Abstract 304: Micronuclei in circulating stromal cells correlates with PD-L1 expression and predicts progression in metastatic breast cancer
Authors: Kasabwala Dimpal M. , Cristofanilli Massimo , Alpaugh R. Katherine , Chumsri Saranya , Reduzzi Carolina , Tang Cha-Mei , Lapidus Rena G. , Priore Giuseppe Del , Williams William V. , Adams Daniel L. 
Published: April 2023

Abstract
Background: Micronuclei (MN) are a result of biological DNA repair mechanisms which form due to internal chromosomal aberrations indicating sub-clonal cancer populations with higher cell survivability and drug therapy resistance. MN are often observed as small fragments of nucleic acids excised from a primary nucleus in Circulating Stomal Cells (CStCs) in response to DNA damage. CStCs with damaged DNA undergoing repair mechanisms, such as those that form MN, are likely to have upregulated expression of programmed cell death ligand (PD-L1) which can be abnormally high on cancer cells that have high mutational burdens. We evaluated CStCs in metastatic breast cancer (mBC) patients for presence of MN and the cell's PD-L1 expression, to determine its prognostic significance to clinical outcomes.
Methods: We enumerated MN formation in CStCs in a prospective pilot study using n=76 mBC patients starting new lines of treatment. Whole peripheral blood (7.5mL) was procured and filtered for CStCs and then stained for PD-L1. DAPI was used to identify MN, defined by small (&lt;3 µm) DAPI+ circular formations within the cytoplasm, separate from the primary nucleus. We compared number of MN to PD-L1 expression of all cells, and the MN presence to all available clinical variables. Patients’ progression-free survival (PFS) and overall survival (OS) hazard ratios (HRs) were analyzed by censored univariate analysis based on RECIST v1.1 over two-years.
Results: MN were identified in 62% (n=46/76) of CStCs and MN positive CStCs had a significantly higher PD-L1 expression than MN negative CStCs (p=0.0082). A linear relationship between increasing MN number and higher PDL-1 expression within cells was identified, R=0.9411. Further, presence of MN with in CStCs was significantly prognostic for worse PFS (HR=2.62 95%CI 1.50-4.59, p=0.0012) and worse OS (HR= 3.07 95%CI 1.56-6.03, p = 0.002) over 24 months.
Conclusion: MN formations in mBC are observable biomarkers of an underlying repair mechanism which suggest the survivability of sub-clonal cancer populations associated with more aggressive cancer subtypes with worsening progression rates. Further studies to evaluate the effect of PD-1 immunotherapies in MN positive patients is ongoing.
Citation Format: Dimpal M. Kasabwala, Massimo Cristofanilli, R. Katherine Alpaugh, Saranya Chumsri, Carolina Reduzzi, Cha-Mei Tang, Rena G. Lapidus, Giuseppe Del Priore, William V. Williams, Daniel L. Adams. Micronuclei in circulating stromal cells correlates with PD-L1 expression and predicts progression in metastatic breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 304.