Journal
HEPATOLOGY
Volume 59, Issue 4, Pages 1435-1447Publisher
WILEY-BLACKWELL
DOI: 10.1002/hep.26790
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Funding
- National Institutes of Health [P01-CA080124, R01-CA159258, R21-CA139168, R01-CA126642]
- National Cancer Institute/Proton Beam Federal Share Program awards
- American Cancer Society [120733-RSG-11-073-01-TBG]
- Max Kade Fellowship
- Austrian Science Fund (FWF) [J3618] Funding Source: Austrian Science Fund (FWF)
- Austrian Science Fund (FWF) [J 3618] Funding Source: researchfish
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Sorafenib-a broad kinase inhibitor-is a standard therapy for advanced hepatocellular carcinoma (HCC) and has been shown to exert antifibrotic effects in liver cirrhosis, a precursor of HCC. However, the effects of sorafenib on tumor desmoplasia-and its consequences on treatment resistance-remain unknown. We demonstrate that sorafenib has differential effects on tumor fibrosis versus liver fibrosis in orthotopic models of HCC in mice. Sorafenib intensifies tumor hypoxia, which increases stromal-derived factor 1 alpha (SDF-1 alpha) expression in cancer and stromal cells and, subsequently, myeloid differentiation antigen-positive (Gr-1(+)) myeloid cell infiltration. The SDF-1 alpha/C-X-C receptor type 4 (CXCR4) pathway directly promotes hepatic stellate cell (HSC) differentiation and activation through the mitogen-activated protein kinase pathway. This is consistent with the association between SDF-1 alpha expression with fibrotic septa in cirrhotic liver tissues as well as with desmoplastic regions of human HCC samples. We demonstrate that after treatment with sorafenib, SDF-1 alpha increased the survival of HSCs and their alpha-smooth muscle actin and collagen I expression, thus increasing tumor fibrosis. Finally, we show that Gr-1(+) myeloid cells mediate HSC differentiation and activation in a paracrine manner. CXCR4 inhibition, using AMD3100 in combination with sorafenib treatment, prevents the increase in tumor fibrosis-despite persistently elevated hypoxia-in part by reducing Gr-1(+) myeloid cell infiltration and inhibits HCC growth. Similarly, antibody blockade of Gr-1 reduces tumor fibrosis and inhibits HCC growth when combined with sorafenib treatment. Conclusion: Blocking SDF-1 alpha/CXCR4 or Gr-1(+) myeloid cell infiltration may reduce hypoxia-mediated HCC desmoplasia and increase the efficacy of sorafenib treatment. (Hepatology 2014;59:1435-1447)
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