GDC-9545 (Giredestrant): A Potent and Orally Bioavailable Selective Estrogen Receptor Antagonist and Degrader with an Exceptional Preclinical Profile for ER+ Breast Cancer

Breast cancer remains a leading cause of cancer death in women, representing a significant unmet medical need. Here, we disclose our discovery efforts culminating in a clinical candidate, 35 (GDC-9545 or giredestrant). 35 is an efficient and potent selective estrogen receptor degrader (SERD) and a full antagonist, which translates into better antiproliferation activity than known SERDs (1, 6, 7, and 9) across multiple cell lines. Fine-tuning the physiochemical properties enabled once daily oral dosing of 35 in preclinical species and humans. 35 exhibits low drug-drug interaction liability and demonstrates excellent in vitro and in vivo safety profiles. At low doses, 35 induces tumor regressions either as a single agent or in combination with a CDK4/6 inhibitor in an ESR1^Y537S mutant PDX or a wild-type ERα tumor model. Currently, 35 is being evaluated in Phase III clinical trials.

Antibody-Mediated Delivery of Chimeric BRD4 Degraders. Part 2: Improvement of In Vitro Antiproliferation Activity and In Vivo Antitumor Efficacy

Heterobifunctional compounds that direct the ubiquitination of intracellular proteins in a targeted manner via co-opted ubiquitin ligases have enormous potential to transform the field of medicinal chemistry. These chimeric molecules, often termed proteolysis-targeting chimeras (PROTACs) in the chemical literature, enable the controlled degradation of specific proteins via their direction to the cellular proteasome. In this report, we describe the second phase of our research focused on exploring antibody-drug conjugates (ADCs), which incorporate BRD4-targeting chimeric degrader entities. We employ a new BRD4-binding fragment in the construction of the chimeric ADC payloads that is significantly more potent than the corresponding entity utilized in our initial studies. The resulting BRD4-degrader antibody conjugates exhibit potent and antigen-dependent BRD4 degradation and antiproliferation activities in cell-based experiments. Multiple ADCs bearing chimeric BRD4-degrader payloads also exhibit strong, antigen-dependent antitumor efficacy in mouse xenograft assessments that employ several different tumor models.

Antibody-Mediated Delivery of Chimeric BRD4 Degraders. Part 1: Exploration of Antibody Linker, Payload Loading, and Payload Molecular Properties

The biological and medicinal impacts of proteolysis-targeting chimeras (PROTACs) and related chimeric molecules that effect intracellular degradation of target proteins via ubiquitin ligase-mediated ubiquitination continue to grow. However, these chimeric entities are relatively large compounds that often possess molecular characteristics, which may compromise oral bioavailability, solubility, and/or in vivo pharmacokinetic properties. We therefore explored the conjugation of such molecules to monoclonal antibodies using technologies originally developed for cytotoxic payloads so as to provide alternate delivery options for these novel agents. In this report, we describe the first phase of our systematic development of antibody-drug conjugates (ADCs) derived from bromodomain-containing protein 4 (BRD4)-targeting chimeric degrader entities. We demonstrate the antigen-dependent delivery of the degrader payloads to PC3-S1 prostate cancer cells along with related impacts on MYC transcription and intracellular BRD4 levels. These experiments culminate with the identification of one degrader conjugate, which exhibits antigen-dependent antiproliferation effects in LNCaP prostate cancer cells.

Antibody-mediated delivery of chimeric protein degraders which target estrogen receptor alpha (ERα)

Chimeric molecules which effect intracellular degradation of target proteins via E3 ligase-mediated ubiquitination (e.g., PROTACs) are currently of high interest in medicinal chemistry. However, these entities are relatively large compounds that often possess molecular characteristics which may compromise oral bioavailability, solubility, and/or in vivo pharmacokinetic properties. Accordingly, we explored whether conjugation of chimeric degraders to monoclonal antibodies using technologies originally developed for cytotoxic payloads might provide alternate delivery options for these novel agents. In this report we describe the construction of several degrader-antibody conjugates comprised of two distinct ERα-targeting degrader entities and three independent ADC linker modalities. We subsequently demonstrate the antigen-dependent delivery to MCF7-neo/HER2 cells of the degrader payloads that are incorporated into these conjugates. We also provide evidence for efficient intracellular degrader release from one of the employed linkers. In addition, preliminary data are described which suggest that reasonably favorable in vivo stability properties are associated with the linkers utilized to construct the degrader conjugates.

