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	Author	Van Loenhout, J.; Freire Boullosa, L.; Quatannens, D.; De Waele, J.; Merlin, C.; Lambrechts, H.; Lau, H.W.; Hermans, C.; Lin, A.; Lardon, F.; Peeters, M.; Bogaerts, A.; Smits, E.; Deben, C.
	Title	Auranofin and Cold Atmospheric Plasma Synergize to Trigger Distinct Cell Death Mechanisms and Immunogenic Responses in Glioblastoma			Type	A1 Journal Article;oxidative stress
	Year	2021	Publication	Cells	Abbreviated Journal	Cells
	Volume	10	Issue	11	Pages	2936
	Keywords	A1 Journal Article;oxidative stress; auranofin; cold atmospheric plasma; glioblastoma; cancer cell death; Plasma, laser ablation and surface modeling Antwerp (PLASMANT) ;
	Abstract	Targeting the redox balance of malignant cells via the delivery of high oxidative stress unlocks a potential therapeutic strategy against glioblastoma (GBM). We investigated a novel reactive oxygen species (ROS)-inducing combination treatment strategy, by increasing exogenous ROS via cold atmospheric plasma and inhibiting the endogenous protective antioxidant system via auranofin (AF), a thioredoxin reductase 1 (TrxR) inhibitor. The sequential combination treatment of AF and cold atmospheric plasma-treated PBS (pPBS), or AF and direct plasma application, resulted in a synergistic response in 2D and 3D GBM cell cultures, respectively. Differences in the baseline protein levels related to the antioxidant systems explained the cell-line-dependent sensitivity towards the combination treatment. The highest decrease of TrxR activity and GSH levels was observed after combination treatment of AF and pPBS when compared to AF and pPBS monotherapies. This combination also led to the highest accumulation of intracellular ROS. We confirmed a ROS-mediated response to the combination of AF and pPBS, which was able to induce distinct cell death mechanisms. On the one hand, an increase in caspase-3/7 activity, with an increase in the proportion of annexin V positive cells, indicates the induction of apoptosis in the GBM cells. On the other hand, lipid peroxidation and inhibition of cell death through an iron chelator suggest the involvement of ferroptosis in the GBM cell lines. Both cell death mechanisms induced by the combination of AF and pPBS resulted in a significant increase in danger signals (ecto-calreticulin, ATP and HMGB1) and dendritic cell maturation, indicating a potential increase in immunogenicity, although the phagocytotic capacity of dendritic cells was inhibited by AF. In vivo, sequential combination treatment of AF and cold atmospheric plasma both reduced tumor growth kinetics and prolonged survival in GBM-bearing mice. Thus, our study provides a novel therapeutic strategy for GBM to enhance the efficacy of oxidative stress-inducing therapy through a combination of AF and cold atmospheric plasma.
	Address
	Corporate Author				Thesis
	Publisher		Place of Publication		Editor
	Language		Wos	000807134000001	Publication Date	2021-10-28
	Series Editor		Series Title		Abbreviated Series Title
	Series Volume		Series Issue		Edition
	ISSN	2073-4409	ISBN		Additional Links	UA library record; WoS full record; WoS citing articles
	Impact Factor		Times cited		Open Access	OpenAccess
	Notes	Olivia Hendrickx Research Fund, 21OCL06 ; University of Antwerp, FFB160231 ; The authors would express their gratitude to Hans de Reu for technical assistance with flow cytometry.			Approved	Most recent IF: NA
	Call Number	PLASMANT @ plasmant @c:irua:182915			Serial	6826
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	Author	Van Loenhout, J.
	Title	Targeting pancreatic ductal adenocarcinoma and glioblastoma with oxidative stress-mediated treatment strategies : focus on tumor cell death and modulation of the tumor microenvironment			Type	Doctoral thesis
	Year	2021	Publication		Abbreviated Journal
	Volume		Issue		Pages	167 p.
