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Cancer Therapy: Preclinical |
Authors' Affiliations: 1 Department of Medicine, 2 Program in Molecular Pharmacology, and 3 Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York; and 4 Serenex, Inc., Durham, North Carolina
Requests for reprints: David B. Solit, Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10021. Phone: 646-888-2641; Fax: 253-423-3415; E-mail: solitd{at}mskcc.org.
| Abstract |
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Experimental Design: We determined the pharmacodynamic and antitumor properties of a novel, synthetic Hsp90 inhibitor, SNX-2112, in cell culture and xenograft models of HER kinase–dependent cancers.
Results: We show in a panel of tumor cell lines that SNX-2112 and its prodrug SNX-5542 are Hsp90 inhibitors with properties and potency similar to that of 17-AAG, including: degradation of HER2, mutant epidermal growth factor receptor, and other client proteins, inhibition of extracellular signal-regulated kinase and Akt activation, and induction of a Rb-dependent G1 arrest with subsequent apoptosis. SNX-5542 can be administered to mice orally on a daily schedule. Following oral administration, SNX-5542 is rapidly converted to SNX-2112, which accumulates in tumors relative to normal tissues. A single dose of SNX-5542 causes HER2 degradation and inhibits its downstream signaling for up to 24 h, and daily dosing results in regression of HER2-dependent xenografts. SNX-5542 also shows greater activity than 17-AAG in a non–small cell lung cancer xenograft model expressing mutant EGFR.
Conclusions: These results suggest that Hsp90 inhibition with SNX-2112 (delivered as a prodrug) may represent a promising therapeutic strategy for tumors whose growth and survival is dependent on Hsp90 clients.
; refs. 1–7). A number of mutant oncoproteins also require Hsp90 function, including v-Src, mutant epidermal growth factor receptor (EGFR), and mutant B-Raf, whereas their wild-type counterparts are either not dependent or only weakly dependent on Hsp90 (8–12). Given the critical roles played by Hsp90 clients in tumor growth and maintenance, inhibition of Hsp90 has emerged as a possible strategy for the treatment of advanced cancers. Several natural products, including the ansamycin geldanamycin, inhibit Hsp90 chaperone function by binding to an ATP pocket in the NH2-terminal domain of the protein. Geldanamycin proved too toxic for human use, but a 17-carbon position derivative, 17-(allylamino)-17-demethoxygeldanmycin (17-AAG), is now being tested in ongoing phase 1 and 2 clinical trials. Although antitumor activity has been observed in early-stage clinical trials of 17-AAG, this agent is poorly soluble and has limited oral bioavailability. The poor solubility of 17-AAG has necessitated the use of DMSO and cremaphor-based formulations that likely contribute to the toxicities observed in the clinical trials of this agent. Furthermore, the requirement for i.v. dosing has also likely limited the efficacy of 17-AAG in patients by placing practical limitations on the schedules of administration that can be evaluated. Accumulating data with non-ansamycin Hsp90 inhibitors also suggests that the dose-limiting hepatotoxicity of 17-AAG may be in part "off target", attributable to the chemical reactivity of its benzoquinone group and not a direct consequence of Hsp90 inhibition (13). For these reasons, orally bioavailable Hsp90 inhibitors that lack a quinone moiety may be more efficacious and less toxic than 17-AAG. Finally, expression of P-glycoprotein and loss or mutation of the NQO1 gene, which is required for the bioreduction of 17-AAG to the more potent hydroquinone 17-AAGH2, have been proposed as mechanisms of de novo or acquired resistance to 17-AAG (14, 15). Therefore, Hsp90 inhibitors that are not substrates for P-glycoprotein and do not require NQO1 metabolism may be more effective clinical agents than 17-AAG.
To identify novel inhibitors of Hsp90, a compound library was screened against the purine-binding proteome to identify novel scaffolds that selectively bind to the ATP pocket of Hsp90. Specifically, a purine-based affinity resin was used to capture purine-binding proteins. Compounds that displaced Hsp90 family members from this column were then identified by mass spectrometry (MS) sequencing. Using this technology, SNX-2112 was identified as a compound that selectively binds to the ATP pocket of Hsp90 family members (Hsp90
, Hsp90β, Grp94, and Trap-1). The SNX-2112 scaffold is unrelated in structure to any of the natural product–based Hsp90 inhibitors (including the geldanamycins, radicicols, and macbesins) and to the purine-based PU series (16).
