Sigma Ligands Research Articles

Cytotoxic sigma-2 ligands trigger cancer cell death via cholesterol-induced-ER-stress

Sigma-2-ligands (S2L) are characterized by high binding affinities to their cognate sigma-2 receptor, overexpressed in rapidly proliferating tumor cells. As such, S2L were developed as imaging probes (ISO1) or as cancer therapeutics, alone (SV119 [C6], SW43 [C10]) and as delivery vehicles for cytotoxic drug cargoes (C6-Erastin, C10-SMAC). However, the exact mechanism of S2L-induced cytotoxicity remains to be fully elucidated. A series of high-affinity S2L were evaluated regarding their cytotoxicity profiles across cancer cell lines. While C6 and C10 displayed distinct cytotoxicities, C0 and ISO1 were essentially non-toxic. Confocal microscopy and lipidomics analysis in cellular and mouse models revealed that C10 induced increases in intralysosomal free cholesterol and in cholesterol esters, suggestive of unaltered intracellular cholesterol trafficking. Cytotoxicity was caused by cholesterol excess, a phenomenon that contrasts the effects of NPC1 inhibition. RNA-sequencing revealed gene clusters involved in cholesterol homeostasis and ER stress response exclusively by cytotoxic S2L. ER stress markers were confirmed by qPCR and their targeted modulation inhibited or enhanced cytotoxicity of C10 in a predicted manner. Moreover, C10 increased sterol regulatory element-binding protein 2 (SREBP2) and low-density lipoprotein receptor (LDLR), both found to be pro-survival factors activated by ER stress. Furthermore, inhibition of downstream processes of the adaptive response to S2L with simvastatin resulted in synergistic treatment outcomes in combination with C10. Of note, the S2L conjugates retained the ER stress response of the parental ligands, indicative of cholesterol homeostasis being involved in the overall cytotoxicity of the drug conjugates. Based on these findings, we conclude that S2L-mediated cell death is due to free cholesterol accumulation that leads to ER stress. Consequently, the cytotoxic profiles of S2L drug conjugates are proposed to be enhanced via concurrent ER stress inducers or simvastatin, strategies that could be instrumental on the path toward tumor eradication.

Abstract 3322: Sigma-2-Erastin inhibits PC tumor growth through lipid ROS-DUSP6-MAPK signaling

Abstract Introduction: Pancreatic cancer (PC) is a malignancy with poor prognosis and high mortality with a very low 5-year survival rate. Currently, apoptosis and autophagy are the central mechanisms of programmed cell death (PCD) that maintain cellular homeostasis and regulate cell fate. With the recent emergence of ‘ferroptosis’ as a new type of PCD and its close association with the pathophysiological processes of many diseases including tumors, it is viewed as a potential mechanism to improve systemic treatment of PC. Considering the opportunity to regulate both apoptosis and ferroptosis by a single agent, our group has developed a cancer-targeted small molecule consisting of a sigma-2 ligand (a known apoptotic inducer) delivery moiety linked to an inhibitor of the cystine importer xCT (dm-Erastin, a known ferroptotic inducer) and named it as Sigma-2-Erastin (S2E) or ACXT-3102. The study presented here is aimed at determining the efficacy of ACXT-3102 in PC and defining its underlying mechanism of action. Methods: Using in vitro and in vivo tumor xenograft models of human PC, we determined the effects of ACXT-3102 treatments in regulating PCD of PC cells and defined the signaling pathway involved in mediating the effects. Results: As assessed by TitreGlo assays, we observed dose-dependent inhibition of PC cell (BxPC-3, AsPC-1 & PANC-1) viability. Following the WES-analysis of signaling proteins, we observed that ACXT-3102 induces PC cell death by combinatorial regulation of apoptotic and ferroptotic PCD via lipid ROS-DUSP6-MAPK/ERK-mediated signaling pathway. Interestingly, the results of this study demonstrated a hyperactivation of MAPK/ERK signaling by increased phosphorylation instead of inhibition involved in inducting apoptotic cell death as represented by significant increases in expression of cleaved Capase-3/7 and PARP. In addition, ACXT-3102 treatments deceased GPX4 expression along with an increase in lipid ROS production as key markers of inducing ferroptotic cell death. Results from the murine model of human tumor xenografts using AsPC-1 cells further demonstrated significant decreases in tumor volume and increases in survival proportions in ACXT-3102-treated mice. Conclusions: ACXT-3102, an orally administered conjugate of sigma-2 ligand and Erastin induces PCD of human PC by uniquely regulating apoptosis and ferroptosis together. Therefore, ACXT-3102 offers a novel and improved therapeutic strategy for treating patients of fatal human carcinomas, especially those, which are difficult to diagnose at an early stage. Citation Format: Kumar S. Bishnupuri, Kenneth F. Newcomer, Qingqing Gong, Li Ye, Suwanna Vangveravong, Rony Takchi, Bradley T. Keller, Dirk M. Spitzer, William G. Hawkins. Sigma-2-Erastin inhibits PC tumor growth through lipid ROS-DUSP6-MAPK signaling [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 3322.

