Nutrition Knowledge, Attitudes, and Lifestyle Practices That May Lead to Breast Cancer Risk Reduction among Female University Students in Lebanon

Research has identified both nonmodifiable and modifiable risk factors for breast cancer (BC), with accumulating evidence showing that adopting adequate dietary practices could decrease the risk of this disease. This study aimed to assess nutrition knowledge, attitudes, and lifestyle practices (KAP) that may lead to BC risk reduction among female university students in Lebanon and examine the determinants of their practices. A cross-sectional survey was conducted using a convenience sampling method, comprising 356 (response rate: 71.2%) female students at the American University of Beirut aged 18 to 25 years with no history of BC. Participants completed a pre-tested questionnaire addressing the objectives of the study. The modified Bloom's cut-off of 75% was used to categorize knowledge and practice scores as poor or good and attitudes as negative or positive. Large proportions of students had poor knowledge (68.3%), negative attitudes (65.4%), and poor practices (98.0%) scores. Pursuing a health-related major and having a higher GPA were associated with better knowledge and attitudes while being older and having a lower degree of stress were associated with positive attitudes only. Having a lower body mass index (BMI) was associated with better practice scores. Better knowledge significantly predicted higher intake of fruits and vegetables. Overall knowledge and attitudes were significantly correlated with each other, but neither was significantly correlated with overall practice. These findings underscore the importance of implementing public health programs geared towards improving nutrition KAP that may lead to BC risk reduction.

Periprostatic adipose tissue thromboinflammation triggers prostatic neoplasia in early metabolic impairment: Interruption by rivaroxaban

AIMS

Prostate cancer is among the highest incidence malignancies in men with a prevalence rate increasing in parallel to the rising global trends in metabolic disorders. Whereas a sizeable body of evidence links metabolic impairment to negative prognosis of prostate cancer, the molecular mechanism underlying this connection has not been thoroughly examined. Our previous work showed that localized adipose tissue inflammation occurring in select adipose depots in early metabolic derangement instigated significant molecular, structural, and functional alterations in neighboring tissues underlying the complications observed at this stage. In this context, the periprostatic adipose tissue (PPAT) constitutes an understudied microenvironment with potential influence on the prostatic milieu.

MAIN METHODS AND RESULTS

We show that PPAT inflammation occurs in early prediabetes with signs of increased thrombogenic activity including enhanced expression and function of Factor X. This was mirrored by early neoplastic alterations in the prostate with fibrosis, increased epithelial thickness with marked luminal cellular proliferation and enhanced formation of intraepithelial neoplasia. Significantly, interruption of the procoagulant state in PPAT by a 10-day anticoagulant rivaroxaban treatment not only mitigated PPAT inflammation, but also reduced signs of prostatic neoplastic changes. Moreover, rivaroxaban decreased the murine PLum-AD epithelial prostatic cell viability, proliferation, migration, and colony forming capacity, while increasing oxidative stress. A protease-activated receptor-2 agonist reversed some of these effects.

SIGNIFICANCE

We provide some evidence of a molecular framework for the crosstalk between PPAT and prostatic tissue leading to early neoplastic changes in metabolic impairment mediated by upregulation of PPAT thromboinflammation.

Unveiling a Biomarker Signature of Meningioma: The Need for a Panel of Genomic, Epigenetic, Proteomic, and RNA Biomarkers to Advance Diagnosis and Prognosis

Meningiomas are the most prevalent primary intracranial tumors. The majority are benign but can undergo dedifferentiation into advanced grades classified by World Health Organization (WHO) into Grades 1 to 3. Meningiomas' tremendous variability in tumor behavior and slow growth rates complicate their diagnosis and treatment. A deeper comprehension of the molecular pathways and cellular microenvironment factors implicated in meningioma survival and pathology is needed. This review summarizes the known genetic and epigenetic aberrations involved in meningiomas, with a focus on neurofibromatosis type 2 (NF2) and non-NF2 mutations. Novel potential biomarkers for meningioma diagnosis and prognosis are also discussed, including epigenetic-, RNA-, metabolomics-, and protein-based markers. Finally, the landscape of available meningioma-specific animal models is overviewed. Use of these animal models can enable planning of adjuvant treatment, potentially assisting in pre-operative and post-operative decision making. Discovery of novel biomarkers will allow, in combination with WHO grading, more precise meningioma grading, including meningioma identification, subtype determination, and prediction of metastasis, recurrence, and response to therapy. Moreover, these biomarkers may be exploited in the development of personalized targeted therapies that can distinguish between the 15 diverse meningioma subtypes.

The Antitumor Effect of the DNA Polymerase Alpha Inhibitor ST1926 in Glioblastoma: A Proteomics Approach

Glioblastoma Multiforme (GBM) is the most aggressive form of malignant brain tumor. The median survival rate does not exceed two years, indicating an imminent need to develop novel therapies. The atypical adamantyl retinoid ST1926 induces apoptosis and growth inhibition in different cancer types. We have shown that ST1926 is an inhibitor of the catalytic subunit of DNA polymerase alpha (POLA1), which is involved in initiating DNA synthesis in eukaryotic cells. POLA1 levels are elevated in GBM versus normal brain tissues. Therefore, we studied the antitumor effects of ST1926 in several human GBM cell lines. We further explored the global protein expression profiles in GBM cell lines using liquid chromatography coupled with tandem mass spectrometry to identify new targets of ST1926. Low sub-micromolar concentrations of ST1926 potently decreased cell viability, induced cell damage and apoptosis, and reduced POLA1 protein levels in GBM cells. The proteomics profiles revealed 197 proteins significantly differentially altered upon ST1926 treatment of GBM cells involved in various cellular processes. We explored the differential gene and protein expression of significantly altered proteins in GBM compared to normal brain tissues.

Mannose Inhibits the Pentose Phosphate Pathway in Colorectal Cancer and Enhances Sensitivity to 5-Fluorouracil Therapy

Colorectal cancer (CRC) is one of the leading cancers and causes of death in patients. 5-fluorouracil (5-FU) is the therapy of choice for CRC, but it exhibits high toxicity and drug resistance. Tumorigenesis is characterized by a deregulated metabolism, which promotes cancer cell growth and survival. The pentose phosphate pathway (PPP) is required for the synthesis of ribonucleotides and the regulation of reactive oxygen species and is upregulated in CRC. Mannose was recently reported to halt tumor growth and impair the PPP. Mannose inhibitory effects on tumor growth are inversely related to the levels of phosphomannose isomerase (PMI). An in silico analysis showed low PMI levels in human CRC tissues. We, therefore, investigated the effect of mannose alone or in combination with 5-FU in human CRC cell lines with different p53 and 5-FU resistance statuses. Mannose resulted in a dose-dependent inhibition of cell growth and synergized with 5-FU treatment in all tested cancer cell lines. Mannose alone or in combination with 5-FU reduced the total dehydrogenase activity of key PPP enzymes, enhanced oxidative stress, and induced DNA damage in CRC cells. Importantly, single mannose or combination treatments with 5-FU were well tolerated and reduced tumor volumes in a mouse xenograft model. In summary, mannose alone or in combination with 5-FU may represent a novel therapeutic strategy in CRC.

Inflammasomes as biomarkers and therapeutic targets in traumatic brain injury and related-neurodegenerative diseases: A comprehensive overview

Given the ambiguity surrounding traumatic brain injury (TBI) pathophysiology and the lack of any Food and Drug Administration (FDA)-approved neurotherapeutic drugs, there is an increasing need to better understand the mechanisms of TBI. Recently, the roles of inflammasomes have been highlighted as both potential therapeutic targets and diagnostic markers in different neurodegenerative disorders. Indeed, inflammasome activation plays a pivotal function in the central nervous system (CNS) response to many neurological conditions, as well as to several neurodegenerative disorders, specifically, TBI. This comprehensive review summarizes and critically discusses the mechanisms that govern the activation and assembly of inflammasome complexes and the major methods used to study inflammasome activation in TBI and its implication for other neurodegenerative disorders. Also, we will review how inflammasome activation is critical in CNS homeostasis and pathogenesis, and how it can impact chronic TBI sequalae and increase the risk of developing neurodegenerative diseases. Additionally, we discuss the recent updates on inflammasome-related biomarkers and the potential to utilize inflammasomes as putative therapeutic targets that hold the potential to better diagnose and treat subjects with TBI.

