WO2019226975A1 - Combination therapies for treating cancer - Google Patents
Combination therapies for treating cancer Download PDFInfo
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- WO2019226975A1 WO2019226975A1 PCT/US2019/033889 US2019033889W WO2019226975A1 WO 2019226975 A1 WO2019226975 A1 WO 2019226975A1 US 2019033889 W US2019033889 W US 2019033889W WO 2019226975 A1 WO2019226975 A1 WO 2019226975A1
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- SMDYSPLWRGKCSN-UHFFFAOYSA-N CC1(c(cc2)ncc2OCCOCCOc2ccc(-c3nc4cc(OC(F)(F)F)ccc4[nH]3)nc2)Nc(cc(cc2)OC(F)(F)F)c2N1 Chemical compound CC1(c(cc2)ncc2OCCOCCOc2ccc(-c3nc4cc(OC(F)(F)F)ccc4[nH]3)nc2)Nc(cc(cc2)OC(F)(F)F)c2N1 SMDYSPLWRGKCSN-UHFFFAOYSA-N 0.000 description 1
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/33—Heterocyclic compounds
- A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
- A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
- A61K31/44—Non condensed pyridines; Hydrogenated derivatives thereof
- A61K31/4427—Non condensed pyridines; Hydrogenated derivatives thereof containing further heterocyclic ring systems
- A61K31/444—Non condensed pyridines; Hydrogenated derivatives thereof containing further heterocyclic ring systems containing a six-membered ring with nitrogen as a ring heteroatom, e.g. amrinone
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/33—Heterocyclic compounds
- A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
- A61K31/55—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having seven-membered rings, e.g. azelastine, pentylenetetrazole
- A61K31/551—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having seven-membered rings, e.g. azelastine, pentylenetetrazole having two nitrogen atoms, e.g. dilazep
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/33—Heterocyclic compounds
- A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
- A61K31/55—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having seven-membered rings, e.g. azelastine, pentylenetetrazole
- A61K31/551—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having seven-membered rings, e.g. azelastine, pentylenetetrazole having two nitrogen atoms, e.g. dilazep
- A61K31/5513—1,4-Benzodiazepines, e.g. diazepam or clozapine
- A61K31/5517—1,4-Benzodiazepines, e.g. diazepam or clozapine condensed with five-membered rings having nitrogen as a ring hetero atom, e.g. imidazobenzodiazepines, triazolam
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P35/00—Antineoplastic agents
- A61P35/02—Antineoplastic agents specific for leukemia
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- C—CHEMISTRY; METALLURGY
- C07—ORGANIC CHEMISTRY
- C07D—HETEROCYCLIC COMPOUNDS
- C07D401/00—Heterocyclic compounds containing two or more hetero rings, having nitrogen atoms as the only ring hetero atoms, at least one ring being a six-membered ring with only one nitrogen atom
- C07D401/14—Heterocyclic compounds containing two or more hetero rings, having nitrogen atoms as the only ring hetero atoms, at least one ring being a six-membered ring with only one nitrogen atom containing three or more hetero rings
Definitions
- the invention generally relates to compositions and methods to treat leukemia. More particularly, the invention relates to compositions and methods of treatment using a synergistic combination of specific transcription factor inhibitors and inhibitors targeting chromatin activity.
- Cancer cells adapt to mutations that alter the function of transcription factors and chromatin- associated factors to survive. In leukemia, these factors often drive leukemia initiation and
- the transcription factor complex core-binding factor is a hetero-dimeric factor composed of a stabilizing subunit CBF and the DNA-binding subunit RUNX (encoded by three genes: RUNX1, RUNX2 and RUNX3).
- RUNX1 is expressed in all lineages, and only repressed during erythropoiesis (Lorsbach et al., 2004; North et al., 2004).
- RUNX1/CBF regulates pathways associated with proliferation, survival and differentiation (Blyth et al., 2005).
- the genes encoding CBF and RUNX1 are frequent targets of mutations in hematologic malignancies.
- This fusion protein out-competes wildtype CBF in vitro because it has significantly higher affinity and altered stoichiometry for RUNX1 relative to the native CBF (Cao et al., 1997; Kanno et al., 1998; Lukasik et al., 2002).
- CBF -SMMHC expression blocks definitive hematopoiesis and embryos die at mid gestation (Castilla et al., 1996), a similar phenotype to that of Runxl- and Cbfb-knock out embryos (Wang et al., 1996a; Wang et al., 1996b). These findings imply that CBF -SM MHC has a dominant negative effect on CBF function. [005] In adult hematopoiesis, allelic CBF -SMMHC expression alters hematopoietic stem cell (HSC) differentiation, with a clonal expansion of the short-term HSCs and multi-potential progenitors (Kuo et al., 2006).
- HSC hematopoietic stem cell
- the myeloid pre-leukemic progenitors are leukemia precursors, which acquire cooperating mutations to induce myeloid leukemia in mice (Castilla et al., 1999; Xue et al., 2014).
- RUNX1 associates with chromatin-modifying proteins, including histone deacetylases (Durst and Hiebert, 2004; Guo and Friedman, 2011), acetyltransferases (Kitabayashi et al., 2001; Kitabayashi et al., 1998) and methyltransferases (Reed-lnderbitzin et al., 2006; Vu et al., 2013; Zhao et al., 2008) in hematopoiesis. These interactions regulate RUNX1 affinity to DNA and its transcriptional activity, and modulate its association with activating and repressing chromatin complexes (Lichtinger et al., 2010). Flowever, the role of RUNX1 in establishing chromatin-associated complexes that maintain the survival of AML cells and how they modulate leukemia maintenance remain poorly understood.
- SWItch/Sucrose Non-Fermentable (SWI/SNF) protein complex remodels histone-DNA interactions and is associated with active regulatory regions of the genome, including promoters and enhancers. Components of this multiprotein complex are mutated in cancer (Kadoch and Crabtree, 2015).
- chromatin-associated complexes including SWI/SNF and BET family of bromodomain ("BRD")-proteins, promote enhancer activity to mediate the survival of the leukemia-initiating cells (Blobel et al., 2011; Zuber et al., 2011).
- MYC The protooncogene MYC regulates the balance between self-renewal and differentiation of HSCs (Wilson et al., 2004), and is essential for lymphoid (de Alboran et al., 2001; Douglas et al., 2001) and megakaryocytic/erythroid development (Guo et al., 2009).
- MYC expression however, needs to be downregulated during myeloid differentiation, since MYC repression promotes granulopoiesis while ectopic expression blocks granulopoiesis (Gowda et al., 1986; Holt et al., 1988; Johansen et al., 2001).
- SWI/SNF and BRD4 complexes regulate MYC expression from the distal super-enhancer BDME (BRD4-dependent MYC enhancer), 1.7 megabases (Mb) downstream from its transcription start site (TSS, (Shi et al., 2013; Yashiro-Ohtani et al., 2014)), and is composed of five enhancer elements, each occupied by a number of myeloid transcription factors.
- MYC is expressed at high levels, and regulates expression of its normal high-affinity targets and a new set of targets in a tumor type-specific manner (Kress et al., 2015).
- SWI/SNF ATPase subunit BRG1 (Brahma related gene 1), required for normal granulopoiesis, associates with BDME to maintain MYC levels in mixed-lineage AML cells (Shi et al., 2013; Vradii et al., 2005).
- BDME function seems to be critical for leukemia maintenance in GSI-resistant T-cell acute lymphoblastic leukemia (Yashiro- Ohtani et al., 2014).
- pharmacologic analysis reveals that AI-10-49 and the BRD4 inhibitor JQ1 synergize to induce apoptosis of inv(16) AML cells in vitro and in vivo.
- Genomic analysis of RUNX1 binding and epigenetic marks utilizing chromatin immunoprecipitation coupled with deep-sequencing (ChIP-seq) and ChlP- quantitative-PCR (ChIP-qPCR), determined that AI-10-49 induces increased RUNX1 association to three distal MYC enhancers, including the BDME-E3 and two new regions, called ME1 and ME2.
- This invention generally relates to methods and compositions for treatment of inv (16) leukemia.
- this invention relates to a method of treating inv(16) leukemia comprising the step of:
- Y is O, NH, or NR where R is methyl or ethyl
- n is an integer of from 1 to 10
- a BRD4 inhibitor selected from the group consisting of JQ1, CeMMEC2, l-BET 151 (or GSK1210151A), I- BET 762 (or GSK525762), PFI-1 , bromosporine, OTX-015 (or MK-8628), TEN-010, CPI-203, CPI-0610, RVX- 208, BI2536, TG101348, LY294002, ABBV-075 (or mivebresib), FT-1101, ZEN003694, pharmaceutically acceptable salts and mixtures thereof.
- the therapeutically effective combination of the compound of formula (1) and the BRD4 inhibitor synergistically inhibits proliferation of inv(16) leukemia cells.
- compounds of formula (1) and the BRD4 inhibitor are administered simultaneously, or sequentially.
- the invention also relates to pharmaceutical compositions comprising a therapeutically effective combination of the compound of formula (1) and the BRD4 inhibitor and a pharmaceutically acceptable excipient.
- the therapeutically effective combination of the compound of formula (1) and the BRD4 inhibitor is a combined amount synergistically effective to inhibit proliferation of inv(16) leukemia cells.
