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Therapeutics, Targets, and Chemical Biology

Transplanting Normal Vascular Proangiogenic Cells to Tumor-Bearing Mice Triggers Vascular Remodeling and Reduces Hypoxia in Tumors

Junpei Sasajima, Yusuke Mizukami, Yoshiaki Sugiyama, Kazumasa Nakamura, Toru Kawamoto, Kazuya Koizumi, Rie Fujii, Wataru Motomura, Kazuya Sato, Yasuaki Suzuki, Satoshi Tanno, Mikihiro Fujiya, Katsunori Sasaki, Norihiko Shimizu, Hidenori Karasaki, Toru Kono, Jun-ichi Kawabe, Masaaki Ii, Hiroki Yoshiara, Naohisa Kamiyama, Toshifumi Ashida, Nabeel Bardeesy, Daniel C. Chung and Yutaka Kohgo
DOI: 10.1158/0008-5472.CAN-10-0412 Published August 2010

Abstract

Blood vessels deliver oxygen and nutrients to tissues, and vascular networks are spatially organized to meet the metabolic needs for maintaining homeostasis. In contrast, the vasculature of tumors is immature and leaky, resulting in insufficient delivery of nutrients and oxygen. Vasculogenic processes occur normally in adult tissues to repair “injured” blood vessels, leading us to hypothesize that bone marrow mononuclear cells (BMMNC) may be able to restore appropriate vessel function in the tumor vasculature. Culturing BMMNCs in endothelial growth medium resulted in the early outgrowth of spindle-shaped attached cells expressing CD11b/Flt1/Tie2/c-Kit/CXCR4 with proangiogenic activity. Intravenous administration of these cultured vascular proangiogenic cells (VPC) into nude mice bearing pancreatic cancer xenografts and Pdx1-Cre;LSL-KrasG12D;p53lox/+ genetically engineered mice that develop pancreatic ductal adenocarcinoma significantly reduced areas of hypoxia without enhancing tumor growth. The resulting vasculature structurally mimicked normal vessels with intensive pericyte coverage. Increases in vascularized areas within VPC-injected xenografts were visualized with an ultrasound diagnostic system during injection of a microbubble-based contrast agent (Sonazoid), indicating a functional “normalization” of the tumor vasculature. In addition, gene expression profiles in the VPC-transplanted xenografts revealed a marked reduction in major factors involved in drug resistance and “stemness” of cancer cells. Together, our findings identify a novel alternate approach to regulate abnormal tumor vessels, offering the potential to improve the delivery and efficacy of anticancer drugs to hypoxic tumors. Cancer Res; 70(15); 6283–92. ©2010 AACR.

Introduction

Blood vessels deliver oxygen and nutrients to tissues, and vascular networks are spatially organized to meet the metabolic needs to maintain homeostasis (1). Regions of severe oxygen deprivation (hypoxia) arise in tumors due to rapid cell division and aberrant blood vessel formation (2). The vascular networks are usually disordered, chaotic, and highly leaky, resulting in an insufficient blood supply and, in general, contributing to tumor hypoxia (3). These structural and functional abnormalities of tumor vessels are a hallmark of solid tumors, one that contributes directly to the malignant properties of cancer (2, 4). Hypoxic tumors are usually resistant to conventional chemotherapy and radiotherapies, which typically target actively dividing cells (5), and accumulating evidence indicates that hypoxia has the potential to inhibit tumor cell differentiation and induce quiescence, allowing cancer cells to acquire a phenotype of “stemness” (2, 4). To “normalize” this aberrant tumor vasculature, therapies targeting vascular endothelial growth factor (VEGF) or its cognate receptor have shown clinical success in various human cancers (6–8). However, antiangiogenic therapy is not always effective, and intrinsic resistance to this novel therapy has been shown in some desmoplastic and hypovascular tumors, including pancreatic ductal adenocarcinoma (PDAC; ref. 9). In addition, antiangiogenic therapy may alter the natural history of tumors by inducing an invasive and metastatic phenotype (10).

