Featured Post from ChristianaCare

Researchers Discover That Cancer Stem Cell Populations in Colorectal Cancers Are Diverse, Not Uniform

Apr 4, 2023

4 min

Discovery may lead to more precise treatments for advanced colorectal cancer


Researchers at ChristianaCare’s Cawley Center for Translational Cancer Research at the Helen F. Graham Cancer Center & Research Institute have demonstrated for the first time that microRNA (miRNA) expression leads to a diversity of cancer stem cells within a colorectal cancer tumor. This diversity of cancer cells may explain why advanced colorectal cancer is difficult to treat. Study results have been in the Journal of Stem Cell Research and Therapy.


The findings broaden the understanding of how miRNA expression adds to cancer stem cell diversity and may lead to more precise anti-cancer treatments for patients with advanced colorectal cancer. The research builds on prior discoveries by scientists at the Graham Cancer Center about how cancer stem cell activity contributes to the development and spread of colorectal cancer.


“Our research shows — at least in the laboratory — that there are different subpopulations of cancer stem cells in a tumor, and they may be driving the growth of the cancer,” said Principal Investigator Bruce Boman, M.D., Ph.D., MSPH, FACP, medical director of Cancer Genetics and Stem Cell Biology at the Graham Cancer Center. “In one subpopulation of cancer stem cells, its miRNA will shut down the stem cell genes that are expressed in another subpopulation, and vice versa, within the same tumor.”


From left: ChristianaCare researchers Lynn Opdenaker, Ph.D., Brian Osmond, Bruce Boman, M.D., Ph.D., Chi Zhang, Victoria Hunsu, Caroline Facey, Ph.D. Not pictured Victoria Stark, MS.


The study focused on the composition of cancer stem cells within a colorectal cancer cell line (HT29) in the laboratory setting. Researchers evaluated the different cancer stem cell subpopulations that were identified by examining patterns of miRNA expression in each subpopulation and looking for differences. The researchers found that each of the four diverse subpopulations that were studied (ALDH, LRIG1, CD166 and LGR5) had a different miRNA expression or gene signature.


The researchers found that miRNA expression could inhibit the expression of messenger RNA (mRNA), which carries instructions from the DNA to encode specific proteins within cells. Therefore, miRNA, by controlling gene expression, dictate which proteins are contained in the stem cells. The researchers discovered the miRNA that are upregulated in certain cancer stem cell subpopulations are downregulated in other cancer stem cell subpopulations. In this way, differential miRNA expression leads to cancer stem cell heterogeneity within colorectal tumor tissue.


“It’s an early research finding and needs to be followed up with other experiments, but it has clear relevance to the clinic,” Boman said. “The question is: Can you target the miRNA to make cancer more sensitive to certain treatments? Because we know what the current anti-cancer treatments are targeting, we may be able to modulate or manipulate the cancer, so it becomes more sensitive to the treatment.”


Identification of a network of genes regulated by microRNAs in a cancer stem cell subpopulation.



For more than a decade, ChristianaCare’s researchers have contributed to the understanding of the role that cancer stem cells and miRNA expression play in the development and spread of colorectal cancer. This latest finding builds on earlier discoveries that examined a link between two cellular signaling pathways: retinoic acid (RA) signaling and wingless-related integration site (WNT) signaling, which are dysregulated by different gene mutations in colorectal tumors.


The RA signaling pathway induces growth arrest and differentiation of cancer stem cells. Notably, retinoic acid is effective against other types of cancer such as leukemia. The role of the WNT signaling pathway has an opposite effect on tumor growth. The WNT signaling pathway is activated by a mutation in the APC (adenomatous polyposis coli) gene in about 90% of cases of colorectal cancer. In APC mutant tissue, dysregulated miRNA expression may underlie an imbalance between the RA and WNT signaling, which then leads to intratumoral cancer stem cell heterogeneity. Still, this mechanism that may enable the cancer to proliferate could also provide clues on how to more effectively treat cancer.


