Abstract 69: Chemotherapy-induced cancer cell death diminishes therapeutic efficacy through heme oxygenase-1-mediated inactivation of M1-like tumor associated macrophages
Authors: Kim Seung Hyeon , Zhong Xiancai , Gwak Shin-Young , Muna Ishrat Aklima , Park Sin-Aye , Cha Young-Nam , Surh Young-Joon 
Published: August 2018

Abstract
One of the most common treatment options for cancer is a chemotherapy. After chemotherapy, however, unwanted host effects provoke tumor recurrence and aggressiveness of cancer cells, which often arise as a consequence of disruption in the patient's immune system. Lymphocytes, such as CD8+ cytotoxic T lymphocytes (CTLs), which have capability of suppressing cancer progression, are depleted following chemotherapy. Conventional chemotherapeutic agents kill cancer cells, which boosts recruitment of myeloid cells. Tumor-associated macrophages (TAMs), emerging as abundant tumor-infiltrating myeloid cells in tumor microenvironment, play an important role in immunosuppression caused by conventional chemotherapy. Chemotherapy-induced dying cancer cells could hijack accumulated TAMs, provoking tumor recurrence. Therefore, reprogramming of TAMs to maximize the chemotherapeutic efficacy is considered a promising novel anticancer strategy. In this study, we investigated whether dying cancer cells after chemotherapy could reduce therapeutic efficacy by modulating tumor-infiltrating macrophage activity. In a 4T1 syngeneic mouse breast cancer model, there was a marked decrease in the proportion of M1-like TAMs expressing CD86 with tumor-suppressive activity and reduced tumor infiltration of CTLs following treatment with paclitaxel. Paclitaxel treatment also resulted in an enhancement of heme oxygenase-1 (HO-1) mRNA levels in tumor-infiltrating myeloid cells engulfing dying cancer cells. Consistent with the in vivo profile of TAMs, bone marrow-derived macrophages (BMDMs) phagocytosing dying breast cancer cells exhibited significant upregulation of HO-1 expression. HO-1 induction in BMDMs engulfing dying breast cancer cells facilitated M2 polarization. In contrast, abrogation of HO-1 activity sustained M1 activation of BMDMs co-cultured with dying breast cancer cells. Pharmacologic inhibition of HO-1 activity with zinc protoporphyin IX augmented paclitaxel efficacy by stimulating tumor infiltration of CTLs in a 4T1 breast cancer model. Furthermore, blockade of HO-1 in breast tumor-bearing mice induced increased M1-like TAMs expressing CD86 that plays an important role in stimulating antitumor immune response. Taken together, HO-1 induction by the chemotherapy-derived dying cancer cells in TAMs dampens antitumor effects of chemotherapy by manipulating innate and adaptive immunity. Our results demonstrate that targeting overexpressed HO-1 in the breast tumor microenvironment can control the immune system to potentiate the efficacy of chemotherapy.
Citation Format: Seung Hyeon Kim, Xiancai Zhong, Shin-Young Gwak, Ishrat Aklima Muna, Sin-Aye Park, Young-Nam Cha, Young-Joon Surh. Chemotherapy-induced cancer cell death diminishes therapeutic efficacy through heme oxygenase-1-mediated inactivation of M1-like tumor associated macrophages [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 69.