Skip to main content
Top
Published in: Molecular Cancer 1/2013

Open Access 01-12-2013 | Research

Molecular mechanism of the camptothecin resistance of Glu710Gly topoisomerase IB mutant analyzed in vitro and in silico

Authors: Cinzia Tesauro, Blasco Morozzo della Rocca, Alessio Ottaviani, Andrea Coletta, Laura Zuccaro, Barbara Arnò, Ilda D'Annessa, Paola Fiorani, Alessandro Desideri

Published in: Molecular Cancer | Issue 1/2013

Login to get access

Abstract

Background

DNA topoisomerases are key enzymes that modulate the topological state of DNA through the breaking and rejoining of DNA strands. Human topoisomerase IB can be inhibited by several compounds that act through different mechanisms, including clinically used drugs, such as the derivatives of the natural compound camptothecin that reversibly bind the covalent topoisomerase-DNA complex, slowing down the religation of the cleaved DNA strand, thus inducing cell death. Three enzyme mutations, which confer resistance to irinotecan in an adenocarcinoma cell line, were recently identified but the molecular mechanism of resistance was unclear.

Methods

The three resistant mutants have been investigated in S. cerevisiae model system following their viability in presence of increasing amounts of camptothecin. A systematical analysis of the different catalytic steps has been made for one of these mutants (Glu710Gly) and has been correlated with its structural-dynamical properties studied by classical molecular dynamics simulation.

Results

The three mutants display a different degree of camptothecin resistance in a yeast cell viability assay. Characterization of the different steps of the catalytic cycle of the Glu710Gly mutant indicated that its resistance is related to a high religation rate that is hardly affected by the presence of the drug. Analysis of the dynamic properties through simulation indicate that the mutant displays a much lower degree of correlation in the motion between the different protein domains and that the linker almost completely loses its correlation with the C-terminal domain, containing the active site tyrosine.

