Abstract P148: Glycogen phosphorylase and synthase inhibitors: Novel therapeutic approaches in anaplastic thyroid cancer
Authors: Davidson Cole , Tomczak Jennifer , Amiel Eyal , Carr Frances 
Published: December 2021

Abstract
Thyroid cancer (TC) is the most common endocrine cancer. Effective treatment options for papillary (PTC) and follicular (FTC) thyroid cancers afford positive patient prognoses. However, there are no effective, long-lasting treatments for anaplastic thyroid cancer (ATC), which has a median survival of five to six months. While the receptor tyrosine kinase inhibitor sorafenib can extend ATC patient survival to eleven months, tumor reoccurrence and drug resistance often develop. Therefore, there is a need for more effective targeted therapies for ATC. While the cell signaling landscape is well described in ATC, little is known about tumorigenic adaptations in ATC metabolism. Tumors exhibit an increased consumption of glucose compared to normal tissues to fuel tumor progression. Some cancers meet this high glucose requirement by storing and breaking down glycogen. While glycogen has been detected in bovine and canine thyroids, no report thus far has investigated glycogen in normal human thyroids or thyroid cancer. Therefore, our objective was to determine if normal thyroid and TC cells metabolize glycogen and to evaluate pharmacological inhibition of glycogen metabolism in ATC cells. We show for the first time that normal thyroid, PTC, FTC, and ATC cells express glycogen synthase and glycogen phosphorylase brain and liver (PYGB, PYGL) isoforms. We confirmed these observations in patient samples of normal thyroid and TC tissues via immunofluorescence. We revealed that the TC samples expressed high levels of PYGB compared to normal thyroid tissue. Electron microscopy revealed that normal thyroid cells organized glycogen in discrete glycosomes, while ATC cells exhibited smaller, dispersed glycogen packets. Importantly, we demonstrated that the glycogen synthase inhibitor guaiacol depleted glycogen content and reduced ATC cell viability. Conversely, the glycogen phosphorylase inhibitor CP-91,149 (CP) increased glycogen levels and induced apoptosis. Importantly, CP also reduced the number of stem cells in the ATC cell population. We further showed that CP synergized with sorafenib to more effectively inhibit ATC proliferation. CP enhanced glycolysis but inhibited oxidative phosphorylation as revealed using Seahorse. We confirmed an increase in glucose transporter expression using RT-qPCR and glucose import following CP treatment. This possibly represents a futile response to PYGB inhibition. We reasoned that glycogen was preferentially metabolized in ATC to fuel the pentose phosphate pathway to protect against reactive oxygen species (ROS). Indeed, we detected significantly higher levels of ROS in ATC cells treated with CP. We demonstrated that thyroid cells are able to metabolize glycogen and identified a potential biomarker for thyroid cancer (PYGB), which was targeted with CP-91,149. Our work establishes glycogen metabolism as a novel metabolic process in thyroid cells that is associated with TC dedifferentiation and provides insight to the effectiveness of inhibiting glycogen metabolism as a novel therapeutic strategy in ATC.
Citation Format: Cole Davidson, Jennifer Tomczak, Eyal Amiel, Frances Carr. Glycogen phosphorylase and synthase inhibitors: Novel therapeutic approaches in anaplastic thyroid cancer [abstract]. In: Proceedings of the AACR-NCI-EORTC Virtual International Conference on Molecular Targets and Cancer Therapeutics; 2021 Oct 7-10. Philadelphia (PA): AACR; Mol Cancer Ther 2021;20(12 Suppl):Abstract nr P148.