In view of the vasculogenic process that normally occurs in adult tissues under certain conditions to repair “injured” or newly formed blood vessels, bone marrow (BM)–derived cells have therapeutic potential to restore appropriate vessel function. Angiogenesis has been shown to play a central role in the recovery of the injured tissues including myocardial infarction. We and others have identified BM-derived proangiogenic cells that accumulate in active angiogenic foci and participate in neovascularization after ischemic insult, a concept consistent with postnatal vasculogenesis (11–13). These immature BM-derived cells, which include stem/progenitor cells, can enhance angiogenesis in ischemic heart in mice and protect injured tissues from fibrosis, an unfavorable form of tissue remodeling (11). Therefore, we were curious to determine whether bone marrow mononuclear cells (BMMNC) can also “repair” chaotic tumor vessels and tested this hypothesis using PDAC as a model for a hypoxic tumor. We also speculated that oxygen tension may be restored if the disordered vasculature in solid tumors could be manipulated, which potentially represents a compelling therapeutic intervention against hypoxic tumors.

In the current study, we propose an alternative approach to reorganize the abnormal tumor vasculature, which can potentially improve the delivery and efficacy of anticancer drugs against hypoxic tumors.

Materials and Methods

Cell culture

Three human pancreatic adenocarcinoma cell lines, KP-1N (from Health Science Research Resources Bank, Osaka, Japan), Panc-1, and BxPC-3 [both from the American Type Culture Collection (ATCC)], and four extrapancreatic cancer cell lines, MKN-28 (from Health Science Research Resources Bank), SW480, HepG2, and PC-9 (from ATCC), were used in this study.

The hypoxic workstation INVIVO2 400 (Ruskinn) was used to mimic hypoxic conditions in the tumor microenvironment. Cells were cultured at 5% O2, 5% CO2 for 1 month to adapt to hypoxic conditions, and cell viability was assessed by WST-8 assay in normoxic (20% O2) and hypoxic (5% O2) conditions (Quick Cell Proliferation Assay Kit, Biovision; ref. 14). Briefly, cancer cells were plated in 96-well plates (1 × 103–5 × 103 per well) and grown up to 72 hours, and the number of cells was quantified using a microtiter plate reader at 450 nm according to the manufacturer's instructions.

Animals, cell transplantation, and immunohistochemistry

Protocols for animal experiments were approved by the Asahikawa Medical College Institutional Animal Care and Use Committee. Cancer cells were injected s.c. into female CD-1 nude mice and the xenograft volume was calculated as (length × width2) × 0.5. Tumors were grown to a minimum volume of 125 mm3 before vascular proangiogenic cell (VPC) transplantation. Therapeutic studies were also performed using genetically engineered Pdx1-Cre;LSL-KrasG12D;p53lox/+ mice, which spontaneously develop PDAC with abundant desmoplasia (15), at 12 weeks of age when PDAC lesions were identified by an ultrasound diagnostic system (Aplio XG, Toshiba Medical Systems).

Murine BMMNCs were isolated by density gradient centrifugation using Histopaque-1083 (Sigma) and cultured in EBM2 with supplements (EGM2-MV BulletKit, Lonza) and 10% fetal bovine serum but without hydrocortisone in rat vitronectin (Sigma)-coated dishes for preparation of VPCs (13, 16). Attached cells were suspended at 4 days and reseeded to a new culture dish for VPC transplantation into tumor-bearing mice at day 7. More than 95% of attached cells were positive for acetylated low-density lipoprotein (Biomedical Technologies) uptake and BS1 lectin (Vector laboratories) binding, confirming endothelial and/or monocytic lineage (13, 17). The majority of the cells expressed CD11b as shown by flow cytometry, indicating that these cells were composed of heterogeneous populations including vascular leukocytes (18, 19). In addition to the expression of Tie2, a significant fraction of the attached BMMNCs expressed Flt1, CXCR4, and platelet-derived growth factor receptor β (PDGFR-β). Weak expression of the progenitor markers such as c-Kit and CD34 was also identified (antibody was purchased from Beckman Coulter and BD; Supplementary Fig. S1). Although genes expressed in endothelial cells such as Flk-1 and VE-cadherin were upregulated in the BMMNCs during 7 days of culture as compared with freshly isolated CD11b+ BMMNCs, there was a substantial induction of PDGFR-β mRNA.

The tumor-bearing mice were divided randomly into saline-infused or VPC-treated groups when PDAC tumors were established. The proangiogenic cells were prepared from BMMNCs isolated from syngeneic mice and the transplantation was performed through the retro-orbital cavity. Initially, 104, 105, and 106 VPCs were injected into nude mice bearing KP-1N xenografts (n = 10 for each group), and the growth of tumors was observed for up to 6 weeks. Because we observed effects of VPC transplantation histologically when 105 to 106 cells were injected, additional studies were then performed by transplanting larger numbers of VPCs. Tumor-bearing mice also received VPCs or a saline injection weekly for 2 to 3 weeks at 4- to 7-day intervals before sacrifice. To clarify whether transplanted VPCs were indeed localized to tumors, we injected green fluorescent protein (GFP)–labeled VPCs into mice (5 × 105 per mice) with PDAC xenografts in some of the experiments (13).

