Abstract The angiopoietin (Angpt)–TIE signaling pathway controls vascular maturation and maintains the quiescent phenotype of resting vasculature. The contextual agonistic and antagonistic Tie2 ligand ANGPT2 is believed to be exclusively produced by endothelial cells, disrupting constitutive ANGPT1–TIE2 signaling to destabilize the microvasculature during pathologic disorders like inflammation and cancer. However, scattered reports have also portrayed tumor cells as a source of ANGPT2. Employing ISH-based detection of ANGPT2, we found strong tumor cell expression of ANGPT2 in a subset of patients with melanoma. Comparative analysis of biopsies revealed a higher fraction of ANGPT2-expressing tumor cells in metastatic versus primary sites. Tumor cell–expressed Angpt2 was dispensable for primary tumor growth, yet in-depth analysis of primary tumors revealed enhanced intratumoral necrosis upon silencing of tumor cell Angpt2 expression in the absence of significant immune and vascular alterations. Global transcriptional profiling of Angpt2-deficient tumor cells identified perturbations in redox homeostasis and an increased response to cellular oxidative stress. Ultrastructural analyses illustrated a significant increase of dysfunctional mitochondria in Angpt2-silenced tumor cells, thereby resulting in enhanced reactive oxygen species (ROS) production and downstream MAPK stress signaling. Functionally, enhanced ROS in Angpt2-silenced tumor cells reduced colonization potential in vitro and in vivo. Taken together, these findings uncover the hitherto unappreciated role of tumor cell–expressed ANGPT2 as an autocrine-positive regulator of metastatic colonization and validate ANGPT2 as a therapeutic target for a well-defined subset of patients with melanoma. Significance: This study reveals that tumor cells can be a source of ANGPT2 in the tumor microenvironment and that tumor cell-derived ANGPT2 augments metastatic colonization by protecting tumor cells from oxidative stress.

PDF file 188K, Cross-reactivity and binding affinities of A2V CrossMab and the comparator molecules bevacizumab and LC06

This file consists of supplementary figures (SF) 1-11 consisting of: SF1: Melanoma cells express ANGPT2 (A-F). SF2: Melanoma cell-expressed Angpt2 does not modulate tumor cell proliferation (A-B). SF3: Tumor cell knockdown of Angpt2 does not impact growth of primary tumors (A-J). SF4: Angpt2-depletion in melanoma cells does not affect primary tumor microenvironment (A-F). SF5: Angpt2-depletion alters pathways governing metastasis and oxidative stress (A-B). SF6: Angpt2 knockdown in tumor cells affects the cellular redox balance (A-G). SF7: Tumor cell-expressed Angpt2 alters mitochondrial dynamics (A-E). SF8: Tumor cell-expressed Angpt2 promotes metastasis (A-G). SF9: Tumor cell-expressed Angpt2 does not affect early stages of metastasis in vitro (A-H). SF10: Silencing of Angpt2 impairs invasion through the basement membrane and transmigration across the endothelial barrier (A-H). SF11: Silencing of Angpt2 reduces in vitro colony formation (A-F).

Supplementary Figures 1-3 from Host-Derived Angiopoietin-2 Affects Early Stages of Tumor Development and Vessel Maturation but Is Dispensable for Later Stages of Tumor Growth

PDF file 52K, An overview of the antibodies used in the present study

PDF file 201K, A2V CrossMab characterization and safety profile

PDF file 169K, Schematic representation of Ang2-VEGF-A CrossMab (RO5520985) and binding properties

PDF file 138K, Ex vivo mode of action analysis of Ang-2-VEGF-A inhibition

PDF file 135K, Analysis of hypoxia during Ang-2-VEGF-A inhibition

PDF file 69K, Ang-2 induced VEGFR-2 upregulation

PDF file 67K, A2V CrossMab treatment inhibits angiogenesis in the VEGF-induced cornea pocket assay

ABSTRACT Vascular endothelial growth factor (VEGF)-A blockade has been validated clinically as a treatment for human cancers. Angiopoietin-2 (Ang-2) is a key regulator of blood vessel remodeling and maturation. In tumors, Ang-2 is up-regulated and an unfavorable prognostic factor. Recent data demonstrated that Ang-2 inhibition mediates anti-tumoral effects. We generated a tetravalent bispecific antibody (Ang-2-VEGF-TAvi6) targeting VEGF-A with 2 arms based on bevacizumab (Avastin®), and targeting Ang-2 with 2 arms based on a novel anti-Ang-2 antibody (LC06). The two Ang-2-targeting single-chain variable fragments are disulfide-stabilized and fused to the C-terminus of the heavy chain of bevacizumab. Treatment with Ang-2-VEGF-A-TAvi6 led to a complete abrogation of angiogenesis in the cornea micropocket assay. Metastatic spread and tumor growth of subcutaneous, orthotopic and anti-VEGF-A resistant tumors were also efficiently inhibited. These data further establish Ang-2-VEGF bispecific antibodies as a promising anti-angiogenic, anti-metastatic and anti-tumor agent for the treatment of cancer.

