Background
TP53, the gene encoding the tumor suppressive transcription factor p53, is the most frequently mutated gene in a wide variety of cancers, with mutations present in approximately 50% of all cancer patients [
1]. Unlike other tumor suppressors,
TP53 is predominantly inactivated by missense mutations, resulting in the production of mutant proteins [
1‐
3]. These mutant p53 proteins (mutp53) not only lose their tumor-suppressive functions but also display dominant-negative and neomorphic properties (often referred to as gain-of-function, GOF), switching p53 from a tumor suppressor to a protein with oncogenic activity [
3‐
6]. The oncogenic consequences of
TP53 missense mutations are widely believed to play a key role in multiple steps of tumor initiation, progression, metastasis and treatment response [
4,
5]. Among these, the pro-metastatic activity of mutant p53 proteins is arguably the most prominent function, as demonstrated, for example, by the increased metastasis of tumors arising in mutant p53 knock-in compared to p53 knock-out mice [
7‐
10]. Understanding the mechanisms underlying the pro-metastatic functions of
TP53 missense mutations could pave the way for the development of novel diagnostic tools and targeted therapies for patients with aggressive metastatic cancer.
Several mutp53 targeting approaches are currently being evaluated in preclinical models and early clinical trials, including direct targeting of mutp53 itself [
11‐
13]. The activity of wild-type p53 is tightly controlled by E3 ubiquitin ligases, such as Mdm2 and Chip/Stub1, which tag p53 for proteasomal degradation [
14]. In contrast, p53 missense mutants are shielded from degradation by heat shock proteins, which are repressed by wild-type p53 and upregulated by
TP53 loss of heterozygosity and oncogenic signals [
15,
16]. As a result, missense mutants accumulate in cancer cells, a process considered diagnostic and essential for GOF activities [
17]. In preclinical models, targeting the mechanisms that contribute to the stabilization of mutp53 in cancer cells has demonstrated the ability to induce regression of tumors carrying p53 missense mutations [
18,
19].
Focusing on downstream effector pathways responsible for specific oncogenic functions, such as metastasis, is another strategy to target mutp53 [
11,
12]. Metastasis is a complex process involving the detachment of cells from their primary site, as well as adhesion to and migration along fibers present in the extracellular matrix (ECM). Migrating tumor cells invade through tissue borders to gain access to distant tissues through the vasculature. Mutant p53 directly controls the expression of genes encoding cell surface receptors and secreted factors, and indirectly modulates cellular protein biogenesis and secretion pathways [
20‐
25]. The combined activities of mutp53 shape the interaction and communication between tumor cells and their microenvironment, ultimately contributing to metastatic tumor progression [
9,
20,
21].
One mechanism that connects mutp53 to metastasis operates through ENTPD5 (ectonucleoside triphosphate diphosphohydrolase 5), a UDPase located in the endoplasmic reticulum (ER) [
25‐
28]. Research in mice has shown that depleting ENTPD5 or mutp53 reduces breast cancer metastasis to the lung, while enforced ENTPD5 expression rescues lung colonization by cancer cells that have been depleted of mutp53 [
25]. This suggests that the mutp53-ENTPD5 axis is necessary and sufficient for mutp53-driven metastasis. ENTPD5 is induced by several p53 mutants in different cancer types through mutp53 recruitment to the ENTPD5 core promoter via the transcription factor Sp1 [
25]. ENTPD5 is believed to function in the ER through the calnexin/calreticulin (CANX/CALR) chaperone system [
28]. Unfolded N-glycosylated proteins are tagged at the core glycan with a single glucose moiety by UDP-glucose:glycoprotein glucosyltransferase (UGGT), and then seized by CANX/CALR to promote proper folding and prevent the release of improperly folded proteins from the ER [
29‐
32]. ENTPD5 terminates the chaperone cycle by cleaving UDP to UMP, which in turn exits the ER via an antiporter in exchange for new UDP-glucose molecules [
28]. The upregulation of the folding capacity by mutp53 is expected to boost the biogenesis of those N-glycoproteins, which are especially reliant on the CANX/CALR cycle for proper folding and functioning [
33]. Heavily N-glycosylated proteins are, for example, receptor tyrosine kinases and integrins with established pro-metastatic activity [
25‐
27,
34]. However, the specific N-glycoproteins controlled by the mutp53-ENTPD5 axis and promoting metastasis remain to be identified.
Here, we provide evidence that the mutp53-ENTPD5 axis operates through the CANX/CALR cycle to maintain high expression levels of integrin-α5 (ITGA5), which pairs with integrin-β1 (ITGB1) to form the primary fibronectin receptor. We demonstrate that ITGA5 is required for the pro-invasive and pro-metastatic potential of pancreatic tumor cells with a p53 missense mutation. Our findings strongly emphasize the crucial role of this novel pathway in driving metastatic tumor progression and demonstrate that targeting mutp53 stability, the CANX/CALR cycle, or ITGA5 can effectively interfere with mutp53-mediated pro-metastatic functions. This highlights the importance of the mutp53-ENTPD5 control of ITGA5 as a potential therapeutic target for p53-mutant cancers.
