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Abstract With a lifetime risk of approximately 1 in 8, breast cancer maintains in its position as the most prevalent form of cancer and ranks second in terms of cancer-related fatalities in women. The primary cause of mortality is often attributed to the recurrence of metastatic breast cancer. While immune therapy shows some effectiveness, many patients do not exhibit meaningful responses, likely due to immune-suppressive factors present within the tumor microenvironment. These factors include myeloid cells such as Macrophages (MΦ), therefore, there is a strong need to devise strategies to shift (MΦ) from a pro-tumor to an anti-tumor phenotype. Our previous research has uncovered the susceptibility of MΦs to disruptions in cholesterol metabolic balance. Considering these findings, coupled with epidemiological evidence linking elevated plasma cholesterol to unfavorable prognosis, the impact of cholesterol homeostasis in tumor associated MΦs on breast cancer becomes evident. An in-depth computational screen helped us identify ABCA1—a cholesterol efflux protein with elevated mRNA expression associated with increased survival. Beyond cholesterol efflux, ABCA1 also facilitates the movement of cholesterol from the inner membrane layer to the outer layer. Previous work has shown that cholesterol within the inner membrane layer can directly interact with and activate various receptors on the membrane's surface, initiating downstream signaling events. Consequently, the activities of ABCA1 in cholesterol efflux and translocation likely hold substantial regulatory implications. Underscoring the clinical significance of ABCA1 are our findings that heightened ABCA1 expression within breast tumors correlates with augmented levels of cytotoxic T cells, T cell effector enzymes (Prf-1 and Gzmb), and improved survival rates. Crucially, our in vitro investigations indicate that ABCA1 modulates multiple functions of MΦs to adopt an anti-cancer phenotype, encompassing: (1) the ability to infiltrate tumor spheroids, (2) angiogenesis, (3) efferocytosis—an immune-suppressive phagocytic process devoid of antigen presentation, and (4) the expansion, migration, and activity of cytotoxic T cells. ABCA1 transports cholesterol from macrophages to a lipid poor ApoA1 protein and facilitates the formation of nascent HDL via reverse cholesterol transport. We leveraged this mechanism to therapeutically target ABCA1 using ApoA1 mimetics 5A and 4F. Our data so far indicates that these ApoA1 phenocopy ABCA1 overexpression in MΦs. Together, our data provides compelling evidence for the involvement of ABCA1 in the pathophysiology of breast tumors. The anticipated outcomes of this research will establish the basis for the future utilization of ABCA1 and its downstream effects for therapeutic purposes. Citation Format: Shruti V. Bendre, Natalia Krawczynska, Shaunak Bhogale, Erin Weisser, Simon Han, Basel Hajyousif, Avni Singh, Rajendra K C, Yu Wang, Claire P. Schane, Adam T. Nelczyk, Anasuya DasGupta, Hashni E. Gamage, Kevin T. VanBortle, Emad Tajkhorshid, Saurabh Sinha, Wohnwa Cho, Erik R. Nelson. Cholesterol efflux protein ABCA1 skews macrophages towards an anti-tumor phenotype and consequently impacts breast cancer progression abstract. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts) ; 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84 (6Suppl): Abstract nr 174.
Bendre et al. (Fri,) studied this question.