To assess hypoxic regions, pimonidazole hydrochloride (60 mg/kg; Hypoxyprobe-1, Millipore) was injected i.p. 1.5 hours before killing. We harvested xenograft tumors before the lesions reached 10 mm in diameter (the average volume was 200–300 mm3) for histologic analysis. Tumor tissues were then fixed with zinc-fixative solution (IHC ZINC fixative, BD Pharmingen) for 24 hours at room temperature and embedded in paraffin for immunohistochemistry. For immunofluorescence staining in xenograft tissue, 4-μm sections were incubated with a CD31-specific antibody, MEC13.3 (1:50; BD Pharmingen), overnight at 4°C. Blood vessels were counted in 5 to 10 random viable fields (20× objective), and the vessel area/density was quantified using ImageJ software (version 1.38). For other immunohistochemical studies, the following antibodies were used: anti–MIB-1 (DAKO; 1:100), anti-NG2 (Chemicon; 1:200), anti–cleaved caspase-3 (5A1E, Cell Signaling; 1:200), and anti–CA9 (Novus; 1:100). Nuclei were counterstained with 50 ng/mL 4′,6-diamidino-2-phenylindole (Sigma) and images were examined with a fluorescent microscope (BX-51/DP-71, Olympus).

To visualize the extracellular matrix in xenograft tumors, tissue staining was performed using Masson's trichrome kit (Sigma-Aldrich) according to the manufacturer's protocol.

In vivo vascular imaging by contrast-enhanced ultrasound system

To visualize perfusion within tumors, an ultrasound contrast agent, Sonazoid (Daiichi-Sankyo Co. Ltd.), was administered to tumor-bearing mice (0.25 μL/kg). The vascularized area within tumors was imaged by an ultrasound diagnostic system (AplioXG, Toshiba Medical Systems Corp.) with a 12-MHz linear probe (PLT-1204AT). The phase modulation harmonic imaging mode (transmitted/received at 5.0/10.0 MHz) was used for the nonlinear signal extraction, and the mechanical index was set to around 0.20. The images for 30 seconds after injection were recorded into the U.S. system and transferred to consumer PC after the experiments.

The arrival time parametric images were reconstructed by using the dedicated prototype software programmed by C++ (20). The software reads the Audio Video Interleaving (AVI) image obtained by the U.S. system, calculates the enhanced intensity on the image frame by frame, and paints the colors, which correspond to the time to arrival of the enhancement. Because each color has the numerical value of the arrival, the arrival time of each part will be indicated by the still image of the resulting parametric imaging.

Quantitative real-time PCR assay

Total RNA was extracted using the RNeasy Protect Mini kit (QIAGEN) according to the manufacturer's instructions. TaqMan Gene Expression Assay primer and probe sets (Applied Biosystems) were used for quantitative real-time PCR analysis. The primer sequences are summarized in Supplementary Table S1. Transcript levels were normalized to 18S rRNA. Results are expressed as normalized expression values (2−ΔCT) or normalized expression relative to control cells or tissues without cell transplantation (= 2−ΔΔCT), unless otherwise stated.

Statistical analysis

All results are expressed as mean ± SD unless otherwise noted. The statistical significance of differences was determined using two-tailed Student's t test.

Results and Discussion

Transplantation of cultured VPCs into tumor-bearing mice induces vascular remodeling and reduces tumor hypoxia