The novel drug candidate S2/IAPinh improves survival in models of pancreatic and ovarian cancer

Cancer selective apoptosis remains a therapeutic challenge and off-target toxicity has limited enthusiasm for this target clinically. Sigma-2 ligands (S2) have been shown to enhance the cancer selectivity of small molecule drug candidates by improving internalization. Here, we report the synthesis of a novel drug conjugate, which was created by linking a clinically underperforming SMAC mimetic (second mitochondria-derived activator of caspases; LCL161), an inhibitor (antagonist) of inhibitor of apoptosis proteins (IAPinh) with the sigma-2 ligand SW43, resulting in the new chemical entity S2/IAPinh. Drug potency was assessed via cell viability assays across several pancreatic and ovarian cancer cell lines in comparison with the individual components (S2 and IAPinh) as well as their equimolar mixtures (S2 + IAPinh) both in vitro and in preclinical models of pancreatic and ovarian cancer. Mechanistic studies of S2/IAPinh-mediated cell death were investigated in vitro and in vivo using syngeneic and xenograft mouse models of murine pancreatic and human ovarian cancer, respectively. S2/IAPinh demonstrated markedly improved pharmacological activity in cancer cell lines and primary organoid cultures when compared to the controls. In vivo testing demonstrated a marked reduction in tumor growth rates and increased survival rates when compared to the respective control groups. The predicted mechanism of action of S2/IAPinh was confirmed through assessment of apoptosis pathways and demonstrated strong target degradation (cellular inhibitor of apoptosis proteins-1 [cIAP-1]) and activation of caspases 3 and 8. Taken together, S2/IAPinh demonstrated efficacy in models of pancreatic and ovarian cancer, two challenging malignancies in need of novel treatment concepts. Our data support an in-depth investigation into utilizing S2/IAPinh for the treatment of cancer.

Increased rigidity and bioisosteric replacement in the design, synthesis and preliminary evaluation of novel, functionalized 3,3-dialkyl-γ-butyrolactones as sigma-2 ligands

Increased rigidity and bioisosteric replacement in the design, synthesis and preliminary evaluation of novel, functionalized 3,3-dialkyl-γ-butyrolactones as sigma-2 ligands

Sigma-1 receptor agonism exacerbates immune-driven nociception: Role of TRPV1 + nociceptors

