high-grade serous ovarian cancer

Abstract Objective: Here our goal was to evaluate the impact of the immunosuppressive enzyme cyclooxygenase-2 (COX-2) expression on the immune effector capacity against high-grade serous ovarian cancer (HGSOC) tumor cells through bioinformatic tools and in vitro validation. Methods: We performed an integrated bioinformatics analysis from transcriptomic data based on RNAseq (TCGA-OV, n=368; Australian cohort AOCS, n=80) and RNA microarrays (GSE26193, n=62; GSE30161, n=45). We estimated the proportion and characteristics of immune cells employing Gene Set Variation Analysis (GSVA), MIXTURE and Ecotyper cell deconvolution algorithms. Survival curves and Cox-regression models were built up according to known risk factors and immune scores predicted by in-silico analysis. Afterward, we validated these results using flow cytometry and cytotoxicity assays on circulating NK cells collected from advanced HGSOC patients treated at our institution (n=5). After three days of incubation, isolated NK cell cultures were stimulated with three pulses of a selective COX-2 inhibitor (celecoxib) or MOCK, daily. An anti-CTLA-4 monoclonal antibody (ipilimumab) or MOCK was added at the third pulse. Two ovarian cancer cell lines (SKOV3 and HeyA8) were treated similarly. Next, NK cells were co-cultured with SKOV3 or HeyA8 and cytotoxicity on these cells was examined using lactate dehydrogenase (LDH) cell viability assay. Results: Transcriptomic data evidenced a non-linear relationship between COX-2 gene, PTGS2, and CTLA4 in advanced stages of HGSOC. Hence, PTGS2/CTLA4 ratio allows us to investigate how COX-2 influences changes in the immune profile of these patients. Based on bioinformatics, a high PTGS2/CTLA4 ratio determines particularly dysfunctional NK cell states, along with the reduction of NK gene score associated with infiltration, cytotoxicity, and survival in HGSOC. Additionally, selective COX-2 blockade improves NK cell cytotoxicity against HGSOC cell lines independently of the CTLA-4 signaling. In fact, ipilimumab effect was almost absent in those cases with high COX2 activity. Interestingly, previous treatment with celecoxib on NK cells mainly explains the difference in cytotoxicity (p= 0.0253, two-way ANOVA test with Tukey’s multiple comparisons). Conclusions: This work represents the first evidence of the influence of COX-2 on NK cell function as a crucial factor for the efficacy of anti-CTLA-4 therapy in HGSOC patients who exhibited high tumoral levels of CTLA-4. HGSOC patients present dysfunctional circulating NK cells preferentially due to the strong CO-2 expression. Last, we emphasize the modulation of chronic inflammation to direct an immune pattern with greater antitumor capacity in HGSOC. (Funding: Fondecyt 1201083 and FONDAP 152220002 [MAC], CONICYT/Doctorado Nacional 2019-Folio 21190421 [FGV], CONICYT FONDAP 15130011 [MAC, IW]). Citation Format: Fernan Gomez-Valenzuela, Ignacio Wichmann, Felipe Suárez, Sumie Kato, Enrique Ossandón, Marcela Hermoso, Elmer Fernández, Mauricio A. Cuello. Cyclooxygenase-2 blockade is crucial to restore natural killer cell activity before anti-CTLA-4 therapy against high-grade serous ovarian cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 182.

Abstract 6995: Functional characterization of the novel cell adhesion molecule MPZL3 in ovarian cancer

