More than half of human colorectal cancers (CRCs) carry either KRAS or BRAF mutations, and are often refractory to approved targeted therapies. We report that cultured CRC cells harboring KRAS or BRAF mutations are selectively killed when exposed to high levels of vitamin C. This effect is due to increased uptake of the oxidized form of vitamin C, dehydroascorbate (DHA), via the GLUT1 glucose transporter. Increased DHA uptake causes oxidative stress as intracellular DHA is reduced to vitamin C depleting glutathione. Thus, ROS accumulates and inactivates glyceraldehyde 3-phosphate dehydrogenase (GAPDH). Inhibiting GAPDH in highly glycolytic KRAS or BRAF mutant cells leads to an energetic crisis and cell death not seen in KRAS and BRAF wild-type cells. In vivo studies indicate that high-dose vitamin C can impair tumor growth in Apc/KrasG12D mutant mouse intestinal cancers. While it is unclear whether human tumors will respond similarly, our results provide a mechanistic rationale for exploring the therapeutic use of vitamin C to treat CRCs with KRAS or BRAF mutations.

Tumor progression is driven by genetic mutations, but little is known about the environmental conditions that select for these mutations. Studying the transcriptomes of paired colorectal cancer cell lines that differed only in the mutational status of their KRAS or BRAF genes, we found that GLUT1, encoding glucose transporter-1, was one of three genes consistently upregulated in cells with KRAS or BRAF mutations. The mutant cells exhibited enhanced glucose uptake and glycolysis and survived in low glucose conditions, phenotypes that all required GLUT1 expression. In contrast, when cells with wild-type KRAS alleles were subjected to a low glucose environment, very few cells survived. Most surviving cells expressed high levels of GLUT1 and 4% of these survivors had acquired new KRAS mutations. The glycolysis inhibitor, 3-bromopyruvate preferentially suppressed the growth of cells with KRAS or BRAF mutations. Together, these data suggest that glucose deprivation can drive the acquisition of KRAS pathway mutations in human tumors.Mutations in oncogenes and tumor suppressor genes endow cancer cells with the ability to outgrow their neighboring cells in situ (1). Though numerous studies have identified the downstream effects of such mutations and their biochemical mediators, there is relatively little known about the microenvironmental conditions that provide the selective advantage that allows cells with such mutations to clonally expand. Mutations in KRAS commonly occur in colorectal, pancreatic, and some forms of lung cancer, while BRAF mutations occur commonly in melanomas as well as in colorectal tumors without KRAS mutations (2-4). BRAF and KRAS mutations are mutually exclusive, that is, do not occur in the same tumor, suggesting a common origin and effect. Indeed, KRAS binds to and activates BRAF, thereby activating MAPK signaling pathways (5,6). Despite advances in the molecular delineation of the RAS/ RAF pathway, the specific environmental pressures that drive KRAS and BRAF mutations and how KRAS and BRAF mutations alleviate these pressures are unknown.

Over the past century, the notion that vitamin C can be used to treat cancer has generated much controversy. However, new knowledge regarding the pharmacokinetic properties of vitamin C and recent high-profile preclinical studies have revived interest in the utilization of high-dose vitamin C for cancer treatment. Studies have shown that pharmacological vitamin C targets many of the mechanisms that cancer cells utilize for their survival and growth. In this Opinion article, we discuss how vitamin C can target three vulnerabilities many cancer cells share: redox imbalance, epigenetic reprogramming and oxygen-sensing regulation. Although the mechanisms and predictive biomarkers that we discuss need to be validated in well-controlled clinical trials, these new discoveries regarding the anticancer properties of vitamin C are promising to help identify patient populations that may benefit the most from high-dose vitamin C therapy, developing effective combination strategies and improving the overall design of future vitamin C clinical trials for various types of cancer. The 'magic bullet' theory serves as a paradigm for modern cancer research and has inspired numerous groundbreaking targeted therapies such as imatinib and vemurafenib 1. However, despite remarkable initial responses, the eventual acquisition of resistance and therapyassociated toxic effects continues to impede progress towards achieving meaningful patient survival. Thus, a new strategy for treating and managing cancer is needed. In this Opinion article, we propose that vitamin C, a natural compound with an unusually high safety profile, can be used to target multiple critical pathways in cancer.

Abstract-Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant vascular disorder characterized by epistaxis, mucocutaneous telangiectases, and arteriovenous malformations (AVM). Two genes are linked to HHT: endoglin (ENG) in HHT1 and activin receptor-like kinase 1 (ACVRL1; ALK1) in HHT2. Although both genes are involved in the transforming growth factor ␤ signaling pathways, the pathogenetic mechanisms for HHT remain elusive. It was shown that mutations in the Alk1 gene in mice and zebrafish resulted in an embryonic lethal phenotype due to severe dilation of blood vessels. We created a novel null mutant mouse line for Alk1 (Alk1 lacZ ) by replacing its exons, including the one that encodes the transmembrane domain, with the ␤-galactosidase gene. Using Alk1 lacZ mice, we show that Alk1 is predominantly expressed in developing arterial endothelium. Alk1 expression is greatly diminished in adult arteries, but is induced in preexisting feeding arteries and newly forming arterial vessels during wound healing and tumor angiogenesis. We also show that hemodynamic changes, which require vascular remodeling, may regulate Alk1 expression. Our studies suggest the role of Alk1 signaling in arterialization and remodeling of arteries. Contrary to the current view of HHT as venous disease, our findings suggest that the arterioles rather than the venules are the primary vessels affected by the loss of an Alk1 allele, and that blood vessels with reduction in Alk1 expression may harbor defects in responding to demands for vascular remodeling. , also known as Osler-Weber-Rendu syndrome, is an autosomaldominant vascular disorder that affects more than 1 in 10 000 individuals. 1 HHT is characterized by recurrent epistaxis, localized mucocutaneous telangiectases in the nasal septum, oral mucosa, and gastrointestinal tract, as well as arteriovenous malformations (AVM) in the lungs, liver, gastrointestinal tract, and brain, which can cause severe ischemic injuries or stroke. 2 Multiple mutations in endoglin (ENG) and activin receptor-like kinase 1 (ACVRL1; ALK1) have been identified for HHT1 and HHT2, respectively. 1,3,4 Previous studies have shown that haploinsufficiency of ENG or ALK1 causes HHT. 5,6 The earliest clinically detectable telangiectasia is focal dilation of postcapillary venules. 7,8 However, the pathogenetic mechanisms by which reduced expression of Endoglin or ALK1 causes dilation of venules are not clearly understood. Furthermore, the questions of why only limited vascular beds in a HHT patient are affected and what determines the age of onset and the severity of disease manifestation among HHT patients remain to be answered.Both endoglin and Alk1 are involved in TGF-␤ signaling. TGF-␤ family cytokines exert their effects by binding to heteromeric complexes of two types of transmembrane serine/threonine kinase receptors. 9 The type II receptors function primarily as the binding receptors. On binding their ligand(s), type II receptors associate with and phosphorylate the type I receptors, which in turn a...