- the compound of formula (1) is a compound of formula (la) or a pharmaceutically acceptable salt thereof,
- the BRD4 inhibitor is JQ1 or a pharmaceutically acceptable salt thereof
- FIG. 1 shows that AI-10-49 inhibits MYC transcriptional program in inv(16) AM L cells.
- A shows a heat map representation of differentially expressed genes in RNA-seq analysis between DMSO and AI- 10-49 (ImM) treated ME-1 cells for 6 hrs from three independent experiments. A total of 591 genes (in red) are positively correlated with AI-10-49 and 696 genes (in blue) are negatively correlated (>2 fold change, FDR ⁇ 0.01). Top up- and down-regulated genes are shown.
- (B) shows gene set enrichment analysis showing biological processes and signaling pathways that are correlated with AI-10-49- treatment in ME-1 cells.
- FDR false discovery rate
- NES normalized enrichment score.
- (C) shows that AI-10-49 inhibits MYC transcript levels in ME-1 cells. Cells were treated with luM AI-10-49 for 6 hrs and conducted Real Time RT-PCR for MYC. Results from triplicate experiments shown; error bars represent the SD.
- (D) shows that AI-10-49 inhibits MYC protein levels in ME-1 cells. Cells were treated with AI-10- 49 for 6 hrs and western blotting for whole cell lysates.
- E, F MYC transcriptional levels in wild type lineage negative mouse bone marrow cells (E, left) and lineage negative mouse Cbfb +/MYH11 leukemic cells (E, right), and human cord blood CD34+ cells (F, left) and human primary inv(16) leukemic CD34+ cells (F, right).
- Mouse and human cells were treated with 5 mM AI-10-49 for 24 hrs. Each symbol represents the average for an individual sample from triplicate treatments. For panels C, E and F, significance was calculated as unpaired t-test, *P ⁇ 0.05, or **P ⁇ 0.005. See also FIG. SI.
- FIG. 2 shows that MYC is required for the survival of inv(16) cells.
- A-B show that MYC silencing reduced viability of inv(16) AML cells.
- ME-1 cell line (A) and primary mouse Cbfb +/MYH11 (mCM- LK) leukemic cells (B) were transduced with scramble or MYC shRNAs and assessed live cells (7AAD- Annexin V-) by Annexin V assay.
- Annexin assay was conducted 14 days after viral infection for ME-1 cells (A) or 7 days for primary mouse leukemic cells (B). Each data point represents the mean of triplicate experiments; error bars represent the SD.
- FIG. 1 shows that MYC overexpression by MYC-ER partially rescued viability of ME-1 cells treated with AI-10-49.
- Cells expressing MYC-ER were treated with ethanol or 500 nM 4-FIT for 9 hrs followed by treatment with DMSO or AI-10-49 (ImM) for 24 hrs and assessed live cells (7AAD- Annexin V-) by Annexin V assay. Each data point represents the mean of triplicate experiments; error bars represent the SD.
- FIG. 3 shows inhibition of MYC by AI-10-49 and JQ1 leads to synergistic efficacy against inv(16) leukemia ceil survival.
- A shows MYC transcript level analysis in M E-1 cellstransduced with BRD4 shRNAs (shl and sh2), by qRT-PCR.
- B shows MYC transcript level analysis after dose response treatment with AI-10-49 and JQ1.
- C is an isobologram plot showing synergism between AI-10-49 and JQ1 in combined treatment.
- D and E show viability analysis of primary inv(16) AML cells (D) and mouse leukemic cells (E) treated with AI-10-49 and JQ1.
- FIG. 4 shows that global modification of RUNX1 association to chromatin in inv(16) AML cells.
- A, B show Venn diagram (top) and peak distribution from peak center (bottom) representing the overlap of H3K27ac (A) and RUNX1 (B) peaks in ME-1 cells treated with DMSO (black) or 1 mM AI-10-49 (red) treatment for 6 hrs.
- C is a motif analysis of RUNX1 associated peaks genomewide in AI-10-49 treated M E-1 cells.
- D is a scattered plot representing open chromatin peaks by ATAC-seq analysis in DMSO and AI-10-49 treated ME-1 cells.
- FIG. 5 shows that RUNX1 increases association with chromatin at three distal MYC in inv(16) cells.
- A shows ATAC-seq and K3K27ac and RUNX1 ChIP-seq profiles in a 2 Mb genomic region downstream of MYC. The tree enhancer regions (ME1, ME2 and BDME) are depicted below the profile in green.
- B-D are ChIP-qPCR analysis for RUNX1 in DMSO- or AI-10-49-treated cells (B) and DMSO- or Al- 10-49-treated human primary CD34+ inv(16) AML cells (C) and for p300 in DMSO or AI-10-49-treated ME1 (D). Significance was calculated as unpaired t-test, *P ⁇ 0.05, or **P ⁇ 0.005.
- FIG. 6 shows long-range DNA interaction analysis at the MYC locus.
- A shows 5C interaction matrices for the MYC locus for M E-1 cells treated for 6 hrs with DMSO (control, left panel) and with AI-10-49 (middle panel).
- the right panel shows the log 2 (AI-10-49/DMSO) ratio of the interaction matrices (blue colorscheme: higher interaction frequencies in DMSO treated cells; orange colorscheme: higher interaction frequencies in AI-10-49 treated cells).
- Arrows indicate TAD boundaries, arrowhead points to an example of a CTCF-CTCF looping interaction.
- FIG. B shows 4C-style plots for 15 Kb bins (anchor bins) containing the MYC promoter (Myc-Pr), ME1, ME2, and E3/E5 enhancers for DMSO and AI-10-49 treated cells.
- Anchor bins are shown in orange, solid black lines represent the LOWESS mean (the expected interaction frequency as a function of genomic distance) and the dotted black lines are the LOWESS plus and minus 1 standard deviation. Red lines are the observed 5C interaction frequencies.
- Green dots and vertical dotted lines highlight the positions and interactions between Myc- Pr, ME1, ME2, and E3. Arrowheads indicate interactions with CTCF sites around the BDME
- CTCF binding data were used from ChIP-seq data previously reported in K562 cells (GSE70764; (Pugacheva et al., 2015)).
- FIG. 7(A-FI) shows that AI-10-49 replaces activation for repressive marks at RUNX1 associated MYC enhancers.
- a and B show ChIP-qPCR analysis of treated ME-1 cells at the promoter (PR) and eight MYC enhancers (ME1, ME2, N-Me, and BDME elements El to E5) for BRG1 (A) and H3K4mel (B).
- C shows MYC transcript level analysis in ME-1 cells transduced with scramble (Scr) or SMARCA4 shRNAs (sh3 and sh4), estimated by qRT-PCR.
- D and E show ChIP-qPCR analysis of treated ME-1 cells at MYC promoter and MYC enhancers for RING1B (D) and FI3K27Me3 mark (E).
- F shows MYC transcript level analysis in ME-1 cells transduced with scramble (Scr) or RNF2 shRNAs (sh2 and sh4) and treated with DMSO (D) or AI-10-49 (49), estimated by qRT-PCR.
- G is a time-course ChIP-qPCR analysis of RUNX1, RING1B, and BRG1 binding at E3 in treated ME-1.
- FI is a quantitative ChIP-re-ChIP of treated M E-1 ChIPed for RUNX1 or immunoglobulinG(lgG) and re-ChIPed for IgG (red), RING1B (violet), or BRG1 (blue), at the E3 enhancer. Results from triplicate experiments are shown; error bars represent SD. Significance was calculated using unpaired t test; *p ⁇ 0.05 or **p ⁇ 0.005.
- FIG. 8(A-C) shows deletion of three RUNXl-associated MYC enhancer elements impairs MYC expression and viability of inv(16) AML.
- A is a schematic of CRISPR/Cas9 mediated deletion of MYC enhancer elements (top), and frequency estimates by sequencing of major deletion (del), deletions with lost RUNX1 binding site (RBS), and wild type (wt) alleles at each element (bottom) 48 hrs after sorting of sgRNA/Cas9 transfected ME-1 cells.
- B shows MYC expression by qRT-PCR in ME-1 cells.
- C shows viability (7AAD , Annexin V ) of ME-1 cells 14 days after sorting.
- FIG. 9 shows AI-10-49 mediated MYC transcriptional changes is specific to inv(16) cells.
- A, B show gene set enrichment analysis depicting pyrimidine metabolism, cell cycle and ribosome biogenesis (A) and pathway signatures (B) that are positively correlated with AI-10-49 in ME-1 cells.
- C) shows MYC transcript levels in non- inv(16) AML cells (U937, K562, Jurkat, Kasumi-1 and THP-1) treated with DMSO or ImM AI-10-49 for 6 hrs.
- D) is an immunoblot depicting MYC and GAPDFI protein levels in ME-1 cells treated with ImM AI-10- 49 for 0 hrs, 2 hrs, 4hrs, 6 hrs and 8hrs.
- FIG. 10 shows the effect of MYC silencing in inv(16) AML cells.
- A shows a time course analysis of cell viability (7AAD- Annexin V-) in ME-1 cells transduced with scramble (Scr) or two MYC shRNAs.
- B shows flow cytometry analysis of granulocytic differentiation in ME-1 cells transduced with MYC shRNAs at day 14.