To determine whether cultured CD11b+ VPCs possess a capacity to repair tumor vessels, we performed a series of investigations using spindle-shaped attached BM mononuclear cells cultured in EGM2 medium as crude proangiogenic cells (Supplementary Fig. S1). PDAC was selected as a model for a hypoxic tumor to test our hypothesis that certain malignant phenotypes associated with hypoxia may be abolished if abnormalities of the tumor vasculature could be appropriately manipulated. Intravenous administration of 5 × 105 VPCs into nude mice bearing KP-1N human pancreatic cancer xenografts significantly increased tumor microvessel density (Fig. 1A). The transplanted cells localized to the perivascular area, closely associating with the tumor vasculature rather than directly differentiating into vascular endothelial cells (Fig. 1B). In addition, the number of GFP+ transplanted cells was significantly attenuated at 6 weeks after transplantation, suggesting that the ex vivo cultured VPCs may not constitute blood vessels for long term. In contrast to the narrowed and fragmented vasculature in control xenografts, the vessel surface area in VPC-transplanted tumors was dramatically increased (1.5 ± 0.9% versus 5.3 ± 1.8%; P < 0.01). The enlarged tumor vasculature seemed to be functional because it was accompanied by reduced areas of tumor hypoxia as represented by pimonidazole-positive areas within the tumor (Fig. 1C). In addition, increases in vascularized (perfused) areas within VPC-injected xenografts were observed by arrival time parametric imaging reconstructed from images by an ultrasound diagnostic system with a 12-MHz linear probe during injection of a contrast agent (Sonazoid) when serial i.v. injections of 105 VPCs three times at 4-day intervals were performed (Supplementary Fig. S2; Supplementary Materials 1 and 2), indicating a functional “reorganization/remodeling” of the abnormal tumor vasculature.

Figure 1.
Figure 1.

Intravenous transplantation of ex vivo cultured CD11b+ VPCs induces vascular remodeling and reduces tumor hypoxia in KP-1N xenografts. A, VPC transplantation (5 × 105 cells) was performed in CD-1 nude mice bearing KP-1N xenografts, and mice were sacrificed 2 wk after transplantation. The tumor sections were stained with CD31. Columns, mean microvessel density (MVD) and vessel surface area; bars, SEM. HPF, high-power field. B, to trace transplanted cells, VPCs prepared using GFP-labeled BMMNCs were i.v. injected into mice with KP-1N xenografts. Mice were sacrificed 2 to 6 wk after and the tumor sections were stained with anti-CD31 and anti-GFP. Bar, 100 μm. C, to assess hypoxic regions, frozen sections were stained with anti–Hypoxyprobe-1 antibody. Positive staining area was shown as hypoxic area in xenografts. D, double immunofluorescent staining with NG2 and CD31. The number of CD31+ microvessels covered with NG2 positive pericytes is shown. Bar, 500 μm.

We next confirmed whether the tumor vessels in the VPC-transplanted tumor were structurally mature. Because pericytes play an essential role in the integrity of structural vessels, immunohistochemical staining for NG2 and CD31 was then performed (Fig. 1D). Increased numbers of CD31+ microvessels were covered with NG2+ pericytes, indicating that the resulting tumor vasculature structurally mimicked normal vessels with a high pericyte coverage ratio.

Similar observations were shown in genetically engineered Pdx1-Cre;LSL-KrasG12D;p53lox/+ mice, which spontaneously develop desmoplastic PDAC (15), and undifferentiated tissues with abundant desmoplasia were selected for histologic analysis. Poor tissue perfusion was also successfully corrected by VPC transplantation in this mouse model (Fig. 2). Therefore, the vascular regeneration/remodeling through the cell-mediated approach is not limited to artificial xenograft tumors but is also capable of manipulating abnormal blood perfusion in spontaneously developing desmoplastic PDAC tumors in mice.

Figure 2.
Figure 2.

Transplantation of VPCs promotes maturation of the tumor vasculature, resulting in reduced hypoxic area in spontaneously developed PDAC. Sequential VPC transplantation (5 × 105; twice) was performed in Pdx1-Cre;LSL-KrasG12D;p53lox/+ mice (12 wk old), and mice were sacrificed 2 wk after transplantation. A, double immunofluorescent staining with NG2 and CD31 in zinc-fixed sections. Arrowheads, NG2+ pericyte–covered microvessels. B, double immunofluorescent staining with anti–Hypoxyprobe-1 and anti-CD31 in frozen sections. Bar, 100 μm.

