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| <?xml version="1.0" encoding="UTF-8"?><!DOCTYPE article PUBLIC "-//NLM//DTD JATS (Z39.96) Journal Archiving and Interchange DTD v1.1d1 20130915//EN" "JATS-archivearticle1.dtd"><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" article-type="research-article" dtd-version="1.1d1"><front><journal-meta><journal-id journal-id-type="nlm-ta">elife</journal-id><journal-id journal-id-type="hwp">eLife</journal-id><journal-id journal-id-type="publisher-id">eLife</journal-id><journal-title-group><journal-title>eLife</journal-title></journal-title-group><issn publication-format="electronic">2050-084X</issn><publisher><publisher-name>eLife Sciences Publications, Ltd</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="publisher-id">04069</article-id><article-id pub-id-type="doi">10.7554/eLife.04069</article-id><article-categories><subj-group subj-group-type="display-channel"><subject>Research article</subject></subj-group><subj-group subj-group-type="heading"><subject>Cell biology</subject></subj-group><subj-group subj-group-type="heading"><subject>Human biology and medicine</subject></subj-group></article-categories><title-group><article-title>Defective apical extrusion signaling contributes to aggressive tumor hallmarks</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes" id="author-16827"><name><surname>Gu</surname><given-names>Yapeng</given-names></name><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="corresp" rid="cor1">*</xref><xref ref-type="other" rid="par-2"/><xref ref-type="fn" rid="con1"/><xref ref-type="fn" rid="conf1"/></contrib><contrib contrib-type="author" id="author-16828"><name><surname>Shea</surname><given-names>Jill</given-names></name><xref ref-type="aff" rid="aff2">2</xref><xref ref-type="fn" rid="con2"/><xref ref-type="fn" rid="conf1"/></contrib><contrib contrib-type="author" id="author-16829"><name><surname>Slattum</surname><given-names>Gloria</given-names></name><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="fn" rid="con3"/><xref ref-type="fn" rid="conf1"/></contrib><contrib contrib-type="author" id="author-16830"><name><surname>Firpo</surname><given-names>Matthew A</given-names></name><xref ref-type="aff" rid="aff2">2</xref><xref ref-type="fn" rid="con4"/><xref ref-type="fn" rid="conf1"/></contrib><contrib contrib-type="author" id="author-16831"><name><surname>Alexander</surname><given-names>Margaret</given-names></name><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="fn" rid="con5"/><xref ref-type="fn" rid="conf1"/></contrib><contrib contrib-type="author" id="author-16832"><name><surname>Mulvihill</surname><given-names>Sean J</given-names></name><xref ref-type="aff" rid="aff2">2</xref><xref ref-type="fn" rid="con6"/><xref ref-type="fn" rid="conf1"/></contrib><contrib contrib-type="author" id="author-16833"><name><surname>Golubovskaya</surname><given-names>Vita M</given-names></name><xref ref-type="aff" rid="aff3">3</xref><xref ref-type="fn" rid="con7"/><xref ref-type="fn" rid="conf1"/></contrib><contrib contrib-type="author" corresp="yes" id="author-16500"><name><surname>Rosenblatt</surname><given-names>Jody</given-names></name><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="corresp" rid="cor2">*</xref><xref ref-type="other" rid="par-1"/><xref ref-type="other" rid="par-2"/><xref ref-type="other" rid="par-3"/><xref ref-type="fn" rid="con8"/><xref ref-type="fn" rid="conf1"/></contrib><aff id="aff1"><label>1</label><institution content-type="dept">Huntsman Cancer Institute</institution>, <institution>University of Utah</institution>, <addr-line><named-content content-type="city">Salt Lake City</named-content></addr-line>, <country>United States</country></aff><aff id="aff2"><label>2</label><institution content-type="dept">Department of Surgery</institution>, <institution>University of Utah</institution>, <addr-line><named-content content-type="city">Salt Lake City</named-content></addr-line>, <country>United States</country></aff><aff id="aff3"><label>3</label><institution content-type="dept">Department of Surgical Oncology</institution>, <institution>Roswell Park Cancer Institute</institution>, <addr-line><named-content content-type="city">Buffalo</named-content></addr-line>, <country>United States</country></aff></contrib-group><contrib-group content-type="section"><contrib contrib-type="editor"><name><surname>Paluch</surname><given-names>Ewa</given-names></name><role>Reviewing editor</role><aff><institution>University College London</institution>, <country>United Kingdom</country></aff></contrib></contrib-group><author-notes><corresp id="cor1"><label>*</label>For correspondence: <email>yapeng.gu@hci.utah.edu</email> (YG);</corresp><corresp id="cor2"><email>jody.rosenblatt@hci.utah.edu</email> (JR)</corresp></author-notes><pub-date publication-format="electronic" date-type="pub"><day>26</day><month>01</month><year>2015</year></pub-date><pub-date pub-type="collection"><year>2015</year></pub-date><volume>4</volume><elocation-id>e04069</elocation-id><history><date date-type="received"><day>17</day><month>07</month><year>2014</year></date><date date-type="accepted"><day>22</day><month>01</month><year>2015</year></date></history><permissions><copyright-statement>© 2015, Gu et al</copyright-statement><copyright-year>2015</copyright-year><copyright-holder>Gu et al</copyright-holder><license xlink:href="http://creativecommons.org/licenses/by/4.0/"><license-p>This article is distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License</ext-link>, which permits unrestricted use and redistribution provided that the original author and source are credited.</license-p></license></permissions><self-uri content-type="pdf" xlink:href="elife04069.pdf"/><abstract><object-id pub-id-type="doi">10.7554/eLife.04069.001</object-id><p>When epithelia become too crowded, some cells are extruded that later die. To extrude, a cell produces the lipid, Sphingosine 1-Phosphate (S1P), which activates S1P<sub>2</sub> receptors in neighboring cells that seamlessly squeeze the cell out of the epithelium. Here, we find that extrusion defects can contribute to carcinogenesis and tumor progression. Tumors or epithelia lacking S1P<sub>2</sub> cannot extrude cells apically and instead form apoptotic-resistant masses, possess poor barrier function, and shift extrusion basally beneath the epithelium, providing a potential mechanism for cell invasion. Exogenous S1P<sub>2</sub> expression is sufficient to rescue apical extrusion, cell death, and reduce orthotopic pancreatic tumors and their metastases. Focal Adhesion Kinase (FAK) inhibitor can bypass extrusion defects and could, therefore, target pancreatic, lung, and colon tumors that lack S1P<sub>2</sub> without affecting wild-type tissue.</p><p><bold>DOI:</bold> <ext-link ext-link-type="doi" xlink:href="10.7554/eLife.04069.001">http://dx.doi.org/10.7554/eLife.04069.001</ext-link></p></abstract><abstract abstract-type="executive-summary"><object-id pub-id-type="doi">10.7554/eLife.04069.002</object-id><title>eLife digest</title><p>Epithelial cells cover the surface of our bodies, line our lungs, stomach and intestines and serve as a protective layer around other organs. If too many epithelial cells die and are not replaced, this protective layer may erode and lead to organ damage. However, if too many new cells grow, tumors can form.</p><p>One process that helps to maintain the right number of epithelial cells is called extrusion. When too many epithelial cells are present, the resulting overcrowding triggers this process to squeeze excess cells out of the layer and away from the organ. Usually, these cells quickly die. However, if the pathway that regulates this process—which involves a receptor protein called S1P<sub>2</sub>—is disturbed, the cells may instead be pushed into the space between the epithelial layer and the organ. When this happens, the cells are more likely to survive and may then form a tumor that invades the organ.</p><p>Gu et al. interfered with extrusion by reducing the levels of the S1P<sub>2</sub> receptor in layers of human epithelial cells grown in the laboratory. Fewer epithelial cells were squeezed out of these cell layers, making the layers up to three times as thick in places. Moreover, mutant zebrafish lacking the S1P<sub>2</sub> receptor also accumulated epithelial masses throughout their bodies.</p><p>Gu et al. found that disrupting the extrusion process made the cells resistant to chemotherapy, and that certain hard-to-treat human pancreatic, lung, and colon cancers had lower levels of the S1P<sub>2</sub> receptors. Boosting the activity of S1P<sub>2</sub> receptors helped to restore normal extrusion and reduced the size of pancreatic tumors in mice.</p><p>Gu et al. then focused on an enzyme called Focal Adhesion Kinase that helps cells to survive. Treating zebrafish with a drug to block the activity of this enzyme left normal fish unharmed. However, in mutant fish with malfunctioning extrusion pathways, the drug rescued the number of cells that died, reduced the size and number of masses, and cured their leaky skin barrier. If further studies confirm the results, the drug may offer a new, less toxic, treatment for certain cancers that do not respond to currently available treatments.</p><p><bold>DOI:</bold> <ext-link ext-link-type="doi" xlink:href="10.7554/eLife.04069.002">http://dx.doi.org/10.7554/eLife.04069.002</ext-link></p></abstract><kwd-group kwd-group-type="author-keywords"><title>Author keywords</title><kwd>epithelial</kwd><kwd>extrusion</kwd><kwd>carcinoma</kwd><kwd>invasion</kwd><kwd>pancreatic</kwd><kwd>tumor initiation</kwd></kwd-group><kwd-group kwd-group-type="research-organism"><title>Research organism</title><kwd>human</kwd><kwd>mouse</kwd><kwd>zebrafish</kwd></kwd-group><funding-group><award-group id="par-1"><funding-source><institution-wrap><institution-id institution-id-type="FundRef">http://dx.doi.org/10.13039/100000057</institution-id><institution content-type="university">National Institute of General Medical Sciences</institution></institution-wrap></funding-source><award-id>NIH Director's New Innovator Award 1DP2OD002056-</award-id><principal-award-recipient><name><surname>Rosenblatt</surname><given-names>Jody</given-names></name></principal-award-recipient></award-group><award-group id="par-2"><funding-source><institution-wrap><institution-id institution-id-type="FundRef">http://dx.doi.org/10.13039/100000054</institution-id><institution content-type="university">National Cancer Institute</institution></institution-wrap></funding-source><award-id>Cancer Center Support Grant P30 CA042014</award-id><principal-award-recipient><name><surname>Gu</surname><given-names>Yapeng</given-names></name><name><surname>Rosenblatt</surname><given-names>Jody</given-names></name></principal-award-recipient></award-group><award-group id="par-3"><funding-source><institution-wrap><institution-id institution-id-type="FundRef">http://dx.doi.org/10.13039/100000057</institution-id><institution content-type="university">National Institute of General Medical Sciences</institution></institution-wrap></funding-source><award-id>R01GM102169</award-id><principal-award-recipient><name><surname>Rosenblatt</surname><given-names>Jody</given-names></name></principal-award-recipient></award-group><funding-statement>The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.</funding-statement></funding-group><custom-meta-group><custom-meta><meta-name>elife-xml-version</meta-name><meta-value>2.0</meta-value></custom-meta><custom-meta specific-use="meta-only"><meta-name>Author impact statement</meta-name><meta-value>Disrupting extrusion, a process that drives epithelial cell death, leads to increased cell survival, poor barrier function, and enhanced cell invasion and, thereby, promotes tumor initiation and progression.