- C and D show analysis of MYC protein levels assessed by western blot analysis (C) and cell viability (7AAD- Annexin V-; D) of AML cell lines Kasumi-1, NB4, ME-1, THP1, MV4:11 and K562, 14 days after transduction with MYC shRNAs; each data point represents the mean of triplicate experiments; error bars represent the SD.
- E is an immunoblot analysis of Myc and Gapdh protein levels mouse Cbfb +/MYH11 leukemic cells transduced with Renila (Ren) or Myc shRNAs 1 and 2.
- F is a schematic representation of experimental design for in vivo evaluation of Myc shRNA knockdown experiments.
- FIG. ll(A-J) shows effect of JQ1 mediated MYC silencing in inv(16) cells and non(invl6) cells.
- A shows qRT-PCR analysis of BRD4 transcript levels in ME-1 cells transduced with scramble (Scr) or two BRD4 shRNAs (shl and sh2).
- B shows an immunoblot analysis of MYC and GAPDH protein levels in ME- 1 cells treated with BET inhibitor JQ1 for 6 hr.
- (D) shows the percentage of c-kit+ (leukemic) cells in peripheral blood 25 days after transplantation in respective groups, assessed by flow cytometry.
- (E) shows a viability analysis (MTT assay) of JQ1 and AI-10-49 in human cord blood CD34+ cells 48 hr after treatment with AI-10-49 and/or JQ1 at the indicated concentrations.
- F-J are toxicology analysis of wild-type mice treated with a daily dose of DMSO (green) or 200 mg/kg/day AI-10-49 (10 days) and 50 mg/kg/day JQ1 (21 days) (49+JQ1, green). Mice were analyzed 1 day after last treatment dose; body weight (F), spleen weight (G), bone marrow cellularity (H), percentage of stem and early progenitor cells [LSK+: Lin(-) Scal(+) c-kit(+)] in bone marrow (I), percentage of progenitor cell compartments common myeloid progenitors [CMP: LSK-,CD34(+)CD16/32(-)], megakaryocyte/erythroid progenitors [MEP: LSK-, CD34(-)CD16/32(-)], and granulocyte/monocyte progenitors [GMP: LSK-, CD34(+) CD16/32(+)], in LSK- cells (J). Each symbol represents the mean of
- FIG. 12(A-B) shows that AI-10-49 leads to genome wide RUNX1 binding in inv(16) cells.
- A shows binding intensity at RUNX1 peaks with respect to distance from RUNX1 peak center (left) and distance to transcription start site (right).
- B shows gene distribution of H3K27Ac (top) and RUNX1 (bottom) peaks in ME-1 cells treated with DMSO (left) or AI-10-49 (right).
- FIG. 13(A-B) shows RUNX1 mediated chromatin changes at MYC enhancer elements with AI-10- 49.
- A shows ATAC-seq and ChIP-seq profiles for K3K27ac and RUNX1 in MYC +1.7 Mb genomic region. Five previously reported enhancer regions (El to E5) depicted below the profile.
- B shows ChIP-seq profiles for K3K27ac and RUNX1 peaks in ME-1 cells treated with DMSO (blue) or AI-10-49 (red) in the 2Mb genomic region upstream of MYC-TSS.
- FIG. 14 shows analysis of transcription factor ChIP-Seq at MYC Locus.
- Transcription factor ChIP- seq analysis is from GEO: GSE46044 (Mandoli et al., 2014) at the 2Mb downstream of the MYC TSS.
- Peak location for MYC promoter blue and ME1, ME2 and E3 (black) are shown as dotted line windows.
- FIG. 15(A-E) shows AI-10-49 replaces activation for repressive marks at RUNX1 associated MYC enhancers.
- A shows an immunoblot analysis for BRG1, RING1B and GAPDFI in lysates of ME-1 cells treated with 1 mM AI-10-49 at 2 to 8 hr.
- B and C show qRT-PCR analysis of SMARCA4 (B) and RNF2 (C) transcript levels in ME-1 cells transduced with scramble (Scr) or two gene specific shRNAs. Results from triplicate experiments shown; error bars represent the SD.
- (D) is an evaluation of MYC transcript levels in ME-1 cells treated with RING1B inhibitor PRT 4165 for 8 days followed by treatment with DMSO/ AI- 10-49 (0.6 mM) for 6 hr, and MYC relative expression levels (REL) were estimated using qRT-PCR. Results from triplicate experiments shown; error bars represent the SD.
- (E) shows co-immunoprecipitation analysis of RUNX1 binding to BRG1 and RING1B in nuclear extracts from ME-1 cells treated with DMSO/ AI-10-49 for 6 hr. Significance was calculated as unpaired t test (B-D).
- FIG. 16(A-D) shows sequence analysis of deletions (A) by size and (B) by location, in inv(16) AML ME-1 cells treated with CRISPR-Cas9 and sgRNAs for ME1, ME2 and E3. Analysis performed utilizing CRISPR Genome Analyzer (Guell et al., 2014).
- C shows analysis of deletions for N-Me
- D shows analysis by location for N-Me.
- the invention relates to methods of treatment of inv(16) leukemia comprising administering to a subject in need thereof a therapeutically effective combination of:
- Y is O, NH, or NR where R is methyl or ethyl
- n is an integer of from 1 to 10
- a BRD4 inhibitor selected from the group consisting of JQ1, CeMMEC2, l-BET 151 (or GSK1210151A), I- BET 762 (or GSK525762), PFI-1, bromosporine, OTX-015 (or M K-8628), TEN-010, CPI-203, CPI-0610, RVX- 208, BI2536, TG101348, LY294002, ABBV-075 (or mivebresib), FT-1101, ZEN003694, pharmaceutically acceptable salts, and mixtures, thereof.
- CBF -SMMHC inhibition cooperates with the BET-inhibitor JQ1 to eliminate leukemia cells and delay leukemia latency in mice.
- Analysis of enhancer interaction reveals that the three MYC enhancers are physically connected with the MYC promoter, and genome-editing analysis demonstrated that all three are functionally implicated in the regulation of MYC expression and in cell viability.
- Studies in the examples below reveal a mechanism whereby CBF -SMMHC drives leukemia maintenance and provides support for efficacious in inv(16) leukemia therapy with inhibitors targeting chromatin activity.
- the therapeutically effective combination of the compound of formula (1) and the BRD4 inhibitor synergistically inhibits proliferation of inv(16) leukemia cells.
- Methods of the invention are particularly useful in the treatment of acute myeloid leukemia, one type of inv(16) leukemia.
- Treatment includes prophylaxis of the specific disorder or condition, or alleviation of the symptoms associated with a specific disorder or condition and/or preventing or eliminating those symptoms.
- CBF -SMMFIC is oligomeric, whereas CBF is monomeric.
- AI-10-49 inhibits CBF -SMMFIC activity while having a minimal effect on CBF function.
- compounds of formula (1) contain two 2-(pyridin-2-yl)- 5-(trifluoromethoxy)-lFI-benzo[d]imidazole groups, attached by a linker, -0-[CFI2CFI2Y]n-0-.
- the linker connects the two binding portions of the molecule.
- Dimeric or bivalent inhibitors take advantage of the oligomeric nature of CBF -SMMFIC and apply the principles of poly-valency (Mammen, et al., 1998; Kiessling, et al., 2006) to achieve the desired selectivity.
- CBF -SMMFIC The truncated forms of CBF -SMMFIC lacking the extreme C-terminus have been shown to form dimers in solution. (Lukasik, et al., 2002.) For the full-length protein, these dimers then oligomerize to form high order oligomers. (Shigesada, et al. 2004.) In contrast, CBF is monomeric in solution. This difference in oligomerization provides a means to achieve selective inhibition of CBF -SMMFIC versus CBF .
- Y is O, NH, or S.
- Y is O.
- Y is N-CFI3.
- n is greater than 1, Y can be the same or different.
- n is an integer from 1 to 10. In methods and compositions according to the invention, n is 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10.
- n is from 1 to 5.
- the linker should be long enough to allow the bivalent compound of formula (1) to achieve binding enhancement by means of CBF -SMMFIC— ligand interaction versus a mono-valent CBF -ligand interaction. See U.S. Patent No. 9,221,764, FIG. 5.
- the dissociation constant for a monovalent compound binding to monomeric CBF is equal to K d (monomer).
- a homo-dimer of this compound will bind the monomeric CBF protein with a dissociation constant equal to Kd(monomer)/2.
- Non-limiting exemplary compounds within formula (1) include:
- the BRD4 inhibitor is selected from, for example, JQ1, CeMMEC2, l-BET 151 (or GSK1210151A), l-BET 762 (or GSK525762), PFI-1 , bromosporine, OTX-015 (or MK-8628), TEN-010, CPI-203, CPI-0610,
- the BRD4 inhibitor may also be any one of the compounds disclosed in WO 2012/174487, WO 2014/076146, US 2014/0135336, WO 2014/134583, WO
- BRD4 inhibitors are under clinical investigation. (See, e.g., Alqahtani et al., 2019, Table 2).
- the BRD4 inhibitor is JQ1.
- the BRD4 inhibitor is ABBV-075 or OTX015.
- a compound of formula (1) or a BRD4 inhibitor used in the invention may take the form of a "pharmaceutically acceptable salt", which refers to salts that retain the biological effectiveness and properties of the compounds of the invention and that are not biologically or otherwise undesirable.
