title: Exploiting the mevalonate pathway to distinguish statin-sensitive multiple myeloma.
abstract: Statin inhibitors, used to control hypercholesterolemia, trigger apoptosis of hematologic tumor cells and therefore have immediate potential as anticancer agents. Evaluations of statins in acute myelogenous leukemia and multiple myeloma have shown that statin efficacy is mixed, with only a subset of tumor cells being highly responsive. Our goal was to distinguish molecular features of statin-sensitive and -insensitive myeloma cells and gain insight into potential predictive markers. We show that dysregulation of the mevalonate pathway is a key determinant of sensitivity to statin-induced apoptosis in multiple myeloma. In sensitive cells, the classic feedback response to statin exposure is lost. This results in deficient up-regulation of 2 isoforms of hydroxymethylglutaryl coenzyme A reductase: the rate-limiting enzyme of the mevalonate pathway and hydroxymethylglutaryl coenzyme A synthase 1. To ascertain the clinical utility of these findings, we demonstrate that a subset of primary myeloma cells is sensitive to statins and that monitoring dysregulation of the mevalonate pathway may distinguish these cancers. We also show statins are highly effective and well tolerated in an orthotopic model of myeloma using cells harboring this dysregulation. This determinant of sensitivity further provides molecular rationale for the significant therapeutic index of statins on these tumor cells.
authors.affiliation: Ontario Cancer Institute/Princess Margaret Hospital, Campbell Family Institute for Cancer Research, Toronto, ON, Canada.
authors.forename: James W
authors.initials: JW
authors.lastname: Clendening
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Pandyra
authors.forename: Zhihua
authors.initials: Z
authors.lastname: Li
authors.forename: Paul C
authors.initials: PC
authors.lastname: Boutros
authors.forename: Anna
authors.initials: A
authors.lastname: Martirosyan
authors.forename: Richard
authors.initials: R
authors.lastname: Lehner
authors.forename: Igor
authors.initials: I
authors.lastname: Jurisica
authors.forename: Suzanne
authors.initials: S
authors.lastname: Trudel
authors.forename: Linda Z
authors.initials: LZ
authors.lastname: Penn
mesh_terms: D045744:Cell Line, Tumor; D019008:Drug Resistance, Neoplasm / Q000187:drug effects*; D005260:Female; D006801:Humans; D006903:Hydroxymethylglutaryl CoA Reductases / Q000378:metabolism; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000494:pharmacology* / Q000627:therapeutic use; D007527:Isoenzymes / Q000037:antagonists & inhibitors / Q000378:metabolism; D008297:Male; D008798:Mevalonic Acid / Q000378:metabolism*; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000378:metabolism*
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007527:Isoenzymes; D006903:Hydroxymethylglutaryl CoA Reductases; D008798:Mevalonic Acid