Conclusions

These results indicate that a fully functional linker is required to confer camptothecin sensitivity to topoisomerase I since the destabilization of its structural-dynamical properties is correlated to an increase of religation rate and drug resistance.
Appendix
Available only for authorised users
Literature
1.
go back to reference Wang JC: Cellular roles of DNA topoisomerases: a molecular perspective. Nat Rev Mol Cell Biol. 2002, 3: 430-440.CrossRefPubMed Wang JC: Cellular roles of DNA topoisomerases: a molecular perspective. Nat Rev Mol Cell Biol. 2002, 3: 430-440.CrossRefPubMed
2.
go back to reference Champoux JJ: DNA topoisomerases: structure, function, and mechanism. Annual review of biochemistry. 2001, 70: 369-413.CrossRefPubMed Champoux JJ: DNA topoisomerases: structure, function, and mechanism. Annual review of biochemistry. 2001, 70: 369-413.CrossRefPubMed
3.
go back to reference Stewart L, Ireton GC, Champoux JJ: The domain organization of human topoisomerase I. J Biol Chem. 1996, 271: 7602-7608.CrossRefPubMed Stewart L, Ireton GC, Champoux JJ: The domain organization of human topoisomerase I. J Biol Chem. 1996, 271: 7602-7608.CrossRefPubMed
4.
go back to reference Redinbo MR, Stewart L, Kuhn P, Champoux JJ, Hol WG: Crystal structures of human topoisomerase I in covalent and noncovalent complexes with DNA. Science. 1998, 279: 1504-1513.CrossRefPubMed Redinbo MR, Stewart L, Kuhn P, Champoux JJ, Hol WG: Crystal structures of human topoisomerase I in covalent and noncovalent complexes with DNA. Science. 1998, 279: 1504-1513.CrossRefPubMed
5.
go back to reference Stewart L, Redinbo MR, Qiu X, Hol WG, Champoux JJ: A model for the mechanism of human topoisomerase I. Science. 1998, 279: 1534-1541.CrossRefPubMed Stewart L, Redinbo MR, Qiu X, Hol WG, Champoux JJ: A model for the mechanism of human topoisomerase I. Science. 1998, 279: 1534-1541.CrossRefPubMed
7.
go back to reference Pommier Y: Topoisomerase I inhibitors: camptothecins and beyond. Nature reviews Cancer. 2006, 6: 789-802.CrossRefPubMed Pommier Y: Topoisomerase I inhibitors: camptothecins and beyond. Nature reviews Cancer. 2006, 6: 789-802.CrossRefPubMed
8.
go back to reference Castelli S, Coletta A, D’Annessa I, Fiorani P, Tesauro C, Desideri A: Interaction between natural compounds and human topoisomerase I. Biol Chem. 2012, 393: 1327-1340.CrossRefPubMed Castelli S, Coletta A, D’Annessa I, Fiorani P, Tesauro C, Desideri A: Interaction between natural compounds and human topoisomerase I. Biol Chem. 2012, 393: 1327-1340.CrossRefPubMed
9.
go back to reference Leppard JB, Champoux JJ: Human DNA topoisomerase I: relaxation, roles, and damage control. Chromosoma. 2005, 114: 75-85.CrossRefPubMed Leppard JB, Champoux JJ: Human DNA topoisomerase I: relaxation, roles, and damage control. Chromosoma. 2005, 114: 75-85.CrossRefPubMed
10.
go back to reference Koster DA, Palle K, Bot ES, Bjornsti MA, Dekker NH: Antitumour drugs impede DNA uncoiling by topoisomerase I. Nature. 2007, 448: 213-217.CrossRefPubMed Koster DA, Palle K, Bot ES, Bjornsti MA, Dekker NH: Antitumour drugs impede DNA uncoiling by topoisomerase I. Nature. 2007, 448: 213-217.CrossRefPubMed
11.
go back to reference Pommier Y, Pourquier P, Urasaki Y, Wu J, Laco GS: Topoisomerase I inhibitors: selectivity and cellular resistance. Drug Resist Updat. 1999, 2: 307-318.CrossRefPubMed Pommier Y, Pourquier P, Urasaki Y, Wu J, Laco GS: Topoisomerase I inhibitors: selectivity and cellular resistance. Drug Resist Updat. 1999, 2: 307-318.CrossRefPubMed
12.
go back to reference Beretta GL, Gatti L, Perego P, Zaffaroni N: Camptothecin resistance in cancer: insights into the molecular mechanisms of a DNA-damaging drug. Curr Med Chem. 2013, 20: 1541-1565.CrossRefPubMed Beretta GL, Gatti L, Perego P, Zaffaroni N: Camptothecin resistance in cancer: insights into the molecular mechanisms of a DNA-damaging drug. Curr Med Chem. 2013, 20: 1541-1565.CrossRefPubMed
