Galectin-3 is a β-galactoside binding lectin expressed in tumour cells and macrophages and has been associated with increased malignancy in a variety of cancers. Previous work has shown that galectin-3 is an important regulator of macrophage function, promoting an alternative (M2) phenotype which potentiates chronic inflammation and fibrosis. Tumour associated macrophages (TAMs) adopt an M2 phenotype and are thought to promote tumour growth by down regulating T cell effector function and promoting angiogenesis. This project examines the hypothesis that host galectin-3 promotes lung cancer growth and spread. In order to test this hypothesis, Lewis Lung Carcinoma tumour growth and metastasis was investigated in strain matched mice either expressing or deficient in galectin-3. The Lewis Lung Carcinoma cell line (LLC1) is a spontaneous lung carcinoma line, derived from C57BL/6 mice, which readily forms tumours when transplanted. Furthermore, LLC1 cells were stably transfected with a Luciferase expressing vector in order to assist detection of tumour growth and metastasis in vivo. An orthotopic model of LLC1 growth suggested that galectin-3-/- animals do not support lung carcinoma growth and spread. This finding was confirmed by a subcutaneous model of cancer growth, where it was found that wild type animals display a higher proportion of macrophages expressing a prototypic M2 marker around tumour sites compared to galectin-3-/- animals. M2-promoting cytokine transcripts were also reduced in galectin-3-/- mice. Additionally, tumours of wild type mice were more invasive and presented more mature blood vessels compared to galectin-3-/- mice. To specifically address the role of recruited cells on tumour growth, metastasis and the inflammation profile around tumour sites, in relation to galectin-3 expression, bone marrow cells (BMCs) were transplanted from wild type to galectin-3-/- mice and vice versa. It was shown that galectin-3 positive BMCs restore the wild type phenotype of tumour growth in galectin-3-/- mice, while galectin-3 deficient BMCs impair tumour growth in wild type animals. Furthermore, macrophage ablation experiments demonstrated incapacity for tumour establishment in the absence of macrophages. A series of experiments investigating reported inhibition of galectin-3 by modified citrus pectin (MCP) via competitive inhibition did not provide conclusive results. MCP had no effect in vivo, but was able to inhibit LLC1 cell growth in vitro. Most importantly though, results were inconclusive as to whether galectin-3 binds MCP. Some ligand displacement was seen, but direct binding of the molecules could not be shown. In general, the results obtained demonstrate a strong pro-tumoural effect of galectin-3 on growth, tissue invasion and metastasis of LLC1 tumours via an increased proportion of Ym1-expressing macrophages around tumour sites. It was shown that macrophages are key cells for tumour initiation and that BMC phenotype in relation to galectin-3 expression determines the phenotype of tumour development in subcutaneous and orthotopic LLC1 models. Therefore, galectin-3 has a strong regulatory effect on tumour phenotype and could present a key target in the management of lung carcinomas.

In high-grade ‘starry-sky’ non-Hodgkin’s lymphoma (NHL), particularly Burkitt’s lymphoma (BL), large numbers of apoptotic tumour cells are engulfed by infiltrating tumour-associated macrophages (TAM). In situ studies suggest that in starry-sky TAM in a xenograft model of BL various tumour-promoting, trophic, angiogenic, tissue remodelling, and anti-inflammatory pathways are activated. Furthermore, apoptotic cells have been shown to activate expression of tumour-promoting matrix metalloproteinases in macrophages. This work investigates the hypothesis that apoptotic cells or factors released from apoptotic cells induce additional aspects of the starry-sky TAM signature, which serve to promote tumour growth. Macrophages at different stages of maturation, cultured in vitro in the presence of large numbers of apoptotic cells, were shown to differ in phenotype, giving credibility to the hypothesis. Less mature mouse bone marrow-derived macrophages (BMDM) were better at migrating towards apoptotic cells, whereas mature BMDM were better at phagocytosing them. Lactoferrin, which