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Scala JJ, Cha H, Shamardani K, Rashes ER, Acosta-Alvarez L, Mediratta RP. Training the next generation of community-engaged physicians: a mixed-methods evaluation of a novel course for medical service learning in the COVID-19 era. BMC Med Educ 2024; 24:426. [PMID: 38649984 PMCID: PMC11034080 DOI: 10.1186/s12909-024-05372-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 03/29/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Medical school curricula strive to train community-engaged and culturally competent physicians, and many use service learning to instill these values in students. The current standards for medical service learning frameworks have opportunities for improvement, such as encouraging students to have more sustainable and reciprocal impact and to ingrain service learning as a value to carry throughout their careers rather than a one-time experience. PEDS 220: A COVID-19 Elective is a Stanford University course on the frontlines of this shift; it provides timely education on the COVID-19 pandemic, integrating community-oriented public health work to help mitigate its impact. METHODS To analyze our medical service learning curriculum, we combined qualitative and quantitative methods to understand our students' experiences. Participants completed the Course Experience Questionnaire via Qualtrics, and were invited to complete an additional interview via Zoom. Interview transcripts were analyzed using an interactive, inductive, and team-based codebook development process, where recurring themes were identified across participant interviews. RESULTS We demonstrate through self-determination theory that our novel curriculum gives students valuable leadership and project management experience, awards strong academic and community-based connections, and motivates them to pursue future community-engaged work. CONCLUSIONS This educational framework, revolving around students, communities, and diversity, can be used beyond the COVID-19 pandemic at other educational institutions to teach students how to solve other emergent global health problems. Using proven strategies that empower future physicians to view interdisciplinary, community-engaged work as a core pillar of their responsibility to their patients and communities ensures long-term, sustainable positive impact. TRIAL REGISTRATION N/A.
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Affiliation(s)
- Jack J Scala
- Department of Biology, BS Candidate, Stanford University, Palo Alto, CA, USA
| | - Hannah Cha
- Department of Symbolic Systems, BS Candidate, Stanford University, Palo Alto, CA, USA.
| | | | - Emma R Rashes
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Rishi P Mediratta
- Department of Pediatrics, Division of Pediatric Hospital Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
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2
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Galenza A, Moreno-Roman P, Su YH, Acosta-Alvarez L, Debec A, Guichet A, Knapp JM, Kizilyaprak C, Humbel BM, Kolotuev I, O'Brien LE. Basal stem cell progeny establish their apical surface in a junctional niche during turnover of an adult barrier epithelium. Nat Cell Biol 2023; 25:658-671. [PMID: 36997641 PMCID: PMC10317055 DOI: 10.1038/s41556-023-01116-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 02/23/2023] [Indexed: 04/01/2023]
Abstract
Barrier epithelial organs face the constant challenge of sealing the interior body from the external environment while simultaneously replacing the cells that contact this environment. New replacement cells-the progeny of basal stem cells-are born without barrier-forming structures such as a specialized apical membrane and occluding junctions. Here, we investigate how new progeny acquire barrier structures as they integrate into the intestinal epithelium of adult Drosophila. We find they gestate their future apical membrane in a sublumenal niche created by a transitional occluding junction that envelops the differentiating cell and enables it to form a deep, microvilli-lined apical pit. The transitional junction seals the pit from the intestinal lumen until differentiation-driven, basal-to-apical remodelling of the niche opens the pit and integrates the now-mature cell into the barrier. By coordinating junctional remodelling with terminal differentiation, stem cell progeny integrate into a functional, adult epithelium without jeopardizing barrier integrity.
