Research Article Accumulation of Extracellular Hyaluronan ...Research Article Accumulation of...

Research ArticleAccumulation of Extracellular Hyaluronan byHyaluronan Synthase 3 Promotes Tumor Growth and Modulatesthe Pancreatic Cancer Microenvironment

Anne Kultti1 Chunmei Zhao1 Netai C Singha1 Susan Zimmerman1

Ryan J Osgood1 Rebecca Symons1 Ping Jiang1 Xiaoming Li1 Curtis B Thompson1

Jeffrey R Infante2 Michael A Jacobetz3 David A Tuveson4 Gregory I Frost5

H Michael Shepard1 and Zhongdong Huang1

1 Halozyme Therapeutics Inc 11388 Sorrento Valley Road San Diego CA 92121 USA2 Sarah Cannon Research InstituteTennessee Oncology PLLC 250 25th Avenue North Nashville TN 37203 USA3 Labfinity 8110 Cordova Road Suite 119 Cordova TN 38016 USA4Cold Spring Harbor Laboratory 1 Bungtown Road Cold Spring Harbor NY 11724 USA5 Intrexon Corporation 6620 Mesa Ridge Road San Diego CA 92121 USA

Correspondence should be addressed to Anne Kultti akulttihalozymecom and Zhongdong Huang jhuanghalozymecom

Received 25 April 2014 Accepted 27 June 2014 Published 24 July 2014

Academic Editor Paraskevi Heldin

Copyright copy 2014 Anne Kultti et al This is an open access article distributed under the Creative Commons Attribution Licensewhich permits unrestricted use distribution and reproduction in any medium provided the original work is properly cited

Extensive accumulation of the glycosaminoglycan hyaluronan is found in pancreatic cancer The role of hyaluronan synthases2 and 3 (HAS2 3) was investigated in pancreatic cancer growth and the tumor microenvironment Overexpression of HAS3increased hyaluronan synthesis in BxPC-3 pancreatic cancer cells In vivo overexpression of HAS3 led to faster growing xenografttumors with abundant extracellular hyaluronan accumulation Treatment with pegylated human recombinant hyaluronidase(PEGPH20) removed extracellular hyaluronan and dramatically decreased the growth rate of BxPC-3 HAS3 tumors comparedto parental tumors PEGPH20 had a weaker effect on HAS2-overexpressing tumors which grew more slowly and contained bothextracellular and intracellular hyaluronan Accumulation of hyaluronan was associated with loss of plasma membrane E-cadherinand accumulation of cytoplasmic 120573-catenin suggesting disruption of adherens junctions PEGPH20 decreased the amount ofnuclear hypoxia-related proteins and induced translocation of E-cadherin and 120573-catenin to the plasma membrane Translocationof E-cadherin was also seen in tumors from a transgenic mouse model of pancreatic cancer and in a human non-small cell lungcancer sample from a patient treated with PEGPH20 In conclusion hyaluronan accumulation by HAS3 favors pancreatic cancergrowth at least in part by decreasing epithelial cell adhesion and PEGPH20 inhibits these changes and suppresses tumor growth

1 Introduction

Pancreatic ductal adenocarcinoma is the fourth-leading causeof cancer-related deaths in the United States with amedian 5-year survival rate of 6 [1] Pancreatic cancer is characterizedby a desmoplastic response involving stromal fibroblastsinflammatory cells and pathological deposition of alteredextracellular matrix [2 3] that contains high levels of fibrouscollagen proteoglycans and glycosaminoglycans includ-ing hyaluronan (HA hyaluronic acid) [3] Hyaluronan is

a negatively charged linear glycosaminoglycan composed ofrepeating disaccharide units of N-acetylglucosamine and D-glucuronic acid Excess hyaluronan is found in several tumortypes including pancreatic breast and prostate cancers [4ndash7]and its accumulation has been shown to be a factor associatedwith poor prognosis for cancer patients [5 7 8] Hyaluronanaccumulation leads to increased tumor interstitial fluid pres-sure and poor perfusion [6 9] explained by continuous tumorcell secretion of hyaluronan and its substantial absorptionof water molecules (sim15 per disaccharide) [10] Elevated

Hindawi Publishing CorporationBioMed Research InternationalVolume 2014 Article ID 817613 15 pageshttpdxdoiorg1011552014817613

2 BioMed Research International

tumor interstitial fluid pressure and poor perfusion can benormalized by hyaluronan depletion from the tumor [6 9] Inaddition hypoxia often found in advanced solid tumors andcharacterized by upregulation of hypoxia-inducible factor-1120572(HIF-1120572) [11] has been associated with increased hyaluronanaccumulation [11 12]

The hyaluronan molecule composed of 2000ndash25000disaccharides with molecular weight of 1ndash10 million Da issynthesized at the plasma membrane by three transmem-brane synthases (HAS1-3) and is simultaneously extruded toextracellular space Hyaluronan interacts with several bind-ing proteins and can be incorporated into the extracellularmatrix or bound to its cell surface receptors Hyaluronanbinding to its best-characterized receptor CD44 inducesactivation of the PI3K-Akt and MAP kinase pathways andpromotes tumor cell proliferation invasion and chemore-sistance [13 14] Accumulation of intracellular hyaluronanis also found in several cell types [15ndash17] where it hasbeen suggested to be a result of hyaluronan endocytosisand degradation [18] or activation of intracellular hyaluro-nan synthesis [17 19] Hyaluronan is degraded mainly bythe hyaluronidase-1 (HYAL1) and hyaluronidase-2 (HYAL2)enzymes [20] In addition to hyaluronidases exoglycosidasesand reactive oxygen species are known to participate in thedegradation of high molecular weight hyaluronan to smallerfragments [21] Recently KIAA1199 has been suggested tobe a hyaluronan binding protein and may be involved inhyaluronan degradation that is independent of CD44 andHYAL enzymes [22]

Hyaluronan synthases share 57ndash71 identity at the aminoacid level [23] but have different expression patterns differin their enzymatic properties and are differentially regulated[24] Overexpression of any of the HAS genes in COS-1and rat fibroblasts leads to the formation of a pericellu-lar hyaluronan coat where HAS1 produces smaller coatscompared to HAS2 or HAS3 [25 26] The HAS2 isoformhas been most studied and is the only isoform requiredfor embryonic development [27] HAS2 is believed to bethe main HAS in epithelial cells and has been reported tomediate epithelial-mesenchymal transition (EMT) [28 29]Overexpression of HAS3 leads to the formation of longplasma membrane protrusions [30] which have recentlybeen associated with the increased release of hyaluronan-coated and plasma membrane-derived microvesicles [31]Moreover overexpression of HAS3 has been reported toinduce misorientation of the mitotic spindle and disturbedorganization of epithelium [32] which is associated withmalignancies [33] Recently HASs have also been suggestedto form homodimers and heterodimers which may affecttheir function and regulate their activity [24 34]

In human pancreatic cancer 87 of tumors contain highlevels of hyaluronan [4ndash6] Similarly extensive hyaluronandeposition is also found in a transgenic mouse model (LSL-KrasG12D+ LSLTrp53R172H+ and Pdx-1-Cre (KPC)) of pancre-atic adenocarcinoma [4 6]The importance of hyaluronan inthe pancreatic cancermicroenvironment is further supportedby the finding that pancreatic cancer cells encapsulatedwithin hyaluronan gel produce faster growing tumors and are

more metastatic than cancer cells with no hyaluronan in amouse model [35] Suppression of hyaluronan synthesis bydownregulation ofHASs has beenpreviously shown to inhibitthe growth of implanted breast prostate squamous cellcarcinoma and osteosarcoma tumors [15 36ndash38] Similarlyhyaluronan synthesis inhibitor 4-methylumbelliferone or itsderivatives suppress metastasis of several tumor types [38ndash41]

In agreement with previous findings enzymatic removalof hyaluronan by pegylated human recombinant hyaluroni-dase (PEGPH20) leads to suppression of tumor growthand metastasis and enhanced delivery of chemotherapy inhyaluronan-rich tumormodels of prostate lung and pancre-atic cancer [5 9 42] In the KPC mouse model of pancre-atic adenocarcinoma that closely resembles human diseasePEGPH20 suppressed tumor growth increased drug deliveryand increased overall survival when used in combinationwith gemcitabine compared to gemcitabine monotherapy [46] Increased drug delivery of gemcitabine was associatedwith stromal remodeling reduction of tumor interstitialfluid pressure expansion of intratumoral blood vessels andultrastructural changes in tumor endothelium characterizedas formation of fenestrae in tumor endothelium [4 6]

Over the years HAS2 has been the focus of mostresearch in this area and has been widely associated withmalignant transformation and aggressive tumor growth [2829 43] However elevated HAS3 protein levels have alsobeen associated with ovarian cancer [44] and overexpressionof HAS3 promotes tumor growth in a preclinical model[45] Regulation and possible differential mechanisms ofHAS2- andHAS3-mediated tumor growth are not completelyunderstood To date there are no reports comparing theroles of HAS2 and HAS3 in pancreatic cancer In thisstudy we explored the biological consequences of HAS2and HAS3 overexpression in BxPC-3 pancreatic cancer cellsand in xenograft tumor models HAS3 overexpression led toincreased accumulation of extracellular hyaluronan that wasassociated with faster tumor growth and enhanced responseto PEGPH20 Deposition of extracellular hyaluronan wasassociated with loss of adhesion proteins from the plasmamembrane that was inhibited by hyaluronan depletionTheseresults are further supported by the finding that more plasmamembrane E-cadherin was observed in KPC tumors as wellas in a human non-small cell lung cancer (NSCLC) patientbiopsy after PEGPH20 therapy

2 Material and Methods

21 Cell Lines BxPC-3 cells were obtained from AmericanType Culture Collection (Manassas VA) BxPC-3 cells andlentiviral-transduced BxPC-3 cell lines overexpressing emptyvector HAS2 or HAS3 were cultured in RPMI medium withL-glutamine (Cat 10-040-CV CellgroMediatechManassasVA) containing 10 fetal bovine serum (Foundation B Gem-ini Bio-Products Sacramento CA) at 37∘C in a humidifiedincubator supplied with 5 CO

25 air For experimental

use cells were thawed andmaintained in culture for no longerthan 10 passages Each cell line was routinely tested negative

BioMed Research International 3

for mycoplasma contamination by MycoAlert MycoplasmaDetection Kit (Lonza Biologics Hopkinton MA)

22 Establishment of BxPC-3 Vector BxPC-3 HAS2 andBxPC-3 HAS3 Cell Lines Lentiviral vectors pLV-EF1a-MCS-IRES-Hyg (vector only) pLV-EF1a-hHAS2-IRES-Hyg(HAS2) and pLV-EF1a-hHAS3-IRES-Hyg (HAS3 BiosettiaSan Diego CA) were added to subconfluent BxPC-3 culturesfollowed by centrifugation for 30min at 1200 rpm andincubation at 37∘C for 6 h Fresh medium was added to thecultures and incubation was continued for 48 h followedby selection and expansion of stable cultures using mediumcontaining hygromycin

23 Hyaluronidase-Sensitive Particle Exclusion Assay Tovisualize aggrecan-mediated hyaluronan pericellular matri-ces in vitro particle exclusion assays were performed aspreviously described [9 42] with some modifications Sub-confluent cultures were treated with 1mgmL bovine nasalseptum proteoglycan (Elastin Products Owensville MO) for1 h at 37∘C followed by incubationwith vehicle or 1000UmLrecombinant human PH20 (rHuPH20 Halozyme Thera-peutics San Diego CA) as a negative control for 2 h at37∘CGlutaraldehyde-fixedmouse red blood cells were addedto the cultures which were then imaged with a phase-contrast microscope coupled with a camera scanner andSPOT advanced imaging program (Version 46 DiagnosticInstruments Sterling Heights MI) Particle exclusion areaand cell area were measured and relative hyaluronan coatarea was calculated using the formula matrix areandashcell area(expressed as 120583m2)

24 Hyaluronan Assay To analyze hyaluronan secretiontissue culture supernatants were collected from subconfluentcultures after 24 h culture and cells were trypsinized andcounted for normalization Hyaluronan concentration in thesamples was quantified using an enzyme-linked hyaluronan-binding protein sandwich assay (CatDY3614 RampD SystemsMinneapolis MN) according to manufacturerrsquos instructions[42]

