Visualizing the antivascular effect of bortezomib on the hypoxic tumor microenvironment

Assessment of Early Response to Lung Cancer Chemotherapy by Semiquantitative Analysis of Dynamic Contrast-Enhanced MRI

Objective

To evaluate the early chemotherapy response in patients with lung cancer using semiquantitative analysis of dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI).

Methods

Twenty-two patients with lung cancer treated with chemotherapy were subjected to DCE-MRI at two time points: before starting treatment and after one week of therapy. The image data were collected by DCE-MRI, and the semiquantitative parameters including positive enhancement integral (PEI), signal enhancement ratio (SER), maximum slope of increase (MSI), and time to peak (TTP) were calculated. After chemotherapy, the parameters and relevant variations between the responders and nonresponders were compared with Mann–Whitney U tests. Student's t-test for paired samples was used to evaluate the temporal changes between pre- and posttreatment images.

Results

The patients were categorized as 13 responders and 9 nonresponders based on the tumor response evaluation. After chemotherapy, the PEI, SER, and MSI were significantly increased in responders compared with the pretreatment values (P < 0.05), while no obvious decrease in TTP was observed (P > 0.05). However, 9 nonresponders showed no significant changes in PEI, SER, MSI, and TTP values, as compared with those of pretreatment (P > 0.05). Moreover, the increase of PEI was more dramatically in responders than in nonresponders (P < 0.05), but no significantly differences were observed in SER, MSI, and TTP (P > 0.05).

Conclusion

Semiquantitative analysis of DCE-MRI could provide a reliable noninvasive method for assessing early chemotherapy response in lung cancer patients.

The transcriptomic responses of blunt snout bream (Megalobrama amblycephala) to acute hypoxia stress alone, and in combination with bortezomib

BACKGROUND

Blunt snout bream (Megalobrama amblycephala) is sensitive to hypoxia. A new blunt snout bream strain, "Pujiang No.2", was developed to overcome this shortcoming. As a proteasome inhibitor, bortezomib (PS-341) has been shown to affect the adaptation of cells to a hypoxic environment. In the present study, bortezomib was used to explore the hypoxia adaptation mechanism of "Pujiang No.2". We examined how acute hypoxia alone (hypoxia-treated, HN: 1.0 mg·L^- 1), and in combination with bortezomib (hypoxia-bortezomib-treated, HB: Use 1 mg bortezomib for 1 kg fish), impacted the hepatic ultrastructure and transcriptome expression compared to control fish (normoxia-treated, NN).

RESULTS

Hypoxia tolerance was significantly decreased in the bortezomib-treated group (LOE_crit, loss of equilibrium, 1.11 mg·L^- 1 and 1.32 mg·L^- 1) compared to the control group (LOE_crit, 0.73 mg·L^- 1 and 0.85 mg·L^- 1). The HB group had more severe liver injury than the HN group. Specifically, the activities of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in the HB group (52.16 U/gprot, 32 U/gprot) were significantly (p < 0.01) higher than those in the HN group (32.85 U/gprot, 21. 68 U/gprot). In addition, more severe liver damage such as vacuoles, nuclear atrophy, and nuclear lysis were observed in the HB group. RNA-seq was performed on livers from the HN, HB and NN groups. KEGG pathway analysis disclosed that many DEGs (differently expressed genes) were enriched in the HIF-1, FOXO, MAPK, PI3K-Akt and AMPK signaling pathway and their downstream.

CONCLUSION

We explored the adaptation mechanism of "Pujiang No.2" to hypoxia stress by using bortezomib, and combined with transcriptome analysis, accurately captured the genes related to hypoxia tolerance advantage.

Does the proteasome inhibitor bortezomib sensitize to DNA-damaging therapy in gastroenteropancreatic neuroendocrine neoplasms? - A preclinical assessment in vitro and in vivo

BACKGROUND

Well-differentiated gastroenteropancreatic neuroendocrine neoplasms are rare tumors with a slow proliferation. They are virtually resistant to many DNA-damaging therapeutic approaches, such as chemo- and external beam therapy, which might be overcome by DNA damage inhibition induced by proteasome inhibitors such as bortezomib.