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Affiliation(s)
- Anthony Galenza
- Department of Molecular & Cellular Physiology and Institute of Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Paola Moreno-Roman
- Department of Molecular & Cellular Physiology and Institute of Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Foldscope Instruments, Inc., Palo Alto, CA, USA
| | - Yu-Han Su
- Department of Molecular & Cellular Physiology and Institute of Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Lehi Acosta-Alvarez
- Department of Molecular & Cellular Physiology and Institute of Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Alain Debec
- Université Paris Cité, CNRS, Institut Jacques Monod, Paris, France
- Institute of Ecology and Environmental Sciences, iEES, Sorbonne University, UPEC, CNRS, IRD, INRA, Paris, France
| | - Antoine Guichet
- Université Paris Cité, CNRS, Institut Jacques Monod, Paris, France
| | | | - Caroline Kizilyaprak
- Université de Lausanne, Bâtiment Biophore, Quartier Sorge, Lausanne, Switzerland
| | - Bruno M Humbel
- Université de Lausanne, Bâtiment Biophore, Quartier Sorge, Lausanne, Switzerland
- Department of Cell Biology and Neuroscience, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Provost's Office, Okinawa Institute of Science and Technology, Tancha, Japan
| | - Irina Kolotuev
- Université de Lausanne, Bâtiment Biophore, Quartier Sorge, Lausanne, Switzerland
| | - Lucy Erin O'Brien
- Department of Molecular & Cellular Physiology and Institute of Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA.
- Chan-Zuckerberg Biohub, San Francisco, CA, USA.
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3
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Nie EH, Ahmadian SS, Bharadwaj SN, Acosta-Alvarez L, Threlkeld ZD, Frank MJ, Miklos DB, Monje M, Scott BJ, Vogel H. Multifocal demyelinating leukoencephalopathy and oligodendroglial lineage cell loss with immune effector cell-associated neurotoxicity syndrome (ICANS) following CD19 CAR T-cell therapy for mantle cell lymphoma. J Neuropathol Exp Neurol 2023; 82:160-168. [PMID: 36592076 PMCID: PMC10655196 DOI: 10.1093/jnen/nlac121] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Immune effector cell-associated neurotoxicity syndrome (ICANS) is a prevalent condition seen after treatment with chimeric antigen receptor T-cell (CAR T) therapy and other cancer cell therapies. The underlying pathophysiology and neuropathology of the clinical syndrome are incompletely understood due to the limited availability of brain tissue evaluation from patient cases, and a lack of high-fidelity preclinical animal models for translational research. Here, we present the cellular and tissue neuropathologic analysis of a patient who experienced grade 4 ICANS after treatment with anti-CD19 CAR T therapy for mantle cell lymphoma. Our pathologic evaluation reveals a pattern of multifocal demyelinating leukoencephalopathy associated with a clinical course of severe ICANS. A focused analysis of glial subtypes further suggests region-specific oligodendrocyte lineage cell loss as a potential cellular and pathophysiologic correlate in severe ICANS. We propose a framework for the continuum of neuropathologic changes thus far reported across ICANS cases. Future elucidation of the mechanistic processes underlying ICANS will be critical in minimizing neurotoxicity following CAR T-cell and related immunotherapy treatments across oncologic and autoimmune diseases.
