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Expression and Confers Hypersensitivity to Etoposide in Human Leukemic Cell Lines1
Department of Pharmaceutical Sciences [E. U. K., S. E. W., K. B. L., B. P. S., D. J. K.], Center for Pharmaceutical Biotechnology [D. J. K.], and Program in Molecular Toxicology and Environmental Health Sciences [B. P. S., D. K. J.], School of Pharmacy, University of Colorado Health Sciences Center, and University of Colorado Cancer Center [E. U. K., D. J. K.], Denver, Colorado 80262, and Department of Pharmacology, University of Pittsburgh School of Medicine and Cancer Institute, Pittsburgh, Pennsylvania 15261 [W. P. A., J. C. Y.]
| Abstract |
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(topo II
) gene promoter activity and a 2-fold increase in topo II
protein early in monocytic differentiation of HL-60 cells. This observation has now been extended to other short chain fatty acids and aromatic butyrate analogues, and evidence is presented that human topo II
promoter induction correlates closely with histone H4 acetylation status. Because increased topo II
expression is associated with enhanced efficacy of topo II-poisoning antitumor drugs such as etoposide, the hypothesis tested in this report was whether NaB pretreatment could sensitize HL-60 myeloid leukemia and K562 erythroleukemia cells to etoposide-triggered DNA damage and cell death. A 2472 h NaB treatment (0.40.5 mM) induced topo II
22.5-fold in both HL-60 and K562 cells and caused a dose-dependent enhancement of etoposide-stimulated, protein-linked DNA complexes in both cell lines. At concentrations with minimal effects on cell cycle kinetics (0.4 mM in HL-60; 0.5 mM in K562), NaB pretreatment also modestly enhanced etoposide-triggered apoptosis in HL-60 cells, as determined morphologically after acridine orange/ethidium bromide staining, and substantially increased K562 growth inhibition and poly(ADP-ribose)polymerase cleavage after etoposide exposure. Therefore, a temporal window may exist whereby a differentiating agent may sensitize experimental leukemias to a cytotoxic antitumor agent. These results indicate that histone deacetylase inhibitors should be investigated for etoposide sensitization of other butyrate-responsive hematopoietic and nonhematopoietic tumor lines in vitro and in vivo. | Introduction |
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, a nuclear enzyme essential for completion of mitosis (1-3), has been a primary focus of our research groups (4-8). Drugs such as the epipodophyllotoxins (etoposide and teniposide), anthracyclines, ellipticines, anthracenediones, and aminoacridine derivatives exert their cytotoxic activity, at least in part, by trapping topo II in a covalent complex with DNA (9). These "cleavable complexes" (10) can act as physical barriers to DNA replication (11-13), cause mitotic catastrophes (14), induce recombination events (15, 16), and/or trigger a cytotoxicity cascade culminating in apoptosis (17-19). Because the class of antitumor drugs converts this essential enzyme into a lethal instrument, it follows that tumor cell populations possessing high levels of topo II
are more effectively killed by these agents.
Two genes exist for mammalian type II DNA topoisomerases, termed
and ß, likely attributable to evolutionary gene duplication (20, 21). topo II
is often the more predominant cellular form (22, 23). Cleavable complexes formed with topo II
correlate more closely with teniposide cytotoxicity in leukemia cells than do those formed with topo IIß (24), but in other systems topo IIß may also influence drug sensitivity (25, 26). The
form is expressed in a proliferation-dependent manner, whereas the ß form is expressed independently of growth status (27-29). Therefore, rapidly growing cells that contain high topo II
levels are effectively killed by the topo II-directed drugs, whereas differentiated or otherwise growth-arrested cells usually possess diminished topo II
levels and are intrinsically resistant to these agents (9, 30, 31). Similarly, acquired resistance to a topo II-directed agent is often attributable to suppressed topo II
and/or topo IIß expression (8, 32, 33).
Several transcription factors have been linked to the high, proliferation-dependent expression of topo II
including c-Myb and B-Myb (5), NF-M (4), NF-Y (34-37), and YB-1 (38). The Sp3 transcription factor is also known to activate the human topo II
gene (39). Conversely, the p53 tumor suppressor protein represses the human topo II
gene through the basal transcriptional machinery (40) or via an inverted CCAAT box at position -68 (41). The activated Ras pathway also stimulates both topo II
activity and expression. topo II
activity is enhanced via protein interactions with extracellular signal-regulated kinase 2 (42), and topo II
trans-activation can be driven through a Ets-like enhancer element at position -480 of the topo II
promoter (43). Finally, hyperthermia also induces topo II
expression in vitro (44) as a result of increased topo II
mRNA stability (45).
