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TRANSCRIPT
4/30/2014
1
Department of Surgery
Minnelide: A Novel Therapy for
Pancreatic Cancer
Ashok K. Saluja, Ph.D.Professor and Vice Chair
Director of Basic and Translational Research
Department of Surgery
University of Minnesota
• Diseases of the exocrine pancreas cause considerable morbidity. In the US alone, pancreatitis causes 300,000 hospitalizations and 7,000 deaths, while pancreatic cancerclaims another 38,000 deaths annually.
• Treatment is limited for both, likely reflecting an inadequate understanding of their etiological and pathophysiological mechanisms. The national economy suffers by $3.5 billion annually.
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Heat Shock Proteins
• Discovered serendipitously by Ritossa
in 1962.
• One of the mechanisms that have
evolved to ensure the survival of living
cells under stressful conditions.
• One of the most highly conserved mechanisms of cellular protection.
Department of Surgery
Thermal Stress Induces HSP70
Expression in the Pancreas
HS
P70 le
vels
(O
.D.)
0
20
40
60
80*
Con Heated
HSP70
1 2 1 2
Con Heated
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Department of Surgery
Effect of Prior Thermal Stress on Parameters Associated with Caerulein-Induced Pancreatitis
Frossard J-L…Saluja AK, Gut (2002)
0
40
80
120
Amylase Pancreaticedema
PancreaticMPO
Pancreaticnecrosis
Control Hyperhermia
Caerulin Caerulin + hyperthermia%
maxi
mal i
ncre
ases
Department of Surgery
Transgenic Mice Over-expressing
HSP70 are Protected Against
Pancreatitis
Dawra R and Saluja AK, unpublished
HSP70 overexpressing mice were generated using a constructcontaining human HSP70 under control of the CMV promoter
Wild Type HSP70-Transgenic
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Department of Surgery
Effect of Caerulein Administration on the
Parameters Associated with Pancreatitis
in HSP70 Transgenic Mice
Dawra R and Saluja AK, unpublished
Pancreatic MPO Activity
MP
O A
cti
vit
y/ 5
0 µµ µµ
g p
rote
in
0
100
200
300
400
WTCON
WT+CER
Tg+CER
*
TGCON
Acinar Cell Necrosis
Ac
inar
Ce
ll N
ec
ros
is (
%)
0
4
8
12
16
WTCON
WT+CER
Tg+CER
*
TgCON
Department of Surgery
HSP70 and Pancreatitis
Bhagat et al., Gastroenterology (2002)
Frossard et al., Gut (2002)
Bhagat et al., J. Clin. Invest. (2000)
Insult
HSP70
Cell death Survival
Insult
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Department of Surgery
Pancreatic Cancer
• Pancreatic cancer is the most lethal
cancer known to humankind.
• 45,000 Americans will be diagnosed
with pancreatic cancer this year, and
most everyone will succumb to the
disease.
• Pancreatic cancer causes more than
250,000 deaths worldwide per year.
Department of Surgery
Current Treatments for
Pancreatic Cancer
• Current therapies for pancreatic
cancer are not very effective.
• Gemcitabine, approved more than 14
years ago, provides a 1.5 month
survival advantage.
• Tarceva adds 10 more days.
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Department of Surgery
HSP70 in Pancreatic Cancer
Pancreatic Cancer Cells
Cell Death
HSP70
Department of Surgery
HSP70 is Overexpressed in Pancreatic
Cancer Cells
Aghdassi A…Saluja AK, Cancer Research (2007)
Hsp70
Western Blots
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Department of Surgery
HSP70 Expression in Pancreatic Cancer
Patients
Aghdassi A…Saluja AK, Cancer Research (2007)
0
500
1000
1500
2000
2500
Normal Tumor
*
*p<0.002; n=7 patients
HS
P7
0 E
xp
ressio
n
(% o
f co
ntr
ol)
Re
al-
tim
e P
CR
Department of Surgery
HSPs and Pancreatic Cancer Hypothesis
Blocking HSPs should increase apoptosis in cancer cells thereby slowing the growth and spreading of tumor cells.
