Jousma Edwin, Rizvi Tilat A, Wu Jianqiang, Janhofer David, Dombi Eva, Dunn Richard S, Kim Mi-Ok, Masters Andrea R, Jones David R, Cripe Timothy P, Ratner Nancy
Division of Experimental Hematology and Cancer Biology, Children's Hospital Medical Center, Cincinnati, Ohio.
Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland.
Pediatr Blood Cancer. 2015 Oct;62(10):1709-16. doi: 10.1002/pbc.25546. Epub 2015 Apr 22.
Neurofibromatosis type 1 (NF1) is a genetic disorder that predisposes affected individuals to formation of benign neurofibromas, peripheral nerve tumors that can be associated with significant morbidity. Loss of the NF1 Ras-GAP protein causes increased Ras-GTP, and we previously found that inhibiting MEK signaling downstream of Ras can shrink established neurofibromas in a genetically engineered murine model.
We studied effects of MEK inhibition using 1.5 mg/kg/day PD-0325901 prior to neurofibroma onset in the Nf1 (flox/flox); Dhh-Cre mouse model. We also treated mice with established tumors at 0.5 and 1.5 mg/kg/day doses of PD-0325901. We monitored tumor volumes using MRI and volumetric measurements, and measured pharmacokinetic and pharmacodynamic endpoints.
Early administration significantly delayed neurofibroma development as compared to vehicle controls. When treatment was discontinued neurofibromas grew, but no rebound effect was observed and neurofibromas remained significantly smaller than controls. Low dose treatment of mice with PD-0325901 resulted in neurofibroma shrinkage equivalent to that observed at higher doses. Tumor cell proliferation decreased, although less than at higher doses with drug. Tumor blood vessels per area correlated with tumor shrinkage.
Neurofibroma development was not prevented by MEK inhibition, beginning at 1 month of age, but tumor size was controlled by early treatment. Moreover, treatment with PD-0325901 at very low doses may shrink neurofibromas while minimizing toxicity. These studies highlight how genetically engineered mouse models can guide clinical trial design.
1型神经纤维瘤病(NF1)是一种遗传性疾病,使受影响个体易患良性神经纤维瘤,这种周围神经肿瘤可能伴有严重的发病率。NF1 Ras-GAP蛋白的缺失导致Ras-GTP增加,我们之前发现,在基因工程小鼠模型中,抑制Ras下游的MEK信号传导可使已形成的神经纤维瘤缩小。
我们在Nf1(flox/flox);Dhh-Cre小鼠模型中,于神经纤维瘤发病前使用1.5 mg/kg/天的PD-0325901研究MEK抑制的效果。我们还用0.5和1.5 mg/kg/天剂量的PD-0325901治疗患有已形成肿瘤的小鼠。我们使用MRI和体积测量监测肿瘤体积,并测量药代动力学和药效学终点。
与载体对照相比,早期给药显著延迟了神经纤维瘤的发展。当停止治疗时,神经纤维瘤生长,但未观察到反弹效应,且神经纤维瘤仍明显小于对照。用PD-0325901低剂量治疗小鼠导致神经纤维瘤缩小,与高剂量时观察到的情况相当。肿瘤细胞增殖减少,尽管比高剂量用药时少。每单位面积的肿瘤血管与肿瘤缩小相关。
从1月龄开始的MEK抑制并不能预防神经纤维瘤的发展,但早期治疗可控制肿瘤大小。此外,极低剂量的PD-0325901治疗可能使神经纤维瘤缩小,同时将毒性降至最低。这些研究突出了基因工程小鼠模型如何指导临床试验设计。