Histone Deacetylase Inhibitor Panobinostat Research Articles

Thermal profiling reveals phenylalanine hydroxylase as an off-target of panobinostat.

We describe a two-dimensional thermal proteome profiling strategy that can be combined with an orthogonal chemoproteomics approach to enable comprehensive target profiling of the marketed histone deacetylase inhibitor panobinostat. The N-hydroxycinnamide moiety is identified as critical for potent and tetrahydrobiopterin-competitive inhibition of phenylalanine hydroxylase leading to increases in phenylalanine and decreases in tyrosine levels. These findings provide a rationale for adverse clinical observations and suggest repurposing of the drug for treatment of tyrosinemia.

Influence of a novel histone deacetylase inhibitor panobinostat (LBH589) on the growth of ovarian cancer

BackgroundPre-clinical studies have demonstrated that natural and synthetic histone deacetylase (HDAC) inhibitors can impede the in vitro and in vivo growth of cell lines from a variety of gynecologic and other malignancies. We investigated the anti-tumor activity of panobinostat (LBH589) both in vitro and in vivo as either a single agent or in combination with conventional cytotoxic chemotherapy using patient-derived xenograft (PDX) models of primary serous ovarian tumors.MethodsThe ovarian cancer cell lines OVCAR8, SKOV3 and their paclitaxel-resistant derivatives OVCAR8-TR and SKOV3-TR were treated with increasing doses of LBH589. The effect of LBH589 on cell viability was assessed using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Serially transplanted primary human high-grade serous ovarian adenocarcinoma tissue was utilized to generate xenografts in 6-week old female NOD/SCID mice. The mice were then randomized into one of 4 treatment groups: (1) vehicle control; (2) paclitaxel and carboplatin (P/C); (3) LBH589; or (4) P/C + LBH589. Mice were treated for 21 days and tumor volumes and mouse weights were obtained every 3 days. These experiments were performed in triplicate with three different patient derived tumors. Wilcoxan rank-sum testing was utilized to assess tumor volume differences.ResultsIn vitro treatment with LBH589 significantly reduced the viability of both taxol-sensitive and taxol-resistant ovarian cancer cell lines (p < 0.01). In vivo treatment with LBH589 alone appeared tumorstatic and reduced tumor growth when compared to vehicle treatment (p < 0.007) after 21 days. This single agent activity was confirmed in two additional experiments with other PDX tumors (p < 0.03, p < 0.05). A potential additive effect of LBH589 and P/C, manifested as enhanced tumor regression with the addition of LBH589 compared to vehicle (p < 0.02), in one of the three analyzed serous PDX models.ConclusionsOur findings suggest that pan-HDAC inhibition with panobinostat precludes the growth of ovarian cancer cell lines in vitro and PDXs in vivo. Added benefit of LBH589 to standard P/C therapy was observed in one of three PDX models suggesting improved response in a subset of serous ovarian cancers.

Panobinostat for the treatment of acute myelogenous leukemia

ABSTRACTIntroduction: Therapeutic strategies in patients with acute myeloid leukemia (AML) have not changed significantly over the last decades. Appropriate strategies are ultimately driven by the assessment of patients’ fitness to define suitability for intensive induction chemotherapy, which produces high initial remission rates but, increased likelihood of relapse. Old/unfit AML patients still represent an urgent and unmet therapeutic need. Epigenetic deregulation represents a strategic characteristic of AML pathophysiology whereby aberrant gene transcription provides an advantage to leukemic cell survival. Efforts to re-establish impaired epigenetic regulation include hypomethylating agents and histone deacetylase inhibitors (HDACi).Areas covered: The review discusses the underlying mechanisms leading to disruption of lysine acetyltransferases (KAT or HAT)/deacetylase (KDAC or HDAC) balance and the rationale for using the HDACi panobinostat (LBH-589) in AML.Expert opinion: Although panobinostat has produced significant results in myeloma, its efficacy remains limited in AML. Panobinostat exerts pleiotropic activity and lack of specificity, which likely contributes to its inadequate safety in elderly AML patients. Phase I-II trials, utilizing panobinostat associated with well-known chemotherapeutic agents are ongoing and combinations with other druggable targets may likely be evaluated in future trials. The clinical use of this HDACi in AML the near future does not appearing promising.

Epigenetic regulation of miRNA-124 and multiple downstream targets is associated with treatment response in myeloid malignancies.

Epigenetic regulation of microRNA (miRNA) expression has recently been implicated in the pathogenesis of myelodysplastic syndrome (MDS). Particular interest has focused on miRNA-124 expression, which is inhibited in MDS and has recently been demonstrated to be upregulated in response to epigenetic treatment (EGT). Previous studies have determined the in vitro and in vivo expression of miRNA-124 and several molecular targets, including cyclin-dependent kinase (CDK) 4, CDK6 and enhancer of zeste homolog 2 (EZH2), in order to elucidate the molecular mechanisms associated with the miRNA-124-mediated therapeutic response to EGT in MDS and identify additional potential biomarkers of early EGT treatment response in myeloid malignancies. In vitro studies in the HL60 leukemic cell line identified upregulation of miRNA-124 expression in response to single-agent EGT with either azacytidine (AZA) or the histone deacetylase inhibitor panobinostat (LBH589). Combination EGT with AZA and LBH589 resulted in significant additive induction of miRNA-124 expression. Expression of downstream targets of miRNA-124, including CDK4, CDK6 and EZH2, in response to single agent and combined EGT was determined in HL60 cells. Single and combination EGT treatment resulted in inhibition of CDK4, CDK6 and EZH2 expression with combination EGT resulting in a significant and additive inhibitory effect. In vivo studies using peripheral blood mononuclear cells from patients receiving combination EGT for high risk MDS or acute myeloid leukemia demonstrated significant induction of miRNA-124 and inhibition CDK4 and CDK6 messenger (m)RNA expression in patients that responded to combination EGT. A trend to inhibited EZH2 mRNA expression was also identified in response to combination EGT. Overall, the present observations identify a potential molecular mechanism for miRNA-124-mediated response to EGT involving regulation of CDK4, CDK6 and EZH2 expression. In addition, the present findings further qualify miRNA-124 as a possible biomarker of early response to EGT in myeloid malignancies and potentially a valid therapeutic target, together with CDK4, CDK6 and EZH2.

