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Esophageal cancer (EC) originates in the setting of chronic inflammation. Although previous studies have sought to understand the role of inflammatory signaling in EC, the effect of these immunologic changes on patient outcomes remains understudied. This study's objective was to identify relationships between cytokine levels and prognosis in a mixed cohort of esophageal adenocarcinoma (EAC) and esophageal squamous cell carcinoma (ESCC) patients.A total of 37 serum cytokines were profiled at the time of resection using multiplex ELISA in 47 patients (42 esophageal adenocarcinoma, 5 esophageal squamous cell carcinoma). Cytokine levels were median-binarized and assessed using Cox regression models. Findings were validated at the RNA level using The Cancer Genome Atlas EC cohort (81 esophageal adenocarcinoma, 81 esophageal squamous cell carcinoma).Univariable analysis revealed high serum interleukin 4 (IL4) and granulocyte-macrophage colony-stimulating factor (GMCSF) were negatively associated with overall survival (p = 0.046, p = 0.040). Multivariable analysis determined both high serum IL4 or high serum GMCSF were negatively associated with survival independent of important clinical factors (hazard ratio [HR] 7.55, p0.001; HR 5.24, p = 0.001). These findings were validated at the RNA level in The Cancer Genome Atlas EC cohort, where multivariable analysis identified high IL4 expression, high CSF2 expression (encodes GMCSF), and advanced pathologic stage as independent negative predictors of survival when controlled for clinical factors (HR 2.35, p = 0.012; HR 1.97, p = 0.040).These results show that high IL4/GMCSF levels are negatively associated with survival in EC. These relationships are independent of pathologic stage and are identified across modalities, histologic subtypes, and the presence/absence of neoadjuvant therapy.

Lung cancer remains the leading cause of cancer mortality. Efficacious targeted therapy options are urgently needed for lung cancer prevention and treatment. Epidermal growth factor receptor (EGFR) mutant lung cancer represents about 15% of lung cancer cases generally occurring in patients with minimal to no smoking history and with higher prevalence in females. Linkages to environmental exposures have been postulated. Our group synthesized Mito-lonidamine (Mito-LND), a mitochondrial targeted analog of lonidamine which inhibits aerobic glycolysis in cancer cells. We previously identified that Mito-LND induces mitophagy in KRAS mutant lung cells and inhibits lung tumorigenesis and brain metastasis in vivo. Yet, the cancer inhibitory capacity of Mito-LND in EGFR mutant lung cancer has not been investigated. Viability staining assessed Mito-LND induced cell death in EGFR mutant cell lines PC9 (parent) and PC9BrM3 (brain metastatic). Transcriptomic profiling was conducted following Mito-LND treatment and results analyzed in Metacore to assess molecular changes. Deconvolution analysis interrogated alterations in immune cell populations. To discern cell death mechanisms, we evaluated FDA-approved inhibitors for autophagy (chloroquine, CQ), mitophagy/apoptosis (cyclosporin A, CsA) and necrosis (Ponatinib) in EGFR mutant cell lines using viability assays with Mito-LND treatment. In PC9 cells, the IC50 for Mito-LND at 24h and 48h was 1.5µM and 0.5µM, respectively and in PC9BrM3 cells at 24h and 48h was 1.5µM and 0.7µM, respectively. These data support that EGFR mutant cell lines are >2-fold more sensitive to Mito-LND induced cell death compared to KRAS mutant lung cell lines H2030 and H2030BrM3. Transcriptomic profiling results show that Mito-LND treatment upregulated pathway maps linked to heat shock protein and HIF-1A signaling in both PC9 and PC9BrM3 cells. Process networks linked to unfolded protein response, response to hypoxia and oxidative stress, apoptosis and the immune response were upregulated with Mito-LND treatment. Deconvolution analysis revealed monocytes and macrophages were upregulated in Mito-LND treated EGFR mutant cell lines, with CD8+ T cells increased in PC9BrM3 cells and regulatory T cells increased in PC9 cells. Last, CsA significantly inhibited Mito-LND induced cell death in both cell lines, while CQ had no effect suggesting blocking apoptosis, but not late autophagy inhibits cell death induction in EGFR mutant cell lines. Further, necrosis inhibition with Ponatinib synergistically increased Mito-LND induced cell death in EGFR mutant cell lines. These results begin to define the cancer inhibitory mechanisms of Mito-LND in EGFR mutant lung cancer cells which appear to differ from those observed in KRAS mutant lung cancer cells. Future directions include dissecting apoptotic and necrosis driven Mito-LND induced cell death using additional pharmacological inhibitors and genetic approaches. Citation Format: Katherine M. Weh, Connor Howard, Yun Zhang, Jean-Jack Riethoven, Jennifer Clarke, Gang Cheng, Balaraman Kalyanaraman, Ming You, Laura Kresty. Mechanisms by which Mito-lonidamine inhibits EGFR mutant lung cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 6141.

Esophageal adenocarcinoma (EAC) is a cancer characterized by rapidly rising incidence and poor survival, resulting in the need for new prevention and treatment options. We utilized two cranberry polyphenol extracts, one proanthocyanidin enriched (C-PAC) and a combination of anthocyanins, flavonoids, and glycosides (AFG) to assess inhibitory mechanisms utilizing premalignant Barrett’s esophagus (BE) and EAC derived cell lines. We employed reverse phase protein arrays (RPPA) and Western blots to examine cancer-associated pathways and specific signaling cascades modulated by C-PAC or AFG. Viability results show that C-PAC is more potent than AFG at inducing cell death in BE and EAC cell lines. Based on the RPPA results, C-PAC significantly modulated 37 and 69 proteins in JH-EsoAd1 (JHAD1) and OE19 EAC cells, respectively. AFG treatment significantly altered 49 proteins in both JHAD1 and OE19 cells. Bioinformatic analysis of RPPA results revealed many previously unidentified pathways as modulated by cranberry polyphenols including NOTCH signaling, immune response, and epithelial to mesenchymal transition. Collectively, these results provide new insight regarding mechanisms by which cranberry polyphenols exert cancer inhibitory effects targeting EAC, with implications for potential use of cranberry constituents as cancer preventive agents.