Department of Neurological Surgery, and.
Northwestern Medicine Malnati Brain Tumor Institute, Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
J Clin Invest. 2023 Dec 15;133(24):e161142. doi: 10.1172/JCI161142.
A paucity of chemotherapeutic options for metastatic brain cancer limits patient survival and portends poor clinical outcomes. Using a CNS small-molecule inhibitor library of 320 agents known to be blood-brain barrier permeable and approved by the FDA, we interrogated breast cancer brain metastasis vulnerabilities to identify an effective agent. Metixene, an antiparkinsonian drug, was identified as a top therapeutic agent that was capable of decreasing cellular viability and inducing cell death across different metastatic breast cancer subtypes. This agent significantly reduced mammary tumor size in orthotopic xenograft assays and improved survival in an intracardiac model of multiorgan site metastases. Metixene further extended survival in mice bearing intracranial xenografts and in an intracarotid mouse model of multiple brain metastases. Functional analysis revealed that metixene induced incomplete autophagy through N-Myc downstream regulated 1 (NDRG1) phosphorylation, thereby leading to caspase-mediated apoptosis in both primary and brain-metastatic cells, regardless of cancer subtype or origin. CRISPR/Cas9 KO of NDRG1 led to autophagy completion and reversal of the metixene apoptotic effect. Metixene is a promising therapeutic agent against metastatic brain cancer, with minimal reported side effects in humans, which merits consideration for clinical translation.
转移性脑癌的化疗选择有限,限制了患者的生存并预示着不良的临床结局。我们使用了 320 种已知可穿透血脑屏障并获得 FDA 批准的中枢神经系统小分子抑制剂库,对乳腺癌脑转移的脆弱性进行了研究,以确定有效的药物。美替嗪,一种抗帕金森病药物,被确定为一种顶级治疗药物,能够降低不同转移性乳腺癌亚型的细胞活力并诱导细胞死亡。该药物在原位异种移植模型中显著减小了乳腺肿瘤的大小,并在心脏内多器官转移模型中提高了存活率。美替嗪进一步延长了颅内异种移植模型和颈动脉内多发性脑转移模型中小鼠的存活期。功能分析表明,美替嗪通过 N-Myc 下游调节因子 1(NDRG1)磷酸化诱导不完全自噬,从而导致原发和脑转移细胞中的 caspase 介导的细胞凋亡,无论癌症亚型或起源如何。CRISPR/Cas9 敲除 NDRG1 导致自噬完成并逆转美替嗪的凋亡作用。美替嗪是一种有前途的治疗转移性脑癌的药物,在人类中报告的副作用最小,值得考虑进行临床转化。
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