Most people studying the obesity
paradox in kidney cancer think that changing medical guidelines to endorse obesity or weight gain rather than weight reduction is misguided.
The Hopkins scientists report that the loss of a single gene
in kidney cancer cells causes them to stop making mitochondria, the tiny powerhouses of the cell that consume oxygen to generate energy.
This study is a thorough analysis, because overexpressed genes were functionally
tested in kidney cancer cells to ensure they were important to some aspect of the cancer process, says the study's senior investigator, molecular biologist, John A. Copland, Ph.D..
The researchers also discovered that a receptor — known as GluR4 — that the NPTX2 protein usually targets in the brain is also
found in the kidney cancer samples.
Co-author Derek Radisky, Ph.D., a cancer biologist, then searched for prevalence of the NPTX2
gene in kidney cancer using nine public genomic datasets, representing thousands of patients, and found it to be the top aberrantly expressed gene associated with this cancer.
«This is a seminal step in identifying key pathways and molecules
involved in kidney cancer so that specific therapies that target these new genes can be developed to treat this cancer.»
«The power of this study is that we looked at genes discovered to be over-expressed in patients» tumors and determined their
function in kidney cancer, which has not been done on a large scale before,» he says.
The study not only shows that NPTX2 is
active in kidney cancer, but is the first to reveal that the gene is over-expressed in any human cancer.
«Nobody ever looked for NPTX2 as a potential tumor
promoter in kidney cancer or any other cancer, from what we can tell,» says Dr. Radisky.
«We don't know why NPTX2 is
expressed in kidney cancer, but we now know what it is doing and how it contributes to cancer progression,» he says.
Determining whether the obesity paradox is
valid in kidney cancer matters for clinicians who treat and manage the disease.
Rather than ratchet up the competition, the various players investigating the obesity paradox
in kidney cancer did something unusual in the cutthroat world of scientific research: they decided to collaborate.
Narrowing down their search, the Wucherpfennig team identified the PBAF subtype of the SWI / SNF chromatin remodeling complex — the same group of proteins implicated by the Van Allen and Choueiri
team in kidney cancer cells — as being involved in resistance to immune T cells.
Combination immunotherapy with nivolumab and ipilimumab as tested
in the kidney cancer study described here is already FDA - approved for treatment of melanoma, and is being tested for other cancers.
Ongoing
efforts in the Kidney Cancer Program focus on leveraging Nobel Prize - winning discoveries from UT Southwestern's Dr. Bruce Beutler leading to a new family of proteins that activate the immune system, the toll - like receptors.
The second clinical study COG - ANGIO (Pr Joly) demonstrated that antiangiogenics exert a direct negative impact on cognitive functions and
fatigue in kidney cancer patients.
Insights present opportunities to develop early detection and early intervention approaches in kidney cancer
«Because MYC is turned on in many other cancers, these results suggest that shutting down the mitochondria must be a very important
event in kidney cancer,» Semenza notes.
To understand the obesity
paradox in kidney cancer, some researchers are now homing in on the fat that surrounds the kidneys.
Study author, Dr Timothy Humphrey said «Mutations in SETD2 are frequently
found in kidney cancer and some childhood brain tumors, so we were excited when we discovered that a new drug we were studying specifically killed cancer cells with this mutation.»
Semenza and colleagues measured mitochondria content and oxygen use
in kidney cancer cells that contain no VHL protein and in the same cells with VHL «engineered» back in.
In kidney cancer, the over-expressed NPTX2 protein is secreted from the cell and then attaches itself to GluR4 on the kidney cancer cell membrane.
To further investigate the role of obesity
in kidney cancer, South Korean researchers identified 1,543 patients who had undergone surgery to remove a kidney tumour between 1994 and 2008.
That counter-intuitive finding added to a growing body of evidence for an obesity paradox
in kidney cancer.
When Hakimi, Furberg and colleagues started researching the obesity paradox
in kidney cancer, they looked into all the ways that their approach might skew the results.