Lessons learned from the discovery and development of the sesquiterpene lactones in cancer therapy and prevention

INTRODUCTION

Sesquiterpene lactones (SLs) are one of the most diverse bioactive secondary metabolites found in plants and exhibit a broad range of therapeutic properties . SLs have been showing promising potential in cancer clinical trials, and the molecular mechanisms underlying their anticancer potential are being uncovered. Recent evidence also points to a potential utility of SLs in cancer prevention.

AREAS COVERED

This work evaluates SLs with promising anticancer potential based on cell, animal, and clinical models: Artemisinin, micheliolide, thapsigargin dehydrocostuslactone, arglabin, parthenolide, costunolide, deoxyelephantopin, alantolactone, isoalantolactone, atractylenolide 1, and xanthatin as well as their synthetic derivatives. We highlight actionable molecular targets and biological mechanisms underlying the anticancer therapeutic properties of SLs. This is complemented by a unique assessment of SL mechanisms of action that can be exploited in cancer prevention. We also provide insights into structure-activity and pharmacokinetic properties of SLs and their potential use in combination therapies.

EXPERT OPINION

We extract seven major lessons learned and present evidence-based solutions that can circumvent some scientific limitations or logistic impediments in SL anticancer research. SLs continue to be at the forefront of cancer drug discovery and are worth a joint interdisciplinary effort in order to leverage their potential in cancer therapy and prevention.

2-Nucleobase-substituted 4,6-Diaminotriazine Analogs: Synthesis and Anti-cancer Activity in 5-Fluorouracil-Sensitive and Resistant Colorectal Cancer Cells

Background:

Cancer continues to be the second leading cause of death worldwide with colorectal cancer (CRC) being the third most common type. Despite significant advances in cancer therapies, current treatment of CRC remains suboptimal. In addition, the effectiveness of available chemotherapeutic drugs such as 5-Fluorouracil (5-FU) is limited by CRC-acquired resistance.

Methods:

In this study, we provide innovative approaches employed in synthesizing four novel nucleobase analogs. Equally, we describe the effects of these compounds on proliferation, migration, aggregation, adhesion of 5-FU-sensitive (HCT116) and -resistant (5-FU-R-HCT116) human CRC cells. In either cell type, our synthesized novel analogs significantly inhibited cell viability in a concentration- and time-dependent manner. This highlights the higher potency of these novel analogs. In addition, these compounds attenuated migration and adhesion of both cell types, while they promoted homotypic cell-cell interaction.

Results:

These changes were reflected by the downregulation matrix metalloproteases (MMP-2 and MMP-9). Furthermore, our analogs exhibited a potent anti-angiogenic activity in vivo.

Conclusion:

In addition, these compounds reduced the level of secreted vascular endothelial growth factor (VEGF) and nitric oxide (NO) production in both 5-FU-sensitive and -resistant cells. Taken together, our data highlight the potential chemotherapeutic properties of our novel analogs against CRC, including the 5-FU-resistant form.

Development and Challenges of Synthetic Retinoid Formulations in Cancer

Retinoids represent a class of chemical compounds derived from, or structurally and functionally related to vitamin A. Retinoids play crucial roles in regulating a range of crucial biological processes spanning embryonic development to adult life. These include regulation of cell proliferation, differentiation, and cell death. Due to their promising characteristics, retinoids emerged as potent anti-cancer agents, and their effects were validated in in vitro and in vivo pre-clinical models of several solid and hematological malignancies. However, their clinical translation remained limited due to their poor water solubility, photosensitivity, short half-life, and toxicity. To overcome these limitations, the development of retinoid delivery formulations was extensively studied. In this review, we will provide a comprehensive summary of some preclinical and commercial synthetic retinoids in cancer and discuss their different delivery systems.

The Pentose Phosphate Pathway in Cancer: Regulation and Therapeutic Opportunities

BACKGROUND

Tumorigenesis is associated with deregulation of nutritional requirements, intermediary metabolites production, and microenvironment interactions. Unlike their normal cell counterparts, tumor cells rely on aerobic glycolysis, through the Warburg effect.

SUMMARY

The pentose phosphate pathway (PPP) is a major glucose metabolic shunt that is upregulated in cancer cells. The PPP comprises an oxidative and a nonoxidative phase and is essential for nucleotide synthesis of rapidly dividing cells. The PPP also generates nicotinamide adenine dinucleotide phosphate, which is required for reductive metabolism and to counteract oxidative stress in tumor cells. This article reviews the regulation of the PPP and discusses inhibitors that target its main pathways. Key Message: Exploiting the metabolic vulnerability of the PPP offers potential novel therapeutic opportunities and improves patients' response to cancer therapy.

Antitumor activity of novel POLA1-HDAC11 dual inhibitors

Hybrid molecules targeting simultaneously DNA polymerase α (POLA1) and histone deacetylases (HDACs) were designed and synthesized to exploit a potential synergy of action. Among a library of screened molecules, MIR002 and GEM144 showed antiproliferative activity at nanomolar concentrations on a panel of human solid and haematological cancer cell lines. In vitro functional assays confirmed that these molecules inhibited POLA1 primer extension activity, as well as HDAC11. Molecular docking studies also supported these findings. Mechanistically, MIR002 and GEM144 induced acetylation of p53, activation of p21, G1/S cell cycle arrest, and apoptosis. Oral administration of these inhibitors confirmed their antitumor activity in in vivo models. In human non-small cancer cell (H460) xenografted in nude mice MIR002 at 50 mg/kg, Bid (qd × 5 × 3w) inhibited tumor growth (TGI = 61%). More interestingly, in POLA1 inhibitor resistant cells (H460-R9A), the in vivo combination of MIR002 with cisplatin showed an additive antitumor effect with complete disappearance of tumor masses in two animals at the end of the treatment. Moreover, in two human orthotopic malignant pleural mesothelioma xenografts (MM473 and MM487), oral treatments with MIR002 and GEM144 confirmed their significant antitumor activity (TGI = 72-77%). Consistently with recent results that have shown an inverse correlation between POLA1 expression and type I interferon levels, MIR002 significantly upregulated interferon-α in immunocompetent mice.

Immunodeficiency Accelerates Vitamin A Deficiency

BACKGROUND

Vitamin A deficiency increases susceptibility to infection caused by impaired immune function.

OBJECTIVES

We investigated whether immunodeficiency could facilitate the development of vitamin A deficiency.

METHODS

Vitamin A deficiency was followed in 2 mouse models of immunodeficiency: the athymic nude mouse (nu/nu) and the humoral immunodeficient SENCAR (SENsitive to CARcinogenesis) mouse. Vitamin A deficiency was also monitored in outbred Balb/c and in NIH mice. The monitoring of vitamin A deficiency was done after feeding the mice and their mothers a semisynthetic, vitamin A-deficient diet from birth of the experimental mice. These mice were weaned onto the same deficient diet at 3-4 wk of age, while control groups were fed the same diet containing 3 μg retinoic acid per gram of diet.

RESULTS

The immunodeficient nu/nu and SENCAR mice developed vitamin A deficiency earlier than either the heterozygous nu/+ controls or the Balb/c and NIH strains. In female mice, symptoms included depletion of liver retinol and retinyl palmitate, squamous metaplasia of the uterus, and death. Male mice lost weight more frequently and sooner than female mice, in which mortality generally occurred in the absence of loss of body weight. Pairwise comparisons using Tukey's honest significant difference test of the nu/nu and SENCAR mice versus the Balb/c and NIH mice showed a faster loss of retinol and retinyl palmitate in all pairs (P ≤ 0.0001) except for retinol when comparing nu/nu and NIH strains (P = 0.3383).

CONCLUSIONS

Our findings are consistent with an increased usage of liver retinol and retinyl palmitate in the immunocompromised nu/nu and in the immunodeficient SENCAR mice and suggest that compensatory mechanisms dependent on vitamin A utilization are called upon to rescue immunodeficiency both in the T-cell-deficient phenotype of the nu/nu mice and in the humoral immunodeficient SENCAR mice.

