Cancer Research Communications

BackgroundBreast cancer, the most common cancer type among women, was recently found to contain a specific tumor microbiome, but its impact on host biology remains unclear. CD8+ tumor-infiltrating lymphocytes (TILs) are pivotal effectors of anti-tumor immunity that influence cancer prognosis and response to therapy. This study aims to elucidate interactions between CD8+ TILs and the breast tumor microbiome and metabolites, as well as how the breast tumor microbiome may affect the tumor metabolome. MethodsWe investigated the interplay among CD8+ TILs, the tumor microbiome, and the metabolome in a cohort of 46 breast cancer patients with mixed subtypes (Cohort A). We characterized the tumor metabolome by mass spectrometry and CD8+ TILs by immunohistochemistry. Microbiome composition and T cell gene transcript levels were obtained from data from our previous study, which utilized 16S rRNA gene sequencing and a targeted mRNA expression panel. To examine interactions between intratumoral Staphylococcus and specific breast cancer subtypes, we analyzed RNA sequencing data from an independent cohort of 370 breast cancer patients (Cohort B). We explored the functions of the tumor microbiome using mouse models of triple-negative breast cancer (TNBC). ResultsIn tumors from Cohort A, the relative abundance of Staphylococcus positively correlated with the expression of T cell activation genes. The abundances of multiple metabolites exhibited significant correlations with CD8+ TILs, of which NADH, {gamma}-glutamyltryptophan, and {gamma}-glutamylglutamate displayed differential abundance in Staphylococcus-positive versus Staphylococcus-negative breast tumors. In a larger breast cancer cohort (Cohort B), we observed positive correlations between tumoral Staphylococcus and CD8+ TIL activity exclusively in TNBC. Preclinical experiments demonstrated that intratumoral administration of S. aureus, the predominant species of Staphylococcus in human breast tumors, resulted in a depletion of total NAD metabolites, and reduced the growth of TNBC tumors by activating CD8+ TILs. ConclusionsWe identified specific metabolites and microbial taxa associated with CD8+ TILs, delineated interactions between the breast tumor microbiome and metabolome, and demonstrated that intratumoral Staphylococcus influences anti-tumor immunity and TIL-associated metabolites. These findings highlight the role of low-biomass microbes in tumor tissues and provide potential biomarkers and therapeutic agents for breast cancer immunotherapy that merit further investigation.

Tumor-derived lactate is increasingly recognized as an immunosuppressive metabolite within the tumor microenvironment (TME), with emerging evidence highlighting its role beyond metabolism to include epigenetic and immune regulatory functions. While prior studies have primarily focused on individual immune checkpoints, most prominently PD-L1, it remains unclear whether lactate broadly coordinates the expression of multiple immune regulatory pathways across distinct tumor types, particularly in the context of chronic exposure mimicking glycolytic tumors. Here, we investigated the relationship between lactate-producing metabolism and immune checkpoint gene expression in four human cancer cell lines representing breast and lung cancer: MCF7 (estrogen receptor-positive breast), MDA-MB-231 (triple-negative breast), A549 (non-small cell lung), and H82 (small cell lung). By manipulating glucose availability and exposure duration to model acute (6 h) versus chronic (48 h) lactate production, and by pharmacologically inhibiting lactate dehydrogenase (LDH) with oxamate, we quantified extracellular lactate accumulation and assessed transcriptional responses of a panel of immune checkpoints (PD-L1, CD80, CD73, LGALS9, VISTA, PVR, CD47, FGL1, STING) and lactate-associated genes (MCT1, MCT4, LDHA, HCAR1) via qPCR. Chronic high-glucose conditions produced robust, LDH-dependent lactate accumulation and were associated with coordinated, lineage-specific remodeling of multiple checkpoint transcripts, whereas acute exposure induced minimal changes. MDA-MB-231 and A549 cells displayed striking but distinct checkpoint patterns under chronic lactate-producing conditions: MDA-MB-231 cells showed strong co-induction of PD-L1 and CD80, while A549 cells exhibited dominant CD80 induction with modest PD-L1 upregulation. H82 cells upregulated PD-L1 alongside CD73, LGALS9, CD47, and CD80, whereas MCF7 cells demonstrated more modest yet coordinated increases across several checkpoints. Chronic glucose exposure resulted in sustained, LDH-dependent lactate accumulation and coordinated induction of multiple immune checkpoint genes, with distinct lineage-specific patterns, e.g., robust PD-L1/CD80 upregulation in MDA-MB-231 versus CD80 dominance in A549. Unsupervised clustering and principal component analysis revealed that duration of glucose exposure, rather than acute glucose availability, was the primary axis of variation and that MCT4 and HCAR1 clustered with strongly induced checkpoints, consistent with a transcriptional program linking lactate export and sensing to immune regulation. These findings support a model in which lactate acts as an upstream regulator of a broader immune escape program, potentially via mechanisms like lactylation and HCAR1 signaling. This work highlights the limitations of single-checkpoint blockade strategies in solid tumors and underscores the potential of targeting lactate metabolism to enhance immunotherapy efficacy in breast and lung cancers.