“If you’ve got an imbalance between these two signaling pathways, then you’ve likely got a growth driver,” Boman said. “The question is: Can you suppress the WNT signaling and enhance the retinoic acid signaling?”


It may be possible to increase the sensitivity of colorectal cancer to retinoic acid-type drugs, and therapeutically shift the balance between different cancer stem cell subpopulations, thereby suppressing cancer growth. More research is needed to determine how targeted cancer therapies containing retinoic acid-type drugs may be made more effective against advanced cancer.


This research will be presented at the annual meeting of the American Association for Cancer Research in Orlando, Florida, April 14-19.


This research project was supported by a grant from the Lisa Dean Moseley Foundation.

Powered by

You might also like...

Check out some other posts from ChristianaCare

ChristianaCare Expands Access to Physical Therapy With New In Home Collaboration With Luna featured image

3 min

ChristianaCare Expands Access to Physical Therapy With New In Home Collaboration With Luna

ChristianaCare is joining forces with Luna, the leading provider of in home, in person outpatient physical therapy, to expand access to care by bringing hands on physical therapy directly into patients’ homes. The new service, ChristianaCare Physical Therapy At Home, Powered by Luna, will begin taking appointments in June. The collaboration is designed to reduce barriers to care, support strong recovery outcomes and give patients a convenient way to begin physical therapy. Care Delivered Where Patients Need It Most Unlike remote or virtual therapy, the service will provide one on one, hands on care delivered by licensed physical therapists in the convenience of a patient’s home or office. Through Luna’s platform, patients can request care and are matched with a licensed physical therapist who delivers 45 to 55 minute in home sessions and continues in person care throughout the patient’s treatment plan. “Our collaboration with Luna reflects a simple belief: if we can safely deliver high quality care in the home, we should make that option available,” said Jennifer Thomas, MBA, MS, vice president, Rehabilitation Services at ChristianaCare. “By meeting patients where they are, we remove common barriers to care and help people stay engaged in their recovery, regain independence and remain connected to daily life.” Designed to Help More Patients Get Started Too many people who are referred to physical therapy never take the first step. Research on patients referred to physical therapy has found that only about 50% to 76% attend an initial appointment. Travel challenges, scheduling conflicts and difficulty accessing care can all get in the way. ChristianaCare Physical Therapy At Home, Powered by Luna, is designed to make it easier for patients to begin care without delay by bringing licensed physical therapists directly to them and offering scheduling that fits into daily life. “Our focus is on timely access and helping patients get started,” Thomas said. “When care is easier to access and fits into a person’s routine, it is much more likely they will begin treatment. From there, our care teams support patients through a plan that is tailored to their needs and focused on meaningful recovery.” Different From Home Health Care ChristianaCare Physical Therapy At Home, Powered by Luna, follows an outpatient care model, not home health care. Patients do not need to be homebound to receive services. The program focuses on improving strength, balance and movement and is typically covered under Medicare Part B. This differs from home health care, which serves homebound patients who need short term medical services and is usually covered under Medicare Part A. ChristianaCare Physical Therapy At Home, Powered by Luna, can address many of the conditions commonly treated by ChristianaCare Rehabilitation Services, including orthopedic and sports injuries, post surgical rehabilitation, geriatric care, vestibular therapy, women’s health and lymphedema. Experienced Partner With Broad Clinical Expertise Luna has extensive experience delivering in home outpatient physical therapy and partners with health systems nationwide. “We are proud to work with ChristianaCare to expand access to high quality physical therapy in the home,” said Lily Beltran, co-founder and President at Luna. “Our shared focus is on removing barriers to care and delivering consistent, hands on therapy that helps patients recover, stay engaged and achieve their goals.” The service is covered by most major insurance plans, including Medicare, with the same co pay as facility based physical therapy. Patients can request in home care by calling ChristianaCare Rehab Services’ access center at 302-623-1500. ChristianaCare Physical Therapy At Home, Powered by Luna is a service offering of ChristianaCare Rehabilitation Services, which provides comprehensive, patient centered rehabilitation care across a wide range of settings, including outpatient clinics, inpatient facilities, community locations and now in the home.