The analgesic effects of sigma-1 antagonists are undisputed, but the effects of sigma-1 agonists on pain are not well studied. Here, we used a mouse model to show that the administration of the sigma-1 agonists dextromethorphan (a widely used antitussive drug), PRE-084 (a standard sigma-1 ligand), and pridopidine (a selective drug being investigated in clinical trials for the treatment of neurodegenerative diseases) enhances PGE2-induced mechanical hyperalgesia. Superficial plantar incision induced transient weight-bearing asymmetry at early time points, but the mice appeared to recover at 24 h, despite noticeable edema and infiltration of neutrophils (a well-known cellular source of PGE2) at the injured site. Sigma-1 agonists induced a relapse of weight bearing asymmetry in a manner dependent on the presence of neutrophils. The effects of sigma-1 agonists were all reversed by administration of the sigma-1 antagonist BD-1063 in wild-type mice, and were absent in sigma-1 knockout mice, supporting the selectivity of the effects observed. The proalgesic effects of sigma-1 agonism were also abolished by the TRP antagonist ruthenium red and by in vivo resiniferatoxin ablation of TRPV1 + peripheral sensory neurons. Therefore, sigma-1 agonism exacerbates pain-like responses in mice with a mild inflammatory state through the action of TRPV1 + nociceptors. We also show that sigma-1 receptors are present in most (if not all) mouse and human DRG neurons. If our findings translate to humans, further studies will be needed to investigate potential proalgesic effects induced by sigma-1 agonism in patients treated with sigma-1 agonists.

Cytotoxicity Profiles and Neuroprotective Properties of the Novel Ifenprodil Analogues as Sigma Ligands.

Neurodegeneration is a slow and progressive loss of neuronal cells or their function in specific regions of the brain or in the peripheral system. Among several causes responsible for the most common neurodegenerative diseases (NDDs), cholinergic/dopaminergic pathways, but also some endogenous receptors, are often involved. In this context, sigma 1 receptor (S1R) modulators can be used as neuroprotective and antiamnesic agents. Herein, we describe the identification of novel S1R ligands endowed with antioxidant properties, potentially useful as neuroprotective agents. We also computationally assessed how the most promising compounds might interact with the S1R protein's binding sites. The in silico predicted ADME properties suggested that they could be able to cross the brain-blood-barrier (BBB), and to reach the targets. Finally, the observation that at least two novel ifenprodil analogues (5d and 5i) induce an increase of the mRNA levels of the antioxidant NRF2 and SOD1 genes in SH-SY5Y cells suggests that they might be effective agents for protecting neurons against oxidative damage.

Design, synthesis and biological evaluation of novel aminopropylcarboxamide derivatives as sigma ligands

In our continuing effort to develop novel sigma receptor (SR) ligands, we present the design, synthesis and binding studies of a small library of aminopropylcarboxamide derivatives, obtained from a deconstruction of the piperidine ring of previously synthesized piperidine-based compounds. The best results were achieved with benzofuran (5c, 5g) and quinoline (5a, 5e) derivatives. These compounds revealed the highest affinity for both receptor subtypes. In particular, the 3,4-dimethoxyphenyl derivatives 5e and 5g showed the highest selectivity profile for S2R, especially the quinoline derivative 5e exhibited a 35-fold higher affinity for S2R subtype. The cytotoxic activity of aforementioned compounds was evaluated against SKBR3 and MCF7 cell lines, widely used for breast cancer studies. Whereas the potency of 5g was similar that of Siramesine and Haloperidol in both cell lines, compounds 5a, 5c and 5e exhibited a potency at least comparable to that of Haloperidol in SKBR3 cells. A molecular modelling evaluation towards the S2R binding site, confirmed the strong interaction of compound 5e thus justifying its highest S2R affinity.

Discovery of novel, selective, functionalized 5-(2-(5-arylhexahydropyrrolo[3,4-c]pyrrol-2(1H)-yl)ethyl)-γ-butyrolactone sigma-2 ligands

Discovery of novel, selective, functionalized 5-(2-(5-arylhexahydropyrrolo[3,4-c]pyrrol-2(1H)-yl)ethyl)-γ-butyrolactone sigma-2 ligands

Sigma receptor ligands haloperidol and ifenprodil attenuate hypoxia induced dopamine release in rat striatum