Abstract 3198: HDAC inhibitor panobinostat as a selective agent, synergizes with chemotherapeutics in medulloblastoma and neuroblastoma

Abstract Background: Embryonal tumors of the central nervous system continue to present therapeutic challenges with high rates of relapse and poor prognosis at advanced stages. Medulloblastoma (MB) accounts for over 15% of pediatric brain tumors, with a five-year survival rate of 62%. Neuroblastoma (NB) is the most common extracranial solid tumor in children, accounting for 15% of pediatric cancer deaths. Among many pathways that contribute to MB and NB potency, several histone deacetylases (HDACs) have been shown to prevent cell differentiation. In cells expressing wt-p53, HDAC inhibitors induce nuclear relocalization of p53 to the nucleus to induce expression of the cell cycle inhibitor p21/Waf1/Cip1. As most NB tumors express wt-p53, HDAC inhibitors are promising candidates for therapy. Panobinostat has been shown to induce differentiation, cell cycle arrest, and apoptosis in NB cells. This effect is partially due to down-regulation of CHK1, a pathway by which cancer cells can develop resistance to conventional chemotherapeutic drugs. This study proposes panobinostat coupled with conventional chemotherapeutics such as doxorubicin, etoposide, and velcade, as an effective target against the HDAC pathway in MB and NB. Methods: Established MB and NB cell lines and patient derived cell lines (MB: DAOY, D283, D341, 384MED, 458MED, 487MED, 556MED, 581MED, 721MED; NB: BE(2)-C, CHLA-90, SMS-KCNR, SH-SY5Y, MGT8-117-08, BIO-036-08) were used to quantify panobinostat's effects. Cell viability was measured using Calcein AM fluorescent assay at doses of 0.39-50 nM. Isobologram analysis of panobinostat in combination with doxorubicin, etoposide, and velcade were generated using Calcein AM. Western blot was used to measure HIF1 alpha, CHK1, and acetyl H4, Caspase 3 and PARP levels. ATP level per cell was measured using CyQuant fluorescent DNA assay with CellTiter-Glo luminescent cell viability assay. Results: Cell viability assays show cytotoxicity of panobinostat in MB and NB cell lines, with IC50 values from 2-10 nM in MB cells, 5-20 nM in established NB cell lines and 23-91 nM in patient derived NB lines. ATP/cell activity was inhibited in MB and NB cells following treatment with panobinostat alone. Isobologram experiments suggest synergistic cytotoxicity of panobinostat in combination with doxorubicin, etoposide, and velcade in NB cell lines BE(2)-C and SMS-KCNR. Western blot analysis indicates caspase-mediated apoptosis occurs, with inhibition of overexpressed HDAC proteins among multiple classes in MB and NB cells. Conclusions: This study indicates that panobinostat targets the HDAC inhibition pathway of MB and NB cells. Additionally, panobinostat synergizes with doxorubicin, etoposide, and velcade in inducing apoptosis in MB and NB cells. This study provides rationale for initiation of a clinical trial in treating MB and NB patients with panobinostat in combination with conventional chemotherapeutics. Citation Format: Amanda B. Witte, Mary Durston, Ping Zhao, Abhinav B. Nagulapally, Jeffrey Bond, Giselle L. Saulnier Sholler. HDAC inhibitor panobinostat as a selective agent, synergizes with chemotherapeutics in medulloblastoma and neuroblastoma. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 3198.

Abstract 4730: The histone deacetylase inhibitor panobinostat sensitizes cyclin E-amplified ovarian cancer cells to poly ADP-ribose polymerase inhibitor olaparib

