VEGF165b, an antiangiogenic VEGF-A isoform, binds and inhibits bevacizumab treatment in experimental colorectal carcinoma: balance of pro- and antiangiogenic VEGF-A isoforms has implications for therapy

Abstract

Bevacizumab, an anti-vascular endothelial growth factor (VEGF-A) antibody, is used in metastatic colorectal carcinoma (CRC) treatment, but responses are unpredictable. Vascular endothelial growth factor is alternatively spliced to form proangiogenic VEGF165 and antiangiogenic VEGF165b. Using isoform-specific enzyme-linked immunosorbent assay and quantitative polymerase chain reaction, we found that over 90% of the VEGF in normal colonic tissue was VEGFxxxb, but there was a variable upregulation of VEGFxxx and downregulation of VEGFxxxb in paired human CRC samples. Furthermore, cultured colonic adenoma cells expressed predominantly VEGFxxxb, whereas colonic carcinoma cells expressed predominantly VEGFxxx. However, adenoma cells exposed to hypoxia switched their expression from predominantly VEGFxxxb to predominantly VEGFxxx. VEGF165b overexpression in LS174t colon cancer cells inhibited colon carcinoma growth in mouse xenograft models. Western blotting and surface plasmon resonance showed that VEGF165b bound to bevacizumab with similar affinity as VEGF165. However, although bevacizumab effectively inhibited the rapid growth of colon carcinomas expressing VEGF165, it did not affect the slower growth of tumours from colonic carcinoma cells expressing VEGF165b. Both bevacizumab and anti-VEGF165b-specific antibodies were cytotoxic to colonic epithelial cells, but less so to colonic carcinoma cells. These results show that the balance of antiangiogenic to proangiogenic isoforms switches to a variable extent in CRC, regulates tumour growth rates and affects the sensitivity of tumours to bevacizumab by competitive binding. Together with the identification of an autocrine cytoprotective role for VEGF165b in colonic epithelial cells, these results indicate that bevacizumab treatment of human CRC may depend upon this balance of VEGF isoforms.