A synergistic two-drug therapy specifically targets a DNA repair dysregulation that occurs in p53-deficient colorectal and pancreatic cancers

The tumor-suppressor p53 is commonly inactivated in colorectal cancer and pancreatic ductal adenocarcinoma, but existing treatment options for p53-mutant (p53Mut) cancer are largely ineffective. Here, we report a therapeutic strategy for p53Mut tumors based on abnormalities in the DNA repair response. Investigation of DNA repair upon challenge with thymidine analogs reveals a dysregulation in DNA repair response in p53Mut cells that leads to accumulation of DNA breaks. Thymidine analogs do not interrupt DNA synthesis but induce DNA repair that involves a p53-dependent checkpoint. Inhibitors of poly(ADP-ribose) polymerase (PARPis) markedly enhance DNA double-strand breaks and cell death induced by thymidine analogs in p53Mut cells, whereas p53 wild-type cells respond with p53-dependent inhibition of the cell cycle. Combinations of trifluorothymidine and PARPi agents demonstrate superior anti-neoplastic activity in p53Mut cancer models. These findings support a two-drug combination strategy to improve outcomes for patients with p53Mut cancer.

Abstract 3397: Evaluation of a novel two-drug combination strategy for p53-deficient colorectal and pancreatic cancers

Colorectal Cancer (CRC) and Pancreatic Ductal Adenocarcinoma (PDAC) are the most lethal cancers worldwide. Despite initial response to standard-of-care therapy, a significant proportion of CRC/PDAC cancers relapse and progress to metastatic disease with poor overall survival (OS). Thus, better treatment options are urgently needed. Genetic alterations in the tumor suppressor p53 gene (TP53) are found in most CRC and PDAC cases and contribute to cancer relapse, progression, and metastasis. Even though the functional consequences of p53 mutations have been extensively studied, there are no FDA approved drug or their combination targeting p53 mutant (p53mut) cancers. Here we present a novel inducer-amplifier strategy for selective targeting p53-deficient CRC and PDAC. The Cancer Genome Atlas (TCGA) data showed elevated tumor mutational burden (TMB) and high expression levels of Base-Excision Repair (BER) in p53mut CRC and PADC. Assessment of the BER activity in CRC and PADC cells by a new methodology with deoxyuridine analogues ethynyl-deoxyuridine (EdU) and trifluorothymidine (TFT) revealed a significant delay in removal of genomic EdU and TFT in p53-deficient cells compared to isogenic p53 wildtype (p53wt) cells. Notably, p53-deficient cells accumulated in late S/G2 phase. Further, deoxyuridine analogues such as TFT-containing TAS102 induced buildup of DNA damage in p53-deficient cancer cells. Mechanistically, TAS102 did not block DNA replication but rather provoked activation of DNA Damage Response (DDR) resulting in DNA breaks in p53-deficient cells, while p53wt repaired the DNA lesion. This response was further enhanced by poly (ADP-ribose) polymerase (PARP) inhibitors (PARPi) leading to elevated cell death selectively in p53-deficient cancer cells, along with accumulation of cells in G2 phase. PARPi alone did not induce DNA damage in cancer cells. In preclinical in vivo models, the TAS102-PARPi combination was far more effective than either drug alone in the p53mut Cell-Derived Xenograft (CDX) and Patient-Derived xenograft (PDX) models. Immunohistochemistry data showed that the two-drug combination increased DNA damage and cell death while decreasing cell proliferation in p53-mutant models. In comparison, the two-drug combination and TAS102 exhibited comparable effectiveness in p53wt PDX model. Notably, the two-drug therapy did not exhibit significant toxicity in mouse models. In summary, this work demonstrates that our novel inducer-amplifier strategy provides effective treatment option for aggressive p53-deficient CRC and PDAC cancers while limiting adverse toxic events and improving the quality of life for cancer patients.

Citation Format: Mohammed M. Alruwaili, Justin Zonneville, Mohammed A. Alqarni, Priyanka Rajan, Hannah Serio, Robert Straubinger, Christos Fountzilas, Andrei Bakin. Evaluation of a novel two-drug combination strategy for p53-deficient colorectal and pancreatic cancers [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 3397.

