Radiotherapy is used to treat many types of cancer, but many treated patients relapse with local tumor recurrence. Tumor-infiltrating myeloid cells (TIMs), including CD11b (ITGAM)+F4/80 (EMR1)+ tumor-associated macrophages (TAMs) and CD11b+Gr-1 (LY6G)+ myeloid-derived suppressor cells (MDSCs), respond to cancer-related stresses and play critical roles in promoting tumor angiogenesis, tissue remodeling and immunosuppression. In this report, we employed a prostate cancer model to investigate the effects of irradiation on TAMs and MDSCs in tumor-bearing animals. Unexpectedly, when primary tumor sites were irradiated we observed a systemic increase of MDSCs in spleen, lung, lymph nodes and peripheral blood. Cytokine analysis showed that the macrophage colony-stimulating factor CSF1 increased by 2-fold in irradiated tumors. Enhanced macrophage migration induced by conditioned media from irradiated tumor cells was completely blocked by a selective inhibitor of CSF1R. These findings were confirmed in prostate cancer patients, where serum levels of CSF1 increased after radiotherapy. Mechanistic investigations revealed the recruitment of the DNA damage-induced kinase ABL1 into cell nuclei where it bound the CSF1 gene promoter and enhanced CSF1 gene transcription. When added to radiotherapy, a selective inhibitor of CSF1R suppressed tumor growth more effectively than radiation alone. Our results highlight the importance of CSF1/CSF1R signaling in the recruitment of TIMs which can limit the efficacy of radiotherapy. Further, they suggest that CSF1 inhibitors should be evaluated in clinical trials in combination with radiotherapy as a strategy to improve outcomes.

Growing evidence suggests that tumor-associated macrophages (TAMs) promote cancer progression and therapeutic resistance by enhancing angiogenesis, matrix-remodeling and immunosuppression. In this study prostate cancer (PCa) under androgen blockade therapy (ABT) was investigated, demonstrating that TAMs contribute to PCa disease recurrence through paracrine signaling processes. ABT induced the tumor cells to express macrophage colony-stimulating factor 1 (M-CSF-1 or CSF-1) and other cytokines that recruit and modulate macrophages, causing a significant increase in TAM infiltration. Inhibitors of CSF-1 signaling through its receptor, CSF-1R, were tested in combination with ABT, demonstrating that blockade of TAM influx in this setting disrupts tumor promotion and sustains a more durable therapeutic response compared to ABT alone.

Radiotherapy is one of the major frontline treatments for prostate cancer (PCa). However, a large proportion of patients suffer from tumor recurrence after radiotherapy. Tumor-infiltrating myeloid cells (TIMs), including CD11b+F4/80+ tumor-associated macrophages (TAM) and CD11b+Gr-1+ myeloid-derived suppressive cells (MDSCs), play critical roles in promoting tumoral angiogenesis, tissue remodeling and immunosuppression. Recently several reports suggested that TIMs might play a critical role in mediating tumor regrowth after radiation therapy. Here, we showed that there is enhanced recruitment of both TAMs and MDSCs after 5 days of 3 Gy radiation treatment in subcutaneously implanted RM-1 syngeneic PCa model. Infiltration of two MDSC subsets, CD11b+Gr-1loLy6Chi mononuclear-MDSC (MO-MDSC) and CD11b+Gr-1hiLy6Clo polymorphnuclear-MDSC (PMN-MDSC), are both increased. Although treatment is localized to the tumor site, the effects of radiation are systematic. Dramatic increases of MDSCs and TAMs were also observed in the spleen, lymph nodes and peripheral blood. To better understand the mechanism of enhanced recruitment of myeloid cells to tumors, we performed RT-PCR analysis on tumor tissues for commonly known factors that mediate the recruitment of myeloid cells. Indeed, we found that macrophage colony stimulating factor 1 (M-CSF-1 or CSF-1) increases by 2 fold in irradiated tumors compared to non-irradiated tumors. In vitro migration assays using conditioned medium from irradiated tumor cells increases migration of RAW246.7 macrophages by 4 fold, and this increase is completely blocked by the very selective CSF1R inhibitor, GW2580. Immunohistochemical analysis confirmed the induction of TAMs and MDSC recruitment to tumors, and the effectiveness of GW2580 in blocking their infiltration. Most importantly, combination therapy using GW2580 with radiation synergistically suppressed tumor growth and recurrence. This data highlights the importance of CSF1/CSF1R signaling in the recruitment of TIMs post-radiation treatment and their significant role in promoting tumor re-growth. Moreover, our data could potentially provide a more effective and durable treatment strategy for PCa patients. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2011 Nov 12-16; San Francisco, CA. Philadelphia (PA): AACR; Mol Cancer Ther 2011;10(11 Suppl):Abstract nr C227.

<p>PDF file - 1234K, Supplemental figure 4: ABL1 mediates CSF1 expression in other human prostate cancer cell lines.</p>

<p>PDF file - 13003K, Supplemental figure 1: Local irradiation enhances recruitment of TAMs and MDSCs to tumors in RM-9 model.</p>

<p>PDF file - 2858K, Supplemental figure 3: Irradiation increases CSF1 expression in other human and murine cancer cell lines.</p>

<p>PDF file - 1720K, Supplemental figure 2: Local irradiation enhances recruitment of TAMs to tumors in Myc-CaP model.</p>

<p>PDF file - 3509K, Supplemental figure 5: CSF1/CSF1R blockade by GW2580 inhibits tumor growth after irradiation.</p>