Endothelial cell-derived angiopoietin-2 is a therapeutic target in treatment-naive and bevacizumab-resistant glioblastoma

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Alexander Scholz - , University Hospital Frankfurt, Stanford University (Author)
  • Patrick N. Harter - , University Hospital Frankfurt, German Cancer Research Center (DKFZ) (Author)
  • Sebastian Cremer - , University Hospital Frankfurt (Author)
  • Burak H. Yalcin - , University Hospital Frankfurt (Author)
  • Stefanie Gurnik - , University Hospital Frankfurt (Author)
  • Maiko Yamaji - , University Hospital Frankfurt (Author)
  • Mariangela Di Tacchio - , University Hospital Frankfurt (Author)
  • Kathleen Sommer - , University Hospital Frankfurt (Author)
  • Peter Baumgarten - , University Hospital Frankfurt (Author)
  • Oliver Bähr - , University Hospital Frankfurt (Author)
  • Joachim P. Steinbach - , German Cancer Research Center (DKFZ), University Hospital Frankfurt (Author)
  • Jörg Trojan - , University Hospital Frankfurt (Author)
  • Martin Glas - , Robert Janker Klinik (Author)
  • Ulrich Herrlinger - , University of Bonn (Author)
  • Dietmar Krex - , Department of Neurosurgery, TUD Dresden University of Technology (Author)
  • Matthias Meinhardt - , Institute of Pathology, TUD Dresden University of Technology (Author)
  • Astrid Weyerbrock - , University of Freiburg (Author)
  • Marco Timmer - , University of Cologne (Author)
  • Roland Goldbrunner - , University of Cologne (Author)
  • Martina Deckert - , University of Cologne (Author)
  • Christian Braun - , University of Tübingen (Author)
  • Jens Schittenhelm - , University of Tübingen (Author)
  • Jochen T. Frueh - , University Hospital Frankfurt (Author)
  • Evelyn Ullrich - , University Hospital Frankfurt (Author)
  • Michel Mittelbronn - , University Hospital Frankfurt, German Cancer Research Center (DKFZ) (Author)
  • Karl H. Plate - , University Hospital Frankfurt, German Cancer Research Center (DKFZ) (Author)
  • Yvonne Reiss - , University Hospital Frankfurt, German Cancer Research Center (DKFZ) (Author)

Abstract

Glioblastoma multiforme (GBM) is treated by surgical resection followed by radiochemotherapy. Bevacizumab is commonly deployed for anti-angiogenic therapy of recurrent GBM; however, innate immune cells have been identified as instigators of resistance to bevacizumab treatment. We identified angiopoietin-2 (Ang-2) as a potential target in both naive and bevacizumab-treated glioblastoma. Ang-2 expression was absent in normal human brain endothelium, while the highest Ang-2 levels were observed in bevacizumab-treated GBM. In a murine GBM model, VEGF blockade resulted in endothelial upregulation of Ang-2, whereas the combined inhibition of VEGF and Ang-2 leads to extended survival, decreased vascular permeability, depletion of tumor-associated macrophages, improved pericyte coverage, and increased numbers of intratumoral T lymphocytes. CD206+ (M2-like) macrophages were identified as potential novel targets following anti-angiogenic therapy. Our findings imply a novel role for endothelial cells in therapy resistance and identify endothelial cell/myeloid cell crosstalk mediated by Ang-2 as a potential resistance mechanism. Therefore, combining VEGF blockade with inhibition of Ang-2 may potentially overcome resistance to bevacizumab therapy. Synopsis: While recurrent glioblastoma is treated by inhibiting angiogenesis, resistance limits therapeutic efficacy. Angiopoietin-2 (Ang-2), a potent endothelium-derived angiogenesis factor and regulator of myeloid cell infiltration, is a therapeutic target for treating naive and bevacizumab-resistant glioblastoma. The therapeutic benefit of co-targeting Ang-2 and VEGF signaling (using AMG386 and aflibercept/VEGF-trap) is shown in mouse models of GBM. Ang-2 and VEGF combination therapy decreased GBM angiogenesis and permeability, improved vascular maturation, and limited the number of tumor-associated macrophages. Numbers of CD206+ (M2-like) macrophages remained high upon therapy, suggestive of subsequent targeting of M2-like macrophages in bevacizumab-resistant GBM. Inhibition of Ang-2, either alone or in combination with VEGF inhibition is of potential use to overcome resistance in GBM patients that have failed bevacizumab therapy. While recurrent glioblastoma is treated by inhibiting angiogenesis, resistance limits therapeutic efficacy. Angiopoietin-2 (Ang-2), a potent endothelium-derived angiogenesis factor and regulator of myeloid cell infiltration, is a therapeutic target for treating naive and bevacizumab-resistant glioblastoma.

Details

Original languageEnglish
Pages (from-to)39-57
Number of pages19
JournalEMBO molecular medicine
Volume8
Issue number1
Publication statusPublished - 1 Jan 2016
Peer-reviewedYes

External IDs

PubMed 26666269

Keywords

ASJC Scopus subject areas

Keywords

  • Anti-angiogenic therapy, Glioblastoma, Macrophage polarization, Therapy resistance, Tumor angiogenesis