Abstract Objective: Ovarian cancer is the second most common gynecological cancer and the number one cause of cancer death in gynecological cancers. In the United States alone, there are about 21,290 expected new cases in 2015 and about 14,180 expected deaths. Approximately 95% of ovarian malignancies are epithelial ovarian cancer (EOC). Most (50%) of these EOC tumors have BRCAness features - contain molecular defect in homologous recombination (HR) DNA repair pathways. About 20% of the non-BRACness subtypes of EOC exhibit increased expression of cyclin E (CCNE1) which is associated with resistance to DNA damaging drugs and increased mortality. A first-in-class drug, a poly(ADP-ribose) polymerase inhibitor (PARPi) olaparib was approved by the FDA for the treatment of advanced ovarian cancer patients with BRCA mutations who have had three or more lines chemotherapy. PARPi efficacy is lower in non-BRCAness tumors but may be enhanced by other drug combinations. Our group has shown that epigenetic histone deacetylase inhibitor (HDACi) therapy sensitizes ovarian cancer cells to various chemotherapeutic drugs. Our goal is to expand olaparib therapy to patients with chemoresistant tumors by sensitizing CCNE1 amplified EOC with the potent HDACi, panobinostat. Method: Ovarian cancer cell lines used were OVCAR-3 (CCNE1-amplified) and SKOV3 (CCNE1-non-amplified). They were co-treated with 0.01% DMSO vehicle, olaparib, panobinostat or olaparib/panobinostat combination. Sulforhodamine B (SRB) assays assessed cytotoxicity and immunofluorescence (IF) assessed markers of apoptosis (cleaved caspase-3). Images were analyzed using the Adobe Photoshop counting tool. Data analysis was performed via the Microsoft Excel average and percentage functions. Figures and p-value analysis were created using GraphPad Prism. Results: Our previous studies have demonstrated through western blot analysis of cleaved PARP expression that panobinostat enhances the pro-apoptotic effect of olaparib in CCNE1 amplified OVCAR-3 ovarian cancer cells. In this current study, IF was used to assess the established marker of apoptosis, cleaved caspase-3, in OVCAR3 and SKOV3 cells. Compared to vehicle-treated cells, olaparib alone induced no difference in the number of cleaved caspase-3 expression in both SKOV3 and OVCAR3 cells. However, there was significant upregulation in the percentage of cells positive for cleaved caspase-3 expression in combination treatments compared to single drug treatments in both cell lines. Conclusion: The response of ovarian cancer cells to the PARPi olaparib is enhanced by co-treatment with HDACi panobinostat in vitro. This indicates that, responses to olaparib in HR-proficient EOC can be improved by combination therapy with panobinostat. Thus we have identified a novel way to expand the use of olaparib for the treatment of advanced ovarian cancer to patients with non-BRCA tumors. Citation Format: Kofi Sarfo-Kantanka, Andrew J. Wilson, Alexandra Steck, Jeanette Saskowski, Dineo Khabele. The histone deacetylase inhibitor panobinostat sensitizes cyclin E-amplified ovarian cancer cells to poly ADP-ribose polymerase inhibitor olaparib. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 4730.

Abstract 4634: Novel dual HDAC &amp; PI3K inhibitor, CUDC-907, for MYC-driven malignancies

Abstract MYC family genes are among the most frequently deregulated oncogenic drivers in human cancer. Pharmacologic inhibition of HDAC activity and blockade of the PI3K pathway have both been shown to suppress MYC-induced transcription. HDAC activity is critical for MYC gene regulation, as MYC represses transcription of target genes through recruitment of HDACs. HDAC inhibitors have been shown to restore expression of genes suppressed by MYC family members and to induce rapid downregulation of expression of MYC itself. The PI3K pathway plays a central role in regulating MYC at the post-transcriptional level. Activation of PI3K signaling leads to activation of AKT, which phosphorylates and inhibits GSK3β. As GSK3β normally phosphorylates MYC which facilitates the degradation of MYC, activation of PI3K signaling leads to increased stability of MYC, whereas PI3K inhibitors decrease MYC stability. A recent study has demonstrated addiction to MYC signaling and hypersensitivity to PI3K inhibition in PTEN-deficient diffuse large B-cell (DLBCL) cell lines, suggesting that MYC-driven cancers may be particularly sensitive to PI3K inhibition. As HDACs and PI3K regulate MYC protein levels and functions through nonoverlapping mechanisms, simultaneous HDAC and PI3K inhibition may further enhance MYC suppression. CUDC-907 is an orally bioavailable, small-molecule dual HDAC and PI3K inhibitor that primarily inhibits class I and II HDACs and the PI3Kα, β, and δ isoforms. CUDC-907 shows greater anti-tumor activity in vitro than single-target HDAC or PI3K inhibitors, especially in MYC-dependent cell types, such as DLBCL and NUT midline carcinoma (NMC). In preclinical testing, CUDC-907 treatment leads to a dose-dependent decrease in MYC protein levels, and is also more potent in decreasing MYC than the HDAC inhibitor panobinostat and the pan-PI3K inhibitor pictilisib alone or in combination. Significant antitumor effects have been consistently observed in MYC-driven DLBCL xenograft and genetically engineered mouse models exposed to CUDC907. In particular, certain MYC translocation (Daudi), double-hit (concurrent MYC and BLC2 translocation, WSUDLCL2 and DOHH2), double-expresser (expression of MYC and BCL2 proteins, U2932) xenograft models, and the Eμ-Myc transgenic mouse model achieve tumor growth inhibition of 100%, 69%, 56%, 97% and 72%, respectively. These findings raise the possibility that hematologic and solid tumors driven by aberrant overexpression of MYC family genes (e.g., MYC-altered DLBCL and NMC) might be more responsive to simultaneous HDAC and PI3K inhibition with CUDC-907 than they are to single-target therapy. Clinical Phase 1 studies are currently testing CUDC-907 in patients with relapsed/refractory (R/R) DLBCL and advanced MYC-aberrant solid tumors. Preliminary data are encouraging and support the planned Phase 2 study in R/R MYC-altered DLBCL, as well as further testing in other MYC-driven malignancies. Citation Format: Kaiming Sun, Ruzanna Atoyan, Mylissa A. Borek, Steven Dellarocca, Maria E. Samson, Anna W. Ma, Guangxin Xu, Troy Patterson, David P. Tuck, Jaye L. Viner, Ali Fattaey, Jing Wang. Novel dual HDAC &amp; PI3K inhibitor, CUDC-907, for MYC-driven malignancies. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 4634.