Prostate cancer (PC) is the second most lethal cancer for men and metastatic PC is treated by androgen deprivation therapy (ADT). While effective, ADT has many metabolic side effects. Previously, serum metabolome analysis showed that ADT reduced androsterone sulfate, 3-hydroxybutyric acid, acyl-carnitines while increased serum glucose. Since ADT reduced ketogenesis, we speculate that low-carbohydrate diets (LCD) may reverse many ADT-induced metabolic abnormalities in animals and humans. To test this possibility, we conducted a multi-center trial of PC patients initiating ADT randomized to no diet change (control) or LCD. We previously showed LCD led to significant weight loss, reduced fat mass, improved insulin resistance and lipid profiles. To determine whether and how LCD affects ADT-induced metabolic effects, we analyzed serum metabolites after 3-, and 6-months of ADT on LCD vs. control. We found androsterone sulfate was most consistently reduced by ADT, and was slightly further reduced by LCD. Contrastingly, LCD increased 3-hydroxybutyric acid and various acyl-carnitines, counteracting their reduction during ADT. LCD also reversed the ADT-reduced lactic acid, alanine and S-adenosyl Methionine (SAM), elevating glycolysis metabolites, amino acids and sulfur-containing metabolites. While the degree of ADT-reduced androsterone was strongly correlated with glucose and indole-3-carboxaldehyde, LCD disrupted such correlation. However, many LCD-induced changes were seen at 3-but not 6-month, suggesting metabolic adaption. Together, LCD significantly reversed many ADT-induced metabolic changes while slightly enhancing androgen reduction. Future research is needed to confirm these findings and determine whether LCD can mitigate ADT-linked comorbidities and possibly delaying disease progression by further lowering androgens. Statement of translational relevanceProstate cancer (PC) is the most common non-skin cancer and second leading cause of cancer-related death in men. While androgen deprivation therapy (ADT) is the main treatment for metastatic PC, it has many metabolic side effects. Previous serum metabolome analysis of PC patients receiving ADT identified reduced ketogenesis. Therefore, low-carbohydrate diets (LCD), ketogenic in nature, may reverse many ADT-induced metabolic abnormalities. We conducted a 6-month multi-center trial of no diet change (control) vs. LCD in men initiating ADT. We found that LCD reversed many ADT-induced metabolic abnormalities while slightly further reducing androgen levels. Also, LCD disrupted the diabetogenic effects of ADT, but some effects seen at 3-month were lost at 6-month, suggesting metabolic adaptation to LCD. These data suggest the potential metabolic benefits of LCD with potential to enhance ADT efficacy. Larger studies testing whether LCDs mitigate metabolic side effects and slow disease progression are warranted given acceptable safety profiles, metabolic benefits, and possibly lowered androgens.

5-fluorouracil (5-FU) is a successful and broadly used anti-cancer therapeutic. A major mechanism of action of 5-FU is thought to be through thymidylate synthase (TYMS) inhibition resulting in dTTP depletion and activation of the DNA damage response. This suggests that 5-FU should synergize with other DNA damaging agents. However, we found that combinations of 5-FU and oxaliplatin or irinotecan failed to display any evidence of synergy in clinical trials, and resulted in sub-additive killing in a panel of colorectal cancer (CRC) cell lines. In seeking to understand this antagonism, we unexpectedly found that an RNA damage response during ribosome biogenesis dominates the drugs efficacy in tumor types for which 5-FU shows clinical benefit. 5-FU has an inherent bias for RNA incorporation, and blocking this greatly reduced drug-induced lethality, indicating that accumulation of damaged RNA is more deleterious than the lack of new RNA synthesis. Using 5-FU metabolites that specifically incorporate into either RNA or DNA revealed that CRC cell lines and patient-derived colorectal cancer organoids are inherently more sensitive to RNA damage. This difference held true in cell lines from other tissues in which 5-FU has shown clinical utility, whereas cell lines from tumor tissues that lack clinical 5-FU responsiveness typically showed greater sensitivity to the drugs DNA damage effects. Analysis of changes in the phosphoproteome and ubiquitinome shows RNA damage triggers the selective ubiquitination of multiple ribosomal proteins leading to autophagy-dependent rRNA catabolism and proteasome-dependent degradation of ubiquitinated ribosome proteins. Further, RNA damage response to 5-FU is selectively enhanced by compounds that promote ribosome biogenesis, such as KDM2A inhibitors. These results demonstrate the presence of a strong RNA damage response linked to apoptotic cell death, with clear utility of combinatorially targeting this response in cancer therapy.