25 Isolation of Secreted Cell Surface and IntracellularHyaluronan Isolation of secreted cell surface and intracel-lular hyaluronan was performed as previously described [16]with some modifications The conditioned media containingsecreted hyaluronan were collected from subconfluent cul-tures after 48 h of culture Cells were detached and collectedby centrifugation and supernatant was transferred to a cleantube Cell pellets were rinsed with 1 times PBS and centrifugedand supernatant was combined with the supernatant fromthe previous centrifugation and was designated as ldquocellsurface hyaluronanrdquo Combined supernatants were incubatedbriefly at 100∘C to inactivate trypsin The cell pellet wasrinsed the supernatant was discarded and the cell pelletwas designated as ldquointracellular hyaluronanrdquo To ensure thatno residual cell surface hyaluronan was present some ofthe cell fractions were treated with 1000UmL rHuPH20for 20min and rinsed with ice-cold 1 times PBS followed by

centrifugation and collection of the cell pellet All the sampleswere digested with Proteinase K at +55∘C overnight followedby heat inactivation at 95∘C for 10min and centrifugation at12000 rpm at 4∘C for 10min

26 Fluorescent Staining of Intracellular Hyaluronan andCD44 For fluorescent staining subconfluent cultures werefixedwith 4paraformaldehyde and pericellular hyaluronanwas digested with rHuPH20 (Halozyme Therapeutics IncSan Diego CA) Cells were then permeabilized with 03Triton-x-100 (Calbiochem La Jolla CA 1BSA) and blockedwith 3 BSA Hyaluronan and CD44 were stained withbiotinylated hyaluronan-binding protein (bHABP 25120583gmLCalbiochemEMDChemicals Inc San Diego CA) and anti-CD44 antibody (1 120583gmL BBA10 RampD Systems) overnightat 4∘C bHABP and anti-CD44 antibody were detectedby Fluorescein-labeled streptavidin (05120583gmL Vector Lab-oratories Burlingame CA) and Texas Red labeled anti-mouse antibody (05 120583gmL Vector) respectively Nucleiwere stained with Prolong Antifade with 410158406-diamidino-2-phenylindole (DAPI Invitrogen Carlsbad CA) and cultureswere imaged with a spinning disk microscope (Nikon EclipseTE 2000-U (Nikon Eugene OR) and BD Bioscience spin-ning disk unit (BD Bioscience Rockville MD)) using 60xobjective andMetaMorph software version 7760 (MolecularDevices Sunnyvale CA)

27 Pancreatic Cancer Xenograft Models Six- to eight-week-old nunu (Ncr) athymic mice handled in accordance withapproved Institutional Animal Care and Use Committee pro-tocols were used for xenograft studies Mice were inoculatedwith 005mL of 5 times 106 BxPC-3 BxPC-3 vector BxPC-3HAS2 or BxPC-3 HAS3 cells (concentration 1 times 108 cellsmL)peritibially in the hind leg (adjacent to the tibia periosteum)Tumor growth was monitored by ultrasound imaging (Visu-alSonics Vevo 7702100 High Resolution Imaging System(VisualSonics Ontario Canada)) until the average tumorsize reached 200ndash500mm3 The animals were then dividedinto treatment groups and treated intravenously (iv) twicea week for 2-3 weeks with vehicle 375 120583gkg 1000120583gkgor 4500120583gkg PEGPH20 At the end of the study tumorswere collected and divided into parts one part was fixedin 10 formalin for histology and the other parts werefrozen for later biochemical analysis Some additional tumor-bearing mice with large tumors (sim2000mm3) received twoinjections of vehicle or 4500 120583gkg PEGPH20 and tumorswere harvested in 10 formalin 6 h after treatment

28 KPC Mouse Model Mouse pancreatic cancer tissuesections fromKPCmice [46]were obtained from the Jacobetzet al 2013 study [4] As described previously mice weretreated iv with a single injection of 4500 120583gkg PEGPH20once tumor volume reached 270mm3 and tumors werecollected 1 8 24 and 72 h after dosing [4]

29 Human Patient Samples Pretreatment and posttreat-ment biopsies were obtained from a patient with ad-vanced NSCLC who was enrolled in a Phase 1 study of


PEGPH20 given iv to patients with advanced solid tumors(NCT01170897) The protocol was approved by InstitutionalReview Board and all patients consented to study Thepatient was treated with a single dose of 50 120583gkg PEGPH20Posttreatment biopsy was taken 7 days after iv treatment

210 Tissue Samples Tissues were fixed in 10 neutralbuffered formalin and processed to paraffin Five microm-eter sections were used for Hematoxylin and Eosin (HampE)staining that was performed according to a standard protocolFor hyaluronan assay fresh frozen tumor pieceswere digestedwith Proteinase K at +55∘C overnight then heat-inactivatedat 95∘C for 10min and centrifuged at 12000 rpm at 4∘C for10min

211 Hyaluronan Staining Hyaluronan in tumor tissues waslocalized as previously described [42] with some modifica-tions Briefly five micrometer sections were deparaffinizedand rehydrated and endogenous peroxidase was blockedwith Peroxo-Block solution (Invitrogen) Nonspecific stain-ing was blocked using 2 BSA (Jackson ImmunoResearchWest Grove PA) and 2 normal goat serum (Vector)for 1 h followed by blocking of endogenous avidin andbiotin (AvidinBiotin Blocking Kit Invitrogen) Hyaluro-nan was detected by incubating sections with 25 120583gmLbHABP (Seikagaku Tokyo Japan) for 1 h at 37∘C Signalwas amplified by incubation with streptavidin-horseradishperoxidase solution (HRP BD Biosciences) and detectedwith 331015840-diaminobenzidine (DAB Dako North AmericaCarpinteria CA) Sections were then counterstained in Gillrsquoshematoxylin (Vector) and mounted in Cytoseal 60 medium(American MasterTech Lodi CA) Specificity of the stainingwas assessed by incubation of a section of each sample withrHuPH20 (12000UmL) in PIPES buffer (25mM PIPES70mM NaCl 01 BSA pH 55) at 37∘C for 2 h prior toincubation with bHABP

212 Immunohistochemistry For cleaved caspase-3 (CC3)phosphohistone 3 (PH3) E-cadherin and 120573-cateninimmunohistochemistry five micrometer sections weredeparaffinized rehydrated and pretreated in boiling citratebuffer (pH 60) for 10min For CC3 and 120573-catenin stainingsendogenous peroxidase was blocked with 3H

2O2 followed

by blocking with 5 normal goat serum Sections wereincubated with CC3 (021 120583gmL Cat 9661 Cell SignalingDanvers MA) and 120573-catenin (40 120583gmL Cat 8480 CellSignaling) antibodies in SignalStain Antibody Diluent (CellSignaling) overnight at 4∘C Signal was detected with anti-rabbit SignalStain Boost IHC Detection Reagent (Cat 8114Cell Signaling) and DAB For PH3 immunohistochemistrysections were blocked with 3 H

2O2and 5 normal goat

serum Then PH3 antibody (65 ngmL Cat 9701 CellSignaling) was added and incubated overnight at 4∘CPrimary antibody was detected with HRP-conjugated anti-rabbit immunoglobulin G (IgG) (017 120583gmL Cat 7074 CellSignaling) andDAB For E-cadherin immunohistochemistry

slides were blocked with 3 H2O2 followed by blocking

of endogenous avidin and biotin E-cadherin (025 120583gmLab76055 Abcam Cambridge UK) antibody was dilutedin mouse-on-mouse (MOM) diluent and added to thesections for 1 h (Cat PK-2200 Vector) SubsequentlyMOM biotinylated anti-mouse IgG was added to the slidesand signal was amplified with Vectastain ABC reagent(Vector) and DABThen slides were counterstained with GillHematoxylin and mounted with synthetic media

213 Western Blot Tumor pieces were homogenized in coldhypotonic buffer (25mMTris HCl pH 74 50mMNaCl 10glycerol 05 Triton X-100 and 5mM EDTA with proteaseand phosphatase inhibitor cocktail) the homogenates wereincubated at 4∘C for 30min and centrifuged at 7500 rpmfor 10min at 4∘C The pellet was resuspended in nuclearextraction buffer (25mM Tris-HCl pH 74 250mM NaCl10 glycerol 05 Triton X-100 and 5mM MgCl

2with

protease and phosphatase inhibitor cocktail) treated withprotease-free DNAse I briefly sonicated and incubatedwith 200120583gmL ethidium bromide for 1 h Finally sampleswere centrifuged and the supernatant was collected Nuclearextracts were separated on SDS-PAGE transferred into anitrocellulose membrane and blocked with 5 BSA in PBSwith 01 Tween 20 The membrane was probed with HIF-1120572 antibody (05 120583gmL ab16066 Abcam) Snail (1 120583gmLab130245 Abcam) 120573-actin (13 120583gmL Cat 2148 Cell Sig-naling) and Histone 3 (11 120583gmL Cat 9717 Cell Signaling)antibodies HIF-1120572 and Snail antibodies were detected withHRP-conjugated goat anti-mouse IgG antibody (1 10000Jackson ImmunoResearch) and chemiluminescent reagent(GE Healthcare Life Sciences Piscataway Township NJ)and 120573-actin and Histone 3 with HRP-conjugated anti-rabbitIgG and chemiluminescent reagent Images were capturedusing GE ImageQuant 400 (GE Healthcare) and bands werequantified using Image-Pro Analyzer 70 software (MediaCybernetics Rockville MD)

214 Quantification of Staining Stained sections werescanned at Flagship Biosciences LLC (Boulder CO) andautomated quantification of CC3 staining was performedusing Aperio Positive Pixel algorithm v9 (Aperio BuffaloGrove IL) and results were normalized to the total numberof pixels Quantification of PH3 stainings was performed byAperio Imagescope using Nuclear v9 algorithm

215 Statistical Analysis Values are presented as mean plusmn SDor SEM Results expressed as ratios or percent values werelog transformed prior to the analysis Statistical differencewas analyzed by 119905 test one-way ANOVA and Tukeyrsquos posthoc test or two-way ANOVA with Bonferronirsquos post hoctestusing Graphpad Prism 5 software (Graphpad La Jolla CA)Statistical difference was set at 119875 lt 005 (lowast119875 lt 005 lowastlowast119875 lt001 and lowastlowastlowast119875 lt 0001)


3 Results and Discussion

31 HAS3 Overexpression Is Associated with Increased Levelsof Hyaluronan Production Extensive hyaluronan accumu-lation is found in pancreatic cancer [4 6] which is char-acterized by massive desmoplastic stroma high interstitialtumor pressure poor perfusion and resistance to therapy[47] Hyaluronan is synthesized by three HAS enzymes atthe plasma membrane and HAS overexpression has beenassociated with cancer growth [43 45 48] In this study weused BxPC-3 pancreatic cancer cells that overexpress HAS3to assess the roles of this HAS isoform on pancreatic cell linesand tumors

Human BxPC-3 pancreatic adenocarcinoma cells wereengineered to overexpress HAS3 and functional conse-quences of hyaluronan production by HAS3 were analyzedby hyaluronan secretion and size of pericellular hyaluronanmatrix BxPC-3 cells secreted 181 ng hyaluronan to culturemedium per 10000 cells over 24 h while hyaluronan secre-tion of BxPC-3 HAS3 cells was 20-fold higher at 3607 ng per10000 cells (Table 1) Similarly relative hyaluronan matrixarea was increased by 24-fold after HAS3 overexpression(Table 1) Overexpression of HAS2 and HAS3 has beenreported to lead to increased hyaluronan secretion andincreased size of hyaluronan coat in several cell lines [2526] Thus we generated and tested HAS2-overexpressingBxPC-3 cells and found that similar amounts of hyaluronanwere secreted by BxPC-3 HAS2 and BxPC-3 HAS3 cells(Table 1) resulting in similar hyaluronan coat sizes The sizeof hyaluronan coat on BxPC-3 cells transducedwith an emptyvector was also analyzed and coat size did not significantlydiffer from that on parental cells (data not shown)

