Ovarian carcinosarcoma (OCS) is a rare and aggressive subtype of ovarian cancer, characterised by the presence of both epithelial (carcinomatous) and mesenchymal (sarcomatous) components(1). We and others have produced data supporting the conversion theory of development, where the sarcoma component arises from the carcinoma component via epithelial-to-mesenchymal transition (EMT)(2-4). Platinum- and taxane-based chemotherapy is not as effective against OCS, compared to high grade serous ovarian carcinoma (HGSOC), the most common subtype of ovarian cancer. As OCS and HGSOC have similar aberrations, it is likely that the sarcoma component in OCS causes the disparity in treatment response(5).
Partial EMT (pEMT), where cells gain characteristics associated with mesenchymal cells whilst retaining expression of epithelial markers, is believed to be more common in cancer than a full EMT(6). Cells in this state have also been shown to contribute more significantly to metastasis, compared to full EMT cells, and have an increased capacity to revert to an epithelial state via a mesenchymal-to-epithelial transition (MET), making them ideal targets for treatment strategies(6,7). Therefore, we are using single nuclear RNA sequencing (snRNAseq) and spatial transcriptomics to study patient-derived xenograft (PDX) models of OCS, to analyse gene expression differences between the carcinomatous and sarcomatous regions with a particular focus on the cells transitioning between carcinoma and sarcoma. We have completed a pilot study of four PDX tumours and are using common epithelial and mesenchymal markers, such as CDH1, CDH2, VIM, ZEB1 and SNAI1, to distinguish more carcinomatous and sarcomatous regions of the tumour in the spatial transcriptomics data. We will then use snRNAseq data to identify genes highly expressed in the pEMT cells. Concurrently, we have been analysing the expression of pEMT markers identified in other cancer types in our OCS models using flow cytometry(8). Western blotting and in vitro functional assays are being carried out on these sorted subpopulations to further characterise this process in OCS.
By targeting the key elements involved in the development of the sarcomatous component of OCS we hope to increase the epithelial nature of the tumour. This may make the tumour more susceptible to standard first-line platinum- and taxane-based chemotherapy.