posted on 2025-11-26, 13:40authored byPamela J. Maxwell, Melanie McKechnie, Christopher W. Armstrong, Judith M. Manley, Chee Wee Ong, Jenny Worthington, Ian G. Mills, Daniel B. Longley, James P. Quigley, Amina Zoubeidi, Johann S. de Bono, Elena Deryugina, Melissa J. LaBonte, David J.J. Waugh
<p>IL8 and VEGF signaling sustain AR pathway activation and modulate response to enzalutamide. Cells were treated with anti-IL8 nAb (5 μg/mL), anti-VEGF nAb (10 μg/mL) or the highest concentration of isotype-matched human IgG antibody. <b>A,</b> Effect of anti-IL8 nAb/anti-VEGF nAb on the response of hypoxic or normoxic LNCaP cells to 10 μmol/L Enazlutamide (Enz) over 72 hours. Data shown are mean ± SEM of <i>N</i> = 3 experiments. <b>B,</b> Effect of anti-IL8 nAb and/or anti-VEGF nAb on hypoxia (6 hours)-induced AR and AR-V7 expression in LNCaP and CWRR1 cells. Blots are representative of <i>N</i> = 3 experiments. Equal loading was assessed using GAPDH. Relative expression was determined by densitometry using Image J software. <b>C,</b> Effect of 10 μmol/L E (Enz) with anti-IL8 nAb (5 μg/mL), anti-VEGF nAb (10 μg/mL) or the highest concentration of isotype-matched human IgG antibody on viability of LNCaP cells under normoxia and hypoxia for 72 hours. <b>D,</b> Effect of VEGF (2 ng/mL) or rhIL8 (3 nmol/L) on tubule formation over 10 days. Suramin (20 μmol/L) was included as a negative control. <b>E,</b> Effect of CM harvested from LNCaP cells cultured in hypoxia for 24 hours, in the presence or absence of anti-IL8 nAb and/or anti-VEGF nAb, on tubule formation over 10 days. For both experiments (<b>D</b> and <b>E</b>), number of junctions was measured using AngioSys 2.0 software. Data are mean±SEM of <i>N</i> = 8 fields of view. <b>F,</b> Tumor growth data (<i>N</i> = 5/group), obtained by measuring tumor volume every 2 days for 28 days. Treatment groups were: vehicle-only (VC); Enz (4 mg/kg); Enz (4 mg/kg) + IgG (150 μg/mL); Enz (4 mg/kg) + anti-VEGF nAb (100 μg/mL); and Enz (4 mg/mL) + anti-VEGF (100 μg/mL) and anti-IL8 (50 μg/mL) nAbs. Treatment schematic is shown above graph. Data points represent mean ± SEM. <b>G,</b> Average tumor weights at study completion. Values are mean ± SEM (<i>N</i> = 5/group). For all experiments statistical analysis was carried out using Student two-tailed <i>t</i> test or Mann–Whitney U test: *, <i>P</i> < 0.05; **, <i>P</i> < 0.01; ***, <i>P</i> < 0.001.</p>
Inhibiting androgen signaling using androgen signaling inhibitors (ASI) remains the primary treatment for castrate-resistant prostate cancer. Acquired resistance to androgen receptor (AR)-targeted therapy represents a major impediment to durable clinical response. Understanding resistance mechanisms, including the role of AR expressed in other cell types within the tumor microenvironment, will extend the clinical benefit of AR-targeted therapy. Here, we show the ASI enzalutamide induces vascular catastrophe and promotes hypoxia and microenvironment adaptation. We characterize treatment-induced hypoxia, and subsequent induction of angiogenesis, as novel mechanisms of relapse to enzalutamide, highlighting the importance of two hypoxia-regulated cytokines in underpinning relapse. We confirmed AR expression in CD34+ vascular endothelium of biopsy tissue and human vascular endothelial cells (HVEC). Enzalutamide attenuated angiogenic tubule formation and induced cytotoxicity in HVECs in vitro, and rapidly induced sustained hypoxia in LNCaP xenografts. Subsequent reoxygenation, following prolonged enzalutamide treatment, was associated with increased tumor vessel density and accelerated tumor growth. Hypoxia increased AR expression and transcriptional activity in prostate cells in vitro. Coinhibition of IL8 and VEGF-A restored tumor response in the presence of enzalutamide, confirming the functional importance of their elevated expression in enzalutamide-resistant models. Moreover, coinhibition of IL8 and VEGF-A resulted in a durable, effective resolution of enzalutamide-sensitive prostate tumors. We conclude that concurrent inhibition of two hypoxia-induced factors, IL8 and VEGF-A, prolongs tumor sensitivity to enzalutamide in preclinical models and may delay the onset of enzalutamide resistance.
Targeting hypoxia-induced signaling may extend the therapeutic benefit of enzalutamide, providing an improved treatment strategy for patients with resistant disease.