Abstract 3596: The combinatory effect of bevacizumab and metabolic inhibitors on angiogenesis and autophagy in gastrointestinal cancer cells
Authors: Mahfouz Nadine , Ammoury Rita , Moussa Mayssam , Khalil Charbel , Aoun Joe , Hilal George 
Published: August 2019

Abstract
Background: Bevacizumab is anti-VEGF drug that has shown therapeutic. However, treatment with bevacizumab has been associated to the development of resistance in several types of cancer. Glycolysis has been considered as a potential target for anti-cancer therapies and several molecules that target this pathway have been developed, including 2-Deoxy-D-glucose (2-DG) and 3-Bromopyruvate (3-BP). Autophagy is a process that degrades cellular organelles and proteins and maintains cellular biosynthesis during nutrient deprivation or metabolic stress. Since anti-angiogenic therapy and metabolic inhibitors both lead to nutrient deprivation in cancers, we investigated how a combination therapy would affect angiogenesis and autophagy in gastrointestinal cancer cells.
Methods: AGS and Caco-2 cells were treated with glycolysis inhibitors 2-DG (4 mM) and 3-BP (20 µM), in the presence or in the absence of bevacizumab at 100 µg/ml. Cell proliferation was assessed using tetrazolium salt. VEGF protein levels were quantified by ELISA. Autophagy and apoptosis markers’ expression was assessed by quantitative real time PCR. Tube formation by human umbilical vein endothelial cells (HUVECs) was assessed using ECMatrix™.
Results: Our results showed that combining bevacizumab to 2-DG decreased AGS and Caco-2 cells’ proliferation rates compared to each of these compounds alone. Interestingly, VEGF quantification showed that 2-DG increased VEGF secretion, in contrary to 3-BP. Moreover, our results showed that 3-BP reduced tube formation by HUVECs and amplified bevacizumab’s anti-angiogenic effect when combined together. In autophagy markers’ assessment, our results showed that 2-DG, 3-BP, and bevacizumab treatment increased FOXO1, FOXO3, LC3II, and HIF-1α expression. However, Beclin-1 expression, a protein implicated in the autophagic programmed cell death, decreased following bevacizumab treatment while it was upregulated by 2-DG and 3-BP. Hence, it was important to evaluate apoptotic markers’ expression, caspase-3 and BAX. Our results showed that bevacizumab decreased caspase-3 and BAX expression while their expression was upregulated by 2-DG and that its combination to bevacizumab reestablished their levels.
Conclusions: Taken together, our results suggest that 2-DG and 3-BP, both improve cancer cells response to bevacizumab treatment by increasing its antiangiogenic outcome and reversing its anti-apoptotic effect. Moreover, it was interesting to find that bevacizumab treatment decreased Beclin-1, caspase-3, and BAX expression, suggesting a possible implication of autophagy in the development of resistance to bevacizumab. Hence, further studies are required in order to uncover the means by which bevacizumab modulates cancer cells autophagy and metabolism, and the effect of these changes on cancer cells survival.
Citation Format: Nadine Mahfouz, Rita Ammoury, Mayssam Moussa, Charbel Khalil, Joe Aoun, George Hilal. The combinatory effect of bevacizumab and metabolic inhibitors on angiogenesis and autophagy in gastrointestinal cancer cells [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3596.