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Affiliation(s)
- Esther H Nie
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Saman S Ahmadian
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Sushma N Bharadwaj
- Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
- Division of Hematology/Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Lehi Acosta-Alvarez
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Zachary D Threlkeld
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Matthew J Frank
- Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
- Division of Hematology/Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - David B Miklos
- Division of Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
- Division of Hematology/Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Michelle Monje
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Brian J Scott
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Hannes Vogel
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
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4
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Fernández-Castañeda A, Lu P, Geraghty AC, Song E, Lee MH, Wood J, O'Dea MR, Dutton S, Shamardani K, Nwangwu K, Mancusi R, Yalçın B, Taylor KR, Acosta-Alvarez L, Malacon K, Keough MB, Ni L, Woo PJ, Contreras-Esquivel D, Toland AMS, Gehlhausen JR, Klein J, Takahashi T, Silva J, Israelow B, Lucas C, Mao T, Peña-Hernández MA, Tabachnikova A, Homer RJ, Tabacof L, Tosto-Mancuso J, Breyman E, Kontorovich A, McCarthy D, Quezado M, Vogel H, Hefti MM, Perl DP, Liddelow S, Folkerth R, Putrino D, Nath A, Iwasaki A, Monje M. Mild respiratory COVID can cause multi-lineage neural cell and myelin dysregulation. Cell 2022; 185:2452-2468.e16. [PMID: 35768006 PMCID: PMC9189143 DOI: 10.1016/j.cell.2022.06.008] [Citation(s) in RCA: 184] [Impact Index Per Article: 92.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 05/04/2022] [Accepted: 06/07/2022] [Indexed: 12/13/2022]
Abstract
COVID survivors frequently experience lingering neurological symptoms that resemble cancer-therapy-related cognitive impairment, a syndrome for which white matter microglial reactivity and consequent neural dysregulation is central. Here, we explored the neurobiological effects of respiratory SARS-CoV-2 infection and found white-matter-selective microglial reactivity in mice and humans. Following mild respiratory COVID in mice, persistently impaired hippocampal neurogenesis, decreased oligodendrocytes, and myelin loss were evident together with elevated CSF cytokines/chemokines including CCL11. Systemic CCL11 administration specifically caused hippocampal microglial reactivity and impaired neurogenesis. Concordantly, humans with lasting cognitive symptoms post-COVID exhibit elevated CCL11 levels. Compared with SARS-CoV-2, mild respiratory influenza in mice caused similar patterns of white-matter-selective microglial reactivity, oligodendrocyte loss, impaired neurogenesis, and elevated CCL11 at early time points, but after influenza, only elevated CCL11 and hippocampal pathology persisted. These findings illustrate similar neuropathophysiology after cancer therapy and respiratory SARS-CoV-2 infection which may contribute to cognitive impairment following even mild COVID.
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Affiliation(s)
| | - Peiwen Lu
- Department of Immunobiology, Yale University, New Haven, CT, USA
| | - Anna C Geraghty
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Eric Song
- Department of Immunobiology, Yale University, New Haven, CT, USA
| | - Myoung-Hwa Lee
- National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Jamie Wood
- Abilities Research Center, Department of Rehabilitation and Human Performance, Mount Sinai School of Medicine, New York, NY, USA
| | - Michael R O'Dea
- Neuroscience Institute, NYU Grossman School of Medicine, New York, NY, USA
| | - Selena Dutton
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Kiarash Shamardani
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Kamsi Nwangwu
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Rebecca Mancusi
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Belgin Yalçın
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Kathryn R Taylor
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Lehi Acosta-Alvarez
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Karen Malacon
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Michael B Keough
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Lijun Ni
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Pamelyn J Woo
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | | | | | | | - Jon Klein
- Department of Immunobiology, Yale University, New Haven, CT, USA
| | | | - Julio Silva
- Department of Immunobiology, Yale University, New Haven, CT, USA
| | | | - Carolina Lucas
- Department of Immunobiology, Yale University, New Haven, CT, USA
| | - Tianyang Mao
- Department of Immunobiology, Yale University, New Haven, CT, USA
| | | | | | - Robert J Homer
- Department of Pathology, Yale University, New Haven, CT, USA
| | - Laura Tabacof
- Abilities Research Center, Department of Rehabilitation and Human Performance, Mount Sinai School of Medicine, New York, NY, USA
| | - Jenna Tosto-Mancuso
- Abilities Research Center, Department of Rehabilitation and Human Performance, Mount Sinai School of Medicine, New York, NY, USA
| | - Erica Breyman
- Abilities Research Center, Department of Rehabilitation and Human Performance, Mount Sinai School of Medicine, New York, NY, USA
| | - Amy Kontorovich
- Cardiovascular Research Institute, Mount Sinai School of Medicine, New York, NY, USA
| | - Dayna McCarthy
- Abilities Research Center, Department of Rehabilitation and Human Performance, Mount Sinai School of Medicine, New York, NY, USA
| | | | - Hannes Vogel
- Department of Pathology, Stanford University, Stanford, CA, USA
| | - Marco M Hefti
- Department of Pathology, University of Iowa, Iowa City, IA, USA
| | - Daniel P Perl
- Department of Pathology, Uniformed Services University of Health Sciences, Bethesda, MD, USA
| | - Shane Liddelow
- Neuroscience Institute, NYU Grossman School of Medicine, New York, NY, USA; Departments of Neuroscience & Physiology and of Ophthalmology, NYU Grossman School of Medicine, New York, NY, USA; Parekh Center for Interdisciplinary Neurology, NYU Grossman School of Medicine, New York, NY, USA
| | | | - David Putrino
- Abilities Research Center, Department of Rehabilitation and Human Performance, Mount Sinai School of Medicine, New York, NY, USA
| | - Avindra Nath
- National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Akiko Iwasaki
- Department of Immunobiology, Yale University, New Haven, CT, USA; Howard Hughes Medical Institute, Yale University, New Haven, CT, USA.
