Blocking the Unblockable

 

It’s very nearly 40 years since the first human ‘cancer gene’ was identified — in 1982 to be precise. By ‘cancer gene’ we mean a region of DNA that encodes a protein that has a role in normal cell behaviour but that has acquired a mutation of some sort that confers abnormal activity on the protein.

The discovery of RAS ‘oncogene’ activation by DNA and protein mutation stimulated intense activity in unveiling the origins of cancer at the molecular level that has continued to this day. It’s been an exciting and sobering story and RAS has emerged as perhaps the best example you could have of the paradox of cancer. On the one hand it seems startlingly simple: on the other it’s been impenetrably complex.

The simple bit first

Relatively quickly it was shown that there were three closely related RAS genes (KRAS, HRAS & NRAS): they all encode a small protein of just 189 amino acids and they all act as a molecular switches. That means RAS proteins can bind to a small regulator molecule (it’s GTP (guanosine triphosphate) — one of the nucleotides found in DNA and RNA). When that happens RAS changes shape so that it can interact with (i.e. stick to) a variety of effector proteins within the cell. These trigger signalling cascades that ultimately control the activity of genes in the nucleus that control cell proliferation, cell cycle progression and apoptosis (cell death). The switch is flicked off when GTP is converted to GDP — so RAS looses its effector binding capacity.

The other simple bit is that RAS turned out to be one end of the spectrum of DNA damage that can activate an oncogene: the smallest possible change in DNA — mutation of just one base changed one amino acid in the RAS protein and hence its shape. Result: permanently switched on RAS: it’s always stuck to GTP.

Cell signalling. Cells receive many signals from messengers that attach to receptor proteins spanning the outer membrane. Activated receptors turn on relays of proteins. RAS proteins are key nodes that transmit multiple signals. The coloured blocks represent a RAS controlled pathway (a relay of proteins, A, B, C, D) that ‘talk’ to the nucleus, switching on genes that drive proliferation. The arrows diverging from RAS indicate that it regulates many pathways controlling such processes as actin cytoskeletal integrity, cell proliferation, cell differentiation, cell adhesion, apoptosis and cell migration.

Oncogenic RAS and human cancers

We’ve noted that RAS signalling controls functions critical in cancer development and it’s therefore not surprising that it’s mutated, on average, in 22% of all human tumours with pancreatic cancer being an extreme example where 90% of tumours have RAS mutations (the form of RAS is actually KRAS). Those facts, together with the seeming simplicity of its molecular action, put RAS at the top of the target table for chemists seeking cancer therapies. We’ve tried to keep up with events in Mission Impossible, Molecular Dominoes and Where’s that tumour? but the repeated story has been that the upshot of the expenditure of much cash, inspiration and perspiration has, until fairly recently, been zippo. Lots of runners but none that made it into clinical trials. However, that has slowly begun to change over the last ten years and now at least five KRAS-modulating agents are in clinical trials.

A few months back Kevin Lou, Kevan Shokat and colleagues at the University of California published a study of a small molecule, ARS-1620, showing that it inhibited mutant KRAS in lung and pancreatic cancer cells. They screened for other interactions that contribute to the KRAS-driven tumour state and identified two sets of such effectors, one enhancing the engagement of ARS-1620 with its target and others that regulated tumour survival pathways in cells and in vivo. Targetting these synergised with ARS-1620 in suppressing tumour growth.

The RAS switch. Scheme of normal RAS action (top): replacement of a bound guanosine diphosphate (GDP) molecule with guanosine triphosphate (GTP) flips the switch so that RAS can interact with other proteins to turn on downstream signalling pathways that control cell growth and differentiation. Oncogenic RAS (with a single amino acid change at position 12 (Glycine to Valine) blocks the breakdown of bound GTP so the switch is always ‘on’. The new small molecule inhibitor characterized by Canon et al., AMG 510, interacts with KRASG12C to block GTP binding. The switch remains ‘off’ and the cancer-promoting activity of mutant KRAS is inhibited.

More recently Jude Canon at Amgen Research, together with colleagues from a number of institutes, described another small molecule, AMG 510, that also recognises the mutant form of KRAS with high specificity, hence impairing cell proliferation. In mice carrying human pancreatic tumours AMG 510 caused permanent tumour regression — provided the mice had functioning immune systems. In mice lacking T cells (i.e. ‘nude’ mice) the tumours re-grew but combining AMG 510 with immunotherapy (an antibody against anti-PD1) gave complete tumour regression. AMG 510 stimulated the expression of inflammatory chemokines that promoted infiltration of the tumours by T cells and dendritic cells (sometimes called ‘antigen-presenting cells’, these cells process antigens and present fragments thereof on their surface to T cells and B cells to promote the adaptive immune response). In preliminary trials four patients with non-small cell lung cancer showed significant effects — either tumour shrinkage or complete inhibition of growth.

So maybe at long last the enigma of RAS is being prised open. The efficacy of AMG 510 against lung cancers is particularly heartening as there remains little in the way of therapeutic options for these tumours.

References

Canon, J. et al. (2019). The clinical KRAS(G12C) inhibitor AMG 510 drives anti-tumour immunity. Nature 575, 217–223.

Lou, K. et al. (2019). KRASG12C inhibition produces a driver-limited state revealing collateral dependencies. Science Signaling 12, Issue 583, eaaw9450. DOI: 10.1126/scisignal.aaw9450

Taking the MYC out of cancer

It has been famously said, though no one quite knows who gave first utterance, that England and America are two nations divided by a common language. In deference to readers from the US of A, therefore, we need a word about English before we embark on the current topic. You can get quite a long way in the States on an English accent, partly because the inhabitants are, by and large, very tolerant and cosmopolitan souls and also because they perceive Brits as being rather weird but harmlessly entertaining – at least since they gave up the idea of owning America, signed the Treaty of Paris and slung their hook. But that last phrase is an example of how things can get sticky when you talk to an American audience and it slips your mind that 1783 was quite a long time ago – long enough in fact for a good deal of divergent language evolution. Put another way, use idioms unthinkingly and you can die the death – leaving your listeners wishing that you would indeed sling your hook (American translation: beat it). One of the odder things about this linguistic separation is that American doesn’t have a good phrase that means gently making fun of someone. You can pull a Yankee leg it is true and you may mess them about – but that one’s really fraught as it carries a different innuendo in English. So it’s a pity that over there you can’t extract the Mick, take the Mickey or remove the Michael. It’s deeply regrettable that this phrase probably owes its origins to Cockney rhyming slang referring to the act of urination but strawberries grow in manure and all that. Similar pratfalls work in the other direction, of course, and British audiences are likely to look blank if you mention your keister: start talking about booty and mussing with someone and they’ll really be baffled.

To the current topic. We saw in Mission Impossible that many different pathways pass signals saying ‘grow’ from the outside world to the nucleus at the centre of a cell. Many of these relays use RAS proteins – they’re a major junction in the cellular network so they’re a very tempting target for disruption of signaling. But if all roads lead to Rome, so to speak, is there not an even better target – a main gate, the critical portal through which everything that drives cell proliferation must pass? There is and it’s called MYC (pronounced ‘mick’ – Ah! Now all is clear!!), the gene encoding a protein of the same sound that is a unique master regulator. MYC coordinates the expression of a large panel of genes involved in cell growth and division – it’s essential for cell proliferation.

 MYC pic

Cell signaling. Many messengers turn on lots of relays that focus on the nucleus telling cells to grow and divide. The MYC protein is a master coordinator.

But there’s an obvious problem: to survive we need to make new cells all the time – about one million every second, just to maintain the status quo. It seems hardly worth pointing out that if you gave someone a drug that blocked MYC it would be fatal: the body simply couldn’t survive for very long with a blocked cell production line. Indeed it’s been known for some time that knocking out the MYC gene in mice is fatal: they fail to develop beyond an early embryonic stage. And yet there’s a huge temptation to ask ‘What would inhibiting MYC do to tumors: might it actually kill them?’ – a curiosity fuelled by the knowledge that MYC is deregulated in most – perhaps all – cancers. That is, an almost invariable upshot of the mutation patterns found in tumors is that excessive amounts of MYC protein are made – and, as it drives cells round the cell cycle and into division, more MYC equals abnormal cell growth, aka cancer.

So, in an experiment that all logic said would not work, Gerard Evan and his colleagues in San Francisco and Cambridge devised a way to switch on an inhibitor of MYC in transgenic mice to ask the unaskable: ‘Is blocking MYC fatal and, if is isn’t, what does it do to tumors?’ The method is to use a trick of genetic engineering to give mice a novel gene that is switched on by dosing them with a drug added to their drinking water. Omitting the drug switches it off. The gene encodes a protein that sticks to the MYC protein and prevents it from interacting with its normal partner so that the dynamic duo that drives cell growth can’t be formed.

The results were startlingly dramatic. First of all, MYC blockade didn’t kill the mice although it certainly had some effects. A shaved patch of fur doesn’t re-grow quickly as it normally would and males become infertile because they can’t make new sperm. But the mice aren’t aware of these little problems and in general are as full of beans as their chums with normal levels of MYC activity – and in any case these mild effects are reversible. Switch off the MYC block and they return rapidly to normal.

That was surprising enough but the really staggering result came from introducing the MYC blockade into mice that develop lung tumors (driven by the expression of a mutant RAS gene). Inhibition of MYC has an almost immediate effect on tumor size: tumors regress and the side effects remain mild and reversible. A single burst of MYC blockade results in a significant extension of life span for tumor-bearing mice. Even more remarkable, successive episodes of MYC inhibition (a ‘metronomic’ regime) leads to the gradual eradication of the tumors – and the elimination of lung cancer means that the mice now have a normal life span.

It should be emphasized that so far this has only happened in mice and the Appian Way of cancer therapy is littered with the corpses of brilliant ideas that worked a treat in those wonderful little models but were utterly useless when it came to humans. However, science is the practice of eternal optimism and there are sound grounds for hope here. Switching a gene on and off by genetic engineering is fine in mice. It won’t do for us but already some small molecule inhibitors have been made that appear to work in mice. The hope is that both the anti-cancer effect and the mild side-effects will be recapitulated in humans – and that, because all pathways do indeed lead to it, taking the MYC out of cancer will kill tumours. Then the really optimistic bit – that even crafty cancer cells will be unable to find a way round such a block. Because all proliferation signals lead to MYC there will be no adaptive mechanism to which cells can turn to ensure their survival.

In short, the tumour will be stuffed – which rather brings us back to where we started except that, having taken the MYC, this needs no translation.

Reference

Soucek, L., Whitfield, J.R., Sodir, N.M., Massó-Vallés, D., Serrano, E., Karnezis, A.N., Swigart, L.B. and Evan, G.I. (2013). Inhibition of Myc family proteins eradicates KRas-driven lung cancer in mice. Genes Dev., 27, 504-513.