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Mikala Egeblad

From left, Mikala Egeblad and Xue-Yan He. Photo from Constance Brukin

By Daniel Dunaief

They both have left Cold Spring Harbor Laboratory, but the innovative research they did on Long Island and that they continue to do, is leaving its mark.

From left, Mikala Egeblad and Xue-Yan He at the American Association for Cancer Research (AACR) annual meeting in New Orleans, Louisiana in 2022. Photo from Xue-Yan He

When Xue-Yan He was a postdoctoral researcher in the lab of Mikala Egeblad, who was Associate Professor at CSHL, the tandem, along with collaborators, performed innovative research on mice to examine how stress affected the recurrence and spread of cancer in a mouse model.

In a paper published in late February in the journal Cancer Cell, He, who is currently Assistant Professor of Cell Biology & Physiology at Washington University School of Medicine in St. Louis, discovered that stress-induced neutrophil extracellular traps (NETs), which typically trap and kill bacteria, trigger the spread of cancer.

“The purpose of our study is to find out what stress does to the body” of an animal model of cancer, said He.

The data in mice demonstrated that targeting NETs in stressed animals significantly reduced the risk for metastases, He explained, suggesting that reducing stress should help cancer treatment and prevention. The researchers speculate that drugs preventing NET formation can be developed and used as new treatments to slow or stop cancer’s spread.

To be sure, this finding, which is encouraging and has generated interest among cancer scientists and neurobiologists, involved a mouse model. Any potential application of this research to the diagnosis and treatment of people will take considerably more effort.

“I want to stress that the evidence for the link between stress, NETs, and cancer is from mouse studies,” Egeblad explained. “We will need to design human studies to know for sure whether the link also exists for humans.”

Still, Egeblad hopes that eventually reducing stress or targeting NETs could be options to prevent metastatic recurrence in cancer survivors. “One major challenge is that a cancer diagnosis by itself is incredibly stressful,” she explained. The results of these experiments have attracted considerable attention in the scientific community, where “there is a lot more to learn!” 

Three part confirmation

When she was a postdoctoral researcher, He removed neutrophils from the mice using antibodies. Neutrophils, which are cells in the immune system, produce the NETs when they are triggered by the glucocorticoid stress hormone.

She also injected an enzyme called DNAse to destroy NETs in the test mice. The former CSHL postdoctoral researcher also used genetically engineered mice that didn’t respond to glucocorticoids.

With these approaches, the test mice developed metastasis at a much lower rate than those that had intact NETs. In addition, chronically stressed mice who didn’t have cancer had NETs that modified their lung tissue.

“Stress is doing something to prepare the organs for metastasis,” said He.

Linda Van Aelst, CSHL Professor and a collaborator on the study, suggested that this work validates efforts to approach mental health in the context of cancer.

“Reducing stress should be a component of cancer treatment and prevention,” Van Aelst said in a statement.

After He removed the primary tumor in the mouse models, the stressed mice developed metastatic cancer at a four-fold higher rate than the mice who weren’t stressed but who also previously had cancer.

The CSHL scientists primarily studied breast cancer for this work.

He appreciated the help and support from her colleagues at CSHL. “To really understand the mechanism” involved in the connection between stress and cancer, “you need a mouse model in the lab, an expert in neuroscience and an expert in the cancer field,” she said.

As a neuroscientist, Van Aelst offered suggestions and comments and helped He conduct behavioral tests to determine a mouse’s stress level. The work for this project formed the focus ofHe’s postdoctoral research, which started in 2016 and ended in 2023.

The link between stress and cancer is receiving increasing attention in the scientific community and has attracted attention on social media, He said.

CSHL “provided a great environment to perform all these experiments,” said He. The numerous meetings CSHL hosts and the willingness of principal investigators across departments made the lab “one of the best places” for a postdoctoral scientist.

“If you need anything from a neural perspective or a technical perspective, you can always find a collaborator” at CSHL, He added.