| | - Michelle Monje
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA; Department of Pathology, Stanford University, Stanford, CA, USA; Howard Hughes Medical Institute, Stanford University, Stanford, CA, USA.
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5
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Fernández-Castañeda A, Lu P, Geraghty AC, Song E, Lee MH, Wood J, Yalçın B, Taylor KR, Dutton S, Acosta-Alvarez L, Ni L, Contreras-Esquivel D, Gehlhausen JR, Klein J, Lucas C, Mao T, Silva J, Peña-Hernández MA, Tabachnikova A, Takahashi T, Tabacof L, Tosto-Mancuso J, Breyman E, Kontorovich A, McCarthy D, Quezado M, Hefti M, Perl D, Folkerth R, Putrino D, Nath A, Iwasaki A, Monje M. Mild respiratory SARS-CoV-2 infection can cause multi-lineage cellular dysregulation and myelin loss in the brain. bioRxiv 2022:2022.01.07.475453. [PMID: 35043113 PMCID: PMC8764721 DOI: 10.1101/2022.01.07.475453] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Survivors of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection frequently experience lingering neurological symptoms, including impairment in attention, concentration, speed of information processing and memory. This long-COVID cognitive syndrome shares many features with the syndrome of cancer therapy-related cognitive impairment (CRCI). Neuroinflammation, particularly microglial reactivity and consequent dysregulation of hippocampal neurogenesis and oligodendrocyte lineage cells, is central to CRCI. We hypothesized that similar cellular mechanisms may contribute to the persistent neurological symptoms associated with even mild SARS-CoV-2 respiratory infection. Here, we explored neuroinflammation caused by mild respiratory SARS-CoV-2 infection - without neuroinvasion - and effects on hippocampal neurogenesis and the oligodendroglial lineage. Using a mouse model of mild respiratory SARS-CoV-2 infection induced by intranasal SARS-CoV-2 delivery, we found white matter-selective microglial reactivity, a pattern observed in CRCI. Human brain tissue from 9 individuals with COVID-19 or SARS-CoV-2 infection exhibits the same pattern of prominent white matter-selective microglial reactivity. In mice, pro-inflammatory CSF cytokines/chemokines were elevated for at least 7-weeks post-infection; among the chemokines demonstrating persistent elevation is CCL11, which is associated with impairments in neurogenesis and cognitive function. Humans experiencing long-COVID with cognitive symptoms (48 subjects) similarly demonstrate elevated CCL11 levels compared to those with long-COVID who lack cognitive symptoms (15 subjects). Impaired hippocampal neurogenesis, decreased oligodendrocytes and myelin loss in subcortical white matter were evident at 1 week, and persisted until at least 7 weeks, following mild respiratory SARS-CoV-2 infection in mice. Taken together, the findings presented here illustrate striking similarities between neuropathophysiology after cancer therapy and after SARS-CoV-2 infection, and elucidate cellular deficits that may contribute to lasting neurological symptoms following even mild SARS-CoV-2 infection.
