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Zhang HQ, Lin JL, Pan L, Mao L, Pang JL, Yuan Q, Li GY, Yi GS, Lin YB, Feng BL, Li YD, Wang Y, Jie LJ, Zhang YH. Enzastaurin cardiotoxicity: QT interval prolongation, negative inotropic responses and negative chronotropic action. Biochem Pharmacol 2023; 209:115443. [PMID: 36720353 DOI: 10.1016/j.bcp.2023.115443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/22/2023] [Accepted: 01/23/2023] [Indexed: 01/31/2023]
Abstract
Several clinical trials observed that enzastaurin prolonged QT interval in cancer patients. However, the mechanism of enzastaurin-induced QT interval prolongation is unclear. Therefore, this study aimed to assess the effect and mechanism of enzastaurin on QT interval and cardiac function. The Langendorff and Ion-Optix MyoCam systems were used to assess the effects of enzastaurin on QT interval, cardiac systolic function and intracellular Ca2+ transient in guinea pig hearts and ventricular myocytes. The effects of enzastaurin on the rapid delayed rectifier (IKr), the slow delayed rectifier K+ current (IKs), transient outward potassium current (Ito), action potentials, Ryanodine Receptor 2 (RyR2) and the sarcoplasmic/endoplasmic reticulum Ca2+ ATPase 2a (SERCA2a) expression and activity in HEK 293 cell system and primary cardiomyocytes were investigated using whole-cell recording technique and western blotting. We found that enzastaurin significantly prolonged QT interval in guinea pig hearts and increased the action potential duration (APD) in guinea pig cardiomyocytes in a dose-dependent manner. Enzastaurin potently inhibited IKr by binding to the human Ether-à-go-go-Related gene (hERG) channel in both open and closed states, and hERG mutant channels, including S636A, S631A, and F656V attenuated the inhibitory effect of enzastaurin. Enzastaurin also moderately decreased IKs. Additionally, enzastaurin also induced negative chronotropic action. Moreover, enzastaurin impaired cardiac systolic function and reduced intracellular Ca2+ transient via inhibition of RyR2 phosphorylation. Taken together, we found that enzastaurin prolongs QT, reduces heart rate and impairs cardiac systolic function. Therefore, we recommend that electrocardiogram (ECG) and cardiac function should be continuously monitored when enzastaurin is administered to cancer patients.
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Affiliation(s)
- He-Qiang Zhang
- Institute of Cardiovascular Diseases, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Jia-le Lin
- Institute of Cardiovascular Diseases, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Lei Pan
- Institute of Cardiovascular Diseases, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Liang Mao
- Institute of Cardiovascular Diseases, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China; Key Laboratory of Medical Electrophysiology, Southwest Medical University, Luzhou, Sichuan, China
| | - Jing-Long Pang
- Institute of Cardiovascular Diseases, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Qian Yuan
- Institute of Cardiovascular Diseases, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Gui-Yang Li
- Department of Cardiology, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Gang-Si Yi
- Institute of Cardiovascular Diseases, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Yang-Bin Lin
- Institute of Cardiovascular Diseases, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Bao-Long Feng
- Institute of Cardiovascular Diseases, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Yun-da Li
- Institute of Cardiovascular Diseases, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Yan Wang
- Department of Cardiology, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China.
| | - Ling-Jun Jie
- Institute of Cardiovascular Diseases, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China; Department of Cardiology, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China.
| | - Yan-Hui Zhang
- Institute of Cardiovascular Diseases, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China.
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Kilburn LB, Kocak M, Decker RL, Wetmore C, Chintagumpala M, Su J, Goldman S, Banerjee A, Gilbertson R, Fouladi M, Kun L, Boyett JM, Blaney SM. A phase 1 and pharmacokinetic study of enzastaurin in pediatric patients with refractory primary central nervous system tumors: a pediatric brain tumor consortium study. Neuro Oncol 2014; 17:303-11. [PMID: 25431212 DOI: 10.1093/neuonc/nou114] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND We sought to estimate the maximum tolerated or recommended phase 2 dose and describe the pharmacokinetics and toxicities of enzastaurin, an oral inhibitor of protein kinase Cβ, in children with recurrent central nervous system malignancies. METHODS Enzastaurin was administered continuously once daily at 3 dose levels (260, 340, and 440 mg/m(2)) and twice daily at 440 mg/m(2)/day. Plasma pharmacokinetics were evaluated following a single dose and at steady state. Inhibition of protein kinase C and Akt cell signaling in peripheral blood mononuclear cells was evaluated. Akt pathway activity was measured in pretreatment tumor samples. RESULTS Thirty-three patients enrolled; 1 was ineligible, and 3 were nonevaluable secondary to early progressive disease. There were no dose-limiting toxicities during the dose-finding phase. Two participants receiving 440 mg/m(2) given twice daily experienced dose-limiting toxicities of grade 3 thrombocytopenia resulting in delayed start of course 2 and grade 3 alanine transaminase elevation that did not recover within 5 days. There were no grade 4 toxicities during treatment. The concentration of enzastaurin increased with increasing dose and with continuous dosing; however, there was not a significant difference at the 440 mg/m(2) dosing level when enzastaurin was administered once daily versus twice daily. There were no objective responses; however, 11 participants had stable disease >3 cycles, 7 with glioma, 2 with ependymoma, and 2 with brainstem glioma. CONCLUSION Enzastaurin was well tolerated in children with recurrent CNS malignancies, with chromaturia, fatigue, anemia, thrombocytopenia, and nausea being the most common toxicities. The recommended phase 2 dose is 440 mg/m(2)/day administered once daily.