Materials and methods
Cell Culture
Pancreatic cancer (PANC-1, MIA PaCa-2), breast cancer (MDA-MB-231), lung cancer (PC-9, H1975, H1299), and HEK293T cell lines were obtained from the American Type Culture Collection (ATCC) through their European distributor LGC Standards GmbH and cultured in Dulbecco's Modified Eagle's Medium (DMEM) supplemented with 10% fetal bovine serum (FBS), 1% (v/v) Penicillin (10.000 U mL
−1)/Streptomycin (10 mg mL
−1), and 0.4% Amphotericin B (250 μg mL
−1). MIA PaCa-2 cells with tet-inducible expression of ENTPD5, p53
R248W, or p53
R175H have been described [
25] and were generated by lentiviral transduction using the pInducer20 system [
35]. Ovarian carcinoma cell lines (OC-121, OC-58; [
36]) were cultured in a 1:1 mix of DMEM/Ham’s F12 + 2 mM stabilized Glutamine (Millipore/Biochrome) and M199 medium with the addition of 5% FCS (Fetal Calf Serum), 20 μg mL
−1 Insulin solution from bovine pancreas, 10 ng mL
−1 hrEGF (human recombinant epidermal growth factor), 500 ng mL
−1 Hydrocortisone, 25 ng mL
−1 Cholera toxin, 10 mM HEPES (4-(2-hydroxyethyl)-1-piperazineethanesulfonic acid), 10 μg mL
−1 Transferrin, 0.2 pg mL
−1 Triiodothyronine, 5 μg mL
−1 O-phosphoryl ethanolamine, 8 ng mL
−1 selenious acid, 25 ng mL
−1 all-trans retinoic acid, and 5 μg mL
−1 linoleic acid. Cells were maintained at 37 °C with 5% CO
2 in a humid atmosphere (95%).
The following reagents were used for cell cultures and treatments at the indicated dose ranges: Suberoylanilide hydroxamic acid (SAHA, SML0061, Sigma-Aldrich; 10–15 µM), Doxycycline (D9891, Sigma-Aldrich; 1 µg mL−1), Acarbose (A8980, Sigma-Aldrich; 1–6 µM), Nutlin-3a (SML0580, Sigma-Aldrich; 10 µM), 17-Allylamino-17-demethoxygeldanamycin (17-AAG, Tanespimycin, S1141, Selleckchem; 10–15 µM), Ganetespib (S1159, Selleckchem; 0.5–1 µM), UV-4 (HY-U00160, MedChemExpress; 5–20 µM), anti-Integrin α5 Antibody (clone P1D6, MAB1956Z, Merck; 15 µg cm−2), Fibronectin from bovine plasma (F1141, Sigma-Aldrich; 5–10 µg mL−1), Collagen I from rat tail (A1048301, Thermo Fisher Scientific; 12 µg cm−2).
For retroviral transduction of cells, Platinum-E cells (Cell Biolabs) were transfected with pMSCV-Firefly-T2A-Gaussia plasmids using a standard calcium phosphate protocol [
37,
38]. After three days, retrovirus-containing supernatants were collected, filtered through a 0.45 μm filter, and supplemented with 8 μg mL
−1 polybrene for infection. MIA PaCa-2 cells were infected in 6-well plates (Sarstedt) using spinoculation for one hour at 600 g and 37 °C.
RNAi experiments
Cell cultures were transfected with siRNAs using Lipofectamine RNAiMax (#13,778,075, Thermo Fisher Scientific) at a final concentration of 20 nM, unless otherwise stated, following the manufacturer’s protocol. Cells were harvested 72 h after transfection. The siRNAs used were obtained from Dharmacon with ON-TARGET plus modification, unless otherwise stated: nsi153 (non-targeting siRNA pool of the following four siRNAs): nsi1 (UGG UUU ACA UGU CGA CUA A), nsi2 (UGG UUU ACA UGU UGU GUG A), nsi3 (UGG UUU ACA UGU UUU CUG A), nsi4 (UGG UUU ACA UGU UUU CCU A); p53-si1 (GAC UCC AGU GGU AAU CUA C), p53-si3 (GCA GUC AGA UCC UAG CGU C), p53-si4 (GGA CAU ACC AGC UUA GAU UUU, siGenome); ENTPD5-si6 (AGA CUU GGU UUG AGG GUA U), ENTPD5-si7 (CAG GAC AGC UUC CAA UUC U), ENTPD5-si8 (CAU AUU AGC UUG GGU UAC U), ENTPD5-si9 (CGA GAU GGU UGG AAG CAG A); CANX-si8 (UGA CAU GAC UCC UCC UGU A); CANX-si9 (GAA AGA CGA UAC CGA UGA U); CALR-si7 (GCA CGG AGA CUC AGA AUA C); CALR-si8 (GAA GCU GUU UCC UAA UAG U); UGGT-si5 (GAG CUG ACA UUG CGG AGU U); UGGT-si8 (GGG ACG CUC UGA AGA UAU U); ITGA5-si10 (ACA CGU UGC UGA CUC CAU U); ITGA5-si11 (CAA ACG CUC CCU CCC AUA U); ITGB1-si5 (GUG CAG AGC CUU CAA UAA A); ITGB1-si8 (GGG CAA ACG UGU GAG AUG U).
