AOH1996 New Cancer Pill

Flynn

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A recent study published in the
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Journal described a small molecule inhibitor of proliferating cell nuclear
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(PCNA) that selectively kills cancer cells.

Background​

PCNA is a conserved multi-faceted protein in eukaryotes with a critical role in DNA replication and repair and has been historically used as a marker for tumor progression.

DNA replication stress is a key hallmark of cancer cells that have been exploited as a therapeutic strategy to induce further DNA damage leading to catastrophic consequences for cancer cells.

Thus, PCNA represents a major anti-cancer target, given its role in DNA replication/repair. Besides, discovering a distinct cancer-associated PCNA isoform (caPCNA) has opened new avenues for developing novel chemotherapeutics. Previously, the authors described a potential inhibitor (AOH1160) of caPCNA that lacked suitable metabolic properties.

The study and findings​

In the present study, researchers identified and characterized the molecular features of AOH1996, an analog of AOH1160. They modeled the interactions between PCNA and potential ligands to design and synthesize around 70 analogs of AOH1160 by modifying the molecule's
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linker, diphenyl ether, and a naphthyl group.

The Naphthyl group was replaced with mono- or bi-cyclic aromatic groups; the glycine linker was substituted with unnatural and natural amino acids. These modifications caused no improvements in potency. Thus, diphenyl ether was explored for its structure-activity relationship in several ways that led to the identification of two analogs, AOH1160-1LE and AOH1996.

Thermal denaturation analyses of these compounds indicated stabilizing interactions with PCNA. The researchers created cell lines with mutant PCNA, with L47V substitution, and evaluated their sensitivity to AOH1996. All mutant cells were less sensitive to inhibition by AOH1996 than wild-type cells, and homozygous mutants were the least sensitive.

Next, the team tested AOH1996 in normal cells and over 70 (cancer) cell lines. They found that AOH1996 selectively killed cancer cells, with a median concentration of about 300 nM for 50% growth inhibition.

AOH1996 was not significantly toxic to non-malignant cells, even up to 10 µM. It induced cell cycle changes (G2/M or S phase arrest) and apoptosis in cancer cells but not non-malignant cells.

AOH1996's half-life increased by approximately 27% relative to that of AOH1160 in oral pharmacokinetic studies in mice.

Next, its anti-cancer activity was evaluated in mice with xenograft tumors of small-cell lung cancer, breast cancer, or neuroblastoma. Drug treatment significantly decreased tumor burden without causing significant weight loss or death.

Further analyses showed that AOH1996 altered more than half the proteins associated with chromatin-bound PCNA, and these proteins were transcription components. However, only two proteins, subunits of RNA polymerase II (RNAPII), including its largest subunit (RPB1), harbored a known PCNA binding motif.

Next, the team exogenously expressed FLAG-tagged wildtype and mutant RPB1 proteins and performed immunoprecipitation, noting that AOH1996 increased chromatin-bound wildtype RPB1 as well as PCNA co-precipitation with wildtype RPB1. This suggested that AOH1996 increased transcription-replication conflict (TRC) and enhanced RPB1-PCNA interactions.

These effects were further amplified in the presence of a proteasome inhibitor (MG132), suggesting that AOH1996 can trigger RPB1 proteasomal degradation. Contrastingly, PCNA co-precipitation with mutant RPB1 was reduced in the presence of MG132 and AOH1966, suggesting weakened interactions.

Examination of exogenous RPB1 levels in whole cell extracts revealed that AOH1996 degraded wildtype RPB1 in a proteasome-dependent manner but not the mutant RPB1.

Further, AOH1996 caused the dissociation of PCNA from actively transcribed regions but not in low or non-transcribed heterochromatin regions. This suggested that AOH1996 triggered the collapse of replication forks only during active transcription.

Conclusions​

In sum, the study reported two AOH1160-based inhibitor analogs, and the lead candidate, AOH1996, was more metabolically stable with drug-like characteristics. AOH1996 enhanced PCNA-RPB1 interactions, leading to the overall degradation of RPB1 and the collapse of replication forks in actively transcribed regions.

Specifically, these enhanced interactions prevent TRC resolution, leading to lethal double-strand breaks and the disruption of the transcription machinery by the degradation of RPB1.

CaPCNA disrupts the PCNA-TRC interface in cancer cells, allowing AOH1996 to exert selective and potent anti-cancer effects with a remarkable safety profile.

Overall, the study underscores the therapeutic potential of AOH1996 and its utility in characterizing TRC in cancer cells. Given its multi-functionality, further studies are required to understand the effects of AOH1996 on other aspects of PCNA.
 