In previous studies, the serendipitous observation was made that topo II
transcription and gene expression was transiently induced by the monocytic differentiating agent, NaB (6). NaB has long been recognized as an inhibitor of HDAC activity (46), an effect that is, in turn, associated with selective gene activation or repression (47-49). It was hypothesized that as a result of increased topo II
expression, NaB-pretreated leukemia cells would exhibit increased sensitivity to etoposide because of increased topo II-mediated DNA damage.
In the present study, we show that several SCFAs and aromatic butyrate analogues also stimulate the activity of a synthetic topo II
promoter-reporter construct in direct relation to the magnitude of histone deacetylase inhibition. NaB, the most efficacious stimulator of topo II
promoter activity and histone H4 acetylation, also induces the endogenous expression of pharmacologically competent topo II
protein in both HL-60 and K562 cells. Consequently, NaB pretreatment sensitizes human leukemia cells to etoposide cytotoxicity measured by increased fraction of morphologically apoptotic cells (HL-60), enhanced growth inhibition (K562), or stimulation of PARP proteolytic cleavage. Our results are discussed in light of other recent reports of a physical relationship between topo II
and HDACs and indicate that other butyrate-responsive hematopoietic and nonhematopoietic cell lines should be investigated for synergism between HDAC inhibitors and classical cytotoxic agents.
| Materials and Methods |
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Mammalian Cell Culture
HL-60 human promyelocytic cells (ATCC CCL 240) or K562 human erythroleukemia cells (ATCC CCL 243) were obtained from the ATCC (Manassas, VA). Cells were maintained as suspension cultures in either RPMI 1640 (HL-60) or Iscoves modified Minimal Essential Medium (K562; Life Technologies, Inc.) supplemented with 10% fetal bovine serum, 50 units/ml penicillin G, and 50 µg/ml streptomycin sulfate. All cells were maintained at 37°C in a humidified atmosphere containing 5% CO2. Cells were carried as exponentially growing cultures by propagation at 5 x 105 cells/ml every 23 days.
Cellular Histone Acetylation Assay
Nuclei were isolated, and histone fractions were prepared from cell nuclei as described (50) with the following modifications. Pelleted nuclei were resuspended in 1.35 ml of sterile, ice-cold water containing 1 mM phenylmethylsulfonyl fluoride and 0.15 ml of 4 N H2SO4 added dropwise with swirling and histones extracted overnight. After centrifugation at 12,000 x g for 10 min, histone supernatants were transferred to 15 ml of Falcon polypropylene tubes and filled with cold acetone/HCl (99:1 acetone:5 N HCl) and incubated at -20°C for 72 h. During the final pelleting of the histone isolates, all samples were initially centrifuged for 10 min at 2,000 x g in a swinging-bucket rotor. The supernatants were aspirated to
1 ml, mixed by pipetting, then transferred to a 1.5 ml of Eppendorf tube for centrifugation at 12,000 x g for 10 min at 4°C. Supernatants were carefully aspirated, and pellets were lyophilized and then resuspended in loading buffer (8 M urea, 10% glycerol, 0.9 N acetic acid, 5% 2-mercaptoethanol, and 0.25% methyl green) for Triton-acid-urea gel electrophoresis. Triton-acid-urea gels containing 12% polyacrylamide (in 7.5 M urea, 0.37% Triton X-100, 0.9 N acetic acid, 0.125% ammonium persulfate, and 0.125% TEMED) were prerun for 6 h at 115 V until constant amperage was achieved. The wells were loaded with 1 M cysteamine, 7.5 M urea, 0.9 N acetic acid and run for another hour at 115 V. Solubilized histones were boiled for 5 min and then loaded and subjected to electrophoresis at 115 V for 1518 h. After Coomassie Blue staining, gels were scanned, and acetylated bands were quantified on a Bio-Rad Fluor-S MultiImager (f/11, white light scan, clear filter, 3 s). The intensity of uni-, bi-, and triacetylated histone H4 bands (denoted 1, 2, and 3, respectively) were combined, and data were expressed as a ratio relative to the unacetylated form (denoted 0).
topo II Assays
Western immunoblotting for steady-state topo II
protein levels from HL-60 nuclear extracts was performed exactly as described by Fraser et al. (6) using a polyclonal antiserum generated in the Yalowich laboratory to a COOH-terminal recombinant topo II
peptide (7).