Born and raised in Nanjing, China, He enjoyed living on Long Island, visiting vineyards and trying to explore every state park. In the harbor, He caught blue crabs while her husband Chen Chen, who was a postdoctoral researcher at CSHL in the lab of Camila dos Santos, went fly fishing at Jones Beach.

In her current research, where she manages a lab that includes a senior scientist, a postdoctoral researcher and an undergraduate, He is extending the work she did at CSHL to colorectal cancer, where she is also analyzing how stress affects the spread of cancer.

“When you’re stressed, you can develop gastrointestinal problems, which is why I wanted to switch from breast cancer to colorectal cancer,” she said.

Extensions of the work

As for context for the research at CSHL, Egeblad wrote that doctors treating patients where the known risk of recurrence is high might use NETs in the blood as a biomarker.

The scientists think cancers that tend to metastasize to the liver, lung or spleen are the strongest candidates to determine the effect of NETs and stress on cancer.

“We have not seen any effects of targeting NETs for metastasis to the bone or the brain in our mouse model and similarly, the studies that have linked NETs to metastasis in human patients have mostly been cancer that has spread to the liver or the lung,” Egeblad said.

Egeblad appreciated the “fantastic job” He did on the work and described her former researcher as being “fearless.”

“She found that stress increased metastasis early in her project but it was a lot of work to discover it was the NETs that were responsible and to conduct studies to ensure that the results were applicable to different types of cancer,” Egeblad explained.

While the two researchers have gone to different institutions and are leading other lab efforts, Egeblad said she’d be happy to collaborate with her former student, who shares the same sense of humor.

Egeblad recalled how He ended her talks by telling the audience that her results showed that Egeblad should give her a “long vacation.”

“I think indeed that she has deserved one after all this work!” Egeblad offered.

JoAnne Hewett. Twitter photo

By Daniel Dunaief

Daniel Dunaief

Finally!

Brookhaven National Laboratory has had nine lab directors since it was founded in 1946. Earlier this week, the Department of Energy facility, which has produced seven Nobel Prizes, has state-of-the-art facilities, and employs over 2,800 scientists and technicians from around the world announced that it hired JoAnne Hewett as its first female lab director.

Successful, determined, dedicated and award-winning local female scientists lauded the hire of Hewett, who comes to BNL from SLAC National Accelerator Laboratory where she was associate lab director for fundamental physics and chief research officer. SLAC is operated by Stanford University in Menlo Park, California. In email responses, local female scientists suggested that Hewett’s hiring can and would inspire women in science, technology, engineering and math (STEM) fields.

“I am so delighted by the news that Dr. JoAnne Hewett has been named to be the next director of Brookhaven National Laboratory,” wrote Esther Takeuchi, William and Jane Knapp chair in Energy and the Environment and SUNY distinguished professor at Stony Brook University and chair of the Interdisciplinary Science Department at BNL. As the first female director for the lab, Hewett “is an inspiration not only for the women who are in the field, but for future female scientists who will witness first hand that success at the highest level.”

Stella Tsirka, SUNY distinguished professor in the Department of Pharmacological Sciences at the Renaissance School of Medicine at Stony Brook University, suggested this hire was a part of an increasing number of women in prominent positions in science at local institutions.

Stony Brook and BNL are “becoming a hub of strong female role models for younger females, in STEM, in medicine, in leadership!” Tsirka wrote. “Between [SB President] Maurie McInnis, Hewett, Ivet Bahar (the director of the Laufer Center), Anissa Abi-Dargham [principal investigator for the Long Island Network for Clinical and Translational Science] and many other successful female faculty in leadership positions, hopefully, the message comes out loud and clear to our young women who are in science already, or aspire to be in science.”

For her part, Abi-Dargham, who is chair in the Department of Psychiatry and Behavioral Health, described Hewett’s hire as “amazing” and suggested it was “really exciting to see an accomplished female scientist selected to head our collaborating institution at BNL!”

