title: The vascular endothelial growth factor receptor tyrosine kinase inhibitors vatalanib and pazopanib potently induce apoptosis in chronic lymphocytic leukemia cells in vitro and in vivo.
abstract: OBJECTIVE
  There is evidence that vascular endothelial growth factor (VEGF) is a critical microenvironmental factor that exerts angiogenesis-independent effects on the survival of chronic lymphocytic leukemia (CLL) cells. Vatalanib and pazopanib are potent orally available VEGF receptor tyrosine kinase inhibitors. We investigated the efficacy and selectivity of both compounds in CLL cells, simulated potential combination with conventional cytostatics, and tested the effect of both substances on CLL-like tumor xenografts.
  
  
  METHODS
  Primary CLL and normal peripheral blood cells were tested for viability after incubation with varying concentrations of both inhibitors. Further, phosphorylation status of VEGF receptor on treatment, caspase activation, and poly(ADP-ribose) polymerase cleavage were assessed. Combinations of each inhibitor with fludarabine, vincristine, and doxorubicin were analyzed for possible synergistic effects in vitro. For in vivo testing, mice grafted with the CLL-like cell line JVM-3 were treated orally with each inhibitor.
  
  
  RESULTS
  Vatalanib and pazopanib decreased phosphorylation of the VEGF receptor, along with induction of apoptosis in CLL cells in clinically achievable concentrations. Healthy B cells were only mildly affected. Immunoblots showed downregulation of the antiapoptotic proteins XIAP and MCL1, whereas poly(ADP-ribose) polymerase cleavage was increased. Combinations with conventional cytostatic agents resulted in synergistic effects. Treatment of xenografted mice with 100 mg/kg of body weight for 21 days resulted in tumor inhibition rates of 76% (vatalanib) and 77% (pazopanib). In two mice, a total tumor eradication could be observed. No gross systemic toxicity occurred.
  
  
  CONCLUSIONS
  We conclude that VEGF inhibition is a promising new therapeutic approach in CLL. Vatalanib and pazopanib seem to be effective and safe candidates to be further evaluated for this purpose.
authors.affiliation: Department I of Internal Medicine, University at Cologne, Cologne, Germany.
authors.forename: Julian
authors.initials: J
authors.lastname: Paesler
authors.forename: Iris
authors.initials: I
authors.lastname: Gehrke
authors.forename: Rajesh Kumar
authors.initials: RK
authors.lastname: Gandhirajan
authors.forename: Alexandra
authors.initials: A
authors.lastname: Filipovich
authors.forename: Magdalena
authors.initials: M
authors.lastname: Hertweck
authors.forename: Felix
authors.initials: F
authors.lastname: Erdfelder
authors.forename: Sabrina
authors.initials: S
authors.lastname: Uhrmacher
authors.forename: Simon Jonas
authors.initials: SJ
authors.lastname: Poll-Wolbeck
authors.forename: Michael
authors.initials: M
authors.lastname: Hallek
authors.forename: Karl-Anton
authors.initials: KA
authors.lastname: Kreuzer
mesh_terms: D000818:Animals; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017209:Apoptosis / Q000187:drug effects; D020169:Caspases / Q000378:metabolism; D045744:Cell Line, Tumor; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007191:Indazoles; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy*; D051379:Mice; D010766:Phosphorylation; D010793:Phthalazines / Q000008:administration & dosage / Q000627:therapeutic use*; D047428:Protein Kinase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D011725:Pyridines / Q000008:administration & dosage / Q000627:therapeutic use*; D011743:Pyrimidines / Q000008:administration & dosage / Q000627:therapeutic use*; D040262:Receptors, Vascular Endothelial Growth Factor / Q000037:antagonists & inhibitors / Q000378:metabolism; D013449:Sulfonamides / Q000008:administration & dosage / Q000627:therapeutic use*; D023041:Xenograft Model Antitumor Assays
chemical_list: D007191:Indazoles; D010793:Phthalazines; D047428:Protein Kinase Inhibitors; D011725:Pyridines; D011743:Pyrimidines; D013449:Sulfonamides; C404768:vatalanib; C516667:pazopanib; D040262:Receptors, Vascular Endothelial Growth Factor; D020169:Caspases