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Affiliation(s)
- Lindsay B Kilburn
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas (L.B.K., M.C., J.S., S.M.B.); Department of Biostatistics, Operations and Biostatistics Center for Pediatric Brain Tumor Consortium, St. Jude Children's Research Hospital, Memphis, Tennessee (M.K., J.M.B.); Eli Lilly and Company, Indianapolis, Indiana (R.L.D.); Division of Neuro-oncology, St. Jude Children's Research Hospital, Memphis, Tennessee (C.W., R.G.); Ann and Robert H. Lurie Children's Hospital of Chicago, Center for Cancer and Blood Disorders, Northwestern University Feinberg School of Medicine, Chicago, Illinois (S.G.); Department of Pediatrics, Division of Hematology/Oncology, University of California San Francisco, San Francisco, California (A.B.); Department of Hematology Oncology, Cincinnati Children's Hospital Medical Center,Cincinnati, Ohio (M.F.); Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee (L.K.); Department of Preventive Medicine, University of Tennessee Health Science Center Memphis, Tennessee (M.K.)
| | - Mehmet Kocak
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas (L.B.K., M.C., J.S., S.M.B.); Department of Biostatistics, Operations and Biostatistics Center for Pediatric Brain Tumor Consortium, St. Jude Children's Research Hospital, Memphis, Tennessee (M.K., J.M.B.); Eli Lilly and Company, Indianapolis, Indiana (R.L.D.); Division of Neuro-oncology, St. Jude Children's Research Hospital, Memphis, Tennessee (C.W., R.G.); Ann and Robert H. Lurie Children's Hospital of Chicago, Center for Cancer and Blood Disorders, Northwestern University Feinberg School of Medicine, Chicago, Illinois (S.G.); Department of Pediatrics, Division of Hematology/Oncology, University of California San Francisco, San Francisco, California (A.B.); Department of Hematology Oncology, Cincinnati Children's Hospital Medical Center,Cincinnati, Ohio (M.F.); Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee (L.K.); Department of Preventive Medicine, University of Tennessee Health Science Center Memphis, Tennessee (M.K.)
| | - Rodney L Decker
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas (L.B.K., M.C., J.S., S.M.B.); Department of Biostatistics, Operations and Biostatistics Center for Pediatric Brain Tumor Consortium, St. Jude Children's Research Hospital, Memphis, Tennessee (M.K., J.M.B.); Eli Lilly and Company, Indianapolis, Indiana (R.L.D.); Division of Neuro-oncology, St. Jude Children's Research Hospital, Memphis, Tennessee (C.W., R.G.); Ann and Robert H. Lurie Children's Hospital of Chicago, Center for Cancer and Blood Disorders, Northwestern University Feinberg School of Medicine, Chicago, Illinois (S.G.); Department of Pediatrics, Division of Hematology/Oncology, University of California San Francisco, San Francisco, California (A.B.); Department of Hematology Oncology, Cincinnati Children's Hospital Medical Center,Cincinnati, Ohio (M.F.); Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee (L.K.); Department of Preventive Medicine, University of Tennessee Health Science Center Memphis, Tennessee (M.K.)
| | - Cynthia Wetmore
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas (L.B.K., M.C., J.S., S.M.B.); Department of Biostatistics, Operations and Biostatistics Center for Pediatric Brain Tumor Consortium, St. Jude Children's Research Hospital, Memphis, Tennessee (M.K., J.M.B.); Eli Lilly and Company, Indianapolis, Indiana (R.L.D.); Division of Neuro-oncology, St. Jude Children's Research Hospital, Memphis, Tennessee (C.W., R.G.); Ann and Robert H. Lurie Children's Hospital of Chicago, Center for Cancer and Blood Disorders, Northwestern University Feinberg School of Medicine, Chicago, Illinois (S.G.); Department of Pediatrics, Division of Hematology/Oncology, University of California San Francisco, San Francisco, California (A.B.); Department of Hematology Oncology, Cincinnati Children's Hospital Medical Center,Cincinnati, Ohio (M.F.); Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee (L.K.); Department of Preventive Medicine, University of Tennessee Health Science Center Memphis, Tennessee (M.K.)
