A phase I clinical trial of 12- O-tetradecanoylphorbol-13-acetate for patients with relapsed/refractory malignancies

Phorbol esters activate protein kinase C and modulate a variety of downstream cell signaling pathways. 12-O-tetradecanoylphorbol-13-acetate (TPA) is a phorbol ester that induces differentiation or apoptosis in a variety of cell lines at low concentrations. A phase I dose escalation trial of TPA was undertaken for patients with relapsed or refractory malignancies. The starting dose was 0.063 mg/m2 and most patients were treated with an intravenous infusion of TPA on days 1-5 and 8-12 followed by a 2-week rest period prior to retreatment. Thirty-five patients were treated. A biological assay was used to monitor levels of TPA-like activity in the blood after treatment. Serious adverse events included individual episodes of gross hematuria, a grand mal seizure, syncope, and hypotension. Many patients had transient fatigue, mild dyspnea, fever, rigors, and muscular aches shortly after the infusion. Dose-limiting toxicities included syncope and hypotension at a dose of 0.188 mg/m2. Only a single patient had evidence of tumor response. These studies establish 0.125 mg/m2 as the maximally tolerated dose when TPA is administered on this schedule.

Inhibitory effects of 12-O-tetradecanoylphorbol-13-acetate alone or in combination with all-trans retinoic acid on the growth of cultured human pancreas cancer cells and pancreas tumor xenografts in immunodeficient mice

Treatment of cultured PANC-1, MIA PaCa-2, and BxPC-3 human pancreatic adenocarcinoma cells with 0.1 to 1.6 nM 12-O-tetradecanoylphorbol-13-acetate (TPA) for 96 h inhibited the proliferation of these cells in a dose-dependent manner, and PANC-1 and MIA PaCa-2 cells were more sensitive to TPA than BxPC-3 cells. Inhibition of proliferation by TPA in PANC-1 cells was associated with an increase in the level of p21, but this was not observed in MIA PaCa-2 or BxPC-3 cells. The TPA-induced increase of p21 in PANC-1 cells was blocked by bisindolylmaleimide or rottlerin (inhibitors of protein kinase C). Studies in NCr-immunodeficient mice with well established PANC-1 tumor xenografts indicated that daily i.p. injections of TPA strongly inhibited tumor growth, increased the percentage of caspase-3-positive cells, and decreased the ratio of mitotic cells to caspase-3-positive cells in the tumors. Studies with BxPC-3 tumors in NCr mice receiving daily i.p. injections of vehicle, TPA, all-trans retinoic acid (ATRA), or a TPA/ATRA combination showed that TPA had an inhibitory effect on tumor growth, but treatment of the animals with the TPA/ATRA combination had a greater inhibitory effect on tumor growth than TPA alone. Treatment with the TPA/ATRA combination resulted in a substantially decreased ratio of the percentage of mitotic cells to the percentage of caspase-3-positive cells in the tumors compared with tumors from the vehicle-treated control animals. The inhibitory effects of TPA on tumor growth occurred at clinically achievable blood levels.

Inhibitory Effect of 12-O-Tetradecanoylphorbol-13-acetate Alone or in Combination with All-trans-Retinoic Acid on the Growth of LNCaP Prostate Tumors in Immunodeficient Mice

Clinically achievable concentrations of 12-O-tetradecanoylphorbol-13-acetate (TPA; 0.16-0.32 nM) and all-trans-retinoic acid (ATRA; 0.5-1 micro M) had a synergistic inhibitory effect on the growth of cultured LNCaP prostate cancer cells, and apoptosis was markedly stimulated. In additional studies, NCr immunodeficient mice received s.c. injection with LNCaP cells in Matrigel. After 4-6 weeks, mice with well-established tumors received i.p. injection with vehicle, TPA (0.16 nmol/g body weight), ATRA (0.5 nmol/g body weight), or TPA+ATRA in vehicle once a day for 46 days. Tumor growth occurred in all of the vehicle-treated control mice. The percentage of animals with some tumor regression after 21 days of treatment was 0% for the control group, 31% for the ATRA group, 62% for the TPA group, and 100% for the TPA+ATRA group (13 mice/group). Although treatment of the mice with TPA or TPA+ATRA continued to inhibit tumor growth for the duration of the 46-day study, treatment of the mice with ATRA alone did not inhibit tumor growth beyond 28 days of daily injections (6 mice/group). Mechanistic studies indicated that treatment of the mice with TPA or TPA+ATRA for 46 days increased apoptosis in the tumors, and treatment with TPA+ATRA also decreased the mitotic index. Because the dose of TPA used in this study was effective and resulted in clinically achievable blood levels, clinical trials with TPA alone or in combination with ATRA in patients with prostate cancer may be warranted.