RTqPCR
RNA isolation from cell cultures was performed using the RNeasy Mini kit (Qiagen) following the manufacturer's instructions. cDNA synthesis was done using the SuperScript VILO cDNA Synthesis kit (Thermo Fisher Scientific) following the manufacturer's instructions. Real-time quantitative PCR (RT-qPCR) was performed using ABsolute QPCR Mix with SYBR Green (Thermo Fisher Scientific) and a LightCycler 480 (Roche). The oligos used for RT-qPCR were designed using Primer3 software, and their specificity was verified using BLAST searches against the NCBI database. The oligo sequences used were as follows: ITGA5_for 5’-TGC AGT GTG AGG CTG TGT ACA-3’; ITGA5_rev 5’-GTG GCC ACC TGA CGC TCT-3’; GAPDH_for 5’-CTA TAA ATT GAG CCC GCA GCC-3’; GAPDH-rev 5’-ACC AAA TCC GTT GAC TCC GA-3’.
Western blot
Cells were harvested and lysed in NP-40 lysis buffer (50 mM Tris–HCl pH 7.4, 150 mM NaCl, 5 mM EDTA pH 8.0, 2% NP-40) containing protease inhibitors (cOmplete ULTRA tablets mini, Roche) and subjected to Western blotting as previously described [
25]. Briefly, protein samples were separated by SDS-PAGE and transferred to nitrocellulose membranes. The membranes were then incubated with primary antibodies, including mouse anti-Integrin-α5 (C-9, SC-376199, Santa Cruz Biotechnology; 1:200), mouse anti-Integrin-β1 (JB1B, sc-59829, Santa Cruz Biotechnology; 1:200), mouse anti-p53 (DO-1, SC-126, Santa Cruz Biotechnology; 1:10,000), rabbit anti-ENTPD5 (EPR3783, ab92542, Abcam; 1:2,500), rabbit anti-CANX (ab22595, Abcam; 1:1000), rabbit anti-CALR (ab92516, Abcam; 1:1000), mouse anti-UGGT1 (H-9, sc-374565, Santa Cruz Biotechnology; 1:200), and mouse anti-β-actin (AC-15, ab6276, Abcam; 1:5,000). The secondary antibodies used were mouse IgG HRP-linked (NA9310; 1:10,000) and rabbit IgG HRP-linked (NA9340; 1:10,000) from Amersham.
Immunohistochemistry and confocal immunofluorescence
Tissues were fixed in buffered formalin and embedded in paraffin. The embedded tissues were cut into sections and fixed on glass slides overnight at 37 °C. Staining was performed as previously described [
39]. Briefly, the slides were deparaffinized, rehydrated, and subjected to antigen retrieval with EDTA (pH 8.0) for ENTPD5, Universal HIER (Abcam; ab208572) for Integrin-α5, and Citrate (pH 6.0) for p53. Primary antibody incubation was performed using mouse anti-Integrin-α5 (C-9; SC-376199; Santa Cruz Biotechnology; 1:200), mouse anti-p53 (DO-1; sc-126; Santa Cruz Biotechnology; 1:1,000), and rabbit anti-ENTPD5 (EPR3784; ab108603; Abcam; 1:400). Images were acquired using the Leica Aperio Versa slide-scanner and Leica Aperio eSlide Manager software v. 1.0.3.37.
For confocal immunofluorescence microscopy, MIA PaCa-2 cells were seeded at a density of 2,500 cells per well in a 96-well plate (µ-Plate 96 Well Black ibiTreat, #89,626, ibidi GmbH). After 3 days, the cells were fixed with ice-cold methanol for 10 min and permeabilized with 0.1% NP-40/PBS (two times for 5 min) at RT. Following a 45 min blocking step at 37 °C with 5% FCS/0.1% NP-40/PBS, the cells were incubated with a mixture of anti-PDIA3 (AMAB 90988, Merck, 1:500) and anti-ENTPD5 (EPR3784, ab108603, Abcam, 1:500) antibodies at 37 °C for 45 min. Subsequently, a secondary antibody mixture (donkey anti-rabbit ready probes Alexa Fluor 488; R37118, Invitrogen, 1:400; goat anti-mouse Alexa Fluor Plus 555, A32727, 15,698,545, Invitrogen, 1:400) along with DAPI (100 nM) were added to the cells for an additional 45 min incubation at 37 °C. The fluorescence signal was measured using a Leica SP8 confocal microscope equipped with a 63 × objective (1024 × 1024 pixels) and analyzed using the LAS X software (Leica Microsystems). Colocalization of ENTPD5 and PDIA3 was analyzed with the Coloc 2 plug-in (release 3.0.6) for ImageJ (version 2.9.0, distribution by Fiji) using the pixel intensity Pearson correlation over space method.
