Antioxidant enhancement of therapy for hyperproliferative conditions

FIELD OF THE INVENTION

[0003] This invention is in the field of medicinal chemistry, and more specifically, the methods and compositions for antioxidant enhancement of therapy for hyperproliferative conditions.

BACKGROUND OF THE INVENTION

[0004] A wide range of disorders involves the hyperproliferation of cells, ranging from psoriasis to benign and malignant tumors. These disorders are generally caused by a loss of control over normal cell growth, differentiation, or the process of programmed cell death (apoptosis). Many of the abnormalities that underlie these disorders, particularly cancer, occur at the genetic level. Antineoplastic agents (also known as cytotoxic agents) are often used in the treatment of hyperproliferative conditions. Therapy with antineoplastic agents is successful in the treatment of a number of malignant conditions; however, in most it is used to palliate the symptoms and to prolong life in patients with advanced disease. Two groups of drugs used in the treatment of hyperproliferative conditions are antimetabolites and alkylating agents. Antimetabolites can be subdivided into folic acid, purine and pyrimidine derivatives. In addition, several natural products, or their derivatives, have been used as mitotic inhibitors. These include vinca alkaloids, and the derivatives of podophyllotoxin. There remains an effort in the research community to understand the genetic basis for abnormal cell hyperproliferation, which can vary among its various manifestations, and to develop therapeutic methods to successfully treat these serious conditions.

[0005] For about four decades, the antimetabolite 5-fluorouracil (5-FU), and nucleosides that include this base (e.g., 5-fluoro-2′-deoxyuridine or FdUrd), have remained among the few “standard” drugs effective against solid tumors in man. 5-Fluorouracil is used mainly for the treatment of colorectal, ovarian, renal, breast and head and neck cancers. 5-Fluoro-2′-deoxyuridine is used for the treatment of solid tumors, including hepatic metastases of advanced gastrointestinal adenocarcinomas, renal cell carcinomas, advanced ovarian cancer, and squamous cell carcinomas of the head and neck. The clinical utility of the fluoropyrimidines is limited by the host-toxicity induced by the administration of these compounds. Manifestations of the host-toxicity of the fluoropyrimidines include mainly gastrointestinal epithelial ulceration, myelosuppression and, to a lesser extent, cardiotoxicities, hepatotoxicities and neurotoxicities.

[0006] A population of cancer patients is intolerant to treatment with 5-fluorouracil and 5-fluoro-2′-deoxyuridine. The intolerance to 5-fluorouracil was initially attributed to a deficiency or low activity of dihydrouracil dehydrogenase (DHUDase, EC 1.3.1.2), the first enzyme in the catabolic pathway of 5-fluorouracil. However, it appeared that not all intolerant patients showed reduced dihydrouracil dehydrogenase activities. Moreover, it has also been shown that cancers, treated with fluoropyrimidines, become resistant, i.e., develop tolerance towards these drugs.

[0007] Colorectal cancer (CRC) is a multi-step process resulting from the accumulation of mutations in clonal populations of colonocytes. Mutations of the p53 tumor suppressor gene are a relatively late, yet common event in the pathogenesis of colorectal cancer, occurring in over 80% of late adenomas and carcinomas (Fearon, et al., FASEB J. 6, 2789 (1992); Srivastarva, et al., Contemp. Oncol. April 63 (192); Kline, et al., Cancer (Phila. 73, 28 (1994). Conventional therapy for advanced disease, such as cytotoxic chemotherapy and gamma-irradiation, induce DNA damage in proliferating cells. This damage, through undefined mechanism(s), signals the induction of p53, which, in turn, leads to inhibition of cellular proliferation by induction of GI cell cycle arrest and, in some instances, apoptosis. Thus, tumors lacking functional p53 are frequently refractory to such therapies (S. C. Righetti et al., Cancer Res. 56, 689 (1996); J. S. Kovack et al., Proc. Natl. Acad, Sci. U.S.A. 93, 1093 (1996)), emphasizing the importance of developing treatments for advanced colorectal cancer that do not rely on functional p53.

[0008] The most effective single chemotherapeutic agent for advanced colorectal cancer to date remains 5-FU. The active metabolite of 5-FU, 5-fluorodeoxyuridine-5′-monophosphate (FdUMP), forms a complex with thymidylate synthase (TS) in the presence of reduced folate, thereby inhibiting enzyme activity, and depleting precursors for DNA synthesis. 5-FU is also incorporated into RNA, altering its processing and function, although how this correlates with cytotoxicity is unknown. Previous data suggest that 5-FU can utilize both p53-dependent and independent pathways (Pritchard, et al., Pharmacol Ther. 72, 149 (1996)), although a loss of p53 function dramatically reduces 5-FU efficacy (B. Cohen et al., Cancer (Phila.) 67, 1859 (1991); Advanced Cancer Meta-Analysis Project, J. Clin. Oncol. 10, 896 (1992)).

[0009] In view of the lack of successful treatments for many hyperproliferative conditions, it would be of benefit both to identify important biological pathways that mediate the loss of normal cell function, including programmed cell death (i.e., apoptosis), and to identify compositions and methods for the treatment of these disorders.

[0010] U.S. Pat. Nos. 5,035,878 and 5,294,430 disclose that dithiocarbamates can reverse the damage to the blood-forming function of the bone marrow (myelosuppression) caused by treatment with antineoplastic agents.

[0011] It is therefore an object of the invention to provide a method and composition for the treatment of abnormal cell proliferative conditions, including benign and malignant tumors.

[0012] It is another object of the present invention to provide a method and composition for the treatment of colon cancer.

[0013] It is a further object of the present invention to provide a method and composition for the treatment of solid tumors.

[0014] It is yet another object of the present invention to provide a method and composition for the treatment of diffuse tumors.

SUMMARY OF THE INVENTION

[0015] It has been discovered that antioxidants, including those specifically disclosed herein, induce cell cycle arrest (G1, G2, S and M type), and thus are useful to enhance the efficacy of antineoplastic drugs for the treatment of abnormal cell proliferation. In one embodiment, therefore, the invention is a method to enhance the cytotoxic activity of an antineoplastic drug comprising administering an effective amount of the antineoplastic drug to a host exhibiting abnormal cell proliferation in combination with an effective cytotoxicity-increasing amount of an antioxidant.

[0016] It has further been discovered that antioxidants not only induce cell cycle arrest, but also can cause the cell to maintain the state of arrest, and perhaps, induce apoptosis, by inhibiting enzymes that would otherwise turn off the process of cell cycle arrest.

