Gastric cancer is among the most prevalent and deadliest of cancers globally. To derive mechanistic insight into the pathways governing this disease, we generated a Claudin18-IRES-CreERT2 allele to selectively drive conditional dysregulation of the Wnt, Receptor Tyrosine Kinase and Trp53 pathways within the gastric epithelium. This resulted in highly reproducible metastatic, chromosomal-instable-type gastric cancer. In parallel, we developed orthotopic cancer organoid transplantation models to evaluate tumour-resident Lgr5+ populations as functional cancer stem cells via in vivo ablation. We show that Cldn18 tumours accurately recapitulate advanced human gastric cancer in terms of disease morphology, aberrant gene expression, molecular markers and sites of distant metastases. Importantly, we establish that tumour-resident Lgr5+ stem-like cells are critical to the initiation and maintenance of tumour burden and are obligatory for the establishment of metastases. These models will be invaluable for deriving clinically relevant mechanistic insights into cancer progression and as preclinical models for evaluating therapeutic targets.
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RNA sequencing data that support the findings of this study have been deposited in the Gene Expression Omnibus under accession code GSE184613. Previously published TCGA data that were re-analysed here are available from the Broad Institute TCGA Genome Data Analysis Centre Firehose (https://gdac.broadinstitute.org/). The data that support the findings of this study are available from the corresponding author upon reasonable request. Source data are provided with this paper.
Code will be made available upon reasonable request
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We would like to thank all members of the laboratory for technical expertise and insightful discussions. We would like to thank S. Mustafah and the staff at SIgN Flow Facility for assistance with FACS (SIgN, A*STAR, Singapore), L. Shuping, J. Lim and G. Wright (AMP, A*STAR, Singapore) for assistance with confocal imaging, and E. Cheah and staff at the SBIC-Nikon facility for assistance with bright-field imaging (A*STAR, Singapore). We also thank T. Ming, S. Srivastava and staff at the Department of Pathology, National University Hospital Singapore, for providing the human material, D. H. Alpers, (Washington University School of Medicine, USA) for providing the Gif-specific antibody, and W. Hunziker (IMCB, A*STAR, Singapore) for the ZO-1-specific antibody. Additionally, we would like to thank F. de Sauvage (Department of Molecular Biology, Genentech, USA) for providing the Lgr5-DTR–GFP mice. A.F. is supported by the National Medical Research Council (NMRC) Singapore under MOH-000366. N.B. is supported by A*STAR, the National Research Foundation (NRF; under NRFI2017-03) and the Japan Society for the Promotion of Science (JSPS) KAKENHI (grant number 17H01399). Y.T. is supported by JSPS KAKENHI grant number 17H06710 and K.M. is supported by JSPS KAKENHI grant number 17K07161. The funding agencies had no role in the study design, data collection and analyses, decision to publish or preparation of manuscript.
The authors declare no competing interests.
Peer review information Nature Cell Biology thanks the anonymous reviewers for their contribution to the peer review of this work. Peer reviewer reports are available.
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
(a) IF images of Cldn18 (red) and E–cadherin (green) co–staining in small intestine, colon, esophagus, liver and pancreas (n = 5 biological replicates). (b) IF images of tdTomato tracing at 24 hrs, 1 week and 6 months post–tamoxifen induction in the small intestine, colon, esophagus, liver and pancreas from Cldn18–dTom mice (n = 5 biological replicates). (c) IF images of Cldn18 (red) and E–cadherin (green) co–staining in pylorus regions from Cldn18–CreERT2 wild–type (top, n = 3 biological replicates), heterozygous (middle, n = 3 biological replicates) and homozygous (bottom, n = 3 biological replicates) mice. (d) IF images of Cldn18 (red) and E–cadherin (green) co–staining in corpus regions from Cldn18–CreERT2 wild–type (top, n = 3 biological replicates), heterozygous (middle, n = 3 biological replicates) and homozygous (bottom, n = 3 biological replicates) mice. (e) IF images of β–catenin (blue) and ZO–1 (magenta) co–staining in pylorus regions from Cldn18–CreERT2 wild–type (top, n = 3 biological replicates), heterozygous (middle, n = 3 biological replicates) and homozygous (bottom, n = 3 biological replicates) mice. (f) IF images of β–catenin (blue) and ZO–1 (magenta) co–staining in corpus regions from Cldn18–CreERT2 wild–type (top, n = 3 biological replicates), heterozygous (middle, n = 3 biological replicates) and homozygous (bottom, n = 3 biological replicates) mice. (g) IF images of pyloric lineage markers from uninduced Cldn18–dTom mice (top, n = 3 biological replicates) and induced mice (bottom, n = 3 biological replicates) 1 month post induction for Gastrin, Muc5 and Ki67 (yellow) and tdTomato (red). (h) IF images of corpus lineage markers from uninduced Cldn18–dTom mice (top, n = 3 biological replicates) and induced mice (bottom, n = 3 biological replicates) 1 month post induction for GIF, H+ pump, Muc5 and Ki67 (yellow) and tdTomato (red). Scale bars 100 μm.