To further characterize BxPC-3 HAS3 cells the quantityof extracellular and intracellular hyaluronan was analyzedIn line with earlier results (Table 1) the amount of extra-cellular hyaluronan composed of secreted and cell surfacehyaluronan was 99-fold higher in BxPC-3 HAS3 cellscompared to BxPC-3 cells (Figure 1(a)) Overexpression ofHAS3 also induced a slight 28-fold increase in intracellularhyaluronan content (Figure 1(b)) HAS2-overexpressing cellscontained a similar amount of extracellular hyaluronan asHAS3-overexpressing cells (Figure 1(a)) but their intracellu-lar hyaluronan level was 35-fold higher than in BxPC-3 cells(Figure 1(b)) Intracellular hyaluronan was also visualized incultures after fixation and digestion of cell surface hyaluro-nan CD44 was stained in the cultures to visualize plasmamembranes of the cells Parental or HAS3-overexpressingcells contained very little intracellular hyaluronan (Figures1(c) and 1(e)) while HAS2-overexpressing cells showed inten-sive accumulation of intracellular hyaluronan (Figure 1(d))These data are consistent with previous reports that HAS2expression has been associated with the presence of intra-cellular hyaluronan induced by epidermal growth factorkeratinocyte growth factor or hyperglycemia [16 19 49]

32 Amount and Localization of Hyaluronan in HAS3-Overexpressing Xenograft Tumors In a follow-up in vivostudy mice bearing BxPC-3 and BxPC-3 HAS3 tumors weredosed twice with vehicle or 4500120583gkg PEGPH20 and

Table 1 Hyaluronan production of BxPC-3 BxPC-3 HAS2 andBxPC-3 HAS3 cells

Tumor cell lineRelative hyaluronan

coat size(120583m2)1

Hyaluronan in CM(ng10000 cells in 24 h)2

BxPC-3 502 plusmn 259 181 plusmn 54BxPC-3 HAS2 1417 plusmn 614 2832 plusmn 643BxPC-3 HAS3 1154 plusmn 439 3607 plusmn 3491Assessed via particle exclusion assay as described in Section 2 Mean plusmn SD2Mean in culture media (119899 = 3 independent cultures) plusmn SD

tumors were collected 6 h after the second dosing Histo-chemistry of the tumors revealed that HAS3 overexpressionchanged the structure of the tumor stroma (Figures 2(a)ndash2(c)) HAS3-overexpressing tumors contained a large amountof hyaluronan located in the extracellular space of the stromawhile hyaluronan in BxPC-3 tumors was mostly associatedwith cancer cells (Figures 2(g) and 2(i)) Total hyaluro-nan content of BxPC-3 HAS3 tumors was 1864 ngmgwhile hyaluronan content of BxPC-3 tumors was 344 ngmg(Figure 2(m)) In line with the in vitro results BxPC-3HAS2 tumors contained a similar amount of hyaluronan asBxPC-3 HAS3 tumors (Figures 2(h)-2(i) and 2(m)) but inaddition to stromal hyaluronan accumulation cancer cell-associated hyaluronan resembling intracellular hyaluronanwas found (Figure 2(h)) Chronic treatment with PEGPH20(twice a week dosing for 3 weeks) depleted 95 of hyaluronanin BxPC-3 HAS3 tumors while in BxPC-3 and BxPC-3HAS2 tumors hyaluronan removal was 72 (Figure 2(m))The results are consistent with previous reports showingthat PEGPH20 can efficiently remove hyaluronan in thetumors [4 6 9 42] Hyaluronan staining of the PEGPH20-treated tumors revealed that PEGPH20 removed most of theextracellular hyaluronan (Figures 2(j)ndash2(l)) and reduced theamount of stroma (Figures 2(d)ndash2(f)) although intracellularhyaluronan in cancer cells was still apparent (Figures 2(j)ndash2(l)) After treatment with PEGPH20 intracellular hyaluro-nan was most prominent in HAS2 tumors (Figure 2(k)) inagreement with in vitro observation of intracellular accumu-lation of hyaluronan in HAS2-overexpressing cells (Figures1(b) and 1(d)) The significance and origin of intracellularhyaluronan accumulation in HAS2-overexpressing pancre-atic cancer cells and tumors is a subject requiring furtherinvestigation Coexpression of HAS2 with CD44 and HYAL2has been reported and could potentially lead to the cleavageof hyaluronan at the plasma membrane and CD44-mediatedinternalization and accumulation of intracellular hyaluronan[36 50 51] Intracellular hyaluronan synthesis has also beenreported in hyperglycemia and inflammatory conditions [1719] These results also confirm that PEGPH20 only degradeshyaluronan within the extracellular space probably due tolack of a mechanism to enter the cells

33 HAS3 Overexpression in BxPC-3 Cells Is Associated withFaster In Vivo Growth and Enhanced Tumor Growth Inhi-bition HAS2 has been widely shown to be associated withcancer [43 48] however much less is known about the role of


lowastlowastlowastlowastlowast

BxPC

-3

BxPC

-3H

AS2

BxPC

-3H

AS3

Extracellular

Hya

luro

nan

( o

f BxP

C-3

cells

)

10000

1000

100

10

(a)

lowastlowast

BxPC

-3

BxPC

-3H

AS2

BxPC

-3H

AS3

Hya

luro

nan

( o

f BxP

C-3

cells

)

10000

1000

100

10

Intracellular

(b)

(c) (d) (e)

Figure 1 HAS3 overexpression is associated with high extracellular hyaluronan accumulation and HAS2 with increased extracellular andintracellular accumulation of hyaluronan Amount of secreted cell surface and intracellular hyaluronan was analyzed in BxPC-3 BxPC-3HAS2 and BxPC-3 HAS3 cells with a hyaluronan assay and results were presented as extracellular hyaluronan showing combined amount ofsecreted and cell surface hyaluronan (a) and intracellular hyaluronan (b) The results were expressed as of hyaluronan content in BxPC-3cells and data representmeanplusmn SD of three independent experiments To visualize intracellular hyaluronan subconfluent cultures of BxPC-3(c) BxPC-3 HAS2 (d) and BxPC-3 HAS3 cells (e) were stained for intracellular hyaluronan (green) and CD44 (red) using bHABP and anti-CD44s-antibody respectively Nuclei were visualized with Prolong Antifade with DAPI Scale bar in (cndashe) is 50 120583m Statistical differencesbetween the groups in (a) and (b) were tested using one-way ANOVA and Tukeyrsquos post hoc test (lowastlowast119875 lt 001 lowastlowastlowast119875 lt 0001)

HAS3 in tumor progression To compare the in vivo growthrate and PEGPH20 response of BxPC-3 and BxPC-3 HAS3cells both cells were inoculated peritibially in the hind limbof nudemice to generate tumors and themice were dosed ivtwice a week with vehicle or 4500120583gkg PEGPH20 BxPC-3 HAS3 cells generated faster growing tumors than parentalcells (Figures 3(a) and 3(c)) which correlateswith the amountof extracellular hyaluronan in the tumor stroma (Figures2(g) and 2(i)) The average size of BxPC-3 HAS3 tumors was1905mm3 on day 15 after initiation of vehicle treatmentwhilethe average size of BxPC-3 tumors was 820mm3 (Figures3(a) and 3(c)) This is consistent with the report that HAS3

overexpression enhances extracellular matrix deposition andtumor growth of prostate cancer cells [45] and thatmetastaticcolon cancer cells have upregulated levels ofHAS3 [52] HAS3protein level is higher in human ovarian cancer than innormal ovary and the amount of HAS3-positive cancer cellscorrelates with hyaluronan accumulation in the stroma [44]Overexpression of HAS2 also increased the tumor growth ina BxPC-3 model but led to less aggressive tumors than thosewith HAS3 overexpression (Figure 3(b)) Stromal hyaluronanhas been reported to contribute to high interstitial fluidpressure compression of tumor blood vessels and poordrug delivery in pancreatic cancer tumors [4 6] To date


0

500

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1500

2000

2500

PEGPH20 (120583gkg)

Hya

luro

nan

(ng

mg)

0 375 1000 0 375 1000 0 375 1000

lowastlowastlowast

lowastlowastlowast

BxPC-3 BxPC-3HAS2

BxPC-3HAS3

Vehi

clePE

GPH

20

Hamp

E st

aini

ng

Vehi

clePE

GPH

20

bHA

BP st

aini

ng

BxPC-3 BxPC-3 HAS2 BxPC-3 HAS3

(a) (b) (c)

(d) (e) (f)

(g) (h) (i)

(j) (k) (l)

(m)

Figure 2 Localization and amount of hyaluronan in BxPC-3 BxPC-3 HAS2 and BxPC-3 HAS3 tumors and response to PEGPH20 Micecarrying BxPC-3 BxPC-3HAS2 and BxPC-3HAS3 peritibial xenograft tumors were treated twice with vehicle or 4500 120583gkg PEGPH20 andtumors were collected 6 h after the last dose Tumor sections were stained with HampE to visualize morphology of the tumors (andashf) and withbHABP for hyaluronan (gndashl) Scale bar in (andashf) and (gndashl) is 500120583m Hyaluronan concentration in the tumors after two weekly treatments ofvehicle 375 120583gkg or 1000120583gkg of PEGPH20 (119899 ge 3group) for three weeks was analyzed by hyaluronan assay (m) Statistical differencesbetween the groups shown in figure (m) were tested using two-way ANOVA and Bonferronirsquos post hoc test (lowast119875 lt 005 lowastlowast119875 lt 001 lowastlowastlowast119875 lt0001)


0 5 10 15 20 25300

600

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1200

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2100

Vehicle

PEGPH20

Time (days)

BxPC-3

P lt 001Tu

mor

vol

ume (

mm

3)plusmn

SEM

(a)

0 5 10 15 20 25300

600

900

1200

1500

1800

2100

Vehicle

PEGPH20

Time (days)

P lt 0001

BxPC-3 HAS2

Tum

or v

olum

e (m

m3)plusmn

SEM

(b)

0 5 10 15 20 25300

600

900

1200

1500

1800

2100

Vehicle

PEGPH20

Time (days)

P lt 0001

BxPC-3 HAS3

Tum

or v

olum

e (m

m3)plusmn

SEM

(c)

Figure 3 Pancreatic cancer xenograft tumors overexpressing HAS3 grow faster and respond better to hyaluronan removal than HAS2 orparental tumors To compare in vivo growth BxPC-3 BxPC-3 HAS2 and BxPC-3 HAS3 tumor cells were inoculated adjacent to the tibialperiosteum in the hind limb of nunu mice (119899 = 7group) and tumor growth was monitored using ultrasound imaging Once average tumorsize reached 500mm3 mice were treated twice a week with an iv injection of vehicle or PEGPH20 (4500 120583gkg) (andashc) Statistical differencewas tested using repeated measured two-way ANOVA and Bonferronirsquos post hoc test

there have been no observed substantial differences in theamount of stromal hyaluronan between HAS2- and HAS3-overexpressing tumors However consequences of HAS2 andHAS3 overexpression on vasculature are not well understoodand the possibility that HAS2 and HAS3 might have distincteffects on vascular function cannot be completely ruled outInterestingly BxPC-3HAS3 tumors showed a strong responseto PEGPH20 which caused 86 tumor growth inhibi-tion (Figure 3(c)) In BxPC-3 and BxPC-3 HAS2 tumorsPEGPH20 induced tumor growth inhibition of 34 and 32respectively (Figures 3(a) and 3(b)) Removal of hyaluronanby PEGPH20 has been shown to lead to decompressionof tumor blood vessels changed ultrastructure of tumorendothelia and increased drug delivery to the tumor [46 9] We show that intravenous injection of PEGPH20 led

to similar depletion of stromal hyaluronan in HAS2- andHAS3-overexpressing tumor models (Figures 2(k) and 2(l))suggesting no differences in drug delivery of PEGPH20to these tumor types Taken together the data show thattumors with HAS3 overexpression show more aggressivetumor growth than parental tumors or tumors with HAS2overexpression In HAS3-overexpressing tumors PEGPH20removes most of the hyaluronan and has a strong inhibitoryeffect on tumor growth whereas in HAS2-overexpressingtumors PEGPH20 removes the extracellular but not theintracellular hyaluronan and causes a weaker inhibitory effecton tumor growth Our results are in line with previous workshowing that depletion of hyaluronan or suppression of itssynthesis leads to inhibition of tumor growth in multipletumor models [9 36ndash38 41 42]


