Vincristine and bortezomib use distinct upstream mechanisms to activate a common SARM1-dependent axon degeneration program

JCI Insight. 2019 Sep 5;4(17):e129920. doi: 10.1172/jci.insight.129920.


Chemotherapy-induced peripheral neuropathy is one of the most prevalent dose-limiting toxicities of anticancer therapy. Development of effective therapies to prevent chemotherapy-induced neuropathies could be enabled by a mechanistic understanding of axonal breakdown following exposure to neuropathy-causing agents. Here, we reveal the molecular mechanisms underlying axon degeneration induced by 2 widely used chemotherapeutic agents with distinct mechanisms of action: vincristine and bortezomib. We showed previously that genetic deletion of SARM1 blocks vincristine-induced neuropathy and demonstrate here that it also prevents axon destruction following administration of bortezomib in vitro and in vivo. Using cultured neurons, we found that vincristine and bortezomib converge on a core axon degeneration program consisting of nicotinamide mononucleotide NMNAT2, SARM1, and loss of NAD+ but engage different upstream mechanisms that closely resemble Wallerian degeneration after vincristine and apoptosis after bortezomib. We could inhibit the final common axon destruction pathway by preserving axonal NAD+ levels or expressing a candidate gene therapeutic that inhibits SARM1 in vitro. We suggest that these approaches may lead to therapies for vincristine- and bortezomib-induced neuropathies and possibly other forms of peripheral neuropathy.

Keywords: Apoptosis pathways; Cell Biology; Neurological disorders; Neuromuscular disease; Neuroscience.

Publication types

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

MeSH terms

  • Animals
  • Antineoplastic Agents / pharmacology
  • Apoptosis
  • Armadillo Domain Proteins / drug effects*
  • Armadillo Domain Proteins / genetics
  • Armadillo Domain Proteins / metabolism*
  • Axons / metabolism*
  • Axons / pathology
  • Bortezomib / pharmacology*
  • Cytoskeletal Proteins / drug effects*
  • Cytoskeletal Proteins / genetics
  • Cytoskeletal Proteins / metabolism*
  • Drug Therapy
  • Female
  • Gene Expression Regulation, Neoplastic
  • Genetic Therapy
  • Humans
  • Male
  • Mice
  • Mice, Inbred C57BL
  • Mice, Knockout
  • Nerve Degeneration / drug therapy
  • Nerve Degeneration / genetics
  • Nerve Degeneration / metabolism*
  • Nerve Degeneration / pathology
  • Neurons / metabolism
  • Nicotinamide Mononucleotide
  • Nicotinamide-Nucleotide Adenylyltransferase
  • Vincristine / pharmacology*


  • Antineoplastic Agents
  • Armadillo Domain Proteins
  • Cytoskeletal Proteins
  • SARM1 protein, human
  • SARM1 protein, mouse
  • Nicotinamide Mononucleotide
  • Vincristine
  • Bortezomib
  • NMNAT2 protein, human
  • Nicotinamide-Nucleotide Adenylyltransferase