Small-molecule Inhibitor Of Apoptosis Antagonists Research Articles

Abstract 2405: Inhibitor of apoptosis protein antagonists as novel targeted chemotherapeutic agents for acute myeloid leukemia

Abstract Acute myeloid leukemia (AML) is a diverse collection of hematological cancers characterized by the bone marrow's excessive production of certain immature myeloid blood cells. The American Cancer Society estimated that there was ~11,000 deaths and ~21,500 new incidences of AML in the U.S. in 2019. While the various AML subtypes have differing prognoses, more than 30% of AML patients fail to enter complete remission upon standard chemotherapy regimens. Furthermore, most patients that do initially respond will relapse within 5 years in the absence of bone marrow transplantation (BMT). As such, the need for novel targets and drugs to treat this disease is a significant unmet medical need. This is especially true in patient populations unable to tolerate aggressive chemotherapy or where BMT is impossible or not recommended. The current standard of care (SOC) for AML has been the same for decades - various combinations of anthracyclines and nucleoside analogues are used as front line agents with debilitating toxicities. Recent evidence showing efficacy of Bcl2 family inhibitors in some leukemias prompted us to investigate whether antagonism of the inhibitor of apoptosis (IAP) proteins may be effective against AML. IAP proteins are involved in many processes including cell death, immunity, inflammation, cell cycle and migration, and are therefore promising targets for the development of cancer therapeutics. As the name suggests, IAP proteins play an important role in the control of apoptotic pathways and have been implicated in AML development and progression. It has been shown that IAPs are over-expressed in AML patient cells and high expression levels are linked to poor prognosis. Although Bcl2 family members only regulate mitochondrial apoptosis, IAPs modulate apoptotic signaling at multiple, and more distal, points suggesting a potential improvement in activity for drugs targeting them. We recently described the characterization and preliminary optimization of monovalent small molecule IAP antagonists. Here we show the design and synthesis of novel second generation bivalent IAP antagonists that kill AML cells much more potently than drugs currently undergoing clinical evaluation, while sparing healthy cells. Our data in leukemia cell lines and patient-derived AML samples using these novel, highly potent, IAP antagonists suggest that these small molecules may be effective as therapeutic agents. Citation Format: Darren Finlay, Nicole Bata, Allison Limpert, Dominik Heimann, Peter Teriete, Carol Burian, James Mason, Nicholas D. Cosford, Kristiina Vuori. Inhibitor of apoptosis protein antagonists as novel targeted chemotherapeutic agents for acute myeloid leukemia [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 2405.

Regulation of innate and adaptive antitumor immunity by IAP antagonists.

Inhibition of the T-cell co-inhibitory checkpoint receptors or their ligands CTLA-4, PD-1 and PD-L1 using monoclonal antibodies has proven to be highly effective against many cancers. Yet many cancers remain resistant to checkpoint blockade, and durable remissions occur in only a minority of patients. Novel approaches to enhancing antitumor responses are thus necessary in order to expand the reach of these treatments. The inhibitor of apoptosis (IAP) protein family comprises a diverse group of proteins, many of which have immunoregulatory roles. Small molecule IAP antagonists have been developed and are undergoing early phase clinical testing. These drugs were initially developed to promote tumor cell apoptosis; however, a considerable body of work now indicates that IAP antagonists induce antitumor activity through modulation of innate and adaptive immunity. Primarily through inhibition of cellular (c)-IAP1 and c-IAP2, IAP antagonists can activate alternative NF-κB signaling, promoting B-cell survival, activation of dendritic cells and delivering a broad co-stimulatory signal to T cells. At the same time, IAP antagonists can promote tumor cell intrinsic sensitization to innate immune signals, and enhance tumor cell killing by inflammatory cytokines and phagocytic macrophages. These drugs thus represent an attractive investigational approach to immunotherapy, providing a positive signaling counterpart to the relief of signal inhibition conferred by checkpoint blockade.

