Efficacy of Cyclin-Dependent-Kinase 9 Inhibitors in a Murine Model Of
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Leukemia (2014) 28, 1427–1435 & 2014 Macmillan Publishers Limited All rights reserved 0887-6924/14 www.nature.com/leu ORIGINAL ARTICLE Efficacy of cyclin-dependent-kinase 9 inhibitors in a murine model of mixed-lineage leukemia M-P Garcia-Cuellar1,EFu¨ ller1,EMa¨thner1, C Breitinger1, K Hetzner1, L Zeitlmann2, A Borkhardt3 and RK Slany1 Mixed-lineage leukemia fusion proteins activate their target genes predominantly by stimulating transcriptional elongation. A core component necessary for this activity is cyclin-dependent kinase 9. Here we explored the effectiveness of small molecules targeting this enzyme as potential therapeutics. A screen of seven compounds with anti-CDK9 activity applied to a panel of leukemia cell lines identified flavopiridol and the experimental inhibitor PC585 as superior in efficacy with inhibitory concentrations in the submicromolar range. Both substances induced rapid dephosphorylation of the RNA polymerase II C-terminal domain, accompanied by downregulation of CDK9-dependent transcripts for MYC and HOXA9. Global gene expression analysis indicated the induction of a general stress response program, culminating in widespread apoptosis. Importantly, colony-forming activity in leukemia lines and primary patient samples could be completely inhibited under conditions that did not affect native precursors from bone marrow. In vivo application in a mouse transplant model significantly delayed disease with PC585 showing also oral activity. These results suggest CDK9 inhibition as novel treatment option for mixed-lineage leukemia. Leukemia (2014) 28, 1427–1435; doi:10.1038/leu.2014.40 Keywords: mixed-lineage leukemia; CDK9; inhibitor; preclinical study INTRODUCTION complex) including P-TEFb is responsible for elongation control,5 Despite considerable progress in leukemia treatment, mixed- DotCom (DOT1L complex) methylates histone H3 at lysine 79 lineage leukemia (MLL) remains a disease with a very dismal through the catalytic activity of the histone methyltransferase 12 prognosis. Five-year survival rates for affected patients hover well DOT1L, and the MLL fusion partner ENL forms a scaffold that below 50%.1,2 MLL occurs mostly either in infants or in adults as integrates these subcomplexes and in addition it neutralizes the 13 late sequelae after previous treatment for an unrelated neoplastic repressive activity of polycomb proteins. Importantly, all these condition. The hallmark of MLL is an aberration of chromosome functions are essential for the transforming activity of MLL fusion eleven, affecting the gene coding for the histone proteins. methyltransferase MLL. As a consequence, transforming fusion In an effort to develop new therapeutics with activity against proteins are created that join part of MLL with a variety of MLL fusions, small-molecule inhibitors of the DOT1L methyltrans- different fusion partners.3,4 We and others have shown that the ferase have been designed and tested in early preclinical trials 14,15 most frequent MLL partners are members of a complex that where they showed efficacy in mouse models of MLL. The specifically stimulates transcriptional elongation.5–8 By this strategies for pharmaceutical targeting of transcriptional mechanism, MLL fusions activate an oncogenic network that elongation are represented by recent publications that use the 16–19 includes the clustered HOX-homeobox genes as important experimental inhibitors JQ1 and/or iBET. These substances determinators of hematopoietic development.9 block the activity of the BET (bromodomain and extra Control of transcriptional elongation is the predominant bromodomain) protein family (BRD2/3/4 and BRDT) by regulatory checkpoint for many genes involved in proliferation, selectively disrupting their binding to chromatin. BET proteins differentiation, and for immediate response transcripts (for are normally instrumental for the proper recruitment of P-TEFb to reviews of this topic see Adelman and Lis10 and Peterlin and acetylated histones. This mark is particularly prevalent in the area Price11). On a molecular level, the rate of elongation is determined surrounding actively initiated transcription units. Because many by the phosphorylation status of the C-terminal repeat domain of growth-related transcripts, with MYC as a prime example, depend RNA polymerase II (CTD). During initiation, TFIIH-associated on P-TEFb, the effect of BET inhibitors is pleiotropic. Consequently, kinases CDK7 and CDK8 phosphorylate Ser5 of the CTD- these molecules have been variably proposed as general heptapeptide. Subsequently, Ser2 needs to be converted to anti-cancer agents targeting mainly MYC17,18 or as a tool for phosphoserine for efficient elongation. This reaction is