	Keywords	Doctoral thesis; Plasma Lab for Applications in Sustainability and Medicine – Antwerp (PLASMANT); Center for Oncological Research (CORE)
	Abstract	Pancreatic ductal adenocarcinoma (PDAC) and glioblastoma multiforme (GBM) are two of the most malignant solid tumor types with poor survival rates, which underscore the urgency of novel and efficacious treatment strategies. Within the last decade, immunotherapy has been established as a breakthrough in cancer therapy. This mainly has been driven by the clinical data and approval associated with several immune checkpoint inhibitors (e.g. anti-CTLA-4 and anti-PD-1/L1). Despite the clinical benefit in specific tumor types, these inhibitors have not yet fulfilled their promise in low immunogenic tumors such as PDAC and GBM. Oxidative stress in cancer cells due to elevated reactive oxygen species (ROS) and an inability to balance intracellular redox state has recently been highlighted as promising target for anticancer treatment strategies with possible immunogenic effects. In this PhD dissertation, I investigated novel oxidative stress-mediated treatment approaches to target PDAC and GBM and to enhance immunogenicity by inducing immunogenic cell death (ICD). In the first part of this thesis (chapter 2), I reviewed the mechanistic responses of cancer cells towards different oxidative stress-inducing treatment strategies and their immunomodulating effects. The resulting literature demonstrated that different exogenous and endogenous ROS-inducing therapies show direct and indirect immunomodulating effects, which can be either immunostimulatory or immunosuppressive. One of the indirect immunostimulatory effects of the ROS-mediating therapies is the capacity of inducing immunogenic cell death (ICD) in tumor cells, which can increase the immunogenicity and consequently can trigger an antitumoral immune response. In chapter 3, I investigated a novel exogenous ROS-inducing treatment method, namely cold atmospheric plasma, to determine the therapeutic and ICD-inducing effects in PDAC, in vitro. I revealed that plasma-treated PBS (pPBS) has the potential to induce ICD in pancreatic cancer cells (PCCs) and to reduce the immunosuppressive tumor microenvironment (TME) by attacking the tumor supportive pancreatic stellate cells (PSCs). Although the cell death induced in PSCs was non-immunogenic as seen by the lack of danger-associated molecular patterns (DAMPs) emission and DC activation, I showed that pPBS could disrupt the physical barrier and lower the immunosuppressive secretion profile (lower TGF-β) of PSCs. In contrast, DAMPs were released by PCCs after treatment with pPBS which resulted in activation and maturation of DCs and a more immunostimulatory secretion profile (higher TNF-α, IFN-γ). Hence, indirect plasma treatment via pPBS has the potential to enhance immunogenicity in PDAC by triggering ICD and by attacking the immunosuppressive PSCs. Tumor cells can evolve adaptation mechanisms to protect themselves against intrinsic oxidative stress by upregulation of pro-survival molecules and their antioxidant defense system to maintain the redox balance. As such, tumor cells can become resistant towards exogenous ROS-inducing therapies, like plasma. Dual targeting of the redox balance of tumor cells by increasing exogenous levels of ROS and inhibiting the antioxidant defense system can maximally exploit ROS-mediated cell death mechanisms as therapeutic anticancer strategy. In this regard, cold atmospheric plasma was combined with auranofin, a thioredoxin reductase inhibitor, in GBM (chapter 4). A synergistic effect was shown after this combination treatment in 2D and 3D, however, in 3D only high concentrations of auranofin synergized with plasma treatment. I confirmed a ROS-mediated response after combination treatment, which was able to induce distinct cell death mechanisms, specifically apoptosis and ferroptosis. Additionally, the auranofin and plasma combined treatment strategy induced cell death, which resulted in an increased release of DAMPs. Together with the observed DC maturation, these results indicates the potential increase in immunogenicity, though, the phagocytotic capacity of DCs was inhibited by auranofin. In chapter 5, I evaluated this promising oxidative stress combination therapy in GBM, in vivo. A decrease in tumor kinetics and an increased survival in GBM-bearing mice was observed when auranofin was sequentially combined with direct plasma treatment. No T cell infiltration was observed after auranofin monotherapy. However, further characterization of the TME after the combination therapy is necessary to provide more insight in the immunogenic effects in vivo. In conclusion, this PhD dissertation comprises novel and important therapeutic and immunogenic insights in cold atmospheric plasma and auranofin as promising oxidative stress-mediated treatment strategies for low immunogenic tumors, like PDAC and GBM. These preclinical results provide a solid basis for future research towards combinations with immunotherapeutic approaches.
	Address
	Corporate Author				Thesis
	Publisher		Place of Publication		Editor
	Language		Wos		Publication Date
	Series Editor		Series Title		Abbreviated Series Title
	Series Volume		Series Issue		Edition
	ISSN		ISBN		Additional Links	UA library record
	Impact Factor		Times cited		Open Access
	Notes				Approved	Most recent IF: NA
	Call Number	UA @ admin @ c:irua:181309			Serial	8643
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	Author	Van Loenhout, J.; Peeters, M.; Bogaerts, A.; Smits, E.; Deben, C.