13.
go back to reference Alagoz M, Gilbert DC, El-Khamisy S, Chalmers AJ: DNA repair and resistance to topoisomerase I inhibitors: mechanisms, biomarkers and therapeutic targets. Curr Med Chem. 2012, 19: 3874-3885.CrossRefPubMed Alagoz M, Gilbert DC, El-Khamisy S, Chalmers AJ: DNA repair and resistance to topoisomerase I inhibitors: mechanisms, biomarkers and therapeutic targets. Curr Med Chem. 2012, 19: 3874-3885.CrossRefPubMed
14.
go back to reference Staker BL, Hjerrild K, Feese MD, Behnke CA, Burgin AB, Stewart L: The mechanism of topoisomerase I poisoning by a camptothecin analog. Proc Natl Acad Sci USA. 2002, 99: 15387-15392.PubMedCentralCrossRefPubMed Staker BL, Hjerrild K, Feese MD, Behnke CA, Burgin AB, Stewart L: The mechanism of topoisomerase I poisoning by a camptothecin analog. Proc Natl Acad Sci USA. 2002, 99: 15387-15392.PubMedCentralCrossRefPubMed
15.
go back to reference Redinbo MR, Stewart L, Champoux JJ, Hol WG: Structural flexibility in human topoisomerase I revealed in multiple non-isomorphous crystal structures. J Mol Biol. 1999, 292: 685-696.CrossRefPubMed Redinbo MR, Stewart L, Champoux JJ, Hol WG: Structural flexibility in human topoisomerase I revealed in multiple non-isomorphous crystal structures. J Mol Biol. 1999, 292: 685-696.CrossRefPubMed
16.
go back to reference Fiorani P, Bruselles A, Falconi M, Chillemi G, Desideri A, Benedetti P: Single mutation in the linker domain confers protein flexibility and camptothecin resistance to human topoisomerase I. J Biol Chem. 2003, 278: 43268-43275.CrossRefPubMed Fiorani P, Bruselles A, Falconi M, Chillemi G, Desideri A, Benedetti P: Single mutation in the linker domain confers protein flexibility and camptothecin resistance to human topoisomerase I. J Biol Chem. 2003, 278: 43268-43275.CrossRefPubMed
17.
go back to reference Fiorani P, Tesauro C, Mancini G, Chillemi G, D’Annessa I, Graziani G, Tentori L, Muzi A, Desideri A: Evidence of the crucial role of the linker domain on the catalytic activity of human topoisomerase I by experimental and simulative characterization of the Lys681Ala mutant. Nucleic acids research. 2009, 37: 6849-6858.PubMedCentralCrossRefPubMed Fiorani P, Tesauro C, Mancini G, Chillemi G, D’Annessa I, Graziani G, Tentori L, Muzi A, Desideri A: Evidence of the crucial role of the linker domain on the catalytic activity of human topoisomerase I by experimental and simulative characterization of the Lys681Ala mutant. Nucleic acids research. 2009, 37: 6849-6858.PubMedCentralCrossRefPubMed
18.
go back to reference Chillemi G, D’Annessa I, Fiorani P, Losasso C, Benedetti P, Desideri A: Thr729 in human topoisomerase I modulates anti-cancer drug resistance by altering protein domain communications as suggested by molecular dynamics simulations. Nucleic Acids Res. 2008, 36: 5645-5651.PubMedCentralCrossRefPubMed Chillemi G, D’Annessa I, Fiorani P, Losasso C, Benedetti P, Desideri A: Thr729 in human topoisomerase I modulates anti-cancer drug resistance by altering protein domain communications as suggested by molecular dynamics simulations. Nucleic Acids Res. 2008, 36: 5645-5651.PubMedCentralCrossRefPubMed
19.
go back to reference Fiorani P, Chillemi G, Losasso C, Castelli S, Desideri A: The different cleavage DNA sequence specificity explains the camptothecin resistance of the human topoisomerase I Glu418Lys mutant. Nucl Acids Res. 2006, 34: 5093-5100.PubMedCentralCrossRefPubMed Fiorani P, Chillemi G, Losasso C, Castelli S, Desideri A: The different cleavage DNA sequence specificity explains the camptothecin resistance of the human topoisomerase I Glu418Lys mutant. Nucl Acids Res. 2006, 34: 5093-5100.PubMedCentralCrossRefPubMed
20.