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Department of Surgery
Quercetin inhibited HSP70 and
caused tumor regression
HSP70
Actin
Control Quercetin
300
200
100
0
Tu
mo
r g
row
th
Control Quercetin
Department of Surgery
Heat Shock Protein 70 Increases Tumorigenicity and Inhibits Apoptosis in Pancreatic Adenocarcinoma
Ali Aghdassi, Phoebe Phillips, Vikas Dudeja, Dhara
Dhaulakhandi, Rifat Sharif, Rajinder Dawra, Markus M. Lerch
and Ashok Saluja
Cancer Research, Feb 2007
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Department of Surgery
Triptolide – A Diterpenoid Triepoxide
Has been used to treat
inflammatory disorders
such as rheumatoid
arthritis.
tripterygium wilfordii Hook. f.
(‘‘Thunder God Vine’’)
Department of Surgery
Triptolide Kills Pancreatic Cancer Cells In Vitro
Phillips PA…Saluja AK, Cancer Research (2007)
HSP70
0.0
0.2
0.4
0.6
0.8
1.0
1.2
0 50 100 200
PDC
MiaPaCa-2
Cell Viability After 48 h
Triptolide (nM)
*p<0.05, n=4
Cell V
iab
ilit
y(F
racti
on
of
Co
ntr
ol)
* * *
Actin
TPL
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Department of Surgery
Triptolide Reduces Pancreatic Tumor Growth In Vivo
Phillips PA…Saluja AK, Cancer Research (2007)
Controls
Triptolide Treatment
Department of Surgery
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Department of Surgery
Disadvantage of Triptolide
• Soluble only in organic solvent
• Limits clinical utility
• No IP (Patent protection)
Department of Surgery
Minnelide™: A Novel Prodrug of
Triptolide
• In collaboration with Dr. Gunda Georg and Satish Patil, we have synthesized a highly water-soluble analog of triptolde.
• Minnelide is as effective as triptolide in killing tumor cells in both in vitro and in vivo models of pancreatic cancer.
• Minnelide is safe in mice at relatively high doses.
• A patent to protect intellectual property has been granted to UMN.
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Department of Surgery
Disclosure
Dr. Saluja has a significant financial interest in and is the Chief Scientific Officer and a consultant for Minneamrita, a company which may commercially benefit from the results of this research. This relationship has been reviewed and managed by the University of Minnesota in accordance with its conflict of interest policies.
Department of Surgery
Effect of Minnelide™ on Pancreatic
Cancer Mortality in Mice
Control Treatment
0.1mg/kg 0.15mg/kg/bid 0.3mg/kg 0.6mg/kg
No of mice at
beginning10 10 10 9 10
No of mice alive at
day 951 9 10 9 10
• MiaPaCa-2 cells were orthotopically implanted into pancreas.
• 10d post-implantation, Minnelide™ was administered at
doses indicated for 60d.
• Treatment was discontinued and mice sacrificed 30d after
stopping treatment.
Chugh, Sangwan… Saluja (Sc Tran Med Oct. 2012)
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Department of Surgery
MiaPaca-2 cell-induced orthotopic tumors in nude mice - Average Tumor Size On Day of Death
-1000
0
1000
2000
3000
4000
5000
6000
Vehicle (1) 0.1 QD 0.15 BID (2) 0.3 QD (3) 0.6 QD 0.9 QD 0.2 Triptolide
Cu
bic
mm
or
mg
svol avg
wt avg
9/10
6/10
9/10
8/107/9
10/10*
5/10
*# of mice found with tumors / # of mice in group
Department of Surgery
Minnelide Increases Survival in an
Orthotopic Pancreatic Cancer Model
Day 1: Aspc-1 (2X 105) implanted into pancreas (n=20)
Day 7: 0.42 mg/kg Minnelide or saline IP begins (n=10)
Day 100: Minnelide treatment stopped (n=5)
Aspc-1
(Ascites)
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Department of Surgery
p=<0.0001
Day 1: Aspc-1 (2X 105) implantedDay 28: Minnelide treatment
Minnelide Causes Tumor Regression in an
Aspc-1 Induced Orthotopic Pancreatic Model
Aspc-1
(Ascites)
Day 85: Experiment terminated
Department of Surgery
Minnelide™ causes tumor regression in S2-013
cell-induced orthotopic pancreatic tumors
S2-013 is one of the most aggressive pancreatic tumor-derived cell lines.