Proliferation assay
Tumor cell proliferation was monitored in real-time using an IncuCyte S3 Live-Cell Analysis System (Sartorius). Cells were seeded in 96-well plates overnight and, depending on the experiment, transfected with siRNAs or treated with compounds. At least two phase-contrast images per well were captured every two hours at 10 × magnification, with three replicate wells per treatment condition. Confluence analysis was performed with IncuCyte S3 2018A software in Phase Object Confluence mode, using a segmentation score of 0.7 and excluding objects smaller than 500 μm2. Confluence curves were normalized to the confluence of non-transfected or non-treated reference cells at the end of the time course. Proliferation was measured as the area under the confluence curve (AUC) using GraphPad Prism (version 9.4.1).
Adhesion assays
Cells were transfected in a 6-well plate format and harvested with Accutase (Sigma-Aldrich) in DMEM after 72 h. Each 6-well plate was split into multiple 96-well plates of a low-binding dish (Sarstedt) that were pre-coated overnight at 37 °C with 5 μg/cm2 Fibronectin. The cells were allowed to adhere for a designated period of time, and non-attached cells were removed by washing twice with 1 × PBS. The attached cells were then measured using the Cell Titer Glo Assay (Promega) according to the manufacturer’s protocol, in an Orion II Microplate Luminometer (Berthold Detection Systems GmbH). To ensure that the measured effect was due to gene knockdown and not a lower cell number, non-coated 96-well plates containing the suspension of the total number of cells seeded for each condition were used as seeding controls for normalization.
Cell spreading assays
MIA PaCa-2 cells were stably transduced with pWXL-sAC-GFP lentivirus, expressing a nucleocytoplasmic shuttling Actin-Chromobody-TagGFP [
40], and enriched for homogenous GFP expression by FACS. MIA PaCa-2-sAC-GFP cells were transfected with siRNAs and incubated for 72 h. Spreading was analyzed on 8-well μ-slides (ibiTreat) pre-coated overnight at 37 °C with 10 μg mL
−1 fibronectin (FN) in PBS. Coating fluids were discarded and 30,000 cells in 200 μL medium were seeded per 8-well chamber. Spreading was monitored in real-time using spinning disc microscopy (Spinning Disc Axio Observer Z1, Zeiss). Spreading of the cells was assessed and discriminated from non-spreading cells by z-stack position and cell shape.
Migration and invasion assays
To prepare for migration and invasion assays, MIA PaCa-2 cells (9 × 105) were transfected with 10 nM siRNA in a 6-well plate format. In experiments, where doxycycline was used to induce ENTPD5 expression, it was added to the media 24 h after transfection. 72 h after transfection, the cells were dissociated with Accutase (Sigma-Aldrich), counted using a Beckman Coulter, and harvested.
For migration assays, 9 × 105 cells were seeded onto the top chamber of 24-well transwell inserts (Sarstedt) that had been pre-coated overnight with 100 µL of 5 μg cm−2 FN. For invasion assays, transwells were coated overnight with a gel-matrix composed of 12 μg cm−2 Collagen I and 10 μg cm−2 FN, in a final volume of 100 µL. Transwells without coating served as controls for migration assays, and transwells coated only with Collagen I served as controls for invasion assays. In parallel, 96-well plates were seeded with the same number of cells and used to control and normalize for differences in the number of seeded cells. After seeding the cells on the transwells, they were allowed to adhere for 1–2 h before the lower chamber was filled with 500 µL DMEM containing 10% FBS, and the upper chamber with 300 µL DMEM with 0.5% FBS. In the case of drug treatments, media (in both top and lower chambers) were supplemented with the specific compounds. Migration assays were stopped 48 h after seeding, invasion assays 72 h after seeding.
The cells that remained in the top chamber were removed by thorough washing with 1 × PBS and wiping with cotton swabs. The cells that passed through the transwell membrane and resided on the bottom surface of the transwell or in the lower chamber were quantified using one of two methods: (1) Cells were dissociated using Accutase, harvested, and measured on a plate reader luminometer (ORION II, Titertek-Berthold) using the Cell Titer Glo Assay (Promega), following the manufacturer’s protocol. (2) Alternatively, cells were fixed with 70% ethanol, stained with 0.2% crystal violet in 10% ethanol, and photographed. The stained cells were then destained in 20% acetic acid for 10 min, and the absorbance of the collected solution was measured at 590 nm on a plate reader (BioTek Synergy HT). In all assays, the measured number of cells that had passed through the transwell membrane was normalized to the reference cells and the seeding controls.