go back to reference Stewart L, Ireton GC, Champoux JJ: A functional linker in human topoisomerase I is required for maximum sensitivity to camptothecin in a DNA relaxation assay. J Biol Chem. 1999, 274: 32950-32960.CrossRefPubMed Stewart L, Ireton GC, Champoux JJ: A functional linker in human topoisomerase I is required for maximum sensitivity to camptothecin in a DNA relaxation assay. J Biol Chem. 1999, 274: 32950-32960.CrossRefPubMed
21.
go back to reference Chillemi G, Fiorani P, Castelli S, Bruselles A, Benedetti P, Desideri A: Effect on DNA relaxation of the single Thr718Ala mutation in human topoisomerase I: a functional and molecular dynamics study. Nucleic acids research. 2005, 33: 3339-3350.PubMedCentralCrossRefPubMed Chillemi G, Fiorani P, Castelli S, Bruselles A, Benedetti P, Desideri A: Effect on DNA relaxation of the single Thr718Ala mutation in human topoisomerase I: a functional and molecular dynamics study. Nucleic acids research. 2005, 33: 3339-3350.PubMedCentralCrossRefPubMed
22.
go back to reference Mancini G, D’Annessa I, Coletta A, Sanna N, Chillemi G, Desideri A: Structural and dynamical effects induced by the anticancer drug topotecan on the human topoisomerase I - DNA complex. PLoS One. 2010, 5: e10934-PubMedCentralCrossRefPubMed Mancini G, D’Annessa I, Coletta A, Sanna N, Chillemi G, Desideri A: Structural and dynamical effects induced by the anticancer drug topotecan on the human topoisomerase I - DNA complex. PLoS One. 2010, 5: e10934-PubMedCentralCrossRefPubMed
23.
go back to reference Mancini G, D’Annessa I, Coletta A, Chillemi G, Pommier Y, Cushman M, Desideri A: Binding of an Indenoisoquinoline to the topoisomerase-DNA complex induces reduction of linker mobility and strengthening of protein-DNA interaction. PLoS One. 2012, 7: e51354-PubMedCentralCrossRefPubMed Mancini G, D’Annessa I, Coletta A, Chillemi G, Pommier Y, Cushman M, Desideri A: Binding of an Indenoisoquinoline to the topoisomerase-DNA complex induces reduction of linker mobility and strengthening of protein-DNA interaction. PLoS One. 2012, 7: e51354-PubMedCentralCrossRefPubMed
24.
go back to reference Gongora C, Vezzio-Vie N, Tuduri S, Denis V, Causse A, Auzanneau C, Collod-Beroud G, Coquelle A, Pasero P, Pourquier P: New topoisomerase I mutations are associated with resistance to camptothecin. Mol Cancer. 2011, 10: 64-PubMedCentralCrossRefPubMed Gongora C, Vezzio-Vie N, Tuduri S, Denis V, Causse A, Auzanneau C, Collod-Beroud G, Coquelle A, Pasero P, Pourquier P: New topoisomerase I mutations are associated with resistance to camptothecin. Mol Cancer. 2011, 10: 64-PubMedCentralCrossRefPubMed
25.
go back to reference Kim N, Huang SN, Williams JS, Li YC, Clark AB, Cho JE, Kunkel TA, Pommier Y, Jinks-Robertson S: Mutagenic processing of ribonucleotides in DNA by yeast topoisomerase I. Science. 2011, 332: 1561-1564.PubMedCentralCrossRefPubMed Kim N, Huang SN, Williams JS, Li YC, Clark AB, Cho JE, Kunkel TA, Pommier Y, Jinks-Robertson S: Mutagenic processing of ribonucleotides in DNA by yeast topoisomerase I. Science. 2011, 332: 1561-1564.PubMedCentralCrossRefPubMed
26.
go back to reference Staker BL, Feese MD, Cushman M, Pommier Y, Zembower D, Stewart L, Burgin AB: Structures of three classes of anticancer agents bound to the human topoisomerase I-DNA covalent complex. J Med Chem. 2005, 48: 2336-2345.CrossRefPubMed Staker BL, Feese MD, Cushman M, Pommier Y, Zembower D, Stewart L, Burgin AB: Structures of three classes of anticancer agents bound to the human topoisomerase I-DNA covalent complex. J Med Chem. 2005, 48: 2336-2345.CrossRefPubMed
27.
go back to reference Losasso C, Cretaio E, Fiorani P, D’Annessa I, Chillemi G, Benedetti P: A single mutation in the 729 residue modulates human DNA topoisomerase IB DNA binding and drug resistance. Nucleic Acids Res. 2008, 36: 5635-5644.PubMedCentralCrossRefPubMed Losasso C, Cretaio E, Fiorani P, D’Annessa I, Chillemi G, Benedetti P: A single mutation in the 729 residue modulates human DNA topoisomerase IB DNA binding and drug resistance. Nucleic Acids Res. 2008, 36: 5635-5644.PubMedCentralCrossRefPubMed