Cold Spring Harbor Laboratory Professor and Cancer Center Program co-leader Mikala Egeblad added that the significance of Hewett’s hire goes “well beyond inspiring young girls. It is important to have women leaders for all sciences, also for someone at my career stage. I hope that one day, we will get to a point when we don’t think about whether a leader is a woman or a man.”

Women remain underrepresented at top leadership positions, so Egeblad finds it “very inspiring to see a woman recognized for her leadership skills and selected” to head BNL.

Leemor Joshua-Tor, professor and HHMI investigator at CSHL, called the hire “really great news” and indicated this was “especially true for the physical sciences, where there are even fewer women in senior positions than in biology.” Joshua-Tor added that the more women in senior, visible positions, “the more young women and girls see this as a normal career to have.”

Alea Mills, professor and Cancer Center member at CSHL, wrote that it is “fantastic that BNL has found the very best scientist to lead them into their next new mission of success. And it’s an extra bonus that this top scientist happens to be a woman!”

Mills added that efforts to enhance diversity are fashionable currently, but all too often fall short. Hiring Hewett makes “real traction that will undoubtedly inspire future generations of young women in STEM.”

Patricia Wright, distinguished service professor at Stony Brook in the Department of Anthropology, wrote that it was “inspiring” to see a female director of BNL and that “young female scientists can aspire to being in that role some day.”

Jose M. Adrover and Mikala Egeblad. Photo by Lijuan Sun

By Daniel Dunaief

Cold Spring Harbor Laboratory Professor Mikala Egeblad thought she saw something familiar at the beginning of the pandemic.

Mikala Egeblad. Photo from CSHL

Egeblad has focused on the way the immune system’s defenses can exacerbate cancer and other diseases. Specifically, she studies the way a type of white blood cell produces an abundance of neutrophil extracellular traps or NETs that can break down diseased and healthy cells indiscriminately. She thought potentially high concentrations of these NETs could have been playing a role in the worst cases of COVID.

“We got the idea that NETs were involved in COVID-19 from the early reports from China and Italy” that described how the sickest patients had severe lung damage, clotting events and damage to their kidneys, which was what she’d expect from overactive NETs, Egeblad explained in an email.

Recently, she, her post doctoral researcher Jose M. Adrover and collaborators at Weill Cornell Medical College and the Icahn School of Medicine at Mt. Sinai proved that this hypothesis had merit. They showed in hamsters infected with COVID and in mice with acute lung injuries that disabling these NETs improved the health of these rodents, which strongly suggested that NETs are playing a role in COVID-19.

“It was very exciting to go from forming a hypothesis to showing it was correct in the context of a complete new disease and within a relatively short time period,” Egeblad wrote.

Egeblad, Andover and their collaborators recently published their work in the Journal of Clinical Investigation Insight.

Importantly, reducing the NETs did not alter how much virus was in the lungs of the hamsters, which suggests that reducing NETs didn’t weaken the immune system’s response to the virus.

Additional experiments would be necessary to prove this is true for people battling the worst symptoms of COVID-19, Egeblad added.

While the research is in the early stages, it advances the understanding of the importance of NETs and offers a potential approach to treating COVID-19.

An unexpected direction

Jose Adrover. Photo from CSHL

When Adrover arrived from Spain, where he had earned his PhD from the Universidad Complutense de Madrid and had conducted research as a post doctoral fellow at the Spanish Center for Cardiovascular Research in March of 2020, he expected to do immune-related cancer research.

Within weeks, however, the world changed. Like other researchers at CSHL and around the world, Egeblad and Adrover redirected their efforts towards combating COVID.

Egeblad and Andover “were thinking about the virus and what was going on and we thought about trying to do something,” Adrover said. 

Egeblad and Adrover weren’t trying to fight the virus but rather the danger from overactive NETs in the immune system.

Finding an approved drug

Even though they were searching for a way to calm an immune system responding to a new threat, Egeblad and Adrover hoped to find a drug that was already approved.

After all, the process of developing a drug, testing its safety, and getting Food and Drug Administration approval is costly and time-consuming. 

