21 The vasculature within a tumor is highly disordered both structurally and functionally. Endothelial 22 cells that comprise the vasculature are poorly connected causing vessels to be leaky and exposing 23 the endothelium to a hypoxic microenvironment. Therefore, most anti-angiogenic therapies are 24 generally inefficient and result in acquired resistance to increased hypoxia due to elimination of 25 the vasculature. Recent studies have explored the efficacy of targeting metabolic pathways in 26 tumor cells in combination with anti-angiogenic therapy. However, the metabolic alterations of 27 endothelial cells in response to hypoxia has been relatively unexplored. Here, we measured polar 28 metabolite levels in microvascular endothelial cells exposed to short-and long-term hypoxia with 29 the goal of identifying metabolic vulnerabilities that can be targeted to normalize tumor 30 vasculature and improve drug delivery. Many amino acid-related metabolites were altered by 31 hypoxia exposure, especially within alanine-aspartate-glutamate, serine-threonine, and cysteine-32 methionine metabolism. Additionally, there were significant changes in de novo pyrimidine 33 synthesis as well as glutathione and taurine metabolism. These results provide key insights into 34 the metabolic alterations that occur in endothelial cells in response to hypoxia, which serve as a 35 foundation for future studies to develop therapies that lead to vessel normalization and more 36 efficient drug delivery.
Introduction
38The tumor vasculature is highly disordered with both dense regions of vessels and areas 39 that lack vessels. This leads to inefficient blood flow and delivery of nutrients to a tumor, resulting 40 in a microenvironment that is nutrient-poor and hypoxic (1-3). The endothelial cells that comprise 41 disordered vessels are not tightly connected, resulting in leaky vessels (4,5) and exposing 3 42 endothelial cells to a hypoxic environment. This leakiness also enables tumor cell intravasation 43 and metastasis, and significantly impedes efficient drug delivery to tumors (1,3,6-9). Therefore, a 44 number of therapeutic approaches in cancer treatment have focused on normalizing the disordered 45 tumor vasculature.
46Traditionally, the goal of anti-angiogenic therapies (AATs) was to eradicate the vasculature 47 and deprive tumors of nutrients (10). Many AATs are approved or in clinical trials for treatment 48 of solid tumors as monotherapies or in combination with chemotherapy (9,11-15). However, 49 tumors adapt to the hypoxic microenvironment induced by AATs and develop resistance to therapy 50 (16-22). To overcome these limitations, an alternative approach to targeting the tumor vasculature 51 has been explored, whereby pruning and normalization of the tumor vasculature promotes the 52 highly ordered vasculature found within normal tissues. The resulting increased oxygenation and 53 blood flow in turn allows efficient drug delivery (1,3,23). Normalization of the tumor vasculature 54 has been achieved in several clinical studies f...