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Hemorrhage-activated NRF2 in tumor-associated macrophages drives cancer growth, invasion, and immunotherapy resistance
Dominik J. Schaer, … , Elena Dürst, Florence Vallelian
Dominik J. Schaer, … , Elena Dürst, Florence Vallelian
Published December 7, 2023
Citation Information: J Clin Invest. 2024;134(3):e174528. https://doi.org/10.1172/JCI174528.
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Research Article Inflammation Oncology

Hemorrhage-activated NRF2 in tumor-associated macrophages drives cancer growth, invasion, and immunotherapy resistance

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Abstract

Microscopic hemorrhage is a common aspect of cancers, yet its potential role as an independent factor influencing both cancer progression and therapeutic response is largely ignored. Recognizing the essential function of macrophages in red blood cell disposal, we explored a pathway that connects intratumoral hemorrhage with the formation of cancer-promoting tumor-associated macrophages (TAMs). Using spatial transcriptomics, we found that NRF2-activated myeloid cells possessing characteristics of procancerous TAMs tend to cluster in perinecrotic hemorrhagic tumor regions. These cells resembled antiinflammatory erythrophagocytic macrophages. We identified heme, a red blood cell metabolite, as a pivotal microenvironmental factor steering macrophages toward protumorigenic activities. Single-cell RNA-Seq and functional assays of TAMs in 3D cell culture spheroids revealed how elevated intracellular heme signals via the transcription factor NRF2 to induce cancer-promoting TAMs. These TAMs stabilized epithelial-mesenchymal transition, enhancing cancer invasiveness and metastatic potential. Additionally, NRF2-activated macrophages exhibited resistance to reprogramming by IFN-γ and anti-CD40 antibodies, reducing their tumoricidal capacity. Furthermore, MC38 colon adenocarcinoma–bearing mice with NRF2 constitutively activated in leukocytes were resistant to anti-CD40 immunotherapy. Overall, our findings emphasize hemorrhage-activated NRF2 in TAMs as a driver of cancer progression, suggesting that targeting this pathway could offer new strategies to enhance cancer immunity and overcome therapy resistance.

Authors

Dominik J. Schaer, Nadja Schulthess-Lutz, Livio Baselgia, Kerstin Hansen, Raphael M. Buzzi, Rok Humar, Elena Dürst, Florence Vallelian

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Figure 5

Heme-TAMs support tumor cell growth, invasiveness, and metastasis.

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Heme-TAMs support tumor cell growth, invasiveness, and metastasis.
(A) S...
(A) Spheroid GFP fluorescence (magenta) and annexin V (cyan). (B) Integrated fluorescence across the spheroid area. Data are mean ± 95% CI of 42 replicates. (C) Spheroids were grown in microwell plates for scRNA-Seq experiments and GFP fluorescence across the spheroid area was quantified for ≥3,000 spheroids per condition and used for cell density correction in F (gray, MC38; red, MC38+heme-TAMs) (ANOVA with Tukey-Kramer post-test corrected with P 0.001 for all comparisons, except MC38 day 8 vs. MC38 day 10, P = 0.99). (D) Multiplexed scRNA-Seq of MC38 tumor cell spheroids (only MC38) or mixed-cell-type spheroids (MC38 + heme-TAM) on days 4, 8, and 10 after formation. After macrophage exclusion, cell densities were scaled by the mean spheroid size before projecting on the UMAP. (E) Leiden clustering defined 3 clusters per experiment, a dominant functional annotation for each cluster was determined by GSEA. Dot plots depict the fraction of tumor cells within each functional state per time point. (F) GFP-MC38 spheroids (top) and mixed GFP-MC38+heme-TAM-tomato spheroids (bottom) were transferred from microwell plates to a flat glass-bottom plate on day 4 after spheroid formation and embedded into an extracellular matrix. Cell invasion was imaged 24 hours later. (G) Four days after formation, spheroids were embedded into an extracellular matrix (t = 0 hours), and cell invasion was measured by live-cell imaging every 4 hours. Top: Representative inverted bright-field images. Scale bar: 0.5 mm. Bottom: The invading cell front was automatically segmented and quantified over time. Data are mean ± 95% CI of 21 replicates analyzed within 1 representative experiment. (H) Spheroids were collected on day 5 after formation and injected i.v. into C57BL/6J mice. Lungs were collected 24 days after injection. t test. Scale bar: 5 mm.

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