That’s where Juliane Daßler-Plenker, also a postdoctoral fellow in Egeblad’s lab, came in. Daßler-Plenker conducted a literature search and found disulfiram, a drug approved in the 1950’s to treat alcohol use disorder. Specifically, she found a preprint reporting that disulfuram can target a key molecule in macrophages, which are another immune cell. Since the researchers knew this was important for the formation of NETs, Daßler-Plenker proposed that the lab test it.

Working with Weill Cornell Medical College and the Icahn School of Medicine at Mt. Sinai, Adrover explored the effect of disulfiram, among several other possible treatments, on NET production.

Using purified neutrophils from mice and from humans, Adrover discovered that disulfiram was the most effective treatment to block the formation of NETs.

He, Assistant Professor Robert Schwartz’s staff at Weill Cornell and Professor Benjamin tenOever at Mt. Sinai tried disulfiram on hamsters infected with SARS-Cov-2. The drug blocked net production and reduced lung injury.

The two experiments were “useful in my opinion as it strengthens our results, since we blocked NETs and injury in two independent models, one of infection and the other of sterile injury,” Adrover said. “Disulfuram worked in both models.”

More work needed

While encouraged by the results, Egeblad cautioned that this work started before the availability of vaccines. The lab is currently investigating how neutrophils in vaccinated people respond to COVID-19.

Still, this research offered potential promise for additional work on NETs with some COVID patients and with people whose battles with other diseases could involve some of the same immune-triggered damage.

“Beyond COVID, we are thinking about whether it would be possible to use disulfiram for acute respiratory distress syndrome,” Egeblad said. She thinks the research community has focused more attention on NETs.

“A lot more clinicians are aware of NETs and NETs’ role in diseases, COVID-19 and beyond,” she said. Researchers have developed an “appreciation that they are an important part of the immune response and inflammatory response.”

While researchers currently have methods to test the concentration of NETs in the blood, these tests are not standardized yet for routine clinical use. Egeblad is “sensing that there is more interest in figuring out how and when to target NETs” among companies hoping to discover treatments for COVID and other diseases.

The CSHL researcher said the initial race to gather information has proven that NETs are a potentially important target. Down the road, additional research will address a wide range of questions, including what causes some patients to develop different levels of NETs in response to infections.

Mikala Egeblad with a blown-up image of a neutrophil extracellular trap, or NET. Photo from CSHL

By Daniel Dunaief

Mikala Egeblad couldn’t shake the feeling that the work she was doing with cancer might somehow have a link to coronavirus.

Egeblad, who is an Associate Professor and cancer biologist at Cold Spring Harbor Laboratory, recently saw ways to apply her expertise to the fight against the global pandemic.

She studies something called neutrophil extracellular traps, which are spider webs that develop when a part of the immune system triggered by neutrophil is trying to fight off a bacteria. When these NETs, as they are known, are abundant enough in the blood stream, they may contribute to the spread of cancers to other organs and may also cause blood clots, which are also a symptom of more severe versions of COVID-19, the disease caused by the coronavirus, which has now infected over two million people worldwide.

“I always felt an urgency about cancer, but this has an urgency on steroids,” Egeblad said.

Cold Spring Harbor Laboratory reached out to numerous other scientists who specialize in the study of NETs, sometimes picking up on the tweets of colleagues who wondered in the social networking world whether NETs could contribute or exacerbate the progression of Covid19.

Egeblad started by reaching out to two scientists who tweeted, “Nothing about NETs and Covid-19?” She then started reaching out to other researchers.

“A lot of us had come to this conclusion independently,” she said. “Being able to talk together validated that this was something worth studying as a group.”

Indeed, the group, which Egeblad is leading and includes scientists at the Feinstein Institutes for Medical Research and the Research Institute of the McGill University Health Centre, published a paper last week in the Journal of Experimental Medicine, in which they proposed a potential role for NETs.

“We are putting this out so the field doesn’t overlook NETs,” said Egeblad, who appreciated the support from Andrew Whiteley, who is the Vice President of Business Development and Technology Transfer at CSHL.

