Sunitinib, an inhibitor of kinases, including VEGFR and platelet-derived growth factor receptor (PDGFR), efficiently induces apoptosis in vitro in glioblastoma (GBM) cells, but does not show any survival benefit in vivo. One detrimental aspect of current in vitro models is that they do not take into account the contribution of extrinsic factors to the cellular response to drug treatment. Here, we studied the effects of substrate properties including elasticity, dimensionality, and matrix composition on the response of GBM stem-like cells (GSC) to chemotherapeutic agents. Thirty-seven cell cultures, including GSCs, parenchymal GBM cells, and GBM cell lines, were treated with nine antitumor compounds. Contrary to the expected chemoresistance of GSCs, these cells were more sensitive to most agents than GBM parenchymal cells or GBM cell lines cultured on flat (two-dimensional; 2D) plastic or collagen-coated surfaces. However, GSCs cultured in collagen-based three-dimensional (3D) environments increased their resistance, particularly to receptor tyrosine kinase inhibitors, such as sunitinib, BIBF1120, and imatinib. Differences in substrate rigidity or matrix components did not modify the response of GSCs to the inhibitors. Moreover, the MEK–ERK and PI3K–Akt pathways, but not PDGFR, mediate at least in part, this dimensionality-dependent chemoresistance. These findings suggest that survival of GSCs on 2D substrates, but not in a 3D environment, relies on kinases that can be efficiently targeted by sunitinib-like inhibitors. Overall, our data may help explain the lack of correlation between in vitro and in vivo models used to study the therapeutic potential of kinase inhibitors, and provide a rationale for developing more robust drug screening models. Mol Cancer Ther; 13(6); 1664–72. ©2014 AACR.
Several strategies have emerged to attempt to inhibit chemoresistance, but the fact remains that resistance is a problem for every effective anticancer drug (1). One of the most challenging problems faced by cancer researchers is the lack of correlation between in vitro cell lines and animal tumor models and human in vivo tumors (2). In line with this, sunitinib, a direct inhibitor of the tyrosine-kinase activities of VEGFR, platelet-derived growth factor receptor (PDGFR), and other related kinases (3), has been shown to induce apoptosis in vitro in glioblastoma (GBM) cells. However, it did not show any survival benefit in GBM xenograft models and its clinical success against GBM is not clear yet (4). A number of cell culture platforms have been developed in recent years to improve predictivity and further to elucidate the mechanisms governing the differing responses observed in vitro versus in vivo. Despite their importance for drug testing, in vitro methods are beset by pitfalls and inherent limitations (5). However, given that it is practically impossible to test large quantities of new anticancer agents in vivo, cell culture conditions that mimic the niche of tumor cells need to be further investigated. It is anticipated that the development of in vitro systems representative of tumor microenvironment will lead to an increase in the quality of and reduction in the timelines and costs associated with screening drugs, and enhancement in efficacy information for regulatory decisions. Current in vitro models do not take into account the contribution of different extrinsic factors on the responsiveness of the cells to drug treatment (6). It has been shown for breast cancer cell lines, that culture within a three-dimensional (3D) environment decreased taxol-induced cell death (6). In addition, several lines of evidence indicate that extracellular matrix-derived biomechanical properties, including extracellular matrix components and matrix rigidity, regulate proliferation and migration of GBM cells (7, 8). GBM is a highly aggressive tumor that invades the surrounding tissue and leads to regrowth of a recurrent tumor, which is not significantly altered by radiation or chemotherapy (9). The identification of GBM stem-like cells (GSC), which are considered to be the cause of tumor formation and recurrence, provided a promising cellular target for more effective therapies against GBM (10). Although cancer stem-like cells are predicted to be more resistant to chemotherapy and radiation therapy than the other surrounding cancer cells, the susceptibility of GSCs to chemotherapeutic drugs is controversial as the existing literature presents conflicting experimental data (11). This is likely because the in vitro models used do not recapitulate extrinsic factors of the niche where GSCs reside, which are needed for these cells to maintain their stem cell features (12). Thus, a systematic study of the contribution of different environmental properties to the chemoresponse of GSCs is yet to come. That study will help develop robust in vitro models of GSCs and will be of clinical importance for the discovery of effective treatments against this deadly disease. In this work, we have analyzed the effects of biophysical and biochemical properties of the substrate on the response of GSCs to an array of chemotherapeutic agents used in the clinic or under clinical trials in patients with cancer.