[0017] Importantly, it has also been discovered that not only do antioxidants increase the cytotoxicity of antineoplastic agents to abnormally proliferating cells, they also decrease the toxicity of antineoplastic agents to normal cells. Therefore, antioxidants both increase the effectiveness and decrease the toxicity of antineoplastic agents. The palliative effect on normal cells is pronounced in epithelial cells. It has, in particular, been discovered that antioxidants exhibit this effect on cells other than white blood cells, as previously reported by Borch in U.S. Pat. Nos. 5,035,878 and 5,294,430.

[0018] Therefore, the invention includes a method to decrease the toxicity of an antineoplastic agent administered for the treatment of a solid growth of abnormally proliferating cells, comprising administering an antioxidant prior to, with, or following the antineoplastic treatment, as well as a method to increase the therapeutic index of an antineoplastic agent administered for the treatment of a solid growth of abnormally proliferating cells, comprising administering an antioxidant prior to, with, or following the antineoplastic treatment.

[0019] At least in certain cell lines, it has been discovered that antioxidants increase the cytotoxicity of antineoplastic drugs by affecting a post translational modification of C/EBPβ (CCAAT/Enhancer Binding Protein (C/EBP) β), also known as NF_IL6, AGP/EBP, LAP, IL-6DBP, rNF_IL6, and CRP2(5-11)), which is a member of a diverse group of nuclear transcription factors that contain a leucine zipper motif required for dimer formation and a basic DNA binding domain which facilitates the interactions between these factors and the regulatory domains of promoters and/or enhancers of target genes. C/EBPβ activates several acute-phase protein genes through the NF_IL6 responsive elements, implying that it has a nuclear target(s). C/EBPβ also has been shown to be responsible for the regulation of genes encoding albumin, c-fos and several adipocyte-specific proteins. Furthermore, C/EBPβ has been implicated in the activation of various genes involved in inflammatory and immune responses, including the interleukin-1 (IL-1) and interleukin-8 (IL-8), granulocyte macrophage/colony-stimulating factor, and immunoglobulin genes. Thus, C/EBPβ is a pleiotropic transactivator involved in a myriad of signal transduction and cell differentiation events.

[0020] In one pathway, which may not be exclusive, it has been discovered that antioxidants increase the cytotoxicity of antineoplastic drugs through a cascade of events that include: (I) increasing the level of cAMP, which causes the activation of protein kinase A, an enzyme that phosphorylates C/EBPβ, which on phosphorylation is then translocated from the cytosol to the nucleus of the cell wherein it mediates the induction of p21, which causes an arrest of cell growth; and (II) preventing the dephosphorylation of C/EBPβ in the nucleus (and thus deactivation and delocalization) through the inhibition of protein phosphatase 2A (PP2A). The inhibition of PP2A activity is caused by a decrease in methyltransferase activity, an enzyme which carboxymethylates the catalytic subunit of PP2A, which is involved in maintaining PP2A in an active form. Decreased methylcarboxylation results in decreased PP2A enzymatic dephosphorylation of C/EBPβ as a substrate. By simultaneously inducing the phosphorylation of C/EBPβ and inhibiting the dephosphorylation of C/EBPβ, antioxidants maintain C/EBPβ in an active state in the nucleus of the cell, which induces the continued expression of a cyclin-dependent kinase inhibitor, p21WAF1/CIP1 and subsequent cell cycle arrest.

[0021] Therefore, more generally, the invention includes a method for increasing the localization of the C/EBPβ protein in the nucleus of a cell that includes the step of administering an antioxidant to the interior of the cell. It has been discovered that this method maintains the C/EBPβ protein in an active, phosphorylated state, which induces cell growth arrest and apoptosis.

[0022] As one nonlimiting example, the present invention demonstrates that compounds exhibiting antioxidant properties (for example, pyrrolidinedithiocarbamate, “PDTC,” and the vitamin E analogue, Trolox® decrease DNA replication in human colorectal cancer cells by the induction of G1 cell cycle arrest and/or apoptosis. However, antioxidant compounds have no effect on normal human colonocytes, keratinocytes or mammary epithelial cells (see Table 1). Cell cycle perturbations were more pronounced in colorectal cancer cells expressing mutant p53 compared to wild type p53. Induction of cell cycle arrest and apoptosis correlated with sustained induction of the cyclin-dependent kinase inhibitor, p21WAF1CIP1. Treatment with antioxidants in combination with 5-FU significantly reduced anchorage-independent colorectal cancer cell growth. Furthermore, antioxidants alone significantly reduced growth of established colorectal cancer tumors in athymic mice, and the combination of 5-FU and antioxidant either arrested tumor growth (Trolox®) or caused tumor regression (pyrrolidinedithiocarbamate).

[0023] DKO-I cells (a human colorectal cancer cell line) constitutively expressing an epitope-tagged C/EBPβ protein were used to further investigate whether a post-translational modification (phosphorylation) of C/EBPβ is responsible for the observed increase in C/EBPβ activity. In vivo labeling with [32P]orthophosphate followed by immunoprecipitation revealed a four to six fold increase in the phosphorylation of epitope tagged C/EBPβ in response to PDTC or forskolin (3R,3α,4aβ,5β,6β,6aα,10α,10aβ,10bα)-5-(acetyloxy)-3-ethenyldodecahydro-6,10,10b-trihydroxy-3,4a,7,7,10a-pentamethyl-1H-naphtho[2,1-b]pyran-1-one) with no change in the amount of protein. As a means of mapping the in vitro phosphorylation site(s) within C/EBPβ, deletion analysis of C/EBPβ was performed. Truncated versions of C/EBPβ that contained only the 160 or 200 COOH-terminal amino acids were poor substrates for PDTC-induced phosphorylation, whereas mutant C/EBPβ that contained the 305 COOH-terminal amino acids was phosphorylated by PDTC as efficiently as the full-length C/EBPβ. Closer inspection of the primary amino acid sequence between 236 and 305 revealed that this region contained a consensus PKA phosphorylation site (Arg-X-Ser299-X; Sequence ID No. 1).

[0024] It appears that phosphorylation of Ser299 of C/EBPβ following activation of the cAMP-dependent protein kinase-mediated pathway, is critical for nuclear translocation of this protein and subsequent transactivation of genes in response to an altered intracellular redox status.

