Tumor Biology

, Volume 37, Issue 7, pp 9023–9035 | Cite as

Inhibition of carbonic anhydrase potentiates bevacizumab treatment in cholangiocarcinoma

  • Kulthida Vaeteewoottacharn
  • Ryusho Kariya
  • Paweena Dana
  • Sawako Fujikawa
  • Kouki Matsuda
  • Koichi Ohkuma
  • Eriko Kudo
  • Ratthaphol Kraiklang
  • Chaisiri Wongkham
  • Sopit Wongkham
  • Seiji Okada
Original Article


Cholangiocarcinoma (CCA) is a unique liver cancer subtype with an increasing incidence globally. The lack of specific symptoms and definite diagnostic markers results in a delayed diagnosis and disease progression. Systemic chemotherapy is commonly selected for advanced CCA even though its advantages remain unknown. Targeted therapy, especially anti-vascular endothelial growth factor (VEGF) therapy, is promising for CCA; however, improvements in the therapeutic regimen are necessary to overcome subsequent resistance. We demonstrated VEGF expression was higher in CCA cell lines than in other liver cancer cells. Secreted VEGFs played roles in the induction of peri- and intra-tumoral vascularization. VEGF neutralization by bevacizumab effectively reduced tumor growth, mainly through the suppression of angiogenesis; however, increases in the expression of hypoxia-inducible factor 1α (HIF1α) and HIF1α-responsive genes (such as VEGF, VEGFR1, VEGFR2, carbonic anhydrase (CA) IX and CAXII) indicated the potential for subsequent therapeutic resistance. Supplementation with a carbonic anhydrase inhibitor, acetazolamide, enhanced the anti-CCA effects of bevacizumab. Anti-angiogenesis and anti-proliferation were observed with the combination treatment. These results suggested a novel treatment strategy to overcome anti-angiogenesis resistance and the importance of “induced essentiality” in the treatment of CCA.


Cholangiocarcinoma Vascular endothelial growth factor Anti-angiogenic treatment Carbonic anhydrase Hypoxia-inducible factor 1α 



We thank Mrs. I. Suzu for her technical assistance and Ms. Y. Endo for her secretarial work. This work was supported by a Grant-in-Aid for Scientific Research in Innovation Areas from the Ministry of Education, Culture, Sport Science and Technology (MEXT) of Japan (Grant No. 25460499), the Tokyo Biochemical Research Foundation, Japan (to SO and KV), the TRF Senior Research Scholar Grant to S. Wongkham (RTA5780012), and the National Research University Project of Thailand through SHeP-GMS; Khon Kaen University (to KV, NRU572012).

Compliance with ethical standards

Conflicts of interest



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Copyright information

© International Society of Oncology and BioMarkers (ISOBM) 2016

Authors and Affiliations

  • Kulthida Vaeteewoottacharn
    • 1
    • 2
    • 3
  • Ryusho Kariya
    • 1
  • Paweena Dana
    • 2
    • 3
  • Sawako Fujikawa
    • 1
  • Kouki Matsuda
    • 1
  • Koichi Ohkuma
    • 1
  • Eriko Kudo
    • 1
  • Ratthaphol Kraiklang
    • 3
    • 4
  • Chaisiri Wongkham
    • 2
    • 3
  • Sopit Wongkham
    • 2
    • 3
  • Seiji Okada
    • 1
  1. 1.Division of Hematopoiesis, Center for AIDS ResearchKumamoto UniversityKumamotoJapan
  2. 2.Department of BiochemistryKhon Kaen UniversityKhon KaenThailand
  3. 3.Liver Fluke and Cholangiocarcinoma Research Center, Faculty of MedicineKhon Kaen UniversityKhon KaenThailand
  4. 4.Department of Nutrition, Faculty of Public HeathKhon Kaen UniversityKhon KaenThailand

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