Abrogating the protumorigenic influences of tumor-infiltrating myeloid cells by CSF1R signaling blockade improves the efficacy of radiotherapy in prostate cancer

Radiotherapy is a major frontline treatment for prostate cancer patients, yet, a large portion of these patients suffer from local tumor recurrence. Tumor-infiltrating myeloid cells (TIMs), including CD11b+F4/80+ tumor-associated macrophages (TAMs) and CD11b+Gr-1+ myeloid-derived suppressor cells (MDSCs), play critical roles in promoting tumor angiogenesis, tissue remodeling and immunosuppression. Here, we show enhanced recruitment of TAMs and MDSCs after local irradiation. Although treatment is directed to the tumor sites, the impact of irradiation is systemic as dramatic increases of MDSCs were observed in the spleen, lung, lymph nodes and peripheral blood. Of the cytokines examined, we found that macrophage colony-stimulating factor 1 (CSF1) increased by 2 fold in irradiated tumors. Enhanced macrophage migration induced by conditioned media from irradiated tumor cells was completely blocked by the selective CSF1R inhibitor, GW2580. Importantly, increased CSF1 levels were also observed in the serum of prostate cancer patients after radiotherapy. ABL1 (c-Abl), a non-receptor tyrosine kinase, known to mediate apoptosis and signal transduction under stress, is activated by irradiation. Activated ABL1 translocates to the nucleus, binds to the CSF1 promoter region and enhances CSF1 transcription. Combination therapy using a CSF1R inhibitor currently in clinical trials, PLX3397, with radiation suppressed tumor growth more effectively than radiation alone. This study highlights the importance of CSF1/CSF1R signaling in the recruitment of TIMs in response to radiotherapy and suggests their significant role in promoting tumor recurrence. Furthermore, our data supports co-targeting TIMs in conjunction with radiotherapy to achieve a more effective and durable treatment strategy for prostate cancer patients.