[0025] The deactivation of C/EBPβ in the nucleus occurs by dephosphorylation of this transcriptional factor by protein phosphatase 2A (PP2A). This enzyme is activated by carboxymethylation of the catalytic subunit of PP2A by methyltransferase. In further experiments, it was established that carboxymethylation of the catalytic subunit of protein phosphatase 2A is inhibited by PDTC as an exemplary antioxidant, and further that the loss of carboxymethylation is caused by an inhibition of activity of methyltransferase. These results support the fact that antioxidants prevent the dephosphorylation of C/EBPβ in the nucleus (and thus deactivation) by protein phosphatase 2A (pp2A) by inhibition of methyltransferase which is involved in maintaining protein phosphatase 2A in an active form. Decreased methylcarboxylation results in decreased PP2A enzymatic dephosphorylation of C/EBPβ as a substrate. It was further discovered that the evaluated antioxidants have little or no effect on protein phosphatase 1 (PP 1).

BRIEF DESCRIPTION OF THE FIGURES

[0026] The figures presented herein illustrate preferred embodiments of the invention and are not considered to limit the scope of the invention.

[0027]
FIG. 1A is a graph of the concentration of PDTC versus soft-agar forming units×106 HCT 15 and HCT 116 cells (as a percent of control). The graph shows that pyrrolidinedithio-carbamate (PDTC) and vitamin E inhibit anchorage-independent growth in vitro. Soft-agar colony formation was measured by seeding HCT 116 or HCT 15 cells in soft agar supplemented with either medium alone (control), or increasing concentrations of pyrrolidine-dithiocarbamate (25-200 μM) or vitamin E (0.1-10 mM). Colonies were scored at the end of 10 days incubation at 37° C. Values are representative of three experiments carried out in quadruplicate.

[0028]
FIG. 1B is a series of flow cytometric analyses that indicate that antioxidants induce G1 cell cycle arrest and apoptosis in CRC cells. Unsynchronized HCT 116 or HCT 15 cells are grown either in the presence or absence of pyrrolidinedithiocarbamate (70 μM) or vitamin E (3 mM). Twenty-four hours following antioxidant exposure, cells were harvested and flow cytometric analysis performed.

[0029]
FIG. 1C is a bar graph of the hours after test compound treatment versus intracellular H2O2 levels. FIG. 1C illustrates the negative association between intracellular redox status and cell cycle perturbations. Changes in the intracellular redox status were determined by the measurement of endogenous H2O2 levels. Background fluorescence was subtracted from each reading. Values are expressed as corrected DHR mean per 104 cells±s.e.m. The percentage of G1 (circle) or apoptotic (TUNEL-positive: square) cells by flow cytometric analysis.

[0030]
FIG. 1D shows the effect of N-acetylcysteine, vitamin C and catalase on endogenous H2O2 levels and cell cycle progression. HCT 15 cells were incubated with pyrrolidinedithio-carbamate (70 μM), vitamin E (3 mM), N-acetylcysteine (50 μM) or vitamin C (200 μM) for 24 hours. Endogenous H2O2 levels and cell cycle changes were measured as described in FIG. 1C. In addition, cells were transiently transfected with an empty plasmid or an expression plasmid for human catalase and assayed 24 hours later as above. Values from cells transfected with the empty plasmid were subtracted from those obtained from the catalase-containing cells and were expressed as mean±s.e.m. from duplicate dishes.

[0031]
FIG. 1E shows that pyrrolidinedithiocarbamate and vitamin E augment 5-FU or doxorubicin induced growth inhibition in vitro. HCT 116 and HCT 15 cells were seeded in soft agar as described above containing increasing concentrations of either 5-FU (5×10−8 to 5×10−5 M) or doxorubicin (1×10−9 to 1×10−6 M), in the presence or absence of pyrrol dithiocarbamate (70 μM) or vitamin E (3 mM). Colonies were scored after 10 days and IC50 values were calculated as the concentration of 5-FU or doxorubicin required to reduce basal colony formation by 50% (±s.e.m.). Values are representative of three experiments carried out in quadruplicate.

[0032]
FIG. 2A is a graph and associated photographs of tumor-bearing mice which indicate that pyrrolidinedithiocarbamate and vitamin E enhance 5-FU efficacy in wild type p53 human CRC tumor xenografts. HCT 116 CRC cells were injected subcutaneously between the scapula of nu/nu mice. Once tumors reached approximately 150 mm3, the animals either received weekly i.p. injections of pyrrolidinedithiocarbamate (70 μM) or vitamin E (3 MM), 5-FU (40 mg/kg) or saline, or both an antioxidant and 5-FU. Tumor volume was calculated weekly. The photograph shows the effect of indicated treatments on gross tumor size after 4 weeks of treatment.

[0033]
FIG. 2B is a graph of the weeks of treatment with various test materials versus tumor volume (mm3) shows that the enhanced efficacy of pyrrolidinedithiocarbamate and 5-FU as primary treatment and as a salvage regimen for mutant p53 tumors. HCT 15-derived tumors were generated as described above. Animals were then treated with pyrrolidinedithio- carbamate, in the presence or absence of 5-FU, for 3 weeks. At this point, treatments were discontinued in animals receiving the combined treatment of pyrrolidinedithiocarbamate and 5-FU for 2 months. All other treatment groups received both 5-FU and pyrrolidinedithio-carbamate for the remaining 3 weeks.

[0034] FIGS. 3A-3C show that pyrrolidinedithiocarbamate bypasses p53 to induce p21WAF1/CIP1 expression.

[0035]
FIG. 3A shows that p21WAF1/CIP1 protein levels were increased in human CRC cells expressing functional (HCT 116) and mutant (HCT 15) p53 following pyrrolidinedithio-carbamate treatment. CRC cells were treated as indicted with pyrrolidinedithiocarbamate (70 μM) and subjected to Western blot analysis.

[0036]
FIG. 3B shows p53-independent induction of p21WAF1/CIP1 mRNA by pyrrolidinedithiocarbamate in human CRC cells. Exponentially growing, asynchronous human CRC cells were incubated in serum-containing medium with 70 μM pyrrolidinedithiocarbamate. In addition, HCT 116 cells containing HPV16 E6 to target degradation of p53 were analyzed. Cells were collected at indicated time points and prepared for poly(A)+ mRNA isolation. Samples (3 μg) were electrophoresed through a 1% (w/v) formaldehyde/agarose gel and transferred onto nitrocellulose membranes. Northern blotting hybridization was performed at 43° C. with a 32P-labeled p21WAF1/CIP1 probe. IB15 is shown as a control for equivalent loading and transfer.