ABSTRACT Objective We aimed to investigate the hypothesis that sigma receptor ligands, haloperidol and ifenprodil, attenuate hypoxia-induced striatal dopamine release in vitro and determine the possible mechanisms. Methods Extracellular concentrations of dopamine were measured using acute brain slices method under hypoxic, aglycemic and ischemic conditions. Sigma receptor ligands haloperidol and ifenprodil attenuate striatal dopamine release induced by hypoxia in contrast to aglycemia and ischemia. To determine the possible contribution of glutamatergic system on this effect, we compared the effect of NMDA receptor antagonist MK-801 and haloperidol in hypoxia induced by Na-K-ATPaz enzyme inhibitor ouabain. Also, we compared the effect of dopamine uptake blocker nomifensine and haloperidol to determine the role of dopamine transporter on this effect. Results Haloperidol and nomifensine almost completely abolish ouabain-induced dopamine release unlike MK-801. Different effects of sigma ligands and glutamate receptor antagonists on the hypoxia and ouabain induced dopamine release show that glutamate receptor blockade is partial involved in inhibitory effect of sigma ligand on dopamine release under hypoxic conditions. Similar effect of dopamine uptake blocker nomifensine and sigma receptor ligand haloperidol on ouabain induced dopamine release supports the possibility that inhibition of reverse dopamine transport by sigma ligands might be involved in their protective effect. Conclusions Data in this study suggest that sigma ligands may be a new therapeutic intervention for the management of hypoxic conditions.

The targeted SMAC mimetic SW IV-134 augments platinum-based chemotherapy in pre-clinical models of ovarian cancer

BackgroundOvarian cancer is initially responsive to frontline chemotherapy. Unfortunately, it often recurs and becomes resistant to available therapies and the survival rate for advanced and recurrent ovarian cancer is unacceptably low. We thus hypothesized that it would be possible to achieve more durable treatment responses by combining cisplatin chemotherapy with SW IV-134, a cancer-targeted peptide mimetic and inducer of cell death. SW IV-134 is a recently developed small molecule conjugate linking a sigma-2 ligand with a peptide analog (mimetic) of the intrinsic death pathway activator SMAC (second-mitochondria activator of caspases). The sigma-2 receptor is overexpressed in ovarian cancer and the sigma-2 ligand portion of the conjugate facilitates cancer selectivity. The effector portion of the conjugate is expected to synergize with cisplatin chemotherapy and the cancer selectivity is expected to reduce putative off-target toxicities.MethodsOvarian cancer cell lines were treated with cisplatin alone, SW IV-134 alone and a combination of the two drugs. Treatment efficacy was determined using luminescent cell viability assays. Caspase-3/7, − 8 and − 9 activities were measured as complementary indicators of death pathway activation. Syngeneic mouse models and patient-derived xenograft (PDX) models of human ovarian cancer were studied for response to SW IV-134 and cisplatin monotherapy as well as combination therapy. Efficacy of the therapy was measured by tumor growth rate and survival as the primary readouts. Potential drug related toxicities were assessed at necropsy.ResultsThe combination treatment was consistently superior in multiple cell lines when compared to the single agents in vitro. The expected mechanism of tumor cell death, such as caspase activation, was confirmed using luminescent and flow cytometry-based assay systems. Combination therapy proved to be superior in both syngeneic and PDX-based murine models of ovarian cancer. Most notably, combination therapy resulted in a complete resolution of established tumors in all study animals in a patient-derived xenograft model of ovarian cancer.ConclusionsThe addition of SW IV-134 in combination with cisplatin chemotherapy represents a promising treatment option that warrants further pre-clinical development and evaluation as a therapy for women with advanced ovarian cancer.

Discovery of oxazolidinone-based heterocycles as subtype selective sigma-2 ligands

Discovery of oxazolidinone-based heterocycles as subtype selective sigma-2 ligands

Synthesis and evaluation of novel, selective, functionalized γ-butyrolactones as sigma-2 ligands

The sigma-2 (σ2) receptor was discovered nearly 40 years ago and was recently identified as the Transmembrane Protein 97 (TMEM97, also known as MAC30 (Meningioma-associated protein)). Aberrant σ2 activity has been linked to diseases and conditions such as schizophrenia, Alzheimer’s disease, neuropathic pain, traumatic brain injury, and cancer. The utility of σ2 as a therapeutic target is currently under investigation in numerous laboratories. Herein, we report on the synthesis and evaluation of a series of novel, functionalized γ-butyrolactones that are potent σ2 receptor ligands.