| | - Murali Chintagumpala
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas (L.B.K., M.C., J.S., S.M.B.); Department of Biostatistics, Operations and Biostatistics Center for Pediatric Brain Tumor Consortium, St. Jude Children's Research Hospital, Memphis, Tennessee (M.K., J.M.B.); Eli Lilly and Company, Indianapolis, Indiana (R.L.D.); Division of Neuro-oncology, St. Jude Children's Research Hospital, Memphis, Tennessee (C.W., R.G.); Ann and Robert H. Lurie Children's Hospital of Chicago, Center for Cancer and Blood Disorders, Northwestern University Feinberg School of Medicine, Chicago, Illinois (S.G.); Department of Pediatrics, Division of Hematology/Oncology, University of California San Francisco, San Francisco, California (A.B.); Department of Hematology Oncology, Cincinnati Children's Hospital Medical Center,Cincinnati, Ohio (M.F.); Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee (L.K.); Department of Preventive Medicine, University of Tennessee Health Science Center Memphis, Tennessee (M.K.)
| | - Jack Su
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas (L.B.K., M.C., J.S., S.M.B.); Department of Biostatistics, Operations and Biostatistics Center for Pediatric Brain Tumor Consortium, St. Jude Children's Research Hospital, Memphis, Tennessee (M.K., J.M.B.); Eli Lilly and Company, Indianapolis, Indiana (R.L.D.); Division of Neuro-oncology, St. Jude Children's Research Hospital, Memphis, Tennessee (C.W., R.G.); Ann and Robert H. Lurie Children's Hospital of Chicago, Center for Cancer and Blood Disorders, Northwestern University Feinberg School of Medicine, Chicago, Illinois (S.G.); Department of Pediatrics, Division of Hematology/Oncology, University of California San Francisco, San Francisco, California (A.B.); Department of Hematology Oncology, Cincinnati Children's Hospital Medical Center,Cincinnati, Ohio (M.F.); Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee (L.K.); Department of Preventive Medicine, University of Tennessee Health Science Center Memphis, Tennessee (M.K.)
| | - Stewart Goldman
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas (L.B.K., M.C., J.S., S.M.B.); Department of Biostatistics, Operations and Biostatistics Center for Pediatric Brain Tumor Consortium, St. Jude Children's Research Hospital, Memphis, Tennessee (M.K., J.M.B.); Eli Lilly and Company, Indianapolis, Indiana (R.L.D.); Division of Neuro-oncology, St. Jude Children's Research Hospital, Memphis, Tennessee (C.W., R.G.); Ann and Robert H. Lurie Children's Hospital of Chicago, Center for Cancer and Blood Disorders, Northwestern University Feinberg School of Medicine, Chicago, Illinois (S.G.); Department of Pediatrics, Division of Hematology/Oncology, University of California San Francisco, San Francisco, California (A.B.); Department of Hematology Oncology, Cincinnati Children's Hospital Medical Center,Cincinnati, Ohio (M.F.); Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee (L.K.); Department of Preventive Medicine, University of Tennessee Health Science Center Memphis, Tennessee (M.K.)
| | - Anuradha Banerjee
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas (L.B.K., M.C., J.S., S.M.B.); Department of Biostatistics, Operations and Biostatistics Center for Pediatric Brain Tumor Consortium, St. Jude Children's Research Hospital, Memphis, Tennessee (M.K., J.M.B.); Eli Lilly and Company, Indianapolis, Indiana (R.L.D.); Division of Neuro-oncology, St. Jude Children's Research Hospital, Memphis, Tennessee (C.W., R.G.); Ann and Robert H. Lurie Children's Hospital of Chicago, Center for Cancer and Blood Disorders, Northwestern University Feinberg School of Medicine, Chicago, Illinois (S.G.); Department of Pediatrics, Division of Hematology/Oncology, University of California San Francisco, San Francisco, California (A.B.); Department of Hematology Oncology, Cincinnati Children's Hospital Medical Center,Cincinnati, Ohio (M.F.); Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee (L.K.); Department of Preventive Medicine, University of Tennessee Health Science Center Memphis, Tennessee (M.K.)