METHODS AND RESULTS

In this study, we assessed several combined treatment modalities in vitro and in vivo. By cell-based functional analyses, in a 3D in ovo and an orthotopic mouse model, we demonstrated sensitizing effects of bortezomib combined with cisplatin, radiation and peptide receptor radionuclide therapy (PRRT). By gene expression profiling and western blot, we explored the underlying mechanisms, which resulted in an impaired DNA damage repair. Therapy-induced DNA damage triggered extrinsic proapoptotic signaling as well as the induction of cell cycle arrest, leading to a decreased vital tumor volume and altered tissue composition shown by magnetic resonance imaging and F-18-FDG-PET in vivo, however with no significant additional benefit related to PRRT alone.

CONCLUSIONS

We demonstrated that bortezomib has short-term sensitizing effects when combined with DNA damaging therapy by interfering with DNA repair in vitro and in ovo. Nevertheless, due to high tumor heterogeneity after PRRT in long-term observations, we were not able to prove a therapeutic advantage of bortezomib-combined PRRT in an in vivo mouse model.

Oxygen-Enhanced Optoacoustic Tomography Reveals the Effectiveness of Targeting Heme and Oxidative Phosphorylation at Normalizing Tumor Vascular Oxygenation

Multispectral optoacoustic tomography (MSOT) is an emerging noninvasive imaging modality that can detect real-time dynamic information about the tumor microenvironment in humans and animals. Oxygen enhanced (OE)-MSOT can monitor tumor vasculature and oxygenation during disease development or therapy. Here, we used MSOT and OE-MSOT to examine in mice the response of human non-small cell lung cancer (NSCLC) xenografts to a new class of antitumor drugs, heme-targeting agents heme-sequestering peptide 2 (HSP2) and cyclopamine tartrate (CycT). HSP2 inhibits heme uptake, while CycT inhibits heme synthesis in NSCLC cells, where heme is essential for ATP generation via oxidative phosphorylation. HSP2 and CycT can inhibit ATP generation and thereby suppress NSCLC cell tumorigenic functions. MSOT showed that treatment of NSCLC tumors with HSP2 or CycT reduced total hemoglobin, increased oxygen saturation, and enhanced the amplitude of response to oxygen gas breathing challenge. HSP2 and CycT normalized tumor vasculature and improved tumor oxygenation, where levels of several hypoxia markers in NSCLC tumors were reduced by treatment with HSP2 or CycT. Furthermore, treatment with HSP2 or CycT reduced levels of angiogenic factor VEGFA, its receptor VEGFR1, and vascular marker CD34. Together, our data show that heme-targeting drugs HSP2 and CycT elicit multiple tumor-suppressing functions, such as inhibiting angiogenic function, normalizing tumor vasculature, alleviating tumor hypoxia, and inhibiting oxygen consumption and ATP generation. SIGNIFICANCE: Heme-targeting agents HSP2 and CycT effectively normalize tumor vasculature and alleviate tumor hypoxia, raising the possibility of their combination with chemo-, radio-, and immunotherapies to improve antitumor efficacy.See related commentary by Tomaszewski, p. 3461.

Cyclopamine tartrate, a modulator of hedgehog signaling and mitochondrial respiration, effectively arrests lung tumor growth and progression

