Abstract A39: An integrated molecular and metabolic approach for harnessing early relapse and chemoresistance in ovarian cancer
Authors: Bagnoli Marina , Nicoletti Roberta , Rizzo Andrea , Roggiani Francesca , Satta Alessandro , Figini Mariangela , Zhang Wei , Anastasiadis Panagiotis Z. , Iorio Egidio , Canevari Silvana , Tomassetti Antonella , Raspagliesi Francesco , Mezzanzanica Delia 
Published: August 2018

Abstract
Despite a good response rate to front-line treatment, most of the patients with epithelial ovarian cancer (EOC) will eventually develop an incurable state of platinum (Pt)-resistant disease. Pt resistance is a multifactorial event driven by different molecular mechanisms such as increased ability to tolerate or repair DNA lesions, tendency to plasticity with acquisition of mesenchymal phenotype, and ability to modify/reprogram cellular metabolism. We recently identified in EOC relevant alterations in all of these factors, largely contributing to EOC aggressiveness.
Focusing our attention on microRNAs (miRNAs), the master regulator of gene expression, we identified a cluster of miRNAs located on ChrXq27.3 (miR-506 family) whose downregulation is associated with advanced-stage EOC early relapse, and we found it to be the main contributor of a 35-miRNA based predictor (MiROvaR) of EOC risk of progression/relapse. We also contributed in defining altered choline metabolism in EOC that, through overexpression of choline kinase alpha (ChoK/CHKA) enzyme whose activity sustains tumor addiction to antioxidants, fosters EOC aggressiveness also by increasing chemoresistance.
By in vitro and ex vivo studies performed in human EOC cell lines, non-tumoral immortalized ovarian cells and ex vivo EOC patient-derived ascitic tumor cells (PDAT), here we analyzed the role of miR-506 in regulating molecular network associated with drug resistance and evaluated the druggability of the cholinic phenotype, exploring its possible crosstalk with the immune system.
We confirmed miR-506 to directly regulate the predicted target RAD17, a gene with a key role in guiding BRCA1 to DNA damage sites and stabilizing active signaling. Since an inactivation of DNA repair genes (BRCA1/2) is associated with better prognosis due to sensitization to DNA-damaging drugs, we investigated whether miR-506 can regulate DNA repair machinery by phenocopying/supporting the effects of BRCA1/2 mutation on Pt and PARP inhibitor sensitivity. We observed that miR-506 forced expression or RAD17 knockdown sensitized EOC cells to Pt and PARP inhibitors and, interestingly, showed a synthetic lethal effect with inhibitors of cell-cycle checkpoint kinases CHK1 and WEE1. Association of miR-506 cluster expression (RT-qPCR) with the BRCAness-phenotype is currently ongoing on a retrospective FFPE case material.
We also recently link EOC cells plasticity, miRNAs expression, and Pt-sensitivity. Indeed, E-cadherin can exert a new and unexpected functional role in EOC cells by contributing to Pt susceptibility. We determined that overexpression of PLEKHA7 (Pleckstrin homology domain-containing family A member 7), a component of the zonula adherens in polarized epithelia and expressed at low levels in EOC biopsies, inhibits cell tumorigenicity and sensitizes EOC cells to Pt treatment. We will evaluate PLEKHA7 ability to regulate miRNAs driving tumor progression, including some of the miR-506 family.
Concerning chemoresistance associated with metabolic rewiring, we showed that CHKA silencing altered the cellular oxidative stress redox status, decreasing glutathione content and raising reactive oxygen species (ROS) levels. Interestingly, the increase in intracellular ROS species improved EOC cells’ sensitivity to Pt/taxane treatments, contributing to cell death triggering. Moreover, upon CHKA silencing both in vitro and in PDAT cells, we observed an enhanced sensitization of cancer cells to TRAIL-mediated citotoxicity due to an augmented expression of pro-apoptotic/reduced expression of anti-apoptotic TRAIL receptor members, thus further increasing tumor cells’ weakness.
Exploiting tumor’s reliance on these altered molecular and metabolic pathways is expected to be an appropriate strategy to improve efficacy of current treatment, possibly circumventing drug resistance.
Funded by CARIPLO Foundation, AIRC and 5x1000 Institutional Research Funding.
Citation Format: Marina Bagnoli, Roberta Nicoletti, Andrea Rizzo, Francesca Roggiani, Alessandro Satta, Mariangela Figini, Wei Zhang, Panagiotis Z. Anastasiadis, Egidio Iorio, Silvana Canevari, Antonella Tomassetti, Francesco Raspagliesi, Delia Mezzanzanica. An integrated molecular and metabolic approach for harnessing early relapse and chemoresistance in ovarian cancer. [abstract]. In: Proceedings of the AACR Conference: Addressing Critical Questions in Ovarian Cancer Research and Treatment; Oct 1-4, 2017; Pittsburgh, PA. Philadelphia (PA): AACR; Clin Cancer Res 2018;24(15_Suppl):Abstract nr A39.