Transcriptional activation of a topo II
promoter-luciferase reporter construct was assessed following cellular electroporation as described previously (6) using the construct, -562TOP2LUC. The promoter region of this plasmid corresponds to positions -562 to +90 of the human topo II
5'-flanking region (51), which had been cloned upstream of the firefly luciferase cDNA in pA3LUC. Various concentrations of NaB or other fatty acids (dissolved in sterile water, or 0.9% saline for the aromatic analogues) were incubated in triplicate with transfected cells continuously for 24 h prior to harvest and quantitation of reporter gene activities. topo II
promoter activity was normalized to the activity derived from an internal control plasmid, pCMV-ßgal, which encodes Escherichia coli ß-gal under control of the CMV immediate/early promoter, as described previously (5, 6).
Etoposide-stabilized topo II-DNA cleavable complexes were quantified using a modification (32) of a K-SDS precipitation assay. Briefly, exponentially growing HL-60 or K562 cells (5 x 105/ml) were incubated for 24 h with [14C]leucine (0.2 µCi/ml; 325 mCi/mmol) and [methyl-3H]]thymidine (0.6 µCi/ml; 6.7 Ci/mmol). In the case of HL-60 cells, the labeling was accompanied by a 24-h exposure to either 0 or 0.4 mM NaB; for K562 cells, the labeling was preceded by a 48-h exposure to 0 or 0.5 mM NaB and continued during the labeling period for a total of a 72 h butyrate exposure. During the final 30 min, cells received 0100 µM etoposide (Sigma Chemical Co.; dissolved in DMSO) or an equivalent amount of vehicle, in triplicate. Cell suspensions were then pelleted by centrifugation at 1000 x g and lysed with 500 µl of a solution containing 2.5% (w/v) SDS, 10 mM EDTA, and 0.8 mg/ml salmon sperm DNA. The lysate was sheared through a 23-gauge needle 15 times and then incubated at 65°C for 15 min. Protein and protein-associated DNA were precipitated by the addition of 110 µl of 1 M KCl. Precipitates were recovered by centrifugation at 5000 x g and washed three times with a solution containing 10 mM Tris-HCl (pH 8.0), 100 mM KCl, 1 mM EDTA, and 0.1 mg/ml salmon sperm DNA. Precipitable 14C and 3H was assessed by dissolving the pellet in 500 µl of water followed by liquid scintillation counting. Cleavable complex data were expressed as the fold-increase over control in the ratio of 3H cpm/14C cpm and plotted relative to etoposide concentration as the mean fold-increase ± SE.
Apoptosis and Cell Growth Inhibition Measurements
The effect of a 24 h of 0.4 mM NaB pretreatment on etoposide-triggered apoptosis was quantified using the ethidium bromide/acridine orange fluorescence microscopy method of Duke and Cohen as extensively described and documented by Dwyer-Nield et al. (52). HL-60 cells were exposed to various concentrations of etoposide during the final 24 h of NaB. Cells were centrifuged at 350 x g for 5 min and then resuspended at
5 x 105 to 5 x 106 cells/ml of RPMI 1640 plus 10% fetal bovine serum. One µl of a dye mixture containing of 100 µg/ml acridine orange (Sigma Chemical Co.) and 100 µg/ml ethidium bromide (Sigma Chemical Co.) prepared in PBS were placed in the bottom of a 12 x 75-mm glass tube, followed by 25 µl of cell suspension. After gentle agitation, 10 µl of the dye-cell mixture was placed on a clean microscope slide and then covered with a 22-mm2 coverslip. Cells were examined under epi-illumination at x400-x800. After counting 200 cells, the number of each of four cellular states were scored: (a) viable cells with normal nuclei (VN; bright green chromatin with organized structure); (b) viable cells with apoptotic nuclei (VA; bright green chromatin highly condensed or fragmented); (c) nonviable cells with normal nuclei (NVN; bright orange chromatin with organized structure); (d) nonviable cells with apoptotic nuclei (NVA; bright orange chromatin highly condensed or fragmented). For the purposes of this report, data were expressed only for the percentage of apoptotic cells (VA + NVA/total).
