Abstract 15624: The Anti-lung Cancer Drug (R)-crizotinib Predisposes and Exacerbates Pulmonary Hypertension

Abstract

Introduction: Pulmonary arterial hypertension (PAH) is a vascular disease characterized by persistent elevation of pulmonary vascular resistance leading to right heart failure and death. In 10% of cases, PAH is induced by drugs including chemotherapeutic agents such as RTK inhibitors (e.g. dasatinib). (R)-Crizotinib is an ALK/ROS1/MET inhibitor increasingly used for the treatment of non-small cell lung cancer (NSCLC). Interestingly, (R)-Crizotinib has been shown to induce endothelial cells (EC) dysfunction and is associated with dyspnea and peripheral oedema, which are central symptoms of PAH. We thus hypothesized that chronic administration of (R)-Crizotinib exacerbates and predisposes PAH. Material and results: We found that daily administration of (R)-Crizotinib (100mg/kg for 2 weeks) in Sugen/Hypoxia (Su/Hx) PAH rat model significantly increased mortality rates. Compared to vehicle-treated rats, (R)-Crizotinib was associated with worsening of hemodynamic parameters (RVSP, mPAP, SV, CO and TPR measured by right heart catheterization; p<0.05; n=4-6). Histologically, (R)-Crizotinib enhanced pulmonary arteries (PA) wall thickness (EVG stain; p<0.05) and increased fibrosis and macrophages accumulation in the lungs and right ventricle. In addition, we showed that pretreatment of rats with (R)-Crizotinib exaggerates the response to monocrotaline (MCT, 40mg/kg), as revealed by histological (increase in vascular remodeling) and hemodynamic measurements (mPAP; TPR; CO) (p<0.01; n=7-10). In vitro, (R)-Crizotinib reduced MET and AKT activation (WB) in human PA endothelial cells promoting endothelial dysfunction via decreased proliferation (Ki67) and increased apoptosis (Annexin V) rates. In addition, (R)-Crizotinib interferes with autophagy flux (increase in LC3-II and p62 accumulation) and was accompanied by the appearance of atypical morphological phenotypes in PA endothelial cells (multinucleated cells). Conclusion: We showed for the first time that (R)-Crizotinib treatment predisposes and exacerbates PAH in animal models (Sugen/Hypoxia and monocrotaline). Understanding the mechanism will provide promising perspectives for a better management of patients treated with (R)-Crizotinib or ALK/ROS1/MET inhibitors.