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Affiliation(s)
| | - Peiwen Lu
- Department of Immunobiology, Yale University, New Haven CT USA
| | - Anna C. Geraghty
- Department of Neurology and Neurological Sciences, Stanford University, Stanford CA USA
| | - Eric Song
- Department of Immunobiology, Yale University, New Haven CT USA
| | - Myoung-Hwa Lee
- National Institute of Neurological Disorders and Stroke, Besthesda MD USA
| | - Jamie Wood
- Abilities Research Center, Department of Rehabilitation and Human Performance, Mount Sinai School of Medicine, New York, NY USA
| | - Belgin Yalçın
- Department of Neurology and Neurological Sciences, Stanford University, Stanford CA USA
| | - Kathryn R. Taylor
- Department of Neurology and Neurological Sciences, Stanford University, Stanford CA USA
| | - Selena Dutton
- Department of Neurology and Neurological Sciences, Stanford University, Stanford CA USA
| | - Lehi Acosta-Alvarez
- Department of Neurology and Neurological Sciences, Stanford University, Stanford CA USA
| | - Lijun Ni
- Department of Neurology and Neurological Sciences, Stanford University, Stanford CA USA
| | | | | | - Jon Klein
- Department of Immunobiology, Yale University, New Haven CT USA
| | - Carolina Lucas
- Department of Immunobiology, Yale University, New Haven CT USA
| | - Tianyang Mao
- Department of Immunobiology, Yale University, New Haven CT USA
| | - Julio Silva
- Department of Immunobiology, Yale University, New Haven CT USA
| | | | | | | | - Laura Tabacof
- Abilities Research Center, Department of Rehabilitation and Human Performance, Mount Sinai School of Medicine, New York, NY USA
| | - Jenna Tosto-Mancuso
- Abilities Research Center, Department of Rehabilitation and Human Performance, Mount Sinai School of Medicine, New York, NY USA
| | - Erica Breyman
- Abilities Research Center, Department of Rehabilitation and Human Performance, Mount Sinai School of Medicine, New York, NY USA
| | - Amy Kontorovich
- Cardiovascular Research Institute, Mount Sinai School of Medicine, New York, NY USA
| | - Dayna McCarthy
- Abilities Research Center, Department of Rehabilitation and Human Performance, Mount Sinai School of Medicine, New York, NY USA
| | | | - Marco Hefti
- Department of Pathology, University of Iowa, Iowa City, IA USA
| | - Daniel Perl
- Department of Pathology, Uniformed Services University of Health Sciences, Bethesda MD USA
| | | | - David Putrino
- Abilities Research Center, Department of Rehabilitation and Human Performance, Mount Sinai School of Medicine, New York, NY USA
| | - Avi Nath
- National Institute of Neurological Disorders and Stroke, Besthesda MD USA
| | - Akiko Iwasaki
- Department of Immunobiology, Yale University, New Haven CT USA
- Howard Hughes Medical Institute, Yale University, New Haven CT USA
| | - Michelle Monje
- Department of Neurology and Neurological Sciences, Stanford University, Stanford CA USA
- Howard Hughes Medical Institute, Stanford University, Stanford CA USA
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6
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Yoo JH, Brady SW, Acosta-Alvarez L, Rogers A, Peng J, Sorensen LK, Wolff RK, Mleynek T, Shin D, Rich CP, Kircher DA, Bild A, Odelberg SJ, Li DY, Holmen SL, Grossmann AH. The Small GTPase ARF6 Activates PI3K in Melanoma to Induce a Prometastatic State. Cancer Res 2019; 79:2892-2908. [PMID: 31048499 DOI: 10.1158/0008-5472.can-18-3026] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 01/11/2019] [Accepted: 04/09/2019] [Indexed: 12/17/2022]
Abstract
