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Badawi M, Menon R, Place AE, Palenski T, Sunkersett G, Arrendale R, Deng R, Federico SM, Cooper TM, Salem AH. Venetoclax Penetrates the Blood Brain Barrier: A Pharmacokinetic Analysis in Pediatric Leukemia Patients. J Cancer 2023; 14:1151-1156. [PMID: 37215448 PMCID: PMC10197937 DOI: 10.7150/jca.81795] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 04/04/2023] [Indexed: 05/24/2023] Open
Abstract
Infiltration of malignant cells into the central nervous system in hematological malignancies correlates with poor clinical outcomes. Investigations into the penetration of venetoclax into the central nervous system have been limited. We report venetoclax pharmacokinetics in plasma and cerebrospinal fluid samples from a Phase 1 study in pediatric patients with relapsed or refractory malignancies that demonstrate venetoclax ability to cross into the central nervous system. Venetoclax was detected in cerebrospinal fluid (CSF) samples, with concentrations ranging from < 0.1 to 26 ng/mL (mean, 3.6 ng/mL) and a plasma:CSF ratio ranging from 44 to 1559 (mean, 385). Plasma:CSF ratios were comparable among patients with AML and ALL and no clear trend was observed in the ratios over the course of treatment. Moreover, improvement in central nervous system (CNS) involvement status was observed in patients who had measurable concentrations of venetoclax in the CSF. CNS resolution was observed for up to six months while on treatment. These findings highlight the potential role of venetoclax and provide the opportunity to further investigate its utility in improving clinical outcomes for patients with CNS complications.
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Affiliation(s)
| | | | - Andrew E. Place
- Dana-Farber/Boston Children's Cancer & Blood Disorders Center, Boston, MA, USA
| | | | | | | | - Rong Deng
- Genentech, Inc, South San Francisco, CA, USA
| | - Sara M. Federico
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Todd M. Cooper
- Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, Washington, USA
| | - Ahmed Hamed Salem
- AbbVie, Inc, North Chicago, IL, USA
- Clinical Pharmacy, Ain Shams University, Cairo, Egypt
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Evans MG, Shestakova A, Haghighi N, Zhao X, Nardi V, Pinter-Brown LC, Rezk SA. Rare case of leptomeningeal small lymphocytic lymphoma with TP53 mutation detected by deep next-generation sequencing. Leuk Lymphoma 2022; 63:2479-2483. [DOI: 10.1080/10428194.2022.2070911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Mark G. Evans
- Department of Hematopathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anna Shestakova
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Nahideh Haghighi
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | - Xiaohui Zhao
- Department of Pathology and Laboratory Medicine, University of California Irvine (UCI) Medical Center, Orange, CA, USA
| | - Valentina Nardi
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lauren C. Pinter-Brown
- Department of Medicine, Hematology/Oncology Division, University of California Irvine (UCI) Medical Center, Orange, CA, USA
| | - Sherif A. Rezk
- Department of Pathology and Laboratory Medicine, University of California Irvine (UCI) Medical Center, Orange, CA, USA
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Madhavan K, Balakrishnan I, Lakshmanachetty S, Pierce A, Sanford B, Fosmire S, Elajaili HB, Walker F, Wang D, Nozik ES, Mitra SS, Dahl NA, Vibhakar R, Venkataraman S. Venetoclax cooperates with ionizing radiation to attenuate Diffuse Midline Glioma tumor growth. Clin Cancer Res 2022; 28:2409-2424. [PMID: 35344040 DOI: 10.1158/1078-0432.ccr-21-4002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/10/2022] [Accepted: 03/24/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE Tumor relapse after radiation therapy (RT) is a major hurdle in treating pediatric H3K27M-mutant diffuse midline gliomas (DMGs). RT-induced stress increases association of BCL2 family of proteins with BH3 pro-apoptotic activators preventing apoptosis. We hypothesized that inhibition of RT-induced BCL2 with a clinically relevant inhibitor, venetoclax, will block BCL2 activity leading to increased apoptosis. BCL2 has never been implicated in DMG as a RT-induced resistant mechanism. EXPERIMENTAL DESIGN We performed an integrated genomic analysis to determine genes responsible for radioresistance and a targeted drug screen to identify drugs that synergize with radiation in DMG. Effect of venetoclax on radiation-na�ve and 6Gy radiation on cells was evaluated by studying cell death, changes in BCL2 phosphorylation, reactive oxygen species (ROS), and apoptosis, as well as BCL2 association with BH3 apoptosis initiators. The efficacy of combining venetoclax with radiation was evaluated in vivo using orthotopic xenograft models. RESULTS BCL2 was identified as a key regulator of tumor growth after radiation in DMGs. Radiation sensitizes DMGs to venetoclax treatment independent of p53 status. Venetoclax as a monotherapy was not cytotoxic to DMG cells. Post-radiation venetoclax treatment significantly increased cell death, reduced BCL2-BIM association and augmented mitochondrial ROS leading to increased apoptosis. Combining venetoclax with RT significantly enhanced the survival of mice with DMG tumors. CONCLUSIONS This study shows that venetoclax impedes the anti-apoptotic function of radiation-induced BCL2 in DMG leading to increased apoptosis. Results from these pre-clinical studies demonstrate the potential use of the BCL2 inhibitor, venetoclax, combined with RT for pediatric DMG.
