Inhibition of Dll4 (delta-like ligand 4)-Notch signaling-mediated
tumor angiogenesis is an attractive approach in
cancer therapy. However, inhibition of Dll4-Notch signaling has produced different effects in various
tumors, and no
biomarkers are available for predicting the anti-Dll4-Notch-associated antitumor activity. We show that human and mouse
tumor cell-derived placental
growth factor (PlGF) is a key determinant of the Dll4-Notch-induced
vascular remodeling and
tumor growth. In natural PlGF-expressing human
tumors, inhibition of Dll4-Notch signaling markedly accelerated
tumor growth by increasing blood perfusion in nonleaking
tumor vasculatures. Conversely, in PlGF-negative
tumors, Dll4 inhibition suppressed
tumor growth by the formation of nonproductive and leaky vessels. Surprisingly, genetic inactivation of
vascular endothelial growth factor receptor 1 (VEGFR1) completely abrogated the PlGF-modulated
vascular remodeling and
tumor growth, indicating a crucial role for VEGFR1-mediated signals in modulating Dll4-Notch functions. These findings provide mechanistic insights on PlGF-VEGFR1 signaling in the modulation of the Dll4-Notch pathway in angiogenesis and
tumor growth, and have therapeutic implications of PlGF as a
biomarker for predicting the antitumor benefits of Dll4 and Notch inhibitors.