DNA damage and cytoplasmic DNA induce type-1 interferon (IFN-1) and potentiate responses to immune checkpoint inhibitors. Our prior work found that inhibitors of the DNA damage response kinase ATR (ATRi) induce IFN-1 and deoxyuridine (dU) incorporation by DNA polymerases, akin to antimetabolites. Whether and how dU incorporation is required for ATRi-induced IFN-1 signaling is not known. Here, we show that ATRi-dependent IFN-1 responses require uracil DNA glycosylase (UNG)-initiated base excision repair and STING. Quantitative analyses of nine distinct nucleosides reveals that ATRi induce dU incorporation more rapidly in UNG wild-type than knockout cells, and that induction of IFN-1 is associated with futile cycles of repair. While ATRi induce similar numbers of micronuclei in UNG wild-type and knockout cells, dU containing micronuclei and cytoplasmic DNA are increased in knockout cells. Surprisingly, DNA fragments containing dU block STING-dependent induction of IFN-1, MHC-1, and PD-L1. Furthermore, UNG knockout sensitizes cells to IFN-{gamma} in vitro, and potentiates responses to anti-PD-L1 in resistant tumors in vivo. These data demonstrate an unexpected and specific role for dU-rich DNA in suppressing STING-dependent IFN-1 responses, and show that UNG-deficient tumors have a heightened response to immune checkpoint inhibitors. STATEMENT OF SIGNIFICANCEAntimetabolites disrupt nucleotide pools and increase dU incorporation by DNA polymerases. We show that unrepaired dU potentiates responses to checkpoint inhibitors in mouse models of cancer. Patients with low tumor UNG may respond to antimetabolites combined with checkpoint inhibitors, and patients with high tumor UNG may respond to UNG inhibitors combined with checkpoint inhibitors.

RationaleImmunosuppression in the tumor microenvironment (TME) is key to the pathogenesis of solid tumors. Tumor cell-intrinsic autophagy is critical for sustaining both tumor cell metabolism and survival. However, the role of autophagy in the host immune system that allows cancer cells to escape immune destruction remains poorly understood. Here, we determined if attenuated host autophagy is sufficient to induce tumor rejection through reinforced adaptive immunity. Furthermore, we determined whether dietary glutamine supplementation, mimicking attenuated host autophagy, is capable of promoting antitumor immunity. MethodsA syngeneic orthotopic tumor model in Atg5+/+ and Atg5flox/flox mice was established to determine the impact of host autophagy on the antitumor effects against mouse malignant salivary gland tumors (MSTs). Multiple cohorts of immunocompetent mice were used for oncoimmunology studies, including inflammatory cytokine levels, macrophage, CD4+, and CD8+ cells tumor infiltration at 14 days and 28 days after MST inoculation. In vitro differentiation and in vivo dietary glutamine supplementation were used to assess the effects of glutamine on Treg differentiation and tumor expansion. ResultsWe showed that mice deficient in the essential autophagy gene, Atg5, rejected orthotopic allografts of isogenic MST cells. An enhanced antitumor immune response evidenced by reduction of both M1 and M2 macrophages, increased infiltration of CD8+ T cells, elevated IFN-{gamma} production, as well as decreased inhibitory Tregs within TME and spleens of tumor-bearing Atg5flox/flox mice. Mechanistically, ATG5 deficiency increased glutamine level in tumors. We further demonstrated that dietary glutamine supplementation partially increased glutamine levels and restored potent antitumor responses in Atg5+/+ mice. ConclusionsDietary glutamine supplementation exposes a previously undefined difference in plasticity between cancer cells, cytotoxic CD8+ T cells and Tregs.

BackgroundAs knowledge of mechanisms that drive the development of cancer grows, there has been corresponding growth in therapies specific to a mechanism. While these therapies show improvements in patient outcomes, they can be expensive and are effective only for a subset of patients. These treatments drive interest in research focused on the assignment of cancer therapies based on aberrations in individual genes or biomarkers that assess the broader mutational landscape, including microsatellite instability (MSI) and tumor mutational burden (TMB). MethodsHere we describe the TruSight Oncology 500 (TSO500; Research Use Only) bioinformatics workflow. This tumor-only approach leverages the next-generation sequencing-based assay TSO500 to enable high fidelity determination of DNA variants across 523 cancer-relevant genes, as well as MSI status and TMB in formalin-fixed paraffin-embedded (FFPE) samples. ResultsThe TSO500 bioinformatic workflow integrates unique molecular identifier (UMI)-based error correction and a dual approach variant filtering strategy that combines statistical modeling of error rates and database annotations to achieve detection of variants with allele frequency approaching 5% with 99.9998% per base specificity and 99% sensitivity in FFPE samples representing a variety of tumor types. TMB determined using the tumor-only workflow of TSO500 correlated well with tumor-normal (N =170, adjusted R2=0.9945) and whole-exome sequencing (N=108, adjusted R2=0.933). Similarly, MSI status determined by TSO500 showed agreement (N=106, 98% agreement) with a MSI-PCR assay. ConclusionTSO500 is an accurate tumor-only workflow that enables researchers to systematically characterize tumors and identify the next generation of clinical biomarkers.