Extended Data Fig. 2 Gastric tumour formation in various Cldn18-CreERT2-driven conditional mouse models.
H&E images of various allelic combinations tested. Tissue harvested for (1) Trp53fl/fl (1 yr, n = 15 biological replicates), (2) APCfl/WT + Trp53fl/fl (1 yr, n = 13 biological replicates), (3) KrasG12D (3 months, n = 8 biological replicates), (4) APCfl/fl (3 months, n = 9 biological replicates), (5) APCfl/fl + KrasG12D (1 month, n = 13 biological replicates), (6) Trp53fl/fl + KrasG12D (6 months, n = 4 biological replicates), (7) APCfl/fl + Trp53fl/fl (3 months, n = 22 biological replicates), (8) APCfl/fl + Trp53fl/fl + KrasG12D (2 months, n = 18 biological replicates) and (9) APCfl/WT + Trp53fl/fl + KrasG12D (4 months, n = 36 biological replicates) post–tamoxifen induction. Dotted lines demarcate the small intestine (SI), pylorus and corpus regions. Scale bars 1000 μm.
Extended Data Fig. 3 Comparison of human gastric cancer and Cldn18-ATK gastric tumour transcriptomes.
(a) PCA analysis for the Cldn18–ATK invasive tumour (green, n = 3 biological replicates) and neoplastic (purple, n = 3 biological replicates) samples. Strip–box plots visualizing the correlation between human normal (peach) or tumour (teal) samples with each Cldn18–ATK (b) invasive tumour and (c) neoplastic sample. The whiskers define the maxima and minima, the box is defined by the first and third quartile and the central line is the median for all data points.
(a) IHC images for β–catenin, E–cadherin, vimentin, parietal cell marker (proton (H+) pump) and F4/80 1 week post–tamoxifen (n = 5 biological replicates). (b) Representative H&E and IHC images for β–catenin, Trp53, Mapk (phosphorylated), Tff2, Muc5, E–cadherin, vimentin, GIF, Ki67, F4/80 and Cdx2 1 month post tamoxifen (n = 5 biological replicates). (c) IHC images for Mapk (phosphorylated), Trp53, Chief cell marker (GIF), Muc5 and Cdx2 at 2 months post–tamoxifen (n = 5 biological replicates). Invasive region is marked by blue line (d) IHC images for Mapk (phosphorylated), Trp53, Tff2 and F4/80 at the terminal stages of disease (n = 5 biological replicates). Blue lines demarcate primary tumour and invasive region. (E) Whole mount images of stomach tissue 1 week, 1 month and 2 month post–tamoxifen and lung metastasis highlighted with dotted black lines (n = 5 biological replicates). (f) H&E staining, IHC images for Mapk (phosphorylated), β–catenin, Trp53, Ki67, E–cadherin and vimentin for mouse liver metastases (n = 5 biological replicates). (g) IHC images for Mapk (phosphorylated), β–catenin and Trp53 in mouse lymph node metastases (n = 3 biological replicates). (h) H&E staining, IHC for Ki67, Cdx2 and Tff2 in mouse lung metastases (n = 5 biological replicates). Scale bars 500 μm.
Single channel IF images for GFP (green), along with (a) GIF – cyan and Muc5 – yellow, (b) H+ pump – red and Tff2 – blue and (c) Ki67 – magenta; for uninduced mice (control) and induced mice at 1 week, 1 month, 2 months, 3 months, terminal stages and invasive glands (n = 4, 5, 8, 5, 3 and 3 biological replicates respectively) in Cldn18–ATK tumours. Scale bars: 50 µm.
(a) IHC images for Mapk, Cdx2, Tff2 and β–catenin in T–UT stomach (top), liver (middle) (n = 4 biological replicates) and T–DT treated stomach (bottom) (n = 9 biological replicates). (b) H&E and IHC images for GFP, Mapk, Cdx2, Ki67, Tff2 and β–catenin in DT treated liver. (c) IHC images for Mapk and β–catenin in DT treated and recovered stomach (top), magnified view of stomach and liver staining (n = 5 biological replicates). (d) IF staining for Ki67 (magenta, top) and Tff2 (yellow, bottom); IHC images for Mapk in T–UT (n = 4 biological replicates) and T–DT x10 stomach tissue (n = 3 biological replicates). (e) Quantification of changes in response to the three DT ablation strategies on tumour volumes. Statistical significance was determined by one way ANOVA and Tukey’s multiple comparisons test; ****adjusted P = < 0.0001. (f) Quantification of changes in proliferating cells after DT ablation. Statistical significance was determined by one way ANOVA and Tukey’s multiple comparisons test; **adjusted P = 0.0035. Graphs are presented as mean ± s.d. Scale bars: 100 µm Panel C macro: 500 μm.