Animal experiments were conducted in compliance with the German animal welfare law and the European legislation for the protection of animals used for scientific purposes (2010/63/EU), and were approved by the regional board (RP Giessen). MIA PaCa-2 cells, with and without tet-inducible ENTPD5 expression, were ex vivo labeled with
Gaussia princeps (GLuc) and firefly luciferases (FLuc) by retroviral transduction. 1 × 10
6 tumor cells were mixed with 20 μL growth factor-reduced Matrigel (Corning) and orthotopically injected into the pancreata of male and female
Rag2tm1.1Flv;
Il2rgtm1.1Flv immunocompromised mice aged 3–6 months. Mice were kept under specified pathogen-free (SPF) conditions in individually ventilated cages with a 12–12 h light–dark cycle and a standard Altromin housing diet. The orthotopic pancreatic model was described in detail in previous studies [
41‐
43]. Briefly, mice were anesthetized using 50 µg/kg Fentanyl (Hameln-Pharma), 500 µg/kg Medetomidine (Alfavet), and 5,000 µg/kg Midazolam (Hameln-Pharma). The abdominal area was shaved and disinfected with Povidone-iodine (B. Braun), after which the left side of the abdominal cavity was opened, and the spleen and pancreas were extracted and injected with a 20 µL cell suspension. After approximately 1 min, the spleen and pancreas were returned to the abdominal cavity, and muscle and skin were closed with 6.0 threads. Mice were administered 1,200 µg/kg Naloxone (Inresa Arzneimittel), 1200–1500 µg/kg Atipamezole (Zoetis), and 500 µg/kg Flumazenil (Inresa Arzneimittel) to reverse anesthesia, and received Meloxicam (CP Pharma or Böhringer Ingelheim) for a minimum of 3 days. To induce ENTPD5 expression in tumors with tet-inducible ENTPD5, the mice were provided with drinking water containing 1 mg mL
−1 doxycycline and 2% (w/v) sucrose, in darkened bottles, starting 3–4 days before surgery. The drinking water was renewed twice a week with freshly prepared doxycycline. Ganetespib (75 mg kg
−1 body weight; STA-9090, Adoq Bioscience LLC) or vehicle was administered once per week starting 2–3 days before surgery by intravenous tail vein injection. Blood samples were taken once a week starting 1–2 days before surgery to monitor tumor growth based on GLuc blood levels, as previously described [
44,
45]. Four weeks post-surgery, the mice were euthanized and their pancreata and livers (primary metastatic organs) were collected. The pancreata were processed for immunohistochemical analyses, and the livers were lysed using a TissueLyser LT (Qiagen) and the Luciferase cell culture lysis 5 × reagent (Promega), according to the manufacturer’s protocol. Firefly luciferase activity was quantified in the liver lysates using the Beetle-Juice Luciferase assay Firefly (PJK) on a plate reader luminometer (ORION II, Titertek-Berthold), following the manufacturer’s protocol.
Survival analysis
The correlation between ITGA5 and ITGB1 expression based on TCGA and GTEx RNAseq data and survival of cancer patients was analyzed using the Gene expression Profiling Interactive Analysis 2 (GEPI A2) online platform (
http://gepia2.cancer-pku.cn) [
46]. Using the Survival Analysis interface, we analyzed the pancreatic adenocarcinoma (PAAD), breast cancer (BRCA), lung adenocarcinoma (LUAD), and ovarian cancer (OV) cohorts for disease-free survival using the quartile cutoff with default parameters.
Statistical analyses
The plots and statistical analyses in this study were created using GraphPad Prism (version 9.4.1). ITGA5 protein levels were quantified from Western blots using ImageJ software (version 1.51). Graphics were assembled in Adobe Illustrator (version 26.5.2) and BioRender.com. The results presented in the graphs represent the mean or median values obtained from n replicates. The error bars in the figures indicate the standard deviation (SD) unless stated otherwise. To compare multiple groups, a one-way ANOVA was used in combination with a multiple comparisons test. For three or more groups that have been divided into two independent variables (such as treatment and genotype), a two-way ANOVA was used in combination with a multiple comparisons test. The ANOVA results and selected pairwise comparisons are reported in the figures. A p-value less than 0.05 was considered statistically significant.
Discussion
Over half of all cancer patients harbor p53 missense mutations, many of which switch the protein from a tumor suppressor to a tumor-promoting oncogene empowered with GOF activities. These activities are associated with increased metastasis, chemoresistance, and decreased survival in both mice and patients [
4‐
6,
55]. While this highlights mutant p53 as an attractive therapeutic target and has spurred research into targeting strategies, establishing the feasibility of mutp53-targeting in clinical settings is still a challenge [
11‐
13,
56]. Therefore, targeting potentially better drug-responsive effectors of mutp53 remains a promising alternative approach for cancer therapy.