- the compounds administered in the methods of the invention form acid and/or base salts by virtue of the presence of amino and/or carboxyl groups or groups similar thereto.
- Pharmaceutically acceptable acid addition salts may be prepared from inorganic and organic acids. Salts derived from inorganic acids include, but are not limited to, hydrochloric acid, hydrobromic acid, sulfuric acid, nitric acid, phosphoric acid, and the like.
- Pharmaceutically-acceptable base addition salts can be prepared from inorganic and organic bases.
- Salts derived from inorganic bases include by way of example only, sodium, potassium, lithium, ammonium, calcium and magnesium salts.
- Salts derived from organic bases include, but are not limited to, salts of primary, secondary and tertiary amines.
- a therapeutically effective combination of an amount of a compound of formula (1), such as compound (la), and a BRD4 inhibitor, such as JQ1, is
- inhibitor refers to the ability of a compound of the invention to reduce or impede a described function, such as cell proliferation.
- inhibition is by at least 10%, more preferably by at least 25%, even more preferably by at least 50%, and most preferably, the function is inhibited by at least 75%.
- a BRD4 inhibitor and a compound of formula (1) have been shown, separately, to be effective at inhibiting proliferation of inv(16) leukemia cells, when combined, the result is more than additive, it is, surprisingly, synergistic. See e.g., FIG. 3 and 11.
- the amount of the synergistic combination of a compound of formula (1) and of BRD4 inhibitor or a salt thereof, required for use in a method of treatment according to the invention may vary with the route of administration, the nature of the condition being treated and the age and condition of the patient and will be ultimately at the discretion of the attendant physician or clinician.
- the duration of administration of the compound of formula (1) may be determined by one of skill in the art, and continued as needed.
- the synergistic combination used in the invention has a weight to weight ratio of the daily administered dose of BRD4 inhibitor to the daily administered dose of compounds of formula (1) ranging from about 0.0001:1 to about 1000:1.
- the ratio may be from about 0.001:1 to about 100:1, e.g., from about .01:1 to about 10:1, e.g. from about 0.1:1 to about 1:1.
- Daily administration may be simultaneous, continuous or discontinuous.
- the compound of formula (1) and the BRD4 inhibitor are administered simultaneously, or sequentially by first administering the compound of formula (1) followed by administering the BRD4 inhibitor.
- the compound of formula (1) and the BRD4 inhibitor may also be administered
- the compound of formula (1) and the BRD4 inhibitor may be administered sequentially by first administering the compound of formula (1) followed by administering the BRD4 inhibitor.
- the BRD4 inhibitor is administered, and then the compound of formula (1) is administered.
- the compound of formula (1) and the BRD4 inhibitor are administered simultaneously, followed by daily administration of the compound of formula (1) for 1 or more days.
- the desired dose may conveniently be presented in a single dose or as divided doses administered at appropriate intervals, for example, as two, three, four, or more sub-doses per day.
- the sub-dose itself may be further divided, e.g., into a number of discrete loosely spaced administrations; such as multiple injections.
- the extent of proliferation of cells from a subject suffering from inv(16) leukemia is measured using techniques known to those skilled in the art.
- a specific population of cells referred to as leukemia initiating cells using mouse models of inv(16) leukemia has been identified and accepted as an appropriate animal model. (Kuo, Y. H., et al., 2006.)
- This population of cells retains the inv(16) but does not possess the secondary mutations associated with disease. Upon acquisition of such secondary mutations, these cells can progress to overt leukemia. These cells are also typically more resistant to traditional cytotoxic chemotherapy and therefore represent a pool of cells from which relapse can occur. Cells may be extracted for measurement from blood, spleen, bone marrow, and/or spinal fluid. For example, populations of Lin- Sca-Kit+ cells extracted from a subject with inv(16) leukemia are measured using flow cytometry. The Lin- Seal- c-Kit+ cell population, is enriched in the leukemia initiating cell (LIC) and leukemia stem cell (LSC) population.
- LIC leukemia initiating cell
- LSC leukemia stem cell
- the compound of formula (1) and the BRD4 inhibitor are administered in a pharmaceutical composition comprising the compound of formula (1), the BRD4 inhibitor, and a pharmaceutically acceptable carrier.
- the compound of formula (1) is administered in a pharmaceutical composition comprising the compound of formula (1) and a pharmaceutically acceptable carrier, and the BRD4 inhibitor is subsequently administered in a pharmaceutical composition comprising the BRD4 inhibitor and a pharmaceutically acceptable carrier.
- the dosage formulations of the pharmaceutical can be the same or different.
- both the BRD4 inhibitor and the compound of formula (1) are formulated as solutions for parenteral delivery.
- the BRD4 inhibitor is formulated as a solution
- the compound of formula (1) is formulated as a tablet.
- a separate embodiment of the invention is a pharmaceutical composition
- a pharmaceutical composition comprising a pharmaceutically-acceptable carrier and a therapeutically effective combination of
- Y is O, NH, or NR where R is methyl or ethyl
- n is an integer of from 1 to 10
- a BRD4 inhibitor selected from the group consisting of JQ1, CeMMEC2, l-BET 151 (or GSK1210151A), I- BET 762 (or GSK525762), PFI-1 , bromosporine, OTX-015 (or MK-8628), TEN-010, CPI-203, CPI-0610, RVX- 208, BI2536, TG101348, LY294002, ABBV-075 (or mivebresib), FT-1101, ZEN003694, or a BRD4 inhibitor selected from the group consisting of JQ1, CeMMEC2, l-BET 151 (or GSK1210151A), I- BET 762 (or GSK525762), PFI-1 , bromosporine, OTX-015 (or MK-8628), TEN-010, CPI-203, CPI-0610, RVX- 208, BI2536, TG101348, LY294002, ABBV
- a pharmaceutical composition according to the invention may be in any pharmaceutical form which contains a synergistic combination of a compound of formula (1) and the BRD4 inhibitor.
- the pharmaceutical composition may be, for example, a tablet, a capsule, a liquid suspension, an injectable composition, a topical composition, an inhalable composition or a transdermal composition. Liquid pharmaceutical compositions may also be prepared.
- the pharmaceutical compositions generally contain, for example, about 0.1% to about 99.9% by weight of a combined amount of a compound of formula (1) and the BRD4 inhibitor, for example, about 0.5% to about 99% by weight of a combined amount of a compound of formula (1) and the BRD4 inhibitor and, for example, 99.5% to 0.5% by weight of at least one suitable pharmaceutical excipient.
- the composition may be between about 5% and about 75% by weight of a combined amount of a compound of formula (1) and the BRD4 inhibitor with the rest being at least one suitable pharmaceutical excipient or at least one other adjuvant, as discussed below.
- the pharmaceutically acceptable carrier may be chosen from any one or a combination of carriers known in the art. The choice of
- pharmaceutically acceptable carrier depends upon the pharmaceutical form and the desired method of administration to be used.
- Suitable liquid pharmaceutical compositions contain solubilizing agents that improve drug aqueous solubility, such as, for example, cyclodextrins.
- cyclodextrins include solubilizing agents that improve drug aqueous solubility, such as, for example, cyclodextrins.
- a cyclodextrin is a polyanionic variably substituted sulfobutyl ether of b-cyclodextrin (b-CD) (Captisol ® ).
- the carrier in a solid pharmaceutical composition should not substantially alter either the compound of formula (1) or the BRD4 inhibitor.
- the carrier be otherwise incompatible with the compound of formula (1) or the BRD4 inhibitor used, such as by producing any undesirable biological effect or otherwise interacting in a deleterious manner with any other component(s) of the pharmaceutical composition.
- compositions of the invention may be prepared by methods known in the pharmaceutical formulation art, for example, see Remington's Pharmaceutical Sciences, 18th Ed., (Mack Publishing Company, Easton, Pa., 1990), which is incorporated herein by reference.
- Suitable solid dosage forms of the pharmaceutical composition of the invention include at least one pharmaceutically acceptable excipient such as, for example, sodium citrate or dicalcium phosphate or (a) (a) fillers or extenders, such as, for example, starches, lactose, sucrose, glucose, mannitol, and silicic acid, (b) binders, such as, for example, cellulose derivatives, starch, alginates, gelatin, polyvinylpyrrolidone, sucrose, and gum acacia, (c) humectants, such as, for example, glycerol, (d) disintegrating agents, such as, for example, agar-agar, calcium carbonate, potato or tapioca starch, alginic acid, cro
- compositions of the invention may also be used in the pharmaceutical compositions of the invention. These include, but are not limited to, preserving, wetting, suspending, sweetening, flavoring, perfuming, emulsifying, and dispensing agents. Prevention of the action of microorganisms may be ensured by inclusion of various antibacterial and antifungal agents, for example, parabens, chlorobutanol, phenol, sorbic acid, and the like. It may also be desirable to include isotonic agents, for example, sugars, sodium chloride, and the like.
- a pharmaceutical composition of the invention may also contain minor amounts of auxiliary substances such as wetting or emulsifying agents, pH buffering agents, antioxidants, and the like, such as, for example, citric acid, sorbitan monolaurate, triethanolamine oleate, butylated hydroxytoluene, etc.