Discovery of a C-8 hydroxychromene as a potent degrader of estrogen receptor alpha with improved rat oral exposure over GDC-0927

Phenolic groups are responsible for the high clearance and low oral bioavailability of the estrogen receptor alpha (ERα) clinical candidate GDC-0927. An exhaustive search for a backup molecule with improved pharmacokinetic (PK) properties identified several metabolically stable analogs, although in general at the expense of the desired potency and degradation efficiency. C-8 hydroxychromene 30 is the first example of a phenol-containing chromene that not only maintained excellent potency but also exhibited 10-fold higher oral exposure in rats. The improved in vivo clearance in rat was hypothesized to be the result of C-8 hydroxy group being sterically protected from glucuronide conjugation. The excellent potency underscores the possibility of replacing the presumed indispensable phenolic group at C-6 or C-7 of the chromene core. Co-crystal structures were obtained to highlight the change in key interactions and rationalize the retained potency.

Abstract P2-06-15: Rational combination of Wee1 and BCL-2 inhibition in preclinical models of triple-negative breast cancer

Background:

Triple-negative breast cancer (TNBC) is an aggressive subtype distinguished by its lack of expression of receptors for estrogen, progesterone, and normal human epidermal growth factor 2 expression. TNBC is difficult to treat and is associated with a high risk of recurrence and mortality. In order to effectively treat TNBC, alternative therapeutic targets need to be identified. Wee1 is a tyrosine kinase that phosphorylates CDC2 to pause the cell cycle at the G2 checkpoint as a means to delay mitosis while DNA damage undergoes repair. Inactivation of Wee1 via adavosertib (AZD1775, MK1775), a highly selective inhibitor of Wee1, allows CDC25 to dephosphorylate the CDC2/cyclin B complex resulting in premature initiation of mitosis and, ultimately, mitotic catastrophe and apoptosis. An unbiased screen of adovosertib in combination with other targeted compounds in TNBC patient-derived xenograft (PDX) models demonstrated that the combination of adavosertib and navitoclax, an inhibitor of anti-apoptotic BCL-2 and BCL-XL proteins, had greater efficacy than the single agents alone. The purpose of this study was to investigate the combination of adavosertib and navitoclax in preclinical TNBC models, both in vitro and in vivo.

Methods:

HCC1937, CAL51, MDA-MB-231 and MDA-MB-468 cells were plated in 96-well plates and exposed to increasing concentrations of adavosertib (125nM – 1000nM), navitoclax (2500nM – 10000nM), or the combination. Cellular proliferation was assessed in real-time using IncuCyte Live Cell Analysis, followed by endpoint sulforhodamine B (SRB) assay. Combination effects were analyzed using Calcusyn to determine combination indexes (CI). Apoptosis was assessed via the Caspase 3/7 assay. Western blotting was used to assess changes in expression of CDC2, phospho-CDC2, and BCL2. TNBC PDX models CU_TNBC_013 and CU_TNBC_014 were treated with vehicle, adavosertib (50mg/kg), navitoclax (100mg/kg), or the combination and assessed for tumor growth inhibition.

Results:

The combination of adavosertib and navitoclax resulted in greater antiproliferative effects in vitro compared to either single agent (p< 0.05). This effect was classified as synergistic with CI values <1. We observed a significant increase in apoptosis with the combination treatment as measured by Caspase 3/7 (p <0.005). The combination of adavosertib and navitoclax treatment resulted in a decrease in phospo-CDC2, and BCL2 in cell lines. In vivo, the combination treatment resulted in greater tumor growth inhibition as compared to adavosertib or navitoclax alone in the CU_TNBC_013 and CU_TNBC_014 PDX models.

Conclusions:

The combination of adavosertib and navitoclax is active in preclinical TNBC models and induces apoptosis and tumor growth inhibition. This data supports the continued development of this combination in TNBC with investigation of potential selective markers.

Citation Format: Simmons DM, Tse TE, Dailey K, Hartman SJ, Bagsby S, Pitts TM, Tentler JJ, Diamond JR. Rational combination of Wee1 and BCL-2 inhibition in preclinical models of triple-negative breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-06-15.