</meta-value></custom-meta></custom-meta-group></article-meta></front><body><sec sec-type="intro" id="s1"><title>Introduction</title><p>Epithelial cells must act collectively to provide a protective barrier for the organs they encase even though they continuously turn over through cell death and division. The link between cell division and death is critical: if the relative death rate is too high, barrier function diseases may result whereas if division outpaces cell death, epithelia could become neoplastic. We previously identified a process critical for promoting cell death when cells within epithelia become overcrowded termed epithelial extrusion (<xref ref-type="bibr" rid="bib19">Rosenblatt et al., 2001</xref>; <xref ref-type="bibr" rid="bib7">Eisenhoffer et al., 2012</xref>). The stretch-activated channel Piezo-1 senses cell crowding and enables some cells to produce the bioactive sphingolipid, <underline>S</underline>phingosine <underline>1</underline>-<underline>p</underline>hosphate (S1P), which binds G-protein coupled receptors (S1P<sub>2</sub>) in neighboring cells to activate Rho-mediated assembly and contraction of an intercellular actomyosin ring (<xref ref-type="bibr" rid="bib12">Gu et al., 2011</xref>). This contraction squeezes live cells apically out of the epithelial sheet while simultaneously closing the gap that might have resulted from the cell's exit, thus preserving epithelial barrier function. Because live extruded cells become stripped from the underlying matrix and its associated survival signaling, they later die by anoikis (<xref ref-type="bibr" rid="bib9">Frisch and Francis, 1994</xref>).</p><p>Advanced tumors typically have increased survival signaling that overrides anoikis, suggesting that cells could survive following extrusion. In this case, the direction a cell extrudes can impact its later fate. Typically, epithelia extrude cells apically into the lumen of the tissue (<xref ref-type="bibr" rid="bib25">Slattum et al., 2009</xref>), which would act to essentially eliminate tumor cells with upregulated survival signaling. However, some cells are extruded basally into the tissue encased by the epithelium (<xref ref-type="bibr" rid="bib25">Slattum et al., 2009</xref>). If basally extruded cells survive following extrusion, they might be able to invade into the underlying tissue (<xref ref-type="bibr" rid="bib26">Slattum and Rosenblatt, 2014</xref>). Interestingly, we have found that oncogenic mutations in either adenomatous polyposis coli or K-Ras misregulate apical extrusion and drive extrusion basally (<xref ref-type="bibr" rid="bib16">Marshall et al., 2011</xref>; <xref ref-type="bibr" rid="bib24">Slattum et al., 2014</xref>).</p><p>Here, we examined the long-term effects of disrupting the S1P-S1P<sub>2</sub> epithelia extrusion-signaling pathway. We found that inhibition of S1P<sub>2</sub> leads to large epithelial masses in both zebrafish epidermis and cultured epithelia and increased rates of basal extrusion. Moreover, disrupting extrusion by a variety of methods leads to chemotherapy resistance. Inhibition of Focal Adhesion Kinase (FAK), a key survival signal generated from cell-matrix adhesion, selectively promotes apoptosis in cells where extrusion is defective and eliminates epidermal cell masses formed in zebrafish S1P<sub>2</sub> mutants without affecting epithelial morphology and function. Pancreatic Ductal Adenocarcinomas (PDACs) have little to no S1P<sub>2</sub>, which could explain why these tumors are typically more invasive and chemo-resistant. HPAF II human pancreatic cancer cells cannot extrude apically and instead extrude basally, survive, and proliferate following extrusion. Ectopically expressing S1P<sub>2</sub> in HPAF II cells rescues apical extrusion and apoptosis and reduces orthotopic mouse tumors and their metastases. Together, our results suggest that defective extrusion may be a new mechanism for how PDACs and other carcinomas lacking S1P<sub>2</sub> initiate and invade. Furthermore, FAK inhibitors, which are currently in clinical trials for other tumors, may provide an effective therapeutic opportunity to treat pancreatic cancer without destroying nearby normal tissue.</p></sec><sec sec-type="results" id="s2"><title>Results</title><sec id="s2-1"><title>Disruption of extrusion signaling reduces epithelial apoptosis rates</title><p>To test if the S1P-S1P<sub>2</sub>-Rho signaling pathway that controls extrusion (<xref ref-type="bibr" rid="bib12">Gu et al., 2011</xref>) was critical for preventing neoplastic growth over time, we knocked down S1P<sub>2</sub> in Human Bronchial Epithelial (HBE) cells (<xref ref-type="fig" rid="fig1">Figure 1A</xref>) and grew them for up to 3 weeks after they formed an intact monolayer. S1P<sub>2</sub>-depleted HBE epithelia, which are extrusion-deficient (<xref ref-type="bibr" rid="bib12">Gu et al., 2011</xref>), accumulated into masses over three layers thick whereas control-knockdown monolayers retained a single layer (<xref ref-type="fig" rid="fig1">Figure 1B</xref>). Because cell extrusion typically promotes epithelial cell death (<xref ref-type="bibr" rid="bib7">Eisenhoffer et al., 2012</xref>; <xref ref-type="bibr" rid="bib15">Marinari et al., 2012</xref>) and because S1P<sub>2</sub> depletion did not affect the proliferation rate in a yellow tetrazolium MTT (3-(4, 5-dimethylthiazolyl-2)-2, 5-diphenyltetrazolium bromide) assay (<xref ref-type="fig" rid="fig1">Figure 1C</xref>), masses were likely to arise due to reduced apoptosis. Additionally, zebrafish larvae carrying a loss-of-function mutation in S1P<sub>2</sub> (Miles apart [<italic>Mil</italic>]) cannot extrude apoptotic epidermal cells (<xref ref-type="bibr" rid="bib12">Gu et al., 2011</xref>), and similarly accumulated numerous epidermal cell aggregates throughout the body (18 ± 3.5 aggregates/fish, n = 22) by only 5 days post fertilization (dpf) (<xref ref-type="fig" rid="fig1">Figure 1D,E</xref>). By contrast, masses were undetectable in heterozygote <italic>Mil</italic> or WT siblings of the same age (<xref ref-type="fig" rid="fig1">Figure 1D,E</xref>).<fig id="fig1" position="float"><object-id pub-id-type="doi">10.7554/eLife.04069.003</object-id><label>Figure 1.</label><caption><title>Loss of S1P<sub>2</sub> and extrusion leads to accumulation of epithelial cell masses.</title><p>(<bold>A</bold>) S1P<sub>2</sub> immunoblot of HBE cells expressing control (left) or S1P<sub>2</sub>-specific shRNA (right) with α-tubulin as loading control. (<bold>B</bold>) Representative images of HBE cells (DNA only) expressing control (left) or S1P<sub>2</sub>-specific shRNA (right) grown for 3 weeks. Scale bar, 10 µm. (<bold>C</bold>) Proliferation assay indicates that S1P<sub>2</sub>-knockdown cells proliferate at the same rate as wild type controls cells. (<bold>D</bold>) Representative DIC micrographs of 5-dpf WT (top) and Mil (S1P<sub>2</sub> mutant) (bottom) zebrafish larvae, where cartoon shows region where fish was imaged. Scale bars, 100 µm where red box indicates region imaged. (<bold>E</bold>) Quantification of epidermal clumps of 22 zebrafish larvae.</p><p><bold>DOI:</bold> <ext-link ext-link-type="doi" xlink:href="10.7554/eLife.04069.003">http://dx.doi.org/10.7554/eLife.04069.003</ext-link></p></caption><graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="elife04069f001"/></fig></p><p>We next wondered if extrusion-deficient cells were also more resistant to cell death in response to apoptotic stimuli. While extrusion promotes apoptosis during normal homeostasis by extruding live cells that later die from loss of contact to matrix-derived survival signaling (<xref ref-type="bibr" rid="bib7">Eisenhoffer et al., 2012</xref>), treating epithelia with apoptotic stimuli causes cells to simultaneously die and extrude (<xref ref-type="bibr" rid="bib19">Rosenblatt et al., 2001</xref>; <xref ref-type="bibr" rid="bib1">Andrade and Rosenblatt, 2011</xref>). Because extrusion normally drives cell death, could it also help promote apoptosis in response to apoptotic stimuli by eliminating competing survival signaling associated with the underlying matrix? We find that disrupting extrusion signaling also disrupted apoptosis in response to a variety of apoptotic stimuli. HBE monolayers lacking S1P<sub>2</sub> (<xref ref-type="fig" rid="fig2">Figure 2A</xref>) or treated with a selective S1P<sub>2</sub> receptor antagonist, JTE-013 (<xref ref-type="fig" rid="fig2">Figure 2B</xref>) had greatly reduced rates of apoptosis in response to a strong apoptotic stimulus, UV-C, compared to controls. Madin–Darby Canine Kidney (MDCK) monolayers treated with S1P<sub>2</sub> antagonist were similarly resistant to several common chemotherapy drugs that cause apoptosis (<xref ref-type="fig" rid="fig2">Figure 2B,C</xref>).<fig id="fig2" position="float"><object-id pub-id-type="doi">10.7554/eLife.04069.004</object-id><label>Figure 2.</label><caption><title>Disruption of S1P<sub>2</sub>-extrusion signaling reduces apoptotic response.</title><p>(<bold>A</bold>) Quantification of UV-induced apoptotic cells in HBE monolayers expressing control or S1P<sub>2</sub>-specific shRNA. (<bold>B</bold>) Quantification of UV-induced apoptosis of HBE monolayers in the presence or absence of the S1P<sub>2</sub> antagonist JTE-013. (<bold>C</bold>) Quantification of indicated chemotherapy-induced apoptotic MDCK cells in the presence or absence of JTE-013, where all error bars are STD (**p < 0.01, and ***p < 0.001).</p><p><bold>DOI:</bold> <ext-link ext-link-type="doi" xlink:href="10.7554/eLife.04069.004">http://dx.doi.org/10.7554/eLife.04069.004</ext-link></p></caption><graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="elife04069f002"/></fig></p><p>The reduced cell death rates in epithelia lacking S1P<sub>2</sub> were due to disruption of extrusion rather than altered S1P signaling, since other inhibitors of extrusion, Rho kinase inhibitor (Y-27632), myosin II inhibitor (Blebbistatin), or Rac inhibitor (EHT1864) all decreased cell death rates to the extent that they inhibit extrusion (<xref ref-type="fig" rid="fig3">Figure 3A</xref>). In each case, the ratio of cell death to extrusion inhibition is ∼1:1 (<xref ref-type="fig" rid="fig3">Figure 3C</xref>). Inhibition of apoptosis was not due to increasing levels of S1P, which can act as a pro-survival signal, as S1P levels in apoptotic cells varied independently of extrusion inhibition (<xref ref-type="fig" rid="fig3">Figure 3B</xref>). Since freshly plated single MDCK cells are resistant to apoptotic stimuli, we tested if these same compounds reduced apoptosis in similarly aged single MDCKs by treating with EGTA to disrupt cadherin-dependent cell–cell contacts. Inhibitors that blocked apoptosis by blocking extrusion in an intact monolayer do not impact the apoptosis rates of single cells that are incapable of extrusion (<xref ref-type="fig" rid="fig3">Figure 3D</xref>). Similarly, UV-induced apoptosis was unaltered in single HBE cells lacking S1P<sub>2</sub> when HBE monolayers where treated with EGTA (<xref ref-type="fig" rid="fig3">Figure 3D</xref>). Additionally, inhibiting S1P<sub>2</sub> with JTE-013 in a cell line that cannot extrude but expresses this receptor (<xref ref-type="bibr" rid="bib5">Clair et al., 2003</xref>; <xref ref-type="bibr" rid="bib18">Pham et al., 2013</xref>), NIH 3T3 fibroblasts, does not affect the cell death rate in response to UV-C (<xref ref-type="fig" rid="fig3">Figure 3E</xref>). These data together suggest that increased cell survival is linked with the inability to extrude rather than to any intrinsic block of the apoptosis pathway.<fig id="fig3" position="float"><object-id pub-id-type="doi">10.7554/eLife.04069.005</object-id><label>Figure 3.</label><caption><title>Decreased apoptosis is due to blocked extrusion rather than S1P signaling.</title><p>(<bold>A</bold>) Rates of MDCK cell death (left Y-axis, blue) correspond with cell extrusion rates (right Y-axis, yellow) in response to UV-C when treated with extrusion inhibitors. (<bold>B</bold>) Representative images of apoptotic cells with and without compounds that block extrusion. When extrusion occurs, the dying cell DNA lies above (out of plane from) the neighboring cells with a contracted actin ring but when it fails, it lies in the same plane as surrounding cells with an uncontracted actin ring. Only the S1P<sub>2</sub> antagonist JTE013 causes significant S1P accumulation in the dying cell (second column), whereas blocking extrusion with the other compounds does not impact S1P levels, where p values of each drug treatment compared to control are listed on each S1P panel as asterisks (n = 4). Bar = 10 µm. (<bold>C</bold>) Ratio of reduction of extrusion to reduction of apoptosis shows nearly a 1:1 correlation throughout, where p-values compared to S1P<sub>2</sub> are not significant. (<bold>D</bold>) Compounds used to block extrusion do not affect apoptosis rates in single MDCK cells treated with EGTA in response to UV. (<bold>E</bold>) Quantification of UV-induced apoptotic NIH 3T3 cells in the presence of vehicle or JTE-013; All results are expressed as mean values ± STD of three separate experiments (*p < 0.01, **p < 0.005, ***p < 0.005, and ****p < 0.0001), and NS in graphs <bold>B</bold>, <bold>D</bold>, and <bold>E</bold> indicate that p values of a unpaired T-test are not significant.