Therapeutic Target MESUPRON®
Although the underlying biochemical processes for metastasis are still not fully understood, a large body of research has shown that the urokinase type Plasminogen Activator (uPA), a member of the serine protease family, and its receptor (uPAR) play a major role in this process.
The uPA content enables doctors to predict the statistical likelihood of a patient’s survival: Patients with a high level of uPA have a significantly lower disease-free survival period as well as a shorter overall survival than patients with low uPA levels. This was established on the basis of a meta analysis of 18 different European studies on the length of survival in relation to the uPA content in the tumour involving a total of 8,377 patients.
In accordance with this the American Society for Clinical Oncology (ASCO) has recommended in their treatment guidelines to measure the uPA-level in patients with breast cancer.
The tumour-associated proteolytic factor ) uPA and its inhibitor PAI-1 are the only tumour biological factors which have provided the highest level of evidence (LOE1) in terms of their prognostic and predictive significance.
The uPA system of WILEX can be considered as a promising new non-cytotoxic approach in cancer therapy to specifically block tumour metastasis in solid cancers. WILEX is not aware of any agents designed to specifically block metastasis through inhibition of the uPA system currently in clinical trials.
uPA System: Components
The uPA system is an extra-cellular enzyme system over-expressed on certain aggressive metastasising solid tumours. The uPA system (see figure) consists of:
- the Plasminogen Activator of the urokinase type (also called urokinase or uPA),
- its physiological inhibitor (PAI-1),
- and the uPA receptor (uPAR), which is over-expressed on tumour cells.
Figure: Components and mode of action of the uPA system
uPA System: Mode of Action
The uPA system triggers off proteolytic processes through which tumour cells are enabled to degrade their surrounding tissue (the extracellular matrix), to invade into healthy tissue and blood vessels and thus to migrate and form new tumours at distant sites. In addition, the uPA-system interacts with other molecular-biological systems, and thus can promote primary tumour growth.
uPA Mode of Action in Detail
Through the binding of uPA to the uPA receptor (uPAR) plasminogen is converted to plasmin, which in turn degrades the extracellular matrix (ECM). The ECM is the protein network, in which the tumour cells are embedded in. Degradation of ECM helps tumour cells to invade into adjacent tissue and, eventually, into the blood stream. It also promotes the release of various growth factors that are otherwise sequestrated by intact ECM. Furthermore, uPA and plasminogen may activate other families of protein-cleaving enzymes such as metalloproteinases, or MMPs, which, along with the uPA system, promote tumour cell invasion and angiogenesis.
The binding of uPA to uPAR induces growth promoting signals in tumour cells, events which are separate from its enzymatic activity. In addition, uPAR interacts with vitronectin and integrins, which are involved in cell adhesion and signal transduction. Thus, tumour cells acquire growth and survival advantages by overexpressing the uPA system, which promotes the growth, invasion, and metastatic spread of tumour cells via multiple mechanisms.
In the opinion of the Company this makes the uPA system an attractive target for the development of cancer drugs which attack cancer by acting at multiple points of the metastatic process.
uPA System: Clinical Relevance
Over the last decade, substantial scientific and clinical evidence has established that components of the uPA system play a key role in metastasis. Examination of human cancers led to the discovery of uPA overexpression in a wide range of tumour types including breast, gastric and ovarian cancer.
In a number of different cancers, high levels of uPA and PAI-1 have been shown to be associated with unfavourable disease progression, whereas low levels of uPA and PAI-1 are associated with a more favourable prognosis. Patients with high levels of uPA expressions have a significantly shorter disease-free survival and overall survival than those with low levels. uPA and PAI-1 have been qualified as new prognostic markers of breast cancer with the highest level of evidence, or LOE-1, by the European Organization for Research and Treatment of Cancer, or EORTC.
Figure: High tumour antigen levels of uPA and PAI-1 correlate with shorter overall survival compared to low tumour antigen levels. Source: Longterm study of over 6,400 breast cancer patients. Look et. al., JNCI, 2002.