Ascites-Driven Modulation of Cell Phenotypes and Proteomes: Implications for Cancer Progression

Abstract Background More than 90% of advanced ovarian cancer patients develop malignant ascites, which describes a buildup of fluid in the peritoneal cavity caused by increased vascular permeability and obstructed lymphatic drainage. Malignant ascites contains spheroidal tumor cell clusters that contain stromal cells, cancer-associated fibroblasts, and blood cells. These spheroids promote peritoneal metastasis and treatment resistance, yet the phenotypic and proteomic changes of cells caused by the ascites environment remain poorly understood, as does its influence on ex vivo responses to chemotherapeutics in personalized medicine approaches. Methods Using mass spectrometry, we compared the proteome profiles of cell-free ascites to serum from ovarian cancer patients. We then analyzed the proteomes of immortalized cancer cells grown as monolayers or spheroids in either malignant ascites or standard cell culture medium. The effects of this fluid on the phenotype, molecular composition, and ex vivo chemotherapy responses of cancer cells were also investigated. Results Proteome analysis revealed that cell-free ascites had higher levels of extracellular, secreted, and membrane proteins compared to serum. Ascites enhanced cell viability and spheroid formation in immortalized ovarian cancer cell lines more effectively than standard cell culture medium. Despite this altered baseline viability, growth of spheroids in ascites versus cell culture medium did not hinder chemotherapy response assessments, indicating the appropriateness of standard cell culture medium in ex vivo applications. The observed phenotypic changes of cells grown in ascites could not be recapitulated by adding chemokines or periostin to the cell culture medium, suggesting that additional factors are required. Notably, elevated levels of transglutaminase 2 were identified in SKOV-3 cells grown in ascites, indicating that ascites directly influences protein expression in cancer cells.