</p><p><bold>DOI:</bold> <ext-link ext-link-type="doi" xlink:href="10.7554/eLife.04069.005">http://dx.doi.org/10.7554/eLife.04069.005</ext-link></p></caption><graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="elife04069f003"/></fig></p></sec><sec id="s2-2"><title>Pancreatic cancer cells lack the S1P<sub>2</sub> receptor and extrude basally rather than apically</title><p>Since disruption of S1P<sub>2</sub> in epithelia results in reduced apoptosis and cellular masses both in vitro and in vivo, we wondered if this receptor might be deficient in carcinomas. Our analysis of published tumor microarray data found S1P<sub>2</sub> mRNA to be significantly reduced in PDAC (<xref ref-type="bibr" rid="bib4">Buchholz et al., 2005</xref>; <xref ref-type="bibr" rid="bib21">Segara et al., 2005</xref>; <xref ref-type="bibr" rid="bib2">Badea et al., 2008</xref>), and some lung and colon tumors (<xref ref-type="bibr" rid="bib3">Bhattacharjee et al., 2001</xref>), compared to their corresponding normal tissues. To investigate if cancer cells lacking S1P<sub>2</sub> also have extrusion and apoptosis defects, we analyzed a pancreatic adenocarcinoma cell line, HPAF II, that has reduced S1P<sub>2</sub> levels (<xref ref-type="fig" rid="fig4">Figure 4A</xref>) and forms epithelial monolayers necessary for assaying extrusion. We used MDCK and HBE cells as controls, which are well characterized in several extrusion studies (<xref ref-type="bibr" rid="bib19">Rosenblatt et al., 2001</xref>; <xref ref-type="bibr" rid="bib25">Slattum et al., 2009</xref>; <xref ref-type="bibr" rid="bib12">Gu et al., 2011</xref>), as the only immortalized normal pancreatic cells, HPDEs, cannot form a confluent monolayer (data not shown).<fig id="fig4" position="float"><object-id pub-id-type="doi">10.7554/eLife.04069.006</object-id><label>Figure 4.</label><caption><title>Pancreatic cancer cell line HPAF II accumulates into masses and extrudes basally.</title><p>(<bold>A</bold>) S1P<sub>2</sub> immunoblot of HBE (left), HPAF II (middle), and MDCK (left) cells with α-tubulin as loading control. (<bold>B</bold>) Cell death rates in response to UV-C. (<bold>C</bold>) Quantification of cell extrusion events from three independent experiments; n = 300 apoptotic cells per cell line, error bars are STD where *<0.01 and ***<0.0001. (<bold>D</bold>) Representative confocal projection and XZ cross-section (from region in dashed line above) of HPAF II cells that grew into masses rather than monolayers. (<bold>E</bold>) Representative confocal projections of HPAF II (upper panel) and HBE (lower panel) cells undergoing apical (left) or basal (middle) extrusion, with XZ sections below. Basal extrusion was scored when an actin ring contracted above the dying cell (marked by DNA and caspase-3 staining) and the DNA of the dying cell lies in the same plane as the neighboring cells. Scale bars, 10 µm.</p><p><bold>DOI:</bold> <ext-link ext-link-type="doi" xlink:href="10.7554/eLife.04069.006">http://dx.doi.org/10.7554/eLife.04069.006</ext-link></p></caption><graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="elife04069f004"/></fig></p><p>Our experiments show that the reduced S1P<sub>2</sub> levels in HPAF II cells disrupted apical extrusion, leading to reduced apoptosis rates and enhanced basal extrusion. Similar to HBE monolayers lacking S1P<sub>2</sub>, HPAF II cells formed masses within a week of culture and displayed extrusion defects and reduced rates of UV-C-induce apoptosis (<xref ref-type="fig" rid="fig4">Figure 4A–D</xref>). While ∼50% of cells did not extrude, most of the remaining cells extruded in the opposite direction—basally, underneath the layer (<xref ref-type="fig" rid="fig4">Figure 4D,E</xref>) at rates similar to when MDCK monolayers are treated with S1P<sub>2</sub> antagonist (<xref ref-type="bibr" rid="bib24">Slattum et al., 2014</xref>). Basal extrusion of cells with upregulated survival signaling could potentially enable their invasion beneath the epithelium (<xref ref-type="bibr" rid="bib26">Slattum and Rosenblatt, 2014</xref>). To investigate if basally extruded cells can survive following extrusion (<xref ref-type="bibr" rid="bib26">Slattum and Rosenblatt, 2014</xref>), we analyzed extrusion from three-dimensional cysts, where the fate of basally extruded cells can be followed outside the cyst, rather than beneath a monolayer. MDCKs were used as controls, which, like HPAF II cells, form cysts with hollow apical lumens of 34 µm ± 5 µm in diameter when grown in Matrigel (<xref ref-type="fig" rid="fig5">Figure 5B</xref>). Approximately 30% of HPAF II cysts extrude cells basally that survive, compared to only ∼3% of MDCK cysts (<xref ref-type="fig" rid="fig5">Figure 5C,D</xref>). Live imaging confirmed that 28.6% of basally extruded cells remained alive throughout a 12-hr video, whereas those from MDCK cysts died during this time (<xref ref-type="other" rid="video1">Video 1</xref>, n = 5 videos of each). Importantly, S1P<sub>2</sub>-GFP expression is sufficient to rescue apical extrusion (<xref ref-type="fig" rid="fig5">Figure 5C</xref>), decrease the frequency of live cells that basally extrude (<xref ref-type="fig" rid="fig5">Figure 5D</xref>), and increase the percentage of cysts with dead cells in their lumens (<xref ref-type="fig" rid="fig5">Figure 5E</xref>). These data suggest that the S1P-S1P<sub>2</sub> signaling required for extrusion is critical not only for promoting cell death but also for preventing basal extrusion, which could enable cells to invade.<fig id="fig5" position="float"><object-id pub-id-type="doi">10.7554/eLife.04069.007</object-id><label>Figure 5.</label><caption><title>Exogenous expression of S1P<sub>2</sub> rescues apical extrusion and cell death.</title><p>(<bold>A</bold>) GFP immunoblot of HPAF II cells expressing S1P<sub>2</sub> GFP. (<bold>B</bold>) Representative confocal projections of MDCK, HPAF II, and HPAF II-S1P<sub>2</sub> cysts, where scale bar = 10 µm. (<bold>C</bold>) Percentages of MDCK, HPAF II GFP, and HPAF II S1P<sub>2</sub> cysts with basal extrusion; n = 300 cysts per cell line. (<bold>D</bold>) Quantification of MDCK, HPAF II GFP, and HPAF II S1P<sub>2</sub> cysts extruding live cells basally; n = 300 cysts per cell line. (<bold>E</bold>) Frequency of HPAF II GFP and HPAF II S1P<sub>2</sub> cysts with dying cells inside the lumen; n = 300 cysts per cell line. All results are expressed as mean values ± STD of three separate experiments (**p < 0.01, and ***p < 0.001).</p><p><bold>DOI:</bold> <ext-link ext-link-type="doi" xlink:href="10.7554/eLife.04069.007">http://dx.doi.org/10.7554/eLife.04069.007</ext-link></p></caption><graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="elife04069f005"/></fig><media id="video1" content-type="glencoe play-in-place height-250 width-310" xlink:href="elife04069v001.mov" mimetype="video" mime-subtype="mov"><object-id pub-id-type="doi">10.7554/eLife.04069.008</object-id><label>Video 1.</label><caption><title>An HPAF II cyst growing without apoptotic stimuli extrudes live cells basally.</title><p>Note that some cells extrude and die while others survive and/or migrate away.</p><p><bold>DOI:</bold> <ext-link ext-link-type="doi" xlink:href="10.7554/eLife.04069.008">http://dx.doi.org/10.7554/eLife.04069.008</ext-link></p></caption></media></p></sec><sec id="s2-3"><title>Inhibiting FAK rescues cell death rates in epithelia defective in extrusion</title><p>Because extrusion promotes cell death in response to apoptotic stimuli (<xref ref-type="bibr" rid="bib19">Rosenblatt et al., 2001</xref>; <xref ref-type="bibr" rid="bib1">Andrade and Rosenblatt, 2011</xref>) and during normal homeostasis (<xref ref-type="bibr" rid="bib7">Eisenhoffer et al., 2012</xref>; <xref ref-type="bibr" rid="bib15">Marinari et al., 2012</xref>), we hypothesized that it does so by eliminating the competing survival signaling associated with cell-matrix attachment. If so, increased cell survival when extrusion is blocked would derive from prolonged cell attachment to the underlying matrix. Since Focal Adhesion Kinase (FAK) is critical for matrix-dependent survival (<xref ref-type="bibr" rid="bib10">Frisch et al., 1996</xref>), we investigated if FAK were increased in cells targeted for death when extrusion was blocked. Surprisingly, we found that control MDCK cells in early stages of extrusion have far higher levels of active FAK, by immunostaining with a phospho-FAK antibody, than surrounding live cells but that these levels decrease during later stages of extrusion (<xref ref-type="fig" rid="fig6">Figure 6A</xref>). This increase in pro-survival phospho-FAK in cells targeted to die mimics the increased levels of S1P, another pro-survival signal, in cells triggered to extrude and die that also decrease once cells extrude (<xref ref-type="fig" rid="fig3">Figure 3C</xref> and [<xref ref-type="bibr" rid="bib12">Gu et al., 2011</xref>]). However, late-staged apoptotic cells (detected by piknotic DNA) still have high levels of active FAK when extrusion is blocked with S1P<sub>2</sub> antagonist (<xref ref-type="fig" rid="fig6">Figure 6A</xref>). This paradoxical survival signaling increase in cells targeted to die may reflect cell-intrinsic compensatory signals to apoptotic signaling that eventually decrease as cells commit to apoptosis. The fact that these survival signals stay high when cell extrusion is blocked suggests that this increased survival signaling derives from inability to detach from matrix.<fig id="fig6" position="float"><object-id pub-id-type="doi">10.7554/eLife.04069.009</object-id><label>Figure 6.</label><caption><title>Inhibition of FAK activity specifically increases cell death in epithelial cells lacking S1P<sub>2</sub>.</title><p>(<bold>A</bold>) Immunostaining of active phospho-FAK in early and late control extrusions and in a JTE-013 (S1P<sub>2</sub> antagonist)-inhibited extrusion with late apoptotic cell or one with the FAK inhibitor PF573228, with averaged arbitrary fluorescence units and their p-values compared to early extruding cells in graph on right (n = 10 measurements each over three separate experiments). (<bold>B</bold>) Quantification of UV-induced MDCK apoptosis in the presence of control, JTE-013, or EHT1864 with or without treatment of the FAK inhibitor PF573228, where n = 3000. (<bold>C</bold>) Quantification of UV-induced apoptosis of MDCK cells and those expressing FRNK, where n = 3000. (<bold>D</bold>) Quantification of PF573228-induced apoptosis of HPAF II cells, where n = 3000. (<bold>E</bold>) Representative confocal projections of HPAF II cysts treated with control or PF573228. Scale bars = 10 µm. (<bold>F</bold>) Frequencies of HPAF II cysts with dying cells, live extruding cells, or neither, where n = 300. All quantification results are expressed as mean values ± STD of three separate experiments (*p < 0.05, **p < 0.01, ***p < 0.001, and ****p < 0.0001).</p><p><bold>DOI:</bold> <ext-link ext-link-type="doi" xlink:href="10.7554/eLife.04069.009">http://dx.doi.org/10.7554/eLife.04069.009</ext-link></p></caption><graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="elife04069f006"/></fig></p><p>Because FAK activity remains high in cells where extrusion is blocked, we wondered if chemically blocking FAK activation would rescue the apoptosis rates of monolayers lacking functional S1P<sub>2</sub> signaling. The specific FAK inhibitor PF 573228 had no effect on untreated or UV-treated wild type monolayers (<xref ref-type="fig" rid="fig6">Figure 6B</xref> and [<xref ref-type="bibr" rid="bib23">Slack-Davis et al., 2007</xref>]), likely because cells not targeted to extrude have quite low levels of active FAK (<xref ref-type="fig" rid="fig6">Figure 6A</xref>). However, this same FAK inhibitor rescued the cell death rates of monolayers where extrusion is blocked with S1P<sub>2</sub> antagonist JTE013 or Rac inhibitor to those seen in wild type monolayers (<xref ref-type="fig" rid="fig6">Figure 6B</xref>). FAK inhibitor dramatically decreased phospho-FAK staining in cells where JTE013 blocks extrusion (<xref ref-type="fig" rid="fig6">Figure 6A</xref>). Over-expression of a dominant negative FAK isoform (FRNK) (<xref ref-type="bibr" rid="bib17">Park et al., 2004</xref>) acted similarly to FAK inhibitor (<xref ref-type="fig" rid="fig6">Figure 6C</xref>). Importantly, FAK inhibitor alone induced apoptosis of HPAF II cells in monolayers (<xref ref-type="fig" rid="fig6">Figure 6D</xref>) and even those basally extruding from HPAF II cysts (<xref ref-type="fig" rid="fig6">Figure 6E,F</xref>). Additionally, treatment with FAK inhibitor to cysts that had already accumulated live basally extruded cells was sufficient to nearly double apoptosis rates of basally extruded cells (from 15 ± 2% to 28 <underline>±</underline> 3%) when added for only 2 hr.