Itraconazole and arsenic trioxide inhibit Hedgehog pathway activation and tumor growth associated with acquired resistance to smoothened antagonists

Cancer Cell. 2013 Jan 14;23(1):23-34. doi: 10.1016/j.ccr.2012.11.017. Epub 2013 Jan 3.

Abstract

Recognition of the multiple roles of Hedgehog signaling in cancer has prompted intensive efforts to develop targeted pathway inhibitors. Leading inhibitors in clinical development act by binding to a common site within Smoothened, a critical pathway component. Acquired Smoothened mutations, including SMO(D477G), confer resistance to these inhibitors. Here, we report that itraconazole and arsenic trioxide, two agents in clinical use that inhibit Hedgehog signaling by mechanisms distinct from that of current Smoothened antagonists, retain inhibitory activity in vitro in the context of all reported resistance-conferring Smoothened mutants and GLI2 overexpression. Itraconazole and arsenic trioxide, alone or in combination, inhibit the growth of medulloblastoma and basal cell carcinoma in vivo, and prolong survival of mice with intracranial drug-resistant SMO(D477G) medulloblastoma.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anilides / pharmacology
  • Anilides / therapeutic use
  • Animals
  • Antineoplastic Agents / pharmacology
  • Antineoplastic Agents / therapeutic use*
  • Arsenic Trioxide
  • Arsenicals / pharmacology
  • Arsenicals / therapeutic use*
  • Carcinoma, Basal Cell / drug therapy*
  • Carcinoma, Basal Cell / metabolism
  • Carcinoma, Basal Cell / pathology
  • Drug Resistance, Neoplasm
  • Hedgehog Proteins / metabolism
  • Hedgehog Proteins / physiology*
  • Itraconazole / pharmacology
  • Itraconazole / therapeutic use*
  • Medulloblastoma / drug therapy*
  • Medulloblastoma / metabolism
  • Medulloblastoma / pathology
  • Mice
  • Oxides / pharmacology
  • Oxides / therapeutic use*
  • Pyridines / pharmacology
  • Pyridines / therapeutic use
  • Receptors, G-Protein-Coupled / antagonists & inhibitors
  • Signal Transduction / drug effects*
  • Smoothened Receptor

Substances

  • Anilides
  • Antineoplastic Agents
  • Arsenicals
  • Hedgehog Proteins
  • HhAntag691
  • Oxides
  • Pyridines
  • Receptors, G-Protein-Coupled
  • Smo protein, mouse
  • Smoothened Receptor
  • Itraconazole
  • Arsenic Trioxide