- auxiliary substances such as wetting or emulsifying agents, pH buffering agents, antioxidants, and the like, such as, for example, citric acid, sorbitan monolaurate, triethanolamine oleate, butylated hydroxytoluene, etc.
- Solid dosage forms as described above may be prepared with coatings and shells, such as enteric coatings and others, as is known in the pharmaceutical art. They may contain pacifying agents and can also be of such composition that they release the active compound or compounds in a certain part of the intestinal tract in a delayed manner.
- Non-limiting examples of embedded compositions that may be used are polymeric substances and waxes. The active compounds may also be in
- microencapsulated form if appropriate, with one or more of the above-mentioned excipients.
- Suitable suspensions may contain suspending agents, such as, for example, ethoxylated isostearyl alcohols, polyoxyethylene sorbitol and sorbitan esters, microcrystalline cellulose, aluminum metahydroxide, bentonite, agar-agar and tragacanth, or mixtures of these substances, and the like.
- suspending agents such as, for example, ethoxylated isostearyl alcohols, polyoxyethylene sorbitol and sorbitan esters, microcrystalline cellulose, aluminum metahydroxide, bentonite, agar-agar and tragacanth, or mixtures of these substances, and the like.
- Liquid dosage forms may be aqueous, may contain a pharmaceutically acceptable solvent as well as traditional liquid dosage form excipients known in the art which include, but are not limited to, buffering agents, flavorants, sweetening agents, preservatives, and stabilizing agents.
- Dosage forms for oral administration which includes capsules, tablets, pills, powders, granules, and suspensions may be used.
- Suitable pharmaceutical compositions according to the invention may also be formulated as liquid or injectable pharmaceutical compositions. Administration may be carried out via any of the accepted modes of administration or agents for serving similar utilities.
- administration may be, for example, orally, buccally, or parenterally (intravenous, intramuscular, intraperitoneal, or subcutaneous), in the form of solid, semi-solid, lyophilized powder, or liquid dosage forms, such as, for example, tablets, pills, soft elastic and hard gelatin capsules, powders, solutions, suspensions, or aerosols, or the like, such as, for example, in unit dosage forms suitable for simple administration of precise dosages.
- One route of administration may be oral administration, using a convenient daily dosage regimen that can be adjusted according to the degree of severity of the condition to be treated.
- the combined concentration of the compound of formula (1) and the BRD4 inhibitor of the invention in a liquid composition will be from about 0.1-25 wt-%, preferably from about 0.5- 10 wt-%.
- concentration in a semi-solid or solid composition such as a gel or a powder will be about 0.1-5 wt-%, preferably about 0.5-2.5 wt-%.
- mice All animal experiments were performed in accordance with a protocol reviewed and approved by the University of Massachusetts Institutional Animal Care and Use Committee. Mice carrying knock in Cbfb +/MYHn and Nras +/G12D oncogenic alleles has previously described (Xue et al., 2014) and maintained at the animal facility at University of Massachusetts Medical School with all protocols approved by the University of Massachusetts Medical School Animal Care Committee (Certificate A1266). C57BL/6J mice for transplantation and toxicology experiments were obtained from Taconic Biosciences (Germantown, MD, U.S.A.).
- ME-1 cells were cultured in RPMI 1640 with 20 % fetal bovine serum, 25 mM HEPES, 100 U/ml Penicillin and 100 mg/ml Streptomycin (Life Technologies) and ImI/ml Plasmocin (Invitrogen).
- 293T cells were cultured in DMEM with 10 % fetal bovine serum, 100 U/ml Penicillin and 100 mg/ml Streptomycin (Life Technologies) and ImI/ml Plasmocin (Invitrogen).
- Human cord blood CD34+ cells as well as human primary leukemic cells were cultured in StemSpan SFEM II (Stemcell Technologies), 100 U/ml Penicillin and 100 mg/ml Streptomycin (Life Technologies) supplemented with 10 ng/mL human recombinant TPO, 10 ng/mL human recombinant FLT3L (10 ng/mL), 100 ng/mL human recombinant SCF, 10 ng/mL human recombinant IL3, and 20 ng/mL human recombinant IL-6.
- Murine bone marrow cells were isolated by crushing femur and tibia of the hind legs of mice. Wild type mouse bone marrow cells were cultured in StemSpan Serum-Free Expansion Medium (SFEM, Stemcell Technologies), 100 U/ml Penicillin and 100 mg/ml Streptomycin (Life Technologies) supplemented with 6 ng/ml murine recombinant IL3, 10 ng/ml murine recombinant IL6, and 50 ng/ml murine recombinant SCF.
- SFEM StemSpan Serum-Free Expansion Medium
- Cbfb +/MYHn and Nras +/G12D leukemic bone marrow and spleen cells were cultured in StemSpan Serum-Free Expansion Medium (SFEM, Stemcell Technologies), 100 U/ml Penicillin and 100 mg/ml Streptomycin (Life Technologies) supplemented with 10 ng/ml murine recombinant IL3, and 50 ng/ml murine recombinant SCF.
- SFEM StemSpan Serum-Free Expansion Medium
- Penicillin and 100 mg/ml Streptomycin Life Technologies
- Retroviral Production and Transduction For studying Myc silencing in inv(16) leukemic cells, 293T packaging cells were transfected with 8 pg retroviral constructs co-expressing GFP (c-Myc (shMyc) or Renilla luciferase (shRen); (Roderick et al., 2014)) and 4 pg-Ecopac packaging plasmid with Fugene transfection reagent. Retroviral supernatants were collected at 40 and 64 hrs, pooled and concentrated using Retro-X Concentrator (Clonetech), following the manufacturer's instructions.
- retroviral constructs co-expressing GFP c-Myc (shMyc) or Renilla luciferase (shRen); (Roderick et al., 2014)
- Retroviral supernatants were collected at 40 and 64 hrs, pooled and concentrated using Retro-X Concentrator (Clonetech), following the manufacturer's instructions.
- Leukemic spleen cells from conditional Cbfb +/MYHn and Nras +/G12D knock in mice were lineage depleted using EasySep ® Mouse Hematopoietic Progenitor Cell Enrichment Kit (Stem cell technologies, following the manufacturer's instructions.
- 1-2 xlO 6 lineage-negative cells were transduced twice by spin infection with shRNA retroviruses with a time gap of 24 hrs.
- Cells expressing GFP+ were sorted 24 hrs after second infection.
- Cbfb+/56M/Cre or Cbfb+/56M conditional knock-in mice were treated with polyinosinic-polycytidylic acid (plpC). Bone marrow lineage negative cells from both groups of mice were spin-infected twice with retrovirus supernatants.
- CRISPR/Cas9 - mediated deletion of the enhancer regions The sgRNAs specific for 5' to the region of interest were cloned in pLentiCRISPRv2 (Addgene #52961). sgRNAs corresponding to 3' to the region of interest were cloned in pDecko-mCherry (Addgene #78534). The puromycin resistance cassette in pLentiCRISPRv2 was replaced by green fluorescent protein (GFP) using standard cloning techniques. All sgRNA cloning was done in respective plasmids using standard guide RNA cloning method.
- GFP green fluorescent protein
- top and bottom strand guide RNA oligos were phosphorylated using T4 Polynucleotide Kinase (NEB), annealed and inserted into the vectors at BsmBl site.
- Guide RNAs cloned inside the pLentiCRISPRv2GFP were transfected into 293T cells using the FuGENE ® 6 method according to the manufacturer's instructions. 48 hrs after transfection, genomic DNA was isolated, and PCR was carried out to amplify the region of interest. PCR product was re-annealed and treated with T7 endonuclease (NEB) according to the manufacturer's instruction. The reaction was later resolved on 2% agarose gel and product was analyzed.
- Oligonucleotide names and sequences (5' -3') are listed in the key resource table. 2-3xl0 6 ME-1 cells were nucleofected with CRISPR/Cas9 plasmids (2pg each) using NucleofectorTM Technology (Lonza) with the program X-01 and Amaxa ® Cell Line Nucleofector ® Kit V. Samples were sorted by flow cytometry 24 hrs later. Cells were cultured overnight, and dead cells were eliminated by dead cell removal kit (Miltenyi Biotec).
- Cell Viability Assay Cell viability was estimated using the MTT kit, CellTiter 96 ® AQueous One Solution (Promega, PA). 20,000 cells/well were seeded in triplicate into 96-well plates. After 24-72 hrs, 20 pi of MTT reagent was added to wells containing cells or medium (blank), and absorption at 490 nm was measured using SpectraMax M5 plate reader (Molecular Devices). [072] Inducible expression of MYC using MYC-ER. 2x10 s ME-1 cells were nucleofected with MYC-ER.
- mice were sacrificed after visible characteristics of AML, including reduced motility and grooming activity, hunched back, and pale paws (anemia).
- Leukemic cells were extracted from spleen and analyzed at time of euthanasia as previously described (Kuo et al., 2006).
- Bone marrow hematopoietic stem and multi-lineage progenitors were analyzed as LSK+: Lin(-), kit(+), Scal(+); common myeloid progenitors, CMP: Lin(-)Scal(-)kit(+)CD34(+)CD16/32(-); granulocyte/monocyte progenitor, GMP: Lin(-)Scal(-)kit(+)CD34(+)CD16/32(+); and megakaryocyte/erythroid progenitors, MEP: Lin(- )Scal(-)kit(+)CD34(-)CD16/32(-). Flow cytometry analysis was performed using FlowJo Software.
