Through the last decade, cold atmospheric plasma (CAP) has emerged as an innovative therapeutic option for cancer treatment. Recently, we have set up a potentially safe atmospheric pressure plasma jet device that displays antitumoral properties in a preclinical model of cholangiocarcinoma (CCA), a rare and very aggressive cancer emerging from the biliary tree with few efficient treatments. In the present study, we aimed at deciphering the molecular mechanisms underlying the antitumor effects of CAP towards CCA in both an in vivo and in vitro context. In vivo, using subcutaneous xenografts into immunocompromised mice, CAP treatment of CCA induced DNA lesions and tumor cell apoptosis, as evaluated by 8-oxoguanine and cleaved caspase-3 immunohistochemistry, respectively. The analysis of the tumor microenvironment showed changes in markers related to macrophage polarization. In vitro, the incubation of CCA cells with CAP-treated culture media (i.e., plasma-activated media, PAM) led to a dose response decrease in cell survival. At molecular level, CAP treatment induced double-strand DNA breaks, followed by an increased phosphorylation and activation of the cell cycle master regulators CHK1 and p53, leading to cell cycle arrest and cell death by apoptosis. In conclusion, CAP is a novel therapeutic option to consider for CCA in the future.

Intrahepatic cholangiocarcinoma (iCCA) is an agressive tumour from the biliary tree that is characterized by a prominent desmoplastic stroma mainly composed of cancer-associated fibroblasts (CAF) and a poor prognosis due to its late clinical presentation and the lack of effective non-surgical treatments. Current therapies still include chemotherapeutic combinations of gemcitabine and cisplatin for the majority of the patients showing poor results due the apparition of resistance. This situation led us to interrogate the potential role in the development of chemoresistance of ZEB1, an EMT-inducing transcription factor (EMT-TF) that we previously identified as a pro tumorigenic factor in tumour cells and CAF of iCCA. By analysing human CCA samples and sc-RNAseq public databases, we show here that ZEB1 is present in the tumour microenvironment of all iCCA patients tested and is prominently expressed by CAF. Using cellular models of CAF, we show that cells depleted for ZEB1 are more sensitive to gemcitabine and cisplatin, via a mechanism involving the regulation of the anti-apoptotic gene BCL2. Moreover, ZEB1 expressing CAF protect iCCA tumour cells against the toxicity of the chemotherapeutic drugs, an event that could be reversed by a BCL2 inhibitor venetoclax. Therefore, our results point to the use of BCL2 inhibitors to improve the efficacy of current chemotherapeutic regimens of gemcitabine and cisplatin in iCCA patients.

Intrahepatic cholangiocarcinoma (iCCA) is an aggressive tumour from the biliary tree that is characterized by a prominent desmoplastic stroma, mainly composed of cancer-associated fibroblasts (CAF), and a poor prognosis due to its late clinical presentation and the lack of effective non-surgical treatments. Current therapies still include chemotherapeutic combinations of gemcitabine and cisplatin for the majority of the patients showing poor results due the apparition of resistance. This situation led us to interrogate the potential role in the development of chemoresistance of ZEB1, an EMT-inducing transcription factor (EMT-TF) that we previously identified as a pro-tumorigenic factor in tumour cells and CAF of iCCA. By analysing human CCA samples and sc-RNAseq public databases, we show here that ZEB1 is present in the tumour microenvironment of all iCCA patients tested and is prominently expressed by the myofibroblastic CAF subpopulation (myCAF). Using cellular models of CAF, we show that cells depleted for ZEB1 are more sensitive to gemcitabine and cisplatin, via a mechanism involving the direct regulation of the anti-apoptotic gene BCL2. Moreover, ZEB1 expressing CAF protect iCCA tumour cells against the toxicity of the chemotherapeutic drugs through the release of paracrine soluble factors, including CTGF, IL6 and IL8, an event that could be reversed by the BCL2 inhibitor venetoclax. Therefore, our results point to the use of BCL2 inhibitors as a way to improve the efficacy of current chemotherapeutic regimens in iCCA patients.