Abstract 3355: Opening up heterochromatin by histone deacetylase inhibition improves response to DNA damage in lung cancer tumor initiating cells

Abstract Tumors are suggested to be highly responsive to epigenetic alterations such as histone modifications and DNA methylation. We have previously reported a resistant phenotype of sphere-forming non-small cell lung cancer (NSCLC) tumor initiating cells (TICs) with an impaired activation of DNA-damage response proteins. Here we set out to analyze chromatin compactness since a heterochromatic structure has been postulated to constitute a barrier to DNA damage and repair. We show that certain NSCLC and small cell lung cancer (SCLC) TICs have elevated levels of the heterochromatin markers heterochromatin protein 1γ (HP1γ) and trimethylated lysine 9 of histone 3 (H3K9me3). Chromatin modulators were tested and histone deacetylase inhibitors (HDACi) vorinostat, panobinostat and trichostatin A reduced the cell viability of NSCLC TICs compared to bulk cells after 72 h. We could also demonstrate that TICs are more responsive to HDAC inhibitors since the euchromatin marker acetylated lysine 8 of histone H4 (H4K8ac) was increased after vorinostat and trichostatin A in NSCLC TICs but not in bulk cells. Pretreatment with HDACi inhibitors sensitized NSCLC TICs to cisplatin and ionizing irradiation. Accordingly, pretreatment with vorinostat increased the phosphorylation of the DNA-damage response proteins ataxia telangiectasia mutated (ATM) and DNA-dependent protein kinase (DNA-PK) upon irradiation in NSCLC TICs, whereas bulk cells already had a higher level with radiation only. In conclusion, we demonstrate that lung cancer TICs display a heterochromatic structure compared to bulk cells and that NSCLC TICs have an enhanced sensitization upon DNA damage inflicted by cisplatin or radiation after HDACi pretreatment. Citation Format: Lovisa Lundholm, Petra Hååg, Mina Eriksson, Beata Brzozowska, Rolf Lewensohn, Andrzej Wojcik, Kristina Viktorsson. Opening up heterochromatin by histone deacetylase inhibition improves response to DNA damage in lung cancer tumor initiating cells. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 3355.

Abstract 4745: Repurposing of valproic acid and simvastatin combination as anticancer agents in prostate cancer: synergistic interaction with docetaxel and suppression of docetaxel resistance

Abstract Although docetaxel (DTX) remains a standard of care for advanced prostate cancer (PCa), limited long-term responses, side effects and resistant disease suggested the need of novel combination strategies. Increased expression of histone deacetylases (HDAC) and alteration of the mevalonate pathway (MVP) are common aberrations in PCa. In this study, we analyzed the antitumor effect of DTX in combination with valproic acid (VPA), an anticonvulsant with HDAC inhibitory activity, and simvastatin (SIM), a cholesterol-lowering drug inhibiting the rate-limiting enzyme of MVP HMG-CoA reductase, on androgen-dependent 22RV1 and LNCAP and androgen-independent PC3 and DU145 PCa cells, as well as on the highly aggressive SIM-resistant DU145R80 subline developed in our laboratory from DU145 cells (Milone MR et al. Cell Death Dis. 2013; Milone MR et al. Oncotarget 2014). We first showed a potent synergistic anti-proliferative effect of VPA/SIM combination, assessed by calculating combination index (CI) according to the method of Chou and Talalay, on all cell lines, including SIM-resistant cells, whatever schedule of administration (simultaneous vs sequential) we used, confirming our previous data on the combination between the HDAC inhibitor (HDACi) panobinostat and zoledronic acid, the latter also targeting the MVP pathway (Bruzzese F. et al, Cell Death Dis. 2013). Notably, exposure to triple combinations (VPA/SIM/DTX) resulted in a further strong synergistic anti-proliferative effect, with sequential exposure with 24h delay between VPA/SIM and DTX as the best schedule. The synergistic interaction of VPA/SIM and DTX combination involved apoptotic effect, measured by FACS analysis of sub-diploid DNA content and caspase 3/7 cleavage, and DNA damage induction, assessed by γH2AX expression. Synergistic effect of VPA/SIM and DTX combination was confirmed by soft agar clonogenic assay and by 3D culture on self-assembled PCa spheroids. Significantly, VPA/SIM combination was also able to revert DTX-resistance in DTX-resistant PC3 and DU145 sublines developed in our laboratory from the parental cells. All together these findings suggested that the combination of two safe generic drugs such as VPA and SIM can improve DTX efficacy, representing a novel therapeutic approach that warrant clinical investigation in advanced PCa patients. Our study also suggests a new strategy to overcome resistance to standard taxane-based therapy in PCa patients. Citation Format: Federica Iannelli, Rita Lombardi, Biagio Pucci, Maria Rita Milone, Chiara Ciardiello, Alessandra Leone, Elena Di Gennaro, Alfredo Budillon, Francesca Bruzzese. Repurposing of valproic acid and simvastatin combination as anticancer agents in prostate cancer: synergistic interaction with docetaxel and suppression of docetaxel resistance. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 4745.

Novel agents in the treatment of multiple myeloma: a review about the future.