[0037]
FIG. 3C shows that antioxidant-induced apoptosis requires p21WAF1/CIP1 expression. HCT 116 cells, containing either functional p21+/+) or deleted p21WAF1/CIP1, were treated with the indicated concentrations of pyrrolidinedithiocarbamate or vitamin E for 24 hours and apoptosis was determined by TUNEL analysis. Values are expressed as percent TUNEL positive cells and represent mean±s.e.m. of triplicate measurements.

[0038]
FIG. 4A shows that pyrrolidinedithiocarbamate induces p21WAF1/CIP1 transcriptional activity via the NF_IL6 consensus sequence. A 2.4 kilobase pair p21WAF1/CIP1 promoter sequence and mutants were fused to a luciferase reporter gene. TATA represents the p21WAF1/CIP1 TATA box located 45 bp from the transcription start site (defined as +1). −2280, −2198, −2078, −1838, −1428 and 1138 define 5′ end points for terminal deletion constructs. The −2280 ANF_IL6 construct contains the intact promoter with a two base pair mutation at the NF_IL6 site. All reporter constructs were transfected into HCT 116 or HCT 15 cells, and antioxidant-induced luciferase activity was measured in relative light units (RLU) after 24 hours. Luciferase activity was normalized to CAT activity, and results were reported as fold activation above basal levels.

[0039]
FIG. 4B shows that pyrrolidinedithiocarbamate treatment induces C/EBPβ DNA binding activity. Left panel: HCT 116 and HCT 15 cells were treated with 70 μM pyrrolidinedithiocarbamate for the indicated times, nuclear extracts were incubated with a γ-32P-labeled p21-NF_IL6 oligonucleotide. Right panel: Lanes 1-3, competition controls were performed on a nuclear extract derived from HCT 116 cells treated with pyrrolidinedithiocarbamate for 12 hours (lane 1), with excess unlabeled wild-type (lane 2) and mutant (lane 3) oligonucleotide. Lanes 4-6, supershift analysis were performed with C/EBPα (lane 4), β (lane 5), or δ (lane 6) polyclonal antibodies.

[0040]
FIGS. 4C and D shows that C/EBPβ can stimulate p21WAF1/CIP1 promoter activity. HCT 116 (FIG. 4C) or HCT 15 (FIG. 4D) cells were transfected with the indicated amounts of cytomegalovirus (CMV) expression plasmids, containing C/EBPα, β or δ cDNAs, and 3 μg of p21WAF1/CIP1-luciferase. A control plasmid was included in FIG. 4A.

[0041]
FIG. 4E shows that C/EBPβ regulates cellular sensitivity to antioxidant-induced apoptosis. Control HCT 15 cells and sense or antisense C/EBPβ cell lines were grown in the presence or absence of 10 μM muristerone A and/or pyrrolidinedithiocarbamate (70 μM) or vitamin E (3 mM) for 24 hours. The apoptotic indices were estimated by the percentage of TUNEL-positive cells scored under a light microscope at 200-fold magnification and values are expressed as mean±s.e.m. for triplicate samples. The inset shows a representative Western blot for p21WAF1/CIP1 protein levels in both transfected cell lines, grown in the presence or absence of 10 μM muristerone A.

[0042]
FIG. 4F shows that elevated C/EBPβ protein levels enhance chemotherapeutic agent cytotoxicity in vitro. Control HCT 15 cells and the sense C/EBPβ cell line were induced with 10 μM muristerone A and exposed to either 5-FU (1.5 μM) or doxorubicin (0.1 μM) for 24 hours. The apoptotic index was calculated as described in FIG. 4C.

[0043]

FIGS. 5

a
and 5b are bar graphs of the growth of BrDU-labelled cells (percent of total cell nuclei; BrDU refers to bromodeoxyuridine) from colorectal cell xenografts derived from athymic mice treated with saline, vitamin E, PDTC, 5-FU, and the combination of vitamin E and 5-FU, as a measure of the effect of the test compound on proliferation of HCT 116 and HCT 15 cells.

[0044]

FIGS. 6

a
and 6b are bar chart graphs of TUNEL-positive cells from colorectal cell xenografts derived from athymic mice (percent of total cell nuclei; TUNEL REFERS TO TdT-mediated dUTP-nick-end-labeling) treated with saline, vitamin E, PDTC, 5-FU, and the combination of vitamin E and 5-FU, as a measure of the effect of the test compound on apoptosis. Tumor tissues were fixed overnight in 4% (v/v) paraformaldehyde and embedded in paraffin according to standard histological procedures. Sections were pretreated with 10 mM citrate buffer (pH 6.0) and incubated with PC10 monoclonal antibody against BrDU (Boehringer Mannheim). TdT labeling of fragmented DNA (TUNEL) was performed according to manufacturer's instructions. The proliferative index (percent of total BrDU cell nuclei) and the apoptotic index (TUNEL) were estimated by the percentage of cells scored under a microscope at 200-fold magnification.

[0045] FIGS. 7A-7D illustrate that PDTC treatment induces C/EBPβ DNA binding activity via a post-translational modification. (A) DKO-1 cell were treated with 70μM PDTC for the indicated times, nuclear extracts were prepared with a [γ-32P]-labeled p21-NF_IL6 oligonucleotide (Lanes 1-9). Specificity assays: Lanes 10-12, competition controls were performed on a nuclear extract derived from DKO-1 cells treated with PDTC for 3 hours (lane 5), with excess unlabeled wild-type (lane 11) and mutant (lane 12) oligonucleotide. Lanes 13-15, supershift analyses were performed with C/EBPβ (lane 13), β (lane 14), or δ (lane 15) polyclonal antibodies. (B) Parallel DKO-1 cell cultures were treated with PDTC (70 μM) for the indicated times. Poly(A) was isolated and treatment-related variations in C/EBPβ mRNA levels were evaluated by Northern blot analysis. IB15 is shown as a control for equivalent loading and transfer. (C) Parallel DKO-1 cultures were treated with PDTC (70 μM) in the presence of [32P]orthophosphate. C/EBPβ from cytosolic and nuclear fractions were purified by immunoprecipitation from cells before (time 0) or at the indicated times after PDTC treatment. Treatment-related variations in the localization of C/EBPβ were analysed by SDS-PAGE followed by autoradiography or Western blot analysis (100 μg of total cellular protein/lane). (D) DKO-1 cells were cultured in the presence of PDTC (70 μM) for 1 hour and then processed for immunocytochemistry to detect treatment-related differences in the compartmentalization of C/EBPβ protein. In all experiments, parallel cultures treated with preimmune sera or primary anti-C/EBPβ antisera that had been preincubated with in vitro translated C/EBPβ protein demonstrated no fluorescent signal after treatment with the secondary Cy3-conjugated antibody. Representative photomicrographs show anti-C/EBPβ stained cells before and after PDTC treatment.