A sensitive bioassay for measuring blood levels of 12-O-tetradecanoylphorbol-13-acetate (TPA) in patients: preliminary pharmacokinetic studies

12-O-Tetradecanoylphorbol-13-acetate (TPA) is a potent stimulator of differentiation in myelocytic leukemia cells, and it has been shown to have activity in patients with acute myelocytic leukemia. Because attempts to develop a suitable mass spectrometry assay for TPA were unsuccessful (because of the lack of sufficient sensitivity), we developed a novel and highly sensitive blood level bioassay for TPA that measures ethyl acetate-extractable differentiating activity in blood. Differentiating activity in ethyl acetate extracts of blood was measured in HL-60 cells by measuring the formation of adherent cells. The sensitivity of the assay was approximately 0.1 ng TPA/ml blood. The assay for TPA has a high degree of specificity and does not measure deesterifed potential metabolites (phorbol, phorbol-13-acetate, or phorbol-12-myristate), and the presence of GM-CSF, G-CSF, interferon-alpha, or interferon-gamma does not interfere with the assay. Blood levels of TPA as measured by the bioassay immediately after an IV infusion of TPA (0.125 mg/m2; approximately 0.25 mg per patient) and 1 and 3 h later were 1.75 +/- 0.55, 0.93 +/- 0.54, and 0.69 +/- 0.42 ng/ml, respectively (mean +/- SD from eight infusions in five patients). Terminal half-lives were determined in a few patients where TPA blood levels were measured at multiple time intervals after the TPA infusion. In these patients, the terminal half-life was 11.1 +/- 3.9 h (from five infusions in four patients). To the best of our knowledge, this is the first analytical method for the measurement of TPA.

Differential usage of signal transduction pathways defines two types of serum response factor target gene

Activation of the transcription factor serum response factor (SRF) is dependent on Rho-controlled changes in actin dynamics. We used pathway-specific inhibitors to compare the roles of actin dynamics, extracellular signal-regulated kinase (ERK) signaling, and phosphatidylinositol 3-kinase in signaling either to SRF itself or to four cellular SRF target genes. Serum, lysophosphatidic acid, platelet-derived growth factor, and phorbol 12-myristate 13-acetate (PMA) each activated transcription of a stably integrated SRF reporter gene dependent on functional RhoA GTPase. Inhibition of mitogen-activated protein kinase-ERK kinase (MEK) signalling reduced activation of the SRF reporter by all stimuli by about 50%, except for PMA, which was effectively blocked. Inhibition of phosphatidylinositol 3-kinase slightly reduced reporter activation by serum and lysophosphatidic acid but substantially inhibited activation by platelet-derived growth factor and PMA. Reporter induction by all stimuli was absolutely dependent on actin dynamics. Regulation of the SRF (srf) and vinculin (vcl) genes was similar to that of the SRF reporter gene; activation by all stimuli was Rho-dependent and required actin dynamics but was largely independent of MEK activity. In contrast, activation of fos and egr1 occurred independently of RhoA and actin polymerization but was almost completely dependent on MEK activation. These results show that at least two classes of SRF target genes can be distinguished on the basis of their relative sensitivity to RhoA-actin and MEK-ERK signaling pathways.

3 beta,5 alpha-Dihydroxycholestan-6-one exists in human blood

3 beta,5 alpha-Dihydroxycholestan-6-one was detected in fresh human plasma at the concentration of 14-44 ng/mL. The oxysterol binds specifically to phorbol ester specific binding protein in vitro, and may be an endogenous ligand of the protein.

