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Bertuccio FR, Montini S, Fusco MA, Di Gennaro A, Sciandrone G, Agustoni F, Galli G, Bortolotto C, Saddi J, Baietto G, Melloni G, D’Ambrosio G, Corsico AG, Stella GM. Malignant Pleural Mesothelioma: From Pathophysiology to Innovative Actionable Targets. Cancers (Basel) 2025; 17:1160. [PMID: 40227645 PMCID: PMC11988075 DOI: 10.3390/cancers17071160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2025] [Revised: 03/25/2025] [Accepted: 03/27/2025] [Indexed: 04/15/2025] Open
Abstract
BACKGROUND Pleural mesothelioma (PM) is a rare and highly aggressive cancer which arises from mesothelial layer and primarily linked to asbestos exposure, genetic predispositions, and specific mutations. Despite current treatment modalities, including chemotherapy, antiangiogenic therapy and more recently immunotherapy, the prognosis remains dismal, with a median survival time of 6-18 months. OBJECTIVES The urgent need for novel therapeutic strategies has prompted research into molecular targets and precision medicine approaches. At present, many potential targets for therapeutic strategies have been identified, and emerging clinical trials are demonstrating certain clinical efficacy. METHODS This review examines advancements in understanding PM's genetic and epigenetic landscape, signaling pathways, and promising therapeutic targets. RESULTS We also discuss the results of recent clinical trials and their potential implications for future treatment paradigms.
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Affiliation(s)
- Francesco Rocco Bertuccio
- Department of Internal Medicine and Medical Therapeutics, University of Pavia Medical School, 27100 Pavia, Italy; (F.R.B.); (S.M.); (M.A.F.); (A.D.G.); (G.S.); (F.A.); (G.G.); (A.G.C.)
- Unit of Respiratory Diseases, Cardiothoracic and Vascular Department, IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Simone Montini
- Department of Internal Medicine and Medical Therapeutics, University of Pavia Medical School, 27100 Pavia, Italy; (F.R.B.); (S.M.); (M.A.F.); (A.D.G.); (G.S.); (F.A.); (G.G.); (A.G.C.)
- Unit of Respiratory Diseases, Cardiothoracic and Vascular Department, IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Maria Antonietta Fusco
- Department of Internal Medicine and Medical Therapeutics, University of Pavia Medical School, 27100 Pavia, Italy; (F.R.B.); (S.M.); (M.A.F.); (A.D.G.); (G.S.); (F.A.); (G.G.); (A.G.C.)
- Unit of Respiratory Diseases, Cardiothoracic and Vascular Department, IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Antonella Di Gennaro
- Department of Internal Medicine and Medical Therapeutics, University of Pavia Medical School, 27100 Pavia, Italy; (F.R.B.); (S.M.); (M.A.F.); (A.D.G.); (G.S.); (F.A.); (G.G.); (A.G.C.)
- Unit of Respiratory Diseases, Cardiothoracic and Vascular Department, IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Gaetano Sciandrone
- Department of Internal Medicine and Medical Therapeutics, University of Pavia Medical School, 27100 Pavia, Italy; (F.R.B.); (S.M.); (M.A.F.); (A.D.G.); (G.S.); (F.A.); (G.G.); (A.G.C.)
- Unit of Respiratory Diseases, Cardiothoracic and Vascular Department, IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Francesco Agustoni
- Department of Internal Medicine and Medical Therapeutics, University of Pavia Medical School, 27100 Pavia, Italy; (F.R.B.); (S.M.); (M.A.F.); (A.D.G.); (G.S.); (F.A.); (G.G.); (A.G.C.)
- Department of Medical Oncology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Giulia Galli
- Department of Internal Medicine and Medical Therapeutics, University of Pavia Medical School, 27100 Pavia, Italy; (F.R.B.); (S.M.); (M.A.F.); (A.D.G.); (G.S.); (F.A.); (G.G.); (A.G.C.)
- Department of Medical Oncology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Chandra Bortolotto
- Diagnostic Imaging and Radiotherapy Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy;
- Radiology Institute, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Jessica Saddi
- Unit of Radiation Therapy, Department of Oncology, Clinical-Surgical, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy;
- Department of Radiation Oncology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Guido Baietto
- Unit of Thoracic Surgery, Cardiothoracic and Vascular Department, IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (G.B.); (G.M.)
| | - Giulio Melloni
- Unit of Thoracic Surgery, Cardiothoracic and Vascular Department, IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (G.B.); (G.M.)
| | - Gioacchino D’Ambrosio
- Pathology Unit, Department of Diagnostical Services and Imaging, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Angelo Guido Corsico
- Department of Internal Medicine and Medical Therapeutics, University of Pavia Medical School, 27100 Pavia, Italy; (F.R.B.); (S.M.); (M.A.F.); (A.D.G.); (G.S.); (F.A.); (G.G.); (A.G.C.)
- Unit of Respiratory Diseases, Cardiothoracic and Vascular Department, IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Giulia Maria Stella
- Department of Internal Medicine and Medical Therapeutics, University of Pavia Medical School, 27100 Pavia, Italy; (F.R.B.); (S.M.); (M.A.F.); (A.D.G.); (G.S.); (F.A.); (G.G.); (A.G.C.)
