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西地尼布通过下调 BRCA1/2 和 RAD51 来抑制同源定向 DNA 修复。

Cediranib suppresses homology-directed DNA repair through down-regulation of BRCA1/2 and RAD51.

机构信息

Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT 06511, USA.

Department of Pathology, Yale University School of Medicine, New Haven, CT 06511, USA.

出版信息

Sci Transl Med. 2019 May 15;11(492). doi: 10.1126/scitranslmed.aav4508.

Abstract

Combining the anti-angiogenic agent cediranib with the poly(ADP-ribose) polymerase (PARP) inhibitor olaparib improves progression-free survival compared to olaparib alone in ovarian cancer patients through an unknown mechanism. PARP inhibitors are used primarily in the treatment of patients with DNA repair-associated (BRCA1/2) mutated cancers because these mutations cause a deficit in homology-directed DNA repair (HDR) that confers sensitivity to these agents. However, the combination of cediranib and olaparib was effective in patients without BRCA1/2 mutations. We report here that cediranib confers sensitivity to olaparib by down-regulating HDR in tumor cells. This occurs partially as a result of cediranib inducing hypoxia, which suppresses expression of the HDR factors BRCA1/2 and RAD51 recombinase (RAD51). However, we also observed that cediranib has a direct effect on HDR independent of its ability to induce tumor hypoxia. This direct effect occurs through platelet-derived growth factor receptor (PDGFR) inhibition, activation of protein phosphatase 2A (PP2A), and E2F transcription factor 4 (E2F4)/RB transcriptional corepressor like 2 (RB2/p130)-mediated repression of and gene expression. This down-regulation was seen in mouse tumor xenografts but not in mouse bone marrow, providing a therapeutic window for combining cediranib and olaparib in cancer therapy. Our work reveals a treatment strategy by which DNA repair can be manipulated in human tumors to induce synthetic lethality, broadening the potential therapeutic scope of cediranib based on its activity as a DNA repair inhibitor.

摘要

联合抗血管生成药物西地尼布(cediranib)与聚(ADP-核糖)聚合酶(PARP)抑制剂奥拉帕利(olaparib)可改善卵巢癌患者的无进展生存期,优于单独使用奥拉帕利,其作用机制尚不清楚。PARP 抑制剂主要用于治疗具有 DNA 修复相关(BRCA1/2)突变的癌症患者,因为这些突变导致同源定向 DNA 修复(HDR)缺陷,从而使这些药物具有敏感性。然而,西地尼布与奥拉帕利联合治疗对无 BRCA1/2 突变的患者有效。我们在此报告,西地尼布通过下调肿瘤细胞中的 HDR 而赋予奥拉帕利敏感性。这部分是由于西地尼布诱导缺氧,从而抑制 HDR 因子 BRCA1/2 和 RAD51 重组酶(RAD51)的表达。然而,我们还观察到西地尼布对 HDR 具有直接作用,而与其诱导肿瘤缺氧的能力无关。这种直接作用通过血小板衍生生长因子受体(PDGFR)抑制、蛋白磷酸酶 2A(PP2A)的激活以及 E2F 转录因子 4(E2F4)/RB 转录核心抑制因子样 2(RB2/p130)介导的和基因表达的抑制来实现。这种下调在小鼠肿瘤异种移植物中可见,但在小鼠骨髓中不可见,为西地尼布和奥拉帕利联合用于癌症治疗提供了治疗窗口。我们的工作揭示了一种治疗策略,通过该策略可以在人类肿瘤中操纵 DNA 修复以诱导合成致死性,从而扩大了基于西地尼布作为 DNA 修复抑制剂的活性的潜在治疗范围。

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