During the previous funding cycle, we identified a mechanism for how hypoxia and reactive oxygen/nitrogen species (ROS/RNS) regulate blood vessel growth (angiogenesis) and radiotherapy responses, via HIF-1 (hypoxia-inducible factor-1) and VEGF (vascular endothelial growth factor). We refer to this as the HRHV axis. Unregulated tumor angiogenesis is known to be tied to hypoxia, HIF1 and VEGF by our work and that of many others, however, it is unclear how the angiogenic stimulus is maintained over time. In this grant, which includes pre-clinical and clinical objectives, we propose to test the overriding hypothesis that activation of the HRHV axis leads to abnormal vascular adaptation and angiogenic shunt flow and, which in turn maintains tumor hypoxic-pathophysiology through positive feedback loops.
In Specific Aim 1 we will examine how aberrant angiogenesis and vascular adaptation form feedback loops with the HRHV axis;hypoxia becomes a consequence of shunt flow and abnormal angioadaptation leads to cycling hypoxia.
In Specific Aim 2 we will test whether inhibiting the HRHV axis with a novel SOD mimetic +/- VEGF inhibition will improve oxygen transport by inhibiting the feedback loops to restore a more normal vascular network structure. This will in turn improve tumor response and local control rate following radiotherapy. In order to examine the importance of the HRHV axis in human tumors we will establish biomarkers of ROS/RNS stress and cycling hypoxia in pre-clinical models, using matched hypoxia marker drugs to localize regions of hypoxia in the same tumor when breathing air and 10% oxygen. We expect to see differences in temporal patterns of biomarker expression after breathing 10% oxygen, as compared with controls.
In Specific Aim 3 we will examine HRHV axis patterns identified in SA2 to assess prevalence of ROS/RNS damage and cycling hypoxia in several human tumor entities: We will acquire material in the course of a clinical study in which human patients with breast cancer will be given the hypoxia marker drug, EF5. We will also investigate archived tissues from prior studies in which patients with cervix, head and neck and breast cancer were administered the hypoxia marker drug, pimonidazole. The hypoxia marker drugs will serve as a marker standard for comparison with biomarker distributions. We will explore potential prognostic significance of the markers of the HRHV axis in retrospective analyses of early stage breast, non small cell lung cancer and cervix cancer (~100 patients each, with known clinical outcome). We expect that the outcome of this project will solidify the importance of the HRHV axis and that it will set the stage for future human trials where the HRHV axis is targeted as a therapeutic strategy in combination with radiotherapy and / or chemotherapy.

Public Health Relevance

Lack of oxygen (hypoxia) is a common feature of solid human cancers that contributes to tumor aggressiveness and treatment resistance. This project focuses on three central features tumor pathophysiology that interact with hypoxia in feedback loops to perpetuate the pathophysiology - namely HIF-1 (a transcription factor that upregulates dozens of genes that protect cells from hypoxia), VEGF (a HIF-1 regulated gene that promotes blood vessel growth) and reactive oxygen and nitrogen species that independently contribute to HIF-1 activity. We term these interactions, which do not occur in normal tissues, the HRHV axis. We will determine whether novel methods to inhibit the HRHV axis improve radiation response in pre-clinical models and whether presence of markers of this axis are related to treatment outcome in patients with early stage lung, breast and cervix cancer. The results of this work may lead to targeting the HRHV axis as a unique tumor specific method to treat virtually all forms of solid cancers.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Research Project (R01)
Project #
Application #
Study Section
Radiation Therapeutics and Biology Study Section (RTB)
Program Officer
Wong, Rosemary S
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Duke University
Schools of Medicine
United States
Zip Code
Hu, Fangyao; Vishwanath, Karthik; Salama, Joseph K et al. (2016) Oxygen and Perfusion Kinetics in Response to Fractionated Radiation Therapy in FaDu Head and Neck Cancer Xenografts Are Related to Treatment Outcome. Int J Radiat Oncol Biol Phys 96:462-9
Ashcraft, Kathleen A; Peace, Ralph M; Betof, Allison S et al. (2016) Efficacy and Mechanisms of Aerobic Exercise on Cancer Initiation, Progression, and Metastasis: A Critical Systematic Review of In Vivo Preclinical Data. Cancer Res 76:4032-50
Turley, Ryan S; Tokuhisa, Yoshihiro; Toshimitsu, Hiroaki et al. (2015) Targeting N-cadherin increases vascular permeability and differentially activates AKT in melanoma. Ann Surg 261:368-77
Ashcraft, Kathleen A; Boss, Mary-Keara; Tovmasyan, Artak et al. (2015) Novel Manganese-Porphyrin Superoxide Dismutase-Mimetic Widens the Therapeutic Margin in a Preclinical Head and Neck Cancer Model. Int J Radiat Oncol Biol Phys 93:892-900
Betof, Allison S; Lascola, Christopher D; Weitzel, Douglas et al. (2015) Modulation of murine breast tumor vascularity, hypoxia and chemotherapeutic response by exercise. J Natl Cancer Inst 107:
Choudhury, Kingshuk Roy; Keir, Stephen T; Ashcraft, Kathleen A et al. (2015) Dynamic treatment effect (DTE) curves reveal the mode of action for standard and experimental cancer therapies. Oncotarget 6:14656-68
Fontanella, Andrew N; Boss, Mary-Keara; Hadsell, Michael et al. (2015) Effects of high-dose microbeam irradiation on tumor microvascular function and angiogenesis. Radiat Res 183:147-58
Yu, Bing; Shah, Amy; Wang, Bingqing et al. (2014) Measuring tumor cycling hypoxia and angiogenesis using a side-firing fiber optic probe. J Biophotonics 7:552-64
Boss, Mary-Keara; Bristow, Robert; Dewhirst, Mark W (2014) Linking the history of radiation biology to the hallmarks of cancer. Radiat Res 181:561-77
Chitneni, Satish K; Bida, Gerald T; Zalutsky, Michael R et al. (2014) Comparison of the Hypoxia PET Tracer (18)F-EF5 to Immunohistochemical Marker EF5 in 3 Different Human Tumor Xenograft Models. J Nucl Med 55:1192-7

Showing the most recent 10 out of 165 publications