Dermatofibrosarcoma protuberans (DFSP) is a rare skin sarcoma known for its high recurrence rates, making treatment particularly challenging. While surgery remains the standard option, it often leads to scarring and other complications. Current in vitro models struggle to capture the complexity of the skin tumor environment, especially the role of immune cells. These limitations highlight the need for more accurate models to explore new treatment strategies. Due to these issues, advancing alternative therapies that can minimize surgical impact while effectively controlling tumor growth is crucial.

Published by Tsinghua University Press, Cell Organoid featured the findings (DOI: 10.26599/CO.2024.9410001) of researchers from Shanghai Lisheng Biotech and Shanghai Ninth People’s Hospital in 2024. The team successfully developed patient-derived organoids from DFSP tumors, closely replicating the histological and genetic characteristics of clinical samples. Using these organoids, they tested both metformin and imatinib, a drug already approved for DFSP treatment. Their study revealed that, beyond inhibiting tumor growth, metformin uniquely impacted immune pathways, suggesting a new therapeutic role for the drug in cancer treatment.

The researchers developed DFSP organoids without the use of enzymes, maintaining the tumor’s natural immune environment. These organoids contained 11 different cell types, including immune cells, offering a detailed model for drug testing. Both metformin and imatinib were shown to reduce tumor growth, but metformin stood out by significantly altering the expression of genes related to immune system activity and cancer cell signaling. This indicates that metformin doesn’t just target tumor cells but also influences the surrounding immune environment, providing a dual mechanism of action. This ability to modulate immune responses highlights metformin’s potential as a repurposed cancer treatment, particularly for rare skin tumors like DFSP. By preserving the tumor’s complexity, the organoids provide a valuable platform for screening drugs and exploring personalized therapies that go beyond standard treatments.

Dr. Jun Chen, a lead researcher, explained the significance of the findings: “By creating DFSP organoids, we’ve gained crucial insights into how drugs affect both tumor and immune cells. Metformin’s unique ability to modulate immune signaling opens up new treatment possibilities that could minimize the need for surgery. This approach not only helps us better understand the biology of these tumors but also suggests ways to improve outcomes for patients with difficult-to-treat cancers like DFSP.”

The success of metformin in modulating immune pathways within DFSP organoids suggests broader applications for cancer treatment. These organoids provide a highly accurate model for testing other drugs and personalized therapies, especially in cancers that are difficult to treat. By replicating the tumor microenvironment, this model opens new doors for developing targeted treatments. As researchers continue to explore metformin’s effects, its repurposing for cancer therapy could revolutionize treatment strategies for rare skin cancers and improve patient outcomes.

The work was supported by the National Natural Science Foundation of China (Nos. 82373719, 82173662, and 32200581), Natural Science Foundation of Shanghai (No. 21ZR1436800), and Clinical Research Project of Multi-Disciplinary Team, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine (No. 201901).

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Patient-derived skin tumor organoids with immune cells respond to metformin

About Cell Organoid

Cell Organoid aims to provide a worldwide platform for research into all aspects of organoids and their applications in medicine. It is an open access, peer-reviewed journal that publishes high-quality articles dealing with a wide range of basic research, clinical and translational medicine study topics in the field.