Abstract Ovarian cancer (OVCA) is the most lethal gynecological malignancy in the United States often detected at advanced stages. OVCA progression involves transcoelomic metastasis, where cells disseminate into the peritoneal fluid, adhere to form multicellular aggregates that promote anchorage-independent survival and facilitate metastatic colonization of the peritoneum. To meet the requirements of each stage of this detachment, aggregation, and re-attachment cycle, OVCA cells have been shown to dynamically regulate the expression of multiple cell adhesion molecules (CAMs) throughout their progression. Moreover, targeting cell-cell adhesion molecules has shown to be an effective method to slow/inhibit the progression of OVCA. In this study, we characterize the novel role of the understudied CAM MPZL3 in OVCA. Myelin protein zero-like 3 (MPZL3) is a transmembrane protein with homology to other immunoglobulin-like (Ig) family of CAMs. While it has been reported that altered Ig-CAM expression plays a role in ovarian cancer, the function of MPZL3 has not been investigated. Interestingly, TCGA data demonstrates that chromosomal loss of the MPZL3 locus (11q23.3) is frequently detected in several cancer types, including 22% of clear cell and 30% of high grade serous ovarian cancers (HGSOC), implying that loss of genes located in this area has tumorigenic consequences. On the other hand, few studies showed that MPZL3 contains an oncogenic potential in breast and MET-amplified cancer cell lines, suggesting that the role of MPZL3 in cancer is context dependent. To study the function of MPZL3 in OVCA, we used shRNA mediated MPZL3 knockdown in OVCAR4 human HGSOC cells and examined transcriptome-wide effects by RNA-sequencing. The subsequent Gene Set Enrichment Analysis indicated that pathways involved in regulating cell growth, death, adhesion, and epithelial-mesenchymal transition were significantly altered by loss of MPZL3. To validate the candidate pathways, we knocked down or over-expressed MPZL3 in OVCA cells to test its importance in regulating OVCA cell growth, apoptosis, adhesion, and migration. We found that loss of MPZL3 resulted in decreased cell growth with a concomitant resistance to both Cisplatin and Olaparib treatments, both of which are commonly used for treating OVCA. Moreover, we show that knockdown of MPZL3 alters the homotypic adhesive-capacity of OVCA cells. Ongoing studies are underway to further characterize the role played by MPLZ3 in the mentioned contexts. Additionally, to elucidate the underlying molecular mechanism and identify novel interactors of MPZL3, we will conduct co-immunoprecipitation experiments in OVCA cells expressing V5-tagged MPZL3. Understanding the novel role of MPZL3 will provide further insight into OVCA progression, thus generating opportunities of developing new treatments for patients with low MPZL3 expression as an approach for precision cancer medicine. Citation Format: Ya-Yun Cheng, Beth Worley, Zaineb Javed, Amal T. Elhaw, Priscilla W. Tang, Nadine Hempel. Functional characterization of the novel cell adhesion molecule MPZL3 in ovarian cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6995.

Abstract 4913: Morphological feature discrepancies in wild-type vs. BRCA1/BRCA2 mutated high-grade serous ovarian cancer

Abstract Introduction: The understanding of morphological heterogeneity at the cellular level in High-Grade Serous Ovarian Cancer (HGSOC), particularly in relation to BRCA1 and BRCA2 mutations, is still an ongoing area of research. This study aims to elucidate the morphological features that distinguish wild-type (WT) tumors from those with BRCA1/BRCA2 mutations using deep learning models. Methods: A total of 300 H&E stained HGSOC slides were collected in a patient-wise manner and tumor areas were annotated by an expert pathologist. We used a convolutional neural network model with spatial attention pre-trained on pathological images to extract features from slides, and the features were clustered into 96 groups. Subsequently, a nuclei segmentation model was employed for precise cell segmentation, followed by measurement of cellular features including cell shape (area, eccentricity) and cell texture (dissimilarity, correlation). The assessment of cell texture evaluates the variation and uniformity in gray-level intensity across the cell. We performed independent t-tests on samples of 100 patches from each cluster, comparing cells of selected patches from the top-N clusters representing the highest proportion of each label. Results: H&E slides (n=300) include 69 (23%) BRCA1 mutants and 50 (16.7%) BRCA2 mutants. In Table1, negative t-statistics suggest that WT carcinoma cancer cells exhibit lower values for the measured features compared to BRCA mutants, whereas positive values denote higher values in WT. BRCA1 and BRCA2 mutant carcinoma cancer cells showed significantly larger areas and higher eccentricity than WT carcinoma cancer cells in all top-N clusters settings (N=3, 5, 10, 30). Furthermore, WT carcinoma cancer cells showed higher dissimilarity and reduced correlation compared to BRCA1 mutant carcinoma cells in four settings. Conclusions: Our observations in BRCA-mutated HGSOC cells enrich our understanding of tumor cell morphology with BRCA mutations. Table 1. Comparison of cell features between WT and BRCA mutants cell feature comparison top-3 clusters (t-statistics, p-value) top-5 clusters (t-statistics, p-value) top-10 clusters (t-statistics, p-value) top-30 clusters (t-statistics, p-value) area WT vs BRCA1 -37.41, <0.001 -50.2, <0.001 -37.53, <0.001 -85.95, <0.001 WT vs BRCA2 -42.14, <0.001 -50.61, <0.001 -16.57, <0.001 -51.98, <0.001 eccentricity WT vs BRCA1 -24.40, <0.001 -34.14, <0.001 -38.02, <0.001 -37.40, <0.001 WT vs BRCA2 -26.77, <0.001 -30.46, <0.001 -29.47, <0.001 -47.64, <0.001 dissimilarity WT vs BRCA1 55.17, <0.001 52.73, <0.001 103.57, <0.001 166.78, <0.001 WT vs BRCA2 -38.15, <0.001 -24.75, <0.001 0.2, <0.001 107.73, <0.001 correlation WT vs BRCA1 1.94, <0.001 -2.46, <0.001 -50.24, <0.001 -65.96, <0.001 WT vs BRCA2 87.62, <0.001 90.83, <0.001 52.6, <0.001 -48.90, <0.001 Citation Format: JaeHeon Lee, Hyunil Kim, Yongeun Lee, Yoon-La Choi, Kyungsoo Jung, Tae-Yeong Kwak, Sun Woo Kim, Hyeyoon Chang. Morphological feature discrepancies in wild-type vs. BRCA1/BRCA2 mutated high-grade serous ovarian cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4913.