[0046] FIGS. 8A-8B illustrate the effect of PDTC on endogenous cAMP levels and PKA activity. DKO-1 cells were treated with 70 μM PDTC for the indicated times. Cell lysates were prepared and assayed for (A) endogenous cAMP levels or (B) PKA activity. The values are expressed as pmol mean per μg protein±s.e.m. and are representative of three experiments carried out in quadruplicate.

[0047] FIGS. 9A-9C illustrate that PDTC phosphorylates C/EBPβ at Ser299. (A) Endogenous C/EBPβ from [32P]orthophosphate-labeled DKO-1 cells (2 mCi/ml. 3 h) that were treated with either 0 μM (lane 1), 70 μM PDTC (lane 2) or 50 μM forskolin were immunoprecipitated with anti C/EBPβ antibodies. Labeled proteins were visualized by SDS-PAGE followed by autoradiography. (B) Tryptic phosphopeptide maps of in vivo labeled epitope-tagged C/EBPβ. Wild type (WT) and mutant (Ala299) C/EBPβ, immunoprecipitated from PDTC treated or untreated DKO-1 cells with the antibody to the FLAG-epitope, were digested with trypsin and the phosphopeptides separated by electrophoresis and thin-layer chromatography and visualized by autoradiography, X1,2 were constitutively phosphorylated. The level of phosphopeptide X3 was increased after PDTC treatment in cells transfected with the wild type, but not mutant, protein. The circle indicates the origin. (C) Comparison of the in vivo phosphorylation of wild type and Ala substitution mutants of C/EBPβ from untreated cells and cells treated with PDTC. Autoradiography (top) and C/EBPβ immunoblot (bottom) are shown.

[0048] FIGS. 10A-10B illustrate that PKA phosphorylation of C/EBPβ is required for nuclear translocation. (A) Parallel DKO-1 cell cultures were treated with PDTC (0 or 70 μM) for 3 hours. Poly(A)+ mRNA and protein were isolated from each group and treatment-related variations in C/EBPβ mRNA and protein levels were evaluated by Northern or Western blot analysis. IB15 is shown as a control for equivalent loading and transfer. (B) DKO-1 cells were treated with PDTC (0 or 70 μM) or PDTC and mPKI (myristylated protein kinase A inhibitor; 1 μM) for 3 hours. Cells were fixed with paraformaldehyde and C/EBPβ, protein visualized by immunofluorescence staining. Treatment of cells with mPKI alone failed to induce nuclear translocation of C/EBPβ (data not shown).

[0049]
FIG. 11 illustrates that carboxymethylation of the catalytic subunit of protein phosphatase 2A is inhibited by PDTC. DKO-1 cells were incubated in serum-containing media containing [methyl-3H]S-adenosyl methionine and/or 70 μM PDTC for three hours. Cytosolic or nuclear fractions were prepared and C/EBPβ immunoprecipitated using standard methods. Antibody/antigen complexes were resolved by SDS-PAGE and the presence of PP2Ac was detected by fluorography. PDTC inhibited carboxymethylation of PP2A subunit in nuclear fractions and to a lesser extent, in cytosolic fractions.

[0050]
FIG. 12 illustrates that PDTC inhibits methyltransferase activation of PP2Ac. PP2A (a and c dimer) was incubated in the presence of [methyl-3H]S-adenosyl methionine, increasing concentrations of PDTC and partially purified rat methyltransferase for thirty minutes at 37 degrees C. The reaction was terminated by the addition of SDS-sample buffer. Samples were resolved by SDS-PAGE and the presence of methylated PP2A catalytic subunit visualized by fluorography. As indicated, PDTC selectively inhibits the ability of methyltransferase to carboxymethylate the catalytic subunit of PP2A in a dose dependent manner.

[0051]
FIG. 13 is a graph of time in hours versus percent radioactivity remaining on the protein substrate. The figure indicates that PDTC inhibits PP2A, but not PP1, activity. The activity of PDTC is compared to I2 (a selective PP1 inhibitor), okadaic acid (an inhibitor of both PP2A and PP1), I2 and PDTC, and okadaic acid and PDTC. DKO-1 cells were grown in the presence of PDTC (test) or not (control). The cells were lysed, and then radioactive phosphorylated C/EBPβ was added. The test compounds were then added, and incubated with the lysate. The protein was collected and the amount of radioactive phosphate remaining in the protein measured.

[0052]
FIG. 14 illustrates that the transcription factor C/EBPβ is complexed with the PP2Ac protein phosphatase. Rat brain soluble extracts were fractionated by phenyl-Sepharose and analyzed for methyltransferase activity using exogenous PP2A heterodimer (a-c complex). The peak of methyltransferase activity was further fractionated by Source Q, a strong anion exchange and gel filtration chromatography. The partially purified methyltransferase illustrated in FIG. 14 represents the peak methyltransferase activity from the gel filtration column. This peak fraction of methyltransferase activity is taken further to DEAE, a weak anion exchange, and MonoQ, a different strong anion exchange resin, columns. Both C/EBPβ and PP2A are detectable following these additional steps. Rat brain extracts are shown as a positive control (C/EBPβ and PP2Ac migrate at approximately 45 and 36 kDa on SDS-PAGE).

DETAILED DESCRIPTION OF THE INVENTION

[0053] It has been discovered that antioxidants induce cell cycle arrest and apoptosis in abnormally proliferating cells through a mechanism mediated by the activation of the transcription factor C/EBPβ that binds to a specific site in the p21 promoter to induce p21 expression independent of p53. It has also been discovered that a site-selective phosphorylation at Ser299 of C/EBPβ by protein kinase A following antioxidant treatment is essential for the observed nuclear translocation of this protein.

