title: LDH-A inhibition, a therapeutic strategy for treatment of hereditary leiomyomatosis and renal cell cancer.
abstract: The genetic basis for the hereditary leiomyomatosis and renal cell cancer syndrome is germ-line inactivating mutation in the gene for the Krebs/tricarboxylic acid cycle enzyme, fumarate hydratase (FH), the enzyme that converts fumarate to malate. These individuals are predisposed to development of leiomyomas of the skin and uterus as well as highly aggressive kidney cancers. Inhibition of FH should result in significant decrease in oxidative phosphorylation necessitating that glycolysis followed by fermentation of pyruvate to lactate will be required to provide adequate ATP as well as to regenerate NAD+. Moreover, FH deficiency is known to up-regulate expression of hypoxia-inducible factor (HIF)-1alpha by enhancing the stability of HIF transcript. This leads to activation of various HIF-regulated genes including vascular endothelial growth factor and glucose transporter GLUT1 and increased expression of several glycolytic enzymes. Because lactate dehydrogenase-A (LDH-A), also a HIF-1alpha target, promotes fermentative glycolysis (conversion of pyruvate to lactate), a step essential for regenerating NAD+, we asked whether FH-deficient cells would be exquisitely sensitive to LDH-A blockade. Here, we report that hereditary leiomyomatosis and renal cell cancer tumors indeed overexpress LDH-A, that LDH-A inhibition results in increased apoptosis in a cell with FH deficiency and that this effect is reactive oxygen species mediated, and that LDH-A knockdown in the background of FH knockdown results in significant reduction in tumor growth in a xenograft mouse model.
authors.affiliation: Department of Medicine, Division of Interdisciplinary Medicine and Biotechnology, Beth Israel Deaconess Medical Center, Harvard Medical School, and Department of Pathology, Brigham and Women's Hospital, Boston, MA 02215, USA.
authors.forename: Han
authors.initials: H
authors.lastname: Xie
authors.forename: Vladimir A
authors.initials: VA
authors.lastname: Valera
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Merino
authors.forename: Angela M
authors.initials: AM
authors.lastname: Amato
authors.forename: Sabina
authors.initials: S
authors.lastname: Signoretti
authors.forename: William M
authors.initials: WM
authors.lastname: Linehan
authors.forename: Vikas P
authors.initials: VP
authors.lastname: Sukhatme
authors.forename: Pankaj
authors.initials: P
authors.lastname: Seth
mesh_terms: D000818:Animals; D000970:Antineoplastic Agents / Q000494:pharmacology / Q000627:therapeutic use; D002292:Carcinoma, Renal Cell / Q000150:complications / Q000188:drug therapy* / Q000235:genetics / Q000473:pathology; D004791:Enzyme Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D005649:Fumarate Hydratase / Q000235:genetics; D055785:Gene Knockdown Techniques; D006801:Humans; D007527:Isoenzymes / Q000037:antagonists & inhibitors / Q000235:genetics / Q000378:metabolism; D007680:Kidney Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000235:genetics / Q000473:pathology; D007770:L-Lactate Dehydrogenase / Q000037:antagonists & inhibitors* / Q000235:genetics / Q000378:metabolism; D000080864:Lactate Dehydrogenase 5; D018231:Leiomyomatosis / Q000150:complications / Q000188:drug therapy* / Q000235:genetics; D008297:Male; D051379:Mice; D008819:Mice, Nude; D008954:Models, Biological; D013577:Syndrome; D014407:Tumor Cells, Cultured; D054928:Validation Studies as Topic; D023041:Xenograft Model Antitumor Assays; D006623:von Hippel-Lindau Disease / Q000235:genetics / Q000473:pathology
chemical_list: D000970:Antineoplastic Agents; D004791:Enzyme Inhibitors; D007527:Isoenzymes; D007770:L-Lactate Dehydrogenase; D000080864:Lactate Dehydrogenase 5; D005649:Fumarate Hydratase