</p></sec><sec id="s2-4"><title>FAK inhibitor eliminates S1P<sub>2</sub> mutant zebrafish embryo epidermal masses and improves epidermal barrier function</title><p>Because inhibition of FAK appears to promote cell death of only extrusion-defective epithelial cells without affecting normal epithelia, we wondered if FAK inhibition could eliminate the epidermal masses of Mil zebrafish embryos as they formed without adversely impacting the animal. While FAK inhibitor had no visible effect on wild-type zebrafish at 5 dpf, it greatly decreased the number and size of epidermal cell masses in S1P<sub>2</sub>-mutant embryos of the same age (<xref ref-type="fig" rid="fig7">Figure 7A–C</xref>). While FAK inhibitor treatment sloughed off many of the epidermal cells, which could be found at the bottom of the dish, it also increased the apoptosis rate within the masses (<xref ref-type="fig" rid="fig7">Figure 7D</xref>). To test if FAK inhibitor could eliminate epidermal masses <italic>after</italic> they form, we needed to inducibly knockdown S1P<sub>2</sub> later in development, since Mil zebrafish mutants die due to heart defects around the time cell masses form (∼5 dpf; [<xref ref-type="bibr" rid="bib14">Kupperman et al., 2000</xref>]). To do so, we used we photo-activated S1P<sub>2</sub> morpholino at 24 hpf (see [<xref ref-type="bibr" rid="bib7">Eisenhoffer et al., 2012</xref>] for characterization of this method) to knockdown S1P<sub>2</sub> after heart development occurred. S1P<sub>2</sub> morphants had 0.18-fold lower S1P<sub>2</sub> protein levels (<xref ref-type="fig" rid="fig7">Figure 7E</xref>) and phenocopied the epidermal masses seen in Mil mutants (<xref ref-type="fig" rid="fig7">Figure 7F</xref>). Addition of FAK inhibitor to an S1P<sub>2</sub> morphant at 5 dpf with epidermal masses caused the masses to slough off within 19 hr (<xref ref-type="fig" rid="fig7">Figure 7F</xref>, where n = 6 videos total). Remarkably, we found that while <italic>Mil</italic> embryos had poor epidermal barrier function, as assayed by Texas Red-Dextran<sup>MW70</sup> permeability, epidermal permeability was significantly reduced with FAK inhibitor (<xref ref-type="fig" rid="fig7">Figure 7A</xref>). These results suggest that FAK inhibitor alone may selectively target masses resulting from cells defective in extrusion and improve overall epithelial integrity without affecting the normal surrounding tissue.<fig id="fig7" position="float"><object-id pub-id-type="doi">10.7554/eLife.04069.010</object-id><label>Figure 7.</label><caption><title>FAK inhibitors eliminate epidermal cell masses in S1P<sub>2</sub> zebrafish mutants and improve epidermal barrier function without affecting wild type zebrafish.</title><p>(<bold>A</bold>) Representative confocal projections of 5-dpf WT (left) and <italic>Mil</italic> (S1P<sub>2</sub> mutant) (right) zebrafish larvae treated with DMSO or FAK inhibitor PF573228, where high Texas-Red Dextran indicates poor permeability in <italic>Mil</italic> but is greatly reduced when barrier function is improved with FAK inhibitor treatment. Scale bar = 10 µm and red box indicates region of fish imaged. (<bold>B</bold>) 5 dpf <italic>Mil</italic> and wild type zebrafish treated with and without FAK inhibitor. Note that while FAK inhibitor-treated <italic>Mil</italic> have other developmental defects (heart and circulation), there are no obvious clumps as seen in the untreated fish. Scale bar = 100 µm and red box indicates region of fish imaged. Note FAK inhibitor does not affect WT zebrafish. (<bold>C</bold>) Quantification of epidermal masses in 5 dpf <italic>Mil</italic> zebrafish larvae with and without PF573228. (<bold>D</bold>) Quantification of apoptotic cells within epidermal masses with and without PF573228. For both, error bars are SD and p values are ***<0.0001. (<bold>E</bold>) Immunoblot showing knockdown of S1P<sub>2</sub> by photo-activatable morpholinos. (<bold>F</bold>) Stills from a video where PF573228 was added to S1P<sub>2</sub> morphant at 5 dpf, where red arrows show the edge of the epidermis over time, scale bar = 50 µm and red box indicates region of fish imaged. Time is hours:minutes following FAK inhibitor addition. Note: epidermal cells that are sloughed off become embedded in the agarose where fish is mounted.</p><p><bold>DOI:</bold> <ext-link ext-link-type="doi" xlink:href="10.7554/eLife.04069.010">http://dx.doi.org/10.7554/eLife.04069.010</ext-link></p></caption><graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="elife04069f007"/></fig></p></sec><sec id="s2-5"><title>Expression of S1P<sub>2</sub> is sufficient to reduce orthotopic pancreatic tumors and their metastases</title><p>We have shown that disrupting S1P/S1P<sub>2</sub> signaling inhibits epithelial cell death, causes masses, and promotes a potential mechanism for invasion—basal extrusion, which together could promote tumor formation and progression. Yet, it was not clear if this signaling pathway plays a role in malignancy. To test the role of S1P<sub>2</sub> in tumorigenesis, we orthotopically transplanted HPAF II tumor cells expressing either GFP or S1P<sub>2</sub>-GFP into nude mice and found that S1P<sub>2</sub> expression was sufficient to markedly reduce both tumor size and metastatic frequency (<xref ref-type="fig" rid="fig8">Figure 8A,B</xref>).<fig id="fig8" position="float"><object-id pub-id-type="doi">10.7554/eLife.04069.011</object-id><label>Figure 8.</label><caption><title>Exogenous S1P<sub>2</sub> expression reduces orthotopic pancreatic tumors and rates of metastasis in mice.</title><p>(<bold>A</bold>) Representative images of HPAF II GFP and HPAF II S1P<sub>2</sub> orthotopic xenograft tumors in nude mice. (<bold>B</bold>) Summary of tumor weights and metastatic frequency.</p><p><bold>DOI:</bold> <ext-link ext-link-type="doi" xlink:href="10.7554/eLife.04069.011">http://dx.doi.org/10.7554/eLife.04069.011</ext-link></p></caption><graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="elife04069f008"/></fig></p></sec><sec id="s2-6"><title>Human pancreatic ductal carcinomas lack S1P<sub>2</sub> receptor</title><p>Further, we found that human pancreatic carcinomas have strikingly down-regulated S1P<sub>2</sub> protein levels. Because tumors typically have different stromal to epithelial ratios compared to uninvolved pancreatic tissue that can confound microarray data, we immunostained fixed tissue slices for both S1P<sub>2</sub> and cytokeratin to highlight epithelial cells so that we could compare S1P<sub>2</sub> protein levels in the epithelia alone (<xref ref-type="fig" rid="fig9">Figure 9A</xref>). We found that S1P<sub>2</sub> was significantly lower in pancreatic cancer (PDAC) cells compared to epithelial acini from uninvolved neck margins, from which PDACs may arise, or to pancreatic intraepithelial neoplasia (PanIN) precursor lesions (<xref ref-type="fig" rid="fig9">Figure 9A–C</xref>). Importantly, lower S1P<sub>2</sub> expression correlates with later tumor stages in both averaged (<xref ref-type="fig" rid="fig9">Figure 9B</xref>) and five patient-matched samples (<xref ref-type="fig" rid="fig9">Figure 9C</xref>). Loss of S1P<sub>2</sub> expression in pancreatic cancers suggests that defective extrusion may contribute to human PDAC development.<fig id="fig9" position="float"><object-id pub-id-type="doi">10.7554/eLife.04069.012</object-id><label>Figure 9.</label><caption><title>Human pancreatic tumors have reduced S1P<sub>2</sub> expression.</title><p>(<bold>A</bold>) H&E (top panel) and confocal fluorescence images (middle and bottom panel) of normal acinar cells from uninvolved neck margin, PanIN, and invasive cancer cells. Scale bars, 100 and 10 µm, respectively. (<bold>B</bold>) Quantification of S1P<sub>2</sub> fluorescence intensity in acinar cells, PanIN, and invasive cancer cells from five individual patients. p values were calculated with a paired t test. (<bold>C</bold>) Changes of S1P<sub>2</sub> fluorescence intensity from normal acinar cells to invasive cancer cells in each individual patient.</p><p><bold>DOI:</bold> <ext-link ext-link-type="doi" xlink:href="10.7554/eLife.04069.012">http://dx.doi.org/10.7554/eLife.04069.012</ext-link></p></caption><graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="elife04069f009"/></fig></p></sec></sec><sec sec-type="discussion" id="s3"><title>Discussion</title><p>Our work presents a new paradigm for how an aggressive class of carcinomas may form and progress: failed extrusion (<xref ref-type="fig" rid="fig10">Figure 10</xref>). Normal epithelial cells produce S1P to trigger their extrusion and death once they become too crowded, simultaneously maintaining correct cell density and barrier function. Epithelia with defective S1P/S1P<sub>2</sub> signaling cannot extrude apically. Extrusion-defective epithelia retain cells, which can result in resistance to homeostatic and chemotherapy-induced cell death and neoplastic masses. Further, a small number of cells also die without getting extruded, which can disrupt barrier function. Aside from allowing access of inappropriate signals, poor epithelia barrier function could cause chronic inflammation—an important factor for tumor progression (<xref ref-type="bibr" rid="bib6">Coussens and Werb, 2002</xref>). Additionally, defective apical extrusion signaling shifts extrusion basally, which could allow transformed cells to invade the underlying tissue (<xref ref-type="bibr" rid="bib26">Slattum and Rosenblatt, 2014</xref>).<fig id="fig10" position="float"><object-id pub-id-type="doi">10.7554/eLife.04069.013</object-id><label>Figure 10.</label><caption><title>Model for how extrusion can promote cell death and suppress tumor formation.</title><p>Apical extrusion promotes death of grey-blue cell (top panel). Here, pro-survival signals phospho-FAK and S1P (which also promotes extrusion) increase in an early extruding cell but decrease once a cell is extruded and targeted to die (right, cell with piknotic nucleus). However, when apical extrusion is blocked due to lack of S1P<sub>2</sub> receptor (bottom panel), epithelial cells do not die and can accumulate (left cell and those accumulating above) from increased matrix-derived survival signaling (arrows from matrix neighboring cells signaling to P-FAK). Additionally, cells can still basally extrude, which could potentially enable their invasion beneath the layer (right cell). Basally extruded cells may also have high P-FAK, since they are sensitive to FAK inhibitor when extruded into matrix in vitro, yet this point will be critical to test in vivo in disseminating tumors. Other cells may still die but not extrude (grey-blue cell with piknotic nucleus), leading to poor barrier function and inflammation, which could also promote tumor progression.</p><p><bold>DOI:</bold> <ext-link ext-link-type="doi" xlink:href="10.7554/eLife.04069.013">http://dx.doi.org/10.7554/eLife.04069.013</ext-link></p></caption><graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="elife04069f010"/></fig></p><p>Basal extrusion may be a common hallmark of invasive tumor types. We have recently discovered that oncogenic KRas<sup>V12</sup> expression degrades S1P through autophagy and causes cell masses and basal extrusion, similar to the extrusion defects observed when S1P<sub>2</sub> is absent (<xref ref-type="bibr" rid="bib24">Slattum et al., 2014</xref>). KRas<sup>V12</sup> is an important driver for the same cancers that lack S1P<sub>2</sub>—pancreatic, lung, and colon carcinomas—and its expression alone reduces S1P<sub>2</sub> (<xref ref-type="bibr" rid="bib24">Slattum et al., 2014</xref>), which may explain why PanIN precursors have reduced S1P<sub>2</sub> expression. Further, we have found that another oncogenic mutation, truncation of the adenomatous polyposis coli gene, also results in increased basal extrusion. While it is not clear what mechanisms drive tumor cell invasion, our work showing that exogenous expression of S1P<sub>2</sub> can dramatically reduce basal extrusion rates and orthotopic tumor metastasis rates in tumor cells that lack this receptor suggests that S1P<sub>2</sub>-mediated extrusion may play an important role in metastatic cell invasion.