Active TGF-β has a high affinity for its receptors, so, in most cases, a released/active TGF-β ligand will initiate a TGF-β signaling cascade as long as TGF-β receptors are within reach [
96]. Since different cellular functions require distinct levels of TGF-β signaling [
78], tight regulation of latent TGF-β activation is necessary to prevent diverse diseases including inflammation, autoimmune disorders, fibrosis, cancer and cataract [
97–
101]. Conversely, inadequate levels of active TGF-β due to mutation of either the TGF-β genes or those for TGF-β activators can lead to pathology. For instance, TGF-β1 deficient mice exhibit a multifocal, mixed inflammatory cell response and tissue necrosis, leading to organ failure and death 20 days after birth [
102,
103]. In humans, inadequate TGF-β signaling can result in various disorders including brain hemorrhage and immune system-associated disorders [
104,
105]. Notably, restoring normal TGF-β signaling and/or inhibiting its inappropriate expression in experimental animals reverses some TGF-β associated pathologies and stands as promising therapeutic approach (See ). TGF-β induced signaling is also known to destabilize E-cadherin mediated cell-cell adhesion during EMT [
106]. Fascinatingly, a study in renal fibrosis revealed that bone morphogenic protein (BMP)-7 can reverse TGF-β1 induced EMT by restoring E-cadherin expression hence halting EMT progression. These results suggest that cross talk between BMP-7 and TGF-β is essential to regulate pathological EMT [
107]. αV integrins can activate TGF-β by binding to its LAP and evidence of such activation has been linked in EMT progression. Therefore, blocking the undesirable activities of αV integrins without interfering with their beneficial functions could impede EMT progression during cancer, wound healing and fibrosis.
| Table 1Attempts to target αV integrin function as a therapeutic strategy to treat TGF-β associated disorders |
Integrin antagonists show clinical promise for the treatment of TGF-β induced EMT associated disorders such as inflammation, fibrosis and cancer [
108]. Most of the therapeutic approaches currently under investigation target integrin function using anti-integrin agents including both naturally occurring and engineered peptides that can mimic their RGD ligand, or antibodies that can act as integrin antagonists [
109–
111]. For example, clinical administration of a peptide antagonist of the αVβ3 receptor successfully inhibits pathological angiogenesis seen in cancer, proliferative retinopathy, rheumatoid arthritis, and psoriasis [
112,
113]. Likewise, TGF-β-mediated enhancement of glioma cell migration via the upregulation of αVβ3 integrin expression is abrogated by echistatin, a Arg-Gly-Asp (RGD) containing snake venom which is a potent antagonist of αVβ3integrin [
114].
Several integrin targeted therapies are in clinical development for the treatment of cancer [
119]. For instance, Cilengitide or EMD12197 (Merck KGaA, Darmstadt, Germany), is a small cyclic RGD designed peptide that selectively and competitively antagonizes ligand binding to αVβ3 and αVβ5 [
120] which is being evaluated in a phase III clinical study for treatment of glioblastoma [
121]. A number of monoclonal antibodies are also in clinical development. CNTO 95 is a fully humanized monoclonal antibody targeting αV integrin which shows anti-tumor and anti-metastatic activity in animal models and is in a Phase I clinical trial for the treatment of solid tumors [
122,
123]. Likewise, Vitaxin, also known as MEDI-522 or Abegrin, is also a humanized monoclonal antibody that can block the interaction of αVβ3 with various ligands such as osteopontin, latent TGF-β and vitronectin [
116]. Vitaxin is currently in clinical trials for the treatment of stage IV metastatic melanoma and androgen-independent prostate cancer [
124]. Notably, MedImmune Inc. ended advanced human testing of Vitaxin to treat rheumatoid arthritis and psoriasis in 2004 because it failed to show clinical benefits in initial studies [
125]. More recently, it was shown that pre-treament of osteoclasts with macrophage colony stimulating factor (M-CSF), which is known to activate αVβ3, enhanced Vitaxin’s inhibitory effect. Furthermore, the PI3-kinase inhibitor wortmannin abolished M-CSF’s effects on the action of Vitaxin suggesting that Vitaxin’s inhibitory effects require an activated form of αVβ3 integrin and that PI3-kinase signaling is involved in the process [
126]. On the other hand, numerous studies have shown that PI3K-Akt signaling is involved in TGF-β induced EMT and cell migration [
127,
128]. This exemplifies how understanding the cross-talk between αV integrins and TGF-β signaling can enhance the therapeutic potential of not only Vitaxin, but other integrin antagonists as well, to make better and more successful therapeutics.