PIK3R1 fusion drives chemoresistance in ovarian cancer by activating ERK1/2 and inducing rod and ring-like structures

Gene fusions are common in high-grade serous ovarian cancer (HGSC). Such genetic lesions may promote tumorigenesis, but the pathogenic mechanisms are currently poorly understood. Here, we investigated the role of a PIK3R1-CCDC178 fusion identified from a patient with advanced HGSC. We show that the fusion induces HGSC cell migration by regulating ERK1/2 and increases resistance to platinum treatment. Platinum resistance was associated with rod and ring-like cellular structure formation. These structures contained, in addition to the fusion protein, CIN85, a key regulator of PI3K-AKT-mTOR signaling. Our data suggest that the fusion-driven structure formation induces a previously unrecognized cell survival and resistance mechanism, which depends on ERK1/2-activation.

Plasma membrane SK2 channel activity regulates migration and chemosensitivity of high-grade serous ovarian cancer cells.

No data are currently available on the functional role of small conductance Ca2+ -activated K+ channels (SKCa) in ovarian cancer. Here, we characterized the role of SK2 (KCa2.2) in ovarian cancer cell migration and chemosensitivity. Using the selective non-cell-permeant SK2 inhibitor Lei-Dab7, we identified functional SK2 channels at the plasma membrane, regulating store-operated Ca2+ entry (SOCE) in both cell lines tested (COV504 and OVCAR3). Silencing KCNN2 with short interfering RNA (siRNA), or blocking SK2 activity with Lei-Dab7, decreased cell migration. The more robust effect of KCNN2 knockdown compared to Lei-Dab7 treatment suggested the involvement of functional intracellular SK2 channels in both cell lines. In cells treated with lysophosphatidic acid (LPA), an ovarian cancer biomarker of progression, SK2 channels are a key player of LPA pro-migratory activity but their role in SOCE is abolished. Concerning chemotherapy, SK2 inhibition increased chemoresistance to Taxol® and low KCNN2 mRNA expression was associated with the worst prognosis for progression-free survival in patients with serous ovarian cancer. The dual roles of SK2 mean that SK2 activators could be used as an adjuvant chemotherapy to potentiate treatment efficacy and SK2 inhibitors could be administrated as monotherapy to limit cancer cell dissemination.

