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Fox JM, Moynihan JR, Mott BT, Mazzone JR, Anders NM, Brown PA, Rudek MA, Liu JO, Arav-Boger R, Posner GH, Civin CI, Chen X. Artemisinin-derived dimer ART-838 potently inhibited human acute leukemias, persisted in vivo, and synergized with antileukemic drugs. Oncotarget 2016; 7:7268-79. [PMID: 26771236 PMCID: PMC4872784 DOI: 10.18632/oncotarget.6896] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 01/06/2016] [Indexed: 01/08/2023] Open
Abstract
Artemisinins, endoperoxide-containing molecules, best known as antimalarials, have potent antineoplastic activity. The established antimalarial, artesunate (AS), and the novel artemisinin-derived trioxane diphenylphosphate dimer 838 (ART-838) inhibited growth of all 23 tested acute leukemia cell lines, reduced cell proliferation and clonogenicity, induced apoptosis, and increased intracellular levels of reactive oxygen species (ROS). ART-838 was 88-fold more potent that AS in vitro, inhibiting all leukemia cell lines at submicromolar concentrations. Both ART-838 and AS cooperated with several established antileukemic drugs and newer kinase inhibitors to inhibit leukemia cell growth. ART-838 had a longer plasma half-life than AS in immunodeficient NOD-SCID-IL2Rgnull (NSG) mice, remaining at effective antileukemic concentrations for >8h. Intermittent cycles of ART-838 inhibited growth of acute leukemia xenografts and primagrafts in NSG mice, at higher potency than AS. Based on these preclinical data, we propose that AS, with its established low toxicity and low cost, and ART-838, with its higher potency and longer persistence in vivo, should be further developed toward integration into antileukemic regimens.
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Affiliation(s)
- Jennifer M Fox
- Center for Stem Cell Biology & Regenerative Medicine, Departments of Pediatrics and Physiology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - James R Moynihan
- Center for Stem Cell Biology & Regenerative Medicine, Departments of Pediatrics and Physiology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Bryan T Mott
- Department of Chemistry, School of Arts and Sciences, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Jennifer R Mazzone
- Department of Chemistry, School of Arts and Sciences, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Nicole M Anders
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
| | - Patrick A Brown
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
| | - Michelle A Rudek
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
| | - Jun O Liu
- Department of Pharmacology and Molecular Science, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Ravit Arav-Boger
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
| | - Gary H Posner
- Department of Chemistry, School of Arts and Sciences, Johns Hopkins University, Baltimore, MD 21218, USA.,Johns Hopkins Malaria Research Institute, Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Curt I Civin
- Center for Stem Cell Biology & Regenerative Medicine, Departments of Pediatrics and Physiology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Xiaochun Chen
- Center for Stem Cell Biology & Regenerative Medicine, Departments of Pediatrics and Physiology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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Abstract
Abstract
More effective, less toxic treatments are needed to improve quantitative and qualitative outcomes for patients with acute leukemias. Drug repurposing has been validated as a productive approach in which the pharmacologic and safety information available for established drugs promotes their rapid translation to human clinical trials for a new indication. Artesunate (ART), the current WHO-recommended drug for severe malaria, is a semi-synthetic derivative of the natural compound Artemisinin. ART has broad anti-cancer activity in vitro, and is inexpensive, safe, and can be parenterally or orally administered in humans.
We sought to characterize the anti-leukemic activity of ART and ART-838 (a novel potent analog) and to evaluate these drugs in combination with several current and emerging anti-leukemic drugs. We assessed the growth inhibitory effects of ART and ART-838 against a panel of 24 acute leukemia (Acute Myeloid Leukemia [AML], Precursor B cell Acute Lymphoblastic Leukemia [B-ALL], and T cell ALL) cell lines via alamarBlue assays. Both ART (mean IC50: 5.4 μM; median IC50: 4.1 μM) and ART-838 (mean IC50: 0.12 μM; median IC50: 0.06 μM) were active against all 24 cell lines, indicating efficacy against the major types of acute leukemia. Primary leukemia cases, grown on hTERT-immortalized bone marrow stromal cells, were sensitive over a similar concentration range. Both ART (≤10 μM) and ART-838 (≤0.25 μM) reduced or completely inhibited clonigenicity of all 4 acute leukemia cell lines tested in methylcellulose colony-forming assays. In contrast, clonigenicity of normal CD34+ hematopoietic stem-progenitor cells was unaffected by concentrations of ART and ART-838 that inhibited all tested acute leukemia cell lines and primary cases, suggesting high therapeutic indices.
ART exhibited additive or synergistic interactions with several anti-neoplastic agents (including Cytarabine, Doxorubicin, Etoposide, Lestaurtinib, Midostaurin, and Sorafenib) against KOPN8 (B-ALL), MOLM14 (AML), and MV4;11 (biphenotypic AML/B-ALL) leukemia cell lines, suggesting the potential for successful integration of ART or ART-838 into existing or novel combination chemotherapy regimens. 24h treatment with ART or ART-838 caused a marked reduction in BrdU-labeled S-phase cells and a large increase in Annexin-V positive (apoptotic) cells. Finally, both ART and ART-838 inhibited leukemia development in immunodeficient NSG mice transplanted with KOPN8 cells. Based on these data, we propose that ART and ART-838 have high potential to be developed as anti-leukemic agents that could be paired with current standard and/or novel anti-leukemic drugs.
Citation Format: Jennifer M. Fox, James R. Moynihan, Gary H. Posner, Patrick Brown, Curt I. Civin, Xiaochun Chen. Repurposing Artemisinins for treatment of acute leukemias. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 818. doi:10.1158/1538-7445.AM2014-818
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