Combined therapy of AXL and HDAC inhibition reverses mesenchymal transition in diffuse intrinsic pontine glioma

Michaël H. Meel, Mark C. de Gooijer, Dennis S. Metselaar, Charlotte P.A. Sewing, Kenn Zwaan, Piotr Waranecki, Marjolein Breur, Levi C.M. Buil, Tonny Lagerweij, Laurine E. Wedekind, Jos W.R. Twisk, Jan Koster, Rintaro Hashizume, Eric H. Raabe, Ángel Montero Carcaboso, Marianna Bugiani, Timothy N. Phoenix, Olaf van Tellingen, Dannis G. van Vuurden, Gertjan J.L. KaspersEsther Hulleman*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

41 Scopus citations


Purpose: Diffuse intrinsic pontine glioma (DIPG) is an incurable type of pediatric brain cancer, which in the majority of cases is driven by mutations in genes encoding histone 3 (H3K27M). We here determined the preclinical therapeutic potential of combined AXL and HDAC inhibition in these tumors to reverse their mesenchymal, therapy-resistant, phenotype. Experimental Design: We used public databases and patient-derived DIPG cells to identify putative drivers of the mesenchymal transition in these tumors. Patient-derived neurospheres, xenografts, and allografts were used to determine the therapeutic potential of combined AXL/HDAC inhibition for the treatment of DIPG. Results: We identified AXL as a therapeutic target and regulator of the mesenchymal transition in DIPG. Combined AXL and HDAC inhibition had a synergistic and selective antitumor effect on H3K27M DIPG cells. Treatment of DIPG cells with the AXL inhibitor BGB324 and the HDAC inhibitor panobinostat resulted in a decreased expression of mesenchymal and stem cell genes. Moreover, this combination treatment decreased expression of DNA damage repair genes in DIPG cells, strongly sensitizing them to radiation. Pharmacokinetic studies showed that BGB324, like panobinostat, crosses the blood-brain barrier. Consequently, treatment of patient-derived DIPG xenograft and murine DIPG allograft-bearing mice with BGB324 and panobinostat resulted in a synergistic antitumor effect and prolonged survival. Conclusions: Combined inhibition of AXL and HDACs in DIPG cells results in a synergistic antitumor effect by reversing their mesenchymal, stem cell-like, therapy-resistant phenotype. As such, this treatment combination may serve as part of a future multimodal therapeutic strategy for DIPG.

Original languageEnglish (US)
Pages (from-to)3319-3332
Number of pages14
JournalClinical Cancer Research
Issue number13
StatePublished - Jul 2020

ASJC Scopus subject areas

  • General Medicine


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