- Annexin V Assay For detection of apoptotic cell death, the Annexin V Apoptosis Detection Kit I (BD Bioscience) was used as per manufacturer's instructions. Briefly, cells were centrifuged 2000 rpm for 10 min, resuspended in 100 mI IX Annexin V binding buffer, added 5 mI Annexin-PE and 10 mI 7AAD and incubated for 15 min at room temperature in the dark followed by adding 500 mI IX Annexin binding buffer. Cell viability was determined as the percent of 7-AAD negative/ Annexin V negative cells with a BD LSRII flow cytometer.
- RNA Sequencing The RNA for RNA-sequencing was prepared with a PureLink ® RNA Mini Kit. RNA concentration was quantified with a NanoDrop spectrophotometer (Thermo Scientific). RNA integrity was evaluated with a 2100 Bioanalyzer with an RNA 6000 kit (Agilent Technologies). Libraries were prepared with a TruSeq RNA library preparation kit (lllumina). Libraries were quantified by qPCR, normalized and pooled before sequencing with paired-end 90-bp reads on an lllumina HiSeq2000 in triplicate.
- Chromatin Immunoprecipitation (ChlP). ME-1 cells were treated with DMSO or AI-10-49 (1 mM) for six hrs. Cross-linking of proteins to DNA was accomplished by the addition of 1 % formaldehyde for 10 min to cultured cells at room temperature. After neutralization with glycine, cells were lysed in lysis buffer with protease inhibitors and samples were sonicated to an average DNA length of 200-400 bp with a bioruptor (Diagenode). After sonication, the chromatin was immunoprecipitated with 10 pg of antibody of interest at 4 °C overnight. Antibody bound complexes were isolated with Dynabeads (Life Technologies). DNA was purified using phenol-chloroform isoamyl-alcohol method.
- Immunoprecipitated DNA was analyzed by sequencing (explained below) or qPCR on a StepOnePlus System (Applied Biosystems) with Power SYBR ® Green PCR Master Mix and calculated as % of input. Sequences of primers are provided in Table 1.
- CD34 + cells were enriched using a CD34 MicroBead Kit (Miltenyi Biotec) and cultured overnight followed by dead cell removal by dead cell removal kit (Miltenyi Biotec). Cells were treated with DMSO/ AI-10-49 (5mM) for 8 hrs followed by the ChIP procedure mentioned above.
- ChlP-seq data analysis ChlP-seq data analysis. ChlP-seq reads were aligned to the human genome (hgl9) with Bowtie2 v2.1.0 (Langmead and Salzberg, 2012) with the standard default settings. Only the reads with a mapping quality greater than 20 were kept, and the duplicated reads were removed using picard tools vl.96 (https://broadinstitute.github.io/picard/). Peak calling was performed with MACS2 v2.1.0 (Zhang et al., 2008) with default parameters. Input was used as a control for peak-calling. The narrowPeak files were generated by macs2 with a q-value threshold of 0.01, and the bigwig files were generated with the signal as fold enrichment by macs2 following the procedure at
- ATAC-seq Transposase-Accessible Chromatin with sequencing
- Cell pellets were re-suspended in 50 mI of cold lysis buffer (lOmM Tris- HCI pH 7.4, lOmM NaCI, 3mM MgCh, 0.1% IGEPAL CA-630) and nuclei were pelleted by centrifugation for 10 min at 500 x g, 4C. Supernatant was discarded and nuclei were re-suspended in 25 mI reaction buffer containing 2.5 mI of Tn5 transposase and 12.5 mI of TD buffer (Nextera Sample preparation kit, lllumina). The reaction was incubated at 37 Q C for 45 min. Immediately following transposition, tagmented DNA was purified using a Qjagen MiniElute PCR Purification Kit.
- ATAC-seq data analysis The preprocessing of ATAC-seq data was followed as reported (Buenrostro et al., 2013). The adaptors were removed using cutadapt program v 1.3 (Martin, 2011).
- the reads were then mapped onto the human genome hgl9 assembly using Bowtie2 (Langmead and Salzberg, 2012). The standard default settings were modified to allow mapped paired-end fragments up to 2 kb. Only the reads with mapping quality greater than 20 were kept, and the duplicated reads were removed using picard tools vl.96 (https://broadinstitute.github.io/picard/), the reads from
- ATACseqQC (Ou et al., 2017). Reads enrichment were called by MACS2 v2.1.0 (Zhang et al., 2008) with default parameters using the reads with insert size less than 100 bp as nucleosome free regions.
- GSEA Gene Set Enrichment Analysis
- Proteins were separated on precast 8-12% Mini Protean TGX gels at 60-80 V using the Mini Protean electrophoresis system and were blotted onto PVDF membrane at 100V for 90 min in a Mini Trans-Blot Cell. All antibodies were used as recommended by the manufacturer and mentioned in Key Resource Table. Relative band intensities were quantified using ImageJ software.
- 5C primers were designed at Hindlll restriction sites using publicly available 5C primer design tools published previously (Lajoie et al., 2009). Primers were designed according to a double alternating scheme exactly as described before (Hnisz et al., 2016). Primers were designed for each Hindlll fragment: one primer designed on the 5' end of the fragment, and one on the 3' end. For a fragment either a right 5' forward (FOR) and a left 3' reverse (LREV) primer, or a right 5' REV and a left 3' LFOR primer were designed. These two primer designs alternate along consecutive fragments throughout the entire region of interest. This design allows interrogation of all pairwise interactions among all fragments, which is not possible with a more simple alternating design used previously (Lajoie et al., 2009).
- Primer settings U-BLAST, 3; S-BLAST, 50, 15-MER, 800, MIN_FSIZE, 100; MAX_FSIZE, 50,000; OPT_TM, 65; OPT_PSIZE, 40.
- the 5C primer tails were: FOR/LFOR: T7 sequence 5'- T AAT ACG ACT CACT AT AGCC-3' (SEQ ID NO:39); REV/LREV: T3 sequence 5'-TCCCTTTAGTGAGGGTTAATA- 3' (SEQ ID NO:40).
- the full-length of all FOR/LFOR primers was 60 bases; the length of all REV/LREV was 61 bases.
- FOR forward
- LFOR 367 left forward
- REV reverse
- LREV 367 left reverse primers that combined interrogate 532,158 long-range chromatin interactions.
- Ligated 5C primer pairs which represent a specific ligation junction in the 3C library and thus a long- range interaction between the two corresponding loci, were then amplified using 20 cycles of PCR with T7 and T3R universal tail primers that recognize the common tails of the 5C forward and reverse primers.
- Four separate amplification reactions were carried out for each annealing reaction described above and all the PCR products of each library were pooled together. This pool constitutes the 5C library.
- the libraries were concentrated using Amicon Ultra Centrifugal filters - 0.5 ml 30K (Millipore) and purified with Qiaquick PCR purification kit.
- 5C read mapping 5C libraries were sequenced on an lllumina HiSeq 4000 instrument, reads were mapped (with Novoalign mapping algorithm V3.02.00) and 5C interactions assembled exactly as described before (Lajoie et al., 2009; Sanyal et al., 2012). Data from the two biological replicates were pooled, producing a single interaction map for DMSO treated, and AI-10-49 treated cells. The summary statistics and the read depth of each 5C libraries can be found in Supplementary Table 2.
- 5C filtering and analysis 5C matrices were processed using previously described methods (Lajoie et al., 2009; Sanyal et al., 2012). Briefly, first we removed 5C interactions that represent self- ligated restriction fragments. Second, in 5C PCR can lead to over amplification of individual pair-wise interactions (outliers). To remove these, first the average interaction frequency and standard deviation of all pair-wise interactions as a function of their genomic distance using LOWESS smoothing, as described in Sanyal et al. (Sanyal et al., 2012) was calculated. This average value represents the expected interaction frequency for a pair of loci.
- the union of all flagged primers across the four 5C matrices was taken, and these were removed from all four datasets.
- the four matrices to the same number of total reads (5xl0 7 ) were scaled.
- the matrices were balanced according to the ICE method so that the sum of each row and each column is equal (Imakaev et al., 2012).
- Sixth, data were binned at 20Kb (median) with a sliding window with 2.5 Kb steps, or at 15Kb (median) with a sliding window with 2.5 Kb steps when data were plotted as interaction profiles of single loci (4C-style plots).
- Seventh, matrices were balanced again after binning.
- Example 1 Inhibition of CBFB-SMMHC activity by AI-10-49 represses MYC transcript expression.
- the expression of CBF -SMMHC is critical for inv(16) AML blast survival, and the small molecule inhibitor AI-10-49 selectively triggers apoptosis of human and mouse inv(16) AML cells (lllendula et al., 2015).
- RNA-sequencing analysis was performed in human inv(16) AML cell line ME-1 treated with AI-10-49 for 6 hrs. Expression analysis of triplicate samples identified 591 upregulated and 696 downregulated genes (>2 fold change, FDR ⁇ 0.01; FIG. 1(A)).