Saline
Minnelide™
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Department of Surgery
Minnelide™ decreases tumor metastatis in
mice bearing S2-013-induced orthotopic
tumors
ORGAN CONTROL MINNELIDE
Liver 5/8 0/10
Kidney 5/8 0/10
Abdominal Wall 8/8 2/10
Diaphragm 8/8 0/10
Spleen 8/8 1/10
Ascites 8/8 0/10
Minnelide™ significantly decreased the tumor metastasis.
Department of Surgery
Minnelide decreases tumor burden in a
human xenograft
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Department of Surgery
Minnelide decreases tumor burden in a
human xenograft
Department of Surgery
Minnelide decreases tumor burden in a
human xenograft
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Department of Surgery
Minnelide causes tumor regression in a
human xenograft
Department of Surgery
Minnelide causes tumor regression in a
human xenograft
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Department of Surgery
Orthotopic Pancreatic Cancer Model
0.3
0.6
0.9
1.2
1.5
1.8
Control Gemcitabine Minnelide
*
Avera
ge T
um
or
Weig
ht
(gm
s)
Chugh R…Saluja AK, Sci Trans Med,2012
Department of Surgery
• One of the common pediatric tumors
• Advanced stage cases highly aggressive
– Resistant to conventional chemotherapy
– 5-year survival is 30-40%
Neuroblastoma
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Department of Surgery
Results: Tumor Growth In Vivo
0
1
2
3
Triptolide Control
Tumor Volume in cm3
Tumor Mass in gm
Antanoff M…Saluja AK, J. Surgical Research (2010)
Department of Surgery
Hsp-70 in Residual Tumors
Antanoff M…Saluja AK, J. Surgical Research (2010)
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Department of Surgery
Surgery (2009)
Triptolide therapy for neuroblastoma
decreases cell viability in vitro and inhibits tumor growth in vivo
Antonoff MB, Chugh R, Borja-Cacho D, Dudeja V, Clawson KA,
Skube SJ, Sorenson BS, Saltzman DA, Vickers SM, Saluja AK
Journal of Surgical Research, in press
Role of HSP70 in Triptolide-Mediated Cell
Death of Neuroblastoma
Antonoff MB, Chugh R, Borja-Cacho D, Dudeja V, Clawson KA,
Skube SJ, Sorenson BS, Saltzman DA, Vickers SM, Saluja AK
Department of Surgery
Minnelide is Also Effective in Colon, Ovarian,
Osteosarcoma and Several Other Cancers
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Department of Surgery
Minnelide: A Prodrug of Triptolide is
Soluble in Water
Department of Surgery
Minnelide in combination with death
receptor therapy
• Pancreatic cancer is highly resistant to monotherapy.
• Death receptor therapy is not very effective against pancreatic cancer
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Department of Surgery
Effect of triptolide and Anti-DR5 Ab on apoptosis of
pancreatic cancer cells after 24 hrs of exposure
0%
10%
20%
30%
40%
50%
60%
70%
% o
f a
po
pto
tic
cell
s
Panc-1
* p < .0001
*
0%
10%
20%
30%
40%
% o
f a
po
pto
tic
cell
s
ASPC-1
* p < .0001
*
0%
10%
20%
30%
40%
50%
60%
70%
% o
f a
po
pto
tic
cell
s
S-2013
*
* p < .0001
0%
10%
20%
30%
40%
50%
60%
70%
% o
f a
po
pto
tic
cell
s
S2-VP10
* p < .0001
*
* p < .0001
*
0%
10%
20%
30%
40%
50%
60%
70%
80%
% o
f a
po
pto
tic
cell
s
Mia-PaCa 2
* p < .0001
*
n = 4. Run in duplicates.
