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5 Antiadhesive Carbohydrates and Glycomimetics
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6
Targeting Carbohydrates inCancer–Analytical and
Biotechnological Tools
Henrique O. Duarte
1
2
3
4
1,2
, Joana Gomes
1,2
, and Celso A. Reis
1,2,3,4
6.1 Aberrant Protein Glycosylation inCancer
161
Glycosylation is defined as the enzymatic assembly of complex carbohydrate chains,
or glycans, from simple monosaccharide sugar building blocks, and their covalent
attachment to a diverse range of macromolecules to form an ensemble of distinct
types of glycoconjugates, which, as a whole, constitute the cellular glycome [1].
Depending on the nature of their nonglycan component, glycoconjugates can be
grouped into glycosphingolipids, proteoglycans, and glycoproteins. Glycoproteins
constitute the main focus of this chapter. Although numerous cytoplasmic proteins
represent eligible targets for dynamic glycosylation, the majority of a cell’s glycan
repertoire decorates both secreted and membrane‐bound macromolecules[2]. The
oligosaccharidic component of cell surface glycoproteins, which faces the extracellular space, forms an electron‐dense layer known as the glycocalyx, which, under
homeostasis, actively regulates a plethora of biological processes occurring inside
and around a cell. Indeed, this layer of glycoconjugates constitutes a vital interface
between a cell and the surrounding microenvironment, which includes not only
neighboring cells but also noncellular components, such as elements of the extracellular matrix (ECM). This privileged localization grants the cellular glycome significant control over key biological processes, including proliferation, differentiation,
motility, cytoskeletal rearrangements, inter‐ and extracellular communication, and
neoplastic transformation[3].
The major glycan signatures that are significantly enriched in tumor cells and
that have been mechanistically linked to malignant cellular transformation include:
Carbohydrate-Based Therapeutics, First Edition. Edited by Roberto Adamo and Luigi Lay.
© 2024 WILEY-VCH GmbH. Published 2024 by WILEY-VCH GmbH.

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162
highly branched N‐glycan chains [4], highly fucosylated and sialylated glycans
(including Lewis antigens)[5, 6], extended lactosamine polymers[7], and short prematurely terminated O‐glycan structures (such as Tn, sialyl Tn [STn], and
antigens) [8]. The upregulation of specific aberrant carbohydrate antigens is
T
accom
panied by the concomitant reduction of specific homeostatic signatures,
including bisected N‐glycans. Aberrant glycan traits actively tune key malignant
properties of proteins participating in central cellular processes driving oncogenic
transformation, including mitogenic signaling, cell adhesion, motility, and invasion;
metabolic regulation; interaction with cellular and acellular components of the
immune system; angiogenic growth; apoptosis evasion; and acquisition of molecular resistance to targeted therapeutic agents[1, 9–11].