Combinatorial cancer immunotherapy strategies with proapoptotic small-molecule IAP antagonists.

Members of the inhibitor of apoptosis (IAP) family control several critical aspects of innate immunity, cell death, and tumorigenesis. Small molecule antagonists that target specific IAP oncoproteins, primarily cIAP1 and cIAP2, but potentially also XIAP and Livin, modulate distinct immune signal transduction pathways that can lead to an increased sensitivity of tumors cells to cytokine-mediated apoptosis. These antagonists are based on the structure of an endogenous cellular IAP inhibitor called Smac. Smac is normally sequestered within the mitochondria and is released into the cytoplasm upon cell death stimuli, thereby overcoming the anti-apoptotic action of the IAPs. The therapeutic usefulness of recombinant tumoricidal cytokines to treat cancer patients is principally limited due to their unacceptable adverse side effects. Therefore, investigators have sought to develop alternative regimens that do not rely on exogenously delivered death ligands. These approaches include the stimulation of the immune system with oncolytic virus-based agents or Toll-like receptor agonists in combination with Smac mimetics. Similarly, preclinical combination immunotherapy studies reveal that recombinant interferon synergizes with Smac mimetics to kill cancer. This strategy opens up new therapeutic avenues for anti-cancer therapy by modulating specific immune-mediated death pathways employing unique dual-pronged combinatorial approaches.

Abstract SY06-01: Targeting IAP proteins for the treatment of cancer.

Abstract Evasion of cell death is a characteristic feature of human cancers and represents a key cause of resistance to current treatment approaches. Therefore, reactivation of cell death programs in cancer cells is a promising strategy to overcome treatment resistance, one of the major unsolved problems in clinical oncology. Inhibitor of apoptosis (IAP) protein family members block cell death in response to diverse stimuli and are expressed at elevated levels in the majority of human malignancies, which makes them attractive targets for developing a novel class of cancer therapeutics. We have designed small-molecule IAP antagonists (smac mimetics) that bind with high affinities to select baculovirus IAP repeat (BIR) domains of IAPs resulting in a dramatic induction of c IAP auto-ubiquitination activity and rapid proteasomal degradation. IAP antagonists inhibit tumor growth in vivo as single agents and in combination with a number of anti-tumor agents. Using several different proteomic approaches we have discovered novel binding partners for IAP proteins and determined the spatial and temporal pattern of endogenous IAP-mediated ubiquitination during proliferative, apoptotic and necrotic signaling. The differential expression levels and posttranslational modifications of identified proteins will be used to build diagnostic profiles for the treatment with IAP antagonists. These compounds can be used in the treatment of malignancies in which IAP expression contributes to tumor progression and resistance to conventional chemotherapeutic agents. Citation Format: Domagoj Vucic. Targeting IAP proteins for the treatment of cancer. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr SY06-01. doi:10.1158/1538-7445.AM2013-SY06-01

Characterization of ML-IAP protein stability and physiological role in vivo

ML-IAP [melanoma IAP (inhibitor of apoptosis)] is an anti-apoptotic protein that is expressed highly in melanomas where it contributes to resistance to apoptotic stimuli. The anti-apoptotic activity and elevated expression of IAP family proteins in many human cancers makes IAP proteins attractive targets for inhibition by cancer therapeutics. Small-molecule IAP antagonists that bind with high affinities to select BIR (baculovirus IAP repeat) domains have been shown to stimulate auto-ubiquitination and rapid proteasomal degradation of c-IAP1 (cellular IAP1) and c-IAP2 (cellular IAP2). In the present paper, we report ML-IAP proteasomal degradation in response to bivalent, but not monovalent, IAP antagonists. This degradation required ML-IAP ubiquitin ligase activity and was independent of c-IAP1 or c-IAP2. Although ML-IAP is best characterized in melanoma cells, we show that ML-IAP expression in normal mammalian tissues is restricted largely to the eye, being most abundant in ciliary body epithelium and retinal pigment epithelium. Surprisingly, given this pattern of expression, gene-targeted mice lacking ML-IAP exhibited normal intraocular pressure as well as normal retinal structure and function. The results of the present study indicate that ML-IAP is dispensable for both normal mouse development and ocular homoeostasis.

