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2014 ; 147
(6
): 1393-404
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Tumor-associated macrophages produce interleukin 6 and signal via STAT3 to
promote expansion of human hepatocellular carcinoma stem cells
#MMPMID25181692
Wan S
; Zhao E
; Kryczek I
; Vatan L
; Sadovskaya A
; Ludema G
; Simeone DM
; Zou W
; Welling TH
Gastroenterology
2014[Dec]; 147
(6
): 1393-404
PMID25181692
show ga
BACKGROUND & AIMS: Cancer stem cells (CSCs) can contribute to hepatocellular
carcinoma (HCC) progression and recurrence after therapy. The presence of
tumor-associated macrophages (TAMs) in patients with HCC is associated with poor
outcomes. It is not clear whether TAMs interact with CSCs during HCC development.
We investigated whether TAMs affect the activities of CSCs in the
microenvironment of human HCCs. METHODS: HCCs were collected from 17 patients
during surgical resection and single-cell suspensions were analyzed by flow
cytometry. CD14(+) TAMs were isolated from the HCC cell suspensions and placed
into co-culture with HepG2 or Hep3B cells, and CSC functions were measured. The
interleukin 6 (IL6) receptor was blocked with a monoclonal antibody
(tocilizumab), and signal transducer and activator of transcription 3 was knocked
down with small hairpin RNAs in HepG2 cells. Xenograft tumors were grown in
NOD-SCID/Il2Rg(null) mice from human primary HCC cells or HepG2 cells. RESULTS:
CD44(+) cells from human HCCs and cell lines formed more spheres in culture and
more xenograft tumors in mice than CD44(-) cells, indicating that CD44(+) cells
are CSCs. Incubation of the CD44(+) cells with TAMs promoted expansion of CD44(+)
cells, and increased their sphere formation in culture and formation of xenograft
tumors in mice. In human HCC samples, the numbers of TAMs correlated with the
numbers of CD44(+) cells. Of all cytokines expressed by TAMs, IL6 was increased
at the highest level in human HCC co-cultures, compared with TAMs not undergoing
co-culture. IL6 was detected in the microenvironment of HCC samples and induced
expansion of CD44(+) cells in culture. Levels of IL6 correlated with stages of
human HCCs and detection of CSC markers. Incubation of HCC cell lines with
tocilizumab or knockdown of signal transducer and activator of transcription 3 in
HCC cells reduced the ability of TAMs to promote sphere formation by CD44+ cells
in culture and growth of xenograft tumors in mice. CONCLUSIONS: CD44(+) cells
isolated from human HCC tissues and cell lines have CSC activities in vitro and
form a larger number of xenograft tumors in mice than CD44(-) cells. TAMs produce
IL6, which promotes expansion of these CSCs and tumorigenesis. Levels of IL6 in
human HCC samples correlate with tumor stage and markers of CSCs. Blockade of IL6
signaling with tocilizumab, a drug approved by the Food and Drug Administration
for treatment of rheumatoid arthritis, inhibits TAM-stimulated activity of
CD44(+) cells. This drug might be used to treat patients with HCC.