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Epigenetic therapy inhibits metastases by disrupting premetastatic niches

Zhihao Lu, Jianling Zou, Shuang Li, Michael J. Topper, Yong Tao, Hao Zhang, Xi Jiao, Wenbing Xie, Xiangqian Kong, Michelle Vaz, Huili Li, Yi Cai, Limin Xia, Peng Huang, Kristen Rodgers, Beverly Lee, Joanne B. Riemer, Chi-Ping Day, Ray-Whay Chiu Yen, Ying Cui, Yujiao Wang, Yanni Wang, Weiqiang Zhang, Hariharan Easwaran, Alicia Hulbert, KiBem Kim, Rosalyn A. Juergens, Stephen C. Yang, Richard J. Battafarano, Errol L. Bush, Stephen R. Broderick, Stephen M. Cattaneo, Julie R. Brahmer, Charles M. Rudin, John Wrangle, Yuping Mei, Young J. Kim, Bin Zhang, Ken Kang-Hsin Wang, Patrick M. Forde, Joseph B. Margolick, Barry D. Nelkin, Cynthia A. Zahnow, Drew M. Pardoll, Franck Housseau (), Stephen B. Baylin (), Lin Shen () and Malcolm V. Brock ()
Additional contact information
Zhihao Lu: The Johns Hopkins University School of Medicine
Jianling Zou: Peking University Cancer Hospital and Institute
Shuang Li: Peking University Cancer Hospital and Institute
Michael J. Topper: The Sidney Kimmel Comprehensive Cancer Center
Yong Tao: The Sidney Kimmel Comprehensive Cancer Center
Hao Zhang: Johns Hopkins Bloomberg School of Public Health
Xi Jiao: Peking University Cancer Hospital and Institute
Wenbing Xie: The Sidney Kimmel Comprehensive Cancer Center
Xiangqian Kong: The Sidney Kimmel Comprehensive Cancer Center
Michelle Vaz: The Sidney Kimmel Comprehensive Cancer Center
Huili Li: The Sidney Kimmel Comprehensive Cancer Center
Yi Cai: The Sidney Kimmel Comprehensive Cancer Center
Limin Xia: The Sidney Kimmel Comprehensive Cancer Center
Peng Huang: The Sidney Kimmel Comprehensive Cancer Center
Kristen Rodgers: The Johns Hopkins University School of Medicine
Beverly Lee: The Johns Hopkins University School of Medicine
Joanne B. Riemer: The Sidney Kimmel Comprehensive Cancer Center
Chi-Ping Day: National Institutes of Health
Ray-Whay Chiu Yen: The Sidney Kimmel Comprehensive Cancer Center
Ying Cui: The Sidney Kimmel Comprehensive Cancer Center
Yujiao Wang: Peking University Cancer Hospital and Institute
Yanni Wang: Peking University Cancer Hospital and Institute
Weiqiang Zhang: The Johns Hopkins University School of Medicine
Hariharan Easwaran: The Sidney Kimmel Comprehensive Cancer Center
Alicia Hulbert: The Johns Hopkins University School of Medicine
KiBem Kim: The Sidney Kimmel Comprehensive Cancer Center
Rosalyn A. Juergens: McMaster University, Juravinski Cancer Centre
Stephen C. Yang: The Johns Hopkins University School of Medicine
Richard J. Battafarano: The Johns Hopkins University School of Medicine
Errol L. Bush: The Johns Hopkins University School of Medicine
Stephen R. Broderick: The Johns Hopkins University School of Medicine
Stephen M. Cattaneo: Anne Arundel Medical Center
Julie R. Brahmer: The Sidney Kimmel Comprehensive Cancer Center
Charles M. Rudin: Memorial Sloan Kettering Cancer Center
John Wrangle: Medical University of South Carolina
Yuping Mei: The Johns Hopkins University School of Medicine
Young J. Kim: Vanderbilt University
Bin Zhang: Johns Hopkins University
Ken Kang-Hsin Wang: Johns Hopkins University
Patrick M. Forde: The Sidney Kimmel Comprehensive Cancer Center
Joseph B. Margolick: Johns Hopkins Bloomberg School of Public Health
Barry D. Nelkin: The Sidney Kimmel Comprehensive Cancer Center
Cynthia A. Zahnow: The Sidney Kimmel Comprehensive Cancer Center
Drew M. Pardoll: The Sidney Kimmel Comprehensive Cancer Center
Franck Housseau: The Sidney Kimmel Comprehensive Cancer Center
Stephen B. Baylin: The Sidney Kimmel Comprehensive Cancer Center
Lin Shen: Peking University Cancer Hospital and Institute
Malcolm V. Brock: The Johns Hopkins University School of Medicine

Nature, 2020, vol. 579, issue 7798, 284-290

Abstract: Abstract Cancer recurrence after surgery remains an unresolved clinical problem1–3. Myeloid cells derived from bone marrow contribute to the formation of the premetastatic microenvironment, which is required for disseminating tumour cells to engraft distant sites4–6. There are currently no effective interventions that prevent the formation of the premetastatic microenvironment6,7. Here we show that, after surgical removal of primary lung, breast and oesophageal cancers, low-dose adjuvant epigenetic therapy disrupts the premetastatic microenvironment and inhibits both the formation and growth of lung metastases through its selective effect on myeloid-derived suppressor cells (MDSCs). In mouse models of pulmonary metastases, MDSCs are key factors in the formation of the premetastatic microenvironment after resection of primary tumours. Adjuvant epigenetic therapy that uses low-dose DNA methyltransferase and histone deacetylase inhibitors, 5-azacytidine and entinostat, disrupts the premetastatic niche by inhibiting the trafficking of MDSCs through the downregulation of CCR2 and CXCR2, and by promoting MDSC differentiation into a more-interstitial macrophage-like phenotype. A decreased accumulation of MDSCs in the premetastatic lung produces longer periods of disease-free survival and increased overall survival, compared with chemotherapy. Our data demonstrate that, even after removal of the primary tumour, MDSCs contribute to the development of premetastatic niches and settlement of residual tumour cells. A combination of low-dose adjuvant epigenetic modifiers that disrupts this premetastatic microenvironment and inhibits metastases may permit an adjuvant approach to cancer therapy.

Date: 2020
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DOI: 10.1038/s41586-020-2054-x

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