Our previous research has described ENTPD5 as a key effector of the pro-invasive and pro-metastatic mutp53 GOF [
25]. ENTPD5 is an ER-resident UDPase that promotes the proper folding of N-glycoproteins through the CANX/CALR cycle [
28]. This glycoprotein folding cycle is an essential quality control mechanism, ensuring that only correctly folded and functional glycoproteins exit the ER, are further processed by the Golgi, and transported to the cell membrane [
29,
57]. Among the heavily glycosylated glycoproteins, receptor tyrosine kinases play crucial roles in various aspects of tumorigenesis [
34]. Another group of heavily N-glycosylated cell membrane proteins are integrins; a family of heterodimeric transmembrane receptors that promote bidirectional communication of cells with their microenvironment [
47,
58].
In this study, we have delineated a novel pro-metastatic pathway in cancer cells that is stimulated by mutp53. We found that ENTPD5, a downstream target of mutp53 [
25], plays a crucial role in enhancing the expression of the integrins ITGA5 and ITGB1 (Fig.
1 and Supplemental Fig.
1). Focusing on ITGA5, we demonstrated that its increased expression relies on the presence of UGGT as well as the chaperones CANX and CALR (Fig.
3a). Importantly, the elimination of ENTPD5 from the cells, either directly or indirectly, by depleting or destabilizing mutp53, resulted in a significant reduction in ITGA5 protein expression. However, the reintroduction of ENTPD5 expression, even in the absence of mutp53, restored ITGA5 expression. We observed the regulation of ITGA5 by the mutp53/ENTPD5 axis across various clinically relevant cancer types, including pancreatic, lung, and breast cancer and for multiple different p53 missense mutants (Supplemental Fig.
1). Interestingly, in ovarian cancer cells, similar levels of ITGA5 and ITGB1 were expressed, but this expression was not dependent on mutp53 or ENTPD5. In these ovarian cancer cells, FN-adhesion was dependent on ITGA5/B1, but independent of ENTPD5, suggesting potential tissue- or cell type-specific requirements for ENTPD5 in integrin folding. Considering the clinical impact of ITGA5 and ITGB1 expression on the survival of PDAC patients (Supplemental Fig.
2), we focused our subsequent experiments on this cancer type, for which better treatment options are urgently required due to its poor survival outlook [
59].
Integrins serve as primary cell adhesion receptors for components of the extracellular matrix (ECM). They dictate the specific ECM components a cell can adhere to, thereby influencing how a cell senses and reacts to external signals. Cancer cells may lose their original tissue attachment and inevitably undergo changes in cell-to-cell and cell-to-ECM adhesion. These alterations can lead to the entry of cancer cells into the bloodstream or lymphatic system, extravasation, and ultimately the formation of metastatic colonies in distant locations [
60,
61]. In such scenarios, cancer cells not only exploit the standard integrin-mediated adhesion functions for migration but also manipulate their surrounding microenvironment to their advantage. Consequently, alterations in various integrin-signaling pathways or changes in integrin expression patterns have been associated with numerous types of cancer [
60,
61].
ITGA5 pairs with ITGB1 to form the heterodimeric integrin α5β1, the primary receptor for FN, a critical component in the formation of the ECM meshwork [
62]. The high affinity and specificity of α5β1 for the RGD motif of FN is mediated by a specific residue (Asp154) in the extracellular ITGA5 domain [
63]. In addition, integrins undergo conformational changes from a bent to an extended conformation that increase their affinity [
64]. Increasing evidence also suggests a connection between lipid raft microdomains and integrin activation in the context of mechanotransduction [
65]. When integrin-α5β1 binds to FN, this triggers bidirectional signaling which contributes to cancer progression by driving survival, proliferation, migration, and invasion [
66,
67].
Given the central role of the CANX/CALR cycle in glycoprotein biosynthesis, it can be speculated that the stimulating effect of mutp53 on the ER chaperones extends beyond ITGA5 and ITGB1. Other integrins may also experience a similar boost in their expression. However, due to the inverse correlation of ITGA5 and ITGB1 with the survival of PDAC patients (Supplemental Fig.
2), we focused on investigating FN-mediated cell motility and its regulation through the mutp53-ENTPD5-ITGA5 axis. Using FN as the extracellular matrix, our adhesion, migration and invasion experiments demonstrated that cells depleted of ENTPD5 or mutp53 lose their ability to interact with FN (Fig.
2). These effects were comparable to cells directly deprived of ITGA5 (Fig.
2) or treated with ITGA5-blocking antibodies (Fig.
4). These effects were all dependent on the CANX/CALR chaperones (Fig.