Materials and Methods
Antitumor compounds and kinase inhibitors
The following compounds were used for treatment of GBM cells at the indicated concentrations. Carmustine, cisplatin, roscovitine (Sigma-Aldrich), bortezomib (Millennium Pharmaceuticals), flavopiridol (Santa Cruz Biotechnology), sorafenib, sunitinib (Toronto Research Chemicals), ABT-737, BIBF1120 (vargatef), Gleevec (imatinib; Selleck Chemicals), obatoclax (Cayman Chemical), PD98059, LY294002 (Calbiochem), and AG490 (Sigma-Aldrich).
Human GBM cell lines DBTRG, T98, U87, A172 (from American Type Culture Collection), and 8MGBA, 42MGBA, DKMG, GAMG, GMS10 (from DSMZ) were obtained from commercial providers within the last 2 years and no authentication was performed by the authors. Cells were cultured in Dulbecco's Modified Eagle Medium (DMEM; Life Technologies) in the presence of 10% (v/v) FBS (Lonza). Cell lines were seeded at 30,000 cells per cm2 for cytotoxicity analysis.
Primary cell cultures
Cell cultures from tissue specimens used in this study (GBM and mesenchymal stem-like cells) have been previously characterized and described by our group (8, 13, 14). The stem-like origin of the cells was tested by analyzing the patterns of differentiation just before their use (13, 14). GSCs were maintained in serum-free DMEM/F12 medium (Life Technologies) containing 20 ng/mL EGF, 20 ng/mL basic fibroblast growth factor (both from Sigma-Aldrich), 2 μg/mL heparin, and B-27 (20 μL/mL of medium; Invitrogen) and plated at a density of 3 × 106 live cells/60-mm plate. Primary neurospheres were enzimatically dissociated (acutase; Sigma-Aldrich) every 4 to 5 days to facilitate cell growth. To promote differentiation, neurospheres were cultured in the same medium but in the presence of 10% (v/v) FBS for 4 days (14). All primary cells were used at low (<20) passage number and seeded at 30,000 cells per cm2 for cytotoxicity analysis.
Cell culture on 3D matrices
Bovine skin collagen I (PureCol 5005-B, Nutacon BV, Leimuiden) was prepared at 1.7 mg/mL in HEPES, pH 7.3, buffer with serum- and phenol-free DMEM as described (8) and allowed to polymerize at 37°C for 2 hours. For glycation of collagen, collagen stock solutions were mixed with 0.5 mol/L D-ribose (Amresco) to a final concentration of 0, 50, and 200 mmol/L ribose in 0.1% (v/v) sterile acetic acid and incubated at 4°C for 5 days, as described (15). To study matrix composition, 1.7 mg/mL collagen I and 2.4 mg/mL of low- (29 kDa) or high- (1,540 kDa) molecular-weight hyaluronic acid (Sigma-Aldrich) dissolved in DMEM (pH 7.4) were mixed to weight ratios of 1:0, 1:2, and 1:8. The viscous solutions were incubated at 37°C overnight to allow the natural gelatin of the structure. Following polymerization, cells were seeded on top of matrix in medium, allowed to penetrate for 48 hours (more than 90% of cells within the matrix), and treated with the indicated compounds. Gel stiffness was measured using a rheometer (Anton Paar) and quantified in Pascal units (Pa).