For K562 cells, exponentially growing cultures were exposed to 0 or 0.5 mM NaB for 72 h and then pelleted and exposed to increasing concentrations of etoposide in NaB-free medium for 1 h at 37°C. Cells were pelleted and washed twice with drug-free medium and then resuspended at a cell density of 1.2 x 105 cells/ml. Cells were counted 48 h later on a model ZBF Coulter Counter (Coulter Electronics, Hialeah, FL). Cell growth (beyond the starting concentration of 1.2 x 105 cells/ml) in etoposide-treated versus control cells was ultimately expressed as a percentage of inhibition of control cell growth. The 50% growth inhibitory concentration (IC50) was calculated from replicate concentration-response curves generated from three separate experiments.
Cleavage of PARP as a measure of apoptotic caspase activity (53) was also assessed after etoposide exposure in K562 cells pretreated with NaB (0.5 mM for 72 h) by immunoblotting for the Mr 116,000 parent band and the Mr 85,00089,000 proteolytic cleavage product. Following SDS-PAGE with 7.5% acrylamide and electrotransfer to Immobilon-P membranes, blots were probed with a polyclonal antiserum obtained from Santa Cruz Biotechnology Biochemical (Santa Cruz Biotechnology, CA) at a 1:1000 dilution in TBS-T [25 mM Tris-HCl (pH 7.4), 150 mM NaCl, and 0.05% Tween 20] with 5% nonfat dry milk. Secondary detection of immune complexes was accomplished by probing with a 1:5000 dilution of goat antirabbit-horseradish peroxidase conjugate (Pierce, Rockford, IL), and bands were detected by fluorescence radiography using an enhanced chemiluminescence substrate (NEN).
Statistical Analysis
Where indicated, differences from control values were assessed by one-way ANOVA using Dunnetts multiple comparison post-hoc test with GraphPad Prism software. Significant differences were indicated where P < 0.05.
| Results |
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Promoter and Acetylation of Histone H4 in HL-60 Cells
promoter (6), we sought to investigate whether this was a property shared by other SCFAs and, if so, whether the magnitude of induction correlated with HDAC inhibitory activity. HL-60 cells were transfected with -562TOP2LUC and treated for 24 h with 1 mM concentrations of each of the SCFAs with carbon chain lengths from two to seven and the aromatic butyrate analogues, phenylacetate and phenylbutyrate (as sodium salts), followed by quantitation of luciferase reporter enzyme activity. Parallel cultures, treated identically, were subjected to analysis of histone acetylation status by electrophoresis on Triton-acid-urea gels.
SCFAs as short as acetate (C2) produced a significant increase in topo II
promoter activity, which rose substantially as chain length increased, peaking at 9.6-fold with butyrate (C4), then decreasing to 4.3-fold with caproate (C6), and returning to control levels with the seven-carbon fatty acid, heptanoate (Fig. 1). Of the aromatic butyrate analogues, only phenylbutyrate substantially activated this promoter construct in HL-60 cells, although phenylacetate could induce the promoter >2-fold at concentrations
4 mM (data not shown). The biphasic response seen with the SCFAs is highly reminiscent of the relationship between carbon chain length and histone acetylation observed previously in HeLa cells (54). We therefore investigated whether there was a direct correlation between the magnitude of topo II
promoter activation produced by the SCFAs and the increase in histone H4 acetylation status.
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promoter inducers were also the most effective inhibitors of histone H4 deacetylation. This relationship is demonstrated graphically in Fig. 2B. However, this concordance with topo II
promoter activation appeared to plateau at the very high levels of histone acetylation caused by butyrate. This observation suggests an upper limit to this relationship, such that above an acetylated:unacetylated histone H4 ratio of 3, little further induction of the topo II
promoter can be achieved.
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promoter-driven reporter enzyme activity 317-fold but caused only a
2-fold increase in steady-state topo II
protein levels (6). A similar magnitude of NaB induction of topo II
protein levels (2.1 ± 0.3-fold; mean ± SE from three separate experiments) is shown in Fig. 3 by the band at Mr 170,000. Using 24 h pretreatment as the optimal time for observing topo II
induction, we investigated whether greater NaB concentrations (18 mM) would further induce enzyme expression. Although these higher NaB concentrations caused a 1540-fold induction of reporter enzyme activity derived from the promoter construct, endogenous topo II
protein levels still increased by only 2.52.7-fold at 1 mM NaB and fell to under 2-fold control levels at higher NaB concentrations (data not shown). These results are not entirely surprising in that topo II
levels rarely vary by more than 23-fold in proliferating cells, and forced overexpression of the enzyme is known to cause feedback inhibition of its own transcription (55).