Lung cancer remains the leading cause of cancer-related death, despite the advent of targeted therapies and immunotherapies. Therefore, it is crucial to identify novel molecular features unique to lung tumors. Here, we show that cyclopamine tartrate (CycT) strongly suppresses the growth of subcutaneously implanted non-small cell lung cancer (NSCLC) xenografts and nearly eradicated orthotopically implanted NSCLC xenografts. CycT reduces heme synthesis and degradation in NSCLC cells and suppresses oxygen consumption in purified mitochondria. In orthotopic tumors, CycT decreases the levels of proteins and enzymes crucial for heme synthesis, uptake, and oxidative phosphorylation (OXPHOS). CycT also decreases the levels of two regulators promoting OXPHOS, MYC and MCL1, and effectively alleviates tumor hypoxia. Evidently, CycT acts via multiple modes to suppress OXPHOS. One mode is to directly inhibit mitochondrial respiration/OXPHOS. Another mode is to inhibit heme synthesis and degradation. Both modes appear to be independent of hedgehog signaling. Addition of heme to NSCLC cells partially reverses the effect of CycT on oxygen consumption, proliferation, and tumorigenic functions. Together, our results strongly suggest that CycT suppress tumor growth in the lung by inhibiting heme metabolism and OXPHOS. Targeting heme metabolism and OXPHOS may be an effective strategy to combat lung cancer.

Dynamic contrast-enhanced magnetic resonance imaging for pretreatment prediction of early chemo-radiotherapy response in larynx and hypopharynx carcinoma

Purpose

This study is to investigate the use of dynamic contrast-enhanced magnetic resonance imaging in predicting early response to CRT (chemo-radiotherapy) in patients with larynx and hypopharynx carcinoma from primary tumors.

Method

Sixty-two patients with larynx and hypopharynx carcinoma underwent two DCE-MRI studies: a baseline exam before any treatmentanda post-treatment exam 3 weeks after CRT. At the end of treatment, patients were classified as responders, or non-responders according to the Response Evaluation Criteria in Solid Tumors criteria (RECIST). The time intensity curves (TIC) were extracted and processed to obtain time to peak (TTP), maximum slope of increase (MSI), maximum slope of decrease (MSD) and positive enhancement integral (PEI), and the semi-quantitative MRI parameters were compared and analyzed between the two groups.

Results

Fifty-four and 8 patients were included the responder and non-responder groups. It was observed that the MSI, MSD, and PEI were significantly lower post-treatment than pre-treatment(P < 0.05). The pretreatment MSI, MSD, and PEI parameters of responders were significantly higher than those of non-responders (P< 0.05). The post-treatment MSI, MSD, and PEI parameters of responders were significantly lower than those of non-responders (P< 0.05). Based on ROC curve analysis, at a threshold of 154.81 for pretreatment MSI, the corresponding AUC, sensitivity, and specificity were 0.882, 89.3% and 73.5%, respectively.

Conclusion

The semi-quantitative DCE-MRI may aid in the prediction of early response to CRT in patients with larynx and hypopharynx carcinoma.

Bortezomib-resistance is associated with increased levels of proteasome subunits and apoptosis-avoidance

Bortezomib (BTZ), a proteasome inhibitor, is the first proteasome inhibitor to be used in clinical practice. Here we investigated the mechanisms underlying acquired bortezomib resistance in hepatocellular carcinoma (HCC) cells. Using stepwise selection, we established two acquired bortezomib-resistant HCC cell lines, a bortezomib-resistant HepG2 cell line (HepG2/BTZ) and bortezomib-resistant HuH7 cell line (HuH7/BTZ). The 50% inhibitory concentration values of HepG2/BTZ and HuH7/BTZ were respectively 15- and 39-fold higher than those of parental cell lines. Sequence analysis of the bortezomib-binding pocket in the β5-subunit showed no mutation. However, bortezomib-resistant HCC cells had increased expression of β1 and β5 proteasome subunits. These alterations of proteasome expression were accompanied by a weak degree of proteasome inhibition in bortezomib-resistant cells than that in wild-type cells after bortezomib exposure. Furthermore, bortezomib-resistant HCC cells acquired resistance to apoptosis. Bortezomib up-regulated pro-apoptotic proteins of the Bcl-2 protein family, Bax and Noxa in wild-type HCC cells. However, in bortezomib-resistant HCC cells, resistance to apoptosis was accompanied by loss of the ability to stabilize and accumulate these proteins. Thus, increased expression and increased activity of proteasomes constitute an adaptive and auto regulatory feedback mechanism to allow cells to survive exposure bortezomib.