	Title	Oxidative Stress-Inducing Anticancer Therapies: Taking a Closer Look at Their Immunomodulating Effects			Type	A1 Journal article
	Year	2020	Publication	Antioxidants	Abbreviated Journal	Antioxidants
	Volume	9	Issue	12	Pages	1188
	Keywords	A1 Journal article; Pharmacology. Therapy; Plasma Lab for Applications in Sustainability and Medicine – Antwerp (PLASMANT); Center for Oncological Research (CORE)
	Abstract	Cancer cells are characterized by higher levels of reactive oxygen species (ROS) compared to normal cells as a result of an imbalance between oxidants and antioxidants. However, cancer cells maintain their redox balance due to their high antioxidant capacity. Recently, a high level of oxidative stress is considered a novel target for anticancer therapy. This can be induced by increasing exogenous ROS and/or inhibiting the endogenous protective antioxidant system. Additionally, the immune system has been shown to be a significant ally in the fight against cancer. Since ROS levels are important to modulate the antitumor immune response, it is essential to consider the effects of oxidative stress-inducing treatments on this response. In this review, we provide an overview of the mechanistic cellular responses of cancer cells towards exogenous and endogenous ROS-inducing treatments, as well as the indirect and direct antitumoral immune effects, which can be both immunostimulatory and/or immunosuppressive. For future perspectives, there is a clear need for comprehensive investigations of different oxidative stress-inducing treatment strategies and their specific immunomodulating effects, since the effects cannot be generalized over different treatment modalities. It is essential to elucidate all these underlying immune effects to make oxidative stress-inducing treatments effective anticancer therapy.
	Address
	Corporate Author				Thesis
	Publisher		Place of Publication		Editor
	Language		Wos	000602288600001	Publication Date	2020-11-27
	Series Editor		Series Title		Abbreviated Series Title
	Series Volume		Series Issue		Edition
	ISSN	2076-3921	ISBN		Additional Links	UA library record; WoS full record; WoS citing articles
	Impact Factor	7	Times cited		Open Access
	Notes	This research was funded by the Olivia Hendrickx Research Fund (21OCL06) and the University of Antwerp (FFB160231).			Approved	Most recent IF: 7; 2020 IF: NA
	Call Number	PLASMANT @ plasmant @c:irua:173865			Serial	6441
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	Author	Van Loenhout, J.; Flieswasser, T.; Freire Boullosa, L.; De Waele, J.; Van Audenaerde, J.; Marcq, E.; Jacobs, J.; Lin, A.; Lion, E.; Dewitte, H.; Peeters, M.; Dewilde, S.; Lardon, F.; Bogaerts, A.; Deben, C.; Smits, E.
	Title	Cold Atmospheric Plasma-Treated PBS Eliminates Immunosuppressive Pancreatic Stellate Cells and Induces Immunogenic Cell Death of Pancreatic Cancer Cells			Type	A1 Journal article
	Year	2019	Publication	Cancers	Abbreviated Journal	Cancers
	Volume	11	Issue	10	Pages	1597
	Keywords	A1 Journal article; Plasma Lab for Applications in Sustainability and Medicine – Antwerp (PLASMANT); Laboratory for Experimental Hematology (LEH); Center for Oncological Research (CORE)
	Abstract	Pancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive cancers with a low response to treatment and a five-year survival rate below 5%. The ineffectiveness of treatment is partly because of an immunosuppressive tumor microenvironment, which comprises tumor-supportive pancreatic stellate cells (PSCs). Therefore, new therapeutic strategies are needed to tackle both the immunosuppressive PSC and pancreatic cancer cells (PCCs). Recently, physical cold atmospheric plasma consisting of reactive oxygen and nitrogen species has emerged as a novel treatment option for cancer. In this study, we investigated the cytotoxicity of plasma-treated phosphate-buffered saline (pPBS) using three PSC lines and four PCC lines and examined the immunogenicity of the induced cell death. We observed a decrease in the viability of PSC and PCC after pPBS treatment, with a higher efficacy in the latter. Two PCC lines expressed and released damage-associated molecular patterns characteristic of the induction of immunogenic cell death (ICD). In addition, pPBS-treated PCC were highly phagocytosed by dendritic cells (DCs), resulting in the maturation of DC. This indicates the high potential of pPBS to trigger ICD. In contrast, pPBS induced no ICD in PSC. In general, pPBS treatment of PCCs and PSCs created a more immunostimulatory secretion profile (higher TNF-α and IFN-γ, lower TGF-β) in coculture with DC. Altogether, these data show that plasma treatment via pPBS has the potential to induce ICD in PCCs and to reduce the immunosuppressive tumor microenvironment created by PSCs. Therefore, these data provide a strong experimental basis for further in vivo validation, which might potentially open the way for more successful combination strategies with immunotherapy for PDAC.