34 Accumulation of Extracellular Hyaluronan by HAS3 Over-expression Induces Loss of Plasma Membrane E-CadherinHyaluronan is known to be involved in EMT-associatedchanges in cancer progression [27ndash29] E-cadherin and 120573-catenin are essential adhesion molecules in normal epithe-lium and loss of plasma membrane E-cadherin and cateninsleading to disruption of cell-cell junctions is acknowledgedto be an early indication of EMT [53 54] Because accu-mulation of hyaluronan by HAS3 in intercellular space hasbeen suggested to interrupt cell-cell interactions [55] wehypothesized that hyaluronan removalwould reverse changesthat may have occurred in adhesion events E-cadherinand 120573-catenin were visualized by immunohistochemistry invehicle-treated and PEGPH20-treated BxPC-3 and BxPC-3HAS3 tumors HAS3-induced extracellular hyaluronan accu-mulation resulted in loss of plasma membrane E-cadherin(Figure 4(a)) and increased accumulation of cytoplasmic 120573-catenin in tumor cells of BxPC-3 tumors (Figure 4(b)) Thisresult supports previous findings that increased hyaluronanproduction leads to disruption of adherens junctions andleads to EMT [28 43] Since the majority of pancreaticadenocarcinomas have high hyaluronan accumulation [4 5]these results are in line with the previously reported loss ofmembrane E-cadherin in human pancreatic adenocarcinomacompared to pancreatic intraepithelial neoplasia or normalducts [53] Additionally HAS overexpression also inducesloss of plasma membrane E-cadherin in breast cancer cellsand spongiotic keratinocytes [28 43 55] Overexpressionof HAS2 led to the same changes in E-cadherin and 120573-catenin adhesion proteins in BxPC-3 tumors (Figures 4(a)and 4(b)) Interestingly in mammary epithelial cells TGF-120573-induced EMT is mediated by HAS2 but not by extracellularhyaluronan [29] This suggests that HAS2 and HAS3 maymediate EMT-associated events via different mechanismsHAS3 seems to initiate EMT-associated events by extra-cellular hyaluronan while the effect of HAS2 on EMTmay be additionally mediated by intracellular hyaluronanaccumulation or by HAS2 function that is not dependent onhyaluronan synthesis [29]

We then tested the effect of hyaluronan removal byPEGPH20 on EMT-related events in HAS3-overexpressingtumors Removal of extracellular hyaluronan by PEGPH20induced translocation of E-cadherin and 120573-catenin back tothe plasmamembrane (Figures 4(a) and 4(b)) and PEGPH20showed a stronger effect in HAS3-overexpressing tumorsthan in BxPC-3 tumors It has been previously shown thatPEGPH20 removes most tumor-associated hyaluronan inthe KPC mouse model [4] so we investigated transloca-tion of E-cadherin in tumors from KPC mice treated withPEGPH20 Translocation of E-cadherin to plasmamembranewas observed 8 h after treatment with PEGPH20 and itwas most prominent in peripheral duct-like structures atthe edges of the tumor (Figure 4(c)) However the effectseems to be transient since 24 to 72 h later the plasmamembrane residence of E-cadherin started to disappear(Figure 4(c)) E-cadherin status was also studied in pretreat-ment and posttreatment biopsies of a lung cancer patienttreated with PEGPH20 (Phase 1 study NCT01170897) In theposttreatment biopsy a decrease in extracellular hyaluronan

(data not shown) and an increase in cell surface E-cadherinwere found in comparison to the pretreatment biopsy(Figure 4(d)) Removal of extracellular hyaluronan is asso-ciated with translocation of epithelial markers E-cadherinand 120573-catenin back to the plasma membrane suggesting areorganization of intercellular junctions and an inhibitionof early EMT-associated events potentially contributing togrowth inhibition by PEGPH20 [43]

35 Hyaluronan Removal Decreases Nuclear Levels ofHypoxia-Related Proteins Since hypoxia has been reportedto be associated with and able to induce EMT [56 57] weexplored the effect of extracellular hyaluronan accumulationand PEGPH20 on hypoxia-related proteins in BxPC-3 tumors Nuclear protein levels of HIF-1120572 and Snailwere analyzed by Western blotting (Figures 5(a)ndash5(f))Overexpression of HAS3 did not cause a major change innuclear HIF-1120572 level probably because BxPC-3 tumorsalready contain a low amount of hyaluronan (Figures5(a)ndash5(c)) However hyaluronan depletion by PEGPH20decreases nuclear HIF-1120572 levels in both BxPC-3 and BxPC-3HAS3 tumors (Figures 5(a)ndash5(c)) suggesting a decreasein hypoxic conditions after hyaluronan removal Nuclearlevels of transcription factor Snail a target of HIF-1120572were also suppressed by hyaluronan depletion in HAS3-overexpressing tumors (Figures 5(d)ndash5(f)) These resultssuggest that PEGPH20 suppresses HIF-1120572-Snail signalingin tumors with high levels of hyaluronan In agreementwith our observations previous reports have describedan association of hyaluronan accumulation and tumorhypoxia [12] and that depletion of hyaluronan synthesis by4-methylumbelliferone prevents EMT-associated changes[58] EMT has been reported to be mediated via HIF-1120572signaling [56 57] and our data suggest that removal ofhyaluronan can be one step in the inhibition of this process

36 Extracellular Hyaluronan Inhibits Apoptosis of BxPC-3 Tumors To further study the mechanism of how HAS3overexpression favors tumor growth and leads to strongerresponse to PEGPH20 the amount of proliferative andapoptotic cells was analyzed in BxPC-3 and BxPC-3 HAS3tumors The number of apoptotic cells assessed by CC3positivity was decreased in HAS3-overexpressing tumors (4-fold 119875 lt 005) suggesting that BxPC-3 HAS3 overexpressionprotects cells from apoptosis (Figure 6(a)) PEGPH20 treat-ment showed a trend (23-fold) to increase CC3-positive cellsin BxPC-3 HAS3 tumors but had no effect in BxPC-3 tumors(Figure 6(a)) The modest effect of PEGPH20 on promotingapoptosis in the BxPC-3 HAS3 tumor model may be dueto incomplete removal of hyaluronan from the cancer cellsurface (Figure 2(l)) Since HAS3 continuously produces newhyaluronan chains at the plasmamembrane binding of newlysynthesized chains to hyaluronan receptors on the cancer cellsurface may induce some cell survival signaling and reducethe biological effect of PEGPH20 Alternatively overexpres-sion ofHAS3may have other hyaluronan-independent effectson cell survival as reported with HAS2 on TGF-120573-inducedEMT in mammary epithelial cells [29]


Vehi

clePE

GPH

20E-ca

dher

in st

aini

ng


(a)

Vehi

clePE

GPH

20


120573-c

aten

in st

aini

ng

(b)

Control

E-ca

dher

in st

aini

ng

8h

24h 72h

(c)

Post-PEGPH20

Pre-PEGPH20

(d)

Figure 4 HAS overexpression induces loss of plasma membrane E-cadherin and accumulation of cytoplasmic 120573-catenin and removal ofhyaluronan translocates them to the plasma membrane Vehicle- and PEGPH20- (2 doses 4500120583gkg 119899 = 3group) treated tumors werestained for E-cadherin (a) and 120573-catenin (b) E-cadherin was also localized in pancreatic tumors from a KPCmouse model after 0 8 24 and72 h treatment with PEGPH20 (c 119899 = 3group) and in human NSCLC biopsies before and after PEGPH20 therapy (d) Scale bar in (andashd) is250 120583m Insets in (andashd) represent 3x magnification of the original micrograph


Vehicle PEGPH20

1 2 3 1 2 3

HIF-1120572

120573-actionSample

BxPC-3

Vehicle PEGPH20

1 2 3 1 2 3

HIF-1120572

120573-actionSample

BxPC-3 HAS3

0

2

4

6

8

Inte

nsity

ratio

(HIF

-1120573

-act

ion)

Vehicle PEGPH20 Vehicle PEGPH20

lowastlowast

lowastlowastlowast

BxPC-3 BxPC-3HAS3

Vehicle PEGPH20

1 2 3 1 2 3Sample

BxPC-3

Snail

H3

Vehicle PEGPH20

1 2 3 1 2Sample

Snail

H3

BxPC-3 HAS3


lowast

BxPC-3 BxPC-3HAS3

00

05

10

15

20In

tens

ity ra

tio (S

nail-

Hist

one3

)

(a)

(b)

(c)

(d)

(e)

(f)

Figure 5 Removal of extracellular hyaluronan decreases HIF-1120572 and Snail signaling Vehicle- and PEGPH20- (2 doses 4500120583gkg) treatedBxPC-3 and BxPC-3 HAS3 tumors were homogenized and nuclear extracts were analyzed with Western blot using HIF-1120572 (a) and (b) Snail(d) and (e) 120573-actin (a) and (b) and Histone 3 (c) and (d) antibodies In (a) and (b) the blot is a representative of three experiments andeach lane represents a piece of the same vehicle-treated or PEGPH20-treated tumor The HIF-1120572 band is indicated with an arrow In (d)and (e) lysates from the same vehicle-treated or PEGPH20-treated tumor were combined and each lane represents Snail level of one tumorIntensities of the bands in the cropped blots were quantified using Image-Pro Analyzer 70 software and normalized to the intensity of thehousekeeping protein ((c) and (f)) Data were plotted as mean plusmn SD and statistical difference between the groups was tested with 119905 test(lowast119875 lt 005 lowastlowast119875 lt 001 and lowastlowastlowast119875 lt 0001)

Cell proliferation assessed by PH3 was not increasedby HAS3 overexpression or with PEGPH20 treatment(Figure 6(b)) Overexpression of HAS2 and PEGPH20 treat-ment in HAS2-overexpressing tumors did not show a majoreffect on the number of CC3- and PH3-positive cellsThese results suggest that in addition to effects on stromalremodeling and early EMT-associated changes accumulationof extracellular hyaluronan after HAS3 overexpression mayprotect pancreatic cancer cells from apoptosis Hyaluronanremoval alone may not be sufficient to induce substantialcell death in this model but PEGPH20 may be effective incombination with chemotherapy as reported previously in

the prostate cancer model [9] and in the transgenic mousemodel of pancreatic cancer [6] Consistent with our workhyaluronan has also been previously associated with cellsurvival and protection of apoptosis in colon carcinomacells [59] In conditional Has2 transgenic mice that developmammary tumors Has2 overexpression decreases apoptosisbut also increases the proliferation of neu-initiated tumors[43] Differential results on proliferation may be explainedby the fact that the net effect of HASs and hyaluronan onproliferation depends on several factors including cell typecell density and the final concentration of hyaluronan aroundthe cells [15 45 60] In KPC mice PEGPH20 decreases


Vehi

cle

PEG

PH20

Vehi

cle

PEG

PH20

Vehi

cle

PEG

PH20

0

1

2

3

4 lowastlowast

BxPC-3 BxPC-3HAS2

BxPC-3HAS3

CC3+

cells

( o

f tot

al p

ixels

)

(a)

00

05

10

15

20

PH3+

cells

( o

f tot

al ce

lls)

Vehi

cle

PEG

PH20

Vehi

cle

PEG

PH20

Vehi

cle

PEG

PH20

BxPC-3 BxPC-3HAS2

BxPC-3HAS3

(b)