With a range of responses to the coronavirus infection, from people who have it but are asymptomatic all the way to those who are battling for their survival in the intensive care units of hospitals around the world, the biologist said the disease may involve vastly different levels of NETs. “The hypothesis is that in mild or asymptomatic cases, the NETs probably play little if any role,” she said.

In more severe cases, Egeblad and her colleagues would like to determine if NETs contribute or exacerbate the condition. If they do, the NETs could become a diagnostic tool or a target for therapies.

At this point, the researchers in this field have ways of measuring the NETs, but haven’t been able to do so through clinical grade assays. “That has to be developed,” Egeblad explained. “As a group, we are looking into whether the NETs could come up before or after symptoms and whether the symptoms would track” with their presence, she added.

To conduct the lab work at Cold Spring Harbor, Egeblad said her team is preparing to develop special procedures to handle blood samples that contain the virus. 

As the lead investigator on this project, Egeblad said she is organizing weekly conference calls and writing up the summaries of those discussions. She and the first author on the paper Betsy J. Barnes, who is a Professor at the Feinstein Institute, wrote much of the text for the paper. Some specific paragraphs were written by experts in those areas.

At this point, doctors are conducting clinical trials with drugs that would also likely limit NET formation. In the specific sub field of working with this immune-system related challenge, researchers haven’t found a drug that specifically targets these NETs. 

If the study of patient samples indicates that NETs play an important role in the progression of the disease, particularly among the most severe cases, the scientists will look for drugs that have been tried in humans and are already approved for other diseases. This would create the shortest path for clinical use.

Suppressing NETs might require careful management of potential bacterial infections. Egeblad suggested any bacterial invaders might be manageable with other antibiotics.

NETs forming in airways may make it easier to get bacterial infections because the bacteria likes to grow on the DNA.

Thus far, laboratory research studies on NETs in COVID-19 patients have involved taking samples from routine care that have been discarded from their daily routine analysis. While those are not as reliable as samples taken specifically for an analysis of the presence of these specific markers, researchers don’t want to burden a hospital system already stretched thin with a deluge of sick patients to provide samples for a hypothetical pathway.

Egeblad and her colleagues anticipate the NETs will likely be more prevalent among the sicker patients. As more information comes in, the researchers also hope to link comorbidities, or other medical conditions, to the severity of COVID-19, which may implicate specific mechanisms in the progression of the disease.

“There are so many different efforts” to understand what might cause the progression of the disease, Egeblad said. “Everybody’s attention is laser focused.” A measure that is easy to study, such as this hypothesis, could have an impact and “it wouldn’t take long to find out,” she added. Indeed, she expects the results of this analysis should be available within a matter of weeks.

Egeblad believes the NETs may drive mucus production in the lungs, which could make it harder to ventilate in severe cases. They also may activate platelets, which are part of the clotting process. If they did play such a role, they could contribute to the blood clotting some patients with coronavirus experience.

Egeblad recognizes that NETs, which she has been studying in the context of cancer, may not be involved in COVID-19, which researchers should know soon. “We need to know whether this is important.”

Above, Mikala Egeblad works with graduate student Emilis Bružas in the Watson School of Biological Sciences. Photo from Pershing Square Soon Cancer Research Alliance

By Daniel Dunaief

For some people, cancer goes into remission and remains inactive. For others, the cancer that’s in remission returns. While doctors can look for risk factors or genetic mutations, they don’t know why a cancer may come back at the individual level.

In a mouse model of breast and prostate cancers, Mikala Egeblad, an associate professor at Cold Spring Harbor Laboratory, has found an important driver of cancer activation and metastasis: inflammation. When mice with cancer also have inflammation, their cancer is likely to become more active. Those who don’t have inflammation, or whose inflammation is treated quickly, can keep the dreaded disease in check. Cancer cells “may be dormant or hibernating and not doing any harm at all,” she said. “We speculated what might be driving them from harmless to overt metastasis.”

Egeblad cautioned that this research, which was recently published in the journal Science, is on mice and that humans may have different processes and mechanisms.