We now show that SNX-2112 displays the antitumor profile of the natural product Hsp90 inhibitors: degradation of Hsp90 clients including HER2, the Rb-dependent G1 cell cycle arrest of cancer cells, and induction of morphologic differentiation of MCF-7 cells. HER2 degradation by SNX-2112 in HER2-dependent breast cancer cells resulted in potent inhibition of the Akt and extracellular signal-regulated kinase (Erk) pathways and inhibition of tumor cell proliferation both in vitro and in xenograft models. Furthermore, SNX-5542, a water-soluble and orally bioavailable prodrug of SNX-2112, displayed a favorable pharmacodynamic profile with a single oral dose administered to tumor-bearing mice, resulting in preferential tumor accumulation and greater inhibition of the Erk and Akt pathways in tumor compared with normal tissues. These effects were seen at nontoxic doses, which could be delivered chronically on a daily or five times per week schedule. These data suggest that SNX-2112 represents a novel inhibitor of Hsp90 with pharmacologic advantages over the natural product Hsp90 inhibitors and form the basis for the human clinical testing of this agent in patients with breast cancer and other advanced malignancies.
| Materials and Methods |
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Cell culture. BT-474, SKBr-3, SKOV-3, MCF-7, and MDA-468 were obtained from the American Type Culture Collection. Cells were maintained in DMEM-F12 medium supplemented with 100 units/mL penicillin, 100 mg/mL streptomycin, 4 mmol/L glutamine, and 10% heat-inactivated fetal bovine serum and incubated at 37°C in 5% CO2. H1650 was also obtained from American Type Culture Collection and grown in RPMI supplemented with 1 mmol/L pyruvate, 1.5 g/L sodium bicarbonate, 4.5 g/L glucose supplemented with 100 units/mL penicillin, 100 mg/mL streptomycin, 4 mmol/L glutamine, and 10% heat-inactivated fetal bovine serum. Cell viability was determined by seeding 2,000 to 5,000 cells per well in 96-well plates and treating with drug 24 h after plating in complete medium (200 µL). Each drug concentration was tested in eight wells. Cells were assayed using the Alamar blue viability test after a 96-h incubation. Flow cytometry was done using nuclei stained with ethidium bromide and isolated via the Nusse protocol (17).
Animal studies. Four- to 6-week-old nu/nu athymic BALB/c female mice were obtained from the National Cancer Institute-Frederick Cancer Center and maintained in pressurized ventilated caging at the Sloan-Kettering Institute. All studies were done in compliance with Institutional Animal Care and Use Committee guidelines. Before BT-474 cell inoculation, 0.72 mg sustained release 17β-estradiol pellets were placed s.c. with a 10 g trocar. Tumors were established by injecting 1 x 107 cells suspended 1:1 (volume) with reconstituted basement membrane (Matrigel, Collaborative Research). For efficacy studies, mice with established tumors were selected. Fourteen days after inoculation, mice were treated with SNX-5542 using the indicated doses. Tumor dimensions were measured with vernier calipers and tumor volumes were calculated using the formula
/6 x larger diameter x (smaller diameter)2. For pharmacodynamic studies, mice with well-established tumors were treated with SNX-5542 and sacrificed pretreatment, 3, 6, 10, 24, and 48 h posttreatment (two mice per time point).
Immunoblotting. Lysates were prepared by homogenizing tumors in SDS lysis buffer [50 mmol/L Tris-HCl (pH 7.4), 2% SDS], boiling for 10 min, followed by brief sonication. Lysates were then cleared by centrifugation at 14,000 x g for 10 min, and the supernatant was collected. Lysates from cells in culture were prepared by washing twice in cold PBS followed by lysis with NP40 lysis buffer (50 mmol/L Tris-HCl; 1% NP40; 40 mmol/L NaF; 150 mmol/L NaCl; 10 µmol/L/mL Na3VO4/phenylmethylsulfonyl fluoride/DTT; and 1 mg/mL leupeptin, aprotinin, and trypsin inhibitor). Protein concentration of each sample was determined using the BCA kit (Pierce Chemical) as per the manufacturer's instructions. Twenty-five or 50 µg of protein were resolved by SDS-PAGE and transferred onto nitrocellulose membranes. Blots were probed overnight at 4°C with primary antibodies (all from Cell Signaling except the following: HER2, Upstate Biotechnology; phosphatidylinositol 3-kinase–p85, Upstate Biotechnology; cyclin D1, Santa Cruz Biotechnology; P-HER2, Upstate Biotechnology) to detect proteins of interests. After incubation with horseradish peroxidase–conjugated secondary antibodies, proteins were visualized by chemiluminescence (ECL, Amersham Corp.).