Variation of superoxide dismutase levels in fetal calf serum

The results of cytogenetic studies and of other experiments based on tissue-culture systems may be influenced by various components of tissue-culture medium and by variations among batches of fetal calf serum used for supplementation of the media. Negative results may be obtained in breakage studies as a consequence of medium components with a protective effect [6]. Attention has been drawn to differences in growth pattern [8] and mitotic indices [11] in lymphocyte cultures set up with different culture media. Variations in the incidence of sister-chromatid exchanges according to differences in media [7] and sera [5] have also been observed. It has been suggested [9] that the failure of some laboratories to detect increases in sister-chromatid exchanges after treatment with the tumor promoter phorbol-myristate-acetate (PMA) may be due to high concentrations of the free-radical-scavenging enzyme superoxide dismutase (SOD) in the sera used and that heat inactivation of the sera may be responsible for these differences. In the following, we report that considerable variation in the SOD content exists between batches of fetal calf serum, up to levels with anticlastogenic effect.

Specific receptors for phorbol esters in lymphoid cell populations: role in enhanced production of T-cell growth factor

Phorbol ester tumor promoters act synergistically with concanavalin A to cause production of T-cell growth factor by normal human peripheral blood lymphocytes. A specific, saturable, binding component which may mediate the phorbol ester effect has been identified by using [20-3H]phorbol 12,13-dibutyrate in a whole-cell binding assay. Specific binding is maximal with 5 min at 37 or 23 degrees C but the level of bound ligand rapidly decreases to about 50% within 1 hr. At 4 degrees C, 2 hr are required to reach maximal binding, and the binding is stable for at least 20 hr. Binding is reversible at 37 and 4 degrees C with time courses similar to those for initial binding at the respective temperatures. Saturation of the specific binding occurs at a concentration (approximately 30 nM) consistent with that producing maximal T-cell growth factor activity. Scatchard analysis of the binding after 30 min at 37 degrees C demonstrates a lower Kd (9 nM) than that determined after 2 hr at 4 degrees C (22 nM). The median number of sites per cell for six donors was 2 X 10(5) (range, 1.3-4 X 10(5). Other tumor-promoting phorbol esters compete for [20-3H]phorbol 12,13-dibutyrate binding in approximate proportion to their activity in stimulating T-cell growth factor production. Phorbol, 4-alpha-phorbol didecanoate, dexamethasone, retinoic acid, butyric acid, and dimethyl sulfoxide do not compete for specific binding.

Binding of [3H]12-O-tetradecanoylphorbol-13-acetate to intact human peripheral blood lymphocytes

Our studies indicate that tritiated 12-O-tetradecanoylphorbol-13-acetate ([3H]TPA) produced by the reduction of the C-20 aldehyde with sodium [3H]borohydride is recognized by the same cellular site as is unlabeled 12-O-tetradecanoylphorbol-13-acetate (TPA). None of the concentrations of TPA used in these studies had an effect on the cell number and viability of human peripheral blood lymphocytes (HPBL) when incubated up to 1 hr at temperatures of 37 and 4 degrees as compared to untreated controls. [3H]TPA was not significantly metabolized by these cells after 1 hr at 37 degrees. Examination of the binding of [3H]TPA with simultaneous examination of uptake of tritiated thymidine ([3H]dThd) in parallel cultures demonstrated a close correlation between the apparent binding constant (0.94 X 10(8) M-1) and the activation constant for TPA stimulation of [3H]-dThd incorporation (0.95 X 10(-8) M). Binding of [3H]TPA was examined in two experimental conditions in which TPA-induced mitogenesis was inhibited: (a) preincubation of HPBL at 37 degrees for 24 hr causes a decrease of [3H]dThd uptake of 50% and an apparent loss of binding sites for [3H]TPA; and (b) glucocorticoid inhibition of [3H]dThd uptake in HPBL by 50%, however, did not reduce [3H]TPA binding. Our data suggest that cellular receptors either at the membrane or in the cytoplasm exist for TPA in HPBL. Alterations in binding of TPA to these receptors may account for the decrease in mitogenic response in preincubation experiments.