Method: Annexin V
Bar= SEM
Borja-Cacho D…Saluja A and Vickers SM, J. Gastrointest. Surg. (2010)
Chen Z………Saluja A (Cancer Lett. 2014)
Department of Surgery
Pancreatic cancer stem cells and Minnelide
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Department of Surgery
CD133+ tumors responded to therapeutic dose of Minnelide
in vivo
0
400
800
1200
0 49 56 63 70 77 84 91
Untreated
Minnelide
Minnelide started
0
400
800
1200
0 21 28 35 42 48 56 63
Untreated
Minnelide
Minnelide started
Days after implant
Tu
mo
r vo
lum
e
CD133+ CSM CD133+ 12T
Banerjee S……..Saluja A, unpublishedBanerjee S…… Saluja A ,Clin Can Res, 2014
Triptolide/Minnelide
HSP 70
Tumor Cell Death
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Department of Surgery
How does HSP70 Inhibition Results in Tumor Cell Death
Triptolide/Minnelide
HSP 70
Tumor Cell Death
LMP Intracellular Ca2+
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Department of Surgery
0
30
60
90
120
Control T 12h siRNA 48h
Lysotr
acker
Gre
en F
luore
scence
(% o
f contr
ol)
* p ≤ 0.05, n=3
**
T = Triptolide 0.2 µM
Dudeja V…Saluja AK, Gastroenterology (2009)
HSP70 Stabilizes Lysosomes in Pancreatic
Cancer Cells
Department of Surgery
0
100
200
300
Control T 12h siRNA 48h
Cyto
solic
cath
epsin
B a
ctivity
(% o
f contr
ol)
Inhibition of HSP70 results in lysosomal
permeabilization
*
* p ≤ 0.05, n=3
*
T = Triptolide 0.2 µM
Dudeja V…Saluja AK, Gastroenterology (2009)
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Department of Surgery
HSP70 Stabilizes Lysosomes in Pancreatic Cancer Cells
Department of Surgery
Inhibition of HSP70 Resulted in an Increase
in Cytosolic Ca2+
Dudeja V…Saluja AK, Gastroenterology (2009)
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Department of Surgery
HSP70 Attenuates Intracellular Calcium
Department of Surgery
Effect of Cathepsin B Inhibition and Cytosolic
Ca2+ Chelation on Cell Death After HSP70
Downregulation
Dudeja V…Saluja AK, Gastroenterology (2009)
Triptolide 0.2uM + + + +
BAPTA 10uM - + - +
CA074me 10uM - - + +
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Department of Surgery
Mechanisms by Which Triptolide Downregulates Heat Shock Proteins
Department of Surgery
Triptolide Downregulated HSF1 Expression
Fold
change in m
RN
A
exp
ressio
n o
ver
contr
ol
Time after triptolide treatment
Time after triptolide treatment
0
30
60
90
120
8h 24h 48h
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Triptolide/Minnelide
HSP 70
Tumor Cell Death
LMP Intracellular Ca2+
HSF 1
Department of Surgery
Gastroenterology, 2009, May
Heat Shock Protein 70 Inhibits Apoptosis in Cancer Cells
through Simultaneous and Independent Mechanisms
Dudeja V, Mujumdar N, Phillips P, Chugh R, Borja-Cacho D, Dawra RK, Vickers SM,
Saluja AK
Amer J Physiol, 2011
Pro-survival Role of Heat Shock Factor 1 In the Pathogenesis of
PancreatoBiliary tumors
Dudeja V, Chugh R, Sangwan V, Skube S, Mujumdar N, Borja-Cacho D, Antonoff M,
Dawra R, Vickers SM, Saluja AK
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Department of Surgery
A Phase 1, Multi-Center, Open-Label, Dose-Escalation, Safety,
Pharmacokinetic, and Pharmacodynamic Study of Minnelide™
Given Daily for 21 Days Followed by 7 Days Off Schedule in
Patients With Advanced GI Tumors.
Clinical Trials for Minnelide
Trial Period: August 2013 - August 2015
As of this week fourteen patients havebeen enrolled
Department of Surgery
Acknowledgements
Funding:
NIDDK
NCI
Hirshberg Foundation
National Pancreas Foundation
Robert and Katherine Goodale
Foundation
University of Minnesota
Collaborators:
Selwyn Vickers, MD
Bruce Blazar, MD
Gunda Georg, PhD
Osama Alsaied, MDUsman Barlass, MBBSSulagna Banerjee, Ph.DAshley BekolayZhiyu Chen, MD, Ph.DRohit Chugh, MBBSRajinder Dawra, Ph.DAjay Dixit, Ph.DVikas Dudeja, MDKelsey Jensen
Sushil Kumar, MBBSRui Lin, Ph.DTiffany MackenzieOlivia McGinnAlice NomuraJoon Sueng Park, MDVeena Sangwan, Ph.DZuobiao Yuan, MD, Ph.D