Sigma Receptors Ligands: New insights into the Cardioprotective Potential

Cardiovascular diseases (CVDs) are primary reason of mortality and morbidity worldwide. Angina pectoris (AP), myocardial infarction (MI), silent myocardial ischemia and sudden cardiac death occur due to blockage in the coronary artery by atherosclerotic clot. Atherosclerotic clot is a systemic inflammatory process characterised by the accumulation and subsequent thickening of the wall by blood borne materials like low-density lipoproteins and macrophages/lymphocytes within the intima of arteries. These initial fatty streak lesions may also evolve into vulnerable plaques susceptible to rupture or erosion. Plaque rupture initiates both platelet adhesion and aggregation as well as the activation of the clotting cascade leading to so-called athero-thrombotic process and leads to coronary artery blockade. Coronary artery blockage interrupts the coronary blood supply leading to damage of myocardium. Multiple factors such as intra cellular (Ca2+, pH) and inter cellular (adhesion molecules) factors, inflammation, environmental toxins as well as metals and oxygen free radicals are involved in the pathogenesis of coronary artery diseases. Furthermore, certain sigma receptor ligands have been reported to show protective action against coronary artery diseases. Sigma receptor, a transmembrane protein, is expressed in many tissues including cardiovascular, liver and central nervous system. Sigma ligands significantly prevented the deviated biochemical parameters such as cardiac marker enzymes, lipid profile and antioxidant parameters to near normal status. Therefore, sigma receptor stimulation represents a new therapeutic strategy to prevent heart from ischemic and hypertrophic dysfunction in case of cardiovascular disorders. This review summarises the sigma receptors and cardioprotective potential of sigma receptor ligands. The article also provides a comprehensive account of structure, types and medical efficacy of cardioprotective sigma agonists.

Haloperidol Metabolite II Valproate Ester (S)-(-)-MRJF22: Preliminary Studies as a Potential Multifunctional Agent Against Uveal Melanoma.

Increased angiogenesis and vascular endothelial growth factor (VEGF) levels contribute to higher metastasis and mortality in uveal melanoma (UM), an aggressive malignancy of the eye in adults. (±)-MRJF22, a prodrug of the sigma (σ) ligand haloperidol metabolite II conjugated with the histone deacetylase (HDAC) inhibitor valproic acid, has previously demonstrated a promising antiangiogenic activity. Herein, the asymmetric synthesis of (R)-(+)-MRJF22 and (S)-(−)-MRJF22 was performed to investigate their contribution to (±)-MRJF22 antiangiogenic effects in human retinal endothelial cells (HREC) and to assess their therapeutic potential in primary human uveal melanoma (UM) 92-1 cell line. While both enantiomers displayed almost identical capabilities to reduce cell viability than the racemic mixture, (S)-(−)-MRJF22 exhibited the highest antimigratory effects in endothelial and tumor cells. Given the fundamental contribution of cell motility to cancer progression, (S)-(−)-MRJF22 may represent a promising candidate for novel antimetastatic therapy in patients with UM.

Design, synthesis, and evaluation of novel, selective γ-butyrolactones sigma-2 ligands

Nearly 40 years after the first disclosure of sigma receptors, the sigma-2 (σ2) receptor was recently identified as the Transmembrane Protein 97 (TMEM97, also known as MAC30 (Meningioma-associated protein). This macromolecule has been associated with a number of disease states such as schizophrenia, Alzheimer’s disease, neuropathic pain, traumatic brain injury, and cancer. We have recently identified a series of novel, functionalized γ-butyrolactones that are potent σ2 receptor ligands that are drug-like and identified a potential candidate (9z) for future in vivo study.