Given that tumor‐associated carbohydrate antigens (TACAs) have their expression highly restricted to neoplastic tissues and play an undeniable role in the governing of malignant cell behavior, they have emerged as valuable theranostic tools
in the clinical oncology field, either as robust and specific biomarkers for disease
detection and monitoring, or as promising, yet still underexplored candidates for
therapeutic targeting[10, 12–14]. Such efforts require the thorough characterization
of aberrant tumor‐specific glycan alterations in patient neoplastic lesions as well as
the mechanistic dissection of their oncogenic role through the establishment of
robust in vitro and invivo models of disease. However, several structural and biological features of glycans pose unique challenges to their study. Firstly, despite the
limited number of monosaccharides from which complex carbohydrates can be
generated, glycans exhibit remarkable structural diversity stemming from: the specific composition and sequence of their constituent building blocks; the precise anomeric configuration and position of glycosidic linkages; variable degrees of
branching and extension; and their potential to undergo further structural modifications, including sulfation, phosphorylation, and acetylation. Secondly, as glycosylation reflects the post-translational modification of multiple proteins, the
accurate identification and tissue mapping of specific glycan epitopes through the
use of traditional immunohistochemical approaches based on monoclonal antibodies (mAbs) and glycan‐binding proteins (GBPs), including lectins of mammalian or
plant origin, can be difficult to achieve. Furthermore, the expression of a single
carbohydrate product results from the coordinated expression, activity, and localization of multiple isoenzymes, often showing partially redundant and overlapping
specificities. This significantly increases the biological complexity required from
genome‐edited invitro and invivo models for the dissection of glycan biosynthetic
pathways. Moreover, the cellular glycosylation landscape is highly dynamic and
sensitive to spatiotemporal regulation, which further compromises the translational
value of data retrieved from simpler glycoengineered cell and animal models. In
addition, since identical monosaccharide compositions often reflect distinct tridimensional carbohydrate structures with distinct functional attributes, the development of analytical tools capable of retrieving isomeric linkage information has
become fundamental for glycan structural characterization. Finally, although information on the glycan site occupancy and microheterogeneity of a given
glycoprotein

is essential to define its biological role, it may prove difficult to determine experimentally. Indeed, linking a particular glycan structure to a defined biological function remains a challenging task.
This chapter will discuss how recently developed analytical and biotechnological
tools have significantly contributed to overcome the challenges posed by the unique
features of glycans and their intricate biosynthetic pathways, thus supporting the
structural and functional characterization of protein glycosylation in the context of
human neoplastic transformation and the successful establishment of glycan‐based
biomarkers and therapeutic targets for the clinical management of cancer patients
(Figure6.1).
163
Figure6.1 Biotechnological and analytical tools for the identification, functional
characterization, and clinical application of glycan-based cancer biomarkers; FFPE -
formalin-fixed paraffin-embedded; MS - mass spectrometry; GT - glycosyltransferase;
GBP - glycan-binding protein.

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6.2 Detection and Mapping ofCarbohydrate-Based
Antigens inHuman Neoplastic Tissues
Over the past decades, numerous studies have sought to comprehensively characterize both the nature and impact of glycosylation alterations occurring within
malignant cells and tissues (reviewed in[9]). In particular, the advent of hybridoma
technology just under 50
unlimited catalog of highly specific mAbs for the reliable detection of any type of
biological antigen, including glycans, and has, therefore, revolutionized the field of
cancer biomarker discovery[15]. Indeed, the development of highly specific mAbs
targeting TACAs, such as the prematurely truncated O‐glycan determinant STn,
allowed the unprecedented disclosure of their tissue-based cancer‐specific expression pattern [16–18]. In the hybridoma system, activated immunoglobulin‐secreting
B cells, previously challenged with an isolated and structurally defined antigen of
interest (ideally), are fused with myeloma cells, generating a hybrid, isogenic, and
immortalized cell line with antibody‐producing capacity [19]. Generally, mAb‐
based tissue mapping of entirely peptidic epitopes with a known sequence can be
performed with reasonable certainty, as the specificity of the used mAb can be accurately determined. However, the signals produced by carbohydrate‐binding mAbs
often reflect the expression of a variety of distinct protein carriers, which hinders
the precise identification of the target glycan epitope [20]. The same limitation
applies to other glycan‐recognizing molecules whose carbohydrate specificity is not
fully determined, including polyclonal antibody mixtures and other GBPs. The poor
affinity of lectins, usually in the low micromolar range, frequently limits their application for histochemical staining purposes[1, 21]. Indeed, these glycan‐
molecules do not provide insights on complete monosaccharide compositions, glycan tridimensional conformation, glycosylation site occupancy, microheterogeneity, or the precise location of glycan chains on the backbone of specific glycoproteins.
Such affinity reagents facilitate the identification of broader glycosylation traits (e.g.