	Address
	Corporate Author				Thesis
	Publisher		Place of Publication		Editor
	Language		Wos	000498826000194	Publication Date	2019-10-19
	Series Editor		Series Title		Abbreviated Series Title
	Series Volume		Series Issue		Edition
	ISSN	2072-6694	ISBN		Additional Links	UA library record; WoS full record; WoS citing articles
	Impact Factor		Times cited	6	Open Access
	Notes	Universiteit Antwerpen, NA ; Fonds Wetenschappelijk Onderzoek, 11E7719N 1121016N 1S32316N 12S9218N 12E3916N ; Agentschap Innoveren en Ondernemen, 141433 ; Kom op tegen Kanker, NA ; Stichting Tegen Kanker, STK2014-155 ; The authors express their gratitude to Christophe Hermans, Céline Merlin, Hilde Lambrechts, and Hans de Reu for technical assistance; and to VITO for the use of the MSD reader (Mol, Belgium).			Approved	Most recent IF: NA
	Call Number	PLASMANT @ plasmant @c:irua:163328			Serial	5436
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	Author	Lin, A.; Gorbanev, Y.; De Backer, J.; Van Loenhout, J.; Van Boxem, W.; Lemière, F.; Cos, P.; Dewilde, S.; Smits, E.; Bogaerts, A.
	Title	Non‐Thermal Plasma as a Unique Delivery System of Short‐Lived Reactive Oxygen and Nitrogen Species for Immunogenic Cell Death in Melanoma Cells			Type	A1 Journal article
	Year	2019	Publication	Advanced Science	Abbreviated Journal	Adv Sci
	Volume	6	Issue	6	Pages	1802062
	Keywords	A1 Journal article; Engineering sciences. Technology; Plasma Lab for Applications in Sustainability and Medicine – Antwerp (PLASMANT); Center for Oncological Research (CORE)
	Abstract
	Address
	Corporate Author				Thesis
	Publisher		Place of Publication		Editor
	Language		Wos	000462613100001	Publication Date	2019-01-29
	Series Editor		Series Title		Abbreviated Series Title
	Series Volume		Series Issue		Edition
	ISSN	2198-3844	ISBN		Additional Links	UA library record; WoS full record; WoS citing articles
	Impact Factor	9.034	Times cited	39	Open Access	OpenAccess
	Notes	This study was funded in part by the Flanders Research Foundation (grant no. 12S9218N) and the European Marie Sklodowska-Curie Individual Fellowship within Horizon2020 (LTPAM) grant no. 743151). The microsecond-pulsed power supply was purchased following discussions with the C. & J. Nyheim Plasma Institute at Drexel University. The authors would like to thank Dr. Erik Fransen for his expertise and guidance with the statistical models and analysis used here. The authors would also like to thank Dr. Sander Bekeschus of the Leibniz Institute for Plasma Science and Technology for the discussions at conferences and workshops. A.L. contributed to the design and carrying out of all experiments. A.L. also wrote the manuscript. Y.G. contributed to the design and carrying out of experiments involving chemical measurements. Y.G. also contributed to writing the chemical portions of the manuscript. J.D.B. contributed to the design and carrying out of in vivo experiments. J.D.B. also contributed to writing the portions of the manuscript involving animal experiments and care. J.V.L. contributed to the optimization of the calreticulin protocol used in the experiments. W.V.B. contributed to optimization of colorimetric assays used in the experiments. F.L. contributed to mass spectrometry measurements. P.C., S.D., E.S., and A.B. provided workspace, equipment, and valuable discussions for the project. All authors participated in the review of the manuscript.; Flanders Research Foundation, 12S9218N ; European Marie Sklodowska-Curie Individual Fellowship within Horizon2020, 743151 ;			Approved	Most recent IF: 9.034
	Call Number	PLASMANT @ plasmant @UA @ admin @ c:irua:156548			Serial	5165
Permanent link to this record