Figure 6 Effect of HAS2 and HAS3 overexpression and hyaluronan removal on apoptosis and proliferation in BxPC-3 BxPC-3 HAS2 andBxPC-3 HAS3 tumors Vehicle-treated and PEGPH20-treated (2 doses 4500 120583gkg 119899 = 3group) BxPC-3 BxPC-3 HAS2 and BxPC-3 HAS3xenograft tumor sections were stained for CC3 and PH3 to visualize apoptotic and proliferative cells respectively Number of positive cellsper tumor section was analyzed using Aperio Positive Pixel v9 and Nuclear staining algorithms respectively ((a) and (b)) Data were plottedas mean plusmn SD and statistical difference between the groups was tested with two-way ANOVA and Bonferronirsquos post hoc test (lowastlowast119875 lt 001)

proliferation and increases apoptosis in combination withgemcitabine compared to gemcitabine alone [4 6] AlthoughPEGPH20 alone might not have strong effects on prolif-eration and apoptosis it causes remodeling of the tumormicroenvironment and could sensitize tumors to chemother-apy The results from this study shed a light on potentialapplication of extracellular hyaluronan and HAS3 proteinexpression as an indication for stromal hyaluronan depletionby PEGPH20

4 Conclusions

In recent years the importance of the tumor microenviron-ment in cancer progression has been increasingly recognizedand stromal components including hyaluronan have becomeattractive targets for cancer therapy Hyaluronan is a majorcomponent in the stroma of many solid tumors [5 8] andits accumulation is known to promote malignant transfor-mation and tumor growth [28 43 61] The most extensivehyaluronan accumulation is found in pancreatic cancer [4 6]and enzymatic depletion of hyaluronan in combination withchemotherapy is currently being investigated in patients withadvanced pancreatic adenocarcinoma However there is verylittle information about mechanisms leading to hyaluronanaccumulation in desmoplastic response of pancreatic cancerand the roles of different HASs in these dramatic changes oftumor microenvironment

In this study we demonstrate that overexpression ofHAS3 in pancreatic cancer cells results in more aggressivetumors with extracellular hyaluronan accumulation whereasoverexpression of HAS2 is associated withmoderate-growingtumors and both extracellular and intracellular accumula-tions of hyaluronan An increase in extracellular hyaluronan

induces loss of plasma membrane E-cadherin and accu-mulation of cytoplasmic 120573-catenin indicating disruption ofepithelial cell adhesion and an early stage of EMT PEGPH20depletes extracellular hyaluronan and leads to strong inhi-bition of tumor growth in HAS3-overexpressing tumorsTumor growth inhibition is associatedwith decreased nuclearlevels of hypoxia-related proteins and translocation of E-cadherin and 120573-catenin to the plasma membrane The factthat removal of hyaluronan also causes E-cadherin transloca-tion to the plasma membrane in the transgenic mouse modeland in a hyaluronan-rich human NSCLC biopsy samplefurther justifies the relevance of the hyaluronan-rich tumormodel and highlights the role of extracellular hyaluronan inthe early EMT-associated events

Further knowledge about the mechanisms and conse-quences of hyaluronan accumulation in pancreatic cancerand effects of hyaluronan removal by PEGPH20 will increaseour understanding of the role of hyaluronan in the develop-ment ofmalignancies andwill enable the development of newbiomarkers and therapies

Nonstandard Abbreviations Used

bHABP Biotinylated hyaluronan binding proteinCC3 Cleaved caspase-3DAB 331015840-DiaminobenzidineDAPI 410158406-Diamidino-2-phenylindoleEMT Epithelial-mesenchymal transitionHampE Hematoxylin and EosinHAS Hyaluronan synthaseHIF Hypoxia-inducible factorHYAL HyaluronidaseIgG Immunoglobulin G


KPC LSL-KrasG12D+ LSLTrp53R172H+ Pdx-1-Cre

MOM Mouse-on-mouseNSCLC Non-small cell lung cancerPEGPH20 Pegylated recombinant human PH20

hyaluronidasePH3 Phosphohistone 3

Conflict of Interests

All authors except for Jeffrey R Infante Michael A Jacobetzand David A Tuveson are employees consultants andorshareholders of Halozyme Therapeutics The authors declareno other conflicts of interests

Authorsrsquo Contribution

Conception and design were performed by A Kultti CZhao R J Osgood P Jiang X Li C B Thompson GI Frost H M Shepard and Z Huang Development ofmethodology was performed by A Kultti C Zhao N CSingha R Symons and X Li Data were acquired by (andprovided animal and human samples) A Kultti C Zhao NSingha S Zimmerman R J Osgood R Symons P Jiang JR Infante M A Jacobetz and D A Tuveson Analysis andinterpretation of data were performed by (eg image analysisand statistical analysis) A Kultti C Zhao N C Singha R JOsgood and P Jiang Writing reviewing andor revision ofthe paper were performed by A Kultti C Zhao N SinghaR J Osgood R Symons P Jiang X Li J R Infante MA Jacobetz D A Tuveson H M Shepard and Z HuangAdministrative technical or material support was handledby A Kultti P Jiang X Li J R Infante and D A TuvesonStudy was supervised by C B Thompson G I Frost H MShepard and Z Huang

Acknowledgments

The authors wish to thank Calvin Vu and Adrian Radi for invivo study support Lynzie L Moore for histological supportDr Laurence Jadin for image analysis support Dr SannaRosengren for statistical support Drs Gilbert A KellerDaniel C Maneval and Christina M Ardito for carefulreview of the paper and Scott Patton for the editing andformatting of the paper

References

[1] N Howlader A M Noone M Krapcho et al SEER Can-cer Statistics Review 1975ndash2010 2012 SEER Data SubmissionNational Cancer Institute Bethesda Md USA 2013

[2] DMahadevan and D D vonHoff ldquoTumor-stroma interactionsin pancreatic ductal adenocarcinomardquo Molecular Cancer Ther-apeutics vol 6 no 4 pp 1186ndash1197 2007

[3] P P Provenzano and S R Hingorani ldquoHyaluronan fluidpressure and stromal resistance in pancreas cancerrdquo BritishJournal of Cancer vol 108 no 1 pp 1ndash8 2013

[4] M A Jacobetz D S Chan A Neesse et al ldquoHyaluronanimpairs vascular function and drug delivery in a mouse modelof pancreatic cancerrdquo Gut vol 62 no 1 pp 112ndash120 2013

[5] A Kultti X Li P Jiang C B Thompson G I Frost and HMichael Shepard ldquoTherapeutic targeting of hyaluronan in thetumor stromardquo Cancers vol 4 no 3 pp 873ndash903 2012

[6] P P Provenzano C Cuevas A E Chang V K Goel D Dvon Hoff and S R Hingorani ldquoEnzymatic targeting of thestroma ablates physical barriers to treatment of pancreaticductal adenocarcinomardquo Cancer Cell vol 21 no 3 pp 418ndash4292012

[7] X B Cheng N Sato S Kohi and K Yamaguchi ldquoPrognosticimpact of hyaluronan and its regulators in pancreatic ductaladenocarcinomardquo PLoS ONE vol 8 no 8 Article ID e807652013

[8] R H Tammi A Kultti V Kosma R Pirinen P Auvinen andM I Tammi ldquoHyaluronan in human tumors pathobiologicaland prognostic messages from cell-associated and stromalhyaluronanrdquo Seminars in Cancer Biology vol 18 no 4 pp 288ndash295 2008

[9] C B Thompson H M Shepard P M OrsquoConnor et alldquoEnzymatic depletion of tumor hyaluronan induces antitumorresponses in preclinical animal modelsrdquo Molecular CancerTherapeutics vol 9 no 11 pp 3052ndash3064 2010

[10] J Hunger A BerneckerH J BakkerM Bonn andR P RichterldquoHydration dynamics of hyaluronan and dextranrdquo BiophysicalJournal vol 103 no 1 pp L10ndashL12 2012

[11] G L Semenza ldquoTargeting HIF-1 for cancer therapyrdquo NatureReviews Cancer vol 3 no 10 pp 721ndash732 2003

[12] F Gao P Okunieff Z Han et al ldquoHypoxia-induced alterationsin hyaluronan and hyaluronidaserdquo Advances in ExperimentalMedicine and Biology vol 566 pp 249ndash256 2005

[13] B P Toole ldquoHyaluronan-CD44 interactions in cancer para-doxes and possibilitiesrdquo Clinical Cancer Research vol 15 no 24pp 7462ndash7468 2009

[14] B P Toole ldquoHyaluronan from extracellular glue to pericellularcuerdquo Nature Reviews Cancer vol 4 no 7 pp 528ndash539 2004

[15] Y NishidaW Knudson C B Knudson and N Ishiguro ldquoAnti-sense inhibition of hyaluronan synthase-2 in human osteosar-coma cells inhibits hyaluronan retention and tumorigenicityrdquoExperimental Cell Research vol 307 no 1 pp 194ndash203 2005

[16] J Pienimaki K Rilla C Fulop et al ldquoEpidermal growth factoractivates hyaluronan synthase 2 in epidermal keratinocytes andincreases pericellular and intracellular hyaluronanrdquoThe Journalof Biological Chemistry vol 276 no 23 pp 20428ndash20435 2001

[17] VCHascall A KMajors CA de LaMotte et al ldquoIntracellularhyaluronan a new frontier for inflammationrdquo Biochimica etBiophysica ActamdashGeneral Subjects vol 1673 no 1-2 pp 3ndash122004

[18] R Tammi K Rilla J-P Pienimaki et al ldquoHyaluronan enterskeratinocytes by a novel endocytic route for catabolismrdquo TheJournal of Biological Chemistry vol 276 no 37 pp 35111ndash351222001

[19] A Wang and V C Hascall ldquoHyperglycemia intracellularhyaluronan synthesis cyclin D3 and autophagyrdquo Autophagyvol 5 no 6 pp 864ndash865 2009

[20] R Stern ldquoHyaluronidases in cancer biologyrdquo Seminars inCancer Biology vol 18 no 4 pp 275ndash280 2008

[21] R Stern G Kogan M J Jedrzejas and L Soltes ldquoThe manyways to cleave hyaluronanrdquo Biotechnology Advances vol 25 no6 pp 537ndash557 2007


[22] H Yoshida A Nagaoka A Kusaka-Kikushima et alldquoKIAA1199 a deafness gene of unknown function is a newhyaluronan binding protein involved in hyaluronan depolym-erizationrdquo Proceedings of the National Academy of Sciences ofthe United States of America vol 110 no 14 pp 5612ndash5617 2013

[23] A P Spicer J S Olson and J AMcDonald ldquoMolecular cloningand characterization of a cDNA encoding the third putativemammalian hyaluronan synthaserdquo The Journal of BiologicalChemistry vol 272 no 14 pp 8957ndash8961 1997

[24] R H Tammi A G Passi K Rilla et al ldquoTranscriptionaland post-translational regulation of hyaluronan synthesisrdquoTheFEBS Journal vol 278 no 9 pp 1419ndash1428 2011

[25] N Itano T Sawai M Yoshida et al ldquoThree isoforms ofmammalian hyaluronan synthases have distinct enzymaticpropertiesrdquo Journal of Biological Chemistry vol 274 no 35 pp25085ndash25092 1999

[26] K Rilla S Oikari T A Jokela et al ldquoHyaluronan synthase 1(HAS1) requires higher cellular udp-glcnac concentration thanHAS2 and HAS3rdquoThe Journal of Biological Chemistry vol 288no 8 pp 5973ndash5983 2013

[27] T D Camenisch A P Spicer T Brehm-Gibson et al ldquoDis-ruption of hyaluronan synthase-2 abrogates normal cardiacmorphogenesis and hyaluronan-mediated transformation ofepithelium to mesenchymerdquo The Journal of Clinical Investiga-tion vol 106 no 3 pp 349ndash360 2000

[28] A Zoltan-Jones L Huang S Ghatak and B P Toole ldquoElevatedhyaluronan production induces mesenchymal and transformedproperties in epithelial cellsrdquo The Journal of Biological Chem-istry vol 278 no 46 pp 45801ndash45810 2003

[29] H Porsch B Bernert M Mehic A D Theocharis C HHeldin and P Heldin ldquoEfficient TGF120573-induced epithelial-mesenchymal transition depends on hyaluronan synthaseHAS2rdquo Oncogene vol 32 no 37 pp 4355ndash4365 2013

[30] A Kultti K Rilla R Tiihonen A P Spicer RH Tammi andMI Tammi ldquoHyaluronan synthesis induces microvillus-like cellsurface protrusionsrdquo Journal of Biological Chemistry vol 281no 23 pp 15821ndash15828 2006