Proteogenomic analysis of enriched HGSOC tumor epithelium identifies prognostic signatures and therapeutic vulnerabilities

We performed a deep proteogenomic analysis of bulk tumor and laser microdissection enriched tumor cell populations from high-grade serous ovarian cancer (HGSOC) tissue specimens spanning a broad spectrum of purity. We identified patients with longer progression-free survival had increased immune-related signatures and validated proteins correlating with tumor-infiltrating lymphocytes in 65 tumors from an independent cohort of HGSOC patients, as well as with overall survival in an additional 126 HGSOC patient cohort. We identified that homologous recombination deficient (HRD) tumors are enriched in pathways associated with metabolism and oxidative phosphorylation that we validated in independent patient cohorts. We further identified that polycomb complex protein BMI-1 is elevated in HR proficient (HRP) tumors, that elevated BMI-1 correlates with poor overall survival in HRP but not HRD HGSOC patients, and that HRP HGSOC cells are uniquely sensitive to BMI-1 inhibition.

Abstract A013: Auranofin induces lethality driven by reactive oxygen species in high-grade serous ovarian cancer cells

Abstract High-grade serous ovarian cancer (HGSOC) accounts for 70% of ovarian cancer cases in the clinical setting; the survival rate for this disease remains remarkably low due to the lack of a long-term consolidation therapy following standard platinum-based chemotherapy. There is minimal improvement in the survival rate of this disease due to the development of resistance to platinum drugs as the disease recurs. The purpose of this study was to develop a novel treatment modality against HGSOC using the gold complex auranofin (AF). AF primarily functions as a pro-oxidant agent through the inhibition of thioredoxin reductase (TrxR), an antioxidant enzyme that is overexpressed in ovarian cancer. We explored the effect of AF on TrxR activity and various mechanisms of cytotoxicity using HGSOC cells that are clinically sensitive (PEO1) or resistant (PEO4) to platinum. We treated PEO1 cells and PEO4 cells with AF for 72 hours and analyzed its short-term toxicity by assessing cell viability and DNA content by flow cytometry, and the long-term anti-proliferative capacity using colony formation assays. We also assessed the mechanisms of cell death induced by AF including the activation of mechanisms of apoptosis, activation of executor caspases -3 and -7, cleavage of poly-(ADP-ribose) polymerase (PARP), changes in the mitochondrial membrane potential (MMP), and DNA damage. In addition, we studied the interaction between AF and another pro-oxidant, L-buthionine sulfoximine (L-BSO), an anti-glutathione (GSH) agent. We demonstrate that AF potently inhibits the activity of TrxR at non-cytotoxic concentrations while reducing the viability of HGSOC cells regardless of their sensitivities to platinum. We showed that AF induces accumulation of reactive oxygen species (ROS), triggers the depolarization of the mitochondrial membrane, and kills HGSOC cells by inducing apoptosis. AF-induced cell death and morphological effects were abrogated by the ROS scavenger, N-acetyl cysteine (NAC). In addition, the lethality of AF in HGSOC was associated with the activation of caspase-3/7, cleavage of PARP, and the generation of DNA damage, effects that were prevented by the ROS scavenger NAC. Finally, when AF and L-BSO were combined, we observed a synergistic lethality against HGSOC cells, which was mediated by a further increase in ROS with a decrease in the antioxidant, GSH. In summary, our results support the concept that AF can be used alone to kill HGSOC cells by causing ROS-mediated apoptosis. Furthermore, we demonstrate that a large depletion of antioxidants caused by combining AF and L-BSO is highly efficient in synergistically killing HGSOC cells. These findings suggest that the combination of AF and L-BSO is a potential option to develop a consolidation therapy against HGSOC, which can overcome the problem of platinum resistance during recurrent stages of the disease. Citation Format: Farah H. Abdalbari, Elvis M. Jaramillo, Benjamin N. Forgie, Estelle Tran, Alicia A. Goyeneche, Carlos M. Telleria. Auranofin induces lethality driven by reactive oxygen species in high-grade serous ovarian cancer cells [abstract]. In: Proceedings of the AACR Special Conference on Ovarian Cancer; 2023 Oct 5-7; Boston, Massachusetts. Philadelphia (PA): AACR; Cancer Res 2024;84(5 Suppl_2):Abstract nr A013.

