TY - JOUR T1 - Extracellular Vesicles from Pancreatic Cancer Stem Cells Lead an Intratumor Communication Network (EVNet) to fuel tumour progression JF - Gut JO - Gut DO - 10.1136/gutjnl-2021-324994 SP - gutjnl-2021-324994 AU - Carolina F Ruivo AU - Nuno Bastos AU - Barbara Adem AU - Ines Batista AU - Cecilia Duraes AU - Carlos A Melo AU - Stephanie A Castaldo AU - Francisco Campos‐Laborie AU - Pedro Moutinho-Ribeiro AU - Barbara Morão AU - Ana Costa-Pinto AU - Soraia Silva AU - Hugo Osorio AU - Sergio Ciordia AU - Jose Luis Costa AU - David Goodrich AU - Bruno Cavadas AU - Luisa Pereira AU - Tony Kouzarides AU - Guilherme Macedo AU - Rui Maio AU - Fatima Carneiro AU - Marília Cravo AU - Raghu Kalluri AU - Jose Carlos Machado AU - Sonia A Melo Y1 - 2022/01/09 UR - http://gut.bmj.com/content/early/2022/01/09/gutjnl-2021-324994.abstract N2 - Objective Intratumor heterogeneity drives cancer progression and therapy resistance. However, it has yet to be determined whether and how subpopulations of cancer cells interact and how this interaction affects the tumour.Design We have studied the spontaneous flow of extracellular vesicles (EVs) between subpopulations of cancer cells: cancer stem cells (CSC) and non-stem cancer cells (NSCC). To determine the biological significance of the most frequent communication route, we used pancreatic ductal adenocarcinoma (PDAC) orthotopic models, patient-derived xenografts (PDXs) and genetically engineered mouse models (GEMMs).Results We demonstrate that PDAC tumours establish an organised communication network between subpopulations of cancer cells using EVs called the EVNet). The EVNet is plastic and reshapes in response to its environment. Communication within the EVNet occurs preferentially from CSC to NSCC. Inhibition of this communication route by impairing Rab27a function in orthotopic xenographs, GEMMs and PDXs is sufficient to hamper tumour growth and phenocopies the inhibition of communication in the whole tumour. Mechanistically, we provide evidence that CSC EVs use agrin protein to promote Yes1 associated transcriptional regulator (YAP) activation via LDL receptor related protein 4 (LRP-4). Ex vivo treatment of PDXs with antiagrin significantly impairs proliferation and decreases the levels of activated YAP.Patients with high levels of agrin and low inactive YAP show worse disease-free survival. In addition, patients with a higher number of circulating agrin+ EVs show a significant increased risk of disease progression.Conclusion PDAC tumours establish a cooperation network mediated by EVs that is led by CSC and agrin, which allows tumours to adapt and thrive. Targeting agrin could make targeted therapy possible for patients with PDAC and has a significant impact on CSC that feeds the tumour and is at the centre of therapy resistance.Data are available in a public, open access repository. All data relevant to the study are included in the article or uploaded as supplementary information. The mass spectrometry proteomics data have been deposited to the ProteomeXchange Consortium via the PRIDE84,85 partner repository with the dataset identifier PXD023529 and 10.6019/PXD023529. All the codes to reproduce the data alignment and statistical analysis are publicly available at GitHub repository (GitHub, RRID:SCR_002630, https://github.com/fjcamlab/exonet_MS). ER -