Multiple myeloma (MM) is a disease that affects plasma cells and can lead to devastating clinical features such as anemia, lytic bone lesions, hypercalcemia, and renal disease. An enhanced understanding of MM disease mechanisms has led to new more targeted treatments. There is now a plethora of treatments available for MM. In this review article, our aim is to discuss many of the novel agents that are being studied or have recently been approved for the treatment of MM. These agents include the following: immunomodulators (pomalidomide), proteasome inhibitors (carfilzomib, marizomib, ixazomib, oprozomib), alkylating agents (bendamustine), AKT inhibitors (afuresertib), BTK inhibitors (ibrutinib), CDK inhibitors (dinaciclib), histone deacetylase inhibitors (panobinostat, rocilinostat, vorinostat), IL-6 inhibitors (siltuximab), kinesin spindle protein inhibitors (filanesib), monoclonal antibodies (daratumumab, elotuzumab, indatuximab, SAR650984), and phosphoinositide 3-kinase (PI3K) inhibitors.

The HDACi Panobinostat Shows Growth Inhibition Both In Vitro and in a Bioluminescent Orthotopic Surgical Xenograft Model of Ovarian Cancer.

BackgroundIn most epithelial ovarian carcinomas (EOC), epigenetic changes are evident, and overexpression of histone deacetylases (HDACs) represents an important manifestation. In this study, we wanted to evaluate the effects of the novel HDAC inhibitor (HDACi) panobinostat, both alone and in combination with carboplatin, on ovarian cancer cell lines and in a murine bioluminescent orthotopic surgical xenograft model for EOC.MethodsThe effects of panobinostat, both alone and in combination with carboplatin, on proliferation and apoptosis in ovarian cancer cell lines, were evaluated using colony and WST-1 assays, Hoechst staining and flow cytometry analysis. In addition, mechanisms were characterised by western blotting and phosphoflow analysis. Immuno-deficient mice were engrafted orthotopically with SKOV-3luc+ cells and serial bioluminescence imaging monitored the effects of treatment with panobinostat and/or carboplatin and/or surgery. Survival parameters were also measured.ResultsPanobinostat treatment reduced cell growth and diminished cell viability, as shown by the induced cell cycle arrest and apoptosis in vitro. We observed increased levels of cleaved PARP and caspase-3, downregulation of cdc2 protein kinase, acetylation of H2B and higher pH2AX expression. The combined administration of carboplatin and panobinostat synergistically increased the anti-tumour effects compared to panobinostat or carboplatin treatment alone. In our novel ovarian cancer model, the mice showed significantly higher rates of survival when treated with panobinostat, carboplatin or a combination of both, compared to the controls. Panobinostat was as efficient as carboplatin regarding prolongation of survival. No significant additional effect on survival was observed when surgery was combined with carboplatin/panobinostat treatment.ConclusionsPanobinostat demonstrates effective in vitro growth inhibition in ovarian cancer cells. The efficacy of panobinostat and carboplatin was equal in the orthotopic EOC model used. We conclude that panobinostat is a promising therapeutic alternative that needs to be further assessed for the treatment of EOC.

Targeting Intrinsic and Extrinsic Vulnerabilities for the Treatment of Multiple Myeloma

Multiple myeloma (MM) is a malignant plasma cell disorder, clinically characterized by osteolytic lesions, immunodeficiency, and renal disease. Over the past decade, MM therapy is significantly improved by the introduction of novel therapeutics such as immunomodulatory agents (thalidomide, lenalidomide, and pomalidomide), proteasome inhibitors (bortezomib, carfilzomib, and ixazomib), monoclonal antibodies (daratumumab and elotuzumab), histone deacetylase (HDAC) inhibitors (Panobinostat). The clinical success of these agents has clearly identified vulnerabilities intrinsic to the MM cell, as well as targets that emanate from the tumor microenvironment. Despite these significant improvements, MM remains incurable due to the development of drug resistance. This perspective will discuss more recent strategies which take advantage of multiple targets within the proteome recycling pathway, chromatin remodeling, and disruption of nuclear export. In addition, we will review the development of strategies designed to block opportunistic survival signaling that occurs between the MM cell and the tumor microenvironment including strategies for inhibiting myeloma-induced immune suppression. It has become clear that MM tumors continue to evolve on therapy leading to drug resistance. It will be important to understand the emerging drug resistant mechanisms and additional vulnerabilities that occur due to the development of clinical resistance. J. Cell. Biochem. 118: 15-25, 2017. © 2016 Wiley Periodicals, Inc.

Panobinostat—A Potential Treatment for Metastasized Ewing Sarcoma? A Case Report

Ewing sarcoma (ES) is a form of primary bone cancer, with few treatment options for patients who develop relapse with an overall 5-year survival of 13%. New treatment options are needed and histone deacetylase (HDAC) inhibitors show encouraging results in preclinical studies. Our patient developed inoperable progressive lung metastases and was treated with the HDAC inhibitor panobinostat. During 18 months of treatment, no new lesions appeared; the treatment was stopped due to progression. This clinical observation warrants further evaluation of HDAC inhibitors in ES. Combination with chemotherapy and biomarker studies could improve the therapeutic index of these classes of compounds.