BackgroundCurrently, no biomarkers are available to identify resistance to androgen-deprivation therapies (ADT) in men with hormone-naive prostate cancer. Since 5-hydroxymethylcytosines (5hmC) in gene body are associated with gene activation, in this study, we evaluated whether 5hmC signatures in cell-free DNA (cfDNA) predicts early resistance to ADT. ResultsWe collected a total of 139 serial plasma samples from 55 prostate cancer patients receiving ADT at three time points including baseline (prior to initiating ADT, N=55), 3-month (after initiating ADT, N=55), and disease progression (N=15) within 24 months or 24-month if no progression was detected (N=14). To quantify 5hmC abundance across the genome, we used selective chemical labeling sequencing and mapped sequence reads to individual genes. Differential methylation analysis in baseline samples identified significant 5hmC difference in 1,642 of 23,433 genes between patients with and without progression (false discovery rate, FDR<0.1). Patients with disease progression showed significant 5hmC enrichments in multiple hallmark gene sets with androgen responses as top enriched gene set (FDR=1.19E-13). Interestingly, this enrichment was driven by a subgroup of patients featuring a significant 5hmC hypermethylation in the gene sets involving AR, FOXA1 and GRHL2. To quantify overall activities of these gene sets, we developed a gene set activity scoring algorithm and observed significant association of high activity scores with poor progression-free survival (P<0.05). Longitudinal analysis showed that the high activity scores were significantly reduced after 3-months of initiating ADT (P<0.0001) but returned to higher levels when the disease was progressed (P<0.05). ConclusionsThis study demonstrates that 5hmC-based activity scores from gene sets involved in AR, FOXA1 and GRHL2 may be used as biomarkers to determine early treatment resistance, monitor disease progression, and potentially identify patients who would benefit from upfront treatment intensification.

Three-dimensional (3D) cell culture systems have emerged as powerful tools for modeling tumor biology in ex vivo settings. However, the diverse array of available 3D culture methods presents challenges in selecting the most appropriate model for specific research questions. This study provides a comparative analysis of breast cancer cells (SUM149, IBC-3, and MDA-MB-468) in the mammosphere culture (SphC) model or an "emboli" culture (EmC) model, which enrich for cancer stem cells and epithelial features, respectively. The EmC model, designed originally for inflammatory breast cancer, is characterized by media viscosity and mechanical rocking of the culture vessel. Notably, cells in EmC showed a distinct and durable reduction in cell proliferation ex vivo while demonstrating increased capacity to establish experimental lung metastases in vivo. Ultrastructural quantitative analysis of electron microscopy images suggested that cells in EmC acquire nuclear and mitochondrial features that resemble those of tumor tissue. Proteomics, single-cell transcriptomics, and metabolic flux analyses showed that cells in EmC and SphC favor mitochondrial oxidative metabolism (OXPHOS) and glycolysis, respectively. EmC rendered cells hypersensitive to OXPHOS inhibition, but more resistant to oxidative stress. Several genes associated with lung metastasis, including ID1, were specifically enriched in EmC. Given the emerging role of OXPHOS in cancer cell survival during dissemination and as established metastases, we propose that the EmC paradigm is a suitable ex vivo model to study signaling pathways relevant for tumor tissue and to assess drug sensitivities and resistance mechanisms of metastatic breast cancer cells ex vivo. SIGNIFICANCEThis study provides an in-depth characterization of a resource-efficient yet powerful 3D culture paradigm to improve the physiological relevance of ex vivo approaches. Applicable to epithelial cancers, this model offers a platform to accelerate the discovery of physiologically relevant signaling pathways and specific cancer cell vulnerabilities.