Interaction of new sigma ligands with biomembrane models evaluated by differential scanning calorimetry and Langmuir-Blodgett studies

The compound (+)-MR200 [(+)-methyl (1R,2S)-2-{[4-(4-chlorophenyl)-4-hydroxypiperidin-1-yl]methyl}-1-phenylcyclopropanecarboxylate] is a selective sigma 1 (σ1) antagonist with antinociceptive effect, able to increase selective opioid receptor agonist-mediated analgesia. The parent compound (−)-MRV3 [(−)-methyl (1S,2R)-2-[(4-hydroxy-4-phenylpiperidin-1-yl)-methyl]-1-phenylcyclopropanecarboxylate], a σ1 antagonist with an improved σ1/σ2 selectivity respect to (+)-MR200, play a role in both central sensitization and pain hypersensitivity, suggesting a potential use of σ1 antagonists for the treatment of persistent pain conditions. With the intention to assessing the membrane absorption of compounds and their ability to cross it, the interaction of (+)-MR200 and (−)-MRV3 with dimyristoylphosphatidylcholine phospholipids (DMPC), used as biomembrane models was studied by Differential Scanning Calorimetry (DSC) and Langmuir-Blodgett (LB).

Study of the Relationship between Sigma Receptor Expression Levels and Some Common Sigma Ligand Activity in Cancer Using Human Cancer Cell Lines of the NCI-60 Cell Line Panel.

Sigma (σ) receptors have attracted great interest since they are implicated in various cellular functions and biological processes and diseases, including various types of cancer. The receptor family consists of two subtypes: sigma-1 (σ1) and sigma-2 (σ2). Both σ receptor subtypes have been proposed as therapeutic targets for various types of cancers, and many studies have provided evidence that their selective ligands (agonists and antagonists) exhibit antiproliferative and cytotoxic activity. Still, the precise mechanism of action of both σ receptors and their ligands remains unclear and needs to be elucidated. In this study, we aimed to simultaneously determine the expression levels of both σ receptor subtypes in several human cancer cell lines. Additionally, we investigated the in vitro antiproliferative activity of some widely used σ1 and σ2 ligands against those cell lines to study the relationship between σ receptor expression levels and σ ligand activity. Finally, we ran the NCI60 COMPARE algorithm to further elucidate the cytotoxic mechanism of action of the selected σ ligands studied herein.

Sigma-2 Receptor-A Potential Target for Cancer/Alzheimer's Disease Treatment via Its Regulation of Cholesterol Homeostasis.

The sigma receptors were classified into sigma-1 and sigma-2 receptor based on their different pharmacological profiles. In the past two decades, our understanding of the biological and pharmacological properties of the sigma-1 receptor is increasing; however, little is known about the sigma-2 receptor. Recently, the molecular identity of the sigma-2 receptor has been identified as TMEM97. Although more and more evidence has showed that sigma-2 ligands have the ability to treat cancer and Alzheimer’s disease (AD), the mechanisms connecting these two diseases are unknown. Data obtained over the past few years from human and animal models indicate that cholesterol homeostasis is altered in AD and cancer, underscoring the importance of cholesterol homeostasis in AD and cancer. In this review, based on accumulated evidence, we proposed that the beneficial roles of sigma-2 ligands in cancer and AD might be mediated by their regulation of cholesterol homeostasis.

MRP1-Collateral Sensitizers as a Novel Therapeutic Approach in Resistant Cancer Therapy: An In Vitro and In Vivo Study in Lung Resistant Tumor.

Multidrug resistance (MDR) is the main obstacle to current chemotherapy and it is mainly due to the overexpression of some efflux transporters such as MRP1. One of the most studied strategies to overcome MDR has been the inhibition of MDR pumps through small molecules, but its translation into the clinic unfortunately failed. Recently, a phenomenon called collateral sensitivity (CS) emerged as a new strategy to hamper MDR acting as a synthetic lethality, where the genetic changes developed upon the acquisition of resistance towards a specific agent are followed by the development of hypersensitivity towards a second agent. Among our library of sigma ligands acting as MDR modulators, we identified three compounds, F397, F400, and F421, acting as CS-promoting agents. We deepened their CS mechanisms in the “pure” model of MRP1-expressing cells (MDCK-MRP1) and in MRP1-expressing/drug resistant non-small cell lung cancer cells (A549/DX). The in vitro results demonstrated that (i) the three ligands are highly cytotoxic for MRP1-expressing cells; (ii) their effect is MRP1-mediated; (iii) they increase the cytotoxicity induced by cis-Pt, the therapeutic agent commonly used in the treatment of lung tumors; and (iv) their effect is ROS-mediated. Moreover, a preclinical in vivo study performed in lung tumor xenografts confirms the in vitro findings, making the three CS-promoting agents candidates for a novel therapeutic approach in lung resistant tumors.