The Bromodomain Inhibitor JQ1 and the Histone Deacetylase Inhibitor Panobinostat Synergistically Reduce N-Myc Expression and Induce Anticancer Effects

Patients with neuroblastoma associated with MYCN oncogene amplification experience a very poor prognosis. BET bromodomain inhibitors are among the most promising novel anticancer agents as they block BRD3 and BRD4 from activating oncogene transcription. However, treatment with BET bromodomain inhibitors alone does not result in cancer remission in many murine models. MYCN-amplified neuroblastoma cells were treated with vehicle control, the BET bromodomain inhibitor JQ1, the histone deacetylase inhibitor panobinostat, or the combination of JQ1 and panobinostat. Genes modulated by JQ1, panobinostat, or the combination therapy were identified by Affymetrix microarray, and cell proliferation and apoptosis were examined by Alamar blue assays and flow cytometry analysis. Modulation of LIN28B promoter activity by BRD3 and BRD4 was examined by chromatin immunoprecipitation and luciferase assays. In addition, neuroblastoma-bearing mice were treated with vehicle control, JQ1, and/or panobinostat. LIN28B was one of the top genes synergistically reduced by JQ1 and panobinostat. BRD3 and BRD4 directly bound to the LIN28B gene promoter and activated LIN28B gene transcription, and knocking down LIN28B reduced the expression of N-Myc protein, but not N-Myc mRNA. JQ1 and panobinostat synergistically reduced LIN28B gene and N-Myc protein expression, and synergistically induced growth inhibition and apoptosis in neuroblastoma cells, but not normal nonmalignant cells in vitro In neuroblastoma-bearing mice, JQ1 and panobinostat synergistically and considerably reduced N-Myc protein expression in tumor tissues and blocked tumor progression. Our findings have identified a novel strategy to reduce the N-Myc oncoprotein expression and a novel therapeutic approach for the treatment of aggressive neuroblastoma. Clin Cancer Res; 22(10); 2534-44. ©2016 AACR.

Functional and Transcriptional Characterization of Histone Deacetylase Inhibitor-Mediated Cardiac Adverse Effects in Human Induced Pluripotent Stem Cell-Derived Cardiomyocytes.

Histone deacetylase (HDAC) inhibitors possess therapeutic potential to reverse aberrant epigenetic changes associated with cancers, neurological diseases, and immune disorders. Unfortunately, clinical studies with some HDAC inhibitors displayed delayed cardiac adverse effects, such as atrial fibrillation and ventricular tachycardia. However, the underlying molecular mechanism(s) of HDAC inhibitor-mediated cardiotoxicity remains poorly understood and is difficult to detect in the early stages of preclinical drug development because of a delayed onset of effects. In the present study, we show for the first time in human induced pluripotent stem cell-derived cardiomyocytes (hiPS-CMs) that HDAC inhibitors (dacinostat, panobinostat, vorinostat, entinostat, and tubastatin-a) induce delayed dose-related cardiac dysfunction at therapeutic concentrations associated with cardiac adverse effects in humans. HDAC inhibitor-mediated delayed effects on the beating properties of hiPS-CMs developed after 12 hours by decreasing the beat rate, shortening the field potential duration, and inducing arrhythmic behavior under form of sustained contractions and fibrillation-like patterns. Transcriptional changes that are common between the cardiotoxic HDAC inhibitors but different from noncardiotoxic treatments identified cardiac-specific genes and pathways related to structural and functional changes in cardiomyocytes. Combining the functional data with epigenetic changes in hiPS-CMs allowed us to identify molecular targets that might explain HDAC inhibitor-mediated cardiac adverse effects in humans. Therefore, hiPS-CMs represent a valuable translational model to assess HDAC inhibitor-mediated cardiotoxicity and support identification of better HDAC inhibitors with an improved benefit-risk profile. Histone deacetylase (HDAC) inhibitors are a promising class of drugs to treat certain cancers, autoimmune, and neurodegenerative diseases. However, treated patients can experience various cardiac adverse events such as hearth rhythm disorders. This study found that human induced pluripotent stem cell-derived cardiomyocytes (hiPS-CMs) can predict cardiac adverse events in patients caused by HDAC inhibitors. Furthermore, transcriptional changes at the level of gene expression supported the effects on the beating properties of hiPS-CMs and highlight targets that might cause these cardiac adverse effects. hiPS-CMs represent a valuable translational model to assess HDAC inhibitor-mediated cardiotoxicity and to support development of safer HDAC inhibitors.

Abstract C79: The histone deacetylase inhibitor panobinostat sensitizes cyclin E-amplified ovarian cancer cells to poly (ADP-ribose) polymerase inhibitor olaparib