is released from cells undergoing apoptosis and inhibits the migration of neutrophils, was selected as a candidate mediator in the activation of macrophages by apoptotic cells. Lactoferrin was shown to bind viable human and murine monocytes and macrophages, however only high concentrations, which are unlikely to be physiologically or clinically relevant, were found to affect expression of starry-sky TAM genes or reduce classically-activated macrophage cytotoxicity. The direct effect of apoptotic cells on macrophage activation was assessed. Mature BMDM were not used for these studies as their development in vitro in a highly apoptotic environment was judged likely to bias their activation state toward that of TAM, therefore macrophages were first classically-activated with IFN-γ and LPS. This reduced the expression of many starry-sky TAM genes, including several genes associated with responses to apoptotic cells. However, classical activation did not inhibit apoptotic cell engulfment, but rather enhanced it. Co-culture with apoptotic cells, but not viable cells, increased the gene expression of Gas6, Mrc1, Cd36, Timp2, and Pparg, and the latter was dependent on direct interaction with macrophages rather than factors released from apoptotic cells. Furthermore, classically-activated macrophages were found to induce apoptosis in lymphoma cells, and although pre-co-culture of the macrophages with apoptotic cells did not reduce their ability to induce apoptosis, it enhanced tumour cell growth. Macrophage deficiency of IL-4Rα or galectin-3 did not affect classically-activated macrophage responses to apoptotic cells. However, classical activation of galectin-3 deficient macrophages appeared to restore the decreased ability of galectin-3 deficient, untreated macrophages to phagocytose apoptotic cells. Because of the unique new method of laser-capture microdissection by which starry-sky TAM signatures were established, direct comparisons with expression databases of tissue and in vitro cultured macrophages were not possible, but indirect comparisons suggest starry-sky TAM activation reflects the activation phenotype of a mixture of tissue macrophages. Furthermore, it highlighted phagocytosis as one of the most important pathways activated by starry-sky TAM. Together the results presented here suggest apoptotic lymphoma cells can shape TAM activation signatures in starry-sky NHL, even when macrophages are pre-activated to induce apoptosis in lymphoma cells. This is important when considering the consequences of anti-cancer therapies that induce apoptosis or aim to redirect phagocyte activation.

Pancreatic Ductal Adenocarcinoma (PDAC) affects approximately 8000 people every year in the UK and is the fifth leading cause of cancer related death. At a molecular level PDAC is characterized by a significant immune infiltrate. Tumour-associated macrophages (TAMs) infiltrate the tumour and contribute to a worse prognosis by promoting growth, metastasis and resistance to chemotherapy. TAMs are derived from circulating ‘classical’ CD14++ CD16- monocytes in the peripheral blood. Current work in murine models suggests targeting monocyte recruitment in PDAC can reduce TAM infiltration and disease burden therefore improving survival. This project aims to identify markers specific to monocytes from PDAC patients and to investigate their biological relevance and potential for therapeutic intervention. Gene expression and metabolomics analysis was carried out on classical CD14++ CD16- monocytes from locally advanced PDAC patients and age matched healthy donors. Transcriptomic profiling revealed a significantly altered gene expression profile in classical monocytes from patients and genes with the highest fold change difference were chosen for validation using qPCR. Validated gene targets were investigated further in vitro and large-scale gene expression analysis from pancreatic tumours assessed. The results from my work demonstrate that the gene expression profile of classical monocytes from PDAC patients is significantly different compared to healthy volunteers. Identification and validation of up-regulated genes and their biological relevance may represent a relevant novel novel biomarker or therapeutic strategyies to target monocytes and myeloid recruitment in cancer.