N‐glycan branching, core fucosylation, and linkage‐specific sialylation) rather than
elucidating the exact tridimensional structure of individual glycan species. In fact,
such information may only be accurately retrieved through the implementation of
increasingly complex mass spectrometry (MS)‐based methods. However, the majority of glycan‐directed analytical techniques, including MS‐based workflows, require
analyte extraction from the target tissue, which, in turn, leads to the loss of information on glycan spatial distribution and tissue histopathological architecture.
years ago has supported the generation of a virtually
binding
6.3 Imaging Mass Spectrometry
The recent development and maturation of imaging mass spectrometry (IMS) technology has significantly contributed to the circumvention of such technical limitations since it does not rely on target‐specific reagents but rather on direct molecular
measurements[22]. Indeed, this technique has been used to directly characterize
the N‐glycosylation profile of neoplastic tissue sections by generating two‐ and

three‐dimensional (3D) molecular maps of hundreds of distinct glycan species
across a wide mass range while also providing information on analyte relative abundance and on‐tissue spatial distribution, which can be directly linked to the histopathological data from the same clinical specimen [22–29]. The IMS technology
provides the mass accuracy and chemical specificity of MS‐based detection and supports further on‐tissue tandem MS fragmentation (e.g. collision‐induced fragmentation) to achieve exact structure identification while still preserving the spatial
distribution of individual analytes and the histopathological landscape of the target
tissue. The implementation of IMS workflows in the cancer research field is of particular relevance since most clinically approved cancer biomarkers are either glycoproteins or carbohydrate antigens.
The typical IMS glycomic workflow requires the total release of asparagine‐linked
N‐glycans through the surface digestion of the target tissue section with Peptide‐N‐
glycosidase F (PNGase F), an endoglycosidase that efficiently hydrolyzes the amide
bond linking the innermost N‐acetylglucosamine (GlcNAc) of the N‐glycan core to
the asparagine’s side chain of the protein’s peptidic backbone, and the subsequent
MS‐based identification and relative quantification of the released carbohydrate
species. Possible additives in the enzyme’s storage buffer, including glycerol or
detergents, may cause ion suppression during the ionization process, which diminishes the quality of the retrieved spectra[30, 31]. IMS‐based analysis of biological
samples can be performed using one of several MS ionization techniques, which
offer complementary capabilities regarding both spatial resolution and the mass
range of the target analytes. The matrix‐assisted laser desorption/ionization
(MALDI)‐IMS has become increasingly popular in the analysis of glycans due to its
high sensitivity and wide mass range. The preparation of tissue sections involves the
automated and uniform coating of the target sample with an energy‐absorbing
matrix for efficient and homogeneous analyte ionization. Conveniently, IMS workflows are compatible with on‐tissue sialic acid (Neu5Ac) chemical derivatization,
which allows for linkage‐specific discrimination of sialylated glycan species, and
with positive glycan labeling, which significantly improves signal‐to‐noise ratios
[29, 32]. Generated molecular maps of analyte spatial distribution and relative
abundance can then be overlapped with brightfield optical images, such as the corresponding hematoxylin/eosin (H&E) staining of the same tissue section. The
obtained structural and semiquantitative data can then be allocated to well‐defined
histological regions (e.g. nontransformed adjacent mucosa, immune infiltrate,
necrosis, and tumor regions) based on a pathologist’s annotation, making the IMS
technology particularly valuable in the study of solid tumors. Furthermore, subsequent off‐tissue extraction and MS‐based fragmentation of released N‐glycan species allow for unequivocal structural identification. Typically, the MALDI‐IMS
analysis of one cancer tissue section allows the reliable detection of 40–60 distinct
glycan structures[33].
This methodology is highly versatile, and its robustness has been validated across
various types of clinical samples, including formalin‐fixed paraffin‐embedded
(FFPE) tissue blocks and fresh frozen tissue specimens[23, 24, 34–36]. The incorporation of multiple individual FFPE tissue specimens in the tissue microarray (TMA)
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