[31] K Rilla S Pasonen-Seppanen A J Deen et al ldquoHyaluronanproduction enhances shedding of plasma membrane-derivedmicrovesiclesrdquo Experimental Cell Research vol 319 no 13 pp2006ndash2018 2013

[32] K Rilla S Pasonen-Seppanen R Karna et al ldquoHAS3-inducedaccumulation of hyaluronan in 3D MDCK cultures results inmitotic spindle misorientation and disturbed organization ofepitheliumrdquo Histochemistry and Cell Biology vol 137 no 2 pp153ndash164 2012

[33] J C Pease and J S Tirnauer ldquoMitotic spindle misorientationin cancermdashout of alignment and into the firerdquo Journal of CellScience vol 124 no 7 pp 1007ndash1016 2011

[34] E Karousou M Kamiryo S S Skandalis et al ldquoThe activityof hyaluronan synthase 2 is regulated by dimerization andubiquitinationrdquo Journal of Biological Chemistry vol 285 no 31pp 23647ndash23654 2010

[35] C L Scaife J E Shea Q Dai M A Firpo G D Prestwich andS J Mulvihill ldquoSynthetic extracellular matrix enhances tumorgrowth andmetastasis in an orthotopicmousemodel of pancre-atic adenocarcinomardquo Journal of Gastrointestinal Surgery vol12 no 6 pp 1074ndash1080 2008

[36] L Udabage G R Brownlee M Waltham et al ldquoAntisense-mediated suppression of hyaluronan synthase 2 inhibits thetumorigenesis and progression of breast cancerrdquo CancerResearch vol 65 no 14 pp 6139ndash6150 2005

[37] M A Simpson CMWilson and J BMcCarthy ldquoInhibition ofprostate tumor cell hyaluronan synthesis impairs subcutaneousgrowth and vascularization in immunocompromisedmicerdquoTheAmerican Journal of Pathology vol 161 no 3 pp 849ndash857 2002

[38] S Twarock T Freudenberger E Poscher et al ldquoInhibition ofoesophageal squamous cell carcinoma progression by in vivotargeting of hyaluronan synthesisrdquo Molecular Cancer vol 10article 30 2011

[39] H Urakawa Y Nishida JWasa et al ldquoInhibition of hyaluronansynthesis in breast cancer cells by 4-methylumbelliferone sup-presses tumorigenicity in vitro and metastatic lesions of bonein vivordquo International Journal of Cancer vol 130 no 2 pp 454ndash466 2012

[40] S Yoshihara A Kon D Kudo et al ldquoA hyaluronan synthasesuppressor 4-methylumbelliferone inhibits liver metastasis ofmelanoma cellsrdquo FEBS Letters vol 579 no 12 pp 2722ndash27262005

[41] M Hajime Y Shuichi N Makoto et al ldquoInhibitory effect of4-methylesculetin on hyaluronan synthesis slows the develop-ment of human pancreatic cancer in vitro and in nude micerdquoInternational Journal of Cancer vol 120 no 12 pp 2704ndash27092007

[42] P Jiang X Li C B Thompson et al ldquoEffective targeting ofthe tumor microenvironment for cancer therapyrdquo AnticancerResearch vol 32 no 4 pp 1203ndash1212 2012

[43] H Koyama T Hibi Z Isogai et al ldquoHyperproduction ofhyaluronan in neu-inducedmammary tumor accelerates angio-genesis through stromal cell recruitment possible involvementof versicanPG-MrdquoThe American Journal of Pathology vol 170no 3 pp 1086ndash1099 2007

[44] T K Nykopp K Rilla M I Tammi et al ldquoHyaluronan syn-thases (HAS1-3) and hyaluronidases (HYAL1-2) in the accumu-lation of hyaluronan in endometrioid endometrial carcinomardquoBMC Cancer vol 10 article 512 2010

[45] N Liu F Gao Z Han X Xu C B Underhill and L ZhangldquoHyaluronan synthase 3 overexpression promotes the growth ofTSU prostate cancer cellsrdquo Cancer Research vol 61 no 13 pp5207ndash5214 2001

[46] S R Hingorani L Wang A S Multani et al ldquoTrp53R172H andKrasG12D cooperate to promote chromosomal instability andwidely metastatic pancreatic ductal adenocarcinoma in micerdquoCancer Cell vol 7 no 5 pp 469ndash483 2005

[47] K P Olive M A Jacobetz C J Davidson et al ldquoInhibitionof Hedgehog signaling enhances delivery of chemotherapy ina mouse model of pancreatic cancerrdquo Science vol 324 no 5933pp 1457ndash1461 2009

[48] H Okuda A Kobayashi B Xia et al ldquoHyaluronan synthaseHAS2 promotes tumor progression in bone by stimulating theinteraction of breast cancer stem-like cells with macrophagesand stromal cellsrdquo Cancer Research vol 72 no 2 pp 537ndash5472012

[49] S Karvinen S Pasonen-Seppanen J M T Hyttinen et al ldquoKer-atinocyte growth factor stimulates migration and hyaluronansynthesis in the epidermis by activation of keratinocyte hyaluro-nan synthases 2 and 3rdquoThe Journal of Biological Chemistry vol278 no 49 pp 49495ndash49504 2003

[50] L Udabage G R Brownlee S K Nilsson and T J Brown ldquoTheover-expression ofHAS2Hyal-2 and CD44 is implicated in theinvasiveness of breast cancerrdquo Experimental Cell Research vol310 no 1 pp 205ndash217 2005

[51] P Heldin K Basu B Olofsson H Porsch I Kozlova andK Kahata ldquoDeregulation of hyaluronan synthesis degradation


and binding promotes breast cancerrdquo Journal of Biochemistryvol 154 no 5 pp 395ndash408 2013

[52] B P Teng M D Heffler E C Lai et al ldquoInhibition ofhyaluronan synthase-3 decreases subcutaneous colon cancergrowth by increasing apoptosisrdquo Anti-Cancer Agents in Medici-nal Chemistry vol 11 no 7 pp 620ndash628 2011

[53] M M Al-Aynati N Radulovich R H Riddell and M TsaoldquoEpithelial-cadherin and 120573-catenin expression changes in pan-creatic intraepithelial neoplasiardquo Clinical Cancer Research vol10 no 4 pp 1235ndash1240 2004

[54] R Kalluri and R A Weinberg ldquoThe basics of epithelial-mesenchymal transitionrdquo The Journal of Clinical Investigationvol 119 no 6 pp 1420ndash1428 2009

[55] T Ohtani A Memezawa R Okuyama et al ldquoIncreasedhyaluronan production and decreased E-cadherin expressionby cytokine-stimulated keratinocytes lead to spongiosis forma-tionrdquo Journal of Investigative Dermatology vol 129 no 6 pp1412ndash1420 2009

[56] J Lei J Ma QMa et al ldquoHedgehog signaling regulates hypoxiainduced epithelial to mesenchymal transition and invasionin pancreatic cancer cells via a ligand-independent mannerrdquoMolecular Cancer vol 12 no 1 article 66 2013

[57] L Zhang G Huang X Li et al ldquoHypoxia induces epithelial-mesenchymal transition via activation of SNAI1 by hypoxia-inducible factor -1120572 in hepatocellular carcinomardquo BMC Cancervol 13 article 108 2013

[58] S Meran D Thomas P Stephens et al ldquoInvolvement ofhyaluronan in regulation of fibroblast phenotyperdquo The Journalof Biological Chemistry vol 282 no 35 pp 25687ndash25697 2007

[59] S Misra L M Obeid Y A Hannun et al ldquoHyaluronan con-stitutively regulates activation of COX-2-mediated cell survivalactivity in intestinal epithelial and colon carcinoma cellsrdquo TheJournal of Biological Chemistry vol 283 no 21 pp 14335ndash143442008

[60] T S Wilkinson S L Bressler S P Evanko K R Braunand T N Wight ldquoOverexpression of hyaluronan synthasesalters vascular smooth muscle cell phenotype and promotesmonocyte adhesionrdquo Journal of Cellular Physiology vol 206 no2 pp 378ndash385 2006

[61] H Koyama N Kobayashi M Harada et al ldquoSignificanceof tumor-associated stroma in promotion of intratumorallymphangiogenesis pivotal role of a hyaluronan-rich tumormicroenvironmentrdquoTheAmerican Journal of Pathology vol 172no 1 pp 179ndash193 2008

Submit your manuscripts athttpwwwhindawicom

PainResearch and TreatmentHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom

Volume 2014

ToxinsJournal of

VaccinesJournal of

Hindawi Publishing Corporation httpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

AntibioticsInternational Journal of

ToxicologyJournal of


StrokeResearch and TreatmentHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Drug DeliveryJournal of



Advances in Pharmacological Sciences

Tropical MedicineJournal of


Medicinal ChemistryInternational Journal of


AddictionJournal of



BioMed Research International

Emergency Medicine InternationalHindawi Publishing Corporationhttpwwwhindawicom Volume 2014


Autoimmune Diseases


Anesthesiology Research and Practice

ScientificaHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of


Pharmaceutics


MEDIATORSINFLAMMATION

of


tumor interstitial fluid pressure and poor perfusion can benormalized by hyaluronan depletion from the tumor [6 9] Inaddition hypoxia often found in advanced solid tumors andcharacterized by upregulation of hypoxia-inducible factor-1120572(HIF-1120572) [11] has been associated with increased hyaluronanaccumulation [11 12]

The hyaluronan molecule composed of 2000ndash25000disaccharides with molecular weight of 1ndash10 million Da issynthesized at the plasma membrane by three transmem-brane synthases (HAS1-3) and is simultaneously extruded toextracellular space Hyaluronan interacts with several bind-ing proteins and can be incorporated into the extracellularmatrix or bound to its cell surface receptors Hyaluronanbinding to its best-characterized receptor CD44 inducesactivation of the PI3K-Akt and MAP kinase pathways andpromotes tumor cell proliferation invasion and chemore-sistance [13 14] Accumulation of intracellular hyaluronanis also found in several cell types [15ndash17] where it hasbeen suggested to be a result of hyaluronan endocytosisand degradation [18] or activation of intracellular hyaluro-nan synthesis [17 19] Hyaluronan is degraded mainly bythe hyaluronidase-1 (HYAL1) and hyaluronidase-2 (HYAL2)enzymes [20] In addition to hyaluronidases exoglycosidasesand reactive oxygen species are known to participate in thedegradation of high molecular weight hyaluronan to smallerfragments [21] Recently KIAA1199 has been suggested tobe a hyaluronan binding protein and may be involved inhyaluronan degradation that is independent of CD44 andHYAL enzymes [22]

Hyaluronan synthases share 57ndash71 identity at the aminoacid level [23] but have different expression patterns differin their enzymatic properties and are differentially regulated[24] Overexpression of any of the HAS genes in COS-1and rat fibroblasts leads to the formation of a pericellu-lar hyaluronan coat where HAS1 produces smaller coatscompared to HAS2 or HAS3 [25 26] The HAS2 isoformhas been most studied and is the only isoform requiredfor embryonic development [27] HAS2 is believed to bethe main HAS in epithelial cells and has been reported tomediate epithelial-mesenchymal transition (EMT) [28 29]Overexpression of HAS3 leads to the formation of longplasma membrane protrusions [30] which have recentlybeen associated with the increased release of hyaluronan-coated and plasma membrane-derived microvesicles [31]Moreover overexpression of HAS3 has been reported toinduce misorientation of the mitotic spindle and disturbedorganization of epithelium [32] which is associated withmalignancies [33] Recently HASs have also been suggestedto form homodimers and heterodimers which may affecttheir function and regulate their activity [24 34]

In human pancreatic cancer 87 of tumors contain highlevels of hyaluronan [4ndash6] Similarly extensive hyaluronandeposition is also found in a transgenic mouse model (LSL-KrasG12D+ LSLTrp53R172H+ and Pdx-1-Cre (KPC)) of pancre-atic adenocarcinoma [4 6]The importance of hyaluronan inthe pancreatic cancermicroenvironment is further supportedby the finding that pancreatic cancer cells encapsulatedwithin hyaluronan gel produce faster growing tumors and are

more metastatic than cancer cells with no hyaluronan in amouse model [35] Suppression of hyaluronan synthesis bydownregulation ofHASs has beenpreviously shown to inhibitthe growth of implanted breast prostate squamous cellcarcinoma and osteosarcoma tumors [15 36ndash38] Similarlyhyaluronan synthesis inhibitor 4-methylumbelliferone or itsderivatives suppress metastasis of several tumor types [38ndash41]