Anticancer activities of parthenolide in primary effusion lymphoma preclinical models

The sesquiterpene lactone parthenolide is a major component of the feverfew medicinal plant, Tanacetum parthenium. Parthenolide has been extensively studied for its anti-inflammatory and anticancer properties in several tumor models. Parthenolide's antitumor activities depend on several mechanisms but it is mainly known as an inhibitor of the nuclear factor-κB (NF-κB) pathway. This pathway is constitutively activated and induces cell survival in primary effusion lymphoma (PEL), a rare aggressive AIDS-related lymphoproliferative disorder that is commonly caused by the human herpesvirus 8 (HHV-8) infection. The aim of this study is to evaluate the targeted effect of Parthenolide both in vitro and in vivo. Herein, parthenolide significantly inhibited cell growth, induced G₀ /G₁ cell cycle arrest, and induced massive apoptosis in PEL cells and ascites. In addition, parthenolide inhibited the NF-ĸB pathway suppressing IĸB phosphorylation and p65 nuclear translocation. It also reduced the expression of the DNA methylase inhibitor (DNMT1). Parthenolide induced HHV-8 lytic gene expression without inhibiting latent viral gene expression. Importantly, DMAPT, the more soluble parthenolide prodrug, promoted delay in ascites development and prolonged the survival of PEL xenograft mice. This study supports the therapeutic use of parthenolide in PEL and encourages its further clinical development.

Novel adamantyl retinoid-related molecules with POLA1 inhibitory activity

Atypical retinoids (AR) or retinoid-related molecules (RRMs) represent a promising class of antitumor compounds. Among AR, E-3-(3'-adamantan-1-yl-4'-hydroxybiphenyl-4-yl)acrylic acid (adarotene), has been extensively investigated. In the present work we report the results of our efforts to develop new adarotene-related atypical retinoids endowed also with POLA1 inhibitory activity. The effects of the synthesized compounds on cell growth were determined on a panel of human and hematological cancer cell lines. The most promising compounds showed antitumor activity against several tumor histotypes and increased cytotoxic activity against an adarotene-resistant cell line, compared to the parent molecule. The antitumor activity of a selected compound was evaluated on HT-29 human colon carcinoma and human mesothelioma (MM487) xenografts. Particularly significant was the in vivo activity of the compound as a single agent compared to adarotene and cisplatin, against pleural mesothelioma MM487. No reduction of mice body weight was observed, thus suggesting a higher tolerability with respect to the parent compound adarotene.

Abstract 236: Therapeutic targeting of the pentose phosphate pathway in colorectal cancer

Colorectal cancer is the third most common neoplasia and the second cause of cancer-related deaths worldwide. Unlike normal cells, tumor cells reprogram metabolic pathways to meet their bioenergetics, redox, biosynthetic demands and rely mostly on aerobic glycolysis (Warburg effect). Colorectal cancer cells upregulate the pentose phosphate pathway (PPP), and p53 is a crucial regulator. The PPP is a significant route for glucose catabolism and is required for DNA synthesis of rapidly-proliferating cells. Its oxidative phase (oxPPP), catalyzed by the rate-limiting enzyme glucose-6-phosphate dehydrogenase (G6PD), provides the cell with nicotinamide adenine dinucleotide phosphate (NADPH) that is needed for biosynthetic and detoxifying processes. For the past six decades, 5-Fluorouracil (5-FU) has been the treatment of choice in colorectal cancer. However, 5-FU exhibits high toxicity and drug resistance in patients. Therefore, we hypothesized that targeting the PPP might offer novel therapeutic opportunities in colorectal cancer and improve the response to 5-FU at lower and safer doses. Accordingly, we aim to investigate and characterize the anti-tumor effect of the G6PD inhibitor, 6-aminonicotinamide (6-AN), alone, or in combination with 5-FU on colorectal cancer cells. We explored the effects of oxPPP inhibition on colorectal cancer cell growth, reactive oxygen species (ROS) production, cell cycle regulation, and senescence. We have shown that 6-AN arrested cell growth in HCT116 and HCT116 p53−/− colorectal cancer cells while spared normal-like colon cells (NCM460D). Moreover, 6-AN induced S-phase arrest and early senescence in HCT116 cells as demonstrated by cell cycle analysis using flow cytometry and senescence-associated beta-galactosidase assay, respectively. We also tested the effects of 6-AN/5-FU combination treatments on cellular viability using MTT assay and validated our results using SRB and trypan blue exclusion assays. Interestingly, combination treatments of 6-AN with 5-FU resulted in synergistic effects as estimated using Compusyn software. We used HCT116 colorectal cancer cells resistant to 5-FU (HCT116 5FU-R) or lacking p53, as models for tumor resistance. Importantly, the combination treatment sensitized both HCT116 p53−/− and HCT116 5FU-R colorectal cancer cells to 5-FU and was accompanied by a reduction in G6PD activity and increased ROS using NBT reduction assay. Our findings indicate that combining 6-AN with 5-FU may decrease resistance and further sensitize colorectal cancer cells to 5-FU treatment independently of p53 and drug resistance status. Exploiting this metabolic vulnerability may offer a novel clinical approach and improve patient's therapy.

Citation Format: Noorhan Ghanem, Chirine El Baba, Lara Al Saleh, Berthe Hayar, Patrick Aouad, Marwa Al Hassan, Riyad El-Khoury, Julnar Usta, Nadine Darwiche. Therapeutic targeting of the pentose phosphate pathway in colorectal cancer [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 236.

Thymoquinone induces apoptosis and DNA damage in 5-Fluorouracil-resistant colorectal cancer stem/progenitor cells

The high recurrence rates of colorectal cancer have been associated with a small population of cancer stem cells (CSCs) that are resistant to the standard chemotherapeutic drug, 5-fluorouracil (5FU). Thymoquinone (TQ) has shown promising antitumor properties on numerous cancer systems both in vitro and in vivo; however, its effect on colorectal CSCs is poorly established. Here, we investigated TQ's potential to target CSCs in a three-dimensional (3D) sphere-formation assay enriched for a population of colorectal cancer stem/progenitor cells. Our results showed a significant decrease in self-renewal potential of CSC populations enriched from 5FU-sensitive and resistant HCT116 cells at 10-fold lower concentrations when compared to 2D monolayers. TQ decreased the expression levels of colorectal stem cell markers CD44 and Epithelial Cell Adhesion Molecule EpCAM and proliferation marker Ki67 in colonospheres derived from both cell lines and reduced cellular migration and invasion. Further investigation revealed that TQ treatment led to increased TUNEL positivity and a dramatic increase in the amount of the DNA damage marker gamma H2AX particularly in 5FU-resistant colonospheres, suggesting that the diminished sphere forming ability in TQ-treated colonospheres is due to induction of DNA damage and apoptotic cell death. The intraperitoneal injection of TQ in mice inhibited tumor growth of spheres derived from 5FU-sensitive and 5FU-resistant HCT116 cells. Furthermore, TQ induced apoptosis and inhibited NF-κB and MEK signaling in mouse tumors. Altogether, our findings document TQ's effect on colorectal cancer stem-like cells and provide insights into its underlying mechanism of action.

Epigenetic mechanisms and the hallmarks of cancer: an intimate affair

Epigenetic mechanisms comprising DNA methylation, histone modifications, and noncoding RNAs affect chromatin structure and regulate gene expression. These mechanisms control normal embryonic development and adult life and their deregulation contributes to several diseases including cancer. The process of tumorigenesis is complex and results from the evolution of different "hallmarks of cancer". Hanahan and Weinberg presented in 2000 and 2011 seminal contributions in the cancer field, first the six hallmarks of cancer and a decade later two additional hallmarks and two enabling characteristics were added. Here, we surmise that epigenetic mechanisms regulate and contribute to every single hallmark in cancer, and thus represent the hallmark of hallmarks in tumorigenesis. Focusing on epigenetics as a major hallmark in cancer formation has profound preventive, therapeutic, and clinical implications.

