Abstract 901: Sox2 and Oct4 activity identify CSC populations in ovarian cancer
Authors: Cruz Luisjesus S. , Robinson Mikella , Gilbert Samuel F. , Lujano-Olazaba Omar , Alexander Logan A. , Horkowitz Alex , House Carrie D. 
Published: June 2022

Abstract
High Grade Serous Ovarian Cancer is the most lethal gynecological cancer, mainly due to late-stage diagnosis and prevalence of chemotherapy-resistant disease. Tumors are comprised of heterogenous cancer cells, which makes targeted therapies challenging. Studies have identified a subset of cancer stem-like cells (CSCs) that, unlike bulk tumor cells, can evade chemotherapy and induce relapse. Cell surface markers such as CD133, CD44, CD117, or ALDH enzyme activity are typically used to identify and isolate CSCs; however, these markers are inconsistent across cell lines and patient samples making them unreliable for isolating CSCs. Consistent indicators of CSCs may be activity of stem cell transcription factors, such as SOX2, OCT4, and NANOG, which are known to promote long-term self-renewal and asymmetric division, processes required for tumor repopulation. We hypothesize that a reporter responding to SOX2 and OCT4 activity will represent a functionally relevant and reliable marker for identifying CSCs capable of enabling relapse. We have stably transduced a reporter (termed SORE6), which detects SOX2 and OCT4 activity, into OV90 and ACI23 ovarian cancer cells. SORE6+ cells, isolated using fluorescence assisted cell sorting (FACS), have 2 to 15-fold increases in SOX2/OCT4/NANOG transcripts, relative to SORE6- cells. Comparison of CSC markers in chemotherapy versus vehicle conditions suggests that SORE6 more consistently identifies the CSC population. Specifically, flow cytometry analysis of ACI23 cells showed a 2-fold increase in SORE6+ cells, 7-fold increase in CD117+ cells, and a 1.2-fold increase in CD133 cells in carboplatin treated cells relative to vehicle. For OV90, SORE6+ increases again by 2-fold, while CD117+ increases by 5-fold and CD133 increases by 1.5-fold. SORE6+ cells also showed significantly enhanced spheroid formation efficiency in low serum conditions and resistance to carboplatin and paclitaxel chemotherapies, relative to SORE6- cells. Finally, in vivo limiting dilution studies in mice showed a significant difference in tumorigenicity of SORE6+ cells at low dilutions in ACI23 cells, but not for OV90 cells. Flow cytometry analysis of disassociated tumors showed that tumors created using pure SORE6- cells remained SORE6-, while tumors created using pure SORE6+ cells maintained only 10% SORE6+, indicating the ability of SORE6+ cells to asymmetrically divide to create a heterogeneous tumor. In conclusion, these data suggest that the SORE6 reporter identifies a CSC population within ovarian cancer cell lines and could be a useful tool for consistent isolation of CSCs. Use of this reporter will enhance our understanding of mechanisms, such as SOX2 and OCT4 activity, that support chemoresistance and tumor repopulation. More reliable identification of CSCs will enable the design of therapies to overcome chemotherapy resistance and disease recurrence.
Citation Format: Luisjesus S. Cruz, Mikella Robinson, Samuel F. Gilbert, Omar Lujano-Olazaba, Logan A. Alexander, Alex Horkowitz, Carrie D. House. Sox2 and Oct4 activity identify CSC populations in ovarian cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 901.