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Affiliation(s)
- Krishna Madhavan
- University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | | | | | - Angela Pierce
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Bridget Sanford
- University of Colorado Anschutz Medical Campus, United States
| | - Susan Fosmire
- University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Hanan B Elajaili
- University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Faye Walker
- University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Dong Wang
- University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Eva S Nozik
- University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Siddhartha S Mitra
- University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Nathan A Dahl
- University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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Schroeder B, Vander Steen T, Espinoza I, Venkatapoorna CMK, Hu Z, Silva FM, Regan K, Cuyàs E, Meng XW, Verdura S, Arbusà A, Schneider PA, Flatten KS, Kemble G, Montero J, Kaufmann SH, Menendez JA, Lupu R. Fatty acid synthase (FASN) regulates the mitochondrial priming of cancer cells. Cell Death Dis 2021; 12:977. [PMID: 34675185 PMCID: PMC8531299 DOI: 10.1038/s41419-021-04262-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 09/12/2021] [Accepted: 09/24/2021] [Indexed: 12/24/2022]
Abstract
Inhibitors of the lipogenic enzyme fatty acid synthase (FASN) have attracted much attention in the last decade as potential targeted cancer therapies. However, little is known about the molecular determinants of cancer cell sensitivity to FASN inhibitors (FASNis), which is a major roadblock to their therapeutic application. Here, we find that pharmacological starvation of endogenously produced FAs is a previously unrecognized metabolic stress that heightens mitochondrial apoptotic priming and favors cell death induction by BH3 mimetic inhibitors. Evaluation of the death decision circuits controlled by the BCL-2 family of proteins revealed that FASN inhibition is accompanied by the upregulation of the pro-death BH3-only proteins BIM, PUMA, and NOXA. Cell death triggered by FASN inhibition, which causally involves a palmitate/NADPH-related redox imbalance, is markedly diminished by concurrent loss of BIM or PUMA, suggesting that FASN activity controls cancer cell survival by fine-tuning the BH3 only proteins-dependent mitochondrial threshold for apoptosis. FASN inhibition results in a heightened mitochondrial apoptosis priming, shifting cells toward a primed-for-death state "addicted" to the anti-apoptotic protein BCL-2. Accordingly, co-administration of a FASNi synergistically augments the apoptosis-inducing activity of the dual BCL-XL/BCL-2 inhibitor ABT-263 (navitoclax) and the BCL-2 specific BH3-mimetic ABT-199 (venetoclax). FASN inhibition, however, fails to sensitize breast cancer cells to MCL-1- and BCL-XL-selective inhibitors such as S63845 and A1331852. A human breast cancer xenograft model evidenced that oral administration of the only clinically available FASNi drastically sensitizes FASN-addicted breast tumors to ineffective single-agents navitoclax and venetoclax in vivo. In summary, a novel FASN-driven facet of the mitochondrial priming mechanistically links the redox-buffering mechanism of FASN activity to the intrinsic apoptotic threshold in breast cancer cells. Combining next-generation FASNis with BCL-2-specific BH3 mimetics that directly activate the apoptotic machinery might generate more potent and longer-lasting antitumor responses in a clinical setting.