Adenoid cystic carcinoma of the salivary gland (SGACC) is a highly aggressive malignancy characterized by poor patient survival outcomes. While several studies have analyzed the transcriptome of the salivary gland at the bulk and single-cell level, no spatial transcriptomic analyses of this tissue have been published. Most of the existing publications on SGACC have predominantly relied on bulk and single cell RNA sequencing approaches, which do not resolve the spatially localized transcriptional heterogeneity nor have the resolution for defining molecular markers within tumor subpopulations. SGACC is clinically notable for the presence of multiple tumor clones, distinct spatial phenotypes, and its indolent yet invasive nature coupled with a high propensity for distant metastasis. These features may reflect co-expression of tumor-associated markers across diverse cellular niches, and a resultant biological complexity which causes standard treatment such as surgical resection, radiation therapy, and chemotherapy to be largely ineffective in significantly improving long-term survival, and highlights the need for more precise, targeted therapeutic strategies. Herein, we analyzed single cell (n = 4) and high-resolution spatial transcriptomics samples (n = 5) to characterize cancer cell populations in MYB- and non-MYB-expressing cell states, delineated gene expression signatures, and identified critical molecular interactions specific to SGACC. We used Visum HD to obtain spatial transcriptomics data at 2{micro}m squared high resolution. This allowed a multi-omics approach comprising single cell and spatial transcriptomic methods to enable the discovery of novel transcriptional signatures and microenvironmental features not captured by conventional methods. Spatial mapping revealed marked cellular heterogeneity and demonstrated how tissue environments influence cellular transcriptomics. To tumor heterogeneity, we focused on tumorigenic cell populations, profiled plasma and T cell enrichment within the tumor microenvironment and identified key pathways and transcriptional drivers including the MYB-NFIB fusion underlying the tumor cluster formation. Our findings indicate an upregulation of genes involved in extracellular matrix remodeling, autophagy, and reactive stromal cell populations. We further found evidence of partial epithelial-mesenchymal transition (P-EMT) programming within MYB-expressing tumor clusters. Pathway analysis revealed that mutations in the spatial query sample prominently affect the PI3K-AKT and IL-17 signaling pathways, together with a downregulation of canonical Wnt signaling in some regions of the tissue architecture adjacent to immune cells. Collectively, these results underscore the complex regulatory landscape of SGACC and offer insights into its cellular dynamics and possible therapeutic vulnerabilities.

BackgroundSingle-cell transcriptomics has transformed our understanding of cellular diversity in biological systems. However, systematic noise, often introduced by low-quality cells, can obscure biological signals if not properly accounted for. Thus, one of the common quality control steps involves filtering out cells with a high percentage of mitochondrial RNA counts (pctMT), as high pctMT typically indicates cell death. Yet, commonly used filtering thresholds, primarily derived from studies on healthy tissues, may be overly stringent for malignant cells, which often naturally exhibit higher baseline mitochondrial gene expression. We analyzed public single-cell RNA-seq and spatial data to investigate if malignant cells with high pctMT are viable and functionally significant subpopulations. ResultsWe analyzed nine single-cell RNA-seq datasets from uveal melanoma, breast, lung, kidney, head and neck, prostate, and pancreatic cancers, including 439,507 cells from 151 patients. Malignant cells exhibited significantly higher pctMT than nonmalignant cells without a significant increase in dissociation-induced stress signature scores. Malignant cells with high pctMT showed metabolic dysregulation, including increased xenobiotic metabolism, which is implicated in cancer therapeutic response. Our analysis of pctMT in cancer cell lines uncovered associations with resistance and sensitivity to certain classes of drugs. Additionally, we observed a link between pctMT and malignant cell transcriptional heterogeneity as well as patient clinical features. ConclusionsThis study provides a detailed exploration of the functional characteristics of malignant cells with elevated pctMT, challenging current quality control practices in single-cell RNA-seq analyses of tumors. Our findings have the potential to improve data interpretation and refine the biological conclusions of future cancer studies.

Pancreatic ductal adenocarcinoma (PDAC) has a poor survival rate and limited treatments. Agonistic CD40 antibodies are promising, but clinical trials have shown only modest efficacy and significant hepatotoxicity. We previously reported that IL-1 pathway blockade enhances agonistic CD40 antibody efficacy against melanoma by depleting polymorphonuclear myeloid-derived suppressor cells (PMN-MDSCs; CD11b+Ly6C+Ly6G+). Because PMN-MDSCs also cause liver toxicity, we investigated the impact of IL-1R1 blockade on the efficacy and toxicity of agonistic CD40 antibody therapy in PDAC. Agonistic CD40 antibody therapy induced immune activation and significantly prolonged survival in orthotopic PDAC-bearing mice. IL-1R1 blockade monotherapy downregulated innate and adaptive immune response and exacerbated tumor growth. Although combination therapy upregulated several immune-related pathways and boosted innate and adaptive immune responses. IL-1R1 blockade failed to improve the overall antitumor efficacy of agonistic CD40 antibody therapy and exacerbated liver toxicity. Ly6G+ cell depletion in mice reduced the efficacy of agonistic CD40 antibody therapy, suggesting that Ly6G immune cells (PMN-MDSCs or neutrophils) exhibit an antitumor rather than immunosuppressive role in PDAC. Our findings underscore the complex role of IL-1 signaling in modulating immune responses in PDAC and caution against pursuing IL-1R1 blockade, either as monotherapy or combined with agonistic CD40 antibodies, in clinical trials for PDAC.

Cancer cells alter their metabolic phenotypes with nutritional change. Single agent approaches targeting mitochondrial metabolism in cancer have failed due to either dose limiting off target toxicities, or lack of efficacy in vivo. To mitigate these clinical challenges, we investigated the potential utility of repurposing FDA approved mitochondrial targeting anthelmintic agents, niclosamide and pyrvinium pamoate, to be combined with GLUT1 inhibitor BAY-876 to enhance the inhibitory capacity of the major metabolic phenotypes exhibited by tumors. To test this, we used breast cancer cell lines MDA-MB-231 and 4T1 which exhibit differing basal metabolic rates of glycolysis and mitochondrial respiration, respectively. Here, we found that specific responses to mitochondrial and glycolysis targeting agents elicit responses that correlate with tested cell lines basal metabolic rates and fuel preference, highlighting the potential to cater metabolism targeting treatment regimens based on specific tumor nutrient handling. Inhibition of GLUT1 with BAY-876 potently inhibited glycolysis in both MDA-MB-231 and 4T1 cells, and niclosamide and pyrvinium pamoate perturbed mitochondrial respiration that resulted in potent compensatory glycolysis in the cell lines tested. In this regard, combination of BAY-876 with both mitochondrial targeting agents resulted in inhibition of compensatory glycolysis and subsequent metabolic crisis. These studies warrant further investigation into targeting tumor metabolism as a combination treatment regimen that can be tailored by basal and compensatory metabolic phenotypes.

Prostate-specific antigen (PSA) screening has reduced prostate cancer (PCa) mortality but suffers from limited specificity, contributing to unnecessary biopsies and overdiagnosis of indolent disease. There is a critical need for biofluid-based biomarkers that improve the precision of PCa detection. Extracellular vesicles (EVs) offer a promising platform for noninvasive diagnostics, as they carry molecular cargo reflective of their tissue of origin. The ExoDx Prostate IntelliScore (EPI) test, a urine-based EV assay, is currently the only commercial EV diagnostic for clinically significant (cs)PCa, but its performance may be constrained by contamination from renal and bladder-derived EVs. To address this, we developed Exosome Diagnostics Depletion and Enrichment (EDDE), a novel immunocapture-based method for isolating prostate-derived EVs with high specificity. By targeting Prostate Specific Membrane Antigen (PSMA), we optimized EDDE to selectively enrich prostate EVs from post-DRE urine and recover sufficient RNA for transcriptomic analysis. Throughout development, we implemented a quantitative framework to track EV stoichiometry and assess depletion efficiency and yield, enabling rigorous optimization of the workflow. Our findings demonstrate that PSMA EDDE enriches prostate-specific EVs and yields RNA quantities compatible with sequencing. This platform enhances the specificity of EV-based biomarker discovery and holds promise for determining if tissue-specific EV biomarkers contribute advantages over bulk EVs.

Despite advances in cancer therapeutics, early detection is often the best prognostic indicator for survival (1). People with Li-Fraumeni syndrome harbor a germline pathogenic variant in the tumor suppressor gene TP53 (2) and face a near 100% lifetime risk of developing a wide spectrum of, often multiple, cancers (3). TP53 mutation carriers routinely undergo intensive surveillance protocols which, although associated with significantly improved survival, are burdensome to both the patient and the health care system (4). Liquid biopsy, the analysis of cell-free DNA fragments in bodily fluids, has become an attractive tool for a range of clinical applications, including early cancer detection, because of its ability to provide real-time holistic insight into the cellular milieu (5). Here, we assess the efficacy of a multi-modal liquid biopsy assay that integrates a targeted gene panel, shallow whole genome, and cell-free methylated DNA immunoprecipitation sequencing for the early detection of cancer in a cohort of Li-Fraumeni syndrome patients: 196 blood samples from 89 patients, of which 26 were pediatric and 63 were adults. Our integrated analysis was able to detect a cancer-associated signal in 79.4% of samples from patients with active cancer, a 37.5% - 58.8% improvement over each individual analysis. Through analysis of patient plasma at cancer negative timepoints, we were able to detect cancer-associated signals up to 16 months prior to occurrence of cancer as detected by conventional clinical modalities in 17.6% of TP53 mutation carriers. This study provides a framework for the integration of liquid biopsy into current surveillance methods for patients with Li-Fraumeni syndrome.