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Flynn

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AOH1996 was created to target a
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isoform of PCNA, termed caPCNA, which is preferentially found in
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. PCNA is crucial in the body for
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, but targeting it is difficult because of its role in healthy cells. By selectively targeting caPCNA, it may be possible to kill cancer cells without affecting healthy tissues.
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testing demonstrated that AOH1996 inhibited the growth and induced cell cycle arrest and apoptotic cell death in a wide variety of cancer cell lines, but had no effect on several normal, nonmalignant cell types.
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In mouse and dog animal models, there were no observed side effects or toxicity even at six times the effective dose.
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The substance was named after the initials and the birth year of Anna Olivia Healey, who died of
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in 2006. The funds collected by her parents have helped support the development of the chemical compound.
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A New Mode of Cancer Treatment​


Let’s talk about a
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in Cell Chemical Biology, which is also getting some pickup in the wider press. It’s about a molecule designated
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, which seems to have a unique mode of action in tumor cells, one that might make it more more selective for those as compared to normal ones.

The key target here is a protein called
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(from its old name of “proliferating cell nuclear antigen”). If you look at that link, you’ll see its very appealing structure in the cell - three PCNA proteins come together and encircle a DNA strand, and the outside of this ring has binding spots for a lot of other proteins involved in replication (such as
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epsilon), in DNA repair (ditto), in things like making epigenetic signaling marks on DNA-histone complexes, and in chromatin remodeling in general. That makes it sound like a pretty important protein, and so it is - PCNA is absolutely essential in replication, and it was first noticed as something that got expressed heavily in cell nuclei during DNA synthesis as a runup to cell division.

And this brings up a fundamental conflict in the life of a cell. DNA is constantly being transcribed (read off into RNA for the later translation to proteins as well as other uses), and there are huge numbers of proteins and processes involved in that. Replication for cell division is a whole other process, one that also involves a huge number of proteins descending onto the DNA (every single bit of it, as the entire genome is copied for the daughter cell to come). You can imagine that these two mighty networks of DNA-associated machinery might bang into each other from time to time, and so they do -
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, entitled “Transcription as a Threat to Genomic Integrity”, will take you through a lot of this. From a strict cell-replication standpoint, it would be better if the DNA was locked up in a vault where nothing could mess with it until it came time to make a copy, but that’s impossible: day-to-day (and minute-to-minute) cell biology requires constant messing around with that same DNA. Winding and unwinding around histone proteins, huge transcriptional complexes landing on particular sequences and starting the synthesis of mRNA molecules, transcription factors sitting around on their preferred sequences and blocking/promoting such readouts - the activity around a cell’s DNA makes beehives look pretty laid-back.

Cancer cells, many of whom are constantly replicating, are under particular stress in this regard, and a lot of chemotherapy drugs are specifically interfering with replication and DNA repair pathways. The discovery of a “cancer-associated PCNA” (
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) isoform made that a particularly interesting target. Back about ten years ago
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were
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reports of small molecules and cell-penetrating
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as PCNA ligands, and these
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to show up in the literature (although as far as I know, none of them have progressed further). But a peptide in this area has
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Phase I in the clinic. PCNA continues to be targeted whenever some
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comes along that might make it actionable.

The current molecule is a traditional direct small molecule binder that is selective for caPCNA over the regular type, which is a very attractive advantage to explore. The team behind it has been working on it for
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now to validate that mechanism, and the new paper linked first above is their report of going all the way into animal models.

AOH1996 is a very
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molecule - to be honest, it looks like the sort of stuff that you used to see in old combinatorial chemistry libraries in the late 90s and early 2000s, a couple of aryl-rich groups strung together with amide bonds. It’s certainly not going to be the most soluble stuff in the world, but they seem to have been able to formulate it. But I’m definitely not going to make fun of any chemical structure that works!

Mechanistically, it binds to a particular region that’s different in caPCNA (as shown by some very nice structural biology results), and this binding stabilizes the protein’s interaction with the largest subunit (RPB1) of RNA polymerase II - in fact, it stabilizes it so thoroughly that the RPB1 protein gets targeted for degradation by the cellular housekeeping machinery! Binding of AOH1996 also weakens its association with actively-transcribed chromatin regions, and this causes accumulation of double-stranded DNA breaks DSBs), which is just the kind of thing you want to mess up a cancer cell’s replication process (and just the kind of thing you don’t want happening to other cell types). This is an example of deliberately amplifying the transcription/replication conflict - things get so messed up that the transcriptional complex has to be cleared.