A Critical Review of Animal Models Used in Acute Myeloid Leukemia Pathophysiology

Acute myeloid leukemia (AML) is one of the most frequent, complex, and heterogeneous hematological malignancies. AML prognosis largely depends on acquired cytogenetic, epigenetic, and molecular abnormalities. Despite the improvement in understanding the biology of AML, survival rates remain quite low. Animal models offer a valuable tool to recapitulate different AML subtypes, and to assess the potential role of novel and known mutations in disease progression. This review provides a comprehensive and critical overview of select available AML animal models. These include the non-mammalian Zebrafish and Drosophila models as well as the mammalian rodent systems, comprising rats and mice. The suitability of each animal model, its contribution to the advancement of knowledge in AML pathophysiology and treatment, as well as its advantages and limitations are discussed. Despite some limitations, animal models represent a powerful approach to assess toxicity, and permit the design of new therapeutic strategies.

Abstract 3096: Host antitumor immune response activated by Dual POLA1-HDAC11 inhibitors endowed with a large spectrum of antitumor activity

Small molecule modulators of chromatin modifying enzymes became the focus of drug discovery efforts, because of their direct antitumor effects, such as apoptosis and cell-cycle arrest, in addition to their indirect immunomodulation properties (Peedicayil, 2012; West and Johnstone, 2014; Falkenberg and Johnstone, 2014). Recent studies have shown that inhibition of HDACs or POLA1 activity exerts anti-proliferative effects and also potentiates the immune response by activating type I Interferon (Medon et al., 2017; Starokadomskyy et al, 2016). To exploit a potential synergy, hybrid molecules targeting simultaneously POLA1 and HDACs, were designed. Here, we present in vitro and in vivo data concerning the antitumor activity of new dual POLA1-HDAC11 inhibitors. Among a library of screened molecules, MIR002 and MIR144 showed an antiproliferative activity at nanomolar concentrations on a panel of human tumor cell lines. In vitro functional assays revealed that these molecules potently inhibit POLA1 and specifically act on HDAC11 that recently emerged as regulator of several immune cells differentiation, pointing out its immunomodulatory role. Mechanistically, MIR002 and MIR144 induce acetylation of Histone H4 and alpha-Tubulin, canonical targets of HDACs, and p53-K382, as well. Activation of p53 leads to p21 increase and cell cycle arrest in the G1/S boundary. These compounds could be even more effective in treating human cancers when they are appropriately combined with other chemotherapeutics, such as Cisplatin. Indeed, the combination of MIR002 or MIR144 with Cisplatin, revealed a synergistic interaction (Combination Index < 1) on NCI-H460 and H460-R9A (ST1926-resistant sub-line) cell growth. The in vivo oral administration of MIR002 or MIR144 showed a potent antitumor activity, with a Tumor Growth Inhibition comprised between 60 and 100% in a series of human and murine solid and hematological tumors (human MM473 and MM432 Pleural Mesothelioma, H460 and H460R9A NSCLC, A2780-Dx and A2780-DDP ovarian carcinomas, NB-4 Acute Promyelocitic leukemia and Murine EL-4 Lymphoma) xenografted in nude and immunocompetent mice. The strongest antitumor effect of MIR144 was observed in immunocompetent mice rather than in nude mice suggesting that an immunomodulatory effect, along with the direct antiproliferative activity, contributes to tumor inhibition. Further analysis confirmed that MIR144 antitumor activity involves the induction/activation of several components of the host immune system, both at humoral and cellular levels. The large spectrum of antitumor activity, together with the high tolerability observed, open the possibility for their clinical investigation in different population of cancer patients.

Citation Format: Claudio Pisano, Lucio Merlini, Sergio Penco, Raffaella Cincinelli, Nadine Darwiche, Mario B. Guglielmi, Ilaria La Porta, Maddalena Pizzulo, Federica Prosperi, Giacomo Signorino, Fabiana Colelli, Francesco Cardile, Laura Focareta, Alessandra Fucci, Egildo L. D'Andrea, Assunta Riccio, Sabrina Dallavalle. Host antitumor immune response activated by Dual POLA1-HDAC11 inhibitors endowed with a large spectrum of antitumor activity [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3096.

Spinal sarcomas and immunity: An undervalued relationship

Sarcomas, especially spine sarcomas, are rare yet debilitating and are underestimated types of cancer. Treatment options for spine sarcomas are limited to chemotherapy, radiotherapy and surgical intervention. Accumulating evidence suggests a complex course associated with the treatment of spine sarcomas as compared to other soft tissue sarcomas in the extremities since adjuvant therapy adds limited success to the oncological outcome. Likewise, the limitations of surgical interventions imposed by the proximity and high sensitivity of the spinal cord, leads to an increased recurrence and mortality rates associated with spine sarcomas. Finding novel treatment options to spine sarcomas as such is inevitable, necessitating a more thorough understanding of the different mechanisms of the underlying etiologies of these tumors. In this review, we discuss the most recent studies tackling the involvement of the immune system; a key player in the emergence of the different types of spine sarcomas and the promising immune-mediated targeted therapy that can be applied in these kind of rare cancers.

Novel therapeutic strategies for spinal osteosarcomas

At the dawn of the third millennium, cancer has become the bane of twenty-first century man, and remains a predominant public health burden, affecting welfare and life expectancy globally. Spinal osteogenic sarcoma, a primary spinal malignant tumor, is a rare and challenging neoplastic disease to treat. After the conventional therapeutic modalities of chemotherapy, radiation and surgery have been exhausted, there is currently no available alternative therapy in managing cases of spinal osteosarcoma. The defining signatures of tumor survival are characterised by cancer cell ability to stonewall immunogenic attrition and apoptosis by various means. Some of these biomarkers, namely immune-checkpoints, have recently been exploited as druggable targets in osteosarcoma and many other different cancers. These promising strides made by the use of reinvigorated immunotherapeutic approaches may lead to significant reduction in spinal osteosarcoma disease burden and corresponding reciprocity in increase of survival rates. In this review, we provide the background to spinal osteosarcoma, and proceed to elaborate on contribution of the complex ecology within tumor microenvironment giving arise to cancerous immune escape, which is currently receiving considerable attention. We follow this section on the tumor microenvironment by a brief history of cancer immunity. Also, we draw on the current knowledge of treatment gained from incidences of osteosarcoma at other locations of the skeleton (long bones of the extremities in close proximity to the metaphyseal growth plates) to make a case for application of immunity-based tools, such as immune-checkpoint inhibitors and vaccines, and draw attention to adverse upshots of immune-checkpoint blockers as well. Finally, we describe the novel biotechnique of CRISPR/Cas9 that will assist in treatment approaches for personalized medication.

The synthetic retinoid ST1926 attenuates prostate cancer growth and potentially targets prostate cancer stem-like cells

Retinoids are vitamin A derivatives that regulate crucial biological processes such as cellular proliferation, apoptosis, and differentiation. The use of natural retinoids in cancer therapy is limited due to their toxicity and the acquired resistance by cancer cells. Therefore, synthetic retinoids were developed, such as the atypical adamantyl retinoid ST1926 that provides enhanced bioavailability and reduced toxicity. We have assessed the in vitro and in vivo antitumor properties and mechanism of action of ST1926 in targeting cancer stem-like cells population of human prostate cancer (PCa) cell lines, DU145 and PC3, and mouse PCa cell lines, PLum-AD and PLum-AI. We demonstrated that ST1926 substantially reduced proliferation of PCa cells and induced cell cycle arrest, p53-independent apoptosis, and early DNA damage. It also decreased migration and invasion of PCa cells and significantly reduced prostate spheres formation ability in vitro denoting sufficient eradication of the self-renewal ability of the highly androgen-resistant cancer stem cells. Importantly, ST1926 potently inhibited PCa tumor growth and progression in vivo. Our results highlight the potential of ST1926 in PCa therapy and warrant its clinical development.

Abstract 170: Targeting colorectal cancer stem cells with the anticancer molecule thymoquinone

Introduction: 5-fluorouracil (5-Fu) remains the standard chemotherapy for metastatic colorectal cancer (CRC), but drug resistance and unpredictable cardiotoxicity limit its effectiveness. The high recurrence rates and the common resistance are thought to be due to a population of self-renewing cancer stem cells (CSCs). The black seed extract Thymoquinone (TQ) is a promising anticancer molecule known to inhibit cancer cell growth and progression in numerous cancer systems both in vitro and in vivo. This project aims to investigate the effect and mechanism of action of TQ on colon cancer stem/progenitor cells using two isogenic HCT116 colon cancer cell lines that differ in their 5-Fu drug sensitivity.