Transplantation of cultured CD11b+ VPCs does not enhance tumor growth but instead temporarily delays the outgrowth

Because tumor outgrowth is generally dependent on angiogenesis, we initially speculated that enhanced blood perfusion may promote tumor growth and metastasis. However, to our surprise, the growth of PDAC xenografts was significantly inhibited when more than 105 VPCs were transplanted (Fig. 3A). When tumor growth was observed for 6 weeks posttransplantation, the growth of xenograft tumors was temporarily slowed by VPC transplantation although they started to regrow within 3 weeks (Fig. 3B). To determine whether this reduction of tumor growth can also be observed in other cell types, additional xenograft experiments were then performed using various human cancer cell lines (Supplementary Table S2). Serial i.v. injections of 5 × 105 VPCs were performed subsequent to xenograft establishment at 7-day intervals. A significant reduction in tumor growth was observed in other human pancreatic cancer cells, Panc-1 and BxPC-3. Additionally, growth inhibition of xenograft tumors was also shown in MKN-24 (a human gastric cancer cell line) and PC-9 (a human lung cancer cell line). Of note, enhancement of tumor growth was not induced by VPC transplantation in cells tested and metastatic outgrowth was not observed even in SW480 and hypervascular HepG2 xenografts.

Figure 3.
Figure 3.

VPC transplantation does not stimulate tumor outgrowth in KP-1N xenografts. VPCs (104, 105, and 106) were injected into nude mice bearing KP-1N xenografts (n = 10 for each group). A, tumor volume (left) and tumor weight (right) of KP-1N xenografts with or without VPC transplantation. *, P < 0.05, versus control mice (PBS injected). B, growth of KP-1N xenografts with or without VPC transplantation was observed for up to 6 wk (PBS or 105 or 106 VPCs injected; n = 6 for each). Mice were humanely killed following development of a tumor larger than 2,000 mm3 or a tumor harboring an ulcer.

Oxygen and nutrients are required for any tissue including tumors, but cancer cells can survive even in severe hypoxia (21). It is well known that most cancer cells rely on aerobic glycolysis, rather than mitochondrial oxidative phosphorylation, to generate energy needed for cellular processes (22). However, it should be noted that clinical trials have shown that reducing tissue hypoxia either through blood transfusion or erythropoietin could be associated with an improved response to radiotherapy and may improve the survival of cancer patients (23). In addition, a recent study showed that angiopoietin-1–mediated maturation of blood vessels can inhibit tumor growth through a suppression of permeability in tumors with pericyte-rich blood vessels (24). We therefore sought to address the question of whether the tumor microenvironment with abundant oxygen delivered by reorganized blood vessels is favorable for tumor cells or not.

Histopathologic analysis revealed that transplantation of cultured CD11b+ VPCs did not significantly increase areas of necrosis (Fig. 4A). Masson's trichrome staining showed that xenograft tumors in the VPC-transplanted mice were depleted of desmoplastic stroma, resulting in densely packed ductal adenocarcinoma cells (Supplementary Fig. S3), and the number of cells per area was increased by VPC transplantation, suggesting that VPCs increase the density of cells. This could thereby facilitate the blood perfusion in PDAC indirectly. Similar observations have been made with VPC transplantation into mouse models of acute coronary ischemia (25, 26); that is, tissue remodeling composed of extensive fibrosis in infarct heart and cirrhotic liver could be attenuated by transplantation of BMMNCs manipulated by a similar ex vivo differentiation protocol (27).

Figure 4.
Figure 4.

Transplantation of ex vivo cultured VPCs impairs the growth of KP-1N xenografts. A, KP-1N xenografts were treated with or without i.v. administration of cultured VPCs (5 × 105; twice) and mice were sacrificed 2 wk after the procedure. H&E stainings for xenograft sections are shown and percent necrotic area (N) was measured. Bar, 200 μm. B, KP-1N cells adapted to chronic hypoxia (5% O2 in hypoxia workstation INVIVO2 400) were cultured either in normoxic (20% O2) or in hypoxic conditions (5% O2) for 3 d. Cell growth was quantified by WST-8 assay. C, xenograft tissues were stained with anti–Ki-67 (top) and anti–cleaved caspase-3 (bottom). Quantification of proliferating/apoptotic is shown as percent positive cells in 5 viable fields from 10 sections. Bar, 100 μm. Columns, mean proliferation/apoptotic index; bars, SEM.

