Blockade of stromal Gas6 alters cancer cell plasticity, activates NK cells and inhibits 2 pancreatic cancer metastasis. 3
Running title 4Gas6 blockade prevents pancreatic cancer metastasis 5 6 Growth arrest-specific gene 6 (Gas6) is a multifunctional factor that regulates several 50 processes in normal physiology and pathophysiology [1].Gas6 binds to the Tyro3, 51 Axl and Mer (TAM) family of receptor tyrosine kinases (TAM receptors) with the 52 highest affinity for Axl [2]. Gas6 supports erythropoiesis, platelet aggregation, 53 angiogenesis, efferocytosis, and inhibits the immune response [3]. Gas6 is critical for 54 the maintenance of immune homeostasis and mice deficient in Gas6 or TAM 55 receptors experience severe autoimmune diseases [4]. Gas6 and its main receptor 56 Axl are overexpressed in several cancer types including, breast, ovarian, gastric, 57 glioblastoma, lung and pancreatic cancer and their expression correlates with a poor 58 prognosis [5]. Axl is ubiquitously expressed in all tissues [6] but is particularly notable 59 in cancer cells, macrophages, dendritic cells and natural killer cells for its role in 60 driving immunosuppression and tumor progression [7-9]. Several cancer studies 61 have focused on the role of Gas6-Axl signaling on the tumor cells and have 62 demonstrated that Axl activation supports tumor cells proliferation, epithelial-63 mesenchymal transition (EMT), drug resistance, migration and metastasis [5]. 64 Factors secreted within the tumor microenvironment are able to sustain Gas6/Axl 65 signaling. Hypoxia Inducible Factor (HIF) has been shown to bind to the Axl 66 promoter region and upregulate its expression on renal cell carcinoma cells [10]. 67 Secretion of IL-10 and M-CSF by tumor cells induces tumor associated 68 macrophages to secrete Gas6 [11].69However, only a few studies have investigated the role of Gas6-Axl signaling in the 70 immune response to breast cancer, ovarian cancer and melanoma [7, 9]. 71 4In solid tumors such as breast or pancreatic cancer, the tumor stroma can represent 72 up to 80% of the tumor mass and actively influences cancer progression, metastasis 73 [12][13][14] and resistance to therapies [15][16][17]. 74 Pancreatic ductal adenocarcinoma (PDA) is one of the most lethal cancers 75 worldwide and better therapies are urgently needed [18]. Metastasis, therapy 76 resistance, and immunosuppression are key characteristics of pancreatic tumors [19, 77 20]. The Gas6-Axl pathway is activated in 70% of pancreatic cancer patients [21] 78 and is associated with a poor prognosis and increased frequency of distant 79 metastasis [22]. Blocking Gas6 or its receptor Axl inhibits cancer progression [23, 24] 80 and several Axl inhibitors are currently being tested in cancer patients, including 81 PDA patients. While the cancer cell autonomous functions of Gas6 are well 82 documented, the effect of Gas6 signaling in the stroma/immune compartment in 83 pancreatic cancer has not been fully explored. In these studies, we sought to 84 understand the effect of Gas6 bloc...