[0054] It has also been discovered that antioxidants prevent the dephosphorylation of C/EBPβ in the nucleus (and thus deactivation and delocalization) through the inhibition of PP2A. The inhibition of PP2A activity is caused by a decrease in methyltransferase activity, an enzyme which carboxymethylates the catalytic subunit of PP2A, which is involved in maintaining PP2A in an active form. Decreased methylcarboxylation results in decreased PP2A enzymatic dephosphorylation of C/EBPβ as a substrate. By simultaneously inducing the phosphorylation of C/EBPβ and inhibiting the dephosphorylation of C/EBPβ, antioxidants maintain C/EBPβ in an active state in the nucleus of the cell, which induces the continued expression of p21WAF1/CIP1 and subsequent cell cycle arrest.

[0055] The methyltransferase responsible for PP2A subunit carboxymethylation in vivo and in vitro represents a unique type of carboxyl methyltransferase. The mammalian type II and type III carboxyl methyltransferases appear to have substantially different properties from the enzyme that carboxymethylates the PP2Ac subunit. Protein carboxyl methyltransferase type II modifies D-aspartyl and L-isoaspartyl residues that accumulate in proteins with aging, and, therefore methylates a different protein containing these amino acids. Carboxyl methyltransferase type III modifies proteins at cysteine, proceeding to the carboxyl terminus of proteins (G-proteins), and requires isoprenylation of cysteine and proteolytic cleavage of the last three carboxyl-terminal residues. Activity of this carboxyl methyltransferase is not altered by antioxidant treatment of colorectal cancer cell line DKO-1 in vitro. Therefore, in vitro data suggests that antioxidants selectively inhibit the methyltransferase responsible for PP2Ac, but not G-protein, methylation.

[0056] A novel higher order protein complex has also been identified that consists of C/EBPβ, PP2A and methyltransferase. Thus, another embodiment of this invention is this novel complex in isolated form, for example in at least 70%, and preferably 80 or 90% purity. A method for isolating this enzyme is provided in Example 27.

[0057] I. Embodiments of the Invention

[0058] Based on the fundamental discoveries described herein, a method for increasing the localization of the C/EBPβ protein in the nucleus of a cell is presented that includes the step of administering an antioxidant to the interior of the cell. It has been discovered that this method maintains the C/EBPβ protein in an active, phosphorylated state, which induces cell growth arrest and apoptosis.

[0059] In one embodiment, the invention is a method to enhance the cytotoxic activity of an antineoplastic drug comprising administering an effective amount of the antineoplastic drug to a host in need of treatment in combination with an effective cytotoxicity-increasing amount of an antioxidant. It has been discovered that antioxidants, including those specifically disclosed herein, induce cell cycle arrest (G1, G2, S and M type), and thus are useful to enhance the efficacy of antineoplastic drugs for the treatment of disorders associated with abnormal cell proliferation. It has been discovered that this method maintains the C/EBPβ protein in an active, phosphorylated state, which induces cell growth arrest and apoptosis. In an alternative embodiment, a method is presented to increase the cytotoxicity of an antineoplastic or chemotherapeutic agent against a disorder of abnormal cell hyperproliferation, that includes increasing the phosphorylation state of C/EBPβ protein in a host, for example, an individual or animal in need of such treatment, comprising the step of administering to said individual or animal a cytotoxicity-increasing dose of an antioxidant in combination or alternation with a pharmacologically effective dose of a chemotherapeutic agent.

[0060] In another embodiment, the invention is directed to a method of treating a host having a neoplastic condition, comprising the step of administering to the host a therapeutically effective dose of a cytotoxic chemotherapeutic therapy and an antioxidant, wherein the cytotoxic chemotherapeutic therapy is selected from the group consisting of cancer chemotherapeutic agents and radiation therapy. Representative cancer chemotherapeutic agents and antioxidants are listed below. Any radiation therapy that ameliorates a condition of abnormal cellular proliferation is appropriate for use in this method, including ionizing radiation that is particulate or electromagnetic. Suitable and effective dosages of radiation therapy for a wide variety of neoplastic conditions are well known. In one nonlimiting embodiment, radiation therapy is gamma irradiation given at a dose of from about 3,000 centigrey to about 5,000 centigrey over an appropriate time frame, for example, up to six weeks.

[0061] The present invention is also directed to a method of increasing expression of the p21 protein as a means to arrest cell growth and induce apoptosis in an individual in need of such treatment, comprising the step of administering to said individual a pharmacologically effective dose of an antioxidant, or a combination of an antioxidant and an antineoplastic agent.

[0062] The present invention is further directed to a method of regulating cell cycle arrest (G1, G2, S or M) and apoptosis in an individual in need of such treatment, comprising the step of administering to said individual a pharmacologically effective dose of an antioxidant or a combination of an antioxidant and a antineoplastic agent.

[0063] In another embodiment, therapeutic efficacy may be achieved by administration of an effective amount of C/EBPβ , or a protein with substantial homology to C/EBPβ , to achieve the effects described in detail herein. The protein or protein analog can be administered alone or as an adjunct to antineoplastic therapy. A protein with substantial homology to C/EBPβ is defined herein as consisting of or containing a peptide sequence of the form -X1-Arg-X2-Ser-X3 (Sequence ID No. 2) wherein X2 is the C/EBPβ amino acid at position 298, and X1 and X3 represent flanking peptide sequences with substantial homology to those of C/EBPβ. The term substantial homology refers to a protein or peptide sequence that performs substantially the same function as the parent sequence and has at least 60%, or more preferably, 75%, and most preferably, 90% or 95% or greater, sequence identity. Methods for the effective delivery of proteins are known and can be employed in conjunction with this embodiment to enhance the efficacy of this therapy.

[0064] In another embodiment, a synthetic Ser299 phosphorylated C/EBPβ analog can be administered that has a stabilized phosphate bond that is resistant to dephosphorylation. Such stabilized phosphates include, but are not limited to, phosphoroamidates and phosphonate analogs.

[0065] The invention also provides a method of inhibiting protein phosphatase 2A (PP2A) in a cell that includes administering to the interior of the cell a protein phosphatase-inhibiting amount of an antioxidant. In an alternative embodiment of this aspect of the invention, a method of decreasing the carboxymethylation status of the catalytic subunit of PP2A is provided that includes contacting a cell with a methyltransferase- or methylesterase-inhibiting amount of an antioxidant.