To directly address the effect of oxygen during reperfusion (reoxygenation) in hypoxic tumors, we performed an in vitro assay using PDAC cells adapted to long-term hypoxic conditions under low oxygen tension (5% O2) by using a hypoxia workstation. Although hypoxia generally downregulates cell proliferation (28), the KP-1N human PDAC line adapted to 5% O2 (chronic hypoxia) can grow equally with a comparable doubling time as cells cultured in normoxic conditions (20% O2; doubling time in chronic hypoxia and normoxic conditions was 21.0 ± 2.8 and 22.8 ± 3.1 hours, respectively). However, the proliferation of the hypoxia-conditioned KP-1N cells was significantly attenuated when the cells were placed again under normoxic conditions (doubling time, 31.7 ± 4.8 hours; P < 0.01; Fig. 4B). A similar observation was also shown in primary mouse PDAC cells from Pdx1-Cre;LSL-KrasG12D;p53lox/+ mice (doubling time was 13.6 ± 2.5 hours in chronic hypoxia and 16.7 ± 2.9 hours in reoxygenated cells; P < 0.05). These results may account for the attenuated tumor growth when the tumor vasculature was reorganized/remodeled by the ex vivo cultured CD11b+ VPC transplantation that liberated PDAC cells from hypoxic conditions.

We therefore examined the effect of serial VPC transplantation (5 × 105 cells; 7-day intervals) on the proliferation kinetics of xenograft tumors in vivo. There was a modest but statistically significant difference in the Ki-67 labeling index (Fig. 4C), consistent with the growth retardation by VPC transplantation. Because staining the xenograft tissues for Ki-67 showed a reduced proliferation of cancer cells by only 17.6%, additional immunostaining using anti–cleaved caspase-3 was then performed. The apoptotic fraction was markedly increased by 1.72-fold in xenograft tumors when cultured VPCs were serially transplanted (Fig. 4C). These results indicate that enhanced blood perfusion may impair the ability of tumor cells to rapidly grow. The remodeling of abnormal tumor vasculature induces reperfusion of hypoxic tissue and reduced areas of significant hypoxia (Figs. 1 and 2). This potentially leads to an increase in free radical concentration, resulting in growth suppression through an induction of stress-response genes (21, 29).

Transplantation of cultured CD11b+ VPCs attenuates angiogenic cytokine production from cancer cells during reperfusion in PDAC xenografts

VPC transplantation induced repair of the abnormal tumor vasculature and reduced tumor desmoplasia, which could further facilitate blood perfusion. This histologic remodeling may also attenuate oxygen consumption by the microenvironment. We therefore speculated that transplantation of cultured CD11b+ VPCs may alter the imbalance between proangiogenic and antiangiogenic cytokines released from tumor cells. In general, cancer cells express excess amounts of various proangiogenic factors, which primarily regulate the abnormal tumor vasculature. To test this possibility, we quantified the mRNA levels of proangiogenic factors from cancer cells in xenografts by using human-specific probes. Consistent with the marked reduction in tumor hypoxia, the VEGF mRNA levels were significantly attenuated (Fig. 5). Interleukin-8, another proangiogenic cytokine that can be induced by hypoxia in cells with oncogenic Kras (30), was also strongly downregulated. Pigment epithelium–derived factor (PEDF) is a potent angiogenic inhibitor in the pancreas, expressed by both epithelial and stromal compartments and regulated by hypoxia. PEDF expression has been shown to be downregulated during pancreatic tumorigenesis, at least in part playing a role in neovascularization and metastatic outgrowth in PDAC (31, 32). Curiously, VPC transplantation restored PEDF expression in cancer cells, which may account for not only the reduction in aberrant tumor angiogenesis but also the inhibition of proliferation of tumor cells.

Figure 5.
Figure 5.

Transplantation of VPCs terminates aberrant neovascularization by attenuating angiogenic cytokine production from cancer cells. RNA was extracted from xenograft tissues treated with or without VPC transplantation, and mRNA levels of proangiogenic and antiangiogenic factors in cancer cells were analyzed by TaqMan quantitative PCR. Alterations in gene expression associated with desmoplasia are also shown. SDF-1, stromal cell–derived factor 1; IL-8, interleukin-8; TGFβ, transforming growth factor β; OPN, osteopontin.

Because Masson's trichrome staining showed that the transplantation of cultured VPCs significantly reduced the amount of desmoplastic stroma, we speculated that genes involved in fibrosis may also be altered. There was no significant difference in the mRNA levels of cancer cell–derived transforming growth factor-β and osteopontin (27, 33), known fibrosis mediators, and the precise mechanisms by which VPC transplantation reduced PDAC desmoplasia need to be further elucidated. However, The Ihh morphogen, but not Shh, which plays a role in pancreatic fibrosis through an activation of pancreatic stellate cells (34), was downregulated by regeneration of the tumor vasculature in PDAC xenografts. There was upregulation of desmoplasia-related α2 (type I) procollagen (COL1A2) and secreted protein acidic and rich in cysteine (SPARC) genes in tumor cells when VPCs were transplanted; however, the levels were modest when compared with their stromal expression, where VPC transplantation had no influence. Taken together, these data indicate that transplanted VPCs localized to hypoxic areas either in tumors or in infarcted (ischemic) heart may have the capacity to terminate abnormal tissue remodeling including aberrant angiogenesis.

