Research Papers:

Intratumoral acidosis fosters cancer-induced bone pain through the activation of the mesenchymal tumor-associated stroma in bone metastasis from breast carcinoma

Gemma Di Pompo, Silvia Lemma, Lorenzo Canti, Nadia Rucci, Marco Ponzetti, Costantino Errani, Davide Maria Donati, Shonagh Russell, Robert Gillies, Tokuhiro Chano, Nicola Baldini and Sofia Avnet _

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Oncotarget. 2017; 8:54478-54496. https://doi.org/10.18632/oncotarget.17091

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Gemma Di Pompo1,2, Silvia Lemma1,2, Lorenzo Canti1, Nadia Rucci3, Marco Ponzetti3, Costantino Errani4, Davide Maria Donati4, Shonagh Russell5, Robert Gillies5, Tokuhiro Chano6, Nicola Baldini1,2 and Sofia Avnet1

1Orthopaedic Pathophysiology and Regenerative Medicine Unit, Istituto Ortopedico Rizzoli, Bologna, Italy

2Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy

3Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy

4Orthopaedic Oncology Surgical Unit, Istituto Ortopedico Rizzoli, Bologna, Italy

5Department of Imaging Research, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA

6Department of Clinical Laboratory Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan

Correspondence to:

Sofia Avnet, email: [email protected]

Keywords: cancer-induced bone pain, intratumoral acidosis, tumor-associated stroma, hyperalgesia

Received: January 27, 2017    Accepted: March 19, 2017    Published: April 13, 2017


Cancer-induced bone pain (CIBP) is common in patients with bone metastases (BM), significantly impairing quality of life. The current treatments for CIBP are limited since they are often ineffective. Local acidosis derived from glycolytic carcinoma and tumor-induced osteolysis is only barely explored cause of pain. We found that breast carcinoma cells that prefer bone as a metastatic site have very high extracellular proton efflux and expression of pumps/ion transporters associated with acid-base balance (MCT4, CA9, and V-ATPase). Further, the impairment of intratumoral acidification via V-ATPase targeting in xenografts with BM significantly reduced CIBP, as measured by incapacitance test. We hypothesize that in addition to the direct acid-induced stimulation of nociceptors in the bone, a novel mechanism mediated by the acid-induced and tumor-associated mesenchymal stroma might ultimately lead to nociceptor sensitization and hyperalgesia. Consistent with this, short-term exposure of cancer-associated fibroblasts, mesenchymal stem cells, and osteoblasts to pH 6.8 promotes the expression of inflammatory and nociceptive mediators (NGF, BDNF, IL6, IL8, IL1b and CCL5). This is also consistent with a significant correlation between breakthrough pain, measured by pain questionnaire, and combined high serum levels of BDNF and IL6 in patients with BM, and also by immunofluorescence staining showing IL8 expression that was more in mesenchymal stromal cells rather than in tumors cells, and close to LAMP-2 positive acidifying carcinoma cells in BM tissue sections.

In summary, intratumoral acidification in BM might promote CIBP also by activating the tumor-associated stroma, offering a new target for palliative treatments in advanced cancer.

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