C-terminal Hsp90 inhibitors restore glucocorticoid sensitivity in an experimental model for Cushing's disease

Cushing's disease (CD) is a severe neuroendocrine condition caused by partially glucocorticoid (Gc) resistant corticotroph adenomas of the anterior pituitary. No safe and efficacious pharmacologic treatment exists to combat Gc-resistance, the central etiologic mechanism in CD. The molecular chaperone Hsp90 directly regulates the function of GR, and aberrant expression levels of Hsp90 impede GR-activity. To date, the role of Hsp90 in GR-signaling has never been investigated in corticotroph adenomas.

We show by immunohistochemical staining that the inducible Hsp90α-isoform is strongly overexpressed in biopsy specimens of corticotroph adenomas from CD patients as compared to the normal human pituitary. This finding enabled us to elucidate the role of Hsp90 overexpression in corticotroph adenoma cells through pharmacologic inhibition. The N-terminal Hsp90-inhibitor 17-AAG induces GR protein degradation and abolishes all aspects of GR-function. In sharp contrast, Novobiocin and the recently identified C-terminal Hsp90-inhibitor MPP-482 increase the amount of mature receptor that binds agonist, without influencing its cellular protein level. This effect is caused by dissociation of the GR::Hsp90-complex through the C-terminal Hsp90-inhibitors, and results in the potentiation of GR-activity. In primary cultures of human corticotroph adenomas, MPP-482 enhances the suppression of ACTH-production mediated by GR. Finally, MPP-482 shows antitumorigenic and plasma ACTH lowering effects in a mouse model for Cushing's disease, thereby relieving hypercortisolism and related symptoms.

We show here that C-terminal Hsp90-inhibitors potentially restore Gc-sensitivity in human samples and in an experimental model for CD through a novel mechanism of action. This work presents the proof-of-concept that MPP-482 could be a safe pharmaceutical treatment for patients with this disease.