Melanoma has an unusual capacity to spread in early-stage disease, prompting aggressive clinical intervention in very thin primary tumors. Despite these proactive efforts, patients with low-risk, low-stage disease can still develop metastasis, indicating the presence of permissive cues for distant spread. Here, we show that constitutive activation of the small GTPase ARF6 (ARF6Q67L) is sufficient to accelerate metastasis in mice with BRAFV600E/Cdkn2aNULL melanoma at a similar incidence and severity to Pten loss, a major driver of PI3K activation and melanoma metastasis. ARF6Q67L promoted spontaneous metastasis from significantly smaller primary tumors than PTENNULL, implying an enhanced ability of ARF6-GTP to drive distant spread. ARF6 activation increased lung colonization from circulating melanoma cells, suggesting that the prometastatic function of ARF6 extends to late steps in metastasis. Unexpectedly, ARF6Q67L tumors showed upregulation of Pik3r1 expression, which encodes the p85 regulatory subunit of PI3K. Tumor cells expressing ARF6Q67L displayed increased PI3K protein levels and activity, enhanced PI3K distribution to cellular protrusions, and increased AKT activation in invadopodia. ARF6 is necessary and sufficient for activation of both PI3K and AKT, and PI3K and AKT are necessary for ARF6-mediated invasion. We provide evidence for aberrant ARF6 activation in human melanoma samples, which is associated with reduced survival. Our work reveals a previously unknown ARF6-PI3K-AKT proinvasive pathway, it demonstrates a critical role for ARF6 in multiple steps of the metastatic cascade, and it illuminates how melanoma cells can acquire an early metastatic phenotype in patients. SIGNIFICANCE: These findings reveal a prometastatic role for ARF6 independent of tumor growth, which may help explain how melanoma spreads distantly from thin, early-stage primary tumors.Graphical Abstract: http://cancerres.aacrjournals.org/content/canres/79/11/2892/F1.large.jpg.
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Affiliation(s)
- Jae Hyuk Yoo
- Department of Medicine, Program in Molecular Medicine, University of Utah, Salt Lake City, Utah
| | - Samuel W Brady
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Utah, Salt Lake City, Utah.,Department of Biomedical Informatics, School of Medicine, University of Utah, Salt Lake City, Utah
| | | | - Aaron Rogers
- Department of Pathology, University of Utah, Salt Lake City, Utah
| | - Jingfu Peng
- Department of Pathology, University of Utah, Salt Lake City, Utah
| | - Lise K Sorensen
- Department of Medicine, Program in Molecular Medicine, University of Utah, Salt Lake City, Utah
| | - Roger K Wolff
- Department of Pathology, University of Utah, Salt Lake City, Utah
| | - Tara Mleynek
- Department of Medicine, Program in Molecular Medicine, University of Utah, Salt Lake City, Utah
| | - Donghan Shin
- Department of Medicine, Program in Molecular Medicine, University of Utah, Salt Lake City, Utah
| | - Coulson P Rich
- Department of Pathology, University of Utah, Salt Lake City, Utah.,Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - David A Kircher
- Department of Oncological Sciences, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Andrea Bild
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Utah, Salt Lake City, Utah.,Department of Oncological Sciences, School of Medicine, University of Utah, Salt Lake City, Utah.,Department of Medical Oncology and Therapeutics, City of Hope Comprehensive Cancer Institute, Monrovia, California
| | - Shannon J Odelberg
- Department of Medicine, Program in Molecular Medicine, University of Utah, Salt Lake City, Utah.,Department of Neurobiology and Anatomy, University of Utah, Salt Lake City, Utah.,Division of Cardiovascular Medicine, Department of Medicine, University of Utah, Salt Lake City, Utah
| | - Dean Y Li
- Department of Medicine, Program in Molecular Medicine, University of Utah, Salt Lake City, Utah.,Division of Cardiovascular Medicine, Department of Medicine, University of Utah, Salt Lake City, Utah.,Department of Human Genetics, University of Utah, Salt Lake City, Utah
| | - Sheri L Holmen
- Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, Utah.,Department of Oncological Sciences, School of Medicine, University of Utah, Salt Lake City, Utah.,Department of Surgery, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Allie H Grossmann
- Department of Pathology, University of Utah, Salt Lake City, Utah. .,Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, Utah.,ARUP Laboratories, University of Utah, Salt Lake City, Utah
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