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protein levels in another commonly used experimental leukemia cell line, K562. Similar to HL-60 cells, K562 cells will differentiate in response to NaB but exhibit more delayed kinetics in both differentiation as well as in response to cytotoxic agents (18). In K562 cells treated with NaB for 72 h, topo II
expression was induced 2.5 ± 0.2-fold (mean ± SE from five separate experiments; Fig. 3).
Increased topo II
Expression in HL-60 and K562 Cells Correlates with Increased Etoposide-stabilized, Protein-linked DNA
To assess whether the topo II
induced by NaB in HL-60 and K562 cells was pharmacologically functional, a classic protein-linked DNA assay was used in the presence of etoposide as an indicator of the extent of cleavable complex formation in intact cells (Fig. 4). Consistent with the NaB-mediated increase in topo II
expression in HL-60 and K562 cells (Fig. 3), NaB-pretreated HL-60 and K562 cells both displayed a greater magnitude of protein-linked DNA as a function of etoposide concentration, as compared with control cells not exposed previously to NaB (Fig. 4). Therefore, the increased levels of topo II
detected in Fig. 3 represented a pharmacologically functional pool of enzyme in both leukemic cell lines. However, it should be noted that one limitation of this assay is the inability to determine the topo II isoform increasingly trapped in complexes from NaB-pretreated cells. Although these data are consistent with an increase in topo II
, conclusive demonstration of the isoform(s) involved will require immunological confirmation.
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led to an enhancement of the apoptotic efficacy of etoposide in HL-60 cells.
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induction and increased drug-induced protein-linked DNA, the potential contribution of altered cell cycle kinetics to etoposide sensitization was also investigated. topo II-directed drugs are known to be most effective during S-phase but can kill cells to some extent at all phases of the cell cycle (9, 12, 57). Our earlier work demonstrated that a 16-h treatment of HL-60 cells with 0.4 mM NaB could trigger a very transient increase in DNA synthesis (as measured by [3H]thymidine pulse incorporation), which returned to control levels by 24 h (6). Consistent with this earlier finding, the data in Table 1 indicate that 24 h of NaB pretreatment had no substantial effect on HL-60 cell cycle distribution. In fact, the very small but statistically significant increase in G2-M distribution may actually reflect the increased need for topo II
enzyme activity in chromosomal segregation. Therefore, NaB-mediated etoposide sensitization of HL-60 cells did not appear to result from altered cell cycle kinetics but was rather more likely a result of increased cellular topo II
content.
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expression with a concordant increase in etoposide-stimulated, enzyme-mediated DNA damage. | Discussion |
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expression (6), it was reasoned that a window may exist to maximize rationally differentiation/cytotoxic drug efficacy. In the present report, NaB-induced topo II
expression correlated with enhanced etoposide-stimulated, protein-linked DNA in two human leukemia cell lines. On the basis of extensive literature demonstrating a positive relationship between topo II
levels and cytotoxic efficacy of drugs that target this enzyme, the logical assumption was made that increased cleavable complex formation would, in turn, increase etoposide cytotoxicity in NaB-pretreated cells. Indeed, NaB conferred to HL-60 cells a modest hypersensitivity to etoposide-mediated apoptosis, although in K562 cells there was a marked inhibition of cell growth and a substantial enhancement of PARP cleavage.
Other limited attempts to enhance cellular sensitivity to topo II poisons by pharmacological modulation of topo II levels have met with mixed success. For example, substantial induction of topo II
and ß levels was observed in HL-60 cells after 96 h of treatment with all-trans retinoic acid (58). However, induction was not accompanied by increases in etoposide-induced DNA cleavage, and in fact, etoposide-induced apoptosis was reduced significantly relative to controls. In contrast, one clever approach in confluent NIH3T3 cells to block topo II
transcriptional repression by NF-Y with DNA minor groove binding agents effectively induced the enzyme and caused a dramatic 1020-fold reduction in the etoposide IC50 (35). These investigators argued that manipulation of topo II levels in plateau phase cell populations is more likely to represent situations encountered in vivo than with exponentially growing cultures.