Abstract B039: Development of a selective therapeutic intervention for p53 mutant for pancreatic adenocarcinoma

Genetic alterations in the tumor suppressor p53 gene (TP53) are found in over 70% of Pancreatic Adenocarcinoma (PAAD) and contribute to poor prognosis, cancer progression and metastasis. Existing treatment options for p53 mutant (p53mut) cancer are limited and there is an urgent need for better therapeutic interventions that can be greatly beneficial to a large proportion of patients with PAAD. Here we present a novel therapeutic strategy for selective targeting p53mut pancreatic tumors. Genomic data revealed that p53-deficient PAADs express high levels of DNA replication genes as well as genes involved in Base Excision (BER) and Mismatch (MMR) Repair, indicating activation of these mechanisms. Evaluation of BER activity by a novel methodology with a modified deoxyuridine analogue showed a significant dysregulation in BER mediated repair in p53mut cancer cells leading to accumulation of p53mut tumor cells in late S/G2 phase. By exploiting this defect, we found that treatment with a deoxyuridine analogue such as trifluorothymidine (TFT, a component of TAS102) resulted in accumulation of DNA breaks selectively in p53mut cells. A deoxyuridine analogue (TFT) did not block DNA replication but rather activated DNA repair leading to DNA breaks in p53mut cells whereas p53 wild type cells accumulated in G1 with minimal DNA damage. Further, we found that inhibition of poly (ADP) ribose polymerase (PARP) enhanced DNA damage and increased cell death selectively in p53mut tumor cells although PARP inhibitor alone was not effective. In contrast, the TAS102-PARPi did not induce DNA damage in the normal cells such as hTERT-immortalized Human Pancreatic Nestin Expressing cells (HPNE). A new TAS102-PARPi combination regimen demonstrated greater inhibition of tumor growth and improved the survival rates in p53mut PAAD xenograft models including Cell-Derived Xenograft (CDX) and Patient-Derived xenograft (PDX) models, compared to either drug alone without adverse effects in mice. Thus, this preclinical work identified a novel and immediately feasible strategy for p53mut disease that may improve treatment and the quality of life for a significant proportion of patients with PAAD while limiting toxic effects on normal tissues.

Citation Format: Mohammed M. Alruwaili, Justin Zonneville, Mohammed A. Alqarni, Priyanka Rajan, Hannah Serio, Robert Straubinger, Christos Fountzilas, Andrei Bakin. Development of a selective therapeutic intervention for p53 mutant for pancreatic adenocarcinoma [abstract]. In: Proceedings of the AACR Special Conference on Pancreatic Cancer; 2022 Sep 13-16; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2022;82(22 Suppl):Abstract nr B039.

Selective therapeutic strategy for p53-deficient cancer by targeting dysregulation in DNA repair

Breast carcinomas commonly carry mutations in the tumor suppressor p53, although therapeutic efforts to target mutant p53 have previously been unfruitful. Here we report a selective combination therapy strategy for treatment of p53 mutant cancers. Genomic data revealed that p53 mutant cancers exhibit high replication activity and express high levels of the Base-Excision Repair (BER) pathway, whereas experimental testing showed substantial dysregulation in BER. This defect rendered accumulation of DNA damage in p53 mutant cells upon treatment with deoxyuridine analogues. Notably, inhibition of poly (ADP-ribose) polymerase (PARP) greatly enhanced this response, whereas normal cells responded with activation of the p53-p21 axis and cell cycle arrest. Inactivation of either p53 or p21/CDKN1A conferred the p53 mutant phenotype. Preclinical animal studies demonstrated a greater anti-neoplastic efficacy of the drug combination (deoxyuridine analogue and PARP inhibitor) than either drug alone. This work illustrates a selective combination therapy strategy for p53 mutant cancers that will improve survival rates and outcomes for thousands of breast cancer patients.