</p><p>Because cancer cells lacking S1P<sub>2</sub> have increased survival signaling due to an inability to detach from the matrix and its associated survival signaling through increased active FAK, we found that FAK inhibitor on its own could rescue cell death rates to those seen in wild type cells (<xref ref-type="fig" rid="fig7">Figure 7D</xref>). Surprisingly, FAK inhibitor could also reverse other extrusion defects, such as poor barrier function and survival of basally extruded cells, factors that together could contribute to tumor progression. The fact that adding FAK inhibitor can rescue these defects when added after they form further supports the notion that anoikis results from extrusion and also suggests that FAK inhibitors may be particularly good at treating pancreatic and other carcinomas defective in extrusion. Moreover, we expect a specific FAK inhibitor to not cause the common toxicities associated with standard chemotherapies, as it does not affect normal epithelial tissue. Another FAK inhibitor, PF-00562271, reduces tumor growth, metastases, and ameliorates tumor microenvironment when used in an orthotopic mouse model for pancreatic cancer (<xref ref-type="bibr" rid="bib27">Stokes et al., 2011</xref>), suggesting this drug could be promising for pancreatic cancer patients. However, it is important to note that PF-00562271 also inhibits a FAK-related kinase Pyk-2, which promotes non-specific cell death (<xref ref-type="bibr" rid="bib20">Schultze and Fiedler, 2011</xref>). The phase I clinical trial for PF-00562271 showed that while this drug was tolerated fairly well, it did cause nausea, vomiting, and diarrhea (<xref ref-type="bibr" rid="bib13">Infante et al., 2012</xref>), symptoms indicative of poor gut barrier function, likely due to excessive non-specific apoptosis. Our results suggest that a newer more specific FAK inhibitor, such as VS-4718 (<xref ref-type="bibr" rid="bib22">Shapiro et al., 2014</xref>), may provide a more targeted therapy for patients with pancreatic and lung carcinomas that have aberrant extrusion signaling without the common toxicities associated with older chemotherapies.</p><p>Based on our previous findings that extrusion drives normal epithelial cell turnover, we have found that disruption of extrusion may contribute to a class of cancers with poor prognosis. We find that cancer cells that lack the extrusion-signaling axis not only have reduced cell death rates but also have poor barrier function and a propensity to extrude cells basally, properties that could lead to higher invasion and metastatic rates. Therefore, aberrant extrusion signaling in pancreatic and lung carcinomas could not only contribute to tumor initiation but also progression. Importantly, specific inhibition of FAK, which does not disrupt normal epithelial tissue, is sufficient to reverse all of the effects of disrupted extrusion and could provide a better, less toxic therapy for this aggressive class of tumors.</p></sec><sec sec-type="materials|methods" id="s4"><title>Materials and methods</title><sec id="s4-1"><title>Cell culture</title><p>MDCK II cells were cultured in Dulbecco's minimum essential medium (DMEM) high glucose with 5% FBS (all from HyClone, Logan, UT) and 100 μg/ml penicillin/streptomycin (Invitrogen, Grand Island, NY) at 5% CO<sub>2</sub>, 37°C. HBE cells were cultured in MEM supplemented with 10% FBS and l-glutamine in a flask coated with human fibronectin type I (BD, Franklin Lakes, New Jersey), bovine collagen I (Advanced BioMatrix, San Diego, CA), and BSA (Invitrogen). HPAF II cells were cultured in MEM (HyClone) supplemented with 10% FBS.</p><p>Culturing HPAF II and MDCK cells in Matrigel generated HPAF II and MDCK cysts, respectively. Briefly, a single cell suspension of HPAF II cells was resuspended in Growth Factor Reduced Matrigel (BD Biosciences) final concentration 4% and placed in eight well coverglass chambers (Nalge Nunc, Rochester, NY) coated with a thin polymerized layer of Matrigel. For live imaging, cells were placed on 24 well glass-bottom culture dishes (MatTeK Corporation, Ashland, MA). After 20 min incubation at 37°C, cell-growth medium was added on top. Cysts were allowed to grow for the indicated duration and analyzed by time-lapse imaging or fixed with 4% paraformaldehyde for immunostaining.</p></sec><sec id="s4-2"><title>Generation of stable Doxycyclin-inducible MDCK II cells over-expressing dominant negative FAK</title><p>We first transfected MDCK II cells with neomycin-resistant pTet-ON regulator plasmid, encoding rtTA protein (reverse tTA, tetracycline-controlled transactivator). The stable transfected MDCK II cells were selected by cultivation in media containing 500 μg/ml G418. We then transfected Tet-ON MDCK II cells with FAK-CD-TRE-2-hyg plasmids (<xref ref-type="bibr" rid="bib11">Golubovskaya et al., 2009</xref>) and selected for stably transfected cells with 0.1 mg/ml hygromycin. Expression of FAK-CD was induced with 2 µg/ml doxycycline for 4 days.</p></sec><sec id="s4-3"><title>UV and drug treatment</title><p>MDCK II, HBE, or HPAF II cells grown to confluence on glass coverslips were exposed to 1200 μJ/cm<sup>2</sup> UV<sup>254</sup> using a Spectrolinker (Spectroline, Westbury, NY) to induce apoptotic extrusion and incubated for 2 hr before fixation. Cells were treated with 10 μM JTE-013 (Tocris Bioscience, United Kingdom), 10 μM Y-27632, 10 μM Blebbistatin, 10 μM EHT 1864 (all from Sigma–Aldrich, Saint Louis, MO), 10 μM PF 573228 (Tocris Bioscience) or 1% DMSO as a control for 10 min before UV treatment. To induce apoptosis with chemotherapy drugs, cells were treated with 20 μg/ml Cisplatin, 1 μM Gemcitabine, or 20 μg/ml 5-Fluorouracil (all from Sigma–Aldrich) for 24 hr.</p></sec><sec id="s4-4"><title>Cell staining</title><p>Cells were fixed with 4% formaldehyde in PBS at 37°C for 20 min, permeabilized for 10 min with 0.5% Triton in PBS, blocked with AbDil (PBS with 0.1% Triton X-100 and 2% BSA) for 10 min, and incubated with primary antibody for 1 hr. Antibody concentrations used for immunostaining were: 1:200 rabbit anti-active caspase-3 (BD), 1:100 rabbit anti-phospho FAK (Tyr 397) (Cell Signaling, Danvers, Massachusetts), and 50 μg/ml anti-S1P mAb (LPath Inc., San Diego, CA). Alexa Fluor 488 goat anti–rabbit IgG and Alexa Fluor 488 goat anti–mouse IgG were used as secondary antibodies to detect active caspase-3 and S1P, respectively. Actin was detected with Alexa Fluor 568–phalloidin (Invitrogen). DNA was detected with 1 μg/ml Hoechst 33,342 (Sigma–Aldrich).</p></sec><sec id="s4-5"><title>Human pancreatic sections</title><p>Pancreatic tissue sections (3 µm) were generated from formalin-fixed, paraffin-embedded tissue collected from PDAC patient resections at the University of Utah Hospital. The sections were deparaffinised and rehydrated by incubating in citrus clearing solvent (CCS; Richard Allen Scientific, Kalamazoo, MI), 100%, 95%, 80%, 70% ethanol, and PBS. For immunofluorescence, antigens were retrieved by heating the slides in boiling 10 mM sodium citrate for 20 min, then rinsed three times with PBS, blocked with 5% BSA/0.5% Tween-20 in PBS for 4 hr, and incubated overnight with anti-S1P<sub>2</sub> (Imgenex, San Diego, CA) and anti-pan cytokeratin (Sigma–Aldrich) at 4°C, rinsed five times with PBS, incubated in Alexa-488 anti-mouse antibody, 1 µg ml<sup>−1</sup> Hoechst, and Alexa-568 anti-rabbit antibody for 2 hr, rinsed three times in PBS, and mounted in Prolong Gold (Invitrogen). Fluorescence micrographs of stained slides were obtained using a Leica DM 6000B microscope and captured using a Micromax charge-coupled device camera (Roper Scientific, Sarasota, Florida). IPlab Software was used to control the camera and to process images. Pixel intensity interested area was measured with ImageJ. The University of Utah Institutional Review Board approved the use of human tissue in this study. Tissue sections were obtained from excess clinical pathology tissue from patients, deidentified, resected for pancreatic adenocarcinoma at the University of Utah Huntsman Cancer Institute with appropriate informed consent for use of samples for research purposes (IRB_00010924).</p></sec><sec id="s4-6"><title>Zebrafish treatment and staining</title><p>We sorted <italic>Mil</italic> zebrafish embryos from their WT homozygous and heterozygous siblings at 2 days post-fertilization (dpf) by the presence or absence of tail blisters. We then treated half of <italic>Mil</italic> mutants and half of the wild type siblings with FAK inhibitor (10 μM PF 573228) for 3 days and added Texas Red-Dextran<sup>MW70</sup> 30 min before fixation. Embryos were then fixed in PBS with 4% formaldehyde and 0.1% Triton X-100 overnight, blocked with 2 mg/ml BSA for 2 hr, and stained for anti-E Cadherin (Gentex, Zeeland: MI) for 4 hr followed by incubation with Alexa Fluor 488 anti–rabbit IgG Ab. DNA was visualized using 1 μg/ml DAPI.</p></sec><sec id="s4-7"><title>Zebrafish morpholino</title><p>The antisense morpholino oligonucleotides and photo-morpholino oligonucleotides were acquired from Gene Tools, LLC (Philomath, OR). For the photo-morpholino experiments, the translation blocking antisense morpholino (4 ng/embryo of each) was mixed at a 1:1 molar ratio with a 25 bp sense photo-morpholino and injected into 1–2-cell-stage wild-type AB zebrafish embryos. At 28–32 hpf, embryos were exposed to 350 nm light for 20 s to release the caging sense morpholino, then treated with 10 μM PF 573228 (FAK inhibitor), and filmed by timelapse video microscopy on a spinning disc confocal.</p></sec><sec id="s4-8"><title>Image and video acquisition</title><p>Confocal Imaging was performed in a Nikon Eclipse TE300 inverted microscope converted for spinning disc confocal microscopy (Andor Technologies, United Kingdom) using a 40× Nikon Apo LWD lenses. Images were acquired with an electron-multiplied cooled charge-coupled device camera (DV887 1004X1002; Andor Technologies) driven by Andor IQ2 imaging software. All images were processed further using Photoshop and Illustrator (Adobe, San Jose, CA), and QuickTime Pro (Apple, San Jose, CA) software.</p><p>Live imaging of HPAF II cysts was taken with an OLYMPUS 1X71 inverted microscope using a 20× lens. The images were taken every 5 min for 12 hr. Temperature was controlled by a Weather station connected to the microscope.</p><p>For live imaging, FAK inhibitor treated S1P<sub>2</sub> morpholino fish were anesthetized with 0.02% Tricaine in E3, mounted in 1% low melt agarose and imaged on a spinning disc confocal at 20×, capturing a z-series every 2 min (<xref ref-type="bibr" rid="bib8">Eisenhoffer and Rosenblatt, in press</xref>) for 3–6 hr.</p></sec><sec id="s4-9"><title>Quantification of apoptosis and cell extrusion</title><p>To quantify the frequency of apoptosis within a monolayer, we counted the number of active caspase-3 positive cells still in contact with the monolayer per 1000 cells. We excluded round cells with strong caspase-3 staining that were not associated with monolayers, which were likely extruded well before experimental treatments could have impacted them.</p><p>To quantify extrusion, extruding cells were manually scored based on the presence of an actin ring compared to where apoptotic cell localized with respect to its neighboring cells. Apoptotic cells above the plane of the monolayer with strong actin staining around and below them were defined as apically extruded cells. Apoptotic cells remaining in the monolayer and underneath an apical actin ring were considered basally extruded cells. Active caspase-3-positive cells that were not surrounded by a distinguishable actin ring were defined as non-extruded apoptotic cells.