In the present study, a question remains concerning the precise mechanism by which HDAC inhibitors induce topo II
expression and why there is discord between the magnitude of promoter activation and steady-state enzyme levels. Although our data support a direct relationship between topo II
promoter activation (from a transfected plasmid construct) and the degree of histone H4 acetylation, there are likely to be promoter-specific consequences of HDAC inhibition that mediate the magnitude, if any, of endogenous gene activation. For example, the high potency HDAC inhibitor, trapoxin, induces only 2% of genes studied (59). Ectopic expression of the histone acetyltransferase P/CAF (as a mimic of NaB treatment) failed to activate topo II
gene expression in HL-60 cells,7 suggesting that global activation of histone acetylation is unlikely to account for enhanced topo II
expression. In other systems, increasing data suggest the cooperation of specific acetylase/deacetylase enzymes with specific transcription factors via corepressor or coactivator proteins (60). For example, in transcriptional activation the yeast GCN5 histone acetyltransferase appears to function in a complex of proteins that bridges activators to the basal transcriptional machinery (61). Conversely, in the case of transcriptional repression, heterodimers of Mad and Max interact with SIN3 corepressor proteins to recruit RPD3 histone deacetylase activity to specific promoters, allowing lysine tails of deacetylated histones to displace activating transcription factors (62). Precisely how histone acetylation status affects the assembly of transcriptional activators and repressors on the endogenous human topo II
gene promoter remains an ongoing focus of our laboratories.
Other investigators have independently identified additional mechanisms by which HDAC inhibitors may converge on topo II
regulation. HDAC1 was shown recently to interact directly with topo II
(63). These investigators also demonstrated that the potent fungal natural product, TSA, could sensitize CCRF-CEM cells and a number of Chinese hamster ovary cell lines to etoposide (63). However, topo II
levels or activity were not assessed after TSA treatment. Shortly thereafter, Turners group independently confirmed the interaction of topo II
and HDAC1, but these investigators demonstrated paradoxically that TSA treatment confers resistance to etoposide-induced HL-60 cell apoptosis (64). However, this end point was only measured at a single high concentration (100 µM) of etoposide. The present report and these two other recent studies all differ in the type and phasing of HDAC inhibitor treatment and etoposide exposure, making it difficult at present to generalize about the utility of combining these agents. In related work, it should also be noted that TSA was shown recently to induce the activity of the mouse topo II
gene promoter in mouse 3T3 fibroblasts (65), but this study did not investigate TSA effects on endogenous topo II
levels or cellular sensitivity to topo II poisons. We have subsequently observed a 36-fold induction of the human topo II
promoter with 24-h exposure to TSA at 100300 nM in several human tumor cell lines,8 suggesting that this effect is not limited to the murine gene. Whether TSA behaves in our system with regard to increased enzyme expression and etoposide cellular sensitivity is the subject of ongoing study.
The use of differentiating agents, including NaB, in clinical management of neoplastic disease has shown some promise (66-68), especially when combined with cytotoxic chemotherapy (69). However, enthusiasm has been limited because of the short half-life of fatty acids and a lack of mechanistic rationale for their combination with cytotoxic agents. A search for butyrate analogues possessing a more favorable pharmacokinetic profile than NaB has led to clinical trials with phenylacetate, phenylbutyrate, and tributyrin (70) as well as pivalyloxymethyl butyrate (AN9). Newer fungal agents (TSA, as well as trapoxin and apicidin) with nanomolar inhibitory action on HDAC may also represent useful therapeutics. However, most clinical work to date has used the aromatic butyrates. Phenylbutyrate has been used in the treatment of ß-thalassemia because of its ability to induce fetal hemoglobin (71) and in children with urea-cycle disorders (72) because of its glutamine-scavenging activity. In fact, phenylbutyrate was used recently to facilitate the birth of a child harboring a heterozygous mutation for ornithine transcarbamylase (73).