Abstract Objective: Ovarian cancer is the second most common gynecological cancer and the number one cause of cancer death in gynecological cancers. In the United States alone, there are about 21,290 expected new cases in 2015 and about 14,180 expected deaths. Approximately 95% of ovarian malignancies are epithelial ovarian cancer (EOC). Most (50%) of these EOC tumors have BRCAness features - contain molecular defect in homologous recombination (HR) DNA repair pathways. About 20% of the non-BRACness subtypes of EOC exhibit increased expression of cyclin E (CCNE1) which is associated with resistance to DNA damaging drugs and increased mortality. A first-in-class drug, a poly(ADP-ribose) polymerase inhibitor (PARPi) olaparib was approved by the FDA for the treatment of advanced ovarian cancer patients with BRCA mutations who have had three or more lines chemotherapy. PARPi efficacy is lower in non-BRCAness tumors but may be enhanced by other drug combinations. Our group has shown that epigenetic histone deacetylase inhibitor (HDACi) therapy sensitizes ovarian cancer cells to various chemotherapeutic drugs. Our goal is to expand olaparib therapy to patients with chemoresistant tumors by sensitizing CCNE1 amplified EOC with the potent HDACi, panobinostat. Method: Ovarian cancer cell lines used were OVCAR-3 (CCNE1-amplified) and SKOV3 (CCNE1-non-amplified). They were co-treated with 0.01% DMSO vehicle, olaparib, panobinostat or olaparib/panobinostat combination. Sulforhodamine B (SRB) assays assessed cytotoxicity and immunofluorescence (IF) assessed markers of apoptosis (cleaved caspase-3). Images were analyzed using the Adobe Photoshop counting tool. Data analysis was performed via the Microsoft Excel average and percentage functions. Figures and p-value analysis were created using GraphPad Prism. Results: Our previous studies have demonstrated through western blot analysis of cleaved PARP expression that panobinostat enhances the pro-apoptotic effect of olaparib in CCNE1 amplified OVCAR-3 ovarian cancer cells. In this current study, IF was used to assess the established marker of apoptosis, cleaved caspase-3, in OVCAR3 and SKOV3 cells. Compared to vehicle-treated cells, olaparib alone induced no difference in the number of cleaved caspase-3 expression in both SKOV3 and OVCAR3 cells. However, there was significant upregulation in the percentage of cells positive for cleaved caspase-3 expression in combination treatments compared to single drug treatments in both cell lines. These data were supported by SRB cytotoxicity assays, where the combination of panobinostat and olaparib synergized in both OVCAR-3 and SKOV3 cells. Conclusion: The response of ovarian cancer cells to the PARPi olaparib is enhanced by co-treatment with HDACi panobinostat in vitro. This indicates that, responses to olaparib in HR-proficient EOC can be improved by combination therapy with panobinostat. Thus we have identified a novel way to expand the use of olaparib for the treatment of advanced ovarian cancer to patients with non-BRCA tumors. Note: This abstract was not presented at the conference. Citation Format: Kofi Sarfo-Kantanka, Andrew J. Wilson, Alexandra Steck, Jeanette Saskowski, Dineo Khabele. The histone deacetylase inhibitor panobinostat sensitizes cyclin E-amplified ovarian cancer cells to poly (ADP-ribose) polymerase inhibitor olaparib. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C79.

Abstract A09: Preclinical trial using the combination of panobinostat with bortezomib in human orthotopic xenograft mouse models of rhabdomyosarcoma

Abstract Background: Rhabdomyosarcoma (RMS) is an aggressive malignancy of childhood which has a poor prognosis when it has metastasized. Although there has been improvement in overall survival for low and intermediate risk patients, there has been no significant improvement in outcome in the past 25 years for patients with high risk disease. Orthotopic patient derived mouse xenografts (O-PDXs) have been created from patients with high risk disease to facilitate preclinical trials and provide useful information regarding efficacy and toxicity of novel therapeutic agents. Histone deacetylases (HDAC) have emerged as a relevant clinical target in RMS and other pediatric solid tumors, and the synergistic combination of HDAC inhibitors with proteasome inhibitors has led to increased cellular stress and apoptosis in other malignancies. The HDAC inhibitor panobinostat combined with bortezomib, a proteasome inhibitor, is a combination currently in consideration for clinical trial development for this patient population. Methods: Orthotopic xenografts were created by injecting patient derived RMS cells into the hind-leg muscle of CD-1 nude mice. Detailed molecular and histopathologic characterization of the tumors was performed to ensure they recapitulate human disease. Primary cultures of dissociated O-PDXs were used for high-throughput drug screening in dose response. Pharmacokinetic studies on RMS tumor-bearing mice were performed to determine matched human AUC-guided dosing and schedule of chemotherapy agents. Preclinical phase I tolerability studies were performed for all drug combinations. The following preclinical phase II study was performed using 2 different O-PDXs (SJRBH000026_X1, SJRHB012_Y) both derived from patients with metastatic recurrent embryonal RMS: (SJRBH000026_X1, SJRHB012_Y) Group 1 (n = 5, n = 4) Panobinostat/Bortezomib Group 2 (n = 3, n = 3) Vincristine/Irinotecan (relapse standard of care) Group 3 (n = 3, n = 3) Control (no chemotherapy) Enrollment into the 3 treatment groups was randomized for each of the O-PDXs tested. Two courses of therapy were given on a clinically relevant schedule with each course consisting of 21 days. The study endpoint was reached and mice were classified as progressive disease when tumor approached 20% of body weight. Results: Both O-PDXs tested in vitro were found to be highly sensitive to panobinostat and bortezomib with EC50 values in the nanomolar range for both drugs. Drug combinations were found to be well tolerated in preclinical phase I studies at the doses tested with only temporary mild dehydration observed in the panobinostat/bortezomib group. In the preclinical phase II study, mice in group 1 were found to have an average survival of 16.5 days (avg. of 11 days, 22 days respectively). Mice receiving the standard of care therapy (group 2) survived an average of 40.7 days (avg. of 49 days, 32.3 days respectively). Mice in group 3 were determined to have progressive disease on average at 17 days (avg. of 12.3 days, 21.7 days respectively). Conclusions: On the basis of preclinical in vitro data, combining HDAC and proteasome inhibitors is an attractive strategy for RMS and was found to be tolerable in preclinical phase I studies. However, the use of this combination in O-PDXs failed to show meaningful efficacy. The lack of response in relevant RMS models raises concerns about the sensitivity observed in in vitro studies and additional biologic and pharmacokinetic studies are indicated to identify factors leading to this discrepancy prior to further clinical development of these agents for this patient population. Citation Format: Elizabeth Stewart, Cori Bradley, Anang Shelat, Alberto Pappo, Michael A. Dyer. Preclinical trial using the combination of panobinostat with bortezomib in human orthotopic xenograft mouse models of rhabdomyosarcoma. [abstract]. In: Proceedings of the AACR Special Conference on Advances in Pediatric Cancer Research: From Mechanisms and Models to Treatment and Survivorship; 2015 Nov 9-12; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Res 2016;76(5 Suppl):Abstract nr A09.