- GSEA Gene Set Enrichment Analysis
- AI-10-49 directs strong (10-fold) repression of MYC transcript levels (FIG. 1 (C)) in ME-1 cells but not in non-inv(16) AML cell lines (FIG. 9C). Accordingly, MYC protein levels were significantly depleted (approximately 20-fold) at 0.1 mM and greater concentrations in ME-1 cells (FIG. ID and FIG. 9D). Concordant with these results, MYC expression was reduced by AI-10-49 in mouse Cbfb +/MYHn and human primary inv(16) AML cells (FIGS. IE and IF).
- Example 2 MYC is required for the maintenance and survival of inv(16) AML cells. c-MYC levels were analyzed for regulation of survival in inv(16) AML. The knockdown of MYC, using MYC-shRNAs, reduced viability of ME-1 cells 66% and primary mouse Cbfb +/MYH11 leukemic cells 70% (FIGS. 2A, 2B, and FIG. 10A and 10B). Furthermore, ectopic MYC expression, using an MYC-ER system (Ricci et al., 2004), resulted in a partial rescue of AI-10-49 mediated apoptosis (FIG. 2C).
- MYC silencing is required for granulocytic differentiation of myeloid cells (Johansen et al., 2001)
- MYC knockdown in ME-1 cells was investigated.
- the fraction of cells with myeloid markers (CD15 + and CDllb + ) 14 days after transduction was not significantly altered (FIG. 10C), suggesting that MYC repression primarily directs apoptosis and not differentiation of inv(16) AML cells.
- Nras/CM Nras/CM
- Xue et al., 2014 transduced with Renilla- or 2 Myc-shRNAs in retroviruses expressing GFP
- FIG. 10D The engraftment efficiency of GFP+ leukemic cells in bone marrow five days after transplantation was similar between groups (FIG. 2D).
- the fraction of leukemic cells in peripheral blood 28 days after transplantation revealed a marked reduction in mice transplanted with Myc shRNAs, suggesting that Myc is required for the maintenance of inv(16) leukemic cells (FIG. 2E).
- Myc levels in the leukemic cells from either Myc-shRNA group were similar to that of Renilla group (FIG. 10E), suggesting that sustained reduction in Myc levels had been lost in these clones. Therefore, these in vitro and in vivo experiments in mice demonstrate that modulation of MYC oncogene levels is critical to the survival and expansion of inv(16) leukemic cells.
- Example 3 AI-10-49 cooperates with JQ1 to reduce inv(163 ⁇ 4 AML cell survival.
- Bromodomain (BRD) proteins have been established as key drivers of oncogenic transcription factors such as MYC (Delmore et al., 2011).
- the BET-family of BRD inhibitors, such as JQ1 and I-BET151 are potent BRD inhibitors that repress MYC levels (Dawson et al., 2011; Delmore et al., 2011), and second generation BRD-inhibitors are being tested in the clinic.
- MYC expression depends on BRD4 in inv(16) AML by estimating MYC levels in ME-1 cells upon BRD4 knockdown (FIGS. 3A and 11A).
- the MYC transcript and protein levels were readily reduced by AI-10-49 and JQ1 treatment of ME-1 cells, and combined treatment showed a cooperative effect in MYC transcript levels (FIGS 3B and 11B).
- the combination index (Cl) analysis (Chou, 2010) of combined AI-10-49 and JQ1 treatment at various concentrations of the two agents consistently showed Cl values below 1 (FIGS. 3C and 11C), indicative of a substantial synergy of JQ1 and AI-10-49 on ME-1 cell growth.
- mice transplanted with CBF -SM MHC-expressing (Nras+/LSL-G12D/Cbfb+/56M/MxlCre; Nras/CM) leukemia cells was analyzed. Five days after transplantation, mice were randomized in four groups, and treated with vehicle (dimethyl sulfoxide, DMSO), AI-10-49 for 10 days, JQ1 for 21 days, or combined treatment of AI-10-49 and JQ1 (FIG. 3F).
- vehicle dimethyl sulfoxide
- AI-10-49 enhances genome wide RUNX1 DNA binding.
- AI-10-49 inhibits CBF - SMMHC / RUNX1 binding, and increases the occupancy of RUNX1 to selected RUNX target gene promoters (lllendula et al., 2015).
- chromatin immune-precipitation was conducted, followed by next generation sequencing (ChIP-seq) in ME-1 cells treated with AI-10-49 for 6 hrs.
- Histone3-Lysine27 acetylation (H3K27ac) peaks which mark transcriptionally active regions, indicated a significant decrease in positive peaks (31,102 for DMSO versus 24,157 for AI-10-49) (FIG. 4A).
- AI-10-49 promoted a general reduction in the peaks.
- RUNX1 occupied elements were highly enriched for ETS and AP-1 binding motifs (FIG. 4C).
- Association of RUNX1 with ETS factors has been reported in RUNX1-ETO positive leukemic cells (Ptasinska et al., 2012).
- AP-1 transcription factors were up-regulated by RUNX1 during megakaryocytic differentiation and recruited to RUNXl-occupied sites lacking AP-1 motifs (Pencovich et al., 2011). These data suggest that RUNX1 may cooperate with ETS factors to regulate gene expression during AI-10-49 treatment in inv(16) AML cells.
- RUNX1 can regulate chromatin remodeling during myeloid differentiation in mice
- AI-10-49 increases RUNX1 association with DNA
- AI-10-49 was evaluated for whether it can modulate chromatin accessibility in ME-1 cells, using Assay for Transposase-Accessible Chromatin with high throughput sequencing (ATAC-seq; (Buenrostro et al., 2013)).
- ATAC-seq Assay for Transposase-Accessible Chromatin with high throughput sequencing
- Analysis of ATAC-seq data in cell treated with DMSO or AI-10-49 revealed that AI-10-49 induced a significant reduction in chromatin accessibility (FIG. 4D).
- Example 5 RUNX1 represses MYC expression through direct binding at three downstream enhancer elements.
- Active enhancers regulate oncogene expression in cancer, including tumor-type specific distal enhancers that regulate oncogenic MYC expression in solid tumors (Hnisz et al., 2013; Loven et al., 2013; Pomerantz et al., 2009) and leukemia (Fulco et al., 2016; Herranz et al., 2014; Shi et al., 2013).
- Preliminary analysis of RUNX1 binding at the MYC promoter excluded the possibility that RUNX1 may directly regulate MYC expression through promoter occupancy in AI-10-49-treated inv(16) AML cells.
- the primary RUNX1 peak was located within the BDME super-enhancer (BRD4-mediated MYC enhancer), 1.7 Mb downstream of the MYC TSS (FIG. 5A).
- the BDME composed of five elements (E1-E5; FIG. 13A), has been shown to associate with the SWI/SNF proteins BRG1 and BRD4 to regulate MYC expression in myeloid cells and in mixed-lineage leukemia (Shi et al., 2013).
- This primary RUNX1 peak corresponds to the E3, which includes a RUNX1- consensus binding site.
- MYC enhancer 1 and 2 The two other RUNX1 peaks, called MYC enhancer 1 and 2 (ME1 and ME2), were located at 0.18 Mb at 0.5 Mb downstream MYC-TSS, respectively. We did not detect significant changes in RUNX1 peaks in the 2Mb region upstream of MYC (FIG. 13B).
- RUNX1 consensus binding sites were identified at the MYC promoter, ME1, ME2, and BDME elements El, E3 and E5. ChIP-qPCR changes in RUNX1 peaks at eight sites, including MYC promoter, ME1 and ME2 enhancers and the five BDME elements, were evaluated.
- +1.4Mb N-ME the T-cell leukemia associated NOTCFI-dependent MYC enhancer, also referred as NDME;
- RUNX1 peaks were significantly increased by AI-10-49 treatment at the ME1 (5-fold), ME2 (3-fold) and BDME-E3 (8-fold) and E5 (1.8-fold) elements, but not at the MYC promoter, N-ME and BDME El, E2 and E4 (FIG. 5B).
- Example 6 The ME1, ME2 and E3 enhancers physically interact with the MYC promoter.
- a critical determinant of enhancer activity in the regulation of MYC expression is the identification of physical interactions between regulatory elements.
- distant MYC enhancers have been reported up and downstream of MYC in a variety of cancers
- DNA interactions in a 4 Mb region around the MYC locus, including 1 Mb upstream and 3 Mb downstream of the MYC TSS were analyzed utilizing chromosome conformation capture carbon copy (5C; (Dostie et al., 2006)) in ME-1 cells treated with DMSO or AI-10-49 for six hours.
- 5C chromosome conformation capture carbon copy
- TADs Topologically Associating Domains
- FOG. 6A, arrows boundaries
- the MYC gene is located near the left boundary of a large TAD that contains several subregions, one that contains the ME1 and ME2 enhancer, and another that contains the BDME superenhancer encompassing CTCF sites and E3/E5.
- the interactions of the MYC promoter were analyzed in more detail by plotting the 5C interaction frequency of the promoter with the entire domain in a 4C-style interaction plot (FIG. 6B). Interaction frequencies generally decrease as function of genomic distance, as expected. Several peaks superimposed on this general trend were observed, representing specific looping interactions (Dekker et al., 2013). A significant interaction of the MYC promoter with ME1, ME2, and the BDME superenhancer was identified. Within the superenhancer, three peaks of elevated interactions were also identified, the two strongest of which contain CTCF binding sites (FIG. 6B, arrowheads). These interactions may involve interactions between the superenhancer and CTCF sites near the MYC promoter.
