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Deciphering and targeting EMT-mediated cancer stemness Muh-Hwa Yang, M.D., Ph.D. Institute of Clinical Medicine, National Yang-Ming University Division of Hematology-Oncology, Department of Medicine, Taipei Veterans General Hospital 2015-08-22 Epithelial-Mesenchymal Transition (EMT) • EMT is a biologic process that the polarized epithelial cell, which normally interacts with basement membrane, to undergo multiple changes that enable it to assume a mesenchymal cell phenotype: • enhanced migratory capacity • Invasiveness • elevated resistance to apoptosis • increased production of ECM components 2 J Clin Invest 2009;119: 1438-49 EMT is defined by cellular morphology Yang MH et al. Nat Cell Biol 2010; 12:982-992 Yang MH et al. Nat Cell Biol 2008; 10:295-305 3 EMT in the invasive front of cancer Normal Tumor Invasive front E-cadherin vimentin 4 Yang MH et al. Nat Cell Biol 2008; 10:295-305 EMT signaling in cancer metastasis 5 Yang & Weinberg. Cell 2004; 118:277-9 EMT Generates Cells with Properties of Stem Cells Mani et al. Cell 2008:133:704-15 1. Blocking EMT-induced cancer stem cells expansion reverses anti-EGFR resistance in colon cancer 7 Symmetrical vs. Asymmetrical Division in Stem Cells • Stem cells undergo two types of division: ACD (asymmetrical cell division): maintain tissue homeostasis SCD (symmetrical cell division): promote tissue regeneration Deregulation of asymmetric cell division in cancer stem cells • Asymmetric cell division: one daughter stem cells and one differentiated daughter cells, maintain stem cell pool • Symmetric cell division: two daughter stem cells, expand stem cell pool Question: whether EMT expands CSC pool for facilitating cancer progression? 9 Cell Stem Cell 2013;12:602-15 Enrichment colon cancer stem cells (CCSC) through tumorispheres SDCSC: sphere-derived cancer stem cells SDAC: sphere-derived adherent cells Increased symmetrical division in CCSC CE: co-expression IE: inverse expression miR146a is the top-ranked miRNA in two CCSC miR-seq miR146a is segregated into the daughter stem cells Snail is the major EMT factor for guiding symmetrical division CE: co-expression IE: inverse expression Snail regulates MIR146A transcription through -catenin/TCF4 complex miR146a represses Numb to activate Wnt pathway Numb and cell division mode determination • • • • A cell-fate determinant during development Has been found to be associated with Notch1, LNX1, EPS15 Plays crucial role in asymmetrical cell division. During cell division, Numb is asymmetrically localized in daughter cells. The daughter cell containing Numb is able to differentiate. • Inhibits Notch signaling through ubiquitylation of Notch Numb interacts with -catenin to promote its polyubiquitylation & degradation EGFR Expression in Solid Tumors EGFR is expressed in a variety of solid tumors Head and neck (SCCHN) Colorectal Lung (NSCLC) Tumor Target % Colorectal cancer 72–89 Head and neck cancer 95–100 Lung cancer (NSCLC) 40–80 Breast cancer 14–91 Ovarian cancer 35–70 Renal cell cancer 50–90 Pancreatic cancer 30-95 Cunningham et al. N Engl J Med 2004;351:337–345; Grandis et al. Cancer 1996;78:1284–1292; Salomon et al. Crit Rev Oncol Hematol 1995;19:183–232; Walker & Dearing. Breast Cancer Res Treat 1999;53:167–176; Folprecht et al. ASCO 2004 (Abs283). KRAS mutation confers anti-EGFR resistance in CCSC Crosstalk of EGFR and Wnt pathway in CCSC Inhibiting MEK or Wnt activity of SDCSCs reduces symmetric division and suppresses tumor growth PD98059: MEK inhibitor IWR: Wnt inhibitor Snail(+)Numb(-) profile predicts cetuximab resistance & poor prognosis of colorectal cancer patients Yang MH*, et al. Nat Cell Biol 2014;16: 268-280 News & Views in Nat Cell Biol 2014;16: 212-214 2. Targeting Twist1-mediated signal prevents EMT induces invasiveness in head and neck cancer 27 The role of let-7 family microRNAs in stem cell and cancer Cell 140, February 19, 2010 let-7 is important for stem cell differentiation Nature Genetics , volume 41, number 7 (July ,2009 ) let-7 is critical for suppressing cancer progression Downregulation of let-7i enhances stem-like properties 29 Twist1 represses let-7i expression 30 let-7i does not affect EMT phenotype EMT reorganizes cytoskeleton to enable cancer cell movement 32 Nat Rev Mol Cell Biol 2014; 15:178-96 33 Repression of let-7i promotes cellular protrusions & elongation in 3D culture OECM1mCherry OECM1let7i-1 FaDuspg-ctrl FaDuspg-let7i-1 F-actin /DAPI F-actin /DAPI 34 let-7i is critical in Twist1-induced movement through targeting the Rac1 activators NEDD9 & DOCK3 35 Repression of let-7i is critical for Twist1-induced local invasion FaDu + control vector FaDu + Twist1 FaDu + let7i sponge FaDu + Twist1 + let7i 36 Yang WH, et al. Nat Cell Biol 2012; 14: 366-74 Clinical Characteristics of head and neck cancer Includes cancers originating from oral cavity, oropharynx, hypopharynx, and larynx. 4th cause of male cancer death in Taiwan > 90 %: squamous cell carcinoma (HNSCC) Associated with smoking, drinking, betel nut chewing Frequent local invasion with tissue destruction but low incidence of distant metastasis Clinical significance of let-7i in head and neck cancer patients Invasion to adjacent tissue Current Biology 2012 Head and neck cancer and glioma are “invasive-predominant cancers”. Is there any common strategy for treating the invasive-predominant cancers? 40 Imipramine blue halts mesenchymal migration of head and neck cancer 41 Imipramine blue treatment reverses Twist1-induced EMT IB inhibits NF-B activity in head and neck cancer cells Imipramine blue promotes Twist1 degradation through FBXL14mediated polyubiquitination 4444 Imipramine blue promotes degradation of multiple EMT factors Blocking Twist-mediated signals attenuates EMT and local invasion 46 Yang WH., et al. (Oncogene 2015 Aug 10 online ) Acknowledgements Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan Wei-Lun Hwang (postdoc) Wen-Hao Yang (previous postdoc) Chun-Hung Chou (PhD student) Chia-Hsin Hsieh (PhD student) Po-Hsien Chiu (research assistant) Hsin-Yi Lang (research assistant) Hsiao-Jun Wang (research assistant) Wen-Hao Hsu (research assistant) Yun-Hsuan Su (master student) Prof. Hsei-Wei Wang (NYMU, Taiwan) Prof. Shyh-Kuan Tai (Taipei Veterans General Hospital) Prof. Jack L. Arbiser (Emory School of Medicine, USA)