Toxicity Profile of Small-Molecule IAP Antagonist GDC-0152 Is Linked to TNF-α Pharmacology

Inhibitor-of-apoptosis (IAP) proteins suppress apoptosis and are overexpressed in a variety of cancers. Small-molecule IAP antagonists are currently being tested in clinical trials as novel cancer therapeutics. GDC-0152 is a small-molecule drug that triggers tumor cell apoptosis by selectively antagonizing IAPs. GDC-0152 induces NF-κB transcriptional activity leading to expression of several chemokines and cytokines, of which tumor necrosis factor alpha (TNF-α) is the most important for single-agent tumor activity. TNF-α is a pleiotropic cytokine that drives a variety of cellular responses, comprising inflammation, proliferation, and cell survival or death depending on the cellular context. As malignant and normal cells produce TNF-α upon IAP antagonism, increased TNF-α could drive both efficacy and toxicity. The toxicity profile of GDC-0152 in dogs and rats was characterized after iv dose administration once every 2 weeks for four doses. Findings in both species consisted of a dose-related, acute, systemic inflammatory response, and hepatic injury. Laboratory findings included elevated plasma cytokines, an inflammatory leukogram, and increased liver transaminases with histopathological findings of inflammatory infiltrates and apoptosis/necrosis in multiple tissues; a toxicology profile consistent with TNF-α-mediated toxicity. Dogs exhibited more severe findings than rats, and humans did not exhibit these findings, at comparable exposures across species. Furthermore, elevations in blood neutrophil count, serum monocyte chemoattractant protein-1, and other markers of inflammation corresponded to GDC-0152 exposure and toxicity and thus may have utility as safety biomarkers.

Abstract 137: Targeting IAPs: NF-κB signaling pathways play a critical role in IAP antagonist induced apoptosis

Abstract Inhibition of apoptosis enhances the survival of cancer cells and facilitates their escape from immune surveillance and cytotoxic therapies. Inhibitor of apoptosis (IAP) proteins are anti-apoptotic regulators that block cell death in response to diverse stimuli. Because these proteins play an active role in promoting tumor maintenance, they are attractive targets for developing a novel class of cancer therapeutics. Through TRAF2 interactions, c-IAP1 and c-IAP2 are recruited to tumor necrosis factor receptor 1 (TNFR1)-associated protein complexes where they regulate receptor-mediated signaling. The ubiquitin E3 ligase activity of c-IAP1/2 regulates canonical and noncanonical NF-κB pathways by promoting ubiquitination of RIP1 and NIK. We have designed small-molecule IAP antagonists that bind with high affinities to select baculovirus IAP repeat (BIR) domains of IAPs resulting in a dramatic induction of c-IAP auto-ubiquitination and rapid proteasomal degradation. Neutralization of c-IAPs through knockdown or small-molecule IAP antagonists blunts TNF stimulated NF-κB activation and greatly sensitizes cells to TNF induced cell death. Investigation of death receptor signaling complexes revealed that FLIP plays an important role in IAP antagonist stimulated apoptotic pathways and that down-regulation of FLIP sensitizes otherwise resistant cells to IAP antagonist induced cell death. In addition, regulation of NF-kB signaling pathways by cellular IAPs represents a pivotal point in IAP antagonists induced cell death. The interplay between pro-survival and pro-apoptotic signaling involves multiple levels of coordination and the regulation of these processes can determine the fate of treated cells. Finally, our IAP antagonists inhibit tumor growth in vivo as single agents and in combination with a number of standard of care anti-tumor agents including death receptor agonists. Interestingly, while single-agent activity of IAP antagonists relies on TNF signaling, the synergistic activity of IAP antagonists with FasL or anti-DR5 antibody does not depend on TNF signaling but on XIAP antagonism. Understanding the significance of protein stability and death receptors mediated pathways for inhibition of apoptosis by IAP proteins is important for the design of potent IAP-directed compounds. These compounds can be used in the treatment of malignancies in which IAP expression contributes to tumor progression and resistance to conventional chemotherapeutic agents. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 137.