In agreement with previous findings enzymatic removalof hyaluronan by pegylated human recombinant hyaluroni-dase (PEGPH20) leads to suppression of tumor growthand metastasis and enhanced delivery of chemotherapy inhyaluronan-rich tumormodels of prostate lung and pancre-atic cancer [5 9 42] In the KPC mouse model of pancre-atic adenocarcinoma that closely resembles human diseasePEGPH20 suppressed tumor growth increased drug deliveryand increased overall survival when used in combinationwith gemcitabine compared to gemcitabine monotherapy [46] Increased drug delivery of gemcitabine was associatedwith stromal remodeling reduction of tumor interstitialfluid pressure expansion of intratumoral blood vessels andultrastructural changes in tumor endothelium characterizedas formation of fenestrae in tumor endothelium [4 6]

Over the years HAS2 has been the focus of mostresearch in this area and has been widely associated withmalignant transformation and aggressive tumor growth [2829 43] However elevated HAS3 protein levels have alsobeen associated with ovarian cancer [44] and overexpressionof HAS3 promotes tumor growth in a preclinical model[45] Regulation and possible differential mechanisms ofHAS2- andHAS3-mediated tumor growth are not completelyunderstood To date there are no reports comparing theroles of HAS2 and HAS3 in pancreatic cancer In thisstudy we explored the biological consequences of HAS2and HAS3 overexpression in BxPC-3 pancreatic cancer cellsand in xenograft tumor models HAS3 overexpression led toincreased accumulation of extracellular hyaluronan that wasassociated with faster tumor growth and enhanced responseto PEGPH20 Deposition of extracellular hyaluronan wasassociated with loss of adhesion proteins from the plasmamembrane that was inhibited by hyaluronan depletionTheseresults are further supported by the finding that more plasmamembrane E-cadherin was observed in KPC tumors as wellas in a human non-small cell lung cancer (NSCLC) patientbiopsy after PEGPH20 therapy

2 Material and Methods

21 Cell Lines BxPC-3 cells were obtained from AmericanType Culture Collection (Manassas VA) BxPC-3 cells andlentiviral-transduced BxPC-3 cell lines overexpressing emptyvector HAS2 or HAS3 were cultured in RPMI medium withL-glutamine (Cat 10-040-CV CellgroMediatechManassasVA) containing 10 fetal bovine serum (Foundation B Gem-ini Bio-Products Sacramento CA) at 37∘C in a humidifiedincubator supplied with 5 CO

25 air For experimental

use cells were thawed andmaintained in culture for no longerthan 10 passages Each cell line was routinely tested negative

















2O2 followed







2with



















BxPC

-3

BxPC

-3H

AS2

BxPC

-3H

AS3

Extracellular

Hya

luro

nan

( o

f BxP

C-3

cells

)

10000

1000

100

10

(a)

lowastlowast

BxPC

-3

BxPC

-3H

AS2

BxPC

-3H

AS3

Hya

luro

nan

( o

f BxP

C-3

cells

)

10000

1000

100

10

Intracellular

(b)

(c) (d) (e)





0

500

1000

1500

2000

2500

PEGPH20 (120583gkg)

Hya

luro

nan

(ng

mg)

0 375 1000 0 375 1000 0 375 1000

lowastlowastlowast

lowastlowastlowast

BxPC-3 BxPC-3HAS2

BxPC-3HAS3

Vehi

clePE

GPH

20

Hamp

E st

aini

ng

Vehi

clePE

GPH

20

bHA

BP st

aini

ng


(a) (b) (c)

(d) (e) (f)

(g) (h) (i)

(j) (k) (l)

(m)



0 5 10 15 20 25300

600

900

1200

1500

1800

2100

Vehicle

PEGPH20

Time (days)

BxPC-3

P lt 001Tu

mor

vol

ume (

mm

3)plusmn

SEM

(a)

0 5 10 15 20 25300

600

900

1200

1500

1800

2100

Vehicle

PEGPH20

Time (days)

P lt 0001

BxPC-3 HAS2

Tum

or v

olum

e (m

m3)plusmn

SEM

(b)

0 5 10 15 20 25300

600

900

1200

1500

1800

2100

Vehicle

PEGPH20

Time (days)

P lt 0001

BxPC-3 HAS3

Tum

or v

olum

e (m

m3)plusmn

SEM

(c)











Vehi

clePE

GPH

20E-ca

dher

in st

aini

ng


(a)

Vehi

clePE

GPH

20


120573-c

aten

in st

aini

ng

(b)

Control

E-ca

dher

in st

aini

ng

8h

24h 72h

(c)

Post-PEGPH20

Pre-PEGPH20

(d)



Vehicle PEGPH20

1 2 3 1 2 3

HIF-1120572

120573-actionSample

BxPC-3

Vehicle PEGPH20

1 2 3 1 2 3

HIF-1120572

120573-actionSample

BxPC-3 HAS3

0

2

4

6

8

Inte

nsity

ratio

(HIF

-1120573

-act

ion)


lowastlowast

lowastlowastlowast

BxPC-3 BxPC-3HAS3

Vehicle PEGPH20

1 2 3 1 2 3Sample

BxPC-3

Snail

H3

Vehicle PEGPH20

1 2 3 1 2Sample

Snail

H3

BxPC-3 HAS3


lowast

BxPC-3 BxPC-3HAS3

00

05

10

15

20In

tens

ity ra

tio (S

nail-

Hist

one3

)

(a)

(b)

(c)

(d)

(e)

(f)





Vehi

cle

PEG

PH20

Vehi

cle

PEG

PH20

Vehi

cle

PEG

PH20

0

1

2

3

4 lowastlowast

BxPC-3 BxPC-3HAS2

BxPC-3HAS3

CC3+

cells

( o

f tot

al p

ixels

)

(a)

00

05

10

15

20

PH3+

cells

( o

f tot

al ce

lls)

Vehi

cle

PEG

PH20

Vehi

cle

PEG

PH20

Vehi

cle

PEG

PH20

BxPC-3 BxPC-3HAS2

BxPC-3HAS3

(b)



4 Conclusions















Acknowledgments


References





































































Volume 2014

ToxinsJournal of

VaccinesJournal of















AddictionJournal of






Autoimmune Diseases




Journal of


Pharmaceutics



of

















2O2 followed







2with



















BxPC

-3

BxPC

-3H

AS2

BxPC

-3H

AS3

Extracellular

Hya

luro

nan

( o

f BxP

C-3

cells

)

10000

1000

100

10

(a)

lowastlowast

BxPC

-3

BxPC

-3H

AS2

BxPC

-3H

AS3

Hya

luro

nan

( o

f BxP

C-3

cells

)

10000

1000

100

10

Intracellular

(b)

(c) (d) (e)





0

500

1000

1500

2000

2500

PEGPH20 (120583gkg)

Hya

luro

nan

(ng

mg)

0 375 1000 0 375 1000 0 375 1000

lowastlowastlowast

lowastlowastlowast

BxPC-3 BxPC-3HAS2

BxPC-3HAS3

Vehi

clePE

GPH

20

Hamp

E st

aini

ng

Vehi

clePE

GPH

20

bHA

BP st

aini

ng


(a) (b) (c)

(d) (e) (f)

(g) (h) (i)

(j) (k) (l)

(m)



0 5 10 15 20 25300

600

900

1200

1500

1800

2100

Vehicle

PEGPH20

Time (days)

BxPC-3

P lt 001Tu

mor

vol

ume (

mm

3)plusmn

SEM

(a)

0 5 10 15 20 25300

600

900

1200

1500

1800

2100

Vehicle

PEGPH20

Time (days)

P lt 0001

BxPC-3 HAS2

Tum

or v

olum

e (m

m3)plusmn

SEM

(b)

0 5 10 15 20 25300

600

900

1200

1500

1800

2100

Vehicle

PEGPH20

Time (days)

P lt 0001

BxPC-3 HAS3

Tum

or v

olum

e (m

m3)plusmn

SEM

(c)











Vehi

clePE

GPH

20E-ca

dher

in st

aini

ng


(a)

Vehi

clePE

GPH

20


120573-c

aten

in st

aini

ng

(b)

Control

E-ca

dher

in st

aini

ng

8h

24h 72h

(c)

Post-PEGPH20

Pre-PEGPH20

(d)



Vehicle PEGPH20

1 2 3 1 2 3

HIF-1120572

120573-actionSample

BxPC-3

Vehicle PEGPH20

1 2 3 1 2 3

HIF-1120572

120573-actionSample

BxPC-3 HAS3

0

2

4

6

8

Inte

nsity

ratio

(HIF

-1120573

-act

ion)


lowastlowast

lowastlowastlowast

BxPC-3 BxPC-3HAS3

Vehicle PEGPH20

1 2 3 1 2 3Sample

BxPC-3

Snail

H3

Vehicle PEGPH20

1 2 3 1 2Sample

Snail

H3

BxPC-3 HAS3


lowast

BxPC-3 BxPC-3HAS3

00

05

10

15

20In

tens

ity ra

tio (S

nail-

Hist

one3

)

(a)

(b)

(c)

(d)

(e)

(f)





Vehi

cle

PEG

PH20

Vehi

cle

PEG

PH20

Vehi

cle

PEG

PH20

0

1

2

3

4 lowastlowast

BxPC-3 BxPC-3HAS2

BxPC-3HAS3

CC3+

cells

( o

f tot

al p

ixels

)

(a)

00

05

10

15

20

PH3+

cells

( o

f tot

al ce

lls)

Vehi

cle

PEG

PH20

Vehi

cle

PEG

PH20

Vehi

cle

PEG

PH20

BxPC-3 BxPC-3HAS2

BxPC-3HAS3

(b)



4 Conclusions















Acknowledgments


References





































































Volume 2014

ToxinsJournal of

VaccinesJournal of















AddictionJournal of






Autoimmune Diseases




Journal of


Pharmaceutics



of
















BxPC

-3

BxPC

-3H

AS2

BxPC

-3H

AS3

Extracellular

Hya

luro

nan

( o

f BxP

C-3

cells

)

10000

1000

100

10

(a)

lowastlowast

BxPC

-3

BxPC

-3H

AS2

BxPC

-3H

AS3

Hya

luro

nan

( o

f BxP

C-3

cells

)

10000

1000

100

10

Intracellular

(b)

(c) (d) (e)





0

500

1000

1500

2000

2500

PEGPH20 (120583gkg)

Hya

luro

nan

(ng

mg)

0 375 1000 0 375 1000 0 375 1000

lowastlowastlowast

lowastlowastlowast

BxPC-3 BxPC-3HAS2

BxPC-3HAS3

Vehi

clePE

GPH

20

Hamp

E st

aini

ng

Vehi

clePE

GPH

20

bHA

BP st

aini

ng


(a) (b) (c)

(d) (e) (f)

(g) (h) (i)

(j) (k) (l)

(m)



0 5 10 15 20 25300

600

900

1200

1500

1800

2100

Vehicle

PEGPH20

Time (days)

BxPC-3

P lt 001Tu

mor

vol

ume (

mm

3)plusmn

SEM

(a)

0 5 10 15 20 25300

600

900

1200

1500

1800

2100

Vehicle

PEGPH20

Time (days)

P lt 0001

BxPC-3 HAS2

Tum

or v

olum

e (m

m3)plusmn

SEM

(b)

0 5 10 15 20 25300

600

900

1200

1500

1800

2100

Vehicle

PEGPH20

Time (days)

P lt 0001

BxPC-3 HAS3

Tum

or v

olum

e (m

m3)plusmn

SEM

(c)











Vehi

clePE

GPH

20E-ca

dher

in st

aini

ng


(a)

Vehi

clePE

GPH

20


120573-c

aten

in st

aini

ng

(b)

Control

E-ca

dher

in st

aini

ng

8h

24h 72h

(c)

Post-PEGPH20

Pre-PEGPH20

(d)