Tissue distribution. Studies on the distribution of SNX-2112 were done on 40 to 100 mg of tissue flash frozen in liquid nitrogen at the indicated time points. Tissues were homogenized using the Bio-Plex cell lysis kit, and lysates were prepared using the Bio-Plex phosphoprotein detection reagent kit according to the manufacturer's instruction. Bead sets tested included the phospho-Akt (S473) and phospho-Erk1/2 (R202/Y204, R185/Y187). Extracts were prepared with a glass Dounce homogenizer in 100% acetonitrile containing an internal standard. Samples were analyzed by liquid chromatography–tandem MS using a Shimadzu high-performance liquid chromatography and an Applied Biosystems 4000 Q Trap.
ATP displacement assay. For the protein affinity–displacement assay, a purine-based affinity resin was generated by incubating ATP-linked Sepharose with Jurkat cell lysate (flash frozen and homogenized in saline) at 4°C (18). This was then incubated with test compounds (e.g., SNX-2112 or 17-AAG) for 90 min. Proteins eluted by drug were then resolved by SDS-PAGE, visualized with silver staining, and excised from the gel for MS-based identification. Briefly, after destaining and trypsin digestion (described elsewhere), peptides were extracted with µC18 ZipTips (Millipore) and then eluted and spotted directly to a conventional stainless steel matrix-assisted laser desorption/ionization target with a saturated solution of
-cyano-4-hydroxycinnamic acid (Sigma) in 50% acetonitrile (VWR), 0.15% formic acid (Sigma; refs. 19, 20). Mass spectra were then acquired using a MALDI-TOF/TOF 4700 Proteomics Analyzer (Applied Biosystems). MS spectra were acquired (1,000 shots per spectrum), and the three peaks from each with the greatest signal-to-noise ratio were automatically submitted for tandem MS analysis (3000 shots per spectrum). The collision energy was 1 keV. Air was used as the collision gas. Protein identification was done from the MS and tandem MS data using GPS Explorer software (Applied Biosystems) with the integrated Mascot database search engine.
| Results |
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and Hsp90β with low nanomolar affinity. With the exception of the Hsp90 family members Grp94 and Trap-1, SNX-2112 did not displace any of the >2,000 other purine-binding proteins included within the screen. Using this screen, SNX-2112 was observed to bind to Hsp90
and Hsp90β with a Ka of 30 nmol/L, compared with 88 nmol/L for geldanamycin and 1,039 nmol/L for 17-AAG (Table 1
). Moreover, several analogues of SNX-2112 were shown by X-ray crystallography to bind the amino-terminal ATP site of Hsp90 (data not shown).
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Effect of SNX-2112 on proliferation. Several groups, including our own, have observed that breast cancer cell lines with HER2 amplification are more sensitive to 17-AAG than cell lines with low levels of HER2 expression (24). We therefore assessed the effects of 17-AAG and SNX-2112 on tumor cells with variable levels of HER2 expression using a panel of breast, lung, and ovarian cancer cell lines. In all cell lines tested, SNX-2112 inhibited cell proliferation with IC50 values ranging from 10 to 50 nmol/L. In contrast to 17-AAG, the sensitivity of cancer cell lines to SNX-2112 in vitro did not correlate with the level of HER2 expression. Similarly, SNX-2112 sensitivity in vitro did not correlate with the expression or mutational status of ER, PTEN, or PIK3CA (Fig. 2A ).
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Pharmacodynamics of Hsp90 inhibition. Despite its drawbacks, 17-AAG effectively induces the degradation of Hsp90 client proteins in human tumor xenografts and intermittent administration has significant antitumor activity in murine models of HER2-dependent breast cancer (26, 27). SNX-5542 is a prodrug of the active metabolite, SNX-2112, with improved solubility and greater oral bioavailability. As shown in Fig. 3 , oral administration of a single dose of SNX-5542 to mice bearing BT-474 resulted in down-regulation of HER2 expression 6 to 24 h after drug exposure. Concordantly, there was loss of the phosphorylated forms of Akt and Erk as well as cyclin D1 expression. During the interval of Akt and Erk inhibition, an increase in the cleaved form of poly(ADP)ribose polymerase (c-PARP) was noted, indicative of apoptosis. These effects were dose dependent as lower doses (e.g., 25 mg/kg) showed a less profound effect on client protein expression. A maximal biological effect, however, was seen at 75 mg/kg (data not shown). In mice treated with a single dose of SNX-5542 up to 150 mg/kg, no gross toxicity was evident. These data confirm that tolerable doses of SNX-5542 can inhibit Hsp90 function and induces degradation of the HER2 client protein in tumors in vivo.