Cancer cells released from hypoxia represent a phenotype with less resistance to chemotherapy and reduced stemness phenotype

Expression of carbonic anhydrase 9 (CA9), one of the hypoxia-inducible factor (HIF) target genes, has been proposed as a marker of prolonged hypoxia (35). CA9 plays a role in maintaining an alkaline intracellular pH and an acidic extracellular pH (36, 37) and in anchorage-independent tumor cell growth, facilitating invasion of cancer cells into the extracellular matrix by modulating the functions of E-cadherin (38). We therefore examined CA9 expression by immunohistochemistry in VPC-transplanted tumors (Fig. 6A). In line with a significant reduction in pimonidazole-positive areas in xenografts receiving VPC injections, the resulting vascular remodeling also attenuated the number of CA9-positive cells dramatically. The reduction was more prominent in viable areas as compared with perinecrotic areas.

Figure 6.
Figure 6.

Reduction in tumor hypoxia reduces CA9 expression and gene expression–related drug resistance and stemness. KP-1N xenografts were treated with or without i.v. administration of cultured VPCs (105; three times) and mice were sacrificed 2 wk after the procedure. A, xenograft tissues were stained with anti-CA9 in either perinecrotic (top) or viable area (bottom). Quantification of CA9-positive cells is shown in 5 viable fields from 6 sections. Bar, 500 μm. N, necrotic area. B, RNA was extracted from xenograft tissues, and mRNA levels of CA9, Oct-4, hENT1, dCK, MDR-1 (ABCB1), and ABCG2 in cancer cells in xenografts were analyzed by TaqMan quantitative PCR.

Hypoxia and HIFs have been shown to activate signaling pathways that control stem cell self-renewal and multipotency (39). In addition to hematologic malignancies, solid tumors can also develop from a small number of self-renewing transformed cells, the so-called tumor-initiating cells (40). Accumulating evidence has indicated that these rare types of cancer cells with stemness properties can localize in a “hypoxic niche,” giving rise to resistance to chemotherapy and radiotherapy (4). This implies that regional hypoxia plays a fundamental role in both regulating the stemness properties of cancer cells and diminishing therapeutic response and that both of the hypoxia-induced phenotypes could be reversible. We therefore sought to determine whether vascular remodeling induced by VPC transplantation may alter such stemness and resistant phenotypes of hypoxic PDAC cells. Xenograft tumors were used to specifically analyze gene expression in cancer cells rather than stromal cells, using human-specific probes for TaqMan quantitative PCR assays (Fig. 6B). There was a significant reduction in CA9 mRNA levels in VPC-transplanted xenografts, consistent with a massive reduction in CA9 immunostaining (Fig. 6A). Octamer-binding transcription factor 4 (Oct-4), one of the stemness genes that can induce pluripotency in differentiated cells (41), was downregulated by 22.9%. Because HIF-2α can directly regulate Oct-4, it is therefore possible that hypoxia mediates its effects on stem cell function by altering the stemness genes (42). Considering that Oct-4 is involved in tumor progression and motility (43), downregulation of Oct-4 would be beneficial to control the malignant phenotype caused by hypoxia. Additionally, the expression levels of MDR1 (ABCB1) and ABCG2, genes that play a major role in “resistance” to chemotherapy, were also dramatically downregulated by VPC transplantation (Fig. 6B).

Gemcitabine is the standard chemotherapeutic reagent for locally advanced or metastatic PDAC (44), and a recent study performed on cultured PDAC cells indicated that human equilibrative nucleoside transporter-1 (hENT1) is the major transporter for gemcitabine, and increased hENT1 abundance facilitates efficient cellular entry of the drug and confers its increased cytotoxicity (14, 45). We found that there was a 2-fold induction of hNET1 mRNA in tumor cells when xenograft-bearing mice were treated with cultured CD11b+ VPCs, consistent with the observation that hENT1 could be downregulated by hypoxia (46). Therefore, although we did not observe any differences in dCK mRNA, another important intracellular modulator of gemcitabine, PDACs with normalized blood vessels by VPC transplantation may be more sensitive to gemcitabine as compared with hypoxic tumors. Taken together, these data indicate that remodeling of an unstable tumor vasculature leads to a significant reduction in expression of genes associated with the stemness of cancer cells as well as an increase in sensitivity to conventional chemotherapy. We are currently testing this hypothesis by studying a combination of chemotherapeutic agents such as gemcitabine and VPC transplantation.