3). Additionally, in ovarian cancer cells, where mutp53 or ENTPD5 depletion did not affect ITGA5 and ITGB1 expression levels (Supplemental Fig.
1), we observed no inhibition of FN binding by mutp53 or ENTPD5 depletion (Supplemental Fig.
3). This not only strengthens the view that the mutp53-ENTPD5 axis functionally regulates ITGA5 and ITGB1 but also provides new insights into how mutp53 profoundly modulates tumor-stroma interactions to create a pro-metastatic environment by regulating the ER quality control machinery.
Interestingly, p53 mutations have been found to impact glycoprotein biosynthesis at multiple levels, highlighting the pivotal role of glycoproteins as pro-metastatic effectors [
9]. Certain receptor tyrosine kinases, such as EGFR or PDGFRα, are directly induced at the transcriptional level by mutp53 through interactions with transcription factors like Sp1, NF-Y, or p73 [
22,
68]. Additionally, mutp53 interacts with its family member p63 to transcriptionally induce the Rab-coupling protein (RCP), which facilitates the endosomal recycling of EGFR, MET, and integrins [
23,
69,
70]. Moreover, mutp53-expressing tumor cells modulate exosome secretion, influencing integrin recycling in neighboring tumor cells and normal fibroblasts, thereby promoting the deposition of a highly pro-invasive extracellular matrix at both the primary tumor site and pre-metastatic niches in distant organs [
71]. By interacting with the hypoxia-responsive factor HIF1α, mutp53 induces tubulo-vesiculation of the Golgi apparatus, leading to enhanced vesicular trafficking, secretion of soluble factors, and deposition and remodeling of the ECM [
24]. Notably, modulation of secretory vesicle biogenesis in the Golgi has also been reported as a consequence of p53 inactivation, even in the absence of mutp53-dependent GOF properties [
72,
73]. As such, the transcriptional upregulation of cell surface proteins by mutp53 exhibits mechanistic diversity and poses challenges for targeted interventions. However, the chaperone-mediated folding of nascent glycoproteins in the ER represents a central and universal step in the production of most cell membrane and secreted proteins. This highlights the potential of targeting the mutp53-ENTPD5-mediated control of the CANX/CALR cycle as an attractive therapeutic strategy.
In this study, we have explored different approaches to target the mutp53-ENTPD5-ITGA5 axis. We employed strategies such as ITGA5-blocking antibodies, inhibition of the N-glycoprotein folding chaperone machinery in the CANX/CALR cycle, and mutp53 degradation. Our experiments utilizing specific blocking antibodies against ITGA5 confirmed its crucial role as a downstream effector of mutp53-driven motility (Fig.
4). However, clinical testing of integrin-targeting antibodies has yielded rather disappointing results [
74‐
76]. Several factors contribute to the therapeutic failure, including variable expression of integrins, functional redundancy among integrins, distinct roles of integrins at different disease stages, and the sequestration of therapeutics by integrin-containing tumor-derived extracellular vesicles [
76]. In fact, we also observed mutp53-induced expression of ITGA5 on extracellular vesicles in our model, which may impact the efficiency of blocking antibodies.
Therefore, we decided to investigate targeting the ER chaperone machinery as our next approach. As direct inhibitors of CANX or CALR were not available, we focused on inhibiting α-glucosidases I and II, which sequentially trim the core oligosaccharide on nascent N-glycoproteins to generate the monoglucosylated protein recognized by CANX and CALR [
29]. Glucosidase II also removes the remaining single glucose moiety, facilitating the release of proteins from the chaperones [
29]. By inhibiting ER-resident glucosidases, the entry into and exit from the CANX/CALR cycle are blocked. Consequently, the proteins are unable to attain their native conformation and do not pass ER quality control [
77]. These misfolded proteins are retained in the ER and ultimately undergo degradation [
78,
79]. It may be expected that glucosidase inhibitors have significant side effects in normal cells since their function is crucial for proper protein folding. However, not all glycoproteins are equally dependent on glycans for folding and secretion [
29]. In the absence of glycans, many glycoproteins experience only a partial loss of folding and secretion efficiency, while others become temperature-sensitive or remain unaffected [
29]. As a rule, glycoproteins with a larger number of glycans rely more heavily on the chaperone machinery, suggesting a potential therapeutic window that has also been observed when targeting glycoprotein processing for antiviral therapy. Many viruses require the host ER protein-folding machinery in order to correctly fold one or more of their glycoproteins [
80]. Iminosugars, such as UV-4, inhibit the ER-resident α-glucosidases I and II, interfere with proper folding of viral proteins, and display broad-spectrum activity against multiple viruses including SARS-CoV-2 [
51,
53,
80‐
84]. Early clinical trials have demonstrated the good tolerability of iminosugars in patients, with minor and reversible osmotic diarrhea being the main side effect due to the inhibition of α-glucosidases in the gut [
81]. It is worth noting that the widely used antidiabetic drug Acarbose acts through inhibition of intestinal α-glucosidases [
85]. In our study, both the iminosugar UV-4 and Acarbose showed in vitro efficacy in reducing ITGA5 expression and FN-mediated motility in PDAC cells without negatively affecting tumor cell viability and proliferation (Fig.