| | - Richard Gilbertson
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas (L.B.K., M.C., J.S., S.M.B.); Department of Biostatistics, Operations and Biostatistics Center for Pediatric Brain Tumor Consortium, St. Jude Children's Research Hospital, Memphis, Tennessee (M.K., J.M.B.); Eli Lilly and Company, Indianapolis, Indiana (R.L.D.); Division of Neuro-oncology, St. Jude Children's Research Hospital, Memphis, Tennessee (C.W., R.G.); Ann and Robert H. Lurie Children's Hospital of Chicago, Center for Cancer and Blood Disorders, Northwestern University Feinberg School of Medicine, Chicago, Illinois (S.G.); Department of Pediatrics, Division of Hematology/Oncology, University of California San Francisco, San Francisco, California (A.B.); Department of Hematology Oncology, Cincinnati Children's Hospital Medical Center,Cincinnati, Ohio (M.F.); Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee (L.K.); Department of Preventive Medicine, University of Tennessee Health Science Center Memphis, Tennessee (M.K.)
| | - Maryam Fouladi
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas (L.B.K., M.C., J.S., S.M.B.); Department of Biostatistics, Operations and Biostatistics Center for Pediatric Brain Tumor Consortium, St. Jude Children's Research Hospital, Memphis, Tennessee (M.K., J.M.B.); Eli Lilly and Company, Indianapolis, Indiana (R.L.D.); Division of Neuro-oncology, St. Jude Children's Research Hospital, Memphis, Tennessee (C.W., R.G.); Ann and Robert H. Lurie Children's Hospital of Chicago, Center for Cancer and Blood Disorders, Northwestern University Feinberg School of Medicine, Chicago, Illinois (S.G.); Department of Pediatrics, Division of Hematology/Oncology, University of California San Francisco, San Francisco, California (A.B.); Department of Hematology Oncology, Cincinnati Children's Hospital Medical Center,Cincinnati, Ohio (M.F.); Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee (L.K.); Department of Preventive Medicine, University of Tennessee Health Science Center Memphis, Tennessee (M.K.)
| | - Larry Kun
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas (L.B.K., M.C., J.S., S.M.B.); Department of Biostatistics, Operations and Biostatistics Center for Pediatric Brain Tumor Consortium, St. Jude Children's Research Hospital, Memphis, Tennessee (M.K., J.M.B.); Eli Lilly and Company, Indianapolis, Indiana (R.L.D.); Division of Neuro-oncology, St. Jude Children's Research Hospital, Memphis, Tennessee (C.W., R.G.); Ann and Robert H. Lurie Children's Hospital of Chicago, Center for Cancer and Blood Disorders, Northwestern University Feinberg School of Medicine, Chicago, Illinois (S.G.); Department of Pediatrics, Division of Hematology/Oncology, University of California San Francisco, San Francisco, California (A.B.); Department of Hematology Oncology, Cincinnati Children's Hospital Medical Center,Cincinnati, Ohio (M.F.); Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee (L.K.); Department of Preventive Medicine, University of Tennessee Health Science Center Memphis, Tennessee (M.K.)
| | - James M Boyett
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas (L.B.K., M.C., J.S., S.M.B.); Department of Biostatistics, Operations and Biostatistics Center for Pediatric Brain Tumor Consortium, St. Jude Children's Research Hospital, Memphis, Tennessee (M.K., J.M.B.); Eli Lilly and Company, Indianapolis, Indiana (R.L.D.); Division of Neuro-oncology, St. Jude Children's Research Hospital, Memphis, Tennessee (C.W., R.G.); Ann and Robert H. Lurie Children's Hospital of Chicago, Center for Cancer and Blood Disorders, Northwestern University Feinberg School of Medicine, Chicago, Illinois (S.G.); Department of Pediatrics, Division of Hematology/Oncology, University of California San Francisco, San Francisco, California (A.B.); Department of Hematology Oncology, Cincinnati Children's Hospital Medical Center,Cincinnati, Ohio (M.F.); Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee (L.K.); Department of Preventive Medicine, University of Tennessee Health Science Center Memphis, Tennessee (M.K.)
| | - Susan M Blaney
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas (L.B.K., M.C., J.S., S.M.B.); Department of Biostatistics, Operations and Biostatistics Center for Pediatric Brain Tumor Consortium, St. Jude Children's Research Hospital, Memphis, Tennessee (M.K., J.M.B.); Eli Lilly and Company, Indianapolis, Indiana (R.L.D.); Division of Neuro-oncology, St. Jude Children's Research Hospital, Memphis, Tennessee (C.W., R.G.); Ann and Robert H. Lurie Children's Hospital of Chicago, Center for Cancer and Blood Disorders, Northwestern University Feinberg School of Medicine, Chicago, Illinois (S.G.); Department of Pediatrics, Division of Hematology/Oncology, University of California San Francisco, San Francisco, California (A.B.); Department of Hematology Oncology, Cincinnati Children's Hospital Medical Center,Cincinnati, Ohio (M.F.); Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee (L.K.); Department of Preventive Medicine, University of Tennessee Health Science Center Memphis, Tennessee (M.K.)
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