The new paper shows preclinical toxicity testing in two species (mice and dogs), which is what you need to get to human trials. It seems to pass those very well, with no signs of trouble at 6x the effective dose in either species. And if you were throwing DSBs all over the place in normal tissues, believe me, you’d see tox. It is clean in an Ames test, for example. As for efficacy, in cell assays the concentration needed for 50% growth inhibition across 70 different cancer cell lines averaged around 300nM, while it showed no toxic effects on various non-cancer lines up to 10 micromolar (at least a 30x window). The affected cells show cell-cycle arrest, replication stress, apoptosis, and so on. And application of AOH1996 along with other known chemotherapy agents made the cells much more sensitive to those, presumably because they couldn’t deal with those on top of the problems that AOH1996 was already causing.

It also shows growth arrest in xenograft tumors in mouse models, with a no-effect dose at least six times its effective dose, and combination therapy with a topoisomerase inhibitor showed even more significant effects. The compound has entered a Phase I trial in humans on the basis of the above data, and I very much look forward to seeing it advance to Phase II, where it will doubtless be used in combination with several existing therapies. I hope that human cancers will prove vulnerable to this new mode of attack in the clinic, and that they are not able to mutate around it with new forms of caPCNA too quickly, either. The comparison with the peptide agent mentioned above will be especially interesting, too. There’s only one way to find out - good luck to everyone involved!
 
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Flynn

Flynn

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I was just telling the man about it. He's going to go read the study himself. He says it sounds like a great development.

Hopefully the clinical trials will go through without a hitch. So far, so good!

Now the question is how much will they be charging for this life saving pill if it works as advertised?
 

Lily

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Hopefully the clinical trials will go through without a hitch. So far, so good!

Now the question is how much will they be charging for this life saving pill if it works as advertised?

Oh, it's going to be expensive. Those patents are good for 20 years from time of filing, plus they can be extended due to regulatory delay. My guy is a pharmaceutical patent attorney and has his doctorate in chemistry - in biochem to be precise.
 
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Flynn

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Oh, it's going to be expensive. Those patents are good for 20 years from time of filing, plus they can be extended due to regulatory delay. My guy is a pharmaceutical patent attorney and has his doctorate in chemistry - in biochem to be precise.

Well, hopefully it won't come to this:

"The Food and Drug Administration approved late last year CSL Behring's hemophilia B gene therapy Hemgenix, a one-off infusion that costs $3.5 million a dose, making it the world's most expensive drug."
 

Lily

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Well, hopefully it won't come to this:

"The Food and Drug Administration approved late last year CSL Behring's hemophilia B gene therapy Hemgenix, a one-off infusion that costs $3.5 million a dose, making it the world's most expensive drug."

I would hope not. The thing with a hemophilia type drug is that the disease itself is fairly rare, so in order to get ROI they seek, it's been priced at that amount. I can't imagine any insurance company covering it though.
 
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Flynn

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I would hope not. The thing with a hemophilia type drug is that the disease itself is fairly rare, so in order to get ROI they seek, it's been priced at that amount. I can't imagine any insurance company covering it though.

There are people who need that drug, rare or not. I read about a family that needs that drug for their little girl. They were trying to scrape up the money through fundraising. It's criminal.
 

Lily

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There are people who need that drug, rare or not. I read about a family that needs that drug for their little girl. They were trying to scrape up the money through fundraising. It's criminal.

I agree. Lots of profit and they can do it because the pharmaceutical lobby is mighty powerful with the dollars the spread around Congress.
 
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Flynn

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I agree. Lots of profit and they can do it because the pharmaceutical lobby is mighty powerful with the dollars the spread around Congress.

Exactly! Sad that human life has become a commodity that big pharma can monetize for their own benefit.
 

Lily

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Exactly! Sad that human life has become a commodity that big pharma can monetize for their own benefit.

I understand that paying a lot of PHD's and lab costs, and the clinical trials costs sometimes into the millions, many millions...but there should be a law that limits their profits once they recoup their costs.
 
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Flynn

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I understand that paying a lot of PHD's and lab costs, and the clinical trials costs sometimes into the millions, many millions...but there should be a law that limits their profits once they recoup their costs.

You do know that they can recoup those costs from the government, right?

They choose not to because if they sell it, they can make waay more money.
 

Lily

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You do know that they can recoup those costs from the government, right?

They choose not to because if they sell it, they can make waay more money.

I didn't know that. Well, they are in the business to make money, so I'm sure they want a little more than simply recouping.

However, all this can be fixed if our freaking "reps" and senators weren't all whores.
 
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Flynn

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I didn't know that. Well, they are in the business to make money, so I'm sure they want a little more than simply recouping.

However, all this can be fixed if our freaking "reps" and senators weren't all whores.

AMEN!!!!!