Cell culture on 2D substrates
Collagen I solution (1.7 mg/mL) was added to culture plates and incubated for 16 hours at 4°C. Non-attached collagen was removed by washing before cell incubation. Polyacrylamide matrices of different rigidities were prepared by mixing acrylamide and bisacrylamide at different ratios in the presence of 10 mg/mL NHS cross-liker (Sigma-Aldrich) as previously described (7). All hydrogels were covalently functionalized with collagen (Sigma-Aldrich) at a nominal surface density of 1.4 μg/cm2. A rheometer (Anton Paar) was used to measure the macroscopic elastic shear modulus of each gel.
Cells were assayed for the expression of glial fibrillary acidic protein (GFAP) and Ki-67 by fluorescence microscopy as described previously (14). Briefly, cells were fixed in 3.7% (v/v) formaldehyde and permeabilized with 0.5% (v/v) Triton X-100. For immunostaining, cells were incubated overnight with 10 μg/mL rabbit anti-GFAP (DAKO) or anti-Ki-67 at a 1:250 dilution (Thermo Scientific). Then, Texas red-conjugated goat anti-rabbit secondary antibodies (Jackson ImmunoResearch) were used for fluorescence detection.
Cell nuclei were stained with 0.5 μg/mL Hoechst fluorochrome (Life Technologies) for 15 minutes.
When indicated, GSCs were stained with 5 μmol/L CFDA SE Cell Tracer, also called CFSE (Invitrogen) for 15 minutes and incorporated into a 3D collagen matrix as described above. Then, blocking antibodies against β1-integrin (1 μg/mL; BD Bioscience) were added to the matrix and 24 hours later, fluorescently labeled cells were visualized under a confocal microscope (Nikon A1R). Images were taken with a ×40 objective.
Cell death and apoptosis analyses
Quantitative analysis of cell viability was performed by using the Alamar blue bioassay (Life Technologies). To quantify apoptosis, cells were incubated with annexin V/7-ADD according to the manufacturer's instructions (Annexin red kit; Millipore). Samples were analyzed on a FACScan cytometer (BD Bioscience) or immunofluorescence. When indicated, apoptosis was determined by analyzing the digestion of PARP, a substrate of caspases, as previously described (16).
Short hairpin RNA (shRNA)-containing plasmid (1 μg per 106 cells) specific for PDGFR-α or a control plasmid containing a scramble sequence (Origene) was transfected into GSCs by using a neural stem cell nucleofector kit as recommended by the manufacturer (Lonza). Following 24 hours of transfection, cells were seeded in a collagen matrix as already described.
Western blot analysis
Total protein extracts were separated on a 10% (w/v) SDS-polyacrylamide gel and transferred to nitrocellulose. Blots were blocked with 5% (w/v) bovine serum albumin and incubated overnight with antibodies against Stat3, pStat3, α-tubulin, PARP (all from Santa Cruz Biotechnologies), Akt, pAkt, extracellular signal-regulated kinase (ERK), or pERK (all from Cell Signaling Technology) at 1:500 or 1:250 dilutions, followed by incubation with IRDye-labeled anti-mouse or anti-rabbit antibodies at a 1:15000 dilution for 1 hours (LI-COR Biosciences). Bound antibody was detected by using the Odyssey Infrared Imaging System (LI-COR Biosciences. Gels were cropped with Adobe Photoshop software for clarity and conciseness purposes.
Total RNA was extracted by using a TRI Reagent solution (Sigma-Aldrich). To assess the expression of individual genes, a cDNA was generated and amplified by using primers for human GFAP and β-actin (8). Quantitative real-time PCR (RT-PCR) was performed in a 7000 Sequence Detection System (Life Technologies) as described (8).
All statistics were calculated with the SPSS statistical package (version 13.0). Data are presented as mean ± SD. Differences between groups were tested for statistical significance using the unpaired two-tailed Student t test. The significance level was set at P < 0.05.
