Abstract
Purine nucleoside phosphorylase (PNP) is a key enzyme in the purine-salvage metabolic pathway. A deficiency in PNP is associated with significant T-cell depletion and immune deficiency. Forodesine is a potent PNP inhibitor that was designed based on the transition-state structure stabilized by the enzyme. When PNP is inhibited by forodesine, 2′-deoxyguanosine remains unmetabolized and is transported into cancer cells via nucleoside transporters. Inside the cells, 2′-deoxyguanosine is phosphorylated to deoxyguanosine monophosphate by deoxycytidine kinase and then to deoxyguanosine triphosphate by other kinases. The intracellular deoxyguanosine triphosphate inhibits ribonucleotide reductase, induces deoxyribonucleotide pool imbalance, and inhibits DNA synthesis and repair. In early clinical trials, forodesine demonstrated modest anticancer efficacies. Drug-related adverse events, including lymphocytopenia and neutropenia, were generally tolerable. Forodesine is now being investigated for its clinical efficacy against T-cell malignancies, such as T-cell leukemia and cutaneous T-cell lymphoma.
Keywords
Forodesine Purine nucleoside phosphorylase 2′-deoxyguanosine Deoxyguanosine triphosphate T-cell malignanciesReferences
- 1.Schramm VL. Enzymatic transition states and transition state analog design. Annu Rev Biochem. 1998;67:693–720.CrossRefPubMedGoogle Scholar
- 2.de Azevedo Jr WF, Canduri F, Dos Santos DM, Pereira JH, Bertacine Dias MV, Silva RG, Mendes MA, Basso LA, Palma MS, Santos DS. Crystal structure of human PNP complexed with guanine. Biochem Biophys Res Commun. 2003;312:767–72.CrossRefPubMedGoogle Scholar
- 3.Giblett ER, Ammann AJ, Wara DW, Sandman R, Diamond LK. Nucleoside-phosphorylase deficiency in a child with severely defective T-cell immunity and normal B-cell immunity. Lancet. 1975;1:1010–3.CrossRefPubMedGoogle Scholar
- 4.Cohen A, Gudas LJ, Ammann AJ, Staal GE, Martin Jr DW. Deoxyguanosine triphosphate as a possible toxic metabolite in the immunodeficiency associated with purine nucleoside phosphorylase deficiency. J Clin Invest. 1978;61:1405–9.CrossRefPubMedPubMedCentralGoogle Scholar
- 5.Bantia S, Ananth SL, Parker CD, Horn LL, Upshaw R. Mechanism of inhibition of T-acute lymphoblastic leukemia cells by PNP inhibitor – BCX-1777. Int Immunopharmacol. 2003;3:879–87.CrossRefPubMedGoogle Scholar
- 6.Markert ML. Purine nucleoside phosphorylase deficiency. Immunodefic Rev. 1991;3:45–81.PubMedGoogle Scholar
- 7.Krenitsky TA, Tuttle JV, Koszalka GW, Chen IS, Beacham 3rd LM, Rideout JL, Elion GB. Deoxycytidine kinase from calf thymus. Substrate and inhibitor specificity. J Biol Chem. 1976;251:4055–61.PubMedGoogle Scholar
- 8.Carson DA, Kaye J, Seegmiller JE. Lymphospecific toxicity in adenosine deaminase deficiency and purine nucleoside phosphorylase deficiency: possible role of nucleoside kinase(s). Proc Natl Acad Sci U S A. 1977;74:5677–81.CrossRefPubMedPubMedCentralGoogle Scholar
- 9.Ullman B, Gudas LJ, Clift SM, Martin Jr DW. Isolation and characterization of purine-nucleoside phosphorylase-deficient T-lymphoma cells and secondary mutants with altered ribonucleotide reductase: genetic model for immunodeficiency disease. Proc Natl Acad Sci U S A. 1979;76:1074–8.CrossRefPubMedPubMedCentralGoogle Scholar
- 10.Ealick SE, Babu YS, Bugg CE, Erion MD, Guida WC, Montgomery JA, Secrist 3rd JA. Application of crystallographic and modeling methods in the design of purine nucleoside phosphorylase inhibitors. Proc Natl Acad Sci U S A. 1991;88:11540–4.CrossRefPubMedPubMedCentralGoogle Scholar
- 11.Gandhi V, Kilpatrick JM, Plunkett W, Ayres M, Harman L, Du M, Bantia S, Davisson J, Wierda WG, Faderl S, Kantarjian H, Thomas D. A proof-of-principle pharmacokinetic, pharmacodynamic, and clinical study with purine nucleoside phosphorylase inhibitor immucillin-H (BCX-1777, forodesine). Blood. 2005;106:4253–60.CrossRefPubMedPubMedCentralGoogle Scholar
- 12.Miles RW, Tyler PC, Furneaux RH, Bagdassarian CK, Schramm VL. One-third-the-sites transition-state inhibitors for purine nucleoside phosphorylase. Biochemistry. 1998;37:8615–21.CrossRefPubMedGoogle Scholar
- 13.Kline PC, Schramm VL. Purine nucleoside phosphorylase. Catalytic mechanism and transition-state analysis of the arsenolysis reaction. Biochemistry. 1993;32:13212–9.CrossRefPubMedGoogle Scholar
- 14.Kline PC, Schramm VL. Pre-steady-state transition-state analysis of the hydrolytic reaction catalyzed by purine nucleoside phosphorylase. Biochemistry. 1995;34:1153–62.CrossRefPubMedGoogle Scholar