Effect of trace mineral source on mineral status and performance of beef steers fed low- or high-sulfur diets

A 2 × 2 factorial assessed the effect of trace mineral (TM) sources fed within low- or high-S diets on the mineral status and performance of cattle. Angus crossbred steers ( = 48; 6/pen) were blocked by BW (316 ± 16.6 kg), assigned to low-S (0.27%; LS) or high-S (0.54%; HS; added as CaSO) diets, and supplemented TM at 10 mg Cu, 30 mg Zn, and 20 mg Mn/kg DM from hydroxy (HYD; IntelliBond; Micronutrients USA LLC, Indianapolis, IN) or inorganic (sulfates; ING) sources ( = 12 steers/treatment). Steers were fed corn silage and corn-based diets via GrowSafe bunks in the growing period (GP; 84 d) and finishing period (FP; 77 d), respectively. Plasma and liver were collected at trial initiation and end of GP and FP for mineral concentrations. End of GP and FP red blood cell lysate superoxide dismutase (SOD) and Mn-SOD activity and liver glutathione concentrations were measured. Data were used as a 2 × 2 factorial using Proc Mixed of SAS (SAS Inst. Inc., Cary, NC) with initial plasma and liver status analyzed as covariates. High S decreased ( < 0.01) liver Cu and tended ( ≤ 0.10) to decrease plasma Cu concentrations. Liver Cu concentrations were lower in HYD than ING in the FP ( < 0.01). High S decreased ( = 0.04) GP plasma Zn concentrations and tended to decrease ( = 0.10) GP liver Zn. There were GP ( = 0.05) and FP ( = 0.02) S × TM effects for liver Mn concentrations where GP LS-HYD was greater than all other treatments, whereas FP LS-HYD was lower than HS-HYD and LS-ING and FP HS-ING was less than LS-ING. Glutathione, SOD, and Mn-SOD were not different ( ≥ 0.13) in the GP, but S × TM tended to affect FP Mn-SOD ( = 0.10), where LS-HYD tended to be lower than LS-ING. Oxidized glutathione in FP tended to be lower ( = 0.06) for HYD than ING. In the GP, there were S × TM effects on performance where LS-HYD had greater ADG and G:F ( ≤ 0.05) than HS-HYD, whereas LS and HS-ING were intermediate. For FP performance S × TM effects were noted where LS-HYD and HS-ING tended ( = 0.10) to gain more than HS-HYD and HS-HYD had lower G:F ( = 0.04) than HS-ING. There were no effects of S × TM on final BW, DMI, or ADG ( ≥ 0.11); however, HS-HYD had lower G:F than other treatments overall ( = 0.05). High S decreased back fat and yield grade ( = 0.03), and rib eye area was smaller for HYD than ING ( = 0.02). In this study HS decreased markers of Cu and Zn status, and differential effects of HYD vs. ING minerals were noted across dietary phases, although all steers maintained adequate TM status.

Abstract P4-04-07: Characterization of the effects of estrogen receptor alpha Y537S and D538G mutations on receptor function and pharmacology

The frontline therapy for estrogen receptor alpha (ERα) positive Breast Cancer (ER+BC) involves various forms of endocrine therapy, consisting of either Selective Estrogen Receptor Modulators (SERMs) or aromatase inhibitors. An emerging mechanism of ER+BC resistance to endocrine therapy, and consequently disease relapse, has been associated with a set of “hotspot” mutations in and near to helix-12 of the ERα ligand binding domain. Selective Estrogen Receptor Degraders/Down-regulators (SERDs), such as GDC-0810, AZD9496 and GDC-0927, represent a current major pharmacological strategy being applied to develop treatments for such resistant ER+BC. Here, we compare 2 of the most frequent ERα hotspot mutations (Y537S and D538G), with ERα wildtype (WT) and the ability of a set of ERα ligands (including GDC-0810, AZD9496 and GDC-0927) to bind, antagonize and degrade ERα. The concentration of each drug required to bind, antagonize or degrade ERα Y537S or ERα D538G was typically higher than that required for ERα WT. Importantly, ERα Y537S is resistant to estradiol stimulated protein degradation and 4-hydroxy-tamoxifen (a major active metabolite of tamoxifen) stabilizes ERα Y537S protein. This represents a potential mechanism of resistance of ERα Y537S ER+BC to Tamoxifen therapy.

Citation Format: Blake RA, Hartman SJ, Kleinheinz TL, White J, Daly S, Goodwin R, Zhou W, Liang J, Wang X, O'Rourke M, Metcalfe C, Friedman L. Characterization of the effects of estrogen receptor alpha Y537S and D538G mutations on receptor function and pharmacology [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-04-07.