28.
go back to reference D’Annessa I, Tesauro C, Fiorani P, Chillemi G, Castelli S, Vassallo O, Capranico G, Desideri A: Role of flexibility in protein-DNA-drug recognition: the case of Asp677Gly-Val703Ile topoisomerase mutant hypersensitive to camptothecin. J Amino Acids. 2012, 2012: 206083-PubMedCentralPubMed D’Annessa I, Tesauro C, Fiorani P, Chillemi G, Castelli S, Vassallo O, Capranico G, Desideri A: Role of flexibility in protein-DNA-drug recognition: the case of Asp677Gly-Val703Ile topoisomerase mutant hypersensitive to camptothecin. J Amino Acids. 2012, 2012: 206083-PubMedCentralPubMed
29.
go back to reference Arno B, D’Annessa I, Tesauro C, Zuccaro L, Ottaviani A, Knudsen B, Fiorani P, Desideri A: Replacement of the human topoisomerase linker domain with the plasmodial counterpart renders the enzyme camptothecin resistant. PLoS One. 2013, 8: e68404-PubMedCentralCrossRefPubMed Arno B, D’Annessa I, Tesauro C, Zuccaro L, Ottaviani A, Knudsen B, Fiorani P, Desideri A: Replacement of the human topoisomerase linker domain with the plasmodial counterpart renders the enzyme camptothecin resistant. PLoS One. 2013, 8: e68404-PubMedCentralCrossRefPubMed
30.
go back to reference Koster DA, Croquette V, Dekker C, Shuman S, Dekker NH: Friction and torque govern the relaxation of DNA supercoils by eukaryotic topoisomerase IB. Nature. 2005, 434: 671-674.CrossRefPubMed Koster DA, Croquette V, Dekker C, Shuman S, Dekker NH: Friction and torque govern the relaxation of DNA supercoils by eukaryotic topoisomerase IB. Nature. 2005, 434: 671-674.CrossRefPubMed
31.
go back to reference Bjornsti MA, Benedetti P, Viglianti GA, Wang JC: Expression of human DNA topoisomerase I in yeast cells lacking yeast DNA topoisomerase I: restoration of sensitivity of the cells to the antitumor drug camptothecin. Cancer Res. 1989, 49: 6318-6323.PubMed Bjornsti MA, Benedetti P, Viglianti GA, Wang JC: Expression of human DNA topoisomerase I in yeast cells lacking yeast DNA topoisomerase I: restoration of sensitivity of the cells to the antitumor drug camptothecin. Cancer Res. 1989, 49: 6318-6323.PubMed
32.
go back to reference Kauh EA, Bjornsti MA: SCT1 mutants suppress the camptothecin sensitivity of yeast cells expressing wild-type DNA topoisomerase I. Proc Natl Acad Sci USA. 1995, 92: 6299-6303.PubMedCentralCrossRefPubMed Kauh EA, Bjornsti MA: SCT1 mutants suppress the camptothecin sensitivity of yeast cells expressing wild-type DNA topoisomerase I. Proc Natl Acad Sci USA. 1995, 92: 6299-6303.PubMedCentralCrossRefPubMed
33.
go back to reference Kaiser C, Michaelis S, Mitchell A: Lithium acetate yeast transformation. 1994, 133-134. New York: Cold Spring Harbor Laboratory Press Kaiser C, Michaelis S, Mitchell A: Lithium acetate yeast transformation. 1994, 133-134. New York: Cold Spring Harbor Laboratory Press
35.
go back to reference Andersen AH, Gocke E, Bonven BJ, Nielsen OF, Westergaard O: Topoisomerase I has a strong binding preference for a conserved hexadecameric sequence in the promoter region of the rRNA gene from tetrahymena pyriformis. Nucleic Acids Res. 1985, 13: 1543-1557.PubMedCentralCrossRefPubMed Andersen AH, Gocke E, Bonven BJ, Nielsen OF, Westergaard O: Topoisomerase I has a strong binding preference for a conserved hexadecameric sequence in the promoter region of the rRNA gene from tetrahymena pyriformis. Nucleic Acids Res. 1985, 13: 1543-1557.PubMedCentralCrossRefPubMed
36.
go back to reference Yang Z, Champoux JJ: Reconstitution of enzymatic activity by the association of the cap and catalytic domains of human topoisomerase I. J Biol Chem. 2002, 277: 30815-30823.CrossRefPubMed Yang Z, Champoux JJ: Reconstitution of enzymatic activity by the association of the cap and catalytic domains of human topoisomerase I. J Biol Chem. 2002, 277: 30815-30823.CrossRefPubMed
37.