With regard to cancer therapy, others have investigated HDAC inhibitors for efficacy as single-agent antitumor drugs. This approach arose originally from the observation that a number of nonhematopoietic cell lines (including melanoma and carcinoma of the breast, ovary, lung, prostate, and colon) were responsive to the differentiating effects of butyrate or butyrate analogues (74-78). A synthetic benzamide HDAC inhibitor (MS-27-275) also possesses antitumor activity in a variety of human tumor xenografts in nude mice (79). Similarly, sodium phenylbutyrate can trigger apoptosis in prostate carcinoma cells (80). In colon carcinoma, NaB causes cell cycle arrest by inducing p21 (78), but this effect does not require p53 (81, 82). The latter finding is provocative in that the HDAC inhibitors may activate normally p53-dependent apoptotic machinery in cells lacking functional p53 (83, 84). Some of the cytostatic effects of phenylacetate and phenylbutyrate may also be mediated by their action as ligands for the peroxisome proliferator-activated receptor
(85). Although it remains to be demonstrated whether any of these other cell types also exhibit NaB-inducible topo II
expression or whether peroxisome proliferator-activated receptor
affects topo II
expression, HDAC inhibitors are already being tested in the clinic against several solid tumor types. Finally, HDAC inhibitors may have antitumor effects that may only be apparent when in vivo models are used. For example, TSA was shown recently to act as an angiogenesis inhibitor in human tumor xenografts of nude mice in part by suppressing hypoxia-responsive tumor suppressor genes (86).
Although our work has focused on the ability of HDAC inhibitors to influence topo II-dependent drug action, evidence suggests that HDAC inhibitors may also be useful combination chemotherapy agents via actions independent of and/or downstream from topo II-mediated DNA damage. Phenylbutyrate, but not NaB, enhanced doxorubicin cytotoxicity in culture, presumably by a loss of numerous cellular antioxidant defenses (87), although topo II
levels were not quantified. In another study (88), pivalyloxymethylbutyrate (AN9) was shown to enhance anthracycline efficacy but via decreased rate of anthracycline aglycone formation and a reduction in NAD(P)H:quinone oxidoreductase and cytochrome P-450 reductase activities. Oxidative stress attributable to reactive oxygen species has also been implicated in butyrate sensitization of colorectal carcinoma cells to tumor necrosis factor-
and Fas ligand (89). Reactive oxygen species may also contribute to p53-independent induction of p21 during growth arrest (83). In addition, NaB potentiates apoptosis in retinoblastoma cells treated with vincristine or cisplatin, although the mechanism of this effect was not elucidated (90). One possible explanation, particularly with regard to vincristine, is that NaB can cause G2 arrest in human breast carcinoma cells and drive DNA endoreduplication, resulting in polyploidy and delayed cell death (91).
In summary, more detailed understanding of the biological consequences of altering histone acetylation may lead to opportunities for synergistic combination chemotherapy between HDAC inhibitors and classical cytotoxic agents. It should also be appreciated that HDAC inhibitors possess other nonhistone activities that may contribute to their single-agent and combination antitumor effects, and moreover, some of these effects may be unique to the HDAC inhibitor in question. Our current work details a direct link between HDAC inhibitors, the induction of topo II
, and the consequent enhancement of etoposide-triggered DNA damage. However, further studies on HDAC inhibitors in post-DNA damage processing events may provide insights for maximizing the anticancer efficacy of these agents.
| Acknowledgments |
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| Footnotes |
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1 This work was supported by Grant RPG-97-084-01-CDD from the American Cancer Society, a grant from the Cancer League of Colorado (both to D. J. K.), NIH Grant CA74972 (to J. C. Y.), and an American Cancer Society/Brooks Trust Fellowship Award (to S. E. W.). The experiments from the University of Colorado Cancer Center Flow Cytometry Core Facility were supported by NIH Grant P30 CA46934 from the National Cancer Institute. ![]()
2 Present address: Department of Biological Sciences, University of Calgary, Calgary, Alberta, T2N 1N4 Canada. ![]()
3 Present address: Department of Biological Sciences, Stanford University, Stanford, CA 94305. ![]()
4 Present address: Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Duke Comprehensive Cancer Center, Durham, NC 27710. ![]()
5 To whom requests for reprints should be addressed, at Duke University Medical Center, Box 3020, Microbiology, Durham, NC 27710. Phone: (919) 668-0281; Fax: (919) 309-4042; Email: kroll001{at}mc.duke.edu ![]()
6 The abbreviations used are: topo, topoisomerase; NaB, sodium butyrate; HDAC, histone deacetylase; IC50, drug concentration that inhibits growth by 50%; PARP, poly(ADP-ribose)polymerase; ATCC, American Type Culture Collection; CMV, cytomegalovirus; ß-gal, ß-galactosidase; SCFA, short-chain fatty acid; TSA, trichostatin A. ![]()
7 D. J. Kroll, unpublished observation. ![]()
8 J. C. Yalowich and D. J. Kroll, manuscript in preparation. ![]()
Received 8/13/01; revised 9/19/01; accepted 9/25/01.
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