Journal
THERANOSTICS
Volume 11, Issue 16, Pages 7735-7754Publisher
IVYSPRING INT PUBL
DOI: 10.7150/thno.60757
Keywords
multiple myeloma; bone marrow; tumor microenvironment; orthogonal drug delivery; nanomicelles; photosensitizer; Cerenkov radiation
Categories
Funding
- National Institutes of Health [R01 CA260855, U54 CA199092, R01 EB030987, R01 EB021048, P30 CA091842, P30 CA091842-19S3, S10 OD027042, S10 OD016237, S10 RR031625, S10 OD020129]
- Department of Defense Breast Cancer Research Program [W81XWH-16-1-0286]
- Siteman Investment Program (SIP) Research Development Award
- NCI Cancer Center Support Grant [P30 CA091842]
- National Institutes of Health's NCATS Clinical and Translational Science Award (CTSA) program [UL1 TR002345]
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The study explores a new treatment approach targeting multiple myeloma, effectively inhibiting disease progression by simultaneously acting on cancer cells and bone cells. Experimental results demonstrate that this combination therapy significantly reduces tumor burden and prevents rapid relapse in mouse models.
Rationale: Multiple myeloma (MM) is a multifocal malignancy of bone marrow plasma cells, characterized by vicious cycles of remission and relapse that eventually culminate in death. The disease remains mostly incurable largely due to the complex interactions between the bone microenvironment (BME) and MM cells (MMC). In the vicious cycle of bone disease, abnormal activation of osteoclasts (OCs) by MMC causes severe osteolysis, promotes immune evasion, and stimulates the growth of MMC. Disrupting these cancer-stroma interactions would enhance treatment response. Methods: To disrupt this cycle, we orthogonally targeted nanomicelles (NM) loaded with non-therapeutic doses of a photosensitizer, titanocene (TC), to VLA-4 (alpha 4 beta 1, CD49d/CD29) expressing MMC (MM1.S) and alpha v beta 3 (CD51/CD61) expressing OC. Concurrently, a non-lethal dose of a radiopharmaceutical, F-18-fluorodeoxyglucose ([F-18]FDG) administered systemically interacted with TC (radionuclide stimulated therapy, RaST) to generate cytotoxic reactive oxygen species (ROS). The in vitro and in vivo effects of RaST were characterized in MM1.S cell line, as well as in xenograft and isograft MM animal models. Results: Our data revealed that RaST induced non-enzymatic hydroperoxidation of cellular lipids culminating in mitochondrial dysfunction, DNA fragmentation, and caspase-dependent apoptosis of MMC using VLA-4 avid TC-NMs. RaST upregulated the expression of BAX, Bcl-2, and p53, highlighting the induction of apoptosis via the BAK-independent pathway. The enhancement of multicopper oxidase enzyme F5 expression, which inhibits lipid hydroperoxidation and Fenton reaction, was not sufficient to overcome RaST-induced increase in the accumulation of irreversible function-perturbing alpha,beta-aldehydes that exerted significant and long-lasting damage to both DNA and proteins. In vivo, either VLA-4-TC-NM or alpha v beta 3-TC-NMs RaST induced a significant therapeutic effect on immunocompromised but not immunocompetent MM-bearing mouse models. Combined treatment with both VLA-4-TC-NM and alpha v beta 3-TC-NMs synergistically inhibited osteolysis, reduced tumor burden, and prevented rapid relapse in both in vivo models of MM. Conclusions: By targeting MM and bone cells simultaneously, combination RaST suppressed MM disease progression through a multi-prong action on the vicious cycle of bone cancer. Instead of using the standard multidrug approach, our work reveals a unique photophysical treatment paradigm that uses nontoxic doses of a single light-sensitive drug directed orthogonally to cancer and bone cells, followed by radionuclide-stimulated generation of ROS to inhibit tumor progression and minimize osteolysis in both immunocompetent murine and immunocompromised human MM models.
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