Targeting the Proline–Glutamine–Asparagine–Arginine Metabolic Axis in Amino Acid Starvation Cancer Therapy

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Targeting the Proline–Glutamine–Asparagine–Arginine Metabolic Axis in Amino Acid Starvation Cancer Therapy pharmaceuticals Review Targeting the Proline–Glutamine–Asparagine–Arginine Metabolic Axis in Amino Acid Starvation Cancer Therapy Macus Tien Kuo 1,*, Helen H. W. Chen 2, Lynn G. Feun 3 and Niramol Savaraj 4 1 Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA 2 Department of Radiation Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70428, Taiwan; [email protected] 3 Department of Medicine, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL 33136, USA; [email protected] 4 Division of Hematology and Oncology, Miami Veterans Affairs Heaithcare System, Miami, FL 33136, USA; [email protected] * Correspondence: [email protected] Abstract: Proline, glutamine, asparagine, and arginine are conditionally non-essential amino acids that can be produced in our body. However, they are essential for the growth of highly proliferative cells such as cancers. Many cancers express reduced levels of these amino acids and thus require import from the environment. Meanwhile, the biosynthesis of these amino acids is inter-connected but can be intervened individually through the inhibition of key enzymes of the biosynthesis of these amino acids, resulting in amino acid starvation and cell death. Amino acid starvation strategies have been in various stages of clinical applications. Targeting asparagine using asparaginase has been approved for treating acute lymphoblastic leukemia. Targeting glutamine and arginine starvations are in various stages of clinical trials, and targeting proline starvation is in preclinical development. The most important obstacle of these therapies is drug resistance, which is mostly due to reactivation of the key enzymes involved in biosynthesis of the targeted amino acids and reprogramming of Citation: Kuo, M.T.; Chen, H.H.W.; compensatory survival pathways via transcriptional, epigenetic, and post-translational mechanisms. Feun, L.G.; Savaraj, N. Targeting the Here, we review the interactive regulatory mechanisms that control cellular levels of these amino acids Proline–Glutamine–Asparagine– for amino acid starvation therapy and how drug resistance is evolved underlying treatment failure. Arginine Metabolic Axis in Amino Acid Starvation Cancer Therapy. Keywords: amino acid starvation therapy; proline; glutamine; arginine; asparagine; drug resistance Pharmaceuticals 2021, 14, 72. https://doi.org/10.3390/ph14010072 Received: 28 December 2020 1. Introduction Accepted: 15 January 2021 Published: 18 January 2021 Amino acid starvation therapy has been emerging as an important treatment strategy in cancer therapy. This strategy is based on the promise of differential requirements of Publisher’s Note: MDPI stays neutral amino acids for supporting cell proliferation between cancer cells and normal cells. The non- with regard to jurisdictional claims in essential amino acids such as proline (Pro), glutamine (Gln), asparagine (Asn), and arginine published maps and institutional affil- (Arg) support this promise. While these amino acids can be synthesized endogenously in iations. normal cells, many human tumors, ranging from leukemia to solid cancers, do not produce sufficient amounts of these amino acids in supporting their growth. This is because the key enzymes involved in biosynthetic pathways of these amino acids are silenced. This forces tumor cells to acquire extracellular sources of amino acids to support their intracellular Copyright: © 2021 by the authors. need. Depleting these extracellular supplies result in amino acid starvation and cell death. Licensee MDPI, Basel, Switzerland. 2. The Interconnecting Proline–Glutamine–Asparagine–Arginine Metabolic Wiring in This article is an open access article Cancer Cells distributed under the terms and conditions of the Creative Commons Cells obtain amino acids from two major routes: one from the extracellular environ- Attribution (CC BY) license (https:// ment through various amino acid transporters [1] and the other from de novo biosynthesis. creativecommons.org/licenses/by/ At least 32 human solute carriers (SLC), belonging to seven families, are involved in trans- 4.0/). porting amino acids. Many of them transport multiple amino acids; likewise, multiple Pharmaceuticals 2021, 14, 72. https://doi.org/10.3390/ph14010072 https://www.mdpi.com/journal/pharmaceuticals Pharmaceuticals 2021, 14, x FOR PEER REVIEW 2 of 20 2. The Interconnecting Proline–Glutamine–Asparagine–Arginine Metabolic Wiring in Cancer Cells Cells obtain amino acids from two major routes: one from the extracellular environ- Pharmaceuticals 2021, 14, 72 ment through various amino acid transporters [1] and the other from de novo biosynthesis. 