Cancer cells from a primary tumor can disseminate to other tissues,
remaining dormant and clinically undetectable for many years. Little is known
about the cues that cause these dormant cells to “awaken,” resume
proliferating and develop into metastases. Studying mouse models, we found that
sustained lung inflammation caused by tobacco smoke exposure or nasal
instillation of lipopolysaccharide converted disseminated, dormant cancer cells
to aggressively growing metastases. Sustained inflammation induced the formation
of neutrophil extracellular traps (NETs), and these were required for awakening
dormant cancer. Mechanistic analysis revealed that two NET-associated proteases,
neutrophil elastase and matrix metalloproteinase 9, sequentially cleaved
laminin. The proteolytically remodeled laminin induced proliferation of dormant
cancer cells by activating integrin alpha-3beta-1 signaling. Antibodies against
NET-remodeled laminin prevented awakening of dormant cells. Therapies aimed at
preventing dormant cell awakening could potentially prolong the survival of
cancer patients.
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