Conclusion

BM cells are thought to play a role in tumor development (47), and various types of BM-derived hematopoietic cells have been observed to closely associate with the tumor neovasculature (18, 48). Indeed, a small number of BM-derived progenitor cells were shown to incorporate into the lumen of a growing vasculature where they differentiate into endothelial cells in a mouse metastasis model (49). The BM-derived cells generally have been thought to augment the malignant phenotype of tumor; however, our data support the notion that certain immature myeloid cells from the BM may have the capacity to repair an abnormal microenvironment if they are appropriately differentiated ex vivo. In support of our results, others have also shown increases in blood flow within tumor xenografts when embryonic stem cell–derived VPCs were transplanted, and no enhancement of tumor growth was observed (50). In the current study, we observed that a considerable number of transplanted CD11b+VPCs localized to the perivascular area, and therefore they did not seem to induce angiogenesis (vasculogenesis) by directly differentiating into vascular endothelial cells. Those transplanted cells have been shown to promote neovascularization indirectly through paracrine stimulation/stabilization of neovessels (11). We found that, in addition to VEGF and angiopoietin-1, the cultured VPCs also express significant levels of antiangiogenic factors (51), suggesting their potential role in terminating aberrant neovascularization. Further studies are required to address the precise mechanisms by which these ex vivo cultured BMMNCs influence the chaotic blood vessels and tumor microenvironment. Our study also implies that the potential risk of enhancing tumor growth may not be an issue during cell therapy using progenitors, at least if cultured (manipulated) cells are used.

Collectively, we have identified an alternative approach to regulate the abnormal tumor vasculature. Tumor vessels remodeled by ex vivo cultured CD11b+ VPCs exhibited maturation of the “abnormal” vasculature, resulting in a significant reduction in tumor hypoxia. The cancer cells seemed to have a distinct phenotype in the reperfused/reoxygenated microenvironment with decreased stemness-related gene expressions. This approach may not only attenuate innate resistance to chemotherapy/radiotherapy but also potentially improve the delivery of anticancer drugs to hypoxic tumors.

Disclosure of Potential Conflicts of Interest

No potential conflicts of interest were disclosed.

Acknowledgments

We thank Shizuo Kato for his assistance in tissue section preparation, Yasuhiko Nagasaka (Beckman Coulter) for technical assistance in flow cytometry analysis, and Kotoe Shibusa for BMMNC collection and cell sorting. We also thank to Azusa Tsukada (Toshiba Medical Systems) for assistance in obtaining contrast-enhanced ultrasound images and Dr. Hideki Kato (Hamamatsu University School of Medicine) for genetic testing of mice and helpful discussions.

Grant Support: New Energy and Industrial Technology Development Organization of Japan grant 07A05010a (Y. Mizukami).

The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked advertisement in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

  • Received February 5, 2010.
  • Revision received April 27, 2010.
  • Accepted May 24, 2010.

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Cancer Research: 70 (15)
August 2010
Volume 70, Issue 15

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Transplanting Normal Vascular Proangiogenic Cells to Tumor-Bearing Mice Triggers Vascular Remodeling and Reduces Hypoxia in Tumors
Junpei Sasajima, Yusuke Mizukami, Yoshiaki Sugiyama, Kazumasa Nakamura, Toru Kawamoto, Kazuya Koizumi, Rie Fujii, Wataru Motomura, Kazuya Sato, Yasuaki Suzuki, Satoshi Tanno, Mikihiro Fujiya, Katsunori Sasaki, Norihiko Shimizu, Hidenori Karasaki, Toru Kono, Jun-ichi Kawabe, Masaaki Ii, Hiroki Yoshiara, Naohisa Kamiyama, Toshifumi Ashida, Nabeel Bardeesy, Daniel C. Chung and Yutaka Kohgo
Cancer Res August 1 2010 (70) (15) 6283-6292; DOI: 10.1158/0008-5472.CAN-10-0412
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