Colon cancer is the second leading cause of cancer deaths among men and women combined. Therefore, alternative therapies are of critical need. In normal tissue, intestinal stem cells act to enable renewal of the entire epithelium every week. It is now known that the transformation of stem cells into colon cancer stem cells is a major inciting event that underlies carcinogenesis. Cancer stem cells are tumor-initiating cells, are refractory to therapy, and are linked to the very poor prognosis associated with late-stage colon cancer diagnosis. Better therapies may result if colon cancer stem cells could be eliminated. However, eradicating this population of cells is an extremely challenging problem, due to the intrinsic capacity of colon cancer stem cells to be long-lived, self-renewing, and highly proliferative. One proposed solution to this problem is to pharmacologically bias cancer stem cell fate toward a terminally differentiated cell fate. In other words, drive cancer stem cells to adopt a cell fate that does not proliferate, that has a short life expectancy, and that is sensitive to chemotherapy. Realization of this differentiation therapy requires that the identity of the cancer stem cell be known and that a candidate molecular target exists for a therapeutic entry point. To this end, the leucine-rich G protein coupled receptor-5 (Lgr5) has been found to act as a marker for colon cancer stem cells and is a tantalizing pharmacological target. Lgr5, together with its homologue Lgr4, act as modulators for the Wnt/catenin signaling pathway. Wnt/catenin signaling is a critical pathway that regulates stem cell homeostasis in the intestine. Mutations in this pathway result in excessive signaling and strongly bias stem cell behavior toward that of a long-lived and highly proliferative cancer stem cell. Lgr5 is therefore an attractive pharmacological target for counteracting this imbalance and restoring normal cell fate dynamics. However, the mechanisms of Lgr5-signaling and its roles in vivo are still vague and represent a major knowledge gap. Therefore, the objective of this proposal will be to determine how Lgr5-signaling controls stem and cancer stem cell fate. To accomplish this objective, I will test the central hypothesis that inhibition of Lgr5 internalization attenuates Wnt/catenin signaling and promotes cancer stem cell differentiation.
Three specific aims have been proposed to test this hypothesis and will in (Aim 1) Clarify the mechanism of Lgr5-mediated Wnt/catenin signaling, (Aim 2) Elucidate Lgr5-dependent signaling mechanisms coordinating stem cell behavior, and (Aim 3) Identify small molecule interventions for driving cancer stem cell differentiation. Key preliminary findings are described in this research plan that enable formulation of the central hypothesis and specific aims. The integration of biochemistry, cell biology, pharmacology, and cancer biology make this an innovative research proposal. This proposal is significant because it will transform Lgr5 from a stem cell marker into a high-value drug candidate that can be pharmacologically targeted to control cancer stem cell fate. My research and career development plan demonstrates the interdisciplinary training that I have received. This spans the biomedical science spectrum and includes stem cell biology, molecular biology, genetic engineering, cancer research, biochemistry, cell-fate analysis, and high-throughput screening. This NCI K22 proposal will solidify the integration of these skills and facilitate my own independent research program, which is my short-term career objective. By completing this proposal I will be in a position to obtain R01 funding and work towards my long-term career objective of making high-impact and foundational discoveries that can be translated into treatments and cures for cancer. In so doing, I will become an instrumental component of the NCI's mission ?to accelerate the rate of scientific discovery and reduce the burden of cancer in the United States and around the world.?

Public Health Relevance

Alternative therapies that improve the poor survival rates of late-stage colon cancer diagnosis are needed. This proposal will provide a firm mechanistic and basic science understanding for a major signaling pathway that controls stem and cancer stem cell differentiation. Therefore, this proposal will provide the framework for future colon cancer differentiation therapy.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Career Transition Award (K22)
Project #
Application #
Study Section
Subcommittee I - Transistion to Independence (NCI)
Program Officer
Jakowlew, Sonia B
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Duke University
Anatomy/Cell Biology
Schools of Medicine
United States
Zip Code
Mackie, Duncan I; Al Mutairi, Fuad; Davis, Reema B et al. (2018) hCALCRL mutation causes autosomal recessive nonimmune hydrops fetalis with lymphatic dysplasia. J Exp Med 215:2339-2353