[0066] In one pathway that may not be exclusive, it has been discovered that antioxidants increase the cytotoxicity of antineoplastic drugs through a cascade of events that include: (i) increasing the level of cAMP, which causes the activation of protein kinase A, an enzyme which phosphorylates C/EBPβ, which on phosphorylation is then translocated from the cytosol to the nucleus of the cell wherein it mediates the induction of p21, which causes an arrest of cell growth; and (ii) preventing the dephosphorylation of C/EBPβ in the nucleus (and thus deactivation and delocalization) through the inhibition of PP2A. The inhibition of PP2A activity is caused by a decrease in methyltransferase activity, an enzyme which carboxymethylates the catalytic subunit of PP2A, which is involved in maintaining PP2A in an active form. Decreased methylcarboxylation results in decreased PP2A enzymatic dephosphorylation of C/EBPβ as a substrate. By simultaneously inducing the phosphorylation of C/EBPβ and inhibiting the dephosphorylation of C/EBPβ, antioxidants maintain C/EBPβ in an active state in the nucleus of the cell, which induces the continued expression of p21WAF1/CIP1 and subsequent cell cycle arrest.

[0067] Based on this discovery, a method for the identification of therapeutically effective compounds for the treatment of abnormal cell proliferation is presented that includes assessing the compound's ability to increase the localization of the C/EBPβ protein in the nucleus of a cell. In an alternative embodiment, a method for the identification of therapeutically effective compounds for the treatment of abnormal cell proliferation is presented that includes assessing the compound's ability to increase the phosphorylation at Ser299 of C/EBPβ. This method includes incubating a selected cell line with a test compound for a predetermined time (for example three hours) at 37 degrees C. followed by immunoprecipitation of C/EBPβ from the nuclear fraction. Tryptic digestion and thin layer chromatography is then carried out to confirm phosphorylation of C/EBPβ.

[0068] Based on the discoveries described in detail herein, one of ordinary skill will understand that the invention further includes, but is not limited to the following aspects.

[0069] (i) A method for the identification of therapeutically effective compounds by assessing the ability of the compound to alter the phosphorylation status of C/EBPβ at Ser299. In this method, the test compound is included in a solution that contains at least phosphorylated C/EBPβ, a dimeric form of protein phosphatase 2A containing a and c subunits, methyltransferase and [methyl-3H]S-adenosyl methionine.

[0070] (ii) A method for the identification of therapeutically effective compounds by assessing the ability of the compound to inhibit protein phosphatase 2a activity, using the method described in (1) or another protocol known or obvious to those skilled in the art.

[0071] (iii) A method for the identification of therapeutically effective compounds by assessing the ability of the compound to alter the carboxymethylation status of protein phosphatase 2a.

[0072] (iv) A method for the identification of therapeutically effective compounds by assessing the ability of the compound to alter the activity of methyltransferase.

[0073] (v) A peptide sequence of the form -X1-Arg-X2-Ser-X3 (Sequence ID No. 2) wherein X2 is the C/EBP-β amino acid at position 298, and X1 and X3 represent flanking peptide sequences with substantial homology to C/EBPβ.

[0074] (vi) A method for the enhancement the phosphorylation status and functionality of C/EBPβ induced by mediators including, but not limited to, cAMP dependent protein kinases, protein kinase C, ras-dependent MAP kinase and calcium-calmodulin dependent kinase, in an individual or animal in need of such treatment comprising the step of administering to said individual or animal a pharmacologically effective dose of an antioxidant that increases the nuclear residence time and functionality of C/EBPβ.

[0075] (vii) A method for the enhancement of the phosphorylation status and functionality of C/EBPβ induced by, but not limited to, cAMP dependent protein kinases, protein kinase C, ras-dependent MAP kinase and calcium-calmodulin dependent kinase, in an individual or animal in need of such treatment comprising the step of administering to said individual or animal a pharmacologically effective dose of an antioxidant.

[0076] (viii) A method for the treatment of a host, for example, an individual or animal, at risk for developing or exhibiting a neoplastic condition comprising the step of administering to said individual or animal a pharmacologically effective dose of an antioxidant.

[0077] (ix) A method for the treatment of individuals or animals at risk for developing a neoplastic condition that includes increasing the nuclear localization of C/EBPβ expression and function.

[0078] (x) A method for the treatment of individuals with a disorder of abnormal cell proliferation, including but not limited to benign and malignant tumors, that includes the step of administering to said individual or animal a pharmacologically effective dose of a therapeutic that increases the nuclear residence time of C/EPBβ, and wherein the therapeutic is either an antioxidant alone or a combination of an antioxidant and antineoplastic agent.

[0079] (xi) A method for the diagnosis and assessment of response to treatment of individuals with neoplastic and cell proliferative diseases through the measurement either alone or in combination, of C/EBPβ activation, phosphorylation and nuclear residence time of C/EBPβ, PP2A inhibition of carboxymethylation of the catalytic subunit of PP2A, and inhibition of methyltransferase or methylesterase activity.

[0080] II. Antioxidants

[0081] As used herein, the term antioxidant refers to a substance that prevents the oxidation of an oxidizable compound under physiological conditions. In one embodiment, a compound is considered an antioxidant for purposes of this disclosure if it reduces endogenous oxygen radicals in vitro. The antioxidant can be added to a cell extract under oxygenated conditions and the effect on an oxidizable compound evaluated. As nonlimiting examples, antioxidants scavenge oxygen, superoxide anions, hydrogen peroxide, superoxide radicals, lipooxide radicals, hydroxyl radicals, or bind to reactive metals to prevent oxidation damage to lipids, proteins, nucleic acids, etc. The term antioxidant includes, but is not limited to, the following classes of compounds.

[0082] A. Dithiocarbamates

[0083] Dithiocarbamates have been extensively described in patents and in scientific literature. Dithiocarbamates and related compounds have been reviewed extensively for example, by G. D. Thorn et al entitled “The Dithiocarbamates and Related Compounds,” Elsevier, New York, 1962. U.S. Pat. Nos. 5,035,878 and 5,294,430 disclose that dithiocarbamates can reverse the damage to the blood-forming function of the bone marrow (myelosuppression) caused by treatment with antineoplastic agents. All of the pharmaceutically acceptable dithiocarbamates disclosed in these two patents that increase the nuclear localization of C/EBPβ are suitable for use in this invention, and are incorporated herein by reference.