Response of GBM cell lines to different chemotherapeutic agents
We first studied the sensitivity of nine different GBM cell lines, cultured on plastic surfaces, to genotoxic drugs (carmustine and cisplatin), inhibitors of antiapoptotic Bcl-2 family members (ABT-737 and obatoclax), cyclin-dependent kinase (CDK) inhibitors (roscovitine and flavopiridol), multikinase inhibitors (sorafenib and sunitinib), and the proteasome inhibitor bortezomib. Kinase and proteasome inhibitors were used at two concentrations either alone or in combination with the antiapoptotic inhibitors to enhance their killing efficacy (Fig. 1A). Carmustine and cisplatin were not lethal for almost any cell line even at concentrations of 30 μmol/L (cisplatin) and 120 μmol/L (carmustine), and similar results were obtained when cells were treated with Bcl-2 inhibitors obatoclax, a pan-Bcl inhibitor, and ABT-737 that inhibits Bcl-2, Bcl-x, and Bcl-w. Targeted therapies showed heterogeneity in treatment efficacy against GBM cell lines. Among the CDK inhibitors, 1 μmol/L flavopiridol was more effective than 15 μmol/L roscovitine. However, roscovitine drastically increased its killing activity when combined with ABT-737 or obatoclax in DKMG, GAMG, and GMS10 cells. The multikinase inhibitor sorafenib promoted a low level of cell death even at concentrations of 30 μmol/L (six of nine cell lines showed a viability higher than 50%), and did not significantly increased its cell death activity in the presence of pan-Bcl inhibitors. On the contrary, another receptor tyrosine kinase inhibitor, sunitinib, at 30 μmol/L was very effective as a single agent (six of nine cell lines showed a viability in the range of 0%–25%) and significantly increased its capacity to induce cell death in combination with obatoclax. Finally, bortezomib showed to be very effective as a single agent in GAMG and GMS10 cells and moderately increased its effectiveness in the presence of pan-Bcl inhibitors. From these data, we concluded that sunitinib was the most effective treatment when used as a single agent. We also determined that U87, GAMG, T98, and 42MGBA formed neurospheres when cultured in the absence of serum (Fig. 1B), similar to those formed by GBM stem-like cells. T98 and 42MGBA, which were two of the most resistant GBM cell lines, were cultured under serum-free conditions and treated with single agents (Fig. 1C). Cisplatin and ABT-737 were not effective in either cell line. However, the sensitivity to roscovitine, sorafenib, and sunitinib was clearly increased in the absence of serum in both cell lines. Taking into consideration that chemoresistance is a main feature of cancer stem-like cells, our results suggest that stem-like cell culture conditions in standard plastic surfaces may not be a reliable in vitro model to test compounds against this cell population. We also confirmed that sunitinib induced apoptotic cell death, as determined by measuring the proportion of Annexin V(+) and 7-Aminoactinomycin D (7-AAD)(−) cells following 12 hours of treatment (Supplementary Fig. S1A). Almost 90% of DKMG cells were apoptotic when treated with 10 μmol/L sunitinib. As apoptosis is mostly regulated by Bcl-2 family members, we analyzed the expression of antiapoptotic proteins Mcl-1, Bcl-2, and Bcl-x in all cell lines. Bcl-2 showed the biggest differences in expression among cell lines. However, there was not a clear correlation between the levels of Bcl-2 and the sensitivity to sunitinib in all cell lines (Supplementary Fig. S1B).
GBM stem-like cells are sensitive to chemotherapeutic agents in a 2D environment
GSCs are considered to be responsible for tumor regrowth, in part, due to their resistance to chemotherapy. We studied the response of thirteen samples of GSCs to the same array of compounds used in cell lines, cultured on flat plastic surfaces. Interestingly, most inhibitors of target proteins (roscovitine, flavopiridol, sunitinib, and bortezomib) were lethal for GSCs as single agents (Fig. 2). Sunitinib alone promoted an almost complete death of the tumor cell population (only one culture showed a viability higher than 25%). Another multikinase inhibitor, sorafenib, was not effective when used alone but killed most cells (cell viability of 11 cultures below 25%) when it was combined with the pan-Bcl inhibitor obatoclax. On the contrary, carmustine, a nitrosourea used in the treatment of GBM, promoted a weak cell death response in 11 GSC cultures. We also studied mesenchymal stem cells (MSC) from bone marrow (two samples) and cells isolated from the bulk of GBM tumors (tumor parenchymal cells; 13 samples) and found that both cell types were clearly more resistant than GSCs to the same treatments (Fig. 2). Moreover, the most effective antitumor agent against GSCs, sunitinib, induced a heterogeneous response in tumor parenchymal cells, but only 1 of 13 samples showed a strong cell death response (below 25%).
Biophysical features of the substrate in the response of GSCs to sunitinib
Very recently, it has been shown that 3D culture platforms induced alterations of markers of malignancy in a GBM cell line (17). We studied the decoupled effects of substrate properties such as elasticity, dimensionality, and matrix composition to the response of GSCs to chemotherapeutic agents using two-dimensional (2D) and 3D platforms (Fig. 3). Significant differences in viability between cells cultured in 2D and 3D substrates were obtained following treatment with cisplatin, flavopiridol, and sunitinib (Fig. 4A). Notably, we observed the highest difference in response to sunitinib. This multikinase inhibitor decreased cell viability to less than 5% on collagen-coated surfaces, whereas the proportion of viable cells in 3D collagen matrices was about 50%. Sunitinib-induced cell death was due to apoptosis as determined by analyzing the cleavage of PARP (Fig. 4B). Consistently, PARP cleavage was more evident in cells cultured on a 2D substrate than in cells incubated in a 3D matrix. To analyze whether this dimensionality-dependent response to sunitinib was specific for GSCs, we treated sunitinib-sensitive and sunitinib-resistant GBM parenchymal cells with increasing concentrations of the kinase inhibitor in 2D and 3D environments (Fig. 4C). In sensitive cells, viability decreased at similar rates both in 2D and 3D substrates, whereas in resistant cells a 3D environment provided a significant protection against sunitinib compared with 2D conditions only at a concentration three times higher than that used in GSCs. These results suggest that a 3D environment is more critical for the survival of GSCs than for the viability of GBM tumor cells. Nevertheless, the comparison of 2D with 3D models may be influenced by differences in stiffness. Thus, we studied the influence of substrate elasticity on the response of GSCs to sunitinib. As a 2D environment, we used a nonpermeable collagen-coated polyacrylamide hydrogel of different stiffness, from 1 kPa (approximately the elastic modulus of brain tissue) to 55 kPa (more than four times stiffer than skeletal muscle), and found that sunitinib was equally effective at killing cells at any of the elasticity coefficients (Fig. 5A). A 3D environment of different elastic conditions was created by glycation of collagen, which allows up to a 4-fold increase in the stiffness of collagen matrices without significant modification to the collagen architecture (15). Again, no significant differences in cell viability were observed between the different elasticity coefficients (Fig. 5B). Finally, to analyze the contribution of substrate composition, we used matrices made of collagen and hyaluronic acid at different ratios. As shown in Fig. 5C, even collagen: hyaluronic acid ratios of 1:8 did not significantly modify sunitinib-mediated cell death in comparison with collagen-only matrices. The same result was obtained using either low- or high-molecular-weight hyaluronic acid. Therefore, our data indicate that substrate stiffness and changes in weight ratios of collagen and hyaluronic acid do not modify the response of GSCs to sunitinib.
MEK–ERK and PI3K–Akt pathways contribute to preserve the resistance of GSCs to sunitinib in 3D collagen matrices
To see whether dimensionality was able to modify biologic features other than cell survival, we cultured GSCs in 2D or 3D collagen substrates and determined the proliferation rate. Following 4 days of incubation, the number of proliferating cells was similar in both conditions as determined by Ki-67 immunofluorescence staining (Supplementary Fig. S2A and S2B) and by counting the number of cells over time (Supplementary Fig. S2C). We also showed that the differentiation pattern of GSCs was similar in both 2D and 3D conditions as determined by immunofluorescence staining of the astrocytic marker GFAP (Supplementary Fig. S2D) and quantitative analysis of the mRNA levels of GFAP (Supplementary Fig. S2E).
Next, we aimed at determining how GSCs sense their physical environment under 3D conditions. The major receptors of extracellular matrix are integrins. The β1-integrin subfamily mediates cell interactions with different extracellular components, including collagen, and it has been shown to regulate chemoresistance of cancer cells (18). Cells were incubated in 3D matrices in the presence or in the absence of a β1-integrin neutralizing antibody. As expected, treated cells lost their elongated shape and adopted a rounded morphology characteristic of cells poorly attached to the substrate (Fig. 6A). However, blockade of β1-integrin did not significantly modify the cell viability of GSCs after treatment with sunitinib (Fig. 6B).
Activation of ERK1/2 has been shown to be associated with resistance to cytotoxic agents in cells exposed to collagen (19). We treated cells with 1 μmol/L PD98059, an inhibitor of MAP–ERK kinase (MEK)-1/2 which is an upstream activator of ERK1/2. Treatment with the inhibitor significantly decreased the phosphorylation of both ERK proteins although pERK1 showed a stronger (about 8-fold) reduction (Fig. 6C). Interestingly, although MEK1/2 inhibitor did not affect viability of GSCs, it drastically decreased (more than 3-fold) cell viability when cotreated with sunitinib (Fig. 6D). Adhesion to collagen may also activate the PI3K–Akt pathway (20). Thus, we inhibited the pathway by treating cells with 1 μmol/L LY294002 as assessed by downregulation of phosphorylated Akt (Fig. 6C), and found a clear reduction of cell viability only when combined with sunitinib (Fig. 6D). However, incubation of cells in the presence of 20 μmol/L AG490, an inhibitor of Stat3, which is a signal transducer relevant in many cancer models, did not modify the response to sunitinib (Fig. 6C and D). Treatment of GSCs with any of these inhibitors alone did not produce a significant reduction of cell viability (85%–100% viable cells) either in 2D or 3D systems (Fig. 6D and data not shown). Other inhibitors that share some kinase targets with sunitinib such as BIBF1120 (Vargatef) and imatinib (Gleevec; ref. 21), were also less effective at inducing cell death in 3D than in 2D substrates (Fig. 6E). All three inhibitors target PDGFR. Silencing with specific shRNAs reduced the expression of PDGFR-α (about 40%) but did not modify the levels of other related genes (Supplementary Fig. S3A). However, this reduction did not promote an increase in cell death (Supplementary Fig. S3B and S3C).
Cancer stem cells play a major role in sustaining tumor growth. Thus, targeting this rare cell population has become a challenge for researchers. However, the in vitro conditions used in most studies do not allow a good correlation between in vitro and in vivo models of chemotherapy response (4, 22, 23). Among the different compounds used in this work, sunitinib was the most effective against GBM cell lines and tumor parenchymal cells isolated from patients with GBM. This is in agreement with previous studies showing that sunitinib was the only receptor tyrosine kinase inhibitor, among eleven compounds, that could induce apoptosis in GBM cells (4). GSCs cultured as neurospheres maintain genomic and phenotypic changes of the primary tumor better than traditional cell lines (24). Interestingly, the cell death response of GSC-containing neurospheres to most compounds tested, including sunitinib, was clearly stronger than that of parenchymal cells, which does not fit with the chemoresistance that characterizes GSCs (11). To shed light on these contradictory data, we analyzed different properties of the in vitro microenvironment. This experimental approach is based on the relevance that the environment plays in regulating migration, proliferation, and apoptosis of cancer stem cells (8, 12). It has been shown that mechanical rigidity of the extracellular matrix contributes to key GBM cell properties, including migration and proliferation (7). However, differences in the stiffness of collagen-based substrates did not promote changes in response to sunitinib. Microenvironment rigidity has been associated with the response of cancer cells to certain apoptotic stimuli (25, 26), which may rely on signaling pathways that regulate actomyosin contractility. However, GSCs are undifferentiated cells with poor adhesion capabilities to substrates. Thus, survival signals are not likely to come from the contractility machinery that needs focal adhesions to initiate the process. Matrix composition may modulate the response to chemotherapy (27) through the interaction between cancer cells and the extracellular matrix molecules. Our data indicate that collagen either alone or in combination with hyaluronic acid, a major component of the brain parenchyma, did not modify the cell death response of GSCs to sunitinib. Although we cannot rule out that other extracellular matrix proteins could have a modifier effect on the chemosensitivity of GSCs, we have confirmed that blockade of integrin-β1, that plays a pivotal role in cell adhesion to many different types of extracellular matrix molecules, had no effect on the viability of sunitinib-treated GSCs. A third important external parameter that may modify cell fate is the dimensionality of the substrate where cells are cultured. 3D in contrast with 2D cell cultures, better recapitulate the features of the in vivo environment (28–31). Most of these works use cancer cell lines or primary tumor cells but not primary cancer stem-like cells, which have biologic properties different from other cancer cells, including the response to chemotherapy. In line with this, we found a highly significant protection against sunitinib and other similar inhibitors when GSCs were cultured in 3D collagen matrices. The effect of dimensionality on chemoresponsiveness could be partly explained in the tumor by the high cell density within the tissue, which may reduce drug penetration. However, cell density did not modify the observed response to sunitinib in our 3D cell system (data not shown). Alternatively, the spatial organization of a cell within a 3D microenvironment could modulate cell fate decisions such as survival, as previously suggested (32). Other multikinase inhibitors such as vargatef and imatinib gave similar results to sunitinib. All three inhibitors have a common kinase target, PDGFR. It has been shown that blockade of PDGFR impairs the ability of embryonic stem cells to assemble 3D extracellular matrix, most likely due to decreased expression of matrix proteins including collagen and fibronectin (33). However, we show that downregulation of PDGFR does not mimic the cell death effect of sunitinib, suggesting that different kinases are needed or alternatively that downstream mediators of cell viability are activated in a 3D environment, likely through focal adhesions proteins. Consistent with this, our data showed that inhibition of the Akt and ERK pathways, which are activated by focal adhesions (34, 35), reverts the protective effect of a 3D environment against sunitinib.
Our work thoroughly analyzed the influence of dimensionality along with other environmental features on the resistance of primary cancer stem-like cells to sunitinib and sunitinib-like multikinase inhibitors. A number of previous works have shown that 3D environments may modulate the response to chemotherapy (36–38). However, they mostly use epithelial tumor cells, but not primary cancer stem cells, which form a distinct cell population with particular properties not shared by other tumor cells, including their tumorigenic potential. Taken together, we show that a culture system that mimics a 3D environment surrounding primary GSCs recapitulates, at least in part, the chemoresistance of GSCs to tyrosine kinase inhibitors. We also provide a simple and robust in vitro model for the screening of multikinase inhibitors, against GSCs and shed light on the molecular pathways that connect a extrinsic factor such as the 3D environment to the machinery of cell survival in GSCs.
Disclosure of Potential Conflicts of Interest
No potential conflicts of interest were disclosed.
Conception and design: J.L. Fernandez-Luna
Development of methodology: G. Fernandez-Fuente, P. Mollinedo, L. Grande, J.L. Fernandez-Luna
Acquisition of data (provided animals, acquired and managed patients, provided facilities, etc.): A. Vazquez-Barquero, J.L. Fernandez-Luna
Analysis and interpretation of data (e.g., statistical analysis, biostatistics, computational analysis): G. Fernandez-Fuente, J.L. Fernandez-Luna
Writing, review, and or revision of the manuscript: J.L. Fernandez-Luna
Administrative, technical, or material support (i.e., reporting or organizing data, constructing databases): P. Mollinedo, L. Grande
Study supervision: J.L. Fernandez-Luna
This work was supported by the Instituto de Salud Carlos III (ISCIII), Spanish Ministry of Science and Innovation grant PI10/02002, and program Red Temática de Investigación Cooperativa en Cáncer (RTICC; grants RD06/0020/0074 and RD12/0036/0022) and from the Instituto de Formación e Investigación Marqués de Valdecilla (IFIMAV) grant API2011-04 (to J.L. Fernandez-Luna).
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.