Pharmacological modulation of epigenetic changes in AML

AML 表观遗传变化的药理学调节

• 批准号: 8645614
• 负责人: Monica L Guzman
• 金额: $ 30.09万
• 依托单位: OHIO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-04-01 至 2014-12-01
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8645614
• 关键词: Aberrant DNA Methylation; Acute Myelocytic Leukemia; Adult; Adult Acute Myeloblastic Leukemia; Aftercare; Attention; Blast Cell; Bortezomib; Cancer and Leukemia Group B; Chemotherapy-Oncologic Procedure; Child; Childhood; Childhood Acute Myeloid Leukemia; Clinic; Clinical; Clinical Trials; Complement; DNA; Data; Decitabine; Disease; Disease remission; Dose; Drug Kinetics; Elderly; Epigenetic Process; FDA approved; Failure; Funding; Gene Expression; Gene Silencing; Genes; Genetic; Goals; Grant; Histone Deacetylase Inhibitor; Hypermethylation; Indium; Laboratory Study; Leadership; Mediating; Methylation; MicroRNAs; Molecular; Mutation; Myelogenous; Ohio; Outcome; Paper; Pathway interactions; Patients; Pharmaceutical Preparations; Pharmacodynamics; Phase; Phase I Clinical Trials; Phase II Clinical Trials; Phenotype; Phosphotransferases; Process; Proteasome Inhibitor; Proteins; Publications; Publishing; Recruitment Activity; Refractory; Regimen; Relapse; Reporting; Research; Resistance; Role; Safety; Series; Testing; Therapeutic; Toxic effect; Translational Research; Universities; Up-Regulation; age group; arm; base; bone marrow hyperplasia; chemotherapy; clinical efficacy; design; gene function; genome wide methylation; genome-wide; high risk; improved; insight; leukemic stem cell; leukemogenesis; member; molecular marker; novel; novel strategies; novel therapeutic intervention; prognostic; public health relevance; resistance mechanism; response; stem cell biology; success; therapeutic target; tripolyphosphate; two-arm study; young adult

DESCRIPTION (provided by applicant): The majority of children and adults with acute myeloid leukemia (AML) die of their disease and therefore, novel therapeutic approaches beyond "one-fits-all" chemotherapy regimens are required. Epigenetic gene silencing has been reported to be involved in the deregulation of hematopoietic cell proliferation, differentiation and survival in AML and contributes to leukemogenesis. We have been focusing on pharmacological targeting of aberrant DNA methylation that mediates epigenetic gene silencing in AML. Decitabine (DAC) is an azanucleoside with hypomethylating activity. In the last funding cycle of this R01 grant, we have brought to the clinic and demonstrated the excellent activity of a regimen of low-dose DAC (20 mg/m2/day x10 day) and the feasibility of the combination of DAC with the proteasome inhibitor bortezomib. We have shown that untreated older AML patients can achieve a complete remission rate of approximately 50% with these DAC-based regimens. In addition we have made several discoveries with regard to: (a) potential molecular predictors of clinical response to DAC (miR-29b and DNMT3A mutations); (b) novel mechanisms of myeloid leukemogenesis involving epigenetics, microRNAs and kinases, and (c) novel compounds that enhance the pharmacologic activity of DAC through up regulation of microRNAs (i.e., AR42, a histone deacetylase inhibitor designed and developed at the OSU). These novel clinical, molecular and pharmacologic findings now need to be validated and their mechanisms further understood in order to move forth the epigenetic-targeting approaches in AML. To achieve this goal, we also need to define the molecular basis for treatment resistance to epigenetic-targeting therapies, not only at the level of bulk AML blasts, but also in leukemia stem cells (LSC). Thus, we have now designed two new clinical trials and a series of novel pharmacodynamic studies that will unveil the interplay among DNA hypermethylation, microRNAs, and LSC through the following Specific Aims: (1)To conduct a larger Phase II clinical trial (CALGB 11002) in untreated older (>60 years) AML to compare the clinical activity of decitabine (DAC) vs. decitabine (DAC) + bortezomib and identify the predictive and pharmacodynamic (PD) factors that determine therapeutic differences between these two regimens; (2) To conduct a Phase I clinical trial (OSU 11130) of the HDAC inhibitor AR42 followed by DAC (AR42->DAC) to define toxicity, clinical response and pharmacokinetic (PK) and pharmacodynamic (PD) factors that determine the clinical outcomes in adult and pediatric patients with AML; (3) To determine the impact of epigenetic- targeting therapies on the function and survival of leukemic stem cells (LSCs) and how this contributes to disease response or resistance in AML patients to DAC-based regimens.

描述(由申请人提供)：大多数患有急性髓系白血病(AML)的儿童和成人死于他们的疾病，因此，需要“一刀切”的化疗方案以外的新的治疗方法。表观遗传基因沉默参与了急性髓系白血病的造血细胞增殖、分化和存活的调控，并参与了白血病的发生。我们一直专注于介导AML表观遗传基因沉默的异常DNA甲基化的药理学靶点。地西他滨(DAC)是一种具有低甲基化活性的氮杂核苷。在这笔R01赠款的最后一个资金周期中，我们已经将一种低剂量DAC(20 mg/m2/天×10天)方案的出色活性带到了临床，并证明了DAC与蛋白酶体抑制剂bortezomib联合使用的可行性。我们已经证明，未经治疗的老年AML患者使用这些以DAC为基础的方案可以达到大约50%的完全缓解率。此外，我们在以下方面取得了几项发现：(A)临床对DAC反应的潜在分子预测因子(miR-29b和DNMT3A突变)；(B)涉及表观遗传学、microRNAs和激酶的髓系白血病发生的新机制；以及(C)通过上调microRNAs(即由俄亥俄州立大学设计和开发的组蛋白脱乙酰酶抑制剂AR42)增强DAC药理活性的新化合物。现在需要验证这些新的临床、分子和药理学发现，并进一步了解它们的机制，以便推进AML的表观遗传学靶向治疗方法。为了实现这一目标，我们还需要确定表观遗传靶向治疗耐药的分子基础，不仅在成批AML原始细胞水平上，而且在白血病干细胞(LSC)水平上。因此，我们现在设计了两个新的临床试验和一系列新的药效学研究，将通过以下特定目标揭示dna超甲基化、microRNA和LSC之间的相互作用：(1)在未经治疗的老年(60岁)急性髓细胞白血病中进行更大规模的II期临床试验(CALGB 11002)，以比较地西他滨(Dac)和地西他滨(Dac)+Bortezomib的临床活性，并确定决定这两种方案之间疗效差异的预测性和药效学(PD)因素；(2)进行HDAC抑制剂AR42的I期临床试验(OSU 11130)，随后进行DAC(AR42&GT；目的：(1)确定决定成人和儿童AML患者临床结局的毒性、临床反应和药代动力学(PK)和药效学(PD)因素；(3)确定表观遗传学靶向治疗对白血病干细胞(LSCs)功能和存活的影响，以及这如何导致AML患者对DAC方案的疾病反应或耐药性。