To assess antivascular effects, and evaluate clinically translatable magnetic resonance imaging (MRI) biomarkers of tumour response in vivo, following treatment with vanucizumab, a bispecific human antibody against angiopoietin-2 (Ang-2) and vascular endothelial growth factor-A (VEGF-A). Colo205 colon cancer xenografts were imaged before and 5 days after treatment with a single 10 mg kg−1 dose of either vanucizumab, bevacizumab (anti-human VEGF-A), LC06 (anti-murine/human Ang-2) or omalizumab (anti-human IgE control). Volumetric response was assessed using T2-weighted MRI, and diffusion-weighted, dynamic contrast-enhanced (DCE) and susceptibility contrast MRI used to quantify tumour water diffusivity (apparent diffusion coefficient (ADC), × 106 mm2 s−1), vascular perfusion/permeability (Ktrans, min−1) and fractional blood volume (fBV, %) respectively. Pathological correlates were sought, and preliminary gene expression profiling performed. Treatment with vanucizumab, bevacizumab or LC06 induced a significant (P<0.01) cytolentic response compared with control. There was no significant change in tumour ADC in any treatment group. Uptake of Gd-DTPA was restricted to the tumour periphery in all post-treatment groups. A significant reduction in tumour Ktrans (P<0.05) and fBV (P<0.01) was determined 5 days after treatment with vanucizumab only. This was associated with a significant (P<0.05) reduction in Hoechst 33342 uptake compared with control. Gene expression profiling identified 20 human genes exclusively regulated by vanucizumab, 6 of which are known to be involved in vasculogenesis and angiogenesis. Vanucizumab is a promising antitumour and antiangiogenic treatment, whose antivascular activity can be monitored using DCE and susceptibility contrast MRI. Differential gene expression in vanucizumab-treated tumours is regulated by the combined effect of Ang-2 and VEGF-A inhibition.

Angiogenesis, the process by which new vessels form from existing ones, plays an important role in many developmental processes and pathological conditions. We study angiogenesis in the context of a highly controllable experimental environment: the cornea micropocket assay. Using a multidisciplinary approach that combines experiments, image processing and analysis, and mathematical modelling, we aim to provide mechanistic insight into the action of two angiogenic factors, vascular endothelial growth factor A (VEGF-A) and basic fibroblast growth factor (bFGF). We use image analysis techniques to extract quantitative data, which are both spatially and temporally resolved, from experimental images, and we develop a mathematical model, in which the corneal vasculature evolves in response to both VEGF-A and bFGF. The experimental data are used for model parametrization, while the mathematical model is used to assess the utility of the cornea micropocket assay and to characterize proposed synergies between VEGF-A and bFGF.

The blockade of VEGF pathway has been clinically validated as an initial treatment for renal cell carcinoma (RCC). Angiopoietin-2 (Ang-2) has been indicated as a key regulator for angiogenesis escape. The effect of a novel bispecific antibody (A2V CrossMab) against both Ang-2 and VEGF was investigated in comparison with either factor. A2V CrossMab significantly reduced tumor volume, vessel density, and interstitial fluid pressure compared to either monotherapy of anti-VEGF or anti-Ang-2. Host-derived angiogenesis-related genes have been significantly down-regulated in A2V CrossMab group. These data demonstrate that A2V CrossMab has additive anti-tumor effect for the treatment of RCC.