Extended Data Fig. 7 Orthotopic transplantation of cancer organoids as a model to study gastric cancer.
(a) E–Cadherin, Cdx2 and Tff2 IHC images for uninduced gastric organoids and (b) gastric cancer organoids (n = 3 biological replicates). (c) Whole mount images and H&E images for stomach, liver and lung 12 weeks post orthotopic transplantation with Cldn18–dTom organoids. IHC images for tdTomato, GFP and Ki67 in the stomach (n = 5 biological replicates). (d) IHC images for GFP, tdTomato, Ki67, Mapk, β–catenin, E–Cadherin, Cdx2 and Tff2 in liver (top) and lung (bottom) metastases 12 weeks post orthotopic transplantation (n = 5 biological replicates). Scale bars: panels A and B 50μm, remaining panels 100 μm.
Extended Data Fig. 8 Tumour resident Lgr5+ stem-like cells are critical for the initiation and dissemination of gastric cancer in an orthotopic transplantation model.
(a) GFP IHC for stomach tissue (left) from mice receiving DT from 2, 6, 8, and 10 weeks post–transplantation. Liver metastases from mice receiving DT from 8 and 10 weeks post–transplantation and lung metastases from mice receiving DT at 10 weeks post transplantation (n = 5 biological replicates, per time point). (b) H&E staining (top panels) and GFP IHC for stomach tissue from untreated mice at 2, 6, 8 and 10 weeks post–transplantation. Liver and lung metastases at 8 and 10 weeks posttransplantation(n = 5 biological replicates, per time point). (c) GFP IHC for 12 week untreated stomach, liver and lung metastases (n = 5 biological replicates). Scale bars: 100 μm.
(a) FACS gating for sorting GFP+ and GFP- epithelial cells (EpCam+) from untreated tumours (left), DT-treated tumours (middle) and wild-type unstained controls (right). (b) Relative expression of Lgr5, GFP, Axin2, Troy, Sox2 and Mist1 in the GFP– cells from normal vs tumour corpus epithelium (Normal epithelium: n = 3, tumour epithelium n = 6 biological replicate). Statistical significance was determined by unpaired t-test; ***P = 0.0004 (Lgr5), ***P = 0.0002 (GFP), ***P = 0.0005 (Sox2), ***P = 0.0001 (Mist1). (c) Relative expression of Axin2, Troy, Sox2 and Mist1 in the GFP– cells from untreated vs DT-treated tumour epithelium (untreated tumours n = 6, DT-treated tumour n = 14 biological replicates, except Mist1: DT-treated tumour n = 10 biological replicates). Statistical significance was determined by unpaired t-test; ****P = < 0.0001 (Troy), *P = 0.0116 (Sox2), **P = 0.0089 (Mist1). Graphs are presented as mean ± s.d.
(a) Timeline for 5FU and 5FU + DT treatment in tamoxifen–induced Cldn18–LATK mice. (b) Whole mount images for stomach and liver from untreated (left, n = 4 biological replicates), 5FU alone (middle, n = 9 biological replicates) and 5FU + DT treated mice (right, n = 13 biological replicates). Tumours and metastases are marked by dotted lines. (c) Percentage of mice displaying invasive tumours and distant metastases following treatment. (d) H&E (top), Ki67 (middle) and Lgr5 (bottom two) expression in untreated (left), 5FU alone (middle) and 5FU + DT treated mice (right). (e) Quantification of reduction in tumour volume following 5FU and 5FU + DT treatment. Statistical significance was determined by one way ANOVA and Tukey’s multiple comparisons test; ****adjusted P = < 0.0001 and *adjusted P = 0.0337. (f) Quantification of proliferating cells following 5FU and 5FU + DT treatment. Statistical significance was determined by one way ANOVA and Tukey’s multiple comparisons test; ****adjusted P = < 0.0001 and **adjusted P = 0.0073. Graphs are presented as mean ± s.d. Scale bars 500μm.
Supplementary Table 1: Summary of the Cldn18-CreERT2-driven conditional compound mutations generated, along with their respective sample size, latency period, tumour location and incidence of invasive and metastatic disease. Supplementary Table 2: Quantification of polymorphonuclear cells (H&E) and tumour-associated macrophages (F4/80 IHC) in the various Cldn18 cancer models. Supplementary Table 3: Quantification of polymorphonuclear cells (H&E) and tumour-associated macrophages (F4/80 IHC) at various time points in the Cldn18-ATK gastric tumours and associated metastases.
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Fatehullah, A., Terakado, Y., Sagiraju, S. et al. A tumour-resident Lgr5+ stem-cell-like pool drives the establishment and progression of advanced gastric cancers. Nat Cell Biol 23, 1299–1313 (2021). https://doi.org/10.1038/s41556-021-00793-9
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