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40% inhibition of tumor growth after 5 weeks of treatment compared with a more than 70% reduction with SNX-5542. Tumor selectivity of Hsp90 inhibition. The basis for the therapeutic index of Hsp90 inhibitors has not yet been fully elucidated. Previous work has suggested that one basis for the selective sensitivity of cancer cells to Hsp90 inhibition may be a preferential accumulation of 17-AAG and other Hsp90 inhibitors in tumor tissues (29). To determine whether selective tumor uptake was also a property of SNX-5542, its tissue distribution after oral administration was assessed in nude mice bearing established BT-474 tumor xenografts. Figure 5 shows the biodistribution of SNX-2112 across a number of tissues in mice treated with a single oral dose (75 mg/kg) of SNX-5542. Of note, SNX-5542 is rapidly converted in vivo to SNX-2112, and measurable levels of SNX-5542 could therefore not be reliably detected in the serum or tumor. MS of homogenized tissues revealed preferential accumulation of the active metabolite, SNX-2112, in tumor tissues, particularly at the 24 and 48 h time points. For instance, at 24 h, there was a >10-fold excess of drug found in tumor tissue (5 µmol/L) compared with that in lung, small intestine, liver, skin, uterus, and kidney. The drug concentrations in muscle, brain, and heart were negligible (<100 nmol/L) at these time points. The latter is notable as cardiac toxicity has been a theoretical concern with this class of agents given the role played by chaperones in the maturation of the cardiac potassium channel HERG (30).
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24 h. In contrast, SNX-5542 treatment had only a minimal effect on the activity of these pathways in liver. We speculate that the lack of effect on Akt and Erk pathway activity in liver versus tumor cells is attributable to the presence of a highly sensitivity Hsp90 client (HER2) in BT-474 tumors, which is absent in liver. | Discussion |
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; refs. 1–7). Given the critical roles played by these Hsp90 clients in tumor growth and maintenance, inhibition of Hsp90 has emerged as a possible strategy for the treatment of advanced cancers. Several mutant oncoproteins, including v-Src, mutant EGFR, and mutant B-Raf, are also Hsp90 clients whereas their wild-type counterparts are either not dependent or only weakly dependent on Hsp90 chaperone function (8–12). The dependence of these gain-of-function mutants on Hsp90 suggests that Hsp90 may be permissive for the development of tumors that express these oncogenes.
In this study, we characterized the antitumor effects of SNX-2112, a novel compound that binds selectively to the NH2-terminal ATP pocket of Hsp90. The SNX-2112 scaffold was identified by screening the purine-binding proteome for nonquinone- and nonpurine-containing scaffolds that bind selectively to Hsp90. This compound is pan-selective for the Hsp90 family in that it binds to Hsp90
, Hsp90β, Grp94, and Trap-1. To determine whether binding of SNX-2112 to Hsp90 resulted in inhibition of Hsp90 chaperone activity, we compared the effects of SNX-2112 to those of the geldanamycin derivative 17-AAG using a panel of breast, ovarian, and lung cancer cell lines. We found that SNX-2112 potently down-regulated HER2 expression and inhibited Akt and Erk pathway activity in breast cancer cells with HER2 amplification. These effects occurred with a kinetics and potency similar to that of 17-AAG. We further showed that treatment of breast cancer cells in vitro with SNX-2112, like 17-AAG, resulted in marked growth inhibition and other hallmarks of the natural product Hsp90 inhibitors, including a Rb-dependent G1 growth arrest and morphologic differentiation in selected models. These data suggest that the drugs have the same target activity (antagonizing Hsp90 activity) and comparable antitumor activities in vitro.
One notable exception, however, was the breast cancer cell line MDA-468. In this model, SNX-2112 was markedly more potent than 17-AAG. Previous work has shown that 17-AAG is metabolized by DT-diaphorase to the more potent hydroquinone 17-AAGH2 (14, 15). MDA-468 cells are resistant to 17-AAG because the gene encoding for this activity, NQO1, is mutated in MDA-468 cells. Transfection of NQO1 into MDA-468 cells, however, restores sensitivity of this model to 17-AAG, confirming that loss of DT-diaphorase expression can confer 17-AAG resistance (15). Our data thus suggest that SNX-2112 activity is independent of NQO1 activity and that SNX-2112 may therefore have a broader spectrum of antitumor activity than 17-AAG. Given that the purine-based synthetic Hsp90 inhibitor PU24FCl has a similar activity profile to SNX-2112 in these cells, we hypothesize that the dependence of MDA-468 cells on Hsp90 function is not accurately reflected by the lack of activity of 17-AAG in this model.