- 15.Kicska GA, Long L, Hörig H, Fairchild C, Tyler PC, Furneaux RH, Schramm VL, Kaufman HL. Immucillin H, a powerful transition-state analog inhibitor of purine nucleoside phosphorylase, selectively inhibits human T lymphocytes. Proc Natl Acad Sci U S A. 2001;98:4593–8.CrossRefPubMedPubMedCentralGoogle Scholar
- 16.Evans GB, Furneaux RH, Lewandowicz A, Schramm VL, Tyler PC. Synthesis of second-generation transition state analogues of human purine nucleoside phosphorylase. J Med Chem. 2003;46:5271–6.CrossRefPubMedGoogle Scholar
- 17.Clinch K, Evans GB, Fleet GW, Furneaux RH, Johnson SW, Lenz DH, Mee SP, Rands PR, Schramm VL, Taylor Ringia EA, Tyler PC. Synthesis and bio-activities of Lenantiomers of two potent transition state analogue inhibitor of purine nucleoside phosphorylases. Org Biomol Chem. 2006;4:1131–9.CrossRefPubMedGoogle Scholar
- 18.Yamauchi T, Ueda T, Nakamura T. A new sensitive method for determination of intracellular 1-β-D-arabinofuranosylcytosine 5′-triphosphate content in human materials in vivo. Cancer Res. 1996;56:1800–4.PubMedGoogle Scholar
- 19.Shigemi H, Yamauchi T, Tanaka Y, Ueda T. Novel leukemic cell lines resistant to clofarabine by mechanisms of decreased active metabolite and increased antiapoptosis. Cancer Sci. 2013;104:732–9.CrossRefPubMedGoogle Scholar
- 20.Yamauchi T, Uzui K, Nishi R, Shigemi H, Ueda T. Reduced drug incorporation into DNA and antiapoptosis as the crucial mechanisms of resistance in a novel nelarabine-resistant cell line. BMC Cancer. 2014;14:547.CrossRefPubMedPubMedCentralGoogle Scholar
- 21.Mitchell BS, Mejias E, Daddona PE, Kelley WN. Purinogenic immunodeficiency diseases: selective toxicity of deoxyribonucleosides for T cells. Proc Natl Acad Sci U S A. 1978;75:5011–4.CrossRefPubMedPubMedCentralGoogle Scholar
- 22.Bantia S, Miller PJ, Parker CD, Ananth SL, Horn LL, Kilpatrick JM, Morris PE, Hutchison TL, Montgomery JA, Sandhu JS. Purine nucleoside phosphorylase inhibitor BCX-1777 (Immucillin-H) – a novel potent and orally active immunosuppressive agent. Int Immunopharmacol. 2001;1:1199–210.CrossRefPubMedGoogle Scholar
- 23.Bantia S, Kilpatrick JM. Purine nucleoside phosphorylase inhibitors in T-cell malignancies. Curr Opin Drug Discov Devel. 2004;7:243–7.PubMedGoogle Scholar
- 24.Balakrishnan K, Nimmanapalli R, Ravandi F, Keating MJ, Gandhi V. Forodesine, an inhibitor of purine nucleoside phosphorylase, induces apoptosis in chronic lymphocytic leukemia cells. Blood. 2006;108:2392–8.CrossRefPubMedPubMedCentralGoogle Scholar
- 25.Alonso R, López-Guerra M, Upshaw R, Bantia S, Smal C, Bontemps F, Manz C, Mehrling T, Villamor N, Campo E, Montserrat E, Colomer D. Forodesine has high antitumor activity in chronic lymphocytic leukemia and activates p53-independent mitochondrial apoptosis by induction of p73 and BIM. Blood. 2009;114:1563–75.CrossRefPubMedGoogle Scholar
- 26.Yamauchi T, Uzui K, Nishi R, Tasaki T, Ueda T. A nelarabine-resistant T-lymphoblastic leukemia CCRF-CEM variant cell line is cross-resistant to the purine nucleoside phosphorylase inhibitor forodesine. Anticancer Res. 2014;34:4885–92.PubMedGoogle Scholar
- 27.Ogura M, Tsukasaki K, Nagai H, et al. Phase I study of BCX1777 (forodesine) in patients with relapsed or refractory peripheral T/natural killer-cell malignancies. Cancer Sci. 2012;103:1290–5.CrossRefPubMedGoogle Scholar
- 28.Balakrishnan K, Verma D, O’Brien S, Kilpatrick JM, Chen Y, Tyler BF, Bickel S, Bantia S, Keating MJ, Kantarjian H, Gandhi V, Ravandi F. Phase 2 and pharmacodynamic study of oral forodesine in patients with advanced, fludarabine-treated chronic lymphocytic leukemia. Blood. 2010;116:886–92.CrossRefPubMedPubMedCentralGoogle Scholar
- 29.Kezar 3rd HS, Kilpatrick JM, Phillips D, Kellogg D, Zhang J, Morris Jr PE. Synthesis and pharmacokinetic and pharmacodynamic evaluation of the forodesine HCl analog BCX-3040. Nucleosides Nucleotides Nucleic Acids. 2005;24:1817–30.CrossRefPubMedGoogle Scholar
- 30.Dummer R, Duvic M, Scarisbrick J, Olsen EA, Rozati S, Eggmann N, Goldinger SM, Hutchinson K, Geskin L, Illidge TM, Giuliano E, Elder J, Kim YH. Final results of a multicenter phase II study of the purine nucleoside phosphorylase (PNP) inhibitor forodesine in patients with advanced cutaneous T-cell lymphomas (CTCL) (Mycosis fungoides and Sézary syndrome). Ann Oncol. 2014;25:1807–12.CrossRefPubMedGoogle Scholar