Introduction: There is great promise in using genomic data to inform individual cancer treatment plans. Assessing intratumor genetic heterogeneity, studies have shown it may be possible to target biopsies to tumor subclones driving disease progression or treatment resistance. Here, we explore if the interpretation of tumor gene expression analysis varies across two specimens from the same patient. Methods: We performed bulk RNA-seq using FFPE samples from 16 patients who also had a previous separate bulk RNA-seq performed and deposited in TCGA. We used three different deconvolution methods to compare cell type proportions for these paired data. We normalized study-specific gene expression values per gene by calculating transcripts per million and adjusted for batch effect across study to compare median expression values. We also compared the reliability of gene expression measurements. We selected KRAS, TP53, SMAD4, and CDKN2A, as the most mutated genes in pancreatic cancer, and CTNNB1, JUN, SMAD3, SMAD7, and TCF7, as these tend to be enriched in pancreatic cancer compared with adjacent normal tissue. Results: We found that average cell type proportion varied the most between studies (i.e., samples for each patient) for NK and macrophages (using adjusted p-value 0.05/21=0.002). For the differential expression analysis, we did not observe significant differences in average expression of any of the selected genes. We observed substantial (kappa=0.75) for only JUN with low to moderate concordance (i.e., Kappa value 0.25-0.5) when using a median cut point for the remaining 8 genes across the two studies. Discussion: Together, the findings suggest that more than one tumor sample may be needed for effective treatment planning. Any potential difference in observed expression values across the paired samples could be related to the different cell type proportions across the samples. The sample size was small, and each study used different sequencing technologies, so any interpretation should be confirmed with additional studies.

Background and purposeProstate cancer (PCa) remains a significant global health concern, warranting the development of new therapeutic strategies.1 Metabolic reprogramming, an emerging hallmark of PCa progression characterized by aberrant nutrient utilization, has become a focus area in developing new treatments. Among these metabolic alterations, the Warburg effect--a shift towards aerobic glycolysis-- has garnered significant attention as a potential therapeutic target. 2 To explore this, we synthesised a novel class of Trojan Horse compounds designed to exploit the unique metabolic profile of cancer cells and investigated their therapeutic potential using cell based models of PCa, as a proof of principle strategy. Experimental approachPreliminary cytotoxicity analysis revealed that native menadione had low efficacy against PCa cells. Consequently, we developed glucose and fatty acid conjugated TH compounds based on a menadione backbone. A library of six novel menadione-glucose and fatty acid-based TH compounds were synthesized through copper-catalysed click chemistry. These compounds were designed to mimic a desirable fuel source (sugar or fatty acid) acting as a "Trojan Horse" for PCa cells to modulate their metabolism. The cytotoxic and selective effects of the TH compounds were evaluated in PCa and non-malignant cell lines cultured under varying glucose conditions. To elucidate the mechanisms of action, mitochondrial bioenergetics, metabolic phenotyping, and metabolomic profiling were employed to assess the impact of each TH compound on cellular metabolism. Key resultsTH3 (glucose) and TH5 (fatty acid) compounds demonstrated promising cytotoxicity for PCa cell lines, with TH5 exhibiting superior selectivity compared to TH3 and particularly over native menadione. Despite these results, alterations in metabolic phenotypes were only modest. Mitochondrial bioenergetics were notably impacted by TH5, while ROS levels remained stable post-treatment, likely due to an increase in ROS scavenging amino acids as a compensatory antioxidant response. Conclusion and ImplicationsThis study demonstrates the potential of employing glucose and fatty acid-conjugated compounds to target the unique metabolic features of PCa. These findings offer promising new avenues for further investigation, aimed at optimizing efficacy and selectivity of these compounds for clinical translation. The intricate relationship between ROS production and antioxidant defence mechanisms emphasizes the complex nature of metabolic interventions in cancer. Elucidating the mode of action and exploring molecular modifications may pave the way for personalised and targeted PCa therapies, ultimately improving patient outcomes and mitigating the global burden of this disease. O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=140 SRC="FIGDIR/small/610353v1_ufig1.gif" ALT="Figure 1"> View larger version (39K): org.highwire.dtl.DTLVardef@1af7915org.highwire.dtl.DTLVardef@1368f16org.highwire.dtl.DTLVardef@ebfe63org.highwire.dtl.DTLVardef@18a181b_HPS_FORMAT_FIGEXP M_FIG C_FIG Significance statementThis body of work gives critical insights into the metabolic vulnerabilities of prostate cancer (PCa), particularly of androgen-independent and metastatic disease, which currently present significant treatment challenges. By designing, synthesising and testing innovative menadione-based Trojan Horse compounds that target altered cancer cell metabolism, this research highlights a promising new therapeutic strategy against malignant cells. The findings underscore the potential for metabolic reprogramming to combat treatment resistance in advanced PCa, paving the way forward for the development of new drugs and personalised treatment approaches. This could lead to improved outcomes for patients with currently untreatable forms of the disease.