Abstract 3621: Characterization of the effects of estrogen receptor alpha Y537S and D538G mutations on receptor pharmacology

The frontline therapy for estrogen receptor alpha (ERα) positive Breast Cancer (ER+BC) involves various forms of endocrine therapy, consisting of either Selective Estrogen Receptor Modulators (SERMs) or aromatase inhibitors. An emerging mechanism of ER+BC resistance to endocrine therapy, and consequently disease relapse, has been associated with a set of “hotspot” mutations in and near to helix-12 of the ERα ligand binding domain. Selective Estrogen Receptor Degraders/Down-regulators (SERDs) represent an important pharmacological strategy being applied to develop treatments for resistant ER+BC. Here, we compare 2 of the most frequent ERα hotspot mutations (Y537S and D538G), with ERα wildtype (WT) and the ability of a set of SERM/SERDs and other ERα ligands to bind, antagonize, degrade/stabilize ERα and affect cell proliferation. Common themes that emerged included the observation that the concentration of each drug required to bind, antagonize or degrade ERα Y537S or ERα D538G was typically higher than that required for ERα WT, although the extent of the shift varied between drugs and the type of measurement. An unexpected observation was that 4-hydroxy-tamoxifen (a major active metabolite of tamoxifen) stabilized nuclear ERα Y537S protein. This represents a potential mechanism that may limit the efficacy of Tamoxifen in treating ERα Y537S ER+BC.

Citation Format: Steven J. Hartman, Tracy Kleinheinz, Jonathan White, Stephen Daly, Ria Goodwin, Wei Zhou, Jun Liang, Xiaojing Wang, Daniel F. Ortwine, Lori Friedman, Martin O’Rourke, Ciara Metcalfe, Robert A. Blake. Characterization of the effects of estrogen receptor alpha Y537S and D538G mutations on receptor pharmacology [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 3621. doi:10.1158/1538-7445.AM2017-3621

Structures of Arg- and Gln-type bacterial cysteine dioxygenase homologs

In some bacteria, cysteine is converted to cysteine sulfinic acid by cysteine dioxygenases (CDO) that are only ∼15-30% identical in sequence to mammalian CDOs. Among bacterial proteins having this range of sequence similarity to mammalian CDO are some that conserve an active site Arg residue ("Arg-type" enzymes) and some having a Gln substituted for this Arg ("Gln-type" enzymes). Here, we describe a structure from each of these enzyme types by analyzing structures originally solved by structural genomics groups but not published: a Bacillus subtilis "Arg-type" enzyme that has cysteine dioxygenase activity (BsCDO), and a Ralstonia eutropha "Gln-type" CDO homolog of uncharacterized activity (ReCDOhom). The BsCDO active site is well conserved with mammalian CDO, and a cysteine complex captured in the active site confirms that the cysteine binding mode is also similar. The ReCDOhom structure reveals a new active site Arg residue that is hydrogen bonding to an iron-bound diatomic molecule we have interpreted as dioxygen. Notably, the Arg position is not compatible with the mode of Cys binding seen in both rat CDO and BsCDO. As sequence alignments show that this newly discovered active site Arg is well conserved among "Gln-type" CDO enzymes, we conclude that the "Gln-type" CDO homologs are not authentic CDOs but will have substrate specificity more similar to 3-mercaptopropionate dioxygenases.

Expression of rhodopsin and arrestin during the light-dark cycle in Drosophila

PURPOSE

To determine the protein and transcript levels for rhodopsin (Rh1), arrestin 1 (Arr1), and arrestin 2 (Arr2) over a 12 h light/12 h dark cycle in the retina of the fruit fly, Drosophila melanogaster. This information is important for understanding the process of photoreceptor membrane turnover.

METHODS

Drosophila were entrained for several generations to a daily 12 h light/12 h dark cycle. They were sacrificed at 4 h intervals, beginning at the time of onset of the light phase. Proteins were resolved by polyacrylamide gel electrophoresis (PAGE) and subjected to immunoblot analysis using antibodies directed to rhodopsin, NinaA, Arr1, and Arr2. Northern blots were incubated with riboprobes corresponding to the rhodopsin gene (ninaE), arrestin1 (arr1), and arrestin2 (arr2).

RESULTS

In entrained Drosophila, protein and mRNA levels for rhodopsin, arrestin1, and arrestin2 were constant during a 12 h light/12 h dark cycle.

CONCLUSIONS

These results indicate that rhodopsin and arrestin protein synthesis in Drosophila photoreceptors do not fluctuate on a daily cycle. These findings are similar to those obtained in Xenopus laevis, but in contrast to a variety of other vertebrate and invertebrate species.

Improving the political skills of health care supervisors

The health care industry in the United States has been in a state of social, economic, and political flux for several years. This transition has put a great deal of pressure on supervisors, managers, and professionals in the health care field to adapt by acquiring new skills. Much of the emphasis has been on improving technical, managerial, and people know-how. An equally important area of expertise--political skills--has been virtually ignored. This may be due to the negative connotations associated with politics. Ways to enhance political skills are examined.