Abstract A017: Comprehensive evaluation of the therapeutic effects of whole-body hyperthermia for pancreatic ductal adenocarcinoma (PDAC) and the potential synergy with standard-of-care chemotherapeutics
Authors: Colenbier Robin , Logghe Tine , Boulet Gaëlle , Bogers Johannes , Timmermans Jean-Pierre 
Published: September 2024

Abstract
Whole-body hyperthermia (WBHT) is a promising therapeutic approach that leverages elevated temperatures to enhance cancer treatment efficacy. By inducing controlled hyperthermia in the range of 39-42.5°C, cellular processes are disrupted and cancer cells can be sensitized to standard-of-care chemotherapies. However, the precise cellular and molecular mechanisms by which WBHT exerts its effects are not fully understood. Elucidating these mechanisms is particularly crucial for optimizing treatment protocols and improving outcomes in aggressive malignancies such as pancreatic ductal adenocarcinoma (PDAC). This study explores the impact of WBHT at 41.5°C on the cell cycle and associated molecular pathways in PDAC cells, providing insights into its therapeutic value and potential for combination regimens. PDAC cell lines, BxPC-3 and AsPC-1, were subjected to WBHT at 41.5°C for 1-6 hours and analyzed immediately, 24h and 48h post-WBHT Cell proliferation was assessed using the 5-ethynyl-2'-deoxyuridine (EdU) base-incorporation assay and proliferating cell nuclear antigen (PCNA) staining for immunofluorescence detection. Morphological changes post-WBHT were monitored using confocal fluorescence microscopy. Total RNA was extracted and sequenced using the Illumina platform. An in-house pipeline was used for QC, alignment and differential expression analysis. Enrichment analysis was performed to identify affected biological processes and pathways. In vivo experiments employed the chorioallantois membrane (CAM) assay per protocol published in STAR protocols. WBHT at 41.5°C significantly disrupted cell cycle progression in PDAC cell lines. The EdU incorporation assay revealed a dose-dependent decrease in DNA synthesis during and following WBHT, indicating cell cycle arrest in the S-phase. Decreases in Ki67, cyclin B1 and PCNA intensities further confirmed this reduction in cell proliferation. Moreover, cells showed notable signs of cellular and mitotic stress, such as the formation of multi-nucleated giant cells, aberrant metaphase morphology and micronuclei. Bulk RNA-seq confirmed alterations in gene expression profiles relating to the cell cycle immediately after HT exposure. Genes associated with the E2F targets and G2/M checkpoint pathways were negatively enriched, whereas genes involved in the Hallmark apoptosis pathway were positively enriched. Preliminary data from in ovo CAM experiments showed a significant inhibitory effect of WBHT monotherapy on growth of BxPC-3 tumors. Our data show that WBHT severely disrupts the cell cycle at the S- and M-phases, via multiple pathways involved in cell proliferation and apoptosis. These cancer hallmarks are targeted by conventional chemotherapeutics, paving the way for combination therapy as one-two punch cancer treatments. The synergy between WBHT with cisplatin and oxaliplatin, but also with gemcitabine and 5-fluorouracil (5-FU) could be optimized based on the improved understanding of the WBHT effects over time, in terms of WBHT duration, sequence of WBHT and chemo and the exact treatment schedule.
Citation Format: Robin Colenbier, Tine Logghe, Gaëlle Boulet, Johannes Bogers, Jean-Pierre Timmermans. Comprehensive evaluation of the therapeutic effects of whole-body hyperthermia for pancreatic ductal adenocarcinoma (PDAC) and the potential synergy with standard-of-care chemotherapeutics [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Advances in Pancreatic Cancer Research; 2024 Sep 15-18; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84(17 Suppl_2):Abstract nr A017.