Altered expression of some miRNAs and their target genes following mesenchymal stem cell treatment in busulfan-induced azoospermic rats

Studies have recently demonstrated that mesenchymal stem cells (MSCs) have therapeutic capabilities on many diseases and this effect is mainly mediated by miRNAs. However, the actual mechanism of MSCs paracrine effect on testis to improve male fertility is still elusive. Herein, we evaluated the altered expression of some spermatogenesis-related miRNAs and their target genes following transplantation of bone marrow (BM)-derived MSCs into testes of busulfan-induced azoospermic rats using real time PCR. Transplantation of MSCs improved fertility of azoospermic rats as revealed by enhanced serum levels of testosterone and estradiol, and upregulated expression of germ cell‑specific genes. Azo rats injected with MSCs also exhibited a significant downregulated expression of miRNA-19b, miRNA-100, miRNA-141, miRNA‑146a, miRNA-429, and let‑7a and a significant upregulated expression of miRNA-21, miRNA-34b, miRNA-34c, miRNA-122, miRNA-449a, miRNA-449b, and miRNA-449c in the testis as compared to Azo rats injected with phosphate buffer saline. Transplantation of MSCs was also accompanied with restoration of the disrupted expression of Ccnd1, E2F1, Myc, and PLCXD3 (target genes for miRNA-34 and miRNA‑449 clusters) and ERα and AKT1 (target genes for miRNA-100 and let‑7a) to level comparable to that of the fertile group. Upon these data, we infer that BM-MSCs can improve fertility of azoospermic rats and this effect was followed by altered expression of some spermatogenesis-related miRNAs and their target genes. These findings provide MSCs as a promising and effective cell-based therapeutic method for azoospermic patients, but further investigations are required before clinical application.

Incensole acetate prevents beta-amyloid-induced neurotoxicity in human olfactory bulb neural stem cells

β-Amyloid peptide (Aβ) is a potent neurotoxic protein associated with Alzheimer's disease (AD) which causes oxidative damage to neurons. Incensole acetate (IA) is a major constituent of Boswellia carterii resin, which has anti-inflammatory and protective properties against damage of a large verity of neural subtypes. However, this neuroprotective effect was not studied on human olfactory bulb neural stem cells (hOBNSCs). Herein, we evaluated this effect and studied the underlying mechanisms. Exposure to Aβ_25-35 (5 and 10 μM for 24 h) inhibited proliferation (revealed by downregulation of Nestin and Sox2 gene expression), and induced differentiation (marked by increased expression of the immature neuronal marker Map2 and the astrocyte marker Gfap) of hOBNSCs. However, pre-treatment with IA (100 μM for 4 h) stimulated proliferation and differentiation of neuronal, rather than astrocyte, markers. Moreover, IA pretreatment significantly decreased the Aβ_25-35-induced viability loss, apoptotic rate (revealed by decreased caspase 3 activity and protein expression, downregulated expression of Bax, caspase 8, cyto c, caspase3, and upregulated expression of Bcl2 mRNAs and proteins, in addition to elevated mitochondrial membrane potential and lowered intracellular Ca⁺²). IA reduced Aβ-mediated ROS production (revealed by decreased intracellular ROS and MDA level, and increased SOD, CAT, and GPX contents), and inhibited Aβ-induced inflammation (marked by down-regulated expression of IL1b, TNFa, NfKb, and Cox2 genes). IA also significantly upregulated mRNA and protein expression of Erk1/2 and Nrf2. Notably, IA increased the antioxidant enzyme heme oxygenase-1 (HO-1) expression and this effect was reversed by HO-1 inhibitor zinc protoporphyrin (ZnPP) leading to reduction of the neuroprotective effect of IA against Aβ-induced neurotoxicity. These findings clearly show the ability of IA to initiate proliferation and differentiation of neuronal progenitors in hOBNSCs and induce HO-1 expression, thereby protecting the hOBNSCs cells from Aβ_25-35-induced oxidative cell death. Thus, IA may be applicable as a potential preventive agent for AD by its effect on hOBNSCs and could also be used as an adjuvant to hOBNSCs in cellular therapy of neurodegenerative diseases.