PI3K-mTORC2 but not PI3K-mTORC1 regulates transcription of HIF2A/EPAS1 and vascularization in neuroblastoma

Hypoxia-inducible factor (HIF) is a master regulator of cellular responses to oxygen deprival with a critical role in mediating the angiogenic switch in solid tumors. Differential expression of the HIF subunits HIF-1α and HIF-2α occurs in many human tumor types, suggesting selective implications to biological context. For example, high expression of HIF-2α that occurs in neuroblastoma is associated with stem cell-like features, disseminated disease and poor clinical outcomes, suggesting pivotal significance for HIF-2 control in neuroblastoma biology. In this study, we provide novel insight into how HIF-2α expression is transcriptionally controlled by hypoxia and how this control is abrogated by inhibition of IGF-1R/INSR-driven PI3K signaling. Reducing PI3K activity was sufficient to decrease HIF-2α mRNA and protein expression in a manner with smaller and less vascularized tumors in vivo. PI3K-regulated HIF2A mRNA expression was independent of Akt or mTORC1 signaling but relied upon mTORC2 signaling. HIF2A mRNA was induced by hypoxia in neuroblastoma cells isolated from metastatic patient-derived tumor xenografts, where HIF2A levels could be reduced by treatment with PI3K and mTORC2 inhibitors. Our results suggest that targeting PI3K and mTORC2 in aggressive neuroblastomas with an immature phenotype may improve therapeutic efficacy.