Pancreatic Cancer Stem Cell Exosomes Drive A Hierarchical Intratumor Communication Network That Fuels Disease Progression Through Hippo Pathway Inhibition.

Abstract Intra-tumor heterogeneity represents a major challenge for cancer treatment. Resistance to therapy and tumorigenic ability varies greatly between distinct subpopulations of cancer cells. Intercellular communication is critical to establish a cooperative environment that maintains tumor heterogeneity and potentiates disease progression. However, how subpopulations of cancer cells interact to support tumor progression is not fully understood. Exosomes have the potential to re-educate recipient cells through the delivery of their cargo, emerging as the main mediators of intercellular communication. Here we demonstrate that subpopulations of pancreatic cancer cells use exosomes to establish a hierarchical and dynamic communication network, the ExoNet. Exosomes from cancer stem cells (CSC) are preferentially taken up by non-CSC (NCSC). Targeted inhibition of CSC exosomes in PDAC orthotopic, genetically engineered and patient-derived xenograft mouse models is sufficient to impair tumor growth and metastasis establishment. A comprehensive comparative proteomic analysis of exosomes derived from distinct subpopulations of pancreatic ductal adenocarcinoma (PDAC) human cell lines identified a significant enrichment of Agrin in CSC exosomes. Blocking exosomes secretion and downregulating Agrin in CSCs significantly diminishes YAP nuclear localization in receiving cells, indicating that CSC exosomes contribute for Hippo pathway inactivation. Agrin+ circulating exosomes correlate with tumor burden in PDAC patients, and most importantly correlate with CD133+ circulating exosomes, indicating that circulating Agrin+ exosomes are from CSC origin. Longitudinal analysis of circulating Agrin+ exosomes in PDAC patients predicts disease progression and response to therapy. Our study describes a novel role of cancer exosomes in the interplay between subpopulations of cancer cells promoting tumor progression. We identified Agrin as a potential non-invasive biomarker to monitor disease progression and predict treatment response. Citation Format: Carolina F. Ruivo, Nuno Bastos, Ines Batista, Barbara Adem, Cecilia Duraes, Carlos A. Melo, Francisco J. Campos-Laborie, Pedro Moutinho-Ribeiro, Barbara Mourão, Marília Cravo, Guilherme Macedo, Fátima Carneiro, Tony Kouzarides, Raghu Kalluri, Jose C. Machado, Sonia Melo. Pancreatic cancer stem cell exosomes drive a hierarchical intratumor communication network that fuels disease progression through hippo pathway inhibition [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2010.