Abstract B031: The PLK1 inhibitor Volasertib as a treatment for HSF1 and MYC coamplified ovarian cancer

Abstract Ovarian cancer is a disease that afflicts 1 in 78 women. This disease only has a 5-year relative survival rate of 49% due to the fact that the first line chemotherapy for this disease, platinum-based chemotherapy with taxanes, has an 80% recurrence rate. To improve the treatment for this disease, it would be wise to find biomarkers of sensitivity to other drugs. Using publicly available data from The Cancer Genome Project, our lab has shown that 36% of High Grade Serous Ovarian Cancers (HGSOC) have gene amplifications for both Cellular Myelocytomatosis (MYC) and Heat Shock Factor 1 (HSF1) genes. These genes encode for transcription factors and are known to contribute to malignant disease in multiple cancer types, including ovarian cancer. Evidence indicates that MYC and HSF1 are both essential to HGSOC cells with co-amplification of these genes, that MYC and HSF1 transcriptional activities are highly correlated in patient tumors, and the two transcription factors have a protein-protein interaction, all suggesting these two transcription factors cooperate to drive this subset of HGSOC tumors. Many drugs have been developed to inhibit MYC or HSF1 though they have not shown success in clinical development. We aimed to decrease the activity of these proteins by targeting polo-like kinase 1 (PLK1), a kinase that phosphorylates and regulates both MYC and HSF1 proteins. Active PLK1 levels were highly correlated with MYC and HSF1 protein levels and inhibition of PLK1 with volasertib reduced MYC and HSF1 protein levels and transcriptional activity. Furthermore, volasertib was found to have 155-fold greater potency in HGSOC cells with MYC-HSF1 co-amplification compared to cells without these genes amplified. The increased potency of volasertib in MYC-HSF1 co-amplified cells were also observed in clonogenic growth and spheroid models. Together, these data indicate that MYC and HSF1 cooperate in HGSOC when these genes are amplified and targeting a common kinase between them in PLK1 disrupts this cooperation. Furthermore, MYC and HSF1 co-amplification may serve as a biomarker for volasertib through a personalized medicine approach to treat HGSOC patients. Citation Format: Matthew O'Malley, Imade W. Williams, Bobby Walker, Haimanti Ray, Kenneth P. Nephew, Richard Carpenter. The PLK1 inhibitor Volasertib as a treatment for HSF1 and MYC coamplified ovarian cancer [abstract]. In: Proceedings of the AACR Special Conference on Ovarian Cancer; 2023 Oct 5-7; Boston, Massachusetts. Philadelphia (PA): AACR; Cancer Res 2024;84(5 Suppl_2):Abstract nr B031.

Abstract B012: Transcriptomic insights reveal role of BCL2 proteins in replication checkpoint inhibitor response

Abstract B012: Transcriptomic insights reveal role of BCL2 proteins in replication checkpoint inhibitor response

Abstract A110: Targeting methionine metabolism inhibits ovarian cancer stem cells

Abstract Ovarian cancer (OC) is the leading cause of gynecologic cancer death. Platinum (Pt)- based chemotherapy can reprogram cancer cells to ovarian cancer stem cells (OCSCs) and contribute to disease recurrence. In the current study, we demonstrated that platinum drugs can enrich for OCSCs. In high grade serous ovarian cancer (HGSOC) cell lines, cisplatin treatment (IC50 for 16hrs) increased the percentage of cells with high aldehyde dehydrogenase (ALDH+) activity, a known OCSCs marker, and altered methionine (Met) metabolism. Extracellular Met uptake is converted to S-adenosyl-methionine (SAM) by methionine adenosyltransferase 2A (MAT2A), the rate-limiting enzyme of Met utilization. Short-term cisplatin treatment decreased SAM level and increased expression of MAT2A. It has been reported that CSCs have a high-flux metabolic state and are dependent on Met metabolism. We observed higher MAT2A expression in ALDH+ cells compared to the whole cell population, and Met depletion blocked the cisplatin-induced increase in %ALDH+ cells and spheroid formation ability. Furthermore, both MAT2A siRNA knockdown and the MAT2A inhibitor FIDAS-5 prevented cisplatin-induced increase in %ALDH+ cells, suggesting that blocking Met metabolism phenotypically inhibited the platinum enrichment of OCSCs. MAT2A inhibition also downregulated Cyclin E and arrested HGSOC cells in G1/S phase, indicating that a lower level of Met utilization re-established G1/S checkpoint in p53-mutant OC. As SAM is the universal methyl-group donor, it was of interest to examine whether the observed cisplatin-induced alterations in SAM level resulted in changes in DNA methylation. Methylation specific-PCR analysis demonstrated that siMAT2A or FIDAS-5 treatment of HGSOC cells inhibited cisplatin-induced hypermethylation of CpG islands of BRCA1 and ALDH1L1, a folate metabolic enzyme of which promoter hypermethylation is associated to tumor progression. Collectively, these results demonstrated a crucial role of Met metabolism in cisplatin-induced OCSCs enrichment. MAT2A has been recognized as a therapeutic target for the treatment of solid tumors and Met inhibition by targeting MAT2A could represent a therapeutic approach for inhibiting CSC in ovarian cancer. Citation Format: Shu Zhang, Tara X. Metcalfe, Christiane A. Hassel, Heather M. O'Hagan, Kenneth P. Nephew. Targeting methionine metabolism inhibits ovarian cancer stem cells [abstract]. In: Proceedings of the AACR Special Conference on Ovarian Cancer; 2023 Oct 5-7; Boston, Massachusetts. Philadelphia (PA): AACR; Cancer Res 2024;84(5 Suppl_2):Abstract nr A110.