Active Compounds

[0084] Dithiocarbamates are transition metal chelators clinically used for heavy metal intoxication. Baselt, R. C., F. W. J. Sunderman, et al. (1977), “Comparisons of antidotal efficacy of sodium diethyldithiocarbamate, D-penicillamine and triethylenetetramine upon acute toxicity of nickel carbonyl in rats.” Res Commun Chem Pathol Pharmacol 18(4): 677-88; Menne, T. and K. Kaaber (1978), “Treatment of pompholyx due to nickel allergy with chelating agents.” Contact Dermatitis 4(5): 289-90; Sunderman, F. W. (1978), “Clinical response to therapeutic agents in poisoning from mercury vapor” Ann Clin Lab Sci 8(4): 259-69; Sunderman, F. W. (1979), “Efficacy of sodium diethyldithiocarbamate (dithiocarb) in acute nickel carbonyl poisoning.” Ann Clin Lab Sci 9(1): 1-10; Gale, G. R., A. B. Smith, et al. (1981), “Diethyldithiocarbamate in treatment of acute cadmium poisoning.” Ann Clin Lab Sci 11(6): 476-83; Jones, M. M. and M. G. Cherian (1990), “The search for chelate antagonists for chronic cadmium intoxication.” Toxicology 62(1): 1-25; Jones, S. G., M. A. Basinger, et al. (1982), “A comparison of diethyldithiocarbamate and EDTA as antidotes for acute cadmium intoxication.” Res Commun Chem Pathol Pharmacol 38(2): 271-8; Pages, A., J. S. Casas, et al. (1985), “Dithiocarbamates in heavy metal poisoning: complexes of N,N-di(1-hydroxyethyl)dithiocarbamate with Zn(II), Cd(II), Hg(II), CH3Hg(II), and C6H5Hg(II).: J. Inorg Biochem 25(1): 35-42; Tandon, S. K., N. S. Hashmi, et al. (1990), “The lead-chelating effects of substituted dithiocarbamates.” Biomed Environ Sci 3(3): 299-305.

[0085] Dithiocarbamates have also been used adjunctively in cis-platinum chemotherapy to prevent renal toxicity. Hacker, M. P., W. B. Ershler, et al. (1982). “Effect of disulfiram (tetraethylthiuram disulfide) and diethyldithiocarbamate on the bladder toxicity and antitumor activity of cyclophosphamide in mice” Cancer Res 42(11): 4490-4. Bodenner, 1986 #733; Saran, M. and Bors, W. (1990). “Radical reactions in vivo-an overview” Radiat. Environ. Biophys. 29(4):249-62.

[0086] A dithiocarbamate currently used in the treatment of alcohol abuse is disulfiram, a dimer of diethyldithiocarbamate. Disulfuram inhibits hepatic aldehyde dehydrogenase. Inoue, K., and Fukunaga, et al., (1982). “Effect of disulfiram and its reduced metabolite, diethyldithiocarbamate on aldehyde dehydrogenase of human erythrocytes” Life Sci 30(5): 419-24.

[0087] It has been reported that dithiocarbamates inhibit HIV virus replication, and also enhance the maturation of specific T cell subpopulations. This has led to clinical trials of diethyldithiocarbamate in AIDS patient populations. Reisinger, E., et al., (1990). “Inhibition of HIV progression by dithiocarb.” Lancet 335: 679.

[0088] Dithiocarboxylates are compounds of the structure A—SC(S)—B, which are members of the general class of compounds known as thiol antioxidants, and are alternatively referred to as carbodithiols or carbodithiolates. It appears that the —SC(S)— moiety is essential for therapeutic activity, and that A and B can be any group that does not adversely affect the efficacy or toxicity of the compound.

[0089] In an alternative embodiment, one or both of the sulfur atoms in the dithiocarbamate is replaced with a selenium atom. The substitution of sulfur for selenium may decrease the toxicity of the molecule in certain cases, and may thus be better tolerated by the patient.

[0090] A and B can be selected by one of ordinary skill in the art to impart desired characteristics to the compound, including size, charge, toxicity, and degree of stability, (including stability in an acidic environment such as the stomach, or basic environment such as the intestinal tract). The selection of A and B will also have an important effect on the tissue-distribution and pharmacokinetics of the compound. The compounds are preferably eliminated by renal excretion.

[0091] An advantage in administering a dithiocarboxylate pharmaceutically is that it does not appear to be cleaved enzymatically in vivo by thioesterases, and thus may exhibit a prolonged half-life in vivo.

[0092] In a preferred embodiment, A is hydrogen or a pharmaceutically acceptable cation, including but not limited to sodium, potassium, calcium, magnesium, aluminum, zinc, bismuth, barium, copper, cobalt, nickel, or cadmium; a salt-forming organic acid, typically a carboxylic acid, including but not limited to acetic acid, oxalic acid, tartaric acid, succinic acid, malic acid, ascorbic acid, benzoic acid, tannic acid, pamoic acid, alginic acid, polyglutamic acid, naphthalenesulfonic acid, naphthalenedisulfonic acid, or polygalacturonic acid; or a cation formed from ammonia or other nitrogenous base, including but not limited to a nitrogenous heterocycle, or a moiety of the formula NR4R5R6R7, wherein R4, R5, R6, and R7 are independently hydrogen, C1-6 linear, branched, or (in the case of C4-6) cyclic alkyl, hydroxy-(C1-6)-alkyl (wherein one or more hydroxyl groups are located on any of the carbon atoms), or aryl, N,N-dibenzylethylene-diamine, D-glucosamine, choline, tetraethylammonium, or ethylenediamine.

[0093] In another embodiment, A can be a physiologically cleavable leaving group that can be cleaved in vivo from the molecule to which it is attached, and includes but is not limited to acyl (including acetyl, propionyl, and butyryl), alkyl, phosphate, sulfate or sulfonate.

[0094] In one embodiment, B is alkyl, alkenyl, alkynyl, alkaryl, aralkyl, haloalkyl, haloalkenyl, haloalkynyl, aryl, alkaryl, hydrogen, C1-6 alkoxy-C1-10 alkyl, C1-6 alkylthio-C1-10 alkyl, NR2R3, —(CHOH)nCH2OH, wherein n is 0, 1, 2, 3, 4, 5 or 6, —(CH2)nCO2R1, including alkylacetyl, alkylpropionyl, and alkylbutyryl, or hydroxy(C1-6)alkyl- (wherein one or more hydroxyl groups are located on any of the carbon atoms).

[0095] In another embodiment, B is NR2R3, wherein R2 and R3 are independently alkyl; —(CHOH)n(CH2)nOH, wherein n is 0, 1, 2, 3, 4, 5 or 6; —(CