Silic-Benussi Micol, Sharova Evgeniya, Corradin Alberto, Urso Loredana, Raimondi Vittoria, Cavallari Ilaria, Buldini Barbara, Francescato Samuela, Minuzzo Sonia A, D'Agostino Donna M, Ciminale Vincenzo
Veneto Institute of Oncology IOV-IRCCS, 35128 Padova, Italy.
Department of Surgery, Oncology and Gastroenterology, University of Padova, 35128 Padova, Italy.
Antioxidants (Basel). 2023 Mar 3;12(3):625. doi: 10.3390/antiox12030625.
New therapies are needed for patients with T-cell lymphoblastic leukemia (T-ALL) who do not respond to standard chemotherapy. Our previous studies showed that the mTORC1 inhibitor everolimus increases reactive oxygen species (ROS) levels, decreases the levels of NADPH and glucose-6-phosphate dehydrogenase (G6PD), the rate-limiting enzyme of the pentose phosphate pathway (PPP), and induces apoptosis in T-ALL cells. Studies in T-ALL-xenografted NOD/SCID mice demonstrated that everolimus improved their response to the glucocorticoid (GC) dexamethasone. Here we show that verapamil, a calcium antagonist used in the treatment of supraventricular tachyarrhythmias, enhanced the effects of everolimus on ROS and cell death in T-ALL cell lines. The death-enhancing effect was synergistic and was confirmed in assays on a panel of therapy-resistant patient-derived xenografts (PDX) and primary samples from T-ALL patients. The verapamil-everolimus combination produced a dramatic reduction in the levels of G6PD and induction of p38 MAPK phosphorylation. Studies of NOD/SCID mice inoculated with refractory T-ALL PDX cells demonstrated that the addition of verapamil to everolimus plus dexamethasone significantly reduced tumor growth in vivo. Taken together, our results provide a rationale for repurposing verapamil in association with mTORC inhibitors and GC to treat refractory T-ALL.
对于对标准化疗无反应的T细胞淋巴母细胞白血病(T-ALL)患者,需要新的治疗方法。我们之前的研究表明,mTORC1抑制剂依维莫司可增加活性氧(ROS)水平,降低NADPH和磷酸戊糖途径(PPP)的限速酶葡萄糖-6-磷酸脱氢酶(G6PD)的水平,并诱导T-ALL细胞凋亡。在T-ALL异种移植的NOD/SCID小鼠中的研究表明,依维莫司可改善它们对糖皮质激素(GC)地塞米松的反应。在此我们表明,用于治疗室上性快速心律失常的钙拮抗剂维拉帕米增强了依维莫司对T-ALL细胞系中ROS和细胞死亡的影响。这种增强死亡的作用是协同性的,并在一组对治疗耐药的患者来源异种移植(PDX)和T-ALL患者的原代样本检测中得到证实。维拉帕米-依维莫司组合使G6PD水平显著降低,并诱导p38 MAPK磷酸化。对接种难治性T-ALL PDX细胞的NOD/SCID小鼠的研究表明,在依维莫司加地塞米松中添加维拉帕米可显著降低体内肿瘤生长。综上所述,我们的结果为将维拉帕米与mTORC抑制剂和GC联合用于治疗难治性T-ALL提供了理论依据。