2 of 20 At least 32 human solute carriers (SLC), belonging to seven families, are involved in trans- porting amino acids. Many of them transport multiple amino acids; likewise, multiple amino acidsamino can acids be transported can be transported by the same by the SLC. same The SLC. high The redundancies high redundancies of these oftrans- these trans- porters portersin conjunction in conjunction of interconnecting of interconnecting de novo de biosynthetic novo biosynthetic processes processes of amino of acids amino acids such as suchPro, Gln, as Pro, Asn, Gln, and Asn, Arg and provide Arg provide opportunities opportunities but also but challenges also challenges for successful for successful targetedtargeted amino acid amino starvation acid starvation therapy therapy that will that be discussed will be discussed here. here. Figure 1Figure illustrates1 illustrates the interconnecting the interconnecting networks networks of amino of acids amino Pro, acids Gln, Pro, Asn, Gln, and Asn, and Arg metabolism.Arg metabolism. We place We glutamate place glutamate (Glu) in (Glu) the center in the centerof the ofnetworks. the networks. Glu is Gluthe isprod- the product uct of Glnof Glncatalyzed catalyzed by enzyme by enzyme glutaminase glutaminase (GLS) (GLS) in the in process the process known known as glutaminoly- as glutaminolysis. sis. RadiatingRadiating from from Glu are Glu the are connections the connections to (i) Pro to (i)via Pro the viapyrroline-5-carboxylate the pyrroline-5-carboxylate (P5C) (P5C) intermediate,intermediate, (ii) Arg (ii)via Argthe urea via the cycle, urea and cycle, (iii) and Asn (iii) via Asnthe aspartate via the aspartate (Asp) intermediate (Asp) intermediate catalyzedcatalyzed by glutamic by glutamic oxaloacetic oxaloacetic transaminase transaminase (GOT). (GOT). Asparagine Proline Glutamine (Gln) Glucose Asparaginase CB-839 BPTES Nucleosides Proline Glutamine Glu-6-P ProDH PYCR Asparagine GLS1 CAD Orotate P5C GS Glu Pyruvate AsnS ASNase Glutamate Citrate Gln isocitrate _ OAA Aspartate GOT GDH IDH Acetyl CoA α-Ketoglutarate Carbamoyl CS OTC ODH Phosphate ASS1 Succinyl-CoA Oxaloacetate P5C Citrulline TCA cycle (OAA) AS Ornithine Succinate NO Urea cycle MDH Polyamines SDH FH AS lyase Fumarate Malate Urea NOS Arginase Arginine Orithine + Urea Arginine Citrulline + Arginase ADI-PEG20 NH3 Figure 1. Metabolic pathways linking proline (Pro), glutamine (Glu), arginine (Arg), and asparagine Figure 1. Metabolic pathways linking proline (Pro), glutamine (Glu), arginine (Arg), and aspara- gine (Asn).(Asn). Abbreviations: Abbreviations: AS, argininosuccinate; AS, argininosuccinate; ASNase, ASNase, aspara asparaginase;ginase; AsnS, AsnS, asparagine asparagine synthe- synthetase; tase; ASS1;ASS1; argininosuccinate argininosuccinate synthetase synthetase 1; GDH, 1; GDH, glutamine glutamine dehydrogenase; dehydrogenase; glutamic-oxaloacetic glutamic-oxaloacetic transam- transaminaseinase 1; 1; FH, FH, fumarate fumarate hydratase; hydratase; GLS, GLS, glutaminase; glutaminase; GS, GS, glutamine glutamine synthetase; synthetase; GOT, GOT, glu- glutamic ox- tamic oxaloaceticaloacetic transaminase transaminase 1; 1; GDH, GDH, glutamin glutaminee dehydrogenase; dehydrogenase; NOS, NOS, nitric nitric oxide oxide synthetase; synthetase; OAA, OAA, oxaloacetate;oxaloacetate; OAT, OAT, Ornithine Ornithine aminotrans aminotransferase;ferase; OTC, OTC, ornithine ornithine transcarbamylase; transcarbamylase; P5C, P5C, pyrroline pyrroline5-carboxylate; 5-carboxylate; ProDH, ProDH, proline proline dehydrogenase; dehydrogenase; PYCR, PYCR, P5C P5C reductase. reductase. Agents Agents used used for for treatments are treatmentsunderlined are underlined and in red;and thein red; enzymes the enzymes in the pathways in the pathwa that haveys that been have considered been considered as targets as for therapies targets for therapies are boxed. CAD represents three major enzymatic steps in the biosynthesis of are boxed. CAD represents three major enzymatic steps in the biosynthesis of nucleosides from nucleosides from glutamine, i.e., carbamoyl phosphate synthetase-II (CPS-II), aspartate transcar- glutamine, i.e., carbamoyl phosphate synthetase-II (CPS-II), aspartate transcarbamylase (ATCase) bamylase (ATCase) and Dihydro orotase. and Dihydro orotase. Figure 1 also shows that starting from Pro threading through P5C, Glu, and α-ke- Figure1 also shows that starting from Pro threading through P5C, Glu, and α- toglutarate (α-KG) and fumarate (in TCA cycle) reaches Arg. Then, Arg is forward-con- ketoglutarate (α-KG) and fumarate (in TCA cycle) reaches Arg. Then, Arg is forward- verted to ornithine (Orn) catalyzed by arginase, and then to P5C by the reversible orni- converted to ornithine (Orn)
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