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Affiliation(s)
- Barbara Schroeder
- Division of Experimental Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA.,Mayo Clinic Cancer Center, Rochester, MN, 55905, USA.,Helmholtz Pioneer Campus, Heimholtz Zentrum München, Deutsches Forschungszentrum für Gesundheit und Umwelt (GmbH), Ingolstädter Landstraße 1 D-85764 Neuherberg, Munich, Germany
| | - Travis Vander Steen
- Division of Experimental Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Ingrid Espinoza
- Department of Preventive Medicine, John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, 39216, USA.,Cancer Institute, School of Medicine, University of Mississippi Medical Center, Jackson, MS, 39216, USA
| | - Chandra M Kurapaty Venkatapoorna
- Division of Experimental Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA.,Department of Nutrition, Dietetics, and Hospital Management, Auburn University, Auburn, AL, 36849, USA
| | - Zeng Hu
- Division of Experimental Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA.,Radiation Oncology Research, Mayo Clinic, Rochester, MN, 55905, USA
| | - Fernando Martín Silva
- Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology (BIST), 08028, Barcelona, Spain
| | - Kevin Regan
- Department of Experimental Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Elisabet Cuyàs
- Girona Biomedical Research Institute, 17190, Salt, Girona, Spain.,Program Against Cancer Therapeutic Resistance (ProCURE), Metabolism & Cancer Group, Catalan Institute of Oncology, 17007, Girona, Spain
| | - X Wei Meng
- Deparment of Oncology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Sara Verdura
- Girona Biomedical Research Institute, 17190, Salt, Girona, Spain.,Program Against Cancer Therapeutic Resistance (ProCURE), Metabolism & Cancer Group, Catalan Institute of Oncology, 17007, Girona, Spain
| | - Aina Arbusà
- Girona Biomedical Research Institute, 17190, Salt, Girona, Spain.,Program Against Cancer Therapeutic Resistance (ProCURE), Metabolism & Cancer Group, Catalan Institute of Oncology, 17007, Girona, Spain
| | | | - Karen S Flatten
- Deparment of Oncology, Mayo Clinic, Rochester, MN, 55905, USA
| | - George Kemble
- Sagimet Biosciences (formerly 3-V Biosciences), San Mateo, CA, 94402, USA
| | - Joan Montero
- Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology (BIST), 08028, Barcelona, Spain
| | - Scott H Kaufmann
- Mayo Clinic Cancer Center, Rochester, MN, 55905, USA.,Deparment of Oncology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Javier A Menendez
- Department of Experimental Pathology, Mayo Clinic, Rochester, MN, 55905, USA. .,Girona Biomedical Research Institute, 17190, Salt, Girona, Spain.
| | - Ruth Lupu
- Division of Experimental Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA. .,Mayo Clinic Cancer Center, Rochester, MN, 55905, USA. .,Department of Biochemistry and Molecular Biology Laboratory, Mayo Clinic Laboratory, Rochester, MN, 55905, USA.
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5
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Nakanishi T, Ito T, Fujita S, Satake A, Konishi A, Hotta M, Yoshimura H, Nomura S. Refractory Chronic Lymphocytic Leukemia with Central Nervous System Involvement: A Case Report with Literature Review. J Blood Med 2020; 11:487-502. [PMID: 33380856 PMCID: PMC7767717 DOI: 10.2147/jbm.s271335] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 11/16/2020] [Indexed: 12/17/2022] Open
Abstract
There have been few reports on central nervous system (CNS) involvement in chronic lymphocytic leukemia (CLL). This is an extremely rare disease with poor prognosis, owing to resistance to various treatments. We describe a 33-year-old man with intractable CLL with CNS involvement. He was diagnosed with CLL, with diplopia as the first manifestation. Magnetic resonance imaging revealed a contrast-enhancing tumor in the right temporal lobe, which was diagnosed as CNS involvement in CLL on brain biopsy. High-dose methotrexate therapy was ineffective for this lesion, which was also resistant to subsequent whole-brain irradiation, treatment with fludarabine–cyclophosphamide–rituximab chemoimmunotherapy, and ibrutinib administration. Because no standard protocol exists for CLL with CNS involvement, it is important to accumulate case data to verify the choice of new drugs for administration at an early stage. Therefore, we also conducted a literature review of 50 case reports of CNS lesions in the last 10 years to consider the pathophysiology, diagnosis, and treatment of CNS involvement in CLL. The possibility of new therapeutic agents, eg, ibrutinib and venetoclax, or a combination of these agents and methotrexate, can be envisioned as a treatment strategy for CLL with CNS involvement.
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Affiliation(s)
- Takahisa Nakanishi
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Tomoki Ito
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Shinya Fujita
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Atsushi Satake
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Akiko Konishi
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Masaaki Hotta
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Hideaki Yoshimura
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Shosaku Nomura
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka, Japan
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