Disruption of cholesterol metabolism via sigma-2 ligands induces cell death in pancreatic cancer

Presenter: Rony Takchi MD | Washington University, St. Louis Background: The malignant transformation of pancreatic ductal adenocarcinoma (PDAC) is accompanied by alteration of the metabolism to adapt to the new hypoxic and nutrient-deprived micro-environment. Recent studies have shown that PDAC is highly dependent on cholesterol import. Consequently, tumors with a high LDL-receptor (LDL-R) expression phenotype are more aggressive, which is linked with worse patient survival. Like other proliferating tumors, PDAC is characterized by overexpression of the sigma-2 receptor, which is involved in enhanced LDL-R activity and the regulation of cholesterol export from the lysosomes in an NPC1-dependent manner. We thus hypothesized that sigma-2 ligands may facilitate pancreatic cancer cell death via cholesterol trapping in the lysosomes through disruption of the NPC1-mediated export mechanism. Methods: The sigma-2 ligands tested are the azabicyclononane analogs SW43, SW96, SV95, and the benzamide analog, ISO-1. To determine the kinetics and the cellular localization properties of a representative member of the sigma-2 ligand family, SW43 was chemically linked to the fluorophore 4-Chloro-7-nitro-1,2,3-benzoxadiazole (NBD-Cl; SW120). To study the impact on cellular cholesterol trafficking upon sigma-2 ligand treatment, cells were stained with Filipin and analyzed via confocal microscopy. Protein abundance of key players involved in intracellular cholesterol processing/trafficking was determined using state-of-the-art WES technology employing the following antibodies: Sterol-regulatory binding protein 2 (SREBP2), LDL-R, Niemann-Pick C1 protein (NPC1). Cell viability was determined using IncuCyte live-cell analysis system. In order to study the predicted synergism between cholesterol sequestration and blocking of de novo cholesterol synthesis, PDAC cells were treated with sigma-2 ligands in combination with simvastatin, which inhibits the rate-limiting enzyme in cholesterol synthesis 3-hydroxy-3-methyl-glutaryl-CoA reductase (HMGCoAr). Drug combination effects (synergy) were determined using CompuSyn software. Results: Utilizing three different human pancreatic cancer cell lines (AsPC1, HPAC, and MiaPaca-2), fluorescently labeled sigma-2 ligand SW120 was shown to be rapidly taken up into the lysosomal compartment within minutes. This rapid uptake mechanism was associated with a moderate cytotoxicity profile of the sigma-2 ligands SW43 and SW96. Of note, the sigma-2 ligand-mediated cytotoxicity correlated with a rapid cholesterol sequestration phenotype in the lysosomes. In contrast, treatment with two other, high-affinity sigma-2 ligands SV95 and ISO1, was not associated with cytotoxicity and did not lead to cholesterol sequestration. Since trapping of cholesterol in the lysosomes renders it unusable for the cell, analogous to the lysosomal storage disease Niemann-Pick type C, actuation of the sterol sensing machinery was predicted. And indeed, shortly (time) after exposure to SW43 or SW96, the cholesterol sensor released SREBP-2 which in turn was activated and induced production of its downstream targets, LDL-R and NPC1. Moreover, the combination of cholesterol sequestration (SW43) and blocking of de novo cholesterol production (simvastatin), demonstrated a synergistic drug activity profile. Conclusion: We identified a cholesterol trapping phenotype as an early event of sigma-2 ligand-mediated cytotoxicity. Targeting both LDL-R-mediated lysosomal cholesterol trapping with sigma-2 ligands in combination with blockage of de-novo cholesterol synthesis lead to synergistic cancer cell death and thus represents an intriguing novel treatment concept for PDAC.