Background: Breast and endometrial cancers are the most common gynaecological cancers in women in the UK. Early detection of tumours is crucial for improving patient survival rates. In breast cancer, mammography is the most reliable screening method for asymptomatic patients; however, its sensitivity is limited by breast density. Currently, there are no early screening assays for endometrial cancer. Thus, there is an urgent need to identify clinical biomarkers for improved non-invasive diagnosis of breast and endometrial cancer. Macrophages are abundant in the tumour microenvironment and their density has been associated with poor prognosis in breast cancer and decreased survival in endometrial cancer. Monocytes are precursors of macrophages and recent studies have shown an association with pro-tumoral functions. The aim of this study has been to examine the transcriptional profiles of human circulating monocytes and tumour associated macrophages (TAMs) in order to investigate their biological relevance and potential as biomarkers for cancer detection and prognosis. Methods: RNA-sequencing was performed on purified monocytes (22 healthy individuals, 21 breast cancer, 16 endometrial cancer samples), as well as purified normal macrophages, TAMs from breast tissue (4 breast cancer, 4 healthy breast) and endometrium tissue (5 endometrial cancer, 9 healthy endometrium). Results: A shift in the transcriptional profile of monocytes in cancer compared to controls was observed. Given these cancer-associated alterations circulating monocytes from cancer patients were called “Tumour Educated Monocytes” (TEMo). A TEMo-derived 13-gene signature was extracted that detected cancer, yielding an accuracy of 94%, a positive predictive value (PPV) of 92% and a negative predictive value (NPV) of 97%. External validation confirmed the ability of the signature to accurately identify cancer patients with perfect accuracy. Transcriptome profiling of TAMs revealed a significantly altered gene expression profile when compared to normal tissue resident macrophages. Furthermore, comparison of TAMs between breast and endometrial cancer also revealed differences suggesting that different tumour microenvironments induce different gene expression profiles in TAMs. Functional analysis of significant genes in breast cancer revealed similar biological pathways to those of murine studies suggesting that TAMs in humans and mice may have similar functions. A gene list of transmembrane receptors has been extracted by comparing breast cancer TAMs with publicly available datasets that could serve as markers for their identification. Finally, exploratory analysis identified a subset of 49 genes associated with recurrence-free and overall survival in publicly available datasets. Conclusion: To my knowledge this is the first genome-wide profiling study of human circulating monocytes and TAMs in breast and endometrial cancer. It provides evidence that monocytes and TAMs can alter their expression profile in the presence of cancer and, using bioinformatics tools I was able to identify biomarkers for diagnosis and prognosis of breast and endometrial cancer.

Glioblastoma Multiforme (GBM) is a primary malignant brain cancer, affecting children and adults and has a very poor prognosis. Up to 30% of the tumour mass consists of host derived immune cells, and a better understanding of how these cells affect tumour behaviour is required. These cells, called ‘Tumour Associated Macrophages’ (TAM) have been shown to occur in peripheral solid organ cancers, where they can cause local immune suppression, increase invasiveness and aid tumour growth. In the brain however, TAMs can consist of centrally derived microglia and peripherally derived macrophages, and although these cells could be exerting different effects on the tumour, there is currently no reliable way of distinguishing between the two. Cancer Stem Cells (CSC) are a subpopulation of cells within the tumour mass with stem-like features, are capable of self-renewal, and can recapitulate a tumour in an immunocompromised mouse host. It is thought that these cells play a role in disease recurrence and hence represent a potential target for anti-GBM therapies. In the first project we investigate the interaction between Cancer Stem Cells and TAMs. We first describe a method of culturing CSCs and TAMs from a single human patient sample, followed by an investigation into the functional properties of these cell types. We found functional differences between established cell line pairings of U87-MG and CHME3 versus primary patient derived CSCs and TAM cell line pairings. Polarisation of microglia/TAMs with lipopolysaccharide caused significant decrease in proliferative capacity of the GBM cell lines. Next we used a Non-Myeloablative Conditioning System (NMCS) to selectively replace the peripheral bone marrow compartment of wild type animals with labelled bone marrow cells, without disturbing brain homeostasis. We demonstrate that peripheral cells home exclusively to the orthotopically implanted tumour, and that some of these cells are CD11b+ and Gr1+, suggestive of myeloid derived suppressor cells (MDSC). We evaluate current CD45 based gating strategies for distinguishing peripheral and central cells and show them to be inadequate. Finally we compared the chemosensitivity profiles of different patient derived CSC lines using high throughput content screening (HTCS), against currently approved chemotherapeutic drugs and rank these drugs in a response space, based on HTCS parameters including 2D and 3D culture with and without irradiation. Differential chemosensitivities were noted between different patient derived cell lines. Drugs not currently used in the treatment of GBM such as Actinomycin D and Mitoxantrone were also identified using HTCS, suggesting the potential utility of such an approach to personalised treatments in GBM.