Improved biomarkers are needed for early cancer detection, risk stratification, treatment selection, and monitoring treatment response. While proteins can be useful blood-based biomarkers, many have limited sensitivity or specificity for these applications. Long INterspersed Element-1 (LINE-1, L1) open reading frame 1 protein (ORF1p) is a transposable element protein overexpressed in carcinomas and high-risk precursors during carcinogenesis with negligible detectable expression in corresponding normal tissues, suggesting ORF1p could be a highly specific cancer biomarker. To explore the potential of ORF1p as a blood-based biomarker, we engineered ultrasensitive digital immunoassays that detect mid-attomolar (10-17 M) ORF1p concentrations in patient plasma samples across multiple cancers with high specificity. Plasma ORF1p shows promise for early detection of ovarian cancer, improves diagnostic performance in a multi-analyte panel, and provides early therapeutic response monitoring in gastric and esophageal cancers. Together, these observations nominate ORF1p as a multi-cancer biomarker with potential utility for disease detection and monitoring. Statement of SignificanceLINE-1 ORF1p transposon protein is pervasively expressed in many cancers and a highly specific biomarker of multiple common, lethal carcinomas and their high-risk precursors in tissue and blood. Ultrasensitive ORF1p assays from as little as 25 L plasma are novel, rapid, cost-effective tools in cancer detection and monitoring.

Tumor heterogeneity is predicted to confer inferior clinical outcomes, however modeling heterogeneity in a manner that still represents the tumor of origin remains a formidable challenge. Sequencing technologies are limited in their ability to identify rare subclonal populations and predict response to the multitude of available treatments for patients. Patient-derived organotypic cultures have significantly improved the modeling of cancer biology by faithfully representing the molecular features of primary malignant tissues. Patient-derived cancer organoid (PCO) cultures contain numerous individual organoids with the potential to recapitulate heterogeneity, though PCOs are most commonly studied in bulk ignoring any diversity in the molecular profile or treatment response. Here we demonstrate the advantage of evaluating individual PCOs in conjunction with cellular level optical metabolic imaging to characterize the largely ignored heterogeneity within these cultures to predict clinical therapeutic response, identify subclonal populations, and determine patient specific mechanisms of resistance.

BackgroundImmune checkpoint blockade (ICB) targeting PD-1/PD-L1 plays a crucial role in breast cancer treatment. Despite clinical success, how ICB reshapes the tumor microenvironment (TME) to enhance anti-tumor activity remains unclear. Anti-PD-1 therapy alters TME cells beyond PD-1+ T cells, with extensive cell-cell communication (CCC) playing a key role. Understanding the dynamic CCC changes upon anti-PD-1 treatment can illuminate ICB mechanisms of action and TME dynamics. MethodsWe analyzed single-cell RNA-seq data from 31 breast cancer patients before and after anti-PD-1 (pembrolizumab) treatment (Bassez et al., 2021). We identified differentially expressed genes (DEGs) induced by treatment in major cell types. We then applied an instrumental variable approach to uncover causal relationships between T-cell and non-T-cell DEGs. We further mapped ligand-receptor interactions mediating signal transduction between cells and constructed a CCC network from T to non-T cells. ResultsAnti-PD-1 therapy induced widespread transcriptional changes across multiple cell populations. Key pathways modulated in T cells included NF-{kappa}B, interferon-{gamma}, and interleukin signaling. CD4+ and CD8+ exhausted T cells engaged in distinct ligand-receptor interactions with tumor-associated macrophages (TAMs) and other types of cells, reshaping the TME. Our results indicated CD4+ exhausted T cells activated M1-like TAMs via TNF-TNFRSF1A and TNFSF14-LTBR, while CD8+ exhausted T cells engaged M1-like TAMs through ICAM1-ITGAL/ITGB2 and CCL8-CCR2, promoting anti-tumor immunity. Conversely, immunosuppressive interactions were also observed, such as TNF-TNFRSF1B (TNFR2) and TNFSF14-TNFRSF14 (HVEM) from CD4 T cells, as well as CSF1-CSF1R and RPS19-C5AR1 from CD8 T cells, which likely promote M2-like tumor-associated macrophage (TAM) polarization and contribute to pro-tumor immune regulation and resistance to therapy. Notably, key receptors in the causal CCC networks, such as C5AR1, TNFR2, and CSF1R, emerged as potential targets to enhance anti-PD-1 efficacy. ConclusionsThese findings elucidate TME remodeling during anti-PD-1 therapy and underscore the pivotal role of CCC in treatment response. Our study identifies critical communication networks that may be biomarkers for immunotherapy responsiveness and highlights novel therapeutic targets, including C5AR1 and HVEM. Furthermore, our application of causal inference methodologies provides a robust framework for dissecting CCC mechanisms in immunotherapy.