</p></sec><sec id="s4-10"><title>Immunoblot analysis</title><p>Whole-cell extracts were prepared by resuspending cells in NP40 Cell Lysis Buffer (Invitrogen) plus protease inhibitor cocktail and PMSF (Roche, Switzerland). Proteins were resolved by SDS-PAGE using NuPage gels (Invitrogen), and transferred to polyvinylidene difluoride membrane (Thermo, Waltham, MA). Membranes were blocked with 5% dry milk and probed with anti-tubulin 1:1000 (Sigma–Aldrich) and anti-GFP 1:10,000 (Clontech, Mountain View, CA) or anti S1P<sub>2</sub> 1:500 (Santa Cruz, Santa Cruz, CA) and identified using horseradish peroxidase conjugated secondary antibodies and enhanced chemiluminescense.</p></sec><sec id="s4-11"><title>Molecular cloning</title><p>pLL5.0 is a lentiviral expression plasmid containing a U6 promoter to drive expression of the shRNA sequence and a 5′-long terminal repeat to drive the expression of GFP. Designing and cloning of S1P<sub>2</sub>-specific shRNA were performed as previously described (<xref ref-type="bibr" rid="bib12">Gu et al., 2011</xref>). The full length of human S1P<sub>2</sub> was PCR amplified and ligated into the <italic>EcoR</italic>I/<italic>Bam</italic>HI sites of pLL5.0.</p></sec><sec id="s4-12"><title>Lentiviral production and transduction</title><p>Retroviral production and infections were as described (<xref ref-type="bibr" rid="bib12">Gu et al., 2011</xref>). Infected HPAF II or HBE cells were sorted for GFP by using a BD FACSAria Cell Sorter.</p></sec><sec id="s4-13"><title>Surgical orthotopic pancreatic cancer xenograft mouse model</title><p>Animals were handled according to protocols approved by the University of Utah Institutional Animal Care and Use Committee. Mice were anesthetized under isoflurane gas; the abdominal skin and muscle were incised just off the midline and directly above the pancreas to allow visualization of the pancreatic lobes; the pancreas was gently retracted and positioned to allow for direct injection of a 100 µl bolus of 1 × 10<sup>6</sup> HPAF II cells expressing GFP or S1P<sub>2</sub> GFP using a 1 cc syringe with a 30 gauge needle; the pancreas was placed back within the abdominal cavity; and both the muscle and skin layers were closed. 8 weeks later, mice were sacrificed and xenograft tumors were resected and weighed. Metastatic tumors within abdominal wall, liver, and mesentery were also examined and resected.</p></sec><sec id="s4-14"><title>Quantifications</title><p>P-FAK was quantified using Nikon Elements as the ‘ROI Sum Intensity’ on ROI statistics using the same ROI size for each projection micrograph measured, subtracting background average fluorescence. Lumen sizes were also measured using Nikon Elements using ‘Radius size’ using the largest diameter in the ‘Annotations and Measurements’ analysis package. The statistical analysis was performed using an unpaired or paired <italic>t</italic> test. Values of p < 0.05 were considered significant.</p></sec></sec></body><back><ack id="ack"><title>Acknowledgements</title><p>We thank Dr George Eisenhoffer, Alexandra Locke, and Richard Dawson for help on zebrafish experiments, and Drs Katie Ullman, Kim Schuske, and Trudy Oliver for helpful comments on our manuscript and LPath for S1P antibody. This work was supported by a National Institute of Health Director's New Innovator Award 1DP2OD002056-01, an R01 R01GM102169 and University of Utah Funding Incentive Seed Grant to JR and P30 CA042014 awarded to The Huntsman Cancer Institute for core facilities.</p></ack><sec sec-type="additional-information"><title>Additional information</title><fn-group content-type="competing-interest"><title>Competing interests</title><fn fn-type="conflict" id="conf1"><p>The authors declare that no competing interests exist.</p></fn></fn-group><fn-group content-type="author-contribution"><title>Author contributions</title><fn fn-type="con" id="con1"><p>YG, Identified the S1P extrusion pathway and that it was defective in tumors, did nearly all of the experiments, and wrote the paper, Conception and design, Acquisition of data, Analysis and interpretation of data, Drafting or revising the article</p></fn><fn fn-type="con" id="con2"><p>JS, Did mouse orthotopic tumor studies, Helped analyze data, Revised manuscript, Acquisition of data, Analysis and interpretation of data, Drafting or revising the article</p></fn><fn fn-type="con" id="con3"><p>GS, Contributed data on Rac inhibitor, Made S1P2 morphant fish and filmed them, Revised manuscript, Acquisition of data, Analysis and interpretation of data, Drafting or revising the article, Contributed unpublished essential data or reagents</p></fn><fn fn-type="con" id="con4"><p>MAF, Analyzed and obtained pancreatic cancer tissue samples, Helped interpret slides, Commented on manuscript, Analysis and interpretation of data, Drafting or revising the article, Contributed unpublished essential data or reagents</p></fn><fn fn-type="con" id="con5"><p>MA, Did experiments on chemotherapies with cell lines, Analyzed data, Had helpful comments on the paper, Acquisition of data, Analysis and interpretation of data, Drafting or revising the article</p></fn><fn fn-type="con" id="con6"><p>SJM, Did surgery on pancreatic cancer patients, Consulted on data, Reviewed the paper, Acquisition of data, Analysis and interpretation of data, Drafting or revising the article, Contributed unpublished essential data or reagents</p></fn><fn fn-type="con" id="con7"><p>VMG, Provided FAK reagents and consulting, Revised paper, Conception and design, Analysis and interpretation of data, Drafting or revising the article, Contributed unpublished essential data or reagents</p></fn><fn fn-type="con" id="con8"><p>JR, Conceived of many experiments, did some fish experiments, helped analyze data, helped write and edit manuscript drafts, Conception and design, Acquisition of data, Analysis and interpretation of data, Drafting or revising the article</p></fn></fn-group><fn-group content-type="ethics-information"><title>Ethics</title><fn fn-type="other"><p>Human subjects: The use of human tissue in this study was approved by the University of Utah Institutional Review Board. Tissue sections were obtained from excess clinical pathology tissue from patients resected for pancreatic adenocarcinoma at the University of Utah Huntsman Cancer Institute with appropriate informed consent for use of samples for research purposes (IRB_00010924). Human tissue sample were deidentified and informed consent was obtained from all study participants. The protocol was approved and monitored by the University of Utah Institutional Review Board.</p></fn><fn fn-type="other"><p>Animal experimentation: This study was performed in strict accordance with the recommendations in the Guide for the Care and Use of Laboratory Animals of the National Institutes of Health. All of the animals were handled according to approved institutional animal care and use committee (IACUC) protocols (#13-06006) of the University of Utah. 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inhibits the growth and metastasis of pancreatic cancer concomitant with altering the tumor microenvironment</article-title><source>Molecular Cancer Therapeutics</source><volume>10</volume><fpage>2135</fpage><lpage>2145</lpage><pub-id pub-id-type="doi">10.1158/1535-7163.MCT-11-0261</pub-id></element-citation></ref></ref-list></back><sub-article article-type="article-commentary" id="SA1"><front-stub><article-id pub-id-type="doi">10.7554/eLife.04069.014</article-id><title-group><article-title>Decision letter</article-title></title-group><contrib-group content-type="section"><contrib contrib-type="editor"><name><surname>Paluch</surname><given-names>Ewa</given-names></name><role>Reviewing editor</role><aff><institution>University College London</institution>, <country>United Kingdom</country></aff></contrib></contrib-group></front-stub><body><boxed-text><p>eLife posts the editorial decision letter and author response on a selection of the published articles (subject to the approval of the authors). An edited version of the letter sent to the authors after peer review is shown, indicating the substantive concerns or comments; minor concerns are not usually shown. Reviewers have the opportunity to discuss the decision before the letter is sent (see <ext-link ext-link-type="uri" xlink:href="http://elifesciences.org/review-process">review process</ext-link>). Similarly, the author response typically shows only responses to the major concerns raised by the reviewers.</p></boxed-text><p>Thank you for sending your work entitled “Defective apical extrusion signaling contributes to aggressive tumor hallmarks” for consideration at <italic>eLife</italic>. Your article has been favorably evaluated by Fiona Watt (Senior editor) and three reviewers, one of whom is a member of our Board of Reviewing Editors.</p><p>The Reviewing editor and the other reviewers discussed their comments before we reached this decision, and the Reviewing editor has assembled the following comments to help you prepare a revised submission.</p><p>This manuscript examines how dysfunction in Sphingosine 1-phosphate receptor (S1PR2) signaling may contribute to cellular overgrowth and tumor biology. All three reviewers found the topic important and the findings presented interesting. The authors demonstrate that disruption of S1PR2 leads to local cellular overgrowth both in cultured mammalian epithelial and zebrafish models. They show that this coincides with loss of both cell extrusion and apoptosis and use a variety of experimental approaches to argue that the primary defect is a failure of extrusion. This is an interesting hypothesis, however, all three reviewers found that the data presented are not sufficient at this point to fully support this conclusion.</p><p>The reviewers believe that a revision may be able to address this concern. However, the revision would have to provide significant new evidence. Specifically:</p><p>1) The principal reservation is that the data does not fully exclude the possibility that the “overgrowth” is due to a primary effect on the control of apoptosis that is separate from extrusion. Indeed, the data presented in <xref ref-type="fig" rid="fig2 fig3">Figures 2 and 3</xref> could also reflect a role for S1P<sub>2</sub> signaling in apoptotic signaling (a process in which the pathway has been widely implicated) or in damage repair. Thorough control experiments would need to be added to exclude this hypothesis:</p><p>A quantification of what percentage of the cell death events reported upon apoptosis-inducing treatments in <xref ref-type="fig" rid="fig2 fig3">Figures. 2 and 3</xref> results from live extrusion (similar to the quantification on <xref ref-type="fig" rid="fig4">Figure 4D</xref>) would be required to fully understand the results reported. Indeed, some of the apoptotic stimuli used (e.g. UV) should have an effect independently of the tissue context.</p><p>The paper would benefit greatly from experiments to show the time-course of apoptosis following UV damage to determine at which stage the induction of apoptosis is affected.</p><p>The authors claim that the experiments with drugs inhibiting actomyosin contractility supports the view that reducing extrusion reduces apoptotic response, as these drugs reduce cell death “to the extent that they inhibit extrusion”. A proper quantification of this effect would be required to support this claim (ratio of death reduction to extrusion reduction?). Particularly because actomyosin contractility has been involved in apoptotic nuclear disintegration (e.g. Croft et al., JCB, 2005) and could thus affect apoptosis independently of extrusion.</p><p>Similarly, the observation that blocking S1PR2 doesn't affect apoptosis in 3T3 cells, which don't extrude, does not exclude the possibility that these cells lack the machinery for S1PR2 signaling to regulate apoptosis.</p><p>Finally, the authors should test whether S1P2 RNAi and the cytoskeletal inhibitors used affect rates of cell death in the same cells under conditions in which there is no extrusion (e.g. in non-confluent cultures/cultures with no cell-cell adhesion). This will determine whether these pathways alter rates of apoptosis directly in the cell types studied (rather than in NIH3T3).</p><p>2) It also remains possible that the overgrowth is due to increased cell proliferation (as well as reduced apoptosis and/or extrusion). Can this be excluded?