Tumours are not autonomous transformed cell populations, but rather a society composed of both malignant and normal, including immune, cells that together foster tumour growth and development. Tumour-associated macrophages have been reported to enhance tumour growth, progression and metastasis. In high-grade non-Hodgkin’s lymphomas, prototypically the B-cell neoplasm, Burkitt’s lymphoma (BL), infiltrating macrophages engulf large numbers of apoptotic tumour cells. Evidence suggests that apoptotic BL cells can condition the tumour microenvironment to promote lymphoma development by selectively attracting macrophages while inhibiting neutrophil infiltration and by stimulating macrophages to produce the B-cell growth and survival factor. Tumour cells grow in a hypoxic and nutrient-deficient environment and the resultant cellular stress can induce apoptosis. It is therefore possible that hostile environmental conditions in the tumour also contribute to the generation of a pro-tumour microenvironment. This thesis describes investigations which examined this hypothesis. BL cells were cultured at high density to mimic conditions of metabolic stress existing in the tumour environment. Cell-free supernatants from such stressed BL cells demonstrated potent chemoattractive activity for mononuclear phagocytes. Supernatants from BL cells that were protected from apoptosis by over-expression of bcl-2 had similar ability, confirming that chemoattractant release was apoptosis-independent. The observation that apyrase and suramin could inhibit the chemotactic activity of these supernatants suggested that nucleotides might be the apoptosis-independent chemoattractant. Detection of ATP in stress supernatants by bioluminescence assay was consistent with this proposal. Significantly, supernatants from BL cells and those transfected with bcl-2 were both found to inhibit neutrophil migration, suggesting the occurrence of a neutrophil migration inhibitory factor whose release was apoptosis-independent. Furthermore, stress supernatants could promote BL cell proliferation in vitro, which was apoptosis and cell line-independent. In order to study the role of TAM in the tumour microenvironment, a novel macrophage model was devised using mouse embryonic stem cells (ES cells). Cells derived from ES cells generated in vitro expressed macrophage-specific markers and were free of dendritic cells and undifferentiated ES cells. ES cell-derived macrophages (ESDM) could migrate towards apoptotic BL cells and engulf them. However, ESDM migrated to stress supernatants with decreasing efficiency as they matured. Preliminary data indicated that the phagocytic ability of ESDM to engulf apoptotic cells increased as they matured, consistent with distinct roles for circulating monocytes and tissue macrophages with regard to this function. Considering the high yields and purities of ESDM described here, together with their non-malignant nature and genetic versatility these cells should provide a superior source of undifferentiated mononuclear phagocytes with which to elucidate the molecular mechanisms underlying tumour infiltration and microenvironmental conditioning by TAM. In conclusion, this work suggests that under conditions of pre-apoptotic stress, BL cells have the capacity to regulate their micro-environment upstream of their apoptosis programme to promote net tumour growth through paracrine signals that attract supportive macrophages and inhibit destructive neutrophils and through release of autocrine/juxtacrine tumour growth factors.