Methods: Sphere-formation and propagation assays were used to assess the efficacy of TQ on targeting self-renewal capacity of colon CSCs enriched from the sensitive and resistant cell lines in 3D cultures over several generations in comparison to 2D monolayers. In addition, xenotransplantation experiments were used to assess for the tumor initiation of 2D vs. 3D cells.

Results: Our results of TQ efficacy in 2D cell culture system showed that it reduced the viability of both cell lines. Importantly, our 3D results showed that TQ inhibits HCT116 colonosphere growth at 10-fold lower concentrations than those required to inhibit the growth of 2D monolayer cells. Interestingly, the injection of 100 spheres derived from HCT116 sensitive cell line and not the 2D equivalent cell density into NOD-SCID immunocompromised mice resulted in tumor development, suggesting that spheres are rich in cells with stem-like properties.

Conclusion: In summary, our data suggests that TQ might be an effective treatment strategy and may prevent colorectal cancer recurrence by targeting CSCs.

Citation Format: Farah R. Ballout, Maamoun Fatfat, Rana Abdel-Samad, Nadine Darwiche, Regine Schneider-Stock, Wassim Abou-Kheir, Hala-Gali Muhtasib. Targeting colorectal cancer stem cells with the anticancer molecule thymoquinone [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 170.

Abstract 4848: Preclinical antitumor activity of novel DNA polymerase 1 (POLA1) inhibitors

The anti-proliferative and pro-apoptotic effects of Retinoid-Related Molecules (RRMs) are described as independent from Retinoids' receptors-mediated transcriptional activity. Prototypes of this class are CD437 and its more potent analogue ST1926, which have a strong antitumor activity by targeting DNA polymerase 1 alpha (POLA1) (Han et al. Nat Chem Biol. 2016; Abdel-Samad et al. AJCR, in press).

With aim to identify new RRMs with an improved pharmacological profile, we synthetized and screened a library of RRMs for their antitumor properties and inhibitory activity on POLA1. From this screening, four molecules, MIR002, MIR020, MIR072 and MIR075, were selected. All exert a potent anti-proliferative effect, with G1/S arrest and apoptosis, in more than 50 cancer cell lines derived from human hematological and solid tumors. From a mechanistic point of view, these RRMs modulate, at different extent, POLA1 activity and/or expression.

Notably, NSCLC cells harboring POLA1-L764F mutation (H460-R9A), are resistant to both CD437 and ST1926 (IC50>50 higher than the one of wild type H460 cells), while they are sensitive to MIR002, showing for this RRM-derivative an improved/different pharmacological profile with respect to CD437 and ST1926.

Hints on the possibility of these new RRMs to be orally absorbed were obtained using cancer cells overexpressing or not P-glycoprotein (Pgp), known as the major player limiting the oral absorption of several chemotherapeutic agents. Results from these experiments revealed that the Tested compounds are not Pgp substrate thus suggesting the possibility for their absorption via oral route

MIR002 in vivo activity was assessed in tumors from Malignant Mesothelioma derived cells (MM487), and lung cancer cells (H460 and H460-R9A). In all the evaluated models, MIR002 induced a strong Tumor Growth Inhibition either alone or in combination with cisplatin (TGI>61% and TGI>80-100%, respectively).

The treatment of orthotopic models of malignant mesothelioma (MM487) with MIR072 in combination with Cisplatin, resulted in a impressive synergic antitumor activity if compared to Cisplatin monotherapy (TGI 95% vs 55%).

Tests on orthotopic transplants of hepatocellular carcinoma cells (HepG2), showed that MIR020 has significant antitumor effects (TGI 72%).

Finally, the activity of MIR075 was evaluated on glioblastoma luciferase-expressing cells (U-87MG) intracranically injected. Also this compound displayed a significant tumor growth inhibition (TGI 72%), as measured by IVIS imaging system.

Taken together, the results from in vitro and in vivo experiments indicate that this new class of RRMs, including MIR002, MIR072, MIR020, and MIR075, modulate POLA1 functions and activate pro-apoptotic pathways. The large spectrum of antitumor activity, together with the high tolerability observed, opens the possibility for their clinical investigation in different population of cancer patients.

Citation Format: Claudio Pisano, Lucio Merlini, Sergio Penco, Raffaella Cincinelli, Nadine Darwiche, Mario B. Guglielmi, Ilaria La Porta, Giacomo Signorino, Gabriele De Rubis, Fabiana Colelli, Francesco Cardile, Alessandra Fucci, Egildo L. D'Andrea, Sabrina Dallavalle. Preclinical antitumor activity of novel DNA polymerase 1 (POLA1) inhibitors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4848.

Mouse Models That Enhanced Our Understanding of Adult T Cell Leukemia

Adult T cell Leukemia (ATL) is an aggressive lymphoproliferative malignancy secondary to infection by the human T-cell leukemia virus type I (HTLV-I) and is associated with a dismal prognosis. ATL leukemogenesis remains enigmatic. In the era of precision medicine in oncology, mouse models offer one of the most efficient in vivo tools for the understanding of the disease biology and developing novel targeted therapies. This review provides an up-to-date and comprehensive account of mouse models developed in the context of ATL and HTLV-I infection. Murine ATL models include transgenic animals for the viral proteins Tax and HBZ, knock-outs for key cellular regulators, xenografts and humanized immune-deficient mice. The first two groups provide a key understanding of the role of viral and host genes in the development of ATL, as well as their relationship with the immunopathogenic processes. The third group represents a valuable platform to test new targeted therapies against ATL.

Genome-Wide Gene Expression Changes in the Normal-Appearing Airway during the Evolution of Smoking-Associated Lung Adenocarcinoma

Smoking perpetuates in cytologically normal airways a molecular "field of injury" that is pertinent to lung cancer and early detection. The evolution of airway field changes prior to lung oncogenesis is poorly understood largely due to the long latency of lung cancer in smokers. Here, we studied airway expression changes prior to lung cancer onset in mice with knockout of the Gprc5a gene (Gprc5a^-/-) and tobacco carcinogen (NNK) exposure and that develop the most common type of lung cancer, lung adenocarcinoma, within 6 months following exposure. Airway epithelial brushings were collected from Gprc5a^-/- mice before exposure and at multiple times post-NNK until time of lung adenocarcinoma development and then analyzed by RNA sequencing. Temporal airway profiles were identified by linear models and analyzed by comparative genomics in normal airways of human smokers with and without lung cancer. We identified significantly altered profiles (n = 926) in the NNK-exposed mouse normal airways relative to baseline epithelia, a subset of which were concordantly modulated with smoking status in the human airway. Among airway profiles that were significantly modulated following NNK, we found that expression changes (n = 22) occurring as early as 2 months following exposure were significantly associated with lung cancer status when examined in airways of human smokers. Furthermore, a subset of a recently reported human bronchial gene classifier (Percepta; n = 56) was enriched in the temporal mouse airway profiles. We underscore evolutionarily conserved profiles in the normal-appearing airway that develop prior to lung oncogenesis and that comprise viable markers for early lung cancer detection in suspect smokers. Cancer Prev Res; 11(4); 237-48. ©2018 AACR.

Mechanism of action of the atypical retinoid ST1926 in colorectal cancer: DNA damage and DNA polymerase α

Despite advances in therapeutic strategies, colorectal cancer (CRC) remains the third cause of cancer-related deaths with a relatively low survival rate. Resistance to standard chemotherapy represents a major hurdle in disease management; therefore, developing new therapeutic agents demands a thorough understanding of their mechanisms of action. One of these compounds is ST1926, an adamantyl retinoid that has shown potent antitumor activities in several human cancer models. Here, we show that ST1926 selectively suppressed the proliferation of CRC cells while sparing normal counterparts, and significantly reduced tumor volume in a xenograft cancer mouse model. Next, we investigated the effects of ST1926 in CRC cells and observed early DNA damage, S-phase arrest, dissipation of mitochondrial membrane potential, and apoptosis induction, in a p53 and p21-independent manner. To address the underlying mechanism of resistance to ST1926, we generated ST1926-resistant HCT116 cells and sequenced DNA polymerase α (POLA1), which was reported to be a direct target to the drug's parent molecule, CD437. We identified similar mutations in POLA1 that conferred resistance to ST1926 and CD437. These mutations were absent in 5-fluorouracil-resistant HCT116 cells, clearly validating the specificity of these mutations to the lack of DNA damage and acquired resistance to ST1926. ST1926 also inhibited POLA1 activity and reduced its protein expression levels. Further, in silico analysis of normal and malignant tissue expression data demonstrated that POLA1 levels are elevated in CRC cells and tissues compared to normal counterparts as well as to other cancer types. Our findings highlight previously uncharacterized mechanisms of action of ST1926 in CRC and suggest that elevated POLA1 expression is a pertinent molecular feature and an attractive target in CRC.