ChristianaCare Advances New Health Campus in Camden, Delaware to Close Care Gaps featured image

3 min

ChristianaCare Advances New Health Campus in Camden, Delaware to Close Care Gaps

ChristianaCare has taken another major step to expand access to high quality care across Delaware by submitting a Notice of Intent to the Delaware Health Resources Board to develop a new health campus in Camden. Like the Georgetown campus announced in February, the proposed campus will include a health center and a neighborhood hospital and is part of the $865 million statewide commitment announced last July. “For many people in central Delaware, getting timely emergency or specialty care can still mean long drives or long waits,” said Janice E. Nevin, M.D., MPH, president and CEO of ChristianaCare. “We are investing in facilities that bring care closer to where people live. This campus reflects our commitment to ensuring every Delawarean, no matter their ZIP code, can count on timely, compassionate, high-quality care close to home.” Closing Care Gaps in Central and Southern Delaware The approximately 38,000‑square‑foot Camden campus will be located on the west side of Route 13, just south of Lochmeath Way. It is expected to open in late 2028 or early 2029 and will bring primary care, specialty care and outpatient services together in one location, supported by eight emergency department beds and eight inpatient beds. The project will create 83 new jobs for the community, including 60 positions at the neighborhood hospital and 23 at the health center. Kent and Sussex counties are both designated as Medically Underserved Areas by the Health Resources and Services Administration. At the same time, the region is growing quickly. By 2030, the population in central and southern Delaware is expected to increase by 8 percent, with residents aged 65 and older growing even faster, by 22 percent. Shortages in primary care, behavioral health and specialty services have forced many residents to travel long distances for care. The Camden campus will help change that by bringing essential services closer to home. Expanding Capacity on a Strong Foundation The Camden campus represents a $58.1 million investment and reflects ChristianaCare’s focus on access, coordination and community need. ChristianaCare already provides a broad range of services in Kent County, including primary care, specialty care, behavioral health, rehabilitation, home health, hospice and virtual care. The Camden campus will build on this foundation by increasing capacity and making care more convenient as demand grows. Partnering to Deliver Care Close to Home ChristianaCare is partnering with Emerus Holdings, Inc. on the neighborhood hospital component. Emerus is the nation’s leading developer of this model, with 49 acute care facilities across the country. “Communities are stronger when people can depend on care close to home,” said Vic Schmerbeck, CEO of Emerus Holdings, Inc. “We are proud to partner with ChristianaCare to deliver a neighborhood hospital that provides high quality care in a setting designed around the needs of the community.” Growing Access Across the Region The ChristianaCare Georgetown campus is planned for 20769 DuPont Boulevard at an estimated cost of $65.1 million. ChristianaCare is also expanding this innovative care model beyond Delaware. In July 2025, the system opened a neighborhood hospital at its West Grove Campus in southern Chester County, Pennsylvania. Additional campuses are planned in Springfield and Aston in Delaware County, Pennsylvania.

ChristianaCare Forms Joint Venture For Cardiovascular Ambulatory Surgery Center featured image

