The PI3K/Akt/mTOR pathway as a preventive target in melanoma brain metastasis

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Cedric Tehranian - , German Cancer Research Center (DKFZ) (Author)
  • Laura Fankhauser - , German Cancer Research Center (DKFZ) (Author)
  • Patrick N. Harter - , University Hospital Frankfurt, German Cancer Research Center (DKFZ), Frankfurt Cancer Institute (Author)
  • Colin D.H. Ratcliffe - , The Francis Crick Institute (Author)
  • Pia S. Zeiner - , University Hospital Frankfurt, Frankfurt Cancer Institute (Author)
  • Julia M. Messmer - , German Cancer Research Center (DKFZ), Heidelberg University  (Author)
  • Dirk C. Hoffmann - , German Cancer Research Center (DKFZ), Heidelberg University  (Author)
  • Katharina Frey - , German Cancer Research Center (DKFZ) (Author)
  • Dana Westphal - , Department of Dermatology, National Center for Tumor Diseases (Partners: UKD, MFD, HZDR, DKFZ) (Author)
  • Michael W. Ronellenfitsch - , University Hospital Frankfurt, Frankfurt Cancer Institute (Author)
  • Erik Sahai - , The Francis Crick Institute (Author)
  • Wolfgang Wick - , German Cancer Research Center (DKFZ), Heidelberg University  (Author)
  • Matthia A. Karreman - , German Cancer Research Center (DKFZ), Heidelberg University  (Author)
  • Frank Winkler - , German Cancer Research Center (DKFZ), Heidelberg University  (Author)

Abstract

Background: Brain metastases (BM) are a frequent complication of malignant melanoma (MM), with limited treatment options and poor survival. Prevention of BM could be more effective and better tolerated than treating established BM in various conditions. Methods: To investigate the temporospatial dynamics of PI3K/Akt/mTOR (PAM) pathway activation during BM formation and the preventive potential of its inhibition, in vivo molecular imaging with an Akt biosensor was performed, and long-term intravital multiphoton microscopy through a chronic cranial window in mice. Results: In vivo molecular imaging revealed invariable PAM pathway activation during the earliest steps of brain colonization. In order to perform a long-term intravascular arrest and to extravasate, circulating MM cells needed to activate their PAM pathway during this process. However, the PAM pathway was quite heterogeneously activated in established human brain metastases, and its inhibition with the brain-penetrant PAM inhibitor GNE-317 resulted in only modest therapeutic effects in mice. In contrast, giving GNE-317 in preventive schedules that included very low doses effectively reduced the growth rate and number of BM in two MM mouse models over time, and led to an overall survival benefit. Longitudinal intravital multiphoton microscopy found that the first, rate-limiting steps of BM formation - permanent intravascular arrest, extravasation, and initial perivascular growth - are most vulnerable to dual PI3K/mTOR inhibition. Conclusion: These findings establish a key role of PAM pathway activation for critical steps of early metastatic brain colonization and reveal its pharmacological inhibition as a potent avenue to prevent the formation of clinically relevant BM.

Details

Original languageEnglish
Pages (from-to)213-225
Number of pages13
JournalNeuro-oncology
Volume24
Issue number2
Publication statusPublished - 1 Feb 2022
Peer-reviewedYes

External IDs

PubMed 34216217
ORCID /0000-0003-4340-0402/work/145223809

Keywords

Sustainable Development Goals

Keywords

  • brain metastasis, dual PI3K/mTOR inhibition, extravasation, PI3K/Akt/mTOR pathway, tertiary prevention