catalyzed intervention in MLL-fusion leukemia because of the particular by P-TEFb (positive transcription elongation factor b) a dimer of importance of P-TEFb in this disease.16 Despite their promise, CDK9 and a cyclin T. P-TEFb purifies with MLL fusion partners in a these compounds are new, with partially difficult pharmacological large macromolecular complex called EAP (ENL-interacting properties, and ‘first in man’ studies have yet to be reported. proteins or elongation-assisting proteins).6 EAP contains at least In contrast, CDK9 inhibitors have been developed for many years. three separable functional modules: SEC (super elongation Although results are mostly outstanding, flavopiridol (alvocidib), 1Department of Genetics, University Erlangen, Erlangen, Germany; 2Ingenium Pharmaceuticals AG, Munich, Germany and 3Clinic of Paediatric Oncology, Haematology and Clinical Immunology, Centre for Child and Adolescent Health, Medical Faculty, Heinrich-Heine-University Du¨sseldorf, Du¨sseldorf, Germany. Correspondence: Professor RK Slany, Deptartment of Genetics, University Erlangen, Erwin Rommel Str. 3, Erlangen 91058, Germany. E-mail: [email protected] Received 11 November 2013; revised 10 January 2014; accepted 15 January 2014; accepted article preview online 21 January 2014; advance online publication, 11 February 2014 CDK9 inhibitors in mixed-lineage leukemia M-P Garcia-Cuellar et al 1428 the best investigated CDK9 inhibitor, was already included in a enriched with 10 ng/ml IL7 (Stemcell Technologies, Grenoble, France). number of mostly phase I and phase II studies testing safety and Primary precursor cells from mouse bone marrow were isolated by magnetic response in a wide variety of solid and hematological tumors selection of CD117 (c-kit)-positive cells according to the instructions (ClinicalTrials.gov). of the manufacturer (Miltenyi Biotech, BergischGladbach, Germany). Here we examined the potential of CDK9 inhibition as potential Transplantation studies were done in a syngeneic model. Three days before transplantation Balb/C mice were prophylactically treated with therapeutic intervention for mixed-lineage leukemia. We show 6 1.1 g/l neomycin and 1 Â 10 units/l polymixinB as addition to drinking efficacy of this approach in vitro and in vivo suggesting that MLL water. Twenty-four hours after sublethal total body irradiation (6 Gy), should be included as further indication for future CDK9 inhibitor 1 Â 106 MLL-ENL-transformed cells were transplanted by retroorbital trials. injection. Treatment commenced either 2 days or 14 days after transplant by subcutaneous injection or by oral gavage. Substances for injection were dissolved in 25% DMSO/75% PBS. Suspensions for oral gavage were MATERIALS AND METHODS prepared in 0.8% methocel in H2O with 300 ml administered per individual Cell lines dose. Animals with clear signs of disease (hunched posture, ruffled fur, labored breathing) were euthanized. Spleen weight was recorded as an Human leukemia lines with MLL rearrangement (HB11;19, SEM, KOPN-8, objective surrogate marker for leukemia burden. Cohorts were followed for MV4;11, RS4,11, THP1 and Karpas45) and cells without involvement of 11q23 (HL60, K562, U937, REH and Jurkat) were obtained from the German a maximum of 120 days and surviving animals without signs of collection of microorganisms and cell cultures (DSMZ, Braunschweig, leukemia (normal physiology, spleen weighto100 mg, no infiltration Germany) or they were laboratory stocks. All human lines were kept in of leukemia cells in lymph nodes or inner organs) were censored from RPMI1640 supplemented with 10% fetal calf serum (FCS), except Karpas45 the results. Engraftment rates were generally between 80% and 100%. Animal procedures have been approved by local and institutional animal that was grown in 20% FCS. Mouse MLL-ENL-transformed lines Me2 and welfare review boards under license numbers 54–2532.1–41/11 and Me3, as well as cells used for transplantation assays were obtained by 20 54–2532.2–5/12. retroviral transduction as described. MeerIV was derived from a mouse with a germ-line integration of an inducible MLL-ENL-ER construct.21 Murine cells were cultivated in RPMI, 10% FCS and recombinant murine cytokines: 50 ng/ml stem cell factor, 5 ng/ml each of IL3, IL6 and RESULTS GM-CSF. For MeerIV cells, 100 nM 4-hydroxytamoxifen was added to Leukemia cell lines are sensitive to CDK9 inhibition in vitro activate MLL-ENL. To select for the most efficient CDK9 inhibitors, we employed seven human leukemia cell lines with MLL rearrangement (Karpas, CDK9 inhibitors, proliferation assays, antibodies THP1, RS4;11, MV4;11, SEM, KOPN-8, HB11;19) and five human cell Alsterpaullone, CDK9 inhibitorII and CDC7_CDK9 inhibitor were bought lines derived from hematological malignancies without 11q23 from Merck/Calbiochem (Darmstadt, Germany).