4 min

ChristianaCare Forms Joint Venture For Cardiovascular Ambulatory Surgery Center

ChristianaCare, Cardiovascular Physicians of Delaware and its partner organization, US Health Partners, have formed a joint venture to establish a new cardiovascular ambulatory surgery center in Newark. This new facility will be launched through the ChristianaCare Atlas ASC partnership. This is a pivotal moment showcasing the power of a local health system, strength of a national ASC management company, and expert community-based physicians working together to deliver a lower cost, easy-to-access model of care to our community. “The ChristianaCare Cardiovascular Surgery Center at Newark represents a deep partnership between ChristianaCare and community cardiovascular experts who are truly committed to caring for this region,” said Kert F. Anzilotti, M.D., MBA, chief physician executive and president of The Medical Group at ChristianaCare. “By working side by side with trusted community physicians, we are aligning expertise and decision making to strengthen heart care across the region and ensure it continues to evolve with the needs of the people we serve.” “By expanding access to outpatient heart care, we can reduce wait times, improve the patient experience and lower the overall cost of care—while using our hospital resources more wisely and preserving capacity for patients who need complex or urgent cardiac services,” Anzilotti added. “With over 30 years of providing cardiac care to Delaware residents, we are proud to collaborate on this center,” said Brian Sarter, M.D., president of Cardiovascular Physicians of Delaware. For patients, this is about getting the right care, in the right place, at the right time. Patients will receive specialized heart care in a focused setting designed for same day procedures, with a smoother experience, faster recovery and seamless coordination with hospital care if it’s ever needed.” “This joint venture brings together ChristianaCare and Cardiovascular Physicians of Delaware’s strong clinical leadership and a proven outpatient care model,” said Aaron Snyder, M.D., chief executive officer of US Health Partners. “Our aim is to build and run a center that is efficient, reliable and patient-focused from day one, so physicians can focus on care and patients can count on a high-quality same-day experience close to home.” Reducing the Cost of Heart Care Ambulatory surgery centers lower the cost of heart care by safely moving appropriate procedures out of the hospital and into a more efficient outpatient setting. Most patients return home the same day, while hospitals preserve capacity for complex and urgent cases. As reported in Ambulatory Surgery Center News, outpatient procedures performed in ambulatory surgery centers cost 30 to 40 percent less than the same care delivered in hospitals, improving access and efficiency as demand for heart care continues to grow. The move also frees up limited hospital resources to better care for people with more complex or urgent cardiovascular needs. Meeting a Growing Need for Heart Care Heart disease remains the leading cause of death in Delaware, and demand for cardiovascular care is rising. According to the Delaware Population Consortium, the number of New Castle County residents age 65 and older is projected to increase by 23 percent by 2035, increasing pressure on cardiovascular services. Forecasts show outpatient heart and vascular procedures could reach nearly 10,800 annually for New Castle County residents by 2029 and more than 24,000 across the broader region, according to health care analytics firm Sg2. At the same time, hospital operating room capacity remains limited. Cardiovascular Physicians of Delaware’s many decades of experience in Newark and across the state positioned the group as a natural fit for the collaboration. Focused on Same Day Cardiovascular Care Expected to open in late 2027, the nearly 9,000 square foot center will be located on the second floor of the HealthCare Center at Christiana, across from Christiana Hospital. The center will focus exclusively on outpatient heart and vascular procedures. Services will include diagnostic heart catheterizations, coronary and peripheral vascular interventions, ablation procedures, pacemaker/ implantable defibrillator implantations and other minimally invasive cardiovascular procedures. Hospital based cardiac care will continue to be available for patients who need inpatient treatment, emergency care or more complex services. Other Details The project will cost an estimated $9.3 million and is expected to create 14 full time jobs across clinical, administrative, leadership and support roles. The facility represents an additional investment beyond ChristianaCare’s previously announced $865 million commitment to Delaware, reinforcing the organization’s focus on expanding services and improving health outcomes statewide. Key features of the surgery center include two new cardiac catheterization/ electrophysiology labs, dedicated pre operative and post anesthesia care space and on site sterile processing and administrative areas. Atlas Healthcare Partners will manage and operate the center, while Cardiovascular Physicians of Delaware will provide clinical oversight and perform outpatient surgical cases. ChristianaCare and Atlas Healthcare Partners formed the joint venture in 2024 to build an ambulatory surgery center network across the Mid-Atlantic region.

View all posts
Powered by