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Dhakal B, Tomita Y, Drew P, Price T, Maddern G, Smith E, Fenix K. Perhexiline: Old Drug, New Tricks? A Summary of Its Anti-Cancer Effects. Molecules 2023; 28:molecules28083624. [PMID: 37110858 PMCID: PMC10145508 DOI: 10.3390/molecules28083624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/17/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
Cancer metabolic plasticity, including changes in fatty acid metabolism utilisation, is now widely appreciated as a key driver for cancer cell growth, survival and malignancy. Hence, cancer metabolic pathways have been the focus of much recent drug development. Perhexiline is a prophylactic antianginal drug known to act by inhibiting carnitine palmitoyltransferase 1 (CPT1) and 2 (CPT2), mitochondrial enzymes critical for fatty acid metabolism. In this review, we discuss the growing evidence that perhexiline has potent anti-cancer properties when tested as a monotherapy or in combination with traditional chemotherapeutics. We review the CPT1/2 dependent and independent mechanisms of its anti-cancer activities. Finally, we speculate on the clinical feasibility and utility of repurposing perhexiline as an anti-cancer agent, its limitations including known side effects and its potential added benefit of limiting cardiotoxicity induced by other chemotherapeutics.
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Affiliation(s)
- Bimala Dhakal
- Discipline of Surgery, Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5005, Australia
- Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Adelaide, SA 5011, Australia
| | - Yoko Tomita
- Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Adelaide, SA 5011, Australia
- Medical Oncology, The Queen Elizabeth Hospital, Adelaide, SA 5011, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Paul Drew
- Discipline of Surgery, Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5005, Australia
- Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Adelaide, SA 5011, Australia
| | - Timothy Price
- Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Adelaide, SA 5011, Australia
- Medical Oncology, The Queen Elizabeth Hospital, Adelaide, SA 5011, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Guy Maddern
- Discipline of Surgery, Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5005, Australia
- Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Adelaide, SA 5011, Australia
| | - Eric Smith
- Discipline of Surgery, Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5005, Australia
- Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Adelaide, SA 5011, Australia
- Medical Oncology, The Queen Elizabeth Hospital, Adelaide, SA 5011, Australia
| | - Kevin Fenix
- Discipline of Surgery, Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5005, Australia
- Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Adelaide, SA 5011, Australia
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Dhakal B, Li CMY, Li R, Yeo K, Wright JA, Gieniec KA, Vrbanac L, Sammour T, Lawrence M, Thomas M, Lewis M, Perry J, Worthley DL, Woods SL, Drew P, Sallustio BC, Smith E, Horowitz JD, Maddern GJ, Licari G, Fenix K. The Antianginal Drug Perhexiline Displays Cytotoxicity against Colorectal Cancer Cells In Vitro: A Potential for Drug Repurposing. Cancers (Basel) 2022; 14:cancers14041043. [PMID: 35205791 PMCID: PMC8869789 DOI: 10.3390/cancers14041043] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/02/2022] [Accepted: 02/05/2022] [Indexed: 01/05/2023] Open
Abstract
Colorectal cancer (CRC) is the second leading cause of cancer-related death worldwide. Perhexiline, a prophylactic anti-anginal drug, has been reported to have anti-tumour effects both in vitro and in vivo. Perhexiline as used clinically is a 50:50 racemic mixture ((R)-P) of (-) and (+) enantiomers. It is not known if the enantiomers differ in terms of their effects on cancer. In this study, we examined the cytotoxic capacity of perhexiline and its enantiomers ((-)-P and (+)-P) on CRC cell lines, grown as monolayers or spheroids, and patient-derived organoids. Treatment of CRC cell lines with (R)-P, (-)-P or (+)-P reduced cell viability, with IC50 values of ~4 µM. Treatment was associated with an increase in annexin V staining and caspase 3/7 activation, indicating apoptosis induction. Caspase 3/7 activation and loss of structural integrity were also observed in CRC cell lines grown as spheroids. Drug treatment at clinically relevant concentrations significantly reduced the viability of patient-derived CRC organoids. Given these in vitro findings, perhexiline, as a racemic mixture or its enantiomers, warrants further investigation as a repurposed drug for use in the management of CRC.
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Affiliation(s)
- Bimala Dhakal
- Department of Surgery, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5005, Australia; (B.D.); (C.M.Y.L.); (R.L.); (K.Y.); (P.D.); (E.S.); (G.J.M.)
- The Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, The University of Adelaide, Woodville, SA 5011, Australia; (B.C.S.); (J.D.H.)
| | - Celine Man Ying Li
- Department of Surgery, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5005, Australia; (B.D.); (C.M.Y.L.); (R.L.); (K.Y.); (P.D.); (E.S.); (G.J.M.)
- The Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, The University of Adelaide, Woodville, SA 5011, Australia; (B.C.S.); (J.D.H.)
| | - Runhao Li
- Department of Surgery, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5005, Australia; (B.D.); (C.M.Y.L.); (R.L.); (K.Y.); (P.D.); (E.S.); (G.J.M.)