go back to reference Pettersen EF, Goddard TD, Huang CC, Couch GS, Greenblatt DM, Meng EC, Ferrin TE: UCSF Chimera–a visualization system for exploratory research and analysis. J Comput Chem. 2004, 25: 1605-1612.CrossRefPubMed Pettersen EF, Goddard TD, Huang CC, Couch GS, Greenblatt DM, Meng EC, Ferrin TE: UCSF Chimera–a visualization system for exploratory research and analysis. J Comput Chem. 2004, 25: 1605-1612.CrossRefPubMed
38.
go back to reference Duan Y, Wu C, Chowdhury S, Lee MC, Xiong G, Zhang W, Yang R, Cieplak P, Luo R, Lee T: A point-charge force field for molecular mechanics simulations of proteins based on condensed-phase quantum mechanical calculations. J Comput Chem. 2003, 24: 1999-2012.CrossRefPubMed Duan Y, Wu C, Chowdhury S, Lee MC, Xiong G, Zhang W, Yang R, Cieplak P, Luo R, Lee T: A point-charge force field for molecular mechanics simulations of proteins based on condensed-phase quantum mechanical calculations. J Comput Chem. 2003, 24: 1999-2012.CrossRefPubMed
40.
go back to reference Hess B: GROMACS 4: algorithms for highly efficient, load-balanced, and scalable molecular simulation. J Chem Theory Comput. 2008, 4: 435-447. 10.1021/ct700301q.CrossRef Hess B: GROMACS 4: algorithms for highly efficient, load-balanced, and scalable molecular simulation. J Chem Theory Comput. 2008, 4: 435-447. 10.1021/ct700301q.CrossRef
41.
go back to reference Jorgensen WCJ, Madura J, Impey R, Klein M: Comparison of simple potential functions for simulating liquid water. J Chem Phys. 1983, 79: 926-935. 10.1063/1.445869.CrossRef Jorgensen WCJ, Madura J, Impey R, Klein M: Comparison of simple potential functions for simulating liquid water. J Chem Phys. 1983, 79: 926-935. 10.1063/1.445869.CrossRef
42.
go back to reference TE Cheatham MJ, Fox T, Darden TA, Kollman PA: Molecular-dynamics simulations on solvated biomolecular systems - the particle mesh Ewald method leads to stable trajectories of DNA, Rna, and proteins. J Am Chem Soc. 1995, 117: 4193-4194. 10.1021/ja00119a045.CrossRef TE Cheatham MJ, Fox T, Darden TA, Kollman PA: Molecular-dynamics simulations on solvated biomolecular systems - the particle mesh Ewald method leads to stable trajectories of DNA, Rna, and proteins. J Am Chem Soc. 1995, 117: 4193-4194. 10.1021/ja00119a045.CrossRef
43.
go back to reference Hess BBH, Berendsen H, Fraaije J: LINCS: a linear constraint solver for molecular simulations. J Comput Chem. 1997, 18: 1463-1472. 10.1002/(SICI)1096-987X(199709)18:12<1463::AID-JCC4>3.0.CO;2-H.CrossRef Hess BBH, Berendsen H, Fraaije J: LINCS: a linear constraint solver for molecular simulations. J Comput Chem. 1997, 18: 1463-1472. 10.1002/(SICI)1096-987X(199709)18:12<1463::AID-JCC4>3.0.CO;2-H.CrossRef
44.
go back to reference Parrinello MRA: Polymorphic transitions in single crystals: a new molecular dynamics method. J Appl Phys. 1981, 52: 7182-7190. 10.1063/1.328693.CrossRef Parrinello MRA: Polymorphic transitions in single crystals: a new molecular dynamics method. J Appl Phys. 1981, 52: 7182-7190. 10.1063/1.328693.CrossRef
45.
go back to reference Humphrey W, Dalke A, Schulten K: VMD: visual molecular dynamics. J Mol Graph. 1996, 14: 33-38. 27–38CrossRefPubMed Humphrey W, Dalke A, Schulten K: VMD: visual molecular dynamics. J Mol Graph. 1996, 14: 33-38. 27–38CrossRefPubMed
Metadata
Title
Molecular mechanism of the camptothecin resistance of Glu710Gly topoisomerase IB mutant analyzed in vitro and in silico
Authors
Cinzia Tesauro
Blasco Morozzo della Rocca
Alessio Ottaviani
Andrea Coletta
Laura Zuccaro
Barbara Arnò
Ilda D'Annessa
Paola Fiorani
Alessandro Desideri
Publication date
01-12-2013
Publisher
BioMed Central
Published in
Molecular Cancer / Issue 1/2013
Electronic ISSN: 1476-4598
DOI
https://doi.org/10.1186/1476-4598-12-100

Other articles of this Issue 1/2013

Molecular Cancer 1/2013 Go to the issue
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine