Therapeutic concentrations of digitoxin inhibit endothelial focal adhesion kinase and angiogenesis induced by different growth factors

Background and Purpose

Cardiac glycosides are Na⁺/K⁺‐ATPases inhibitors used to treat congestive heart failure and cardiac arrhythmias. Epidemiological studies indicate that patients on digitalis therapy are more protected from cancer. Evidence of a selective cytotoxicity against cancer cells has suggested their potential use as anticancer drugs. The effect on angiogenesis of clinically used cardiac glycosides has not been extensively explored.

Experimental Approach

We studied the effect of digoxin, digitoxin and ouabain on early events of the angiogenic process in HUVECs. We determined HUVEC viability, proliferation, migration and differentiation into capillary tube‐like structures. We also tested drug activity using an in vivo angiogenesis model. Activation of protein tyrosine kinase 2 (FAK) and signalling proteins associated with the Na⁺/K⁺‐ATPase signalosome was determined by Western blotting.

Key Results

Digitoxin and ouabain (1–100 nM) inhibited HUVEC migration, concentration‐dependently, without affecting cell viability, while digoxin induced apoptosis at the same concentrations. Digitoxin antagonized growth factor‐induced migration and tubularization at concentrations (1–25 nM) within its plasma therapeutic range. The anti‐angiogenic effect of digitoxin was confirmed also by in vivo studies. Digitoxin induced Src, Akt and ERK1/2 phosphorylation but did not affect FAK autophosphorylation at Tyr³⁹⁷. However, it significantly inhibited growth factor‐induced FAK phosphorylation at Tyr^576/577.

Conclusions and Implications

Therapeutic concentrations of digitoxin inhibited angiogenesis and FAK activation by several pro‐angiogenic stimuli. These novel findings suggest a potential repositioning of digitoxin as a broad‐spectrum anti‐angiogenic drug for diseases where pathological angiogenesis is involved.

DOI: 10.1111/bph.13944

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