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      EGFRvIII expression triggers a metabolic dependency and therapeutic vulnerability sensitive to autophagy inhibition

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          Expression of EGFRvIII is frequently observed in glioblastoma and is associated with increased cellular proliferation, enhanced tolerance to metabolic stresses, accelerated tumor growth, therapy resistance and poor prognosis. We observed that expression of EGFRvIII elevates the activation of macroautophagy/autophagy during starvation and hypoxia and explored the underlying mechanism and consequence. Autophagy was inhibited (genetically or pharmacologically) and its consequence for tolerance to metabolic stress and its therapeutic potential in (EGFRvIII +) glioblastoma was assessed in cellular systems, (patient derived) tumor xenopgrafts and glioblastoma patients. Autophagy inhibition abrogated the enhanced proliferation and survival advantage of EGFRvIII + cells during stress conditions, decreased tumor hypoxia and delayed tumor growth in EGFRvIII + tumors. These effects can be attributed to the supporting role of autophagy in meeting the high metabolic demand of EGFRvIII + cells. As hypoxic tumor cells greatly contribute to therapy resistance, autophagy inhibition revokes the radioresistant phenotype of EGFRvIII + tumors in (patient derived) xenograft tumors. In line with these findings, retrospective analysis of glioblastoma patients indicated that chloroquine treatment improves survival of all glioblastoma patients, but patients with EGFRvIII + glioblastoma benefited most. Our findings disclose the unique autophagy dependency of EGFRvIII + glioblastoma as a therapeutic opportunity. Chloroquine treatment may therefore be considered as an additional treatment strategy for glioblastoma patients and can reverse the worse prognosis of patients with EGFRvIII + glioblastoma.

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          Most cited references 55

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          Hypoxia--a key regulatory factor in tumour growth.

           Claire Harris (2001)
          Cells undergo a variety of biological responses when placed in hypoxic conditions, including activation of signalling pathways that regulate proliferation, angiogenesis and death. Cancer cells have adapted these pathways, allowing tumours to survive and even grow under hypoxic conditions, and tumour hypoxia is associated with poor prognosis and resistance to radiation therapy. Many elements of the hypoxia-response pathway are therefore good candidates for therapeutic targeting.
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            Autophagy and metabolism.

            Autophagy is a process of self-cannibalization. Cells capture their own cytoplasm and organelles and consume them in lysosomes. The resulting breakdown products are inputs to cellular metabolism, through which they are used to generate energy and to build new proteins and membranes. Autophagy preserves the health of cells and tissues by replacing outdated and damaged cellular components with fresh ones. In starvation, it provides an internal source of nutrients for energy generation and, thus, survival. A powerful promoter of metabolic homeostasis at both the cellular and whole-animal level, autophagy prevents degenerative diseases. It does have a downside, however--cancer cells exploit it to survive in nutrient-poor tumors.
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              The role of autophagy in cancer development and response to therapy.

              Autophagy is a process in which subcellular membranes undergo dynamic morphological changes that lead to the degradation of cellular proteins and cytoplasmic organelles. This process is an important cellular response to stress or starvation. Many studies have shed light on the importance of autophagy in cancer, but it is still unclear whether autophagy suppresses tumorigenesis or provides cancer cells with a rescue mechanism under unfavourable conditions. What is the present state of our knowledge about the role of autophagy in cancer development, and in response to therapy? And how can the autophagic process be manipulated to improve anticancer therapeutics?

                Author and article information

                Taylor & Francis
                29 January 2018
                29 January 2018
                : 14
                : 2
                : 283-295
                [a ]Department of Radiotherapy, GROW – School for Oncology and Developmental Biology, Maastricht University Medical Centre+ , Maastricht, The Netherlands
                [b ]Department of Clincial Pathology, Zuyderland MC , Sittard-Geleen, The Netherlands
                [c ]Department of Neurosurgery, Maastricht University Medical Centre
                [d ]Department of Radiation Oncology, Radboud University Medical Center , Nijmegen, The Netherlands
                [e ]Neuroimmunology and Neuro-Oncology Unit, National Institute of Neurology and Neurosurgery , Mexico City, Mexico
                [f ]Heinrich- Heine University Duesseldorf , Germany
                [g ]Department of Radiation Oncology (MAASTRO Clinic), GROW School for Oncology and Developmental Biology , Maastricht University Medical Centre+, The Netherlands
                Author notes
                Kasper M. A. Rouschop Kasper.Rouschop@ Maastricht Radiation Oncology (MaastRO) lab, GROW – School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands

                Color versions of one or more of the figures in the article can be found online at

                Supplemental data for this article can be accessed here

                © 2018 Taylor & Francis

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Figures: 6, Tables: 2, References: 55, Pages: 13
                Funded by: Worldwide Cancer Research 10.13039/100011713
                Award ID: 16-0265
                Funded by: KWF Kankerbestrijding 10.13039/501100004622
                Award ID: 2012-5506, 2015-7735
                This work was supported by the Worldwide Cancer Research [grant number 16-0265]; diseases fund; KWF Kankerbestrijding [grant number 2012-5506], [grant number 2015-7735].
                Research Papers - Basic Science
                Research Paper-Translational


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