5 and Supplemental Fig.
6). However, Acarbose, despite being a clinically approved drug and effective α-glucosidase inhibitor in cell culture, acts locally in the gastrointestinal tract. It has low systemic bioavailability, making it unsuitable for systemic cancer therapy [
86]. On the other hand, iminosugars exhibit a promising therapeutic window as antiviral agents and show a high tolerability in animal infection models. Therefore, they should be further investigated for anti-metastatic activity in preclinical cancer models.
To directly target the mutp53-ENTPD5-integrin axis at the level of mutp53, we investigated compounds that target the heat shock chaperone machinery, specifically HSP90 and its indispensable regulator HDAC6. These chaperones play a crucial role in stabilizing mutp53, which is considered essential for the GOF activity of mutp53 in cancer cells [
15‐
19]. Building on previous research, we examined the HSP90 inhibitors, AAG and Ganet, as well as the potent HDAC inhibitor SAHA [
15‐
19]. Treating cancer cells harboring p53 missense mutations, but not null mutations, with any of these drugs resulted in the destabilization of mutp53 and the simultaneous loss of ENTPD5 and ITGA5 expression (Fig.
6). This finding indicates that the elevated levels of ITGA5 are dependent on the aberrant stabilization of mutp53. Notably, these drugs strongly impaired the cells’ ability to interact with FN for adhesion, migration or invasion. The drug effects were largely restored by enforced expression of ENTPD5, validating that the diminished tumor cell motility was a result of compromised ENTPD5 activity. Importantly, we confirmed these observations in a preclinical model, by treating mice with orthotopic PDAC xenografts with Ganet. The treatment not only reduced mutp53 levels but also concurrently diminished ENTPD5 and ITGA5 expression. Emphasizing the crucial role of ENTPD5, the ectopic expression of ENTPD5 rescued the effects of the drug (Fig.
7). Although we did not observe a negative effect of Ganet on cell proliferation in 2D cell culture (Supplemental Fig.
7c-d), treatment with the drug led to a reduction in both primary tumor growth and metastatic spread (Fig.
7b-d). It is worth noting that mutant p53 (or ENTPD5) depletion by RNAi has been shown to decrease 2D colony formation in MIA PaCa-2 cells [
25,
87], suggesting that mutp53 specifically promotes proliferation under clonogenic growth conditions. Interestingly, mutp53 was found to stimulate FN-independent migration of MIA PaCa-2 and other R248W-mutant PDAC cells, possibly through the formation of a complex between mutp53 and phosphorylated STAT3 [
88]. This FN-independent migration was blocked by HSP90 inhibition as well [
88]. In our study, we also observed some degree of stimulation of FN-independent motility by the mutp53-ENTPD5-CANX/CALR axis. However, the effects were much less pronounced compared to those mediated by ITGA5 or FN (Fig.
2b and d, and Supplemental Fig.
5b). However, considering the central role of ER chaperones in glycoprotein biosynthesis, we cannot exclude an additional role of the mutp53-ENTPD5 axis for expression of JAK receptors and JAK/STAT signaling, which potentially synergizes with the reported downstream effects of mutp53 on STAT3 activity [
19,
88].
Although we observed the mutp53-ENTPD5-dependent ITGA5 expression in different cancer cell lines, our primary focus was on PDAC due to the clear prognostic implications of ITGA5 and its partner ITGB1 in this particular cancer type. However, we previously identified the role of the mutp53-ENTPD5 axis in promoting lung metastasis of breast cancer and now observed the regulation of ITGA5 and ITGB1 by this axis in the same model (Supplemental Fig.
1a and i). Hence, it is tempting to speculate that this pathway may also promote breast cancer metastasis to the lung through its impact on ITGA5 expression.
As our study was conducted using cell cultures and preclinical mouse models, further research is needed to determine the translatability of these findings to clinical settings. Although HSP90 inhibitors and glucosidase-blocking iminosugars have shown promising results in terms of safety in preclinical and early-stage clinical studies [
80,
89‐
91], their efficacy in cancer therapy still needs to be established through further preclinical and clinical trials. The GANNET53 trial, a small phase I/II study for platinum-resistant ovarian cancer, combined paclitaxel with Ganetespib to target mutant p53 and showed no dose-limiting toxicities, leading to its selection for a randomized phase II trial. Novel HSP90 inhibitors are continuously being discovered and tested for their antitumor efficacy in preclinical and clinical trials, raising hope for the development of even more potent drugs to target mutp53 stabilization.