</p><p>3) The HPAFII cyst lumen appears very small compared to MDCK, is this representative and could this explain partly why basal extrusion dominates?</p><p>4) Later, the authors show that FAK inhibition eliminates epidermal cell masses. However, how does this fit with the observations from <xref ref-type="fig" rid="fig6">Figure 6</xref>, which indicate that inhibition of FAK reduces the survival of basally extruded cells? Does FAK inhibition increase cell death in cell masses? If this is the case, could this be quantified?</p><p>5) p-values are missing in several figures (e.g. 3B, 4D, 5D-F).</p><p>[Editors' note: further revisions were requested, as described below.]</p><p>Thank you for resubmitting your work entitled “Defective apical extrusion signaling contributes to aggressive tumor hallmarks” for further consideration at <italic>eLife</italic>. Your revised article has been favorably evaluated by a member of the Board of Reviewing Editors. The manuscript has been improved but there are some remaining issues that need to be addressed before acceptance, as outlined below:</p><p>The authors have addressed many of the points raised by the reviewers. However, one central point remains very unclear: by what mechanism does interfering with S1P<sub>2</sub> protect from induced (by UV or chemotherapy drugs) apoptosis? This was the main point of the reviewers in the initial review. The authors have now clarified that this protection does not result from reduced live extrusion. The current data and text suggest that the protection results from prolonged attachment of cells and thus exposure to competing survival signaling through FAK. For example, the text states: “Because extrusion normally drives cell death, could it also help promote apoptosis in response to apoptotic stimuli by eliminating competing survival signaling associated with the underlying matrix” (paragraph two in the Results section). However, if this were the case, why does FAK inhibition in control cells not increase cell death upon UV treatment? Would it increase cell death in response to some of the chemotherapy drug treatments? A drawing complementing <xref ref-type="fig" rid="fig10">Figure 10</xref> to explain how they envisage S1P<sub>2</sub> reduction protects cells against induced apoptosis would greatly clarify the paper.</p><p>Without clarification of this mechanistic point, the logics of the argument presented in the paper are confusing and unclear, making it difficult to make a decision concerning the paper. Can the authors clarify this? In other words, is there a link between the role of S1P<sub>2</sub> signaling in extrusion and the reduction in induced apoptosis when it is not present? If not, the argument presented does not seem to fully make sense and makes the paper look like a series of interesting, but not necessarily related results.</p><p>[Editors' note: further revisions were requested prior to acceptance, as described below.]</p><p>Thank you for resubmitting your work entitled “Defective apical extrusion signaling contributes to aggressive tumor hallmarks” for further consideration at <italic>eLife</italic>. Your revised article has been favorably evaluated by Fiona Watt (Senior editor) and a member of the Board of Reviewing Editors. We apologise in the delay in getting back to you on this revised version: it took time to get feedback from one reviewer whose expertise is crucial to the paper. The manuscript has been improved but there are a couple of remaining issues that need to be addressed before it can be formally accepted, as outlined below:</p><p>The new <xref ref-type="fig" rid="fig6">Figure 6A</xref> is very helpful in clarifying how interfering with S1P<sub>2</sub> might counteract apoptotic signals. While this makes the conclusion of the paper much clearer, these experiments, as displayed, are not fully convincing. How were the levels of phospho-FAK measured? Are the images displayed a confocal slice? If so, in what region of the cell? If not, how do the authors make sure to focus in a comparable region when comparing conditions? We did not manage to find this information in the Materials and methods. The legend indicates that the mean corresponds to n=3. Do they mean the intensities have been quantified in 3 cells per condition? If so, the sample size seems too small to make conclusive statements. Finally, a control showing (hopefully low) P-FAK levels after treatment with the FAK inhibitor would be helpful.</p><p>A rather minor point relates to the point on lumen sizes in the previous review round. The authors claim that lumens diameters in MDCK and HPAFII cells are comparable. Where/how was the diameter measured? In the example displayed for HPAFII cells the lumen does not appear to be spherical at all, and while the long diameter is indeed comparable to the MDCK example, the transversal cross section seems to be under 10μm, according to the scale bar. We could not find details on how the diameter was measured in the Methods, could the authors clarify?</p></body></sub-article><sub-article article-type="reply" id="SA2"><front-stub><article-id pub-id-type="doi">10.7554/eLife.04069.015</article-id><title-group><article-title>Author response</article-title></title-group></front-stub><body><p><italic>1) The principal reservation is that the data does not fully exclude the possibility that the “overgrowth” is due to a primary effect on the control of apoptosis that is separate from extrusion. Indeed, the data presented in</italic> <xref ref-type="fig" rid="fig2 fig3"><italic>Figures 2 and 3</italic></xref> <italic>could also reflect a role for S1P</italic><sub><italic>2</italic></sub> <italic>signaling in apoptotic signaling (a process in which the pathway has been widely implicated) or in damage repair</italic>. <italic>Thorough control experiments would need to be added to exclude this hypothesis:</italic></p><p><italic>A quantification of what percentage of the cell death events reported upon apoptosis-inducing treatments in</italic> <xref ref-type="fig" rid="fig2 fig3"><italic>Figures. 2 and 3</italic></xref> <italic>results from live extrusion (similar to the quantification on</italic> <xref ref-type="fig" rid="fig4"><italic>Figure 4D</italic></xref><italic>) would be required to fully understand the results reported. Indeed, some of the apoptotic stimuli used (e.g. UV) should have an effect independently of the tissue context</italic>.</p><p><italic>The paper would benefit greatly from experiments to show the time-course of apoptosis following UV damage to determine at which stage the induction of apoptosis is affected</italic>.</p><p>With respect to these questions, we wanted to clarify that while live cell extrusion can be triggered by crowding (during normal turnover), when epithelia are treated with apoptotic stimuli, they activate apoptotic cell extrusion at much higher rates than the intrinsic homeostatic live cell extrusion. In both cases, S1P signaling through the S1P<sub>2</sub> receptor drives extrusion. In the first case, cells are extruded alive that later die via Piezo-1. In the second case, cells are extruded as part of the death pathway (likely via caspase activation)—here we find that extrusion also helps promote the death but because apoptosis has been activated, the cells are often dying while they extrude. I think we may need to make this clearer in our article that in <xref ref-type="fig" rid="fig1">Figure 1</xref>, cells amass from reduced rates of intrinsic homeostatic extrusion-dependent cell death, whereas in <xref ref-type="fig" rid="fig2 fig3">Figures 2 and 3</xref>, we induced cell death with a strong apoptotic stimulus, UV-C. When we induce apoptosis, the low intrinsic rates of live cell extrusion become dwarfed by those induced to die—therefore, most cells that do extrude will be caspase-positive. While some cells die when the extrusion pathway is disrupted, it is greatly reduced due to competing cell survival coming from prolonged attachment of cells (that should have died) to the matrix and its survival signaling through FAK.</p><p>We see how this point could be confusing and to avoid the confusion, we have changed this sentence of the Results section to the following: <italic>“</italic>We next wondered if extrusion-deficient cells were also more resistant to cell death in response to apoptotic stimuli. […] Because extrusion normally drives cell death, could it also help promote apoptosis in response to apoptotic stimuli by eliminating competing survival signaling associated with the underlying matrix? We find that disrupting extrusion signaling also disrupted apoptosis in response to a variety of apoptotic stimuli<italic>.</italic>”</p><p><italic>The authors claim that the experiments with drugs inhibiting actomyosin contractility supports the view that reducing extrusion reduces apoptotic response, as these drugs reduce cell death “to the extent that they inhibit extrusion”. A proper quantification of this effect would be required to support this claim (ratio of death reduction to extrusion reduction?). Particularly because actomyosin contractility has been involved in apoptotic nuclear disintegration (e.g. Croft et al.,</italic> <italic>JCB, 2005</italic><italic>) and could thus affect apoptosis independently of extrusion</italic>.</p><p>As suggested by the reviewers, we have calculated the ratio of death reduction to extrusion reduction (<xref ref-type="fig" rid="fig3">Figure 3B</xref>). The results show that the ratios of death reduction to extrusion reduction caused by inhibitors of S1P<sub>2</sub>, Rock, Myosin II, and Rac are all approximately 1:1, supporting the conclusion that these drugs reduce cell death to the extent that they inhibit extrusion.</p><p>We agree with the reviewers that actomyosin contractility has been involved in apoptotic nuclear disintegration (Croft et al., JCB, 2005). However, disruption of myosin II contractility with Y-27632 or blebbistatin has no effect on activation of caspase 3 in single cells, which we have added in as <xref ref-type="fig" rid="fig3">Figure 3D</xref> by treating similarly-aged MDCK monolayers with these inhibitors in the presence of EGTA to disrupt cell-cell junctions.</p><p><italic>Similarly, the observation that blocking S1PR2 doesn't affect apoptosis in 3T3 cells, which don't extrude, does not exclude the possibility that these cells lack the machinery for S1PR2 signaling to regulate apoptosis</italic>.</p><p>Expression of S1P<sub>2</sub> in NIH 3T3 cell has been shown in many previous publications (<xref ref-type="bibr" rid="bib5">Clair et al., Cancer Res, 2003</xref>; <xref ref-type="bibr" rid="bib18">Pham et al., Oncogene, 2013</xref>) and we added these references to our paper for clarification.</p><p><italic>Finally, the authors should test whether S1P2 RNAi and the cytoskeletal inhibitors used affect rates of cell death in the same cells under conditions in which there is no extrusion (e.g. in non-confluent cultures/cultures with no cell-cell adhesion). This will determine whether these pathways alter rates of apoptosis directly in the cell types studied (rather than in NIH3T3)</italic>.</p><p>Because under-confluent HBE and MDCK cells rarely undergo apoptosis in response to strong apoptotic stimuli, we have instead used EGTA to disrupt cell junction and thus extrusion in similarly aged and confluent cultures. As shown in <xref ref-type="fig" rid="fig3">Figure 3D</xref>, S1P<sub>2</sub> shRNA or cytoskeleton inhibitors do not reduce apoptosis rates in HBE and MDCK cells, respectively, suggesting that the effect of inhibiting S1P<sub>2</sub> or the cytoskeleton on apoptosis depends on extrusion.</p><p><italic>2) It also remains possible that the overgrowth is due to increased cell proliferation (as well as reduced apoptosis and/or extrusion)</italic>. <italic>Can this be excluded?</italic></p><p>We used Biovison Quick Cell Proliferation Colorimetric Assay to compare the proliferation rate between HBE cells expressing control shRNA or S1P<sub>2</sub> shRNA. We found no difference in the proliferation rates between these two cell lines and have added this graph in <xref ref-type="fig" rid="fig1">Figure 1C</xref>.</p><p><italic>3) The HPAFII cyst lumen appears very small compared to MDCK</italic>, <italic>is this representative and could this explain partly why basal extrusion dominates?