- Unit of Respiratory Diseases, Cardiothoracic and Vascular Department, IRCCS Policlinico San Matteo, 27100 Pavia, Italy
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Roshini A, Goparaju C, Kundu S, Nandhu MS, Longo SL, Longo JA, Chou J, Middleton FA, Pass HI, Viapiano MS. The extracellular matrix protein fibulin-3/EFEMP1 promotes pleural mesothelioma growth by activation of PI3K/Akt signaling. Front Oncol 2022; 12:1014749. [PMID: 36303838 PMCID: PMC9593058 DOI: 10.3389/fonc.2022.1014749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 09/28/2022] [Indexed: 11/17/2022] Open
Abstract
Malignant pleural mesothelioma (MPM) is an aggressive tumor with poor prognosis and limited therapeutic options. The extracellular matrix protein fibulin-3/EFEMP1 accumulates in the pleural effusions of MPM patients and has been proposed as a prognostic biomarker of these tumors. However, it is entirely unknown whether fibulin-3 plays a functional role on MPM growth and progression. Here, we demonstrate that fibulin-3 is upregulated in MPM tissue, promotes the malignant behavior of MPM cells, and can be targeted to reduce tumor progression. Overexpression of fibulin-3 increased the viability, clonogenic capacity and invasion of mesothelial cells, whereas fibulin-3 knockdown decreased these phenotypic traits as well as chemoresistance in MPM cells. At the molecular level, fibulin-3 activated PI3K/Akt signaling and increased the expression of a PI3K-dependent gene signature associated with cell adhesion, motility, and invasion. These pro-tumoral effects of fibulin-3 on MPM cells were disrupted by PI3K inhibition as well as by a novel, function-blocking, anti-fibulin-3 chimeric antibody. Anti-fibulin-3 antibody therapy tested in two orthotopic models of MPM inhibited fibulin-3 signaling, resulting in decreased tumor cell proliferation, reduced tumor growth, and extended animal survival. Taken together, these results demonstrate for the first time that fibulin-3 is not only a prognostic factor of MPM but also a relevant molecular target in these tumors. Further development of anti-fibulin-3 approaches are proposed to increase early detection and therapeutic impact against MPM.
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Affiliation(s)
- Arivazhagan Roshini
- Department of Neuroscience and Physiology, State University of New York - Upstate Medical University, Syracuse, NY, United States
| | - Chandra Goparaju
- Department of Cardiothoracic Surgery, Langone Medical Center, New York University School of Medicine, New York, NY, United States
| | - Somanath Kundu
- Department of Neuroscience and Physiology, State University of New York - Upstate Medical University, Syracuse, NY, United States
| | - Mohan S. Nandhu
- Department of Neuroscience and Physiology, State University of New York - Upstate Medical University, Syracuse, NY, United States
| | - Sharon L. Longo
- Department of Neurosurgery, State University of New York - Upstate Medical University, Syracuse, NY, United States
| | - John A. Longo
- Department of Neuroscience and Physiology, State University of New York - Upstate Medical University, Syracuse, NY, United States
| | - Joan Chou
- Department of Neuroscience and Physiology, State University of New York - Upstate Medical University, Syracuse, NY, United States
- Department of Neurosurgery, State University of New York - Upstate Medical University, Syracuse, NY, United States
| | - Frank A. Middleton
- Department of Neuroscience and Physiology, State University of New York - Upstate Medical University, Syracuse, NY, United States
| | - Harvey I. Pass
- Department of Cardiothoracic Surgery, Langone Medical Center, New York University School of Medicine, New York, NY, United States
| | - Mariano S. Viapiano
- Department of Neuroscience and Physiology, State University of New York - Upstate Medical University, Syracuse, NY, United States
- Department of Neurosurgery, State University of New York - Upstate Medical University, Syracuse, NY, United States
- *Correspondence: Mariano S. Viapiano,
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Utility of EFEMP1 in the Prediction of Oncologic Outcomes of Urothelial Carcinoma. Genes (Basel) 2021; 12:genes12060872. [PMID: 34204134 PMCID: PMC8226762 DOI: 10.3390/genes12060872] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/30/2021] [Accepted: 06/04/2021] [Indexed: 12/24/2022] Open
Abstract
Urothelial carcinoma (UC) of the upper tract (UTUC) and urinary bladder (UBUC) is a heterogeneous malignancy. Through transcriptomic profiling of the Gene Expression Omnibus UBUC dataset (GSE31684), we discovered that epidermal growth factor-containing fibulin-like extracellularmatrix protein 1 (EFEMP1) was the most upregulated gene during metastatic development. EFEMP1 is an important component of basement membranes and acts as an enzyme regulator in extracellular matrix biology. Initially, evaluation of EFEMP1 mRNA expression in 50 UBUCs showed significantly upregulated levels in high stage UC. We further validated the clinical significance of EFEMP1 in 340 UTUC and 295 UBUC using immunohistochemistry, evaluated by H-score. High EFEMP1 immunoexpression significantly correlated with high pathologic stage, high histological grade, lymph node metastasis, vascular invasion, perineural invasion and high mitosis (all p < 0.05). After adjusting for established clinicopathological factors, EFEMP1 expression status retained its prognostic impact on disease-specific survival and metastasis-free survival in UTUC and UBUC (all p < 0.01). Furthermore, Ingenuity Pathway Analysis showed that actin cytoskeleton signaling, tumor microenvironment pathway and mitochondrial dysfunction were significantly enriched by EFEMP1 dysregulation. In conclusion, high EFEMP1 expression was associated with adverse pathological features in UC and independently predicted worse outcomes, suggesting its roles in clinical decision-making and risk stratification.
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