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      Integrated cancer tissue engineering models for precision medicine

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          Abstract

          Tumors are not merely cancerous cells that undergo mindless proliferation. Rather, they are highly organized and interconnected organ systems. Tumor cells reside in complex microenvironments in which they are subjected to a variety of physical and chemical stimuli that influence cell behavior and ultimately the progression and maintenance of the tumor. As cancer bioengineers, it is our responsibility to create physiologic models that enable accurate understanding of the multi-dimensional structure, organization, and complex relationships in diverse tumor microenvironments. Such models can greatly expedite clinical discovery and translation by closely replicating the physiological conditions while maintaining high tunability and control of extrinsic factors. In this review, we discuss the current models that target key aspects of the tumor microenvironment and their role in cancer progression. In order to address sources of experimental variation and model limitations, we also make recommendations for methods to improve overall physiologic reproducibility, experimental repeatability, and rigor within the field. Improvements can be made through an enhanced emphasis on mathematical modeling, standardized in vitro model characterization, transparent reporting of methodologies, and designing experiments with physiological metrics. Taken together these considerations will enhance the relevance of in vitro tumor models, biological understanding, and accelerate treatment exploration ultimately leading to improved clinical outcomes. Moreover, the development of robust, user-friendly models that integrate important stimuli will allow for the in-depth study of tumors as they undergo progression from non-transformed primary cells to metastatic disease and facilitate translation to a wide variety of biological and clinical studies.

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          Most cited references203

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          Tensional homeostasis and the malignant phenotype.

          Tumors are stiffer than normal tissue, and tumors have altered integrins. Because integrins are mechanotransducers that regulate cell fate, we asked whether tissue stiffness could promote malignant behavior by modulating integrins. We found that tumors are rigid because they have a stiff stroma and elevated Rho-dependent cytoskeletal tension that drives focal adhesions, disrupts adherens junctions, perturbs tissue polarity, enhances growth, and hinders lumen formation. Matrix stiffness perturbs epithelial morphogenesis by clustering integrins to enhance ERK activation and increase ROCK-generated contractility and focal adhesions. Contractile, EGF-transformed epithelia with elevated ERK and Rho activity could be phenotypically reverted to tissues lacking focal adhesions if Rho-generated contractility or ERK activity was decreased. Thus, ERK and Rho constitute part of an integrated mechanoregulatory circuit linking matrix stiffness to cytoskeletal tension through integrins to regulate tissue phenotype.
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            Hydrogels for tissue engineering.

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              Regression of Glioblastoma after Chimeric Antigen Receptor T-Cell Therapy.

              A patient with recurrent multifocal glioblastoma received chimeric antigen receptor (CAR)-engineered T cells targeting the tumor-associated antigen interleukin-13 receptor alpha 2 (IL13Rα2). Multiple infusions of CAR T cells were administered over 220 days through two intracranial delivery routes - infusions into the resected tumor cavity followed by infusions into the ventricular system. Intracranial infusions of IL13Rα2-targeted CAR T cells were not associated with any toxic effects of grade 3 or higher. After CAR T-cell treatment, regression of all intracranial and spinal tumors was observed, along with corresponding increases in levels of cytokines and immune cells in the cerebrospinal fluid. This clinical response continued for 7.5 months after the initiation of CAR T-cell therapy. (Funded by Gateway for Cancer Research and others; ClinicalTrials.gov number, NCT02208362 .).
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                10 May 2019
                2019
                : 14
                : 5
                : e0216564
                Affiliations
                [1 ] Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, United States of America
                [2 ] Department of Materials Science and Engineering, University of Michigan, Ann Arbor, Michigan, United States of America
                [3 ] Rogel Cancer Center, School of Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
                [4 ] Macromolecular Science and Engineering, University of Michigan, Ann Arbor, Michigan, United States of America
                Monash University, AUSTRALIA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0002-4631-7762
                http://orcid.org/0000-0002-6636-2798
                http://orcid.org/0000-0001-5967-6425
                Article
                PONE-D-19-02631
                10.1371/journal.pone.0216564
                6510431
                31075118
                5decbc30-ba3c-4c2a-94d2-b6f1918a1f4a
                © 2019 Bregenzer et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Page count
                Figures: 4, Tables: 2, Pages: 40
                Funding
                This work is supported primarily by DOD OCRP Early Career Investigator Award W81XWH-13-1-0134(GM), DOD Pilot award W81XWH-16-1-0426 (GM), DOD Investigator Initiated award W81XWH-17-OCRP-IIRA (GM), Rivkin Center for Ovarian Cancer (GM) and Michigan Ovarian Cancer Alliance (GM). Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under award number P30CA046592. SR is supported by the National Institutes of Health under the award NIH/NIDCR T32DE00007057-41/42. CMN is supported by the National Science Foundation Graduate Research Fellowship under Grant No. 1256260. MEB is supported by the Department of Education Graduate Assistance in Areas of National Need (GAANN) Fellowship. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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