Antitumor activity of the synthetic retinoid ST1926 on primary effusion lymphoma in vitro and in vivo models

Primary effusion lymphoma (PEL) is a rare B-cell neoplasm, associated with Kaposi sarcoma-associated herpes virus/human herpes virus-8 (KSHV/HHV-8), arising as malignant effusions in body cavities. PEL cells do not harbor conventional genetic cancer mutations; however, their oncogenesis is mainly attributed to HHV-8 latent genes. Treatment strategies are inefficient resulting in poor prognosis of PEL patients, stressing the need for new effective therapy. ST1926 is a synthetic retinoid with favorable antitumor properties and no cross-resistance with the natural retinoid, all-trans retinoic acid. ST1926 has shown potent apoptotic activities on a variety of solid tumors and hematologic malignancies in in vitro and in vivo models. In the present study we elucidated the antitumor activities and underlying molecular mechanism of ST1926 using in vitro, ex vivo, and in vivo PEL preclinical models. ST1926, at sub‑micromolar concentrations, displayed potent antiproliferative effects on PEL cell lines and malignant ascites. Furthermore, ST1926 treatment of PEL cells and ascites resulted in their accumulation in the sub-G1 region, S phase cell cycle arrest, early DNA damage, PARP cleavage and p53 activation including the upregulation of its target genes p21 and Bax. However, ST1926 did not significantly modulate HHV-8 latent viral transcripts. Importantly, ST1926 delayed formation of ascites and enhanced survival of PEL mice. These results highlight the therapeutic potential of ST1926 in combination with drugs that target HHV-8 in PEL patients.

Abstract 5140: Encapsulation of the atypical retinoid ST1926 in nanoparticles prolongs the survival of acute myeloid leukemia xenografted mice at multiple folds lower concentrations than the naked drug

Acute myeloid leukemia (AML) represents one of the most complex types of leukemia. It is a clinically and genetically heterogeneous disorder of hematopoietic progenitor cells, which have lost their ability to differentiate normally. Retinoids regulate vital biological processes including development, differentiation, proliferation, and cell death of hematopoietic progenitor cells. The natural retinoid all-trans retinoic acid (ATRA) became the paradigm for the treatment of acute promyelocytic leukemia (APL), an AML subtype. However, in non-APL AML patients, ATRA is possibly only effective in patients with Nucleophosmin-1 mutations without FMS-like tyrosine kinase 3 internal tandem duplication (FLT-3 ITD). Therefore, synthetic retinoids, specifically the adamantyl ST1926, emerged as potential alternatives. However, despite its lack of toxicity, ST1926 development in clinic was limited due to its rapid glucuroconjugation resulting in low plasma concentrations. Nanomedicine enables more efficient drug delivery and bioavailability. Here, we investigate the pre-clinical efficacy of ST1926 and polymer stabilized ST1926 nanoparticles in AML in vitro and in vivo models. We show that ST1926, at low sub-µM concentrations, potently inhibited the growth of human non-APL ATRA-resistant AML cell lines and AML patient cells while sparing resting and activated normal leukocytes at ten- to hundred-fold higher concentrations. ST1926 induced early DNA damage and massive apoptosis in all tested AML cell lines. To optimize the drug’s bioavailability burden, polymer stabilized ST1926 nanoparticles were developed using Flash NanoPrecipitation, and were shown to display comparable anti-growth activities to the naked drug in vitro. In murine AML xenograft model, ST1926 and ST1926 nanoparticles significantly prolonged survival. Strikingly, ST1926 encapsulated in nanoparticles extended survival in AML xenografted mice at four-fold lower concentrations than the naked drug. These results highlight the promise of ST1926 in AML therapy and warrant further clinical development of this adamantly retinoid.

Citation Format: Leeanna El-Houjeiri, Walid Saad, Berthe Hayar, Patrick Aouad, Nadim Tawil, Rana Abdel-Samad, Claudio Pisano, Ali Bazarbachi, Hiba El Hajj, Nadine Darwiche. Encapsulation of the atypical retinoid ST1926 in nanoparticles prolongs the survival of acute myeloid leukemia xenografted mice at multiple folds lower concentrations than the naked drug [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5140. doi:10.1158/1538-7445.AM2017-5140

Abstract 4056: Development of Kras mutant lung adenocarcinoma in tobacco carcinogen exposed mice with knockout of the airway lineage-specific G-protein coupled receptor Gprc5a

Lung adenocarcinoma (LUAD) represents the most common lung cancer subtype in smokers. Despite the urgency for prevention in high-risk smokers, we still do not know the earliest changes that drive LUAD development and would thus be ideal targets for chemoprevention. Earlier work revealed that the retinoic acid-inducible G-protein coupled receptor, Gprc5a, is abundantly expressed in mouse normal lung relative to other normal tissues. Moreover, mice with knockout of Gprc5a develop spontaneous late onset lung tumors, including LUADs, suggesting a tumor suppressor role for this gene. In the present study, we sought to better understand the impact of Gprc5a expression on LUAD pathogenesis. We first examined the expression of human GPRC5A in publicly available datasets and found that GPRC5A was highest in human normal lung relative to other normal samples and was down-regulated in human LUADs. We then assessed expression patterns of Gprc5a within different mouse airway compartments and found that the gene was predominantly expressed in alveolar type I (AT1) cells pointing to potential airway lineage-specific functions for Gprc5a. Next we sought to analyze tobacco carcinogen-mediated lung oncogenesis as an attempt to emulate smoking-induced lung cancer in humans. In contrast to wild type littermates, Gprc5a-/- mice treated with the nicotine-specific carcinogen NNK developed LUADs by six months after carcinogen exposure. Following immunofluorescence analysis, these LUADs were found to express surfactant protein C (Sftpc) and lack the clara cell marker Ccsp suggesting that the cells of origin for these LUADs are alveolar type II (AT2) cells. We were then prompted to understand genomic alterations in the pathogenesis of the Gprc5a-/- LUADs. Using the Illumina HiSeq 2500 platform, we performed whole exome sequencing (WES) of five carcinogen-induced LUADs as well as two Gprc5a-/- tail veins and normal lung tissues to infer somatic variants. Of note, all LUADs exhibited somatic activating Kras mutations (p.G12D or p.Q61R), the same variants purported to act as drivers of human LUAD in smokers. The Kras mutations were also observed in premalignant lesions that developed prior to LUAD onset. Moreover, WES analysis revealed additional driver genes that were mutated (Apc, Atm, Kmt2d, Nf1, Trp53) or exhibited copy number alterations (CNAs) (gain of Kras, Met, Braf, Ezh2) in multiple Gprc5a-/- LUADs. Our data suggest that Gprc5a loss coupled with NNK exposure leads to AT2-derived Kras mutant LUADs with co-occurring mutations and CNAs in other driver oncogenes and tumor suppressors. Our findings also imply that the tobacco carcinogen exposed Gprc5a-/- model emulates the molecular pathology of human LUAD and offers unique opportunities to map the temporal evolution of Kras mutant LUAD and identify targets for chemoprevention of this fatal malignancy.

Citation Format: Junya Fujimoto, Sayuri Nunomura, Wenhua Lang, Yihua Liu, Jinsong Wei, Joshua Ochieng, Yasminka Jakubek, Edwin Ostrin, Jason Petersen, Gareth Davies, Nadine Darwiche, Erik Ehli, Jerry Fowler, Paul Scheet, Humam Kadara. Development of Kras mutant lung adenocarcinoma in tobacco carcinogen exposed mice with knockout of the airway lineage-specific G-protein coupled receptor Gprc5a. [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 4056.

