Whole-body imaging of lymphovascular niches identifies pre-metastatic roles of midkine

Abstract

Genetically engineered ‘lymphoreporter’ mouse strains are used to track melanoma dissemination in vivo, identifying midkine as a tumour-secreted factor that acts at a distance, preparing pre-metastatic niches and serving as an indicator of poor prognosis in patients. Lymph nodes are a common metastatic site of many tumour types, including melanomas. The contribution of lymphangiogenesis to metastatic progression is not well defined, as removing the sentinel lymph node does not always improve the survival chances of melanoma patients. Here the authors develop a 'lymphoreporter' mouse model that allows them to track lymphatic vessels with a VEGFR3 reporter, and use it to visualize metastatic routes during relapse. In addition, the authors identify a mediator of lymphangiogenesis, MIDKINE, that contributes to metastasis and indicates a poor prognosis for patients with melanoma. The authors suggest that VEGFR3 reporters could be useful in the search for further drivers and inhibitors of metastasis. Cutaneous melanoma is a type of cancer with an inherent potential for lymph node colonization, which is generally preceded by neolymphangiogenesis1,2,3. However, sentinel lymph node removal does not necessarily extend the overall survival of patients with melanoma4,5. Moreover, lymphatic vessels collapse and become dysfunctional as melanomas progress6,7. Therefore, it is unclear whether (and how) lymphangiogenesis contributes to visceral metastasis. Soluble and vesicle-associated proteins secreted by tumours and/or their stroma have been proposed to condition pre-metastatic sites in patients with melanoma8,9,10,11,12,13,14. Still, the identities and prognostic value of lymphangiogenic mediators remain unclear2,14. Moreover, our understanding of lymphangiogenesis (in melanomas and other tumour types) is limited by the paucity of mouse models for live imaging of distal pre-metastatic niches15. Injectable lymphatic tracers have been developed7, but their limited diffusion precludes whole-body imaging at visceral sites16. Vascular endothelial growth factor receptor 3 (VEGFR3) is an attractive ‘lymphoreporter’17 because its expression is strongly downregulated in normal adult lymphatic endothelial cells, but is activated in pathological situations such as inflammation and cancer17,18. Here, we exploit this inducibility of VEGFR3 to engineer mouse melanoma models for whole-body imaging of metastasis generated by human cells, clinical biopsies or endogenously deregulated oncogenic pathways. This strategy revealed early induction of distal pre-metastatic niches uncoupled from lymphangiogenesis at primary lesions. Analyses of the melanoma secretome and validation in clinical specimens showed that the heparin-binding factor midkine is a systemic inducer of neo-lymphangiogenesis that defines patient prognosis. This role of midkine was linked to a paracrine activation of the mTOR pathway in lymphatic endothelial cells. These data support the use of VEGFR3 reporter mice as a ‘MetAlert’ discovery platform for drivers and inhibitors of metastasis.

Cite this article

Olmeda, D., Cerezo-Wallis, D., Riveiro-Falkenbach, E. et al. Whole-body imaging of lymphovascular niches identifies pre-metastatic roles of midkine. Nature 546, 676–680 (2017). https://doi.org/10.1038/nature22977

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