Cambridge team discovers novel pathway involved in therapy-resistant cancers

25th December 2008

Scientists at The Babraham Institute have begun to unpick the complex mechanisms underpinning the development of drug resistant cancers. They have identified a novel target that may help to combat the growing problem of therapy resistant cancers and pave the way for innovative therapeutic approaches.

Their discovery, reported in the latest edition of the New England Journal of Medicine, centres on the significance of DNA damage for both normal cells and cancer cells. It reveals that a biochemical signalling pathway, that normally ensures damaged cells are diverted towards cellular suicide, is blocked in certain cancers, rendering them resistant to certain types of treatment.

DNA damage is a common event in a cell’s life, a consequence of incorrect copying of the DNA during cell division or provoked by elements in our environment like tobacco smoke and sunlight. However, if DNA damage occurs, the cell normally triggers a repair response and if the damage is not repaired, the cell is targeted for cell death, a process known as apoptosis. In this way the body protects itself from cells that might become cancerous. The cells that do become cancerous manage to by-pass these repair and self-destruction pathways, promoting the survival of damaged cells.

The research is a collaboration between the BBSRC-funded Babraham Institute, the University of Cambridge and Addenbrooke’s Hospital, using cells from patients with chronic myeloid leukaemia (CML), and polycythemia vera (PV), two myeloproliferative disorders.

Cancers, such as the leukaemias investigated in this work, are characterised by an accumulation of DNA damage. DNA damage triggers several pathways to ensure that cells die by apoptosis. The authors describe a key new pathway involved in this process, and its subversion in cancer cells.

The team have found that DNA damage in normal cells increases the activity of a proton pump located in the cell membrane, known as NHE-1, which raises the pH of the cell. This has a critical effect on a protein called Bcl-xL, known as a survival protein because of its ability to suppress cell death. However, in the more alkaline environment (higher pH) a chemical process called deamidation converts Bcl-xL into a form that allows cells with damaged DNA to die. The authors have discovered that this pathway is inhibited in (cancerous) myeloid cells, keeping them alive to proceed with their deadly mission. This is the first demonstration of a role for deamidation in human malignancy.

Both the leukaemias studied by the authors are caused by oncogenic tyrosine kinases. These are enzymes - chemical catalysts - that trigger cancer when their activity is abnormally high. These kinases not only cause cells to become cancerous in the first place, but also make the cells resistant to chemotherapy and radiotherapy once they have turned into cancer cells. The authors have discovered that it is these kinases that block the key Bcl-xL deamidation pathway that normally allows DNA damaged cells to die. The activated tyrosine kinase causing CML is called BCR-ABL, whereas in PV the culprit is JAK-2. Altogether more than 30 aberrant tyrosine kinases are known to cause human cancers.

“This discovery provides new insights into how oncogenes, the genes that cause cancer, allow cells to accumulate more and more damage to their DNA without dying”, explains Dr Denis Alexander. “This new understanding of how oncogenes work also opens up some interesting ideas for future cancer therapies".

Cancer therapies depend to a large degree on the DNA damage caused by chemotherapy or radiotherapy, causing cancer cells to die. However, in cancers caused by tyrosine kinases the cells are often resistant to such therapies, referred to as ‘genotoxic resistance’. Fortunately inhibitors of the oncogenic kinases are now being increasingly used in the clinic but the kinases sometimes mutate so that this therapy no longer works.

The therapeutic interest in this research comes from the authors’ finding that simply switching back on the Bcl-xL deamidation pathway causes the cancer cells to die. This can be engineered in living cells by increasing the pH inside the cells artificially, which causes the Bcl-xL to deamidate so that the cells undergo apoptosis.

This therapeutic ‘proof-of-principle’ was dramatically illustrated by studying a CML patient’s cells which had become resistant to Imatinib, the BCR-ABL inhibitor now widely used in the clinic. As expected, Imatinib was unable to restore the BBcl-xL deamidation pathway in the patient’s cells. But the resistance could be bypassed by artificially (genetically) increasing the level of NHE-1 in the drug-resistant CML cells when studied in the laboratory, so increasing cancer cell death. So drug resistance can be overcome by activating the NHE-1 pathway, thereby increasing the pH inside the cell, and in turn Bcl-xL deamidation and apoptosis.

The discovery that modulating the NHE-1/Bcl-xLsignalling pathway can override resistance to controlled cell death (apoptosis) in cancers like CML and PV, paves the way for new therapeutic approaches that could be of immense importance in cancers where Bcl-xL plays a pivotal role in genotoxic resistance.

This research was supported by the Association for International Cancer Research, the Biotechnology and Biological Sciences Research Council (BBSRC), the U.K. Leukaemia Research Fund, the Wellcome Trust, the U.K. Medical Research Council, Cancer Research UK, and the U.S. Leukemia and Lymphoma Society.


Contact details:

Dr Claire Cockcroft     Head, External Relations
Email:  claire.cockcroft@babraham.ac.uk

Tel:       +44 (0)1223 496260
Mobile : +44 (0)7786 335978

Dr Denis Alexander
Tel.01223 246696
dra24@hermes.cam.ac.uk

The Babraham Institute
Babraham Research Campus
Cambridge CB22 3AT
United Kingdom

Professor A R Green
Head, University of Cambridge Department of Haematology
Cambridge Institute for Medical Research
Hills Road
Cambridge CB2 0XY
Email: arg1000@cam.ac.uk
Tel: (00 44) 1223 336835 
Fax: 01223 762670  

Publication details:
Zhao R, Follows GA, Beer PA, Scott LM, Huntly BJP, Green AR, Alexander DR (2008)
Inhibition of the Bcl-xL deamidation pathway in myeloproliferative disorders.
New England Journal of Medicine 359 2778-2789
http://dx.doi.org/10.1056/NEJMoa0804953

Notes to Editors:

The Babraham Institute is a charitable organisation devoted to biomedical research and is an institute of the Biotechnology and Biological Sciences Research Council (BBSRC). The Institute’s research is focused on understanding the biological events that underlie the normal functions of cells and on how their failure or abnormality may lead to disease. As such, Institute scientists are striving to find cures for conditions where there is currently no treatment or where the existing treatment is not fully effective or causes serious side effects. The latest technologies are being used to study the basis of conditions such as neurodegenerative disorders, birth defects, cancer and diseases of the immune and cardiovascular systems. With a strategic focus on ‘healthy ageing’, novel approaches for tackling chronic diseases and public health concerns like obesity are being discovered. The Institute’s innovative research is commercialised through Babraham Bioscience Technologies (BBT) Ltd, which also manages Babraham’s vibrant Bioincubator on the Babraham Research Campus, six miles south-east of Cambridge.  Website: www.babraham.ac.uk