The CDK9 Inhibitor Dinaciclib Exerts Potent Apoptotic and Antitumor Effects in Preclinical Models of MLL-Rearranged Acute Myeloid Leukemia.

Translocations of the mixed lineage leukemia (MLL) gene occur in 60% to 80% of all infant acute leukemias and are markers of poor prognosis. MLL-AF9 and other MLL fusion proteins aberrantly recruit epigenetic regulatory proteins, including histone deacetylases (HDAC), histone methyltransferases, bromodomain-containing proteins, and transcription elongation factors to mediate chromatin remodeling and regulate tumorigenic gene expression programs. We conducted a small-molecule inhibitor screen to test the ability of candidate pharmacologic agents targeting epigenetic and transcriptional regulatory proteins to induce apoptosis in leukemic cells derived from genetically engineered mouse models of MLL-AF9-driven acute myeloid leukemia (AML). We found that the CDK inhibitor dinaciclib and HDAC inhibitor panobinostat were the most potent inducers of apoptosis in short-term in vitro assays. Treatment of MLL-rearranged leukemic cells with dinaciclib resulted in rapidly decreased expression of the prosurvival protein Mcl-1, and accordingly, overexpression of Mcl-1 protected AML cells from dinaciclib-induced apoptosis. Administration of dinaciclib to mice bearing MLL-AF9-driven human and mouse leukemias elicited potent antitumor responses and significantly prolonged survival. Collectively, these studies highlight a new therapeutic approach to potentially overcome the resistance of MLL-rearranged AML to conventional chemotherapies and prompt further clinical evaluation of CDK inhibitors in AML patients harboring MLL fusion proteins.

Practical Approaches to the Management of Dual Refractory Multiple Myeloma.

The outcome of myeloma patients' dual refractory to lenalidomide and bortezomib is generally poor and represents a significant clinical challenge with a clear need for new therapeutic approaches. This has prompted the development of next-generation proteasome inhibitors and immunodulatory drugs (IMiDs), as well as new classes of drugs with novel mechanisms of action. As a result, several of these agents have received regulatory approval that have shown promising activity in the dual refractory setting including the second-generation proteasome inhibitor carfilzomib and third-generation IMiD pomalidomide. Moreover, the regulatory approval of several first-in-class drugs for myeloma such as the histone deacetylase (HDAC) inhibitor panobinostat and the anti-CD38 monoclonal antibody daratumumab has further broadened the therapeutic landscape for these patients. Collectively, these advances have provided new treatment strategies in dual refractory myeloma as well as important insights for the development of future studies with rationally designed drug combinations to target this challenging patient population.

Short Communication: The Broad-Spectrum Histone Deacetylase Inhibitors Vorinostat and Panobinostat Activate Latent HIV in CD4(+) T Cells In Part Through Phosphorylation of the T-Loop of the CDK9 Subunit of P-TEFb.

Cessation of highly active antiretroviral therapy (HAART) in HIV-infected individual leads to a rebound of viral replication due to reactivation of a viral reservoir composed largely of latently infected memory CD4(+) T cells. Efforts to deplete this reservoir have focused on reactivation of transcriptionally silent latent proviruses. HIV provirus transcription depends critically on the positive transcription elongation factor b (P-TEFb), whose core components are cyclin-dependent kinase 9 (CDK9) and cyclin T1. In resting CD4(+) cells, the functional levels of P-TEFb are extremely low. Cellular activation upregulates cyclin T1 protein levels and CDK9 T-loop (T186) phosphorylation. The broad-spectrum histone deacetylase inhibitors (HDACis) vorinostat and panobinostat have been shown to reactivate latent virus in vivo in HAART-treated individuals. In this study, we have found that vorinostat and panobinostat activate P-TEFb in resting primary CD4(+) T cells through induction of CDK9 T-loop phosphorylation. In contrast, tacedinaline and romidepsin, HDAC 1 and 2 inhibitors, were unable to activate CDK9 T-loop phosphorylation. We used a CCL19 primary CD4(+) T-cell model HIV latency to assess the correlation between induction of CDK9 T-loop phosphorylation and reactivation of latent HIV virus by HDACis. Vorinostat and panobinostat treatment of cells harboring latent HIV increased CDK9 T-loop phosphorylation and reactivation of latent virus, whereas tacedinaline and romidepsin failed to induce T-loop phosphorylation or reactivate latent virus. We conclude that the ability of vorinostat and panobinostat to induce latent HIV is, in part, likely due to the ability of the broad-spectrum HDACis to upregulate P-TEFb through increased CDK9 T-loop phosphorylation.