ZusammenfassungDas maligne Melanom (MM) bleibt trotz aller neuen erfolgreichen Therapieansätze ein schwer zu behandelnder Tumor. Die Bedeutung des Gefäßnetzes für die Metastasierung des MM konnte in unterschiedlichen Studien nachgewiesen werden. Die therapeutischen Effekte von unterschiedlichen anti‐angiogenen Substanzen wurden und werden in Studien für die Therapie des MM getestet. Der Großteil davon konzentriert sich auf eine Inhibition des VEGF (vascular endothelial growth factor)‐Signalweges. Daneben wird der Effekt von Multikinaseinhibitoren und durch Inhibition von angiogener Integrinaktivität untersucht. Jedoch konnte bisher noch keine anti‐angiogene Substanz das Gesamtüberleben von Melanompatienten signifikant verlängern. Unterschiedliche Arbeiten haben den Nachweis erbracht, dass gerade das MM über verschiedene Möglichkeiten verfügt, Resistenzen gegenüber einer Mono‐anti‐VEGF‐Therapie zu erlangen. Neben VEGF stellt Angiopoietin‐2 (Ang‐2) ein Schlüsselmolekül der Angiogenese dar und Ang‐2‐Inhibitoren werden als Anti‐Angiogenese‐Therapie der zweiten Generation angesehen. Auch beim Melanom konnte in präklinischen Studien gezeigt werden, dass Ang‐2 einerseits als Marker für Melanommetastasenbildung dient und sich andererseits auch als therapeutische Zielstruktur eignet. Zukünftige Studien werden zeigen, bessere Ergebnisse bei der Therapie des MM in der Klinik erzielen werden.

Primary cutaneous large B-cell lymphomas, leg type (PCLBCL/LT) are primary cutaneous B-cell lymphoma (PCBCL) with an intermediate prognosis. Therefore, antracycline-based polychemotherapy combined with rituximab has been recommended as first-line treatment. Yet, despite this regimen, the 5-year survival rate remains 50-66% only. Angiogenesis, the formation of a vascular network, is essential for the pathogenesis of nodal lymphomas. So far, no study has analysed angiogenesis and its key factors in PCLBCL/LT. The present study was aimed at characterizing angiogenesis in PCLBCL/LT to identify the angiogenic molecules as potential therapeutic targets. The intra-tumoral microvessel density (MVD) was assessed by immunohistochemical studies of CD20 and CD31. The MVD was higher in PCLBCL/LT compared with indolent PCBCL. Analyses of open-source microarray data showed correlation between the angiogenic molecule angiopoietin-2 (Ang-2) and pan-endothelial cell markers. ELISA studies determined a shift between Ang-2 and Ang-1 towards Ang-2 in the peripheral blood of PCLBCL/LT patients. Immunofluorescence costainings against the Ang receptor Tie2/angiogenic integrins/CD34 revealed that the vasculature in both aggressive and indolent PCBCL tumors harbours an endothelial cell subpopulation with reduced expression of Tie2. In contrast, the alternative Ang-2 binding partners, angiogenic integrins, are strongly expressed in PCBCL. In line with these findings, downstream targets of Ang-2-integrin signalling, that is phosphorylation of focal adhesion kinase at Tyr397, and sprouting angiogenesis are enhanced in PCLBCL/LT. Our data present Ang-2 as a promising therapeutic target and anti-angiogenic therapy as a new line in treatment of PCLBCL/LT as a hitherto intractable disease.

Despite the development of novel therapies, the therapy of malignant melanoma remains challenging. Various studies have shown the vascular system to be pivotal for metastasis in melanoma. Consequently, the effect of various antiangiogenic therapies has been and is being investigated in preclinical and clinical trials. While most studies focus on inhibition of vascular endothelial growth factor (VEGF) signaling, others are aimed at determining the effect of multikinase inhibitors or the inhibition of angiogenic integrin activity. However, overall survival rates have not significantly improved in clinical trials with antiangiogenic agents. Resistance to anti-VEGF monotherapy has been observed in several studies, especially in malignant melanoma. Angiopoietin-2 (Ang-2) represents a promising candidate molecule for antiangiogenic therapy and the effect of Ang-2 inhibitors is currently being explored in first trials. In melanoma, Ang-2 has been shown to be a marker for metastasis formation and represents an interesting therapeutic target molecule. Future studies are required to analyze the effect of a combined approach, using anti-VEGF and anti-Ang-2, as therapy for malignant melanoma.

Antiangiogenic tumor therapy has failed in the adjuvant setting. Here we show that inhibition of the Tie2 ligand angiopoietin-2 (Ang2) effectively blocks metastatic growth in preclinical mouse models of postsurgical adjuvant therapy. Ang2 antibody treatment combines well with low-dose metronomic chemotherapy (LDMC) in settings in which maximum-dose chemotherapy does not prove effective. Mechanistically, Ang2 blockade could be linked to quenching the inflammatory and angiogenic response of endothelial cells (ECs) in the metastatic niche. Reduced EC adhesion molecule and chemokine expression inhibits the recruitment of tumor-promoting CCR2(+)Tie2(-) metastasis-associated macrophages. Moreover, LDMC contributes to therapeutic efficacy by inhibiting the recruitment of protumorigenic bone marrow-derived myeloid cells. Collectively, these data provide a rationale for mechanism-guided adjuvant tumor therapies.