Blockade of Dll4 inhibits tumour growth by promoting non-productive angiogenesis

Tumour growth requires accompanying expansion of the host vasculature, with tumour progression often correlated with vascular density. Vascular endothelial growth factor (VEGF) is the best-characterized inducer of tumour angiogenesis. We report that VEGF dynamically regulates tumour endothelial expression of Delta-like ligand 4 (Dll4), which was previously shown to be absolutely required for normal embryonic vascular development. To define Dll4 function in tumour angiogenesis, we manipulated this pathway in murine tumour models using several approaches. Here we show that blockade resulted in markedly increased tumour vascularity, associated with enhanced angiogenic sprouting and branching. Paradoxically, this increased vascularity was non-productive—as shown by poor perfusion and increased hypoxia, and most importantly, by decreased tumour growth—even for tumours resistant to anti-VEGF therapy. Thus, VEGF-induced Dll4 acts as a negative regulator of tumour angiogenesis; its blockade results in a striking uncoupling of tumour growth from vessel density, presenting a novel therapeutic approach even for tumours resistant to anti-VEGF therapies. VEGF, or vascular endothelial growth factor, is the best-characterized inducer of tumour angiogenesis, and the blockade of VEGF has become an important tool in cancer therapy. But VEGF blockade is not effective against all tumours, so the search for alternative approaches continues. Two groups this week report that one such alternative could be blockade of Dll4, Delta-like ligand 4. This transmembrane molecule is part of the Notch signalling pathway. It was known to be essential for normal development of blood vessels in the embryo: the new work shows that it is also required for tumour angiogenesis. It may be a viable — and potentially well tolerated — alternative in patients with solid tumours that are resistant to anti-VEGF therapy. One of two papers showing that inhibition of Dll4-mediated Notch signalling inhibits tumour growth by deregulation of tumour angiogenesis.