- Example 7 AI-10-49 induces a switch of SWI-SNF active complexes to PRC repressive complexes at the AML-Associated MYC Enhancers. It was hypothesized that increase in RUNX1 peaks may alter the active chromatin complexes at these enhancers. Therefore, AI-10-49-mediated changes in BRG1, a component of the SWI/SNF complex that participates in BDME-mediated MYC expression (Shi et al., 2013) was assessed.
- ChIP-qPCR analysis in ME-1 cells revealed that BRG1 is displaced from the MYC promoter and ME1, ME2, and BDME regulatory elements (FIG. 7A) whereas total BRG1 levels were not altered (FIG. 15A).
- ChIP-PCR analysis for changes in Flistone 3 Lys 4 mono-methylation (H3K4mel), an active enhancer-specific histone mark (Loven et al., 2013) also revealed a significant reduction in ME1, ME2 and ME3 enhancers, but not at N-ME and MYC promoter (FIG. 7B).
- RUNX1 and RING1B binding showed a similar pattern, increasing at approximately 2.5 hr, and reaching 90% occupancy by 5 hr. Conversely, BRG1 binding was reduced between 4 and 6 hr of treatment. The observed delay between RUNX1/RING1B occupancy and the reduction in BRG1 at E3 supports a complex replacement model.
- the interaction between RUNX1 and BRG1 or RING1B at E3, was evaluated utilizing ChIP-re-ChIP technique. This analysis revealed that RUNX1 specifically interacts with RING1B, but not with BRG1 at E3, and that this interaction is induced by AI-10-49 treatment (FIG. 6H).
- Example 8 MYC expression and viability of inv(16) AML cells depend on the activity of three distal enhancers ME1, ME2 and BDME-E3. To establish the functional significance of the three enhancers identified in inv(16) AML cells, a single deletion of each enhancer, utilizing CRISPR/Cas9 technology, was evaluated for whether it was sufficient to alter MYC expression and function. Sequence analysis of ME-1 cells transfected with Cas9 and 2 sgRNAs for each enhancer to produce small deletions surrounding the RUNX1 binding sites within the enhancers, revealed that the most frequent deletions were of 41bp (ME1), 67bp (ME2) and 295 bp (E3) in 60% to 70% of the cells (FIGS.
- ME1 ME1
- ME2 67bp
- E3 295 bp
- CBF -SMMHC maintains MYC expression and cell survival, and that this function is RUNXl-dependent.
- the fusion protein may have RUNX1- dependent or independent functions in hematopoiesis and AML (Hyde et al., 2010; Kamikubo et al., 2010; Mandoli et al., 2014), but the mechanisms underlying CBF -SMM HC oncogenic function in leukemia maintenance remains elusive.
- the fusion protein makes most of RUNX1 inaccessible to chromatin (Kanno et al., 1998; Lukasik et al., 2002) and only basal levels of RUNX1 are found associated with chromatin.
- basal RUNX1 function seems essential for leukemia maintenance as further repression of RUNX1 induces cell death and delays leukemia latency of Runxl 4/4 , Cbfb +/MYH11 mice (Ben-Ami et al., 2013; Hyde et al., 2015).
- RUNX1 expression is not affected by AI-10-49 treatment (lllendula et al., 2015); instead, an acute release of RUNX1 from CBF -SMMHC multimers disrupts the regulation of MYC expression and its oncogenic programs with an adverse effect in the leukemia-initiating cells.
- RUNX1 represses MYC expression by increasing its occupancy at three downstream enhancers (ME1, ME2 and E3) and promoting the switch of activating to repressing chromatin complexes.
- the balance between SWI/SNF and PRC epigenetic complexes modulates enhancer activity and oncogenic transformation.
- SWI/SNF can rapidly evict PRC1 from chromatin, and loss of its ATPase subunit, BRG1, inhibits this function (Stanton et al., 2017).
- the SWI/SNF complex has oncogenic function in t(9;ll) AML, and BRG1 is associated with the distal BDME super-enhancer to maintain MYC expression (Shi et al., 2013).
- the BDME super-enhancer (element E3) is also active in inv(16) AML, suggesting that BDME may be a "pan-AML" enhancer as it may function in many AML subtypes.
- BDME was recently identified in a CRISPR-screen to regulate MYC expression in the t(9:22) myeloblast/erythroid leukemia K562 cell line (Fulco et al., 2016).
- MYC expression in inv(16) AML depends on two additional enhancers (ME1 and ME2), which seem to be specific for inv(16) AML as they have not been identified in the other AML subtypes.
- RUNX1 release is directly associated with MYC expression in inv(16) AML.
- Acute increase in RUNX1 peaks at ME1, ME2 and E3 enhancers is correlated with BRG1 depletion, decrease of H3K4mel, and increase in RINGlb and H3K27me3 repressive marks.
- RUNX1 may drive the SWI/SNF-PRC1 switch, bringing PRC1 complexes to the MYC-associated enhancers and inducing apoptosis of inv(16) AML cells.
- Short hairpin RNA screen reveals bromodomain proteins as novel targets in acute myeloid leukemia. Cancer Cell 20, 287-288.
- CBF beta-SMMHC expressed in M4Eo AML, reduced CBF DNA-binding and inhibited the G1 to S cell cycle transition at the restriction point in myeloid and lymphoid cells. Oncogene 15, 1315-1327.
- Runxl is required for hematopoietic defects and leukemogenesis in Cbfb-MYHll knock-in mice. Leukemia 29, 1771-1778.
- c-Myc is a critical target for c/EBPalpha in granulopoiesis. Mol Cell Biol 21, 3789-3806.
- TopHat2 accurate alignment of transcriptomes in the presence of insertions, deletions and gene fusions. Genome biology 14, R36.
- Modeling of C/EBPalpha mutant acute myeloid leukemia reveals a common expression signature of committed myeloid leukemia-initiating cells. Cancer Cell 13, 299-310.
- Cbf beta-SMMHC induces distinct abnormal myeloid progenitors able to develop acute myeloid leukemia. Cancer Cell 9, 57-68.
- Bmi-1 determines the proliferative capacity of normal and leukaemic stem cells. Nature 423, 255-260.
- CBFB-MYH11/RUNX1 together with a compendium of hematopoietic regulators, chromatin modifiers and basal transcription factors occupies self-renewal genes in inv(16) acute myeloid leukemia. Leukemia 28, 770-778.
- Reed-lnderbitzin E., Moreno-Miralles, L, Vanden-Eynden, S.K., Xie, J., Lutterbach, B., Durst-Goodwin, K.L., Luce, K.S., Irvin, B.J., Cleary, M.L., Brandt, S.J., et al. (2006).
- RUNX1 associates with histone deacetylases and SUV39H1 to repress transcription. Oncogene 25, 5777-5786.
- Polycomb group ring finger 1 cooperates with Runxl in regulating differentiation and self-renewal of hematopoietic cells. Blood 119, 4152-4161.
- RNA-Seq Transcript assembly and quantification by RNA-Seq reveals unannotated transcripts and isoform switching during cell differentiation. Nat Biotech 28, 511-515.
- PRMT4 blocks myeloid differentiation by assembling a methyl-RUNXl- dependent repressor complex. Cell Rep 5, 1625-1638.
- NOTCH1-RBPJ complexes drive target gene expression through dynamic interactions with superenhancers. Proceedings of the National Academy of Sciences of the United States of America 111, 705-710.
- CBFbeta subunit is essential for CBFalpha2 (AML1) function in vivo. Cell 87, 697-708.
- c-Myc controls the balance between hematopoietic stem cell self-renewal and differentiation. Genes Dev 18, 2747-2763.
- NrasG12D oncoprotein inhibits apoptosis of preleukemic cells expressing Cbfbeta-SMMHC via activation of MEK/ERK axis. Blood 124, 426-436.
- ChIPpeakAnno a Bioconductor package to annotate ChIP-seq and ChIP-chip data. BMC bioinformatics 11, 237.
- RNAi screen identifies Brd4 as a therapeutic target in acute myeloid leukaemia. Nature 478, 524-528.
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ILLENDULA ET AL.: "Small Molecule Inhibitor of CBFP-RUNX Binding for RUNX Transcription Factor Driven Cancers", EBIOMEDICINE, vol. 8, 28 April 2016 (2016-04-28), pages 117 - 131, XP055655422 * |
JOHN ANTO PULIKKAN; MAHESH HEGDE; HOUDA BELAGHZAL; ANURADHA ILLENDULA; JUN YU; HAFIZ AHMED; KELSEY O'HAGEN; JIANHONG OU; CARSTEN M: "CBFp-SMMHC Inhibition Disrupts Enhancer Chromatin Dynamics and Represses MYC Transcriptional Program in Inv(16) Leukemia", BLOOD, vol. 130, no. S1, 7 December 2017 (2017-12-07), pages 1 - 6, XP009524937, DOI: 10.1182/blood.V130.Suppl_1.784.784 * |
PULIKKAN ET AL.: "CBFbeta-SMMHC Inhibition Triggers Apoptosis by Disrupting MYC Chromatin Dynamics in Acute Myeloid Leukemia", CELL, vol. 174, 28 June 2018 (2018-06-28), pages 172 - 186, XP085413219 * |
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