Die vorliegende Arbeit beinhaltet umfangreiche histologische Untersuchungen an verschiedenen Tumoren bezüglich ihrer Infiltration durch Makrophagen-Subpopulationen, Granulozyten und Lymphozyten. Hierfür wurden 18 Gewebe-Mikroarrays mit jeweils 200 - 300 Tumorstanzen aus insgesamt 27 Organen des Gastrointestinaltraktes, des Urogenitaltraktes, des Respirationssystems und des endokrinen Systems angefertigt. Da alle Proben mit derselben Technik (Gewebe-Mikroarrays, Immunhiostochemie) ausgewertet wurden, bestand nun erstmalig die Möglichkeit eines direkten Vergleiches zwischen den verschiedenen Tumoren unterschiedlicher Organe. Für die immunhistochemischen Untersuchungen wurden fünf verschiedene Antikörper (anti-KP1, anti-PG-M1, anti-MRP8, anti-MRP14, anti-MRP8/14) eingesetzt. Die Antikörper gegen die Epitope PG-M1 und KP1 gelten als Pan-Makrophagen-Marker. Die Antikörper anti-MRP8, anti-MRP14 und anti-MRP8/14 gelten als Marker für entzündlich aktivierte Makrophagen. Diese Makrophagen wurden in einen aktiven inflammatorischen Typ (MRP14+, MRP8/14+), der proinflammatorische Zytokine wie TNF-a und Sauerstoffradikale bildet, und in einen chronisch inflammatorischen Typ (MRP8+) eingeteilt. Die Formation des MRP8/14-Heterodimers korreliert mit der zellulären Aktivierung wie z. B. mit der Aktivierung der NADPH-Oxidase. Es wurde beschrieben, dass diese Makrophagen auf Grund ihrer Eigenschaften eventuell die Tumorzellproliferation inhibieren und zytotoxische Wirkungen auf Tumorzellen ausüben können. Für die verschiedenen Tumorgewebe wurden höhere Makrophagendichten im Vergleich zum Normalgewebe und eine vergleichsweise geringe Dichte an MRP+ Makrophagen sowie signifikante Korrelationen zwischen den verschiedenen Makrophagen-Subpopulationen festgestellt. Die Dichte der Lymphozyten korrelierte negativ mit steigendem Tumorzellanteil und mit fortgeschrittenem Tumorstadium. Die Abnahme der Lymphozyten (Gastrointestinal- und Respirationstrakt) im Tumorgewebe im Vergleich zum tumorfreien Gewebe sowie die geringe Anzahl der potenziell tumoriziden MRP8/14+ Makrophagen lässt vermuten, dass die Immunantwort gegen den Tumor unterdrückt wird. Die positive Assoziation zwischen Makrophagen und Lymphozyten weist jedoch darauf hin, dass Makrophagen nicht am Rückgang der Lymphozyten beteiligt sind . Eine Korrelation der Makrophagen mit klinisch relevanten Parametern (pT-Stadium, UICC-Stadium, Lymphknotenmetastasen) zeigten ein voneinander abweichendes Infiltrationsmuster der CD68+ und MRP+ Makrophagen, was auf unterschiedliche Funktionen hinweist. Ferner liegen zahlreichen funktionelle Untersuchungsergebnisse anderer Arbeitsgruppen vor, welche darauf hinweisen, dass Makrophagen durch Hypoxie angezogen werden und im hypoxischen Tumorgewebe schließlich an der Neubildung von Blut- und Lymphgefäßen beteiligt sind. Um einen möglichen Zusammenhang zu zeigen, wurde mit den Antikörpern anti-CD31 und anti-CD34 die Gefäßdichte in Tumoren untersucht. Es zeigten sich zahlreiche positive Korrelationen zwischen Gefäßen und Makrophagen, jedoch konnte in den tumorfreien Geweben kein Zusammenhang zwischen beiden Größen gefunden werden. Das Vorkommen größerer Makrophagendichten in Tumoren mit wenig Nekrose als in Tumoren ohne Nekrose, die positive Korrelation zwischen der Anzahl der Gefäße und der Zahl der Makrophagen in Tumoren und die Unabhängigkeit von Makrophagen und Gefäßen im tumorfreien Gewebe legt die Vermutung nahe, dass TAM die Angiogenese begünstigen. Trotz vieler ähnlicher Charakteristika zwischen den Tumoren unterschiedlichen Ursprungsgewebes wurden auch Unterschiede festgestellt, die besonders die Anzahl der Makrophagen-Subpopulationen betreffen. Weitere Studien zur Aufklärung der Funktion unterschiedlicher Makrophagen-Subpopulationen (z. B. Immunsuppression, Neoangiogenese) sind notwendig, um deren Relevanz für das Tumorwachstum und die Tumorprogression aufzuklären.

Die vorliegende Arbeit beinhaltet umfangreiche histologische Untersuchungen an verschiedenen Tumoren bezüglich ihrer Infiltration durch Makrophagen-Subpopulationen, Granulozyten und Lymphozyten. Hierfür wurden 18 Gewebe-Mikroarrays mit jeweils 200 - 300 Tumorstanzen aus insgesamt 27 Organen des Gastrointestinaltraktes, des Urogenitaltraktes, des Respirationssystems und des endokrinen Systems angefertigt. Da alle Proben mit derselben Technik (Gewebe-Mikroarrays, Immunhiostochemie) ausgewertet wurden, bestand nun erstmalig die Möglichkeit eines direkten Vergleiches zwischen den verschiedenen Tumoren unterschiedlicher Organe. Für die immunhistochemischen Untersuchungen wurden fünf verschiedene Antikörper (anti-KP1, anti-PG-M1, anti-MRP8, anti-MRP14, anti-MRP8/14) eingesetzt. Die Antikörper gegen die Epitope PG-M1 und KP1 gelten als Pan-Makrophagen-Marker. Die Antikörper anti-MRP8, anti-MRP14 und anti-MRP8/14 gelten als Marker für entzündlich aktivierte Makrophagen. Diese Makrophagen wurden in einen aktiven inflammatorischen Typ (MRP14+, MRP8/14+), der proinflammatorische Zytokine wie TNF-a und Sauerstoffradikale bildet, und in einen chronisch inflammatorischen Typ (MRP8+) eingeteilt. Die Formation des MRP8/14-Heterodimers korreliert mit der zellulären Aktivierung wie z. B. mit der Aktivierung der NADPH-Oxidase. Es wurde beschrieben, dass diese Makrophagen auf Grund ihrer Eigenschaften eventuell die Tumorzellproliferation inhibieren und zytotoxische Wirkungen auf Tumorzellen ausüben können. Für die verschiedenen Tumorgewebe wurden höhere Makrophagendichten im Vergleich zum Normalgewebe und eine vergleichsweise geringe Dichte an MRP+ Makrophagen sowie signifikante Korrelationen zwischen den verschiedenen Makrophagen-Subpopulationen festgestellt. Die Dichte der Lymphozyten korrelierte negativ mit steigendem Tumorzellanteil und mit fortgeschrittenem Tumorstadium. Die Abnahme der Lymphozyten (Gastrointestinal- und Respirationstrakt) im Tumorgewebe im Vergleich zum tumorfreien Gewebe sowie die geringe Anzahl der potenziell tumoriziden MRP8/14+ Makrophagen lässt vermuten, dass die Immunantwort gegen den Tumor unterdrückt wird. Die positive Assoziation zwischen Makrophagen und Lymphozyten weist jedoch darauf hin, dass Makrophagen nicht am Rückgang der Lymphozyten beteiligt sind . Eine Korrelation der Makrophagen mit klinisch relevanten Parametern (pT-Stadium, UICC-Stadium, Lymphknotenmetastasen) zeigten ein voneinander abweichendes Infiltrationsmuster der CD68+ und MRP+ Makrophagen, was auf unterschiedliche Funktionen hinweist. Ferner liegen zahlreichen funktionelle Untersuchungsergebnisse anderer Arbeitsgruppen vor, welche darauf hinweisen, dass Makrophagen durch Hypoxie angezogen werden und im hypoxischen Tumorgewebe schließlich an der Neubildung von Blut- und Lymphgefäßen beteiligt sind. Um einen möglichen Zusammenhang zu zeigen, wurde mit den Antikörpern anti-CD31 und anti-CD34 die Gefäßdichte in Tumoren untersucht. Es zeigten sich zahlreiche positive Korrelationen zwischen Gefäßen und Makrophagen, jedoch konnte in den tumorfreien Geweben kein Zusammenhang zwischen beiden Größen gefunden werden. Das Vorkommen größerer Makrophagendichten in Tumoren mit wenig Nekrose als in Tumoren ohne Nekrose, die positive Korrelation zwischen der Anzahl der Gefäße und der Zahl der Makrophagen in Tumoren und die Unabhängigkeit von Makrophagen und Gefäßen im tumorfreien Gewebe legt die Vermutung nahe, dass TAM die Angiogenese begünstigen. Trotz vieler ähnlicher Charakteristika zwischen den Tumoren unterschiedlichen Ursprungsgewebes wurden auch Unterschiede festgestellt, die besonders die Anzahl der Makrophagen-Subpopulationen betreffen. Weitere Studien zur Aufklärung der Funktion unterschiedlicher Makrophagen-Subpopulationen (z. B. Immunsuppression, Neoangiogenese) sind notwendig, um deren Relevanz für das Tumorwachstum und die Tumorprogression aufzuklären.