Vehicle PEGPH20

1 2 3 1 2 3

HIF-1120572

120573-actionSample

BxPC-3

Vehicle PEGPH20

1 2 3 1 2 3

HIF-1120572

120573-actionSample

BxPC-3 HAS3

0

2

4

6

8

Inte

nsity

ratio

(HIF

-1120573

-act

ion)


lowastlowast

lowastlowastlowast

BxPC-3 BxPC-3HAS3

Vehicle PEGPH20

1 2 3 1 2 3Sample

BxPC-3

Snail

H3

Vehicle PEGPH20

1 2 3 1 2Sample

Snail

H3

BxPC-3 HAS3


lowast

BxPC-3 BxPC-3HAS3

00

05

10

15

20In

tens

ity ra

tio (S

nail-

Hist

one3

)

(a)

(b)

(c)

(d)

(e)

(f)





Vehi

cle

PEG

PH20

Vehi

cle

PEG

PH20

Vehi

cle

PEG

PH20

0

1

2

3

4 lowastlowast

BxPC-3 BxPC-3HAS2

BxPC-3HAS3

CC3+

cells

( o

f tot

al p

ixels

)

(a)

00

05

10

15

20

PH3+

cells

( o

f tot

al ce

lls)

Vehi

cle

PEG

PH20

Vehi

cle

PEG

PH20

Vehi

cle

PEG

PH20

BxPC-3 BxPC-3HAS2

BxPC-3HAS3

(b)



4 Conclusions















Acknowledgments


References





































































Volume 2014

ToxinsJournal of

VaccinesJournal of















AddictionJournal of






Autoimmune Diseases




Journal of


Pharmaceutics



of


0

500

1000

1500

2000

2500

PEGPH20 (120583gkg)

Hya

luro

nan

(ng

mg)

0 375 1000 0 375 1000 0 375 1000

lowastlowastlowast

lowastlowastlowast

BxPC-3 BxPC-3HAS2

BxPC-3HAS3

Vehi

clePE

GPH

20

Hamp

E st

aini

ng

Vehi

clePE

GPH

20

bHA

BP st

aini

ng


(a) (b) (c)

(d) (e) (f)

(g) (h) (i)

(j) (k) (l)

(m)



0 5 10 15 20 25300

600

900

1200

1500

1800

2100

Vehicle

PEGPH20

Time (days)

BxPC-3

P lt 001Tu

mor

vol

ume (

mm

3)plusmn

SEM

(a)

0 5 10 15 20 25300

600

900

1200

1500

1800

2100

Vehicle

PEGPH20

Time (days)

P lt 0001

BxPC-3 HAS2

Tum

or v

olum

e (m

m3)plusmn

SEM

(b)

0 5 10 15 20 25300

600

900

1200

1500

1800

2100

Vehicle

PEGPH20

Time (days)

P lt 0001

BxPC-3 HAS3

Tum

or v

olum

e (m

m3)plusmn

SEM

(c)











Vehi

clePE

GPH

20E-ca

dher

in st

aini

ng


(a)

Vehi

clePE

GPH

20


120573-c

aten

in st

aini

ng

(b)

Control

E-ca

dher

in st

aini

ng

8h

24h 72h

(c)

Post-PEGPH20

Pre-PEGPH20

(d)



Vehicle PEGPH20

1 2 3 1 2 3

HIF-1120572

120573-actionSample

BxPC-3

Vehicle PEGPH20

1 2 3 1 2 3

HIF-1120572

120573-actionSample

BxPC-3 HAS3

0

2

4

6

8

Inte

nsity

ratio

(HIF

-1120573

-act

ion)


lowastlowast

lowastlowastlowast

BxPC-3 BxPC-3HAS3

Vehicle PEGPH20

1 2 3 1 2 3Sample

BxPC-3

Snail

H3

Vehicle PEGPH20

1 2 3 1 2Sample

Snail

H3

BxPC-3 HAS3


lowast

BxPC-3 BxPC-3HAS3

00

05

10

15

20In

tens

ity ra

tio (S

nail-

Hist

one3

)

(a)

(b)

(c)

(d)

(e)

(f)





Vehi

cle

PEG

PH20

Vehi

cle

PEG

PH20

Vehi

cle

PEG

PH20

0

1

2

3

4 lowastlowast

BxPC-3 BxPC-3HAS2

BxPC-3HAS3

CC3+

cells

( o

f tot

al p

ixels

)

(a)

00

05

10

15

20

PH3+

cells

( o

f tot

al ce

lls)

Vehi

cle

PEG

PH20

Vehi

cle

PEG

PH20

Vehi

cle

PEG

PH20

BxPC-3 BxPC-3HAS2

BxPC-3HAS3

(b)



4 Conclusions















Acknowledgments


References





































































Volume 2014

ToxinsJournal of

VaccinesJournal of















AddictionJournal of






Autoimmune Diseases




Journal of


Pharmaceutics



of


0 5 10 15 20 25300

600

900

1200

1500

1800

2100

Vehicle

PEGPH20

Time (days)

BxPC-3

P lt 001Tu

mor

vol

ume (

mm

3)plusmn

SEM

(a)

0 5 10 15 20 25300

600

900

1200

1500

1800

2100

Vehicle

PEGPH20

Time (days)

P lt 0001

BxPC-3 HAS2

Tum

or v

olum

e (m

m3)plusmn

SEM

(b)

0 5 10 15 20 25300

600

900

1200

1500

1800

2100

Vehicle

PEGPH20

Time (days)

P lt 0001

BxPC-3 HAS3

Tum

or v

olum

e (m

m3)plusmn

SEM

(c)











Vehi

clePE

GPH

20E-ca

dher

in st

aini

ng


(a)

Vehi

clePE

GPH

20


120573-c

aten

in st

aini

ng

(b)

Control

E-ca

dher

in st

aini

ng

8h

24h 72h

(c)

Post-PEGPH20

Pre-PEGPH20

(d)



Vehicle PEGPH20

1 2 3 1 2 3

HIF-1120572

120573-actionSample

BxPC-3

Vehicle PEGPH20

1 2 3 1 2 3

HIF-1120572

120573-actionSample

BxPC-3 HAS3

0

2

4

6

8

Inte

nsity

ratio

(HIF

-1120573

-act

ion)


lowastlowast

lowastlowastlowast

BxPC-3 BxPC-3HAS3

Vehicle PEGPH20

1 2 3 1 2 3Sample

BxPC-3

Snail

H3

Vehicle PEGPH20

1 2 3 1 2Sample

Snail

H3

BxPC-3 HAS3


lowast

BxPC-3 BxPC-3HAS3

00

05

10

15

20In

tens

ity ra

tio (S

nail-

Hist

one3

)

(a)

(b)

(c)

(d)

(e)

(f)





Vehi

cle

PEG

PH20

Vehi

cle

PEG

PH20

Vehi

cle

PEG

PH20

0

1

2

3

4 lowastlowast

BxPC-3 BxPC-3HAS2

BxPC-3HAS3

CC3+

cells

( o

f tot

al p

ixels

)

(a)

00

05

10

15

20

PH3+

cells

( o

f tot

al ce

lls)

Vehi

cle

PEG

PH20

Vehi

cle

PEG

PH20

Vehi

cle

PEG

PH20

BxPC-3 BxPC-3HAS2

BxPC-3HAS3

(b)



4 Conclusions















Acknowledgments


References





































































Volume 2014

ToxinsJournal of

VaccinesJournal of















AddictionJournal of






Autoimmune Diseases




Journal of


Pharmaceutics



of








Vehi

clePE

GPH

20E-ca

dher

in st

aini

ng


(a)

Vehi

clePE

GPH

20


120573-c

aten

in st

aini

ng

(b)

Control

E-ca

dher

in st

aini

ng

8h

24h 72h

(c)

Post-PEGPH20

Pre-PEGPH20

(d)



Vehicle PEGPH20

1 2 3 1 2 3

HIF-1120572

120573-actionSample

BxPC-3

Vehicle PEGPH20

1 2 3 1 2 3

HIF-1120572

120573-actionSample

BxPC-3 HAS3

0

2

4

6

8

Inte

nsity

ratio

(HIF

-1120573

-act

ion)


lowastlowast

lowastlowastlowast

BxPC-3 BxPC-3HAS3

Vehicle PEGPH20

1 2 3 1 2 3Sample

BxPC-3

Snail

H3

Vehicle PEGPH20

1 2 3 1 2Sample

Snail

H3

BxPC-3 HAS3


lowast

BxPC-3 BxPC-3HAS3

00

05

10

15

20In

tens

ity ra

tio (S

nail-

Hist

one3

)

(a)

(b)

(c)

(d)

(e)

(f)





Vehi

cle

PEG

PH20

Vehi

cle

PEG

PH20

Vehi

cle

PEG

PH20

0

1

2

3

4 lowastlowast

BxPC-3 BxPC-3HAS2

BxPC-3HAS3

CC3+

cells

( o

f tot

al p

ixels

)

(a)

00

05

10

15

20

PH3+

cells

( o

f tot

al ce

lls)

Vehi

cle

PEG

PH20

Vehi

cle

PEG

PH20

Vehi

cle

PEG

PH20

BxPC-3 BxPC-3HAS2

BxPC-3HAS3

(b)



4 Conclusions















Acknowledgments


References





































































Volume 2014

ToxinsJournal of

VaccinesJournal of















AddictionJournal of






Autoimmune Diseases




Journal of


Pharmaceutics



of


Vehicle PEGPH20

1 2 3 1 2 3

HIF-1120572

120573-actionSample

BxPC-3

Vehicle PEGPH20

1 2 3 1 2 3

HIF-1120572

120573-actionSample

BxPC-3 HAS3

0

2

4

6

8

Inte

nsity

ratio

(HIF

-1120573

-act

ion)


lowastlowast

lowastlowastlowast

BxPC-3 BxPC-3HAS3

Vehicle PEGPH20

1 2 3 1 2 3Sample

BxPC-3

Snail

H3

Vehicle PEGPH20

1 2 3 1 2Sample

Snail

H3

BxPC-3 HAS3


lowast

BxPC-3 BxPC-3HAS3

00

05

10

15

20In

tens

ity ra

tio (S

nail-

Hist

one3

)

(a)

(b)

(c)

(d)

(e)

(f)





Vehi

cle

PEG

PH20

Vehi

cle

PEG

PH20

Vehi

cle

PEG

PH20

0

1

2

3

4 lowastlowast

BxPC-3 BxPC-3HAS2

BxPC-3HAS3

CC3+

cells

( o

f tot

al p

ixels

)

(a)

00

05

10

15

20

PH3+

cells

( o

f tot

al ce

lls)

Vehi

cle

PEG

PH20

Vehi

cle

PEG

PH20

Vehi

cle

PEG

PH20

BxPC-3 BxPC-3HAS2

BxPC-3HAS3

(b)



4 Conclusions















Acknowledgments


References





































































Volume 2014

ToxinsJournal of

VaccinesJournal of















AddictionJournal of






Autoimmune Diseases




Journal of


Pharmaceutics



of


Vehi

cle

PEG

PH20

Vehi

cle

PEG

PH20

Vehi

cle

PEG

PH20

0

1

2

3

4 lowastlowast

BxPC-3 BxPC-3HAS2

BxPC-3HAS3

CC3+

cells

( o

f tot

al p

ixels

)

(a)

00

05

10

15

20

PH3+

cells

( o

f tot

al ce

lls)

Vehi

cle

PEG

PH20

Vehi

cle

PEG

PH20

Vehi

cle

PEG

PH20

BxPC-3 BxPC-3HAS2

BxPC-3HAS3

(b)



4 Conclusions















Acknowledgments


References





































































Volume 2014

ToxinsJournal of

VaccinesJournal of















AddictionJournal of






Autoimmune Diseases




Journal of


Pharmaceutics



of









Acknowledgments


References





































































Volume 2014

ToxinsJournal of

VaccinesJournal of















AddictionJournal of






Autoimmune Diseases




Journal of


Pharmaceutics



of
















































Volume 2014

ToxinsJournal of

VaccinesJournal of















AddictionJournal of






Autoimmune Diseases




Journal of


Pharmaceutics



of

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