Abstract POSTER-THER-1406: Tissue factor-factor VIIa complex triggers vascular endothelial growth factor-a secretion in epithelial ovarian cancer cell lines via a protease activated receptor-2 dependent mechanism
Authors: Chanakira Alice , Sheehan John P. 
Published: August 2015

Abstract
Purpose of study: Epithelial ovarian cancer (EOC) is highly sensitive to initial platinum-based chemotherapy, but ultimately re-growth of the tumor occurs in the majority of patients with development of platinum resistance. Identification of: 1) the major mechanisms leading to regrowth, and 2) potential drug targets for maintenance therapy to prevent regrowth/relapse of EOC would potentially have a dramatic impact on patient outcomes. Progression of EOC is often associated with a procoagulant phenotype, characterized by increased tissue factor (TF) expression and enhanced metastasis. TF-factor VIIa (FVIIa) complex on the cell surface activates protease activated receptor-2 (PAR-2) directly, and PAR-1 activation indirectly via triggering local thrombin generation. PAR-2 activation is associated with an induction in growth factor release in renal cell carcinoma. We hypothesize that TF-FVIIa dependent activation of PAR-2 on EOC cells up-regulates expression of angiogenic mediators (VEGF-A) that modify the peritoneal microenvironment, enhancing vascular leakage and ascites formation. Incorporation of anti–VEGF therapy in standard treatment of EOC has been shown to prolong progression-free survival, but the underlying mechanisms are incompletely understood. The objective of this study is to determine the role TF-FVIIa-PAR-2 axis plays in EOC progression.
Methods: TF antigen expression in EOC cell lines (CaOV-3, SKOV-3 & OvCAR-3) was determined by western blot (WB) analysis. TF-bearing microparticles were isolated from conditioned media by differential centrifugation (20,800 g) and TF coagulant activity was detected by factor X activation. VEGF-A levels in conditioned media were determined by ELISA. Proliferation of the SKOV-3 and OVCAR-3 cell lines in response to thrombin (PAR-1 agonist) was determined via direct cell count.
Results: WB analysis of EOC cell line lysates demonstrated PAR-2 expression (CaOV-3&gt;OvCAR-3&gt;&gt;SKOV-3), and exposure of SKOV-3 and OVCAR-3 cells to 50 nM FVIIa resulted in 3-fold induction of VEGF-A release over 48 hr relative to untreated cells (p&lt;0.05). TF-FVIIa complex was a more potent inducer of VEGF-A when compared to the PAR-2 peptide agonist (SKIGKL-NH2). Pre-incubation with the PAR-2 antagonist ENMD-1068 reduced VEGF-A to basal levels in the presence of TF-FVIIa; further supporting PAR-2 dependent induction of VEGF-A. Pan-expression of PAR-1 was observed in EOC cell lines by WB. Thrombin (0.1-1U/mL), an established PAR-1 agonist, induced dose-dependent proliferation of SKOV-3 and OVCAR-3 cell lines under serum free conditions (p&lt;0.001). Pre-incubation with the PAR-1 antagonist vorapaxar reduced proliferation to basal levels in the presence of thrombin.
Conclusion: TF expression and coagulant activity is up regulated in EOC. FVIIa triggers a PAR-2 dependent induction of VEGF-A release from EOC cell lines. Similarly, the PAR-1 agonist thrombin triggered a significant increase in EOC cell proliferation. These results suggest that interaction of EOC with the coagulation system in the tumor microenvironment may enhance both PAR-1 dependent cellular proliferation and PAR-2 dependent release of VEGF, a potent regulator of angiogenesis. Thus, PAR-1 and PAR-2 may represent pharmacologically relevant drug targets to block ovarian cancer progression via inhibition of growth and angiogenesis.
Citation Format: Alice Chanakira PhD, John P. Sheehan MD. Tissue factor-factor VIIa complex triggers vascular endothelial growth factor-a secretion in epithelial ovarian cancer cell lines via a protease activated receptor-2 dependent mechanism [abstract]. In: Proceedings of the 10th Biennial Ovarian Cancer Research Symposium; Sep 8-9, 2014; Seattle, WA. Philadelphia (PA): AACR; Clin Cancer Res 2015;21(16 Suppl):Abstract nr POSTER-THER-1406.