U-M team singles out cancer stem cells for attack
Close on the heels of the discovery that cancer has its own rejuvenating stem cells, a U-M research team has found a way to distinguish these bad actors from the normal stem cells they so closely resembleand to kill the cancer stem cells without harming their normal counterparts in the same tissue.
The progression of some cancers, including leukemia, appears to be driven by cancer stem cellsrare cells that have a greater ability to proliferate than other cancer cells, and which, therefore, are the most malignant. To have any hope of curing cancer it is necessary to develop therapies that kill these cancer stem cells. Yet these cells frequently have properties that are similar to normal stem cells in the same tissue.
"This study proves that it is possible to identify differences in the mechanisms that maintain normal stem cells and cancer stem cells, and to therapeutically exploit these differences to kill the cancer stem cells without harming normal stem cells in the same tissue," says Sean Morrison, lead author on the study and director of the Center for Stem Cell Biology.
Three years ago Morrison was part of a U-M team that made the breakthrough discovery that breast cancer has its own stem cells. These cells appear to be the primary drivers in tumor growth, and possibly metastasis, and the discovery pointed to a new direction in cancer therapy: Rather than trying to eliminate every last tumor cell, cancer therapies might more specifically be targeted at just the stem cells in cancer.
But telling the bad guys from the good guysnormal adult stem cells the body relies on to replace cells damaged by injury, disease and old ageis a big problem because they have so many features in common, says Morrison, a Howard Hughes Medical Institute investigator.
In a paper in the April 6 journal Nature, Morrison's team members explain how they have found a way to tell stem cell friends from foes, as well as a drug that can make them behave differently.
"In many types of tumors, the gene Pten is missing or turned off," Morrison says. "Because Pten regulates cell proliferation and survival, we studied its role in the maintenance of normal blood-forming stem cells."
Omer Yilmaz, a graduate student in the Morrison laboratory, deleted the Pten gene from adult blood-forming stem cells in mice and found that the loss of Pten led to leukemia, marked by the generation of leukemic stem cells. Transplantation of even a single leukemic stem cell from these Pten-deficient mice into a second mouse caused leukemia, demonstrating the powerful cancer-causing ability of these cells.
In addition to pumping up leukemic stem cell numbers, Pten deletion also caused normal blood-forming stem cells to start dividing, but over time the normal stem cells became depleted in the absence of Pten. Additional experiments by the team established that every blood-forming stem cell needs Pten to maintain itself, in contrast to leukemic stem cells that thrive without Pten.
This finding of a key difference between normal stem cells and cancer stem cells suggested drugs that target the metabolic pathway in which Pten acts should have opposite effects on normal blood-forming stem cells and leukemic stem cells. To test this, the team treated the mice with rapamycin, a drug that reduces the activity of this metabolic pathway. The drug is used to prevent tissue rejection in transplant patients and currently is being tested in clinical trials for activity against a variety of cancers.
They found that rapamycin inhibited the creation and maintenance of leukemic stem cells. And even better, it rescued the function of normal blood-forming stem cells in these mice that otherwise crashed without Pten.
Mice that were put on rapamycin immediately after Pten deletion failed to develop leukemia, and the drug kept mice that already had leukemia alive longer.
These results suggest that by better understanding the mechanisms that regulate the maintenance of normal stem cells, it will be possible to develop new anti-cancer therapies that are more effective and less toxic. This is a particularly important issue for leukemia patients that often cannot be cured with current therapies, and for whom existing therapies sometimes have fatal side effects.
"The ability to strategically target and kill leukemia-initiating stem cells will undoubtedly have a significant impact on our capacity to treat these often fatal diseases more effectively," says Dr. Riccardo Valdez, assistant professor of pathology, who participated in the study. "At the same time, it would minimize potentially life-threatening side effects caused by conventional drugs."
Morrison is quick to point out that these findings are limited to mice so far and cannot immediately be extrapolated to human patients. The study, however, raises the possibility that rapamycin could be effective in depleting leukemic stem cells for at least certain patients. Clinical trials will be required to test this in human patients.