Department of Neurosurgery and Pediatrics, Duke University Medical Center, Durham, NC, USA.
J Neurooncol. 2014 Jan;116(1):89-97. doi: 10.1007/s11060-013-1283-3. Epub 2013 Oct 27.
Glioblastoma (GBM) is the most common brain cancer and is highly lethal in both adults and children. 2-methoxyestradiol (2ME2) is a microtubule inhibitor that potently inhibits HIF1α, GBM angiogenesis and tumor growth in preclinical models. In patients, 2ME2 exhibits low toxicity and promising but inconsistent efficacy. Given its preclinical potency and its tolerability in patients, we sought to determine whether 2ME2 therapy could be enhanced by addressing resistance via combination therapy, and with biomarkers to identify responsive glioma subgroups. We demonstrate that the PTEN-PI3K axis regulates HIF1α in glioma models. We utilized isogenic-pairs of glioma cell lines, deficient in PTEN or stably reconstituted with PTEN, to determine the role of PTEN in 2ME2 sensitivity in vitro and in vivo. Chou-Talalay synergy studies reveal significant synergy when a pan-PI3K inhibitor is combined with 2ME2. This synergistic activity was correlated with a synergistic suppression of HIF1α accumulation under hypoxic conditions in glioma models. In vivo, 2ME2 markedly inhibited tumor-induced angiogenesis and significantly reduced tumor growth only in a PTEN reconstituted GBM models in both subcutaneous and orthotopic intracranial mouse models. Collectively, these results: (1) suggest that PTEN status predicts sensitivity to 2ME2 and (2) justify exploration of 2ME2 combined with pan-PI3K inhibitors for the treatment of this intractable brain cancer.
胶质母细胞瘤(GBM)是最常见的脑癌,在成人和儿童中均具有高度致命性。2-甲氧基雌二醇(2ME2)是一种微管抑制剂,能强烈抑制 HIF1α、GBM 血管生成和肿瘤生长,在临床前模型中。在患者中,2ME2 表现出低毒性和有前途但不一致的疗效。鉴于其临床前效力及其在患者中的耐受性,我们试图确定通过联合治疗和生物标志物来解决耐药性是否可以增强 2ME2 治疗,以确定有反应性的神经胶质瘤亚组。我们证明,PTEN-PI3K 轴在神经胶质瘤模型中调节 HIF1α。我们利用 PTEN 缺失或稳定重建 PTEN 的神经胶质瘤细胞系同系物,以确定 PTEN 在体外和体内 2ME2 敏感性中的作用。Chou-Talalay 协同研究揭示,当使用泛 PI3K 抑制剂与 2ME2 联合使用时,会产生显著的协同作用。这种协同活性与在神经胶质瘤模型中缺氧条件下 HIF1α积累的协同抑制作用相关。在体内,2ME2 显著抑制肿瘤诱导的血管生成,并仅在 PTEN 重建的 GBM 模型中,无论是在皮下还是原位颅内小鼠模型中,均显著减少肿瘤生长。总之,这些结果:(1)表明 PTEN 状态预测对 2ME2 的敏感性;(2)证明了探索 2ME2 与泛 PI3K 抑制剂联合用于治疗这种难治性脑癌的合理性。