Notch inhibitors induce diarrhea, hypercrinia and secretory cell metaplasia in the human colon

Authors

  • Michael Collins Department of Gastroenterology, Kremlin Bicêtre Hospital, Assistance Publique-Hopitaux de Paris, Le Kremlin Bicêtre, France; Paris Sud University, Le Kremlin Bicêtre, France; INSERM, U1193, Paul-Brousse University Hospital, Hepatobiliary Centre, Villejuif, France; University Paris-Sud, Université Paris-Saclay, Faculté de Médecine Le Kremlin-Bicêtre, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Pôle de Biologie Médicale, Paul-Brousse University Hospital, Villejuif, France http://orcid.org/0000-0002-5785-722X
  • Jean-Marie Michot Drug Development Department (DITEP), Gustave Roussy, Université Paris-Sud, Université Paris-Saclay, Villejuif, France. E-mail: jean-marie.michot@gustaveroussy.fr http://orcid.org/0000-0003-3482-3331
  • Christophe Bellanger Department of Gastroenterology, Kremlin Bicêtre Hospital, Assistance Publique-Hopitaux de Paris, Le Kremlin Bicêtre, France; Paris Sud University, Le Kremlin Bicêtre, France
  • Charlotte Mussini Department of Pathology, Kremlin Bicêtre Hospital, Assistance Publique-Hopitaux de Paris, Le Kremlin Bicêtre, France
  • Karim Benhadji Eli Lilly and Company, Indianapolis, USA
  • Christophe Massard Drug Development Department (DITEP), Gustave Roussy, Université Paris-Sud, Université Paris-Saclay, Villejuif, France http://orcid.org/0000-0001-5505-0564
  • Franck Carbonnel Department of Gastroenterology, Kremlin Bicêtre Hospital, Assistance Publique-Hopitaux de Paris, Le Kremlin Bicêtre, France; Paris Sud University, Le Kremlin Bicêtre, France http://orcid.org/0000-0002-4779-5168

DOI:

https://doi.org/10.17179/excli2021-3572

Keywords:

Notch inhibitor, gamma secretase inhibitor, secretory cell metaplasia

Abstract

In humans, inhibition of Notch oncogenic signaling leads to tumor regression. Preclinical studies indicate that Notch signaling contributes to the maintenance of intestinal homeostasis. Here, we sought to describe the intestinal effects of a first-in-human Notch inhibitor in an indication of refractory cancer. Between 2014 and 2017, adult patients treated for refractory cancer with the novel Notch inhibitor LY3039478 and who had grade ≥ 2 diarrhea were referred to the gastroenterology department of a tertiary hospital in the Paris region of France. Eleven patients (median (range) age: 72 (29–83)) were included in the study. All patients had advanced cancer: adenoid cystic carcinoma (n=3, 27 %), sarcoma (n=3, 27 %), and other types (n=5, 46 %). In all cases, digestive tract endoscopy revealed abundant mucus in the intestinal lumen, and digestive tract biopsies showed an abnormally low proportion of enterocytes and marked elevation of the proportion of pseudostratified goblet cells. Microscopic inflammation was seen in colon biopsies from 2 of the 11 patients (18 %). The clinical, endoscopic and histological abnormalities were dependent on the dose of Notch inhibitor. All patients resolved their digestive signs or symptoms after discontinuing the dose and the median (range) time interval between discontinuation of the Notch inhibitor and resolution of all the gastrointestinal signs and symptoms was 7 days (4–24). Likewise, the median time interval between discontinuation and resolution of the histological abnormalities was 7 days (1–10). Blocking Notch signaling induces secretory cell metaplasia of the intestinal epithelium, which in turn leads to transient diarrhea. Our results confirm the role of Notch signaling in intestinal homeostasis in humans.

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Published

2021-04-26

How to Cite

Collins, M., Michot, J.-M., Bellanger, C., Mussini, C., Benhadji, K., Massard, C., & Carbonnel, F. (2021). Notch inhibitors induce diarrhea, hypercrinia and secretory cell metaplasia in the human colon. EXCLI Journal, 20, 819–827. https://doi.org/10.17179/excli2021-3572

Issue

Vol. 20 (2021)

Section

Original articles

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Copyright (c) 2021 Michael Collins, Jean-Marie Michot, Christophe Bellanger, Charlotte Mussini, Karim Benhadji, Christophe Massard, Franck Carbonnel

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