CSHL’s Mikala Egeblad. Photo from Pershing Square Soon Cancer Research Alliance

“It is critical to verify whether the process happens in humans,” Egeblad suggested in an email, which she will address in her ongoing research. Still, the results offer a window into the way cancer can become active and then spread from the lungs. She believes this is because the lungs are exposed to so many external stimuli. She is also looking into the relevance for bone, liver and brain metastases. The results of this research have made waves in the scientific community.

“This study is fantastic,” declared Zena Werb, a professor of anatomy and associate director for basic science at the Helen Diller Family Comprehensive Cancer Center at the University of California in San Francisco. “When [Egeblad] first presented it at a meeting six months ago, the audience was agog. It was clearly the best presentation of the meeting!”

Werb, who oversaw Egeblad’s research when Egeblad was a postdoctoral scientist, suggested in an email that this is the first significant mechanism that could explain how cancer cells awaken and will “change the way the field thinks.”

Egeblad credits a team of researchers in her lab for contributing to this effort, including first author Jean Albrengues, who is a postdoctoral fellow. This group showed that there’s a tipping point for mice — mice with inflammation that lasts six days develop metastasis.

Egeblad has been studying a part of the immune system called neutrophil extracellular traps, which trap and kill bacteria and yeast. Egeblad and other researchers have shown that some cancers trick these NETs to aid the cancer in metastasizing.

In the new study, inflammation causes cancer cells that are not aggressive to develop NETs, which leads to metastasis. The traps and enzymes on it “change the scaffold that signals that cancer should divide and proliferate instead of sitting there dormant,” Egeblad said.

To test out her theory about the role of enzymes and the NETs, Egeblad blocked the cascade in six different ways, including obstructing the altered tissue scaffold with antibodies. When mice have the antibody, their ability to activate cancer cells after inflammation is prevented or greatly reduced, she explained.

The numbers from her lab are striking: in 100 mice with inflammation, 94 developed metastatic cancer. When she treated these mice with any of the approaches to block the inflammation pathway, 60 percent of them survived, while the remaining 40 percent had a reduced metastatic cancer burden in the lungs.

If inflammation is a key part of determining the cancer prognosis, it would help cancer patients to know, and potentially treat, inflammation even when they don’t show any clinical signs of such a reaction.

In mice, these NETs spill into the blood. Egeblad is testing whether these altered NETs are also detectable in humans. She could envision this becoming a critical marker for inflammation to track in cancer survivors.

The epidemiological data for humans is not as clear cut as the mouse results in Egeblad’s lab. Some of these epidemiological studies, however, may not have identified the correct factor.

Egeblad thinks she needs to look specifically at NETs and not inflammation in general to find out if these altered structures play a role for humans. “We would like to measure levels of NETs and other inflammatory markers in the blood over time and determine if there is a correlation between high levels and risk of recurrence,” she explained, adding that she is starting a study with the University of Kansas.

Werb suggested that inflammation can be pro-tumor or anti-tumor, possibly in the same individual, which could make the net effect difficult to determine.

“By pulling the different mechanisms apart, highly significant effects may be there,” Werb wrote in an email. Other factors including mutation and chromosomal instability and other aspects of the microenvironment interact with inflammation in a “vicious cycle.”

In humans, inflammation may be a part of the cancer dynamic, which may involve other molecular signals or pathways, Egeblad said.

She has been discussing a collaboration with Cold Spring Harbor Laboratory’s Doug Fearon, whose lab is close to hers.

Fearon has been exploring how T-cells could keep metastasis under control. Combining their approaches, she said, cancer might need a go signal, which could come from inflammation, while it also might need the ability to alter the ability of T-cells from stopping metastasis.

In her ongoing efforts to understand the process of metastasis, Egeblad is also looking at creating an antibody that works in humans and plans to continue to build on these results. “We now have a model for how inflammation might cause cancer recurrence,” she said. 

“We are working very actively on multiple different avenues to understand the human implications, and how best to target NETs to prevent cancer metastasis.”