- The Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, The University of Adelaide, Woodville, SA 5011, Australia; (B.C.S.); (J.D.H.)
- Medical Oncology, The Queen Elizabeth Hospital, Woodville, SA 5011, Australia
| | - Kenny Yeo
- Department of Surgery, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5005, Australia; (B.D.); (C.M.Y.L.); (R.L.); (K.Y.); (P.D.); (E.S.); (G.J.M.)
- The Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, The University of Adelaide, Woodville, SA 5011, Australia; (B.C.S.); (J.D.H.)
| | - Josephine A. Wright
- Precision Medicine, South Australian Health and Medical Research Institute, Adelaide, SA 5005, Australia; (J.A.W.); (K.A.G.); (L.V.); (T.S.); (D.L.W.); (S.L.W.)
| | - Krystyna A. Gieniec
- Precision Medicine, South Australian Health and Medical Research Institute, Adelaide, SA 5005, Australia; (J.A.W.); (K.A.G.); (L.V.); (T.S.); (D.L.W.); (S.L.W.)
- Department of Medical Specialties, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Laura Vrbanac
- Precision Medicine, South Australian Health and Medical Research Institute, Adelaide, SA 5005, Australia; (J.A.W.); (K.A.G.); (L.V.); (T.S.); (D.L.W.); (S.L.W.)
- Department of Medical Specialties, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Tarik Sammour
- Precision Medicine, South Australian Health and Medical Research Institute, Adelaide, SA 5005, Australia; (J.A.W.); (K.A.G.); (L.V.); (T.S.); (D.L.W.); (S.L.W.)
- Department of Medical Specialties, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5005, Australia
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, SA 5005, Australia; (M.L.); (M.T.); (M.L.); (J.P.)
| | - Matthew Lawrence
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, SA 5005, Australia; (M.L.); (M.T.); (M.L.); (J.P.)
| | - Michelle Thomas
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, SA 5005, Australia; (M.L.); (M.T.); (M.L.); (J.P.)
| | - Mark Lewis
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, SA 5005, Australia; (M.L.); (M.T.); (M.L.); (J.P.)
| | - Joanne Perry
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, SA 5005, Australia; (M.L.); (M.T.); (M.L.); (J.P.)
| | - Daniel L. Worthley
- Precision Medicine, South Australian Health and Medical Research Institute, Adelaide, SA 5005, Australia; (J.A.W.); (K.A.G.); (L.V.); (T.S.); (D.L.W.); (S.L.W.)
| | - Susan L. Woods
- Precision Medicine, South Australian Health and Medical Research Institute, Adelaide, SA 5005, Australia; (J.A.W.); (K.A.G.); (L.V.); (T.S.); (D.L.W.); (S.L.W.)
- Department of Medical Specialties, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Paul Drew
- Department of Surgery, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5005, Australia; (B.D.); (C.M.Y.L.); (R.L.); (K.Y.); (P.D.); (E.S.); (G.J.M.)
- The Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, The University of Adelaide, Woodville, SA 5011, Australia; (B.C.S.); (J.D.H.)
| | - Benedetta C. Sallustio
- The Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, The University of Adelaide, Woodville, SA 5011, Australia; (B.C.S.); (J.D.H.)
- Discipline of Pharmacology, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Eric Smith
- Department of Surgery, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5005, Australia; (B.D.); (C.M.Y.L.); (R.L.); (K.Y.); (P.D.); (E.S.); (G.J.M.)
- The Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, The University of Adelaide, Woodville, SA 5011, Australia; (B.C.S.); (J.D.H.)
- Medical Oncology, The Queen Elizabeth Hospital, Woodville, SA 5011, Australia
| | - John D. Horowitz
- The Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, The University of Adelaide, Woodville, SA 5011, Australia; (B.C.S.); (J.D.H.)
| | - Guy J. Maddern
- Department of Surgery, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5005, Australia; (B.D.); (C.M.Y.L.); (R.L.); (K.Y.); (P.D.); (E.S.); (G.J.M.)
- The Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, The University of Adelaide, Woodville, SA 5011, Australia; (B.C.S.); (J.D.H.)
| | - Giovanni Licari
- The Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, The University of Adelaide, Woodville, SA 5011, Australia; (B.C.S.); (J.D.H.)
- Discipline of Pharmacology, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5005, Australia
- Correspondence: (G.L.); (K.F.)
| | - Kevin Fenix
- Department of Surgery, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5005, Australia; (B.D.); (C.M.Y.L.); (R.L.); (K.Y.); (P.D.); (E.S.); (G.J.M.)
- The Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, The University of Adelaide, Woodville, SA 5011, Australia; (B.C.S.); (J.D.H.)
- Correspondence: (G.L.); (K.F.)
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