Evaluation of cell death pathways in cancer and inflammation
Authors:   , Knuth Anne-Kathrin 
Published: February 2022

Inducing cell death in tumor cells is a major goal of anti-cancer therapy. However, the preferable mode of cell death to induce is under debate. Apoptosis is known to be an anti-inflammatory and pro-resolving type of programmed cell death, whereas necroptosis results in the release of danger-associated molecular patterns (DAMPs) and is pro-inflammatory. Efferocytosis of apoptotic cells by macrophages results in a pro-resolving switch of macrophages polarization and is required to induce resolution of inflammation. This impact of apoptotic cells on macrophages is a non-desired consequence of cell death in tumors, which are often characterized by an overshooting wound healing response. Moreover, apoptosis resistance is frequently observed in cancer cells. To overcome apoptosis resistance in cancer cells, necroptosis can be induced as an alternative mechanism for cancer treatment. Interferons (IFNs) play an important role in tumor immune responses and act by inducing the expression of IFN-stiumlated genes (ISGs). Furthermore, IFNs were shown to be able to induce necroptosis together with Smac-mimetics when caspases are inhibited in different cancer cell lines. Necroptosis is induced by phosphorylation and activation of receptor-interacting serine/threonine-protein kinase 1 (RIPK1), RIPK3 and pseudokinase mixed lineage kinase domain-like (MLKL). In my thesis, we first identified MLKL as an ISG in various cancer cell lines. MLKL upregulation was found to be a general feature of IFN signaling since both type I and type II IFNs increase the expression of MLKL. IFN was able to upregulate MLKL at messenger ribonucleic acid (mRNA) and protein level indicating that MLKL is elevated transcriptionally. Indeed, Actinomycin D chase experiments showed that inhibition of transcription abolished MLKL upregulation upon IFN treatment. Both, knockdown of the IFN-activated transcription factors interferon regulatory factor 1 (IRF1) and signal transducer and activator of transcription 1 (STAT1) as well as knockout of IRF1 significantly dampened MLKL mRNA upregulation, demonstrating that STAT1 and especially IRF1 are necessary to induce MLKL expression. This first part of the study highlights the upregulation of MLKL by IFN as valuable tool to sensitize cells towards necroptosis and by that overcome apoptosis resistance in cancers. When compared to apoptosis, the immune response to necroptotic cells and the polarization of macrophages phagocytosing necroptotic cells is not well studied. In most studies, cell death was induced by biological or chemical compounds, which may lead to artifacts by affecting the macrophages and triggering of unrelated signaling pathways. Therefore, in the second part of my thesis we used a pure cell death system of NIH 3T3 cells expressing either dimerizable caspase 8 or oligomerizable RIPK3 to induce cell death. Addition of B/B-Homodimerizer (dimerizer) to the cells resulted in apoptosis or necroptosis, which was confirmed by caspase 3/7 activation, phosphorylation of MLKL and inhibitor experiments, respectively. We analyzed the effect of dying cells on peritoneal macrophages by establishing a co-culture in a transwell system. The genetic profile of macrophages co-cultured with dying cells was evaluated by whole transcriptome RNA sequencing. In macrophages co-cultured with necroptotic cells genes corresponding to chemotaxis and hypoxia pathways were upregulated. A significant proportion of hypoxia-related pathways are mediated by hypoxia-inducible factor 1-alpha (HIF-1α), which also induces metabolic changes in polarized macrophages. We could show that macrophages co-cultured with necroptotic cells showed a decreased mitochondrial respiration, indicating an inflammatory (M1) polarization. Protein levels of chemokine C-X-C motif ligand 1 (CXCL1), which was increased in the RNA sequencing data, were also upregulated in supernatant of co-cultured macrophages and of necroptotic cells, demonstrating that necroptotic cells both secrete CXCL1 and induce gene expression of CXCL1 in peritoneal macrophages. This may influence the recruitment of neutrophils as inhibition of necroptosis during Zymosan-A-induced peritonits in mice decreased the levels of neutrophils at day 1 of this model of self-resolving inflammation. Furthermore, RNA sequencing revealed an unexpected impact of apoptotic cells on macrophage biology as cell cycle and cell division pathways were increased. Enhanced proliferation of macrophages was confirmed by two functional assay with peritoneal macrophages isolated from mice and IC-21 macrophages. Inhibition of apoptosis during Zymosan-A-induced peritonits in mice demonstrated decreased mRNA levels of cell cycle mediators in peritoneal macrophages. Simultaneously with cell cycle activation, gene sets of prostaglandin E2 (PGE2) signaling were upregulated during RNA sequencing. In the second part of my thesis we could demonstrate, that apoptotic cells induce transcription of cell cycle genes and proliferation of macrophages and necroptotic cells are able to influence the chemokine profile of macrophages and thereby the recruitment of neutrophils.