Manuel P. Jiménez-García, Daniel Otero-Albiol, Elisa Suarez-Martinez, Amancio Carnero, Adoración G. Quiroga, Blanca Felipe-Abrio, Asunción Espinosa-Sánchez, Lola E. Navas, Eva M. Verdugo-Sivianes, Julia Domínguez-Piñol, Purificacion Estevez-Garcia, Sandra Muñoz-Galván, Juan Marín, Miguel García-Carrasco, José M. García-Heredia, [Munoz-Galvan,S, Felipe-Abrio,B, Dominguez-Pinol,J, Suarez-Martinez,E, Verdugo-Sivianes,EM, Espinosa-Sanchez,A, Navas,LE, Otero-Albiol,D, Marin,JJ, Jimenez-Garcia,MP, Garcia-Heredia,JM, Estevez-Garcia,P, Carnero,A] Instituto de Biomedicina de Sevilla, IBIS, Campus Hospital Universitario Virgen del Rocío, Universidad de Sevilla-Consejo Superior de Investigaciones Científicas, Seville, Spain. [Munoz-Galvan,S, Carnero,A] CIBER de CANCER, Institute of Health Carlos III, Madrid, Spain. [García-Carrasco,M, Estevez-Garcia,P] Medical Oncology Unit, Hospital Universitario Virgen del Rocío, Seville, Spain. [García-Heredia,JM] Department of Vegetal Biochemistry and Molecular Biology, University of Seville, Seville, Spain. [Quiroga,AG] Organic Chemistry Department, Autonomous University of Madrid, Madrid, Spain., SM-G was supported by a Sara Borrell grant from ISCIII (Codigo CD16/00230) and BFA is funded by the Spanish Ministry of Education (FPU12/01380). AC lab was supported by grants from the Spanish Ministry of Economy and Competitivity, Plan Estatal de I + D + I 2013–2016, ISCIII (Fis: PI15/00045), the Ministry of Science, Innovation and Universities (RTI2018–097455-B-I00) and CIBER de Cáncer (CD16/12/00275), co-funded by FEDER from Regional Development European Funds (European Union), the AECC Foundation and Foundation Eugenio Rodriguez Pascual. Especial thanks to Consejeria de Salud of the Junta de Andalucia (PI-0397-2017) for supporting this work., Universidad de Sevilla. Departamento de Bioquímica Vegetal y Biología Molecular, Instituto de Salud Carlos III, Ministerio de Educación (España), Ministerio de Ciencia, Innovación y Universidades (España), European Commission, Junta de Andalucía, and Fundación Eugenio Rodríguez Pascual
[Background] Ovarian cancer is the leading cause of gynecologic cancer-related death, due in part to a late diagnosis and a high rate of recurrence. Primary and acquired platinum resistance is related to a low response probability to subsequent lines of treatment and to a poor survival. Therefore, a comprehensive understanding of the mechanisms that drive platinum resistance is urgently needed., [Methods] We used bioinformatics analysis of public databases and RT-qPCR to quantitate the relative gene expression profiles of ovarian tumors. Many of the dysregulated genes were cancer stem cell (CSC) factors, and we analyzed its relation to therapeutic resistance in human primary tumors. We also performed clustering and in vitro analyses of therapy cytotoxicity in tumorspheres., [Results] Using bioinformatics analysis, we identified transcriptional targets that are common endpoints of genetic alterations linked to platinum resistance in ovarian tumors. Most of these genes are grouped into 4 main clusters related to the CSC phenotype, including the DNA damage, Notch and C-KIT/MAPK/MEK pathways. The relative expression of these genes, either alone or in combination, is related to prognosis and provide a connection between platinum resistance and the CSC phenotype. However, the expression of the CSC-related markers was heterogeneous in the resistant tumors, most likely because there were different CSC pools. Furthermore, our in vitro results showed that the inhibition of the CSC-related targets lying at the intersection of the DNA damage, Notch and C-KIT/MAPK/MEK pathways sensitize CSC-enriched tumorspheres to platinum therapies, suggesting a new option for the treatment of patients with platinum-resistant ovarian cancer., [Conclusions] The current study presents a new approach to target the physiology of resistant ovarian tumor cells through the identification of core biomarkers. We hypothesize that the identified mutations confer platinum resistance by converging to activate a few pathways and to induce the expression of a few common, measurable and targetable essential genes. These pathways include the DNA damage, Notch and C-KIT/MAPK/MEK pathways. Finally, the combined inhibition of one of these pathways with platinum treatment increases the sensitivity of CSC-enriched tumorspheres to low doses of platinum, suggesting a new treatment for ovarian cancer., The authors thank the donors and the biobank of the Hospital Universitario Virgen del Rocío-Instituto de Biomedicina de Sevilla (Sevilla, Spain) (Andalusian Public Health System Biobank and ISCIII-Red de Biobancos PT17/0015/0041) for the human specimens used in this study. SM-G was supported by a Sara Borrell grant from ISCIII (Codigo CD16/00230) and BFA is funded by the Spanish Ministry of Education (FPU12/01380). AC lab was supported by grants from the Spanish Ministry of Economy and Competitivity, Plan Estatal de I + D + I 2013–2016, ISCIII (Fis: PI15/00045), the Ministry of Science, Innovation and Universities (RTI2018–097455-B-I00) and CIBER de Cáncer (CD16/12/00275), co-funded by FEDER from Regional Development European Funds (European Union), the AECC Foundation and Foundation Eugenio Rodriguez Pascual. Especial thanks to Consejeria de Salud of the Junta de Andalucia (PI-0397-2017) for supporting this work.