Independent studies indicate that expression of sialylated
fucosylated mucins by human carcinomas portends a poor prognosis
because of enhanced metastatic spread of tumor cells, that carcinoma
metastasis in mice is facilitated by formation of tumor cell complexes
with blood platelets, and that metastasis can be attenuated by a
background of P-selectin deficiency or by treatment with heparin. The
effects of heparin are not primarily due to its anticoagulant action.
Other explanations have been suggested but not proven. Here, we bring
together all these unexplained and seemingly disparate observations,
showing that heparin treatment attenuates tumor metastasis in mice by
inhibiting P-selectin-mediated interactions of platelets with
carcinoma cell-surface mucin ligands. Selective removal of tumor mucin
P-selectin ligands, a single heparin dose, or a background of
P-selectin deficiency each reduces tumor cell-platelet interactions
in vitro
and
in vivo
. Although each of
these maneuvers reduced the
in vivo
interactions for
only a few hours, all markedly reduce long-term organ colonization by
tumor cells. Three-dimensional reconstructions by using
volume-rendering software show that each situation interferes with
formation of the platelet “cloak” around tumor cells while
permitting an increased interaction of monocytes (macrophage
precursors) with the malignant cells. Finally, we show that human
P-selectin is even more sensitive to heparin than mouse P-selectin,
giving significant inhibition at concentrations that are in the
clinically acceptable range. We suggest that heparin therapy for
metastasis prevention in humans be revisited, with these mechanistic
paradigms in mind.