title: Bradykinin modulation of tumor vasculature: II. activation of nitric oxide and phospholipase A2/prostaglandin signaling pathways synergistically modifies vascular physiology and morphology to enhance delivery of chemotherapeutic agents to tumors.
abstract: Intravenous infusions of the bradykinin agonist Cereport (labradimil, formerly RMP-7) enhance delivery of concomitantly administered hydrophilic chemotherapeutic agents to solid tumors. The enhanced delivery produces greater in vivo efficacy of chemotherapeutic agents, manifested as suppressed tumor growth and increased survival in tumor-bearing rats. Here we elucidate the mechanisms of action involved with this unique phenomenon, at both the physical and biochemical levels. At the physical level we demonstrate that Cereport modifies the tumor vasculature in several important ways, including transient 1) reductions in interstitial fluid pressure within the tumor, 2) increases in pore size of the vasculature, and 3) increases in total vascular surface area. All three of these changes modify tumor-specific characteristics of the vasculature known to impede drug delivery to the tumor interstitium. Biochemically, we demonstrate that the activation of both of bradykinin's major signaling pathways, the nitric oxide and phospholipase A2/prostaglandin E2 are necessary events. Although pharmacologically blocking either pathway greatly reduced the effects of Cereport, stimulation of either pathway alone did not enhance delivery. However, simultaneous stimulation of both pathways (without exogenous bradykinin B2 receptor stimulation) produced a nearly 2-fold increase in delivery of carboplatin to the tumor. Thus, stimulation of endogenous bradykinin B2 receptors induces at least two parallel biochemical cascades that act synergistically to uniquely modify the tumor vasculature in ways that increase delivery and efficacy of chemotherapeutic agents.
authors.affiliation: Preclinical Research and Development, Alkermes, Inc., Cambridge, Massachusetts 02139, USA.
authors.forename: D F
authors.initials: DF
authors.lastname: Emerich
authors.forename: R L
authors.initials: RL
authors.lastname: Dean
authors.forename: P
authors.initials: P
authors.lastname: Snodgrass
authors.forename: D
authors.initials: D
authors.lastname: Lafreniere
authors.forename: M
authors.initials: M
authors.lastname: Agostino
authors.forename: T
authors.initials: T
authors.lastname: Wiens
authors.forename: H
authors.initials: H
authors.lastname: Xiong
authors.forename: B
authors.initials: B
authors.lastname: Hasler
authors.forename: J
authors.initials: J
authors.lastname: Marsh
authors.forename: M
authors.initials: M
authors.lastname: Pink
authors.forename: B S
authors.initials: BS
authors.lastname: Kim
authors.forename: B
authors.initials: B
authors.lastname: Perdomo
authors.forename: R T
authors.initials: RT
authors.lastname: Bartus
mesh_terms: D000465:Algorithms; D000818:Animals; D000970:Antineoplastic Agents / Q000493:pharmacokinetics* / Q000627:therapeutic use*; D001345:Autoradiography; D001711:Biotransformation / Q000187:drug effects; D001794:Blood Pressure / Q000187:drug effects; D001808:Blood Vessels / Q000187:drug effects; D001920:Bradykinin / Q000031:analogs & derivatives / Q000502:physiology* / Q000627:therapeutic use*; D005110:Extracellular Space / Q000187:drug effects; D007150:Immunohistochemistry; D008297:Male; D009368:Neoplasm Transplantation; D009374:Neoplasms, Experimental / Q000098:blood supply* / Q000188:drug therapy; D009569:Nitric Oxide / Q000378:metabolism*; D010741:Phospholipases A / Q000378:metabolism*; D054467:Phospholipases A2; D016062:Porosity / Q000187:drug effects; D011453:Prostaglandins / Q000502:physiology*; D051381:Rats; D011916:Rats, Inbred F344; D012039:Regional Blood Flow / Q000502:physiology*; D015398:Signal Transduction / Q000187:drug effects*; D014407:Tumor Cells, Cultured
chemical_list: D000970:Antineoplastic Agents; D011453:Prostaglandins; C089876:RMP 7; D009569:Nitric Oxide; D010741:Phospholipases A; D054467:Phospholipases A2; D001920:Bradykinin