title: Inflammatory monocyte mobilization decreases patient survival in pancreatic cancer: a role for targeting the CCL2/CCR2 axis.
abstract: OBJECTIVE
  To determine the role of the CCL2/CCR2 axis and inflammatory monocytes (CCR2(+)/CD14(+)) as immunotherapeutic targets in the treatment of pancreatic cancer.
  
  
  METHODS
  Survival analysis was conducted to determine if the prevalence of preoperative blood monocytes correlates with survival in patients with pancreatic cancer following tumor resection. Inflammatory monocyte prevalence in the blood and bone marrow of patients with pancreatic cancer and controls was compared. The immunosuppressive properties of inflammatory monocytes and macrophages in the blood and tumors, respectively, of patients with pancreatic cancer were assessed. CCL2 expression by human pancreatic cancer tumors was compared with normal pancreas. A novel CCR2 inhibitor (PF-04136309) was tested in an orthotopic model of murine pancreatic cancer.
  
  
  RESULTS
  Monocyte prevalence in the peripheral blood correlates inversely with survival, and low monocyte prevalence is an independent predictor of increased survival in patients with pancreatic cancer with resected tumors. Inflammatory monocytes are increased in the blood and decreased in the bone marrow of patients with pancreatic cancer compared with controls. An increased ratio of inflammatory monocytes in the blood versus the bone marrow is a novel predictor of decreased patient survival following tumor resection. Human pancreatic cancer produces CCL2, and immunosuppressive CCR2(+) macrophages infiltrate these tumors. Patients with tumors that exhibit high CCL2 expression/low CD8 T-cell infiltrate have significantly decreased survival. In mice, CCR2 blockade depletes inflammatory monocytes and macrophages from the primary tumor and premetastatic liver resulting in enhanced antitumor immunity, decreased tumor growth, and reduced metastasis.
  
  
  CONCLUSIONS
  Inflammatory monocyte recruitment is critical to pancreatic cancer progression, and targeting CCR2 may be an effective immunotherapeutic strategy in this disease.
authors: Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
authors: Dominic E
authors: DE
authors: Sanford
authors: Brian A
authors: BA
authors: Belt
authors: Roheena Z
authors: RZ
authors: Panni
authors: Allese
authors: A
authors: Mayer
authors: Anjali D
authors: AD
authors: Deshpande
authors: Danielle
authors: D
authors: Carpenter
authors: Jonathan B
authors: JB
authors: Mitchem
authors: Stacey M
authors: SM
authors: Plambeck-Suess
authors: Lori A
authors: LA
authors: Worley
authors: Brian D
authors: BD
authors: Goetz
authors: Andrea
authors: A
authors: Wang-Gillam
authors: Timothy J
authors: TJ
authors: Eberlein
authors: David G
authors: DG
authors: Denardo
authors: Simon Peter
authors: SP
authors: Goedegebuure
authors: David C
authors: DC
authors: Linehan
mesh_terms: D000818:Animals; D001854:Bone Marrow Cells / Q000276:immunology; D002465:Cell Movement / Q000276:immunology*; D018932:Chemokine CCL2 / Q000276:immunology / Q000378:metabolism; D055786:Gene Knockout Techniques; D006801:Humans; D016130:Immunophenotyping; D007958:Leukocyte Count; D008113:Liver Neoplasms / Q000556:secondary; D051379:Mice; D009000:Monocytes / Q000276:immunology* / Q000378:metabolism; D010190:Pancreatic Neoplasms / Q000276:immunology* / Q000378:metabolism / Q000401:mortality* / Q000473:pathology; D010641:Phenotype; D011379:Prognosis; D054390:Receptors, CCR2 / Q000235:genetics / Q000378:metabolism
chemical_list: D018932:Chemokine CCL2; D054390:Receptors, CCR2
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