</italic></p><p>HPAF cells form comparable sizes of cysts and lumens to the MDCK cells. In addition, some HPAF cysts could grow bigger than normal size after long-term culture (beyond our images here). The HPAF II cyst shown in <xref ref-type="fig" rid="fig5">Figure 5B</xref> looks smaller than the MDCK cyst because a different scale bar is used, as noted in the figure legend, to show live extruded cells surrounding it.</p><p><italic>4) Later, the authors show that FAK inhibition eliminates epidermal cell masses</italic>. <italic>However, how does this fit with the observations from</italic> <xref ref-type="fig" rid="fig6"><italic>Figure 6</italic></xref><italic>, which indicate that inhibition of FAK reduces the survival of basally extruded cells? Does FAK inhibition increase cell death in cell masses? If this is the case, could this be quantified?</italic></p><p>In both cases, we believe FAK inhibition increases the cell death specifically in cells that did not apically extrude. In the case of the HPAF II cysts, the cells that die are embedded in the matrix and have nowhere else to go, so we could quantify them (<xref ref-type="fig" rid="fig6">Figure 6E</xref>). However, in the zebrafish, we find that cells from the cells comprising the masses in S1P<sub>2</sub> mutants slough off. While this makes it more difficult to later quantify, we have now added a figure showing stills from a movie demonstrating that the outer clumps detach and become trapped in the agarose after treatment with FAK inhibitor. FAK inhibition also increases cell death in cell masses and we have now added quantification of this as a graph in <xref ref-type="fig" rid="fig7">Figure 7D</xref>. This is also quantified in <xref ref-type="fig" rid="fig6">Figure 6E</xref> in the cysts where FAK inhibitor increases cell death.</p><p><italic>5) p-values are missing in several figures (e.g. 3B, 4D, 5D-F)</italic>.</p><p>We have added the appropriate p-values. Thanks for pointing these out.</p><p>[Editors' note: further revisions were requested, as described below.]</p><p><italic>The authors have addressed many of the points raised by the reviewers. However, one central point remains very unclear: by what mechanism does interfering with S1P</italic><sub><italic>2</italic></sub> <italic>protect from induced (by UV or chemotherapy drugs) apoptosis? This was the main point of the reviewers in the initial review. The authors have now clarified that this protection does not result from reduced live extrusion. The current data and text suggest that the protection results from prolonged attachment of cells and thus exposure to competing survival signaling through FAK. For example, the text states: “Because extrusion normally drives cell death, could it also help promote apoptosis in response to apoptotic stimuli by eliminating competing survival signaling associated with the underlying matrix” (paragraph two in the Results section). However, if this were the case, why does FAK inhibition in control cells not increase cell death upon UV treatment? Would it increase cell death in response to some of the chemotherapy drug treatments? A drawing complementing</italic> <xref ref-type="fig" rid="fig10"><italic>Figure 10</italic></xref> <italic>to explain how they envisage S1P</italic><sub><italic>2</italic></sub> <italic>reduction protects cells against induced apoptosis would greatly clarify the paper</italic>.</p><p><italic>Without clarification of this mechanistic point, the logics of the argument presented in the paper are confusing and unclear, making it difficult to make a decision concerning the paper. Can the authors clarify this? In other words, is there a link between the role of S1P</italic><sub><italic>2</italic></sub> <italic>signaling in extrusion and the reduction in induced apoptosis when it is not present? If not, the argument presented does not seem to fully make sense and makes the paper look like a series of interesting, but not necessarily related results</italic>.</p><p>Apologies, we did not get that this was what you were asking in the first round of reviews and thought that the confusion was instead about extrusion from apoptotic stimuli versus crowding.</p><p>We are now adding data that we had previously considered including but didn’t because we were worried that it would confuse readers: when cells are triggered to extrude and die, they, surprisingly, dramatically increase pro-survival active-FAK, as revealed by phospho-FAK immunostaining (<xref ref-type="fig" rid="fig6">Figure 6A</xref>). While phospho-FAK is high in early-staged extruding cells, it decreases dramatically late in extrusion, as the cells become apoptotic. The same is true for S1P lipid, which is a survival factor in addition to triggering extrusion (<xref ref-type="fig" rid="fig3">Figure 3B</xref> and <xref ref-type="bibr" rid="bib12">Gu et al., JCB, 2011</xref>). When extrusion is blocked and cells remain in contact with matrix, phospho-FAK (and S1P) remains high, which is likely why these cells alone are susceptible to FAK inhibitor. While there is a low basal level of phospho-FAK (and S1P) in the surrounding live cells, it seems that cells targeted to die respond by upregulating their survival signaling to compete with the apoptotic signaling. Presumably, apoptosis occurs if the apoptotic signaling wins over survival signaling. We have seen this increase of survival signaling in cells targeted to die routinely, but as it goes against most people’s ideas about apoptosis, were afraid to put it in our manuscript.</p><p>We have now included pictures with quantification of P-FAK staining and included this in our schematic. We have quantified the P-FAK immunostaining compared to control surrounding non-extruding cells, with P-values compared to live surrounding cells. We believe that this data should clarify why cells targeted to extrude with upregulated survival signaling (P-FAK) do not die if extrusion is blocked since active FAK remains high from prolonged attachment to the matrix. This also explains why FAK inhibitor exclusively targets cells for death that were blocked from extruding whereas it does not affect neighboring cells with low levels of FAK. We expect to see this same P-FAK staining in response to chemotherapy or crowding-induced extrusion since FAK inhibitor promotes apoptosis to the expected levels as controls when extrusion is blocked during homeostasis.</p><p>We have added in the Results section text for <xref ref-type="fig" rid="fig6">Figure 6</xref>: “Since Focal Adhesion Kinase (FAK) is critical for matrix-dependent survival (<xref ref-type="bibr" rid="bib10">Frisch et al., 1996</xref>), we investigated if FAK were increased in cells targeted for death when extrusion was blocked. Surprisingly, we found that control MDCK cells in early stages of extrusion have far higher levels of active FAK, by immunostaining with a phospho-FAK antibody, than surrounding live cells but that these levels decrease during later stages of extrusion (<xref ref-type="fig" rid="fig6">Figure 6A</xref>). […] The specific FAK inhibitor PF 573228 had no effect on untreated or UV-treated wild type monolayers (<xref ref-type="fig" rid="fig6">Figure 6B and</xref> (<xref ref-type="bibr" rid="bib23">Slack-Davis et al., 2007</xref>)), likely because cells not targeted to extrude have quite low levels of active FAK (<xref ref-type="fig" rid="fig6">Figure 6A</xref>).”</p><p>Also, for the schematic (<xref ref-type="fig" rid="fig10">Figure 10</xref>), we have changed the legend to say: “<xref ref-type="fig" rid="fig10">Figure 10</xref>. Model for how extrusion can promote cell death and suppress tumor formation. Apical extrusion promotes death of grey-blue cell (top panel). Here, pro-survival signals phospho-FAK and S1P (which also promotes extrusion) increase in an early extruding cell but decrease once a cell is extruded and targeted to die (right, cell with piknotic nucleus. […] Other cells may still die but not extrude (grey-blue cell with piknotic nucleus), leading to poor barrier function and inflammation, which could also promote tumor progression.”</p><p>[Editors' note: further revisions were requested prior to acceptance, as described below.]</p><p><italic>The new</italic> <xref ref-type="fig" rid="fig6"><italic>Figure 6A</italic></xref> <italic>is very helpful in clarifying how interfering with S1P</italic><sub><italic>2</italic></sub> <italic>might counteract apoptotic signals. While this makes the conclusion of the paper much clearer, these experiments, as displayed, are not fully convincing</italic>. <italic>How were the levels of phospho-FAK measured?</italic></p><p>We used Nikon Elements ROI statistics and measured the Sum Intensity of ROI through each projection. We used the same size ROI for each measurement for consistency and used this number subtracting the average background levels. We repeated the experiment an additional two times (we put n=3, but expect it is 5 but can’t find the old slides) and used 10 images each.</p><p><italic>Are the images displayed a confocal slice? If so, in what region of the cell? If not</italic>, <italic>how do the authors make sure to focus in a comparable region when comparing conditions?</italic></p><p>These are projections from a confocal z series. Further, when we did look at ROI statistics through each section, we saw little variance, suggesting that levels were fairly consistent throughout the cell.</p><p><italic>We did not manage to find this information in the Materials and methods</italic>.</p><p>We have added this information in the ‘Quantifications’ section at the end of the Methods section.</p><p><italic>The legend indicates that the mean corresponds to n=3. Do they mean the intensities have been quantified in 3 cells per condition? If so, the sample size seems too small to make conclusive statements. Finally, a control showing (hopefully low) P-FAK levels after treatment with the FAK inhibitor would be helpful</italic>.</p><p>We repeated this experiment to add the FAK inhibitor and, indeed, the levels do go down. We had done this experiment 3 times but did not have enough old micrographs to get a higher n for quantifying. So, we have taken more pictures and increased the n that we quantified. This did not change the results at all—we still see that PFAK is high in early control and late blocked extrusions but greatly diminished in late control extrusions and FAK inhibitor-treated dying cells. To increase clarity, we now include a graph of P-FAK quantification next to the pictures in <xref ref-type="fig" rid="fig6">Figure 6A</xref>.</p><p><italic>A rather minor point relates to the point on lumen sizes in the previous review round. The authors claim that lumens diameters in MDCK and HPAFII cells are comparable. Where/how was the diameter measured? In the example displayed for HPAFII cells the lumen does not appear to be spherical at all, and while the long diameter is indeed comparable to the MDCK example, the transversal cross section seems to be under 10μm, according to the scale bar</italic>. <italic>We could not find details on how the diameter was measured in the Methods, could the authors clarify?</italic></p><p>Measurements here were also done using Nikon Elements ‘Radius’ measurement in the ‘Annotations and Measurements’ package. We have added this to the ‘Quantification’ section of the Methods.</p><p>We agree that the cyst in <xref ref-type="fig" rid="fig5">Figure 5</xref> in particular is a bit skewed. I tried to go back and find another one with a more spherical lumen that also shows the cells outside but have had problems with our set up. These pictures have to be taken on a confocal but to find the cyst to scan, we must use the wide-field fluorescence lamp on our confocal, which has been out for a few months. Searching while scanning on the confocal is nearly impossible, so this has made it hard to find another cyst with a perfect lumen that shows the main point that we want to convey-that HPAF II cells extrude basally, divide, and migrate. It’s not easy to capture all of these events in one picture, but feel it important to show the best example of this (the present one), as most people don’t view the movies. While some of the lumens were a bit skewed in both MDCKs and HPAFII, quantification was done on the majority of cysts that were spherical on our wide-field microscope so we could get high numbers. There really is no difference in size.</p></body></sub-article></article> |