Targeting TREM2 in Postmenopausal Breast Cancer in Obese and Weight Loss Settings

Abstract

Obesity is an established risk factor for breast cancer development and worsened prognosis; however, the mechanisms for this association - and the potential benefits of weight loss - have not been fully explored. The adipose environment surrounding breast tumors, which is inflamed in obesity, has been implicated in tumor progression. An emerging therapeutic target for cancer is TREM2, a transmembrane receptor of the immunoglobulin superfamily that is expressed on macrophages in adipose tissue and tumors. I utilized genetic loss of function (Trem2+/+ and Trem2-/-) models and dietary (lean, obese, and weight loss) intervention approaches to examine impacts on postmenopausal breast cancer. Remarkably, Trem2 deficiency constrained tumor growth in lean, but not obese or weight loss mice. Single-cell RNA sequencing, in conjunction with VDJ sequencing of tumor and tumor-adjacent mammary adipose tissue (mATTum-adj) immune cells, revealed that tumors of lean Trem2-/- mice exhibited a shift in clonal CD8+ T cells from an exhausted to an effector memory state, accompanied with increased clonality of CD4+ Th1 cells, that was not observed in any other diet-genotype group. Notably, identical T cell clonotypes were identified in the tumor and mATTum-adj of the same mouse. Finally, an immune checkpoint study demonstrated that aPD-1 therapy restricted tumor growth in lean and weight loss, but not obese mice. I conclude that weight history is relevant when considering potential efficacy of TREM2 inhibition in postmenopausal breast cancer. This work reveals immunological interactions between tumors and surrounding adipose tissue, highlighting significant differences under obese and weight loss conditions. In addition to pre-clinical studies, I also performed a retrospective study in breast cancer patient samples in which I analyzed the associations between TREM2+CD68+ cell density in three distinct regions of the tumor with multiple tumor characteristics, prognostic factors, and metabolic syndrome criteria. However, the data mostly demonstrated no associations between TREM2-expressing macrophages and tumor prognostic factors or metabolic syndrome criteria in early-stage ER+ breast cancer.