Therapeutic targeting of SLC6A8 creatine transporter suppresses colon cancer progression and modulates human creatine levels

• Published in: Science advances Vol. 7; no. 41; p. eabi7511
• Main Authors: Kurth, Isabel, Yamaguchi, Norihiro, Andreu-Agullo, Celia, Tian, Helen S, Sridhar, Subhasree, Takeda, Shugaku, Gonsalves, Foster C, Loo, Jia Min, Barlas, Afsar, Manova-Todorova, Katia, Busby, Robert, Bendell, Johanna C, Strauss, James, Fakih, Marwan, McRee, Autumn J, Hendifar, Andrew E, Rosen, Lee S, Cercek, Andrea, Wasserman, Robert, Szarek, Michael, Spector, Scott L, Raza, Syed, Tavazoie, Masoud F, Tavazoie, Sohail F
• Format: Journal Article
• Language: English
• Published: United States American Association for the Advancement of Science 08.10.2021
• Subjects: Animals; Antineoplastic Agents - pharmacology; Biomedicine and Life Sciences; Cancer; Cell Line, Tumor; Cell Proliferation; Colonic Neoplasms - drug therapy; Colonic Neoplasms - genetics; Colorectal Neoplasms - pathology; Creatine - metabolism; Creatine - pharmacology; Creatine - therapeutic use; Diseases and Disorders; Humans; Membrane Transport Proteins; Mice; Mice, Nude; Mutation; Nerve Tissue Proteins - metabolism; Plasma Membrane Neurotransmitter Transport Proteins - genetics; Plasma Membrane Neurotransmitter Transport Proteins - pharmacology; Proto-Oncogene Proteins p21(ras) - metabolism; SciAdv r-articles
• ISSN: 2375-2548; 2375-2548
• DOI: 10.1126/sciadv.abi7511

Colorectal cancer (CRC) is a leading cause of cancer mortality. Creatine metabolism was previously shown to critically regulate colon cancer progression. We report that RGX-202, an oral small-molecule SLC6A8 transporter inhibitor, robustly inhibits creatine import in vitro and in vivo, reduces intracellular phosphocreatine and ATP levels, and induces tumor apoptosis. RGX-202 suppressed CRC growth across KRAS wild-type and KRAS mutant xenograft, syngeneic, and patient-derived xenograft (PDX) tumors. Antitumor efficacy correlated with tumoral expression of creatine kinase B. Combining RGX-202 with 5-fluorouracil or the DHODH inhibitor leflunomide caused regressions of multiple colorectal xenograft and PDX tumors of distinct mutational backgrounds. RGX-202 also perturbed creatine metabolism in patients with metastatic CRC in a phase 1 trial, mirroring pharmacodynamic effects on creatine metabolism observed in mice. This is, to our knowledge, the first demonstration of preclinical and human pharmacodynamic activity for creatine metabolism targeting in oncology, thus revealing a critical therapeutic target.