Abstract 4817: Regression of malignant ascites via PAPP-A inhibition in ovarian cancer patient-derived xenograft model
Authors: Zanfagnin Valentina , Bale Laurie K. , Becker Marc A. , Hou Xiaonan , Torres Diogo , Conover Cheryl A. , Weroha Saravut J. 
Published: July 2017

Abstract
Malignant ascites is one of the most common causes of morbidity in end stage ovarian cancer patients with negative impact on quality of life. Novel non-invasive palliative therapeutic options are lacking for such patients.
The zinc metalloprotease, pregnancy-associated plasma protein-A (PAPP-A), plays a key role in the insulin-like growth factor (IGF) pathway, promoting ovarian cancer cellular transformation, growth and invasiveness. Furthermore, patient primary malignant ascites is known to contain high levels of PAPP-A by ELISA. Preliminary data shows that inhibition of PAPP-A through a neutralizing monoclonal PAPP-A antibody (mAb-PA) inhibits the accumulation and promote the regression of ascites in an ovarian cancer patient-derived xenograft (PDX) models. In the current study, we investigated whether mAb-PA can promote ascites regression in an additional ovarian PDX model with measurable ascites.
Patient derived ascites xenograft (PDAX) models were defined as SCID mice that developed ascites after intraperitoneal heterotransplantation of patient solid tumor collected at the time of primary cytoreduction. Ascites from these models (n=51) was screened for human PAPP-A protein by ELISA and models were divided into two groups by the relative concentration of PAPPA-A: high (n=18) and low (n=33).
PAPP-A High PDAX model PH438 was re-established intraperitoneal in 20 SCID mice by ascites injection (0.1 ml per mouse). When ascites area reached a threshold of &gt;0.60 cm2 by ultrasound, mice were treated with 60mg/Kg of mAb-PA (n=10) or IgG2a control (n=10) on day one and three. On day four, a second ultrasound measurement was obtained and the mice were euthanized. Ascites burden was measured at necropsy. Personnel involved with the acquisition of ultrasounds measurements, subsequent ascites harvests, and post hoc analyses were blinded to the treatments. The ratio of mean ascites (mAb-PA/IgG2a in grams) collected at necropsy was 2.04/2.51, indicating that the mAb-PA arm had less ascites compared to control. These data were consistent with pre- and post-treatment ultrasound measurements of ascites burden; a statistically significant (p=0.0283 by paired t test) reduction of ascites burden of 52.3% was observed, compared to the starting baseline, indicating that mAb-PA treatment causes ascites regression. Ascites weight at necropsy was compared to the area of greatest fluid echogenicity by ultrasound and the Pearson correlation R value achieved was of 0.859 (p&lt;0.0001).
These PDAX data implicate PAPP-A attenuation as a potential strategy to treat malignant ascites in OC. Additional PDAX models are under examination to confirm these findings and support the translational development of PAPP-A as a new therapeutic target for women with refractory ascites.
Citation Format: Valentina Zanfagnin, Laurie K. Bale, Marc A. Becker, Xiaonan Hou, Diogo Torres, Cheryl A. Conover, Saravut J. Weroha. Regression of malignant ascites via PAPP-A inhibition in ovarian cancer patient-derived xenograft model [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4817. doi:10.1158/1538-7445.AM2017-4817