Abstract A028: Investigating the role of SOX2 in promoting anchorage-independent survival of ovarian cancer cells

Abstract Ovarian cancer (OVCA) is the most lethal gynecologic malignancy, often detected at an advanced stage. OVCA progression involves transcoelomic metastasis, where tumor cells disseminate into the peritoneal ascites. Malignant cells in the ascites adapt to survive under Anchorage-Independent (A-I) conditions by altering the expression of genes escalating anoikis (A-I cell death) resistance and metastasis. Our lab has shown that OVCA cells manipulate their transcriptomic profile to promote the expression of anoikis resistance genes in A-I. Expression profiling of genes upregulated in A-I revealed the transcription factor SRY-Box Transcription Factor 2 (SOX2) to be highly upregulated in response to OVCA cell detachment. While we have previously demonstrated that SOX2 is necessary for the A-I survival of OVCA cells, the specific mechanism underlying SOX2-dependent A-I survival remains unknown. RNA-sequencing studies performed in the high-grade serous ovarian cancer cell line, OVCAR3, revealed that the Leucine-rich repeat-containing G-protein coupled receptor 5, LGR5, is the most significantly upregulated gene in A-I compared to attached conditions. Importantly, amongst those genes that are upregulated in A-I, LGR5 is significantly downregulated following SOX2 knockdown in A-I. LGR5 is an ‘orphan’ G-protein coupled receptor known to modulate canonical Wnt signaling upon interacting with its ligand R-spondin1 (RSPO1). Time-course experiments in OVCAR3 cells revealed a striking increase in LGR5 expression that peaked after 24 hours in A-I. Furthermore, siRNA mediated knockdown of SOX2 downregulated LGR5 expression only in A-I, suggesting that LGR5 is a potential SOX2 target under A-I conditions. Interestingly, bioinformatics analysis of the existing OVCA datasets from the Cancer Genome Atlas showed increased expression of RSPO1, which correlated with a significant decrease in the overall survival of OVCA patients. Interaction of LGR5 with its ligand RSPO1 is crucial for the receptor to signal through the Wnt pathway to promote cell survival and cancer stemness. Although SOX2 and LGR5 are established markers of cancer stemness in various tumor types, their direct relationship in promoting tumor progression and regulation of OVCA A-I cell survival remains unknown. Our data suggests that increased SOX2 and LGR5 expression could drive OVCA cell survival under A-I conditions. Our current studies focus on understanding the molecular mechanisms behind SOX2-driven regulation of LGR5 and the role of LGR5 in driving OVCA A-I cell survival. Citation Format: Shriya Kamlapurkar, Coryn Stump, Mythreye Karthikeyan, Nadine Hempel. Investigating the role of SOX2 in promoting anchorage-independent survival of ovarian cancer cells [abstract]. In: Proceedings of the AACR Special Conference on Ovarian Cancer; 2023 Oct 5-7; Boston, Massachusetts. Philadelphia (PA): AACR; Cancer Res 2024;84(5 Suppl_2):Abstract nr A028.