Abstract 1189: Combination treatments with retinoic acid and the synthetic retinoid ST1926 in 2D and 3D breast cancer models overcome retinoic acid resistance and eradicate breast cancer stem/progenitor cells

Despite recent advances in breast cancer therapy, achieving complete remission in metastatic breast cancer patients remains a challenge. Retinoids are crucial regulators of cellular proliferation, differentiation, and cell death, and have shown potent chemotherapeutic and chemopreventive properties. The major drawback of the use of all-trans retinoic acid (ATRA) in cancer therapy is acquired resistance. Therefore, synthetic retinoids such as ST1926 emerged as potent anti-cancer agents. Here, we investigated the anti-tumor activities of ATRA, ST1926, and their combination treatments in 2D and 3D human breast cancer models and their targeting of breast cancer stem cells (CSCs)/progenitor cells. We have shown that in 2D culture models, MCF-7 and MDA-MB-231 cells are resistant to ATRA while being sensitive to ST1926 at sub-micromolar (μM) concentrations in an irreversible manner. Importantly, ST1926 had no effect on the ‘normal-like’ MCF-10A breast epithelial cells. ST1926 induced massive apoptosis in MCF-7 cells and it resulted in S-phase arrest and necrosis in the triple negative and metastatic MDA-MB-231 cells. Furthermore, ST1926 caused early DNA damage, increased the expression of the tumor suppressors p53 and p21, downregulated the Wnt/β-catenin pathway, and modulated the expression levels of the different retinoid receptors. Interestingly, combination treatments as low as 0.1 μM ST1926 and 0.5 μM ATRA synergistically inhibited the proliferation in 2D models of MCF-7 and MDA-MB-231 cells, independently of retinoid receptor signaling, while sparing the normal breast epithelial cells. Anchorage-independent growth of MCF-7 and MDA-MB-231 cells was examined using the soft agar colony formation assay where sub-μM concentrations of ST1926 or μM concentrations of ATRA were shown to reduce the size and the number of breast cancer colonies. ST1926 drastically induced cell death in 3D Matrigel ‘on-top’ assay cultures of breast cancer cells while the lumen of the normal-like breast epithelial cell line S1 was maintained. Finally, treatment with 0.01 μM ST1926 alone or 0.001 μM ST1926 in combination with 0.1 μM ATRA abrogated sphere formation and the self-renewal ability of breast CSCs in the 3D sphere formation assay. In summary, ST1926, ATRA, and their combination treatments were shown to display more potent anti-tumor properties in 3D versus 2D human breast cancer models. Our results also demonstrate the therapeutic potential of ST1926 in sensitizing breast cancer cells to ATRA and in targeting the population of breast CSCs. As 3D culture models are more representative of the tumor microenvironment and serve as valid tools in drug discovery, our results highlight the promising use of ATRA/ST1926 combinations in metastatic and triple negative breast cancers.

Citation Format: Patrick Aouad, Melody Saikali, Rana Abdel-Samad, Leeanna El–Houjeiri, Claudio Pisano, Rabih Talhouk, Nadine Darwiche. Combination treatments with retinoic acid and the synthetic retinoid ST1926 in 2D and 3D breast cancer models overcome retinoic acid resistance and eradicate breast cancer stem/progenitor 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 1189.

Abstract B48: The synthetic retinoid ST1926 as a novel therapeutic agent in rhabdomyosarcoma

Rhabdomyosarcoma (RMS) is the most frequent soft tissue sarcoma in children. Despite multiple attempts at intensifying chemotherapeutic approaches to treatment, only moderate improvements in survival have been made for patients with advanced disease. Retinoic acid is a differentiation agent that has shown some anti-tumor efficacy in RMS cells in vitro, however the effects are of low magnitude. E-3-(4'-hydroxyl-3'-adamantylbiphenyl-4-yl) acrylic acid (known as ST1926) is a novel orally available synthetic atypical retinoid, shown to have more potent activity than retinoic acid in several types of cancer cells. We used in vitro and in vivo models of RMS to explore the efficacy of ST1926 as a possible therapeutic agent in this sarcoma. We found that ST1926 reduced RMS cell viability in all tested alveolar (ARMS) and embryonal (ERMS) RMS cell lines, at readily achievable in vivo micromolar concentrations. ST1926 induced an early DNA damage response, which led to increase in apoptosis, in addition to S-phase cell cycle arrest and a reduction in protein levels of the cell cycle kinase CDK1. Effects were irrespective of TP53 mutational status. Interestingly, in ARMS cells, ST1926 treatment decreased PAX3-FOXO1 fusion protein levels, and this suppression occurred at a post-transcriptional level. In vivo, ST1926 was effective in retarding the growth of ARMS and ERMS xenografts, and induced a prominent DNA damage response. We conclude that ST1926 has preclinical efficacy against RMS, and should be considered further investigated in clinical trials, possibly in combination therapy.

Citation Format: Hussein Basma, Sandra Ghayad, Angelo Mancinelli, Claudio Pisano, Nadine Darwiche, Raya Saab. The synthetic retinoid ST1926 as a novel therapeutic agent in 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 B48.

The synthetic retinoid ST1926 as a novel therapeutic agent in rhabdomyosarcoma

Rhabdomyosarcoma (RMS) is the most frequent soft tissue sarcoma in children. Despite multiple attempts at intensifying chemotherapeutic approaches to treatment, only moderate improvements in survival have been made for patients with advanced disease. Retinoic acid is a differentiation agent that has shown some antitumor efficacy in RMS cells in vitro; however, the effects are of low magnitude. E-3-(4'-hydroxyl-3'-adamantylbiphenyl-4-yl) acrylic acid (ST1926) is a novel orally available synthetic atypical retinoid, shown to have more potent activity than retinoic acid in several types of cancer cells. We used in vitro and in vivo models of RMS to explore the efficacy of ST1926 as a possible therapeutic agent in this sarcoma. We found that ST1926 reduced RMS cell viability in all tested alveolar (ARMS) and embryonal (ERMS) RMS cell lines, at readily achievable micromolar concentrations in mice. ST1926 induced an early DNA damage response (DDR), which led to increase in apoptosis, in addition to S-phase cell cycle arrest and a reduction in protein levels of the cell cycle kinase CDK1. Effects were irrespective of TP53 mutational status. Interestingly, in ARMS cells, ST1926 treatment decreased PAX3-FOXO1 fusion oncoprotein levels, and this suppression occurred at a post-transcriptional level. In vivo, ST1926 was effective in inhibiting growth of ARMS and ERMS xenografts, and induced a prominent DDR. We conclude that ST1926 has preclinical efficacy against RMS, and should be further developed in this disease in clinical trials.

Abstract A39: The novel atypical retinoid ST1926 is active against rhabdomyosarcoma and induces cell cycle arrest in S and G2/M phases

Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children with two subtypes: embryonal rhabdomyosarcoma (ERMS) and alveolar rhabdomyosarcoma (ARMS). With current treatment strategies, most children with recurrent or high-risk disease fare poorly, identifying a need for novel therapeutic approaches. The novel retinoid, ST1926, is an orally available compound belonging to the class of synthetic atypical retinoids and is currently in clinical trials. ST1926 is showing promise because of its increased specificity and reduced toxicity and its unique antitumor mechanism of action that appears different from that of classical all-trans retinoic acid (ATRA). We are investigating the therapeutic potential of this novel synthetic retinoid ST1926, in treatment of RMS. Cell viability assessed by MTT assay showed that ST1926 was a much more potent inhibitor of cell proliferation than ATRA, in both ERMS and ARMS cell lines in vitro. In fact, ST1926 effectively inhibited cell proliferation in all tested cell lines, at concentrations as low as 0.5 micromolar, which is easily achievable in vivo. Unlike ATRA, ST1926 did not induce morphological differentiation in RMS cells. Further analysis showed that ST1926 induced accumulation of cells in S and/or in G2/M phases of the cell cycle, as well as induction of apoptosis in some cell lines, in a p53-independent manner. We are currently investigating the mechanistic details of the cell cycle inhibitory activities of ST1926 in RMS cells. This data identifies ST1926 as an interesting possible therapeutic agent in RMS, and in vivo preclinical studies utilizing this agent are currently underway.

Citation Format: Hussein Basma, Loai Dweik, Nadine Darwiche, Claudio Pisano, Raya Saab. The novel atypical retinoid ST1926 is active against rhabdomyosarcoma and induces cell cycle arrest in S and G2/M phases. [abstract]. In: Proceedings of the AACR Special Conference on Pediatric Cancer at the Crossroads: Translating Discovery into Improved Outcomes; Nov 3-6, 2013; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2013;74(20 Suppl):Abstract nr A39.

Hollow-fiber membrane bioreactor for the treatment of high-strength landfill leachate

Performance assessment of membrane bioreactor (MBR) technology for the treatability of high-strength landfill leachate is relatively limited or lacking. This study examines the feasibility of treating high-strength landfill leachate using a hollow-fiber MBR. For this purpose, a laboratory-scale MBR was constructed and operated to treat leachate with a chemical oxygen demand (COD) of 9000-11,000 mg/l, a 5-day biochemical oxygen demand (BOD5) of 4000-6,000 mg/l, volatile suspended solids (VSS) of 300-500 mg/l, total nitrogen (TN) of 2000-6000 mg/l, and an ammonia-nitrogen (NH3-N) of 1800-4000 mg/l. VSS was used with the BOD and COD data to simulate the biological activity in the activated sludge. Removal efficiencies > 95-99% for BOD5, VSS, TN and NH3-N were attained. The coupled experimental and simulation results contribute in filling a gap in managing high-strength landfill leachate and providing guidelines for corresponding MBR application.

Differential growth inhibitory effects of highly oxygenated guaianolides isolated from the Middle Eastern indigenous plant Achillea falcata in HCT-116 colorectal cancer cells

Medicinal plants play a crucial role in traditional medicine and in the maintenance of human health worldwide. Sesquiterpene lactones represent an interesting group of plant-derived compounds that are currently being tested as lead drugs in cancer clinical trials. Achillea falcata is a medicinal plant indigenous to the Middle Eastern region and belongs to the Asteraceae family, which is known to be rich in sesquiterpene lactones. We subjected Achillea falcata extracts to bioassay-guided fractionation against the growth of HCT-116 colorectal cancer cells and identified four secotanapartholides, namely 3-β-methoxy-isosecotanapartholide (1), isosecotanapartholide (2), tanaphallin (3), and 8-hydroxy-3-methoxyisosecotanapartholide (4). Three highly oxygenated guaianolides were isolated for the first time from Achillea falcata, namely rupin A (5), chrysartemin B (6), and 1β, 2β-epoxy-3β,4α,10α-trihydroxyguaian-6α,12-olide (7). These sesquiterpene lactones showed no or minor cytotoxicity while exhibiting promising anticancer effects against HCT-116 cells. Further structure-activity relationship studies related the bioactivity of the tested compounds to their skeleton, their lipophilicity, and to the type of functional groups neighboring the main alkylating center of the molecule.

Parthenolide: from plant shoots to cancer roots

Parthenolide (PTL), a sesquiterpene lactone (SL) originally purified from the shoots of feverfew (Tanacetum parthenium), has shown potent anticancer and anti-inflammatory activities. It is currently being tested in cancer clinical trials. Structure-activity relationship (SAR) studies of parthenolide revealed key chemical properties required for biological activities and epigenetic mechanisms, and led to the derivatization of an orally bioavailable analog, dimethylamino-parthenolide (DMAPT). Parthenolide is the first small molecule found to be selective against cancer stem cells (CSC), which it achieves by targeting specific signaling pathways and killing cancer from its roots. In this review, we highlight the exciting journey of parthenolide, from plant shoots to cancer roots.

Synergistic anticancer activities of the plant-derived sesquiterpene lactones salograviolide A and iso-seco-tanapartholide

We have previously shown that the two sesquiterpene lactones, salograviolide A (Sal A) and iso-seco-tanapartholide (TNP), isolated from the Middle Eastern indigenous plants Centaurea ainetensis and Achillea falcata, respectively, possess selective antitumor properties. Here, we aimed to assess the anticancer effects of the separate compounds and their combination, study their potential to generate reactive oxygen species (ROS), and investigate their underlying antitumor mechanisms in human colon cancer cell lines. Cells were treated with Sal A and TNP alone or in combination, and cell viability, cell cycle profile, apoptosis, ROS generation and changes in protein expression were monitored. Sal A and TNP in combination caused 80% decrease in HCT-116 and DLD-1 cell viability versus only 25% reduction when the drugs were used separately. The antitumor mechanism involved triggering ROS-dependent apoptosis as well as disruption of the mitochondrial membrane potential. Further studies showed that apoptosis by the Sal A and TNP combination was caspase-independent and that ERK, JNK and p38 of the serine/threonine MAPKs signaling pathway were involved in the cell death mechanism. Taken together, our data suggest that the combination of Sal A and TNP may be of therapeutic interest against colon cancer.

Sesquiterpene lactones isolated from indigenous Middle Eastern plants inhibit tumor promoter-induced transformation of JB6 cells

Background

Sesquiterpene lactones (SL) are plant secondary metabolites that are known for their anti-fungal, anti-bacterial, anti-inflammatory, and anti-tumor properties. Considering that several SL-derived drugs are currently in cancer clinical trials, we have tested two SL molecules, 3-β-methoxy-iso-seco-tanapartholide (β-tan) isolated from Achillea falcata and salograviolide A (Sal A) isolated from Centaurea ainetensis, for their anti-tumor properties. We used the mouse epidermal JB6P + cells as a model for tumor promotion and cellular transformation. Key players that are involved in cellular transformation and tumorigenesis are the AP-1 and NF-κB transcription factors; therefore, we assessed how β-tan and Sal A modulate their signaling pathways in JB6P + cells.

Methods

The effects of β-tan and Sal A on the growth of normal and neoplastic keratinocytes and on the tumor promotion-responsive JB6P + cells were determined using the MTT assay. Anchorage-independent cell growth transformation assays were used to evaluate the anti-tumor promoting properties of these SL molecules in JB6P + cells and dual luciferase reporter assays and western blot analysis were used to investigate their effects on tumor promoter-induced AP-1 and NF-κB activities and protein levels of key AP-1 and NF-кB target genes.

Results

β-tan and Sal A selectively inhibited tumor promoter-induced cell growth and transformation of JB6P + cells at concentrations that do not affect JB6P + and primary keratinocytes basal cell growth. In addition, both molecules reduced basal and tumor promoter-induced NF-κB transcriptional activities, differentially regulated basal and tumor promoter-induced AP-1 transcriptional activities, and modulated key players of the AP-1 and NF-κB signaling pathways.

Conclusions

These results highlight the anti-tumor promoting properties of β-tan and Sal A. These SL molecules isolated from two plant species native to the Middle East may provide opportunities for complementary medicine practices.

Anti-colon cancer effects of Salograviolide A isolated from Centaurea ainetensis

The antitumor activity of extracts of Centaurea ainetensis (C. ainetensis), a plant endemic to Lebanon, was investigated in human colon carcinoma cells. At concentrations that were non-cytotoxic to normal human intestinal epithelial cells, the crude extract inhibited the proliferation of a host of colon-derived cancer cells. The crude extract effect was then investigated in HCT-116 (p53+/+) cells, most sensitive to treatment and was found to cause apoptosis, increase the Bax/Bcl-2 ratio, p53 and p21 protein levels and reduce cyclin B1 proteins. In vivo, the crude extract injected intraperitoneally before the subcutaneous injection of the carcinogen 1,2-dimethylhydrazine, drastically reduced the number of tumors and decreased the mean size of aberrant crypt foci. Further bioassay-guided fractionation of the crude extract resulted in the identification of the bioactive molecule Salograviolide A, a Sesquiterpene Lactone, to which the growth inhibition in colon cancer was linked. Salograviolide A, at non-cytotoxic concentrations to normal human intestinal cells, reduced the growth of colon cancer cell lines. Salograviolide A induced growth inhibition and resulted in an increased preG1 phase and presumably apoptosis induction which was further confirmed by TUNEL. These data support the testing of the C. ainetensis extract and its bioactive molecule, Salograviolide A, in colon cancer treatment.