SNX-2112 has variable oral bioavailability and therefore with the goal of testing the utility of this compound in mice, several prodrugs of SNX-2112 were developed that display improved solubility and pharmacologic properties. We show that a single dose of SNX-5542, a water-soluble prodrug of SNX-2112, was sufficient to induce the degradation of HER2 in tumor-bearing xenografts. Following oral administration of SNX-5542, the drug was rapidly converted to SNX-2112 where it preferentially accumulated in tumor tissues. Notably, recovery of HER2 expression and the activity of its downstream effector pathways were observed at late time points (24 and 48 h) despite the continued presence in the tumor of SNX-2112 concentrations greater than those necessary to inhibit Hsp90 in vitro. We speculate that this may be due to either intracellular compartmentalization of the drug or induction of Hsp70 expression. In experiments where we rechallenged with daily doses of SNX-5542 in vivo, we did observe similar kinetics of client degradation and signal deactivation after a third consecutive dose. Thus, at least for three consecutive doses, we did not find significant tachyphylaxis to the effects of SNX-2112.
In mice with established BT474 (HER2-amplified) xenografts, daily oral administration of SNX-5542 resulted in partial tumor regressions. These data were comparable if not superior to the effects of i.p. administration of 17-AAG in this model system using intermittent dosing schedules (three times per week or days 1-5 every 2 weeks). In prior studies of 17-AAG, daily dosing was not, however, feasible in either mice or in patients due to hepatotoxicity (31–35). For this reason, 17-AAG is currently being tested in phase 2 trials using only intermittent dosing schedules: either weekly or days 1, 4, 8, and 11 every 21 days. Notably, in a pilot dog study, no significant hepatotoxicity was observed after 13 days of twice-daily dosing of SNX-5542 at the highest dose tested, 10 mg/kg. These data suggest that non-ansamycin Hsp90 inhibitors such as SNX-2112 may have a more favorable toxicity profile than 17-AAG, although human clinical trials will be necessary to test this hypothesis.
In addition to 17-AAG, several novel ansamycins are now in clinical development. These include the water-soluble and orally bioavailable geldanamycin derivative 17-(dimethylaminoethylamino)-17-demethoxygeldanamycin and IPI-504, a prodrug of 17-AAG with improved solubility and oral bioavailability (36, 37). Although these agents have superior pharmacologic profiles to 17-AAG in terms of solubility and oral bioavailability, they also contain the quinone species found in 17-AAG and would therefore be predicted to retain the hepatotoxicity characteristic of this class of agents. As a nonquinone-based Hsp90 inhibitor, SNX-2112 may therefore have potential toxicologic advantages over these geldanamycin derivatives.
Finally, it is important to note that Hsp90 inhibition has shown provocative activity in a variety of cancer types. In this report, we show that SNX-5542 has activity in a model of EGFR mutant non–small cell lung cancer. We find that SNX-5542 is superior to 17-AAG in this model. In contrast to the effects of SNX-5542 in mice with established BT-474 tumors, monotherapy with SNX-5542 was insufficient to induce complete growth inhibition in mice with established H1650 xenografts. It is unclear if the greater resistance of this tumor to SNX-5542 relates to intrinsic properties of the tumor model or deficiencies in target inhibition in this system. For example, H1650 cells contain not only an EGFR deletion mutant but also are PTEN deficient. Although tumor regression was not observed in this model with SNX-5542 alone, we have recently shown that the combination of 17-AAG and paclitaxel is synergistic in this model. Therefore, despite its advantages over 17-AAG, the use of combination strategies will likely still prove necessary in some systems despite the presence of a sensitive Hsp90 client oncoprotein. Nevertheless, given the potential advantages of the small-molecule platform, these studies underscore the impetus for the clinical testing of SNX-5542, an Hsp90 inhibitor with superior pharmacologic properties.
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The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked advertisement in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
Received 7/ 9/07; revised 9/ 6/07; accepted 10/10/07.
| References |
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protein via the proteosome pathway in prostate cancer cells. Cancer Res 2002;62:2478–82.This article has been cited by other articles:
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||||
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||||
![]() |
U. Banerji Heat Shock Protein 90 as a Drug Target: Some Like It Hot Clin. Cancer Res., January 1, 2009; 15(1): 9 - 14. [Abstract] [Full Text] [PDF] |
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