X Chromosome-linked Inhibitor of Apoptosis Regulates Cell Death Induction by Proapoptotic Receptor Agonists

Proapoptotic receptor agonists cause cellular demise through the activation of the extrinsic and intrinsic apoptotic pathways. Inhibitor of apoptosis (IAP) proteins block apoptosis induced by diverse stimuli. Here, we demonstrate that IAP antagonists in combination with Fas ligand (FasL) or the death receptor 5 (DR5) agonist antibody synergistically stimulate death in cancer cells and inhibit tumor growth. Single-agent activity of IAP antagonists relies on tumor necrosis factor-alpha signaling. By contrast, blockade of tumor necrosis factor-alpha does not affect the synergistic activity of IAP antagonists with FasL or DR5 agonist antibody. In most cancer cells, proapoptotic receptor agonist-induced cell death depends on amplifying the apoptotic signal via caspase-8-mediated activation of Bid and subsequent activation of the caspase-9-dependent mitochondrial apoptotic pathway. In the investigated cancer cell lines, induction of apoptosis by FasL or DR5 agonist antibody can be inhibited by knockdown of Bid. However, knockdown of X chromosome-linked IAP (XIAP) or antagonism of XIAP allows FasL or DR5 agonist antibody to induce activation of effector caspases efficiently without the need for mitochondrial amplification of the apoptotic signal and thus rescues the effect of Bid knockdown in these cells.

Antagonism of c-IAP and XIAP Proteins Is Required for Efficient Induction of Cell Death by Small-Molecule IAP Antagonists

The inhibitor of apoptosis (IAP) proteins are critical regulators of cancer cell survival, which makes them attractive targets for therapeutic intervention in cancers. Herein, we describe the structure-based design of IAP antagonists with high affinities and selectivity (>2000-fold) for c-IAP1 over XIAP and their functional characterization as activators of apoptosis in tumor cells. Although capable of inducing cell death and preventing clonogenic survival, c-IAP-selective antagonists are significantly less potent in promoting apoptosis when compared to pan-selective compounds. However, both pan-IAP- and c-IAP-selective antagonists stimulate c-IAP1 and c-IAP2 degradation and activation of NF-kappaB pathways with comparable potencies. Therefore, although compounds that specifically target c-IAP1 and c-IAP2 are capable of inducing apoptosis, antagonism of the c-IAP proteins and XIAP is required for efficient induction of cancer cell death by IAP antagonists.

IAP Antagonists Induce Autoubiquitination of c-IAPs, NF-κB Activation, and TNFα-Dependent Apoptosis

Inhibitor of apoptosis (IAP) proteins are antiapoptotic regulators that block cell death in response to diverse stimuli. They are expressed at elevated levels in human malignancies and are attractive targets for the development of novel cancer therapeutics. Herein, we demonstrate that small-molecule IAP antagonists bind to select baculovirus IAP repeat (BIR) domains resulting in dramatic induction of auto-ubiquitination activity and rapid proteasomal degradation of c-IAPs. The IAP antagonists also induce cell death that is dependent on TNF signaling and de novo protein biosynthesis. Additionally, the c-IAP proteins were found to function as regulators of NF-kappaB signaling. Through their ubiquitin E3 ligase activities c-IAP1 and c-IAP2 promote proteasomal degradation of NIK, the central ser/thr kinase in the noncanonical NF-kappaB pathway.