Targeting S100A9 in the Inflammatory Myelodysplastic Hematopoietic Niche Reprograms the Functional Properties of CD271⁺ Mesenchymal Stromal Cells

Myelodysplastic syndromes (MDS) belong to the most common hematological malignancies in the elderly population, characterized by ineffective hematopoiesis, peripheral cytopenia and the risk of transformation into acute myeloid leukemia. An involvement of the bone marrow microenvironment (BMME) in disease initiation and progression is indisputable. The profound immune dysregulation and sustained inflammation, essentially mediated by mesenchymal stromal cells (MSCs), are further factors contributing to ineffective hematopoiesis and driving disease progression. The alarmin S100A9 is a TLR4 and CD33 ligand that acts as key player for the inflammasome activation in the MDS BM. The novel small molecular drug Tasquinimod (TASQ, Active Biotech) is a S100A9 inhibitor and has demonstrated antitumor and immunomodulatory properties in a broad range of solid tumors; however, little is known about its effects in myeloid malignancies.

Here, we aim to decipher the effects of TASQ on MDS MSC subpopulations in more detail.

Therefore, MSCs were isolated from BM aspirates ('asp-MSCs', n=12) or biopsies ('bp-MSCs', n=5) of patients with either low-risk MDS, CMML or age-adjusted healthy donors and were exposed to TASQ (10 µM) in vitro.

Flow cytometry analysis of the MSC markers CD44, CD73, CD90, CD105, and CD146 did not show significant differences in neither asp- nor bp-MSCs after treatment. Interestingly, CD271, which is hard to detect in asp-MSCs, was decreased between 40% and 70% in bp-MSCs after TASQ treatment. This was accompanied by an inhibited expression of the checkpoint inhibitor PD-L1.

The MDS BM has a higher potency for adipogenic differentiation which further supports the inflammatory conditions and the suppression of normal hematopoiesis. Treatment with TASQ resulted in about 50% inhibition of adipogenesis as demonstrated by significantly lower expression of adipocyte protein 2 in differentiated asp- and bp-MSCs.

To investigate possible metabolic modulations of MSCs by TASQ, the oxygen consumption rate was measured as a readout of mitochondrial function by using the Cell Mito Stress Test (Agilent Technologies) in a XF96 analyzer. The basal and the maximal respiratory rate as well as ATP production were increased in TASQ-treated bp-MSC cultures suggesting a positive effect for their bioenergetic capacity. This was supported by detection of higher levels of glutamate dehydrogenase 1, a key enzyme in glutaminolysis converting glutamate to α-ketoglutarate for entry into the TCA cycle, and of the glutamine transporter Slc1a3 in TASQ-treated cells. NMR analyses revealed increased levels of glutamate and citrate as well as of several lipids, such as free cholesterol LDL, phospholipids LDL-6 and Apo-B LDL6 in supernatants of bp-MSCs after TASQ treatment.

To investigate the impact of TASQ on CD271 expression in more detail, we sorted CD45^-/CD73⁺/CD90⁺/CD271^+/- bp-MSCs. Gene expression analysis by RNA sequencing of sorted MSCs revealed differential expression of several pathways, e.g. an enrichment of inflammation related molecules in the CD271+ samples, whereby TASQ could abrogate this effect. Moreover, a cytokine array analysis of culture supernatants of sorted cells showed enhanced IFNg, IL1b and IL-6 secretion of CD271⁺ MSCs compared to CD271^- and TASQ-treated cells.

To evaluate the impact on the hematopoietic support of MSCs, we analyzed CD271-sorted bp-MSC co-cultures with CD34⁺ hematopoietic stem and progenitor cells (HSPCs). We observed a significantly decreased number of cobblestone area forming cells (CAF-C) as well as reduced numbers of colonies (CFU) in a subsequent clonogenic assay for CD271+ MSCs, nominating this MSC subpopulation as responsible for the diminished hematopoietic support. Interestingly, the number of CAF-C and CFU-E/CFU-GM could be increased by TASQ pre-treatment of the stromal layer.

In conclusion, CD271⁺ MSCs play a crucial role in the inflammatory MDS BMME. The inhibition by TASQ efficiently blocks adipogenic differentiation and secretion of pro-inflammatory cytokines, thereby modulating the MSC energetic profile and enhancing their potential to support hematopoiesis in vitro.

Platzbecker:Geron: Honoraria; BMS/Celgene: Honoraria; Novartis: Honoraria; Jazz: Honoraria; Abbvie: Honoraria; Janssen: Honoraria; Silence Therapeutics: Honoraria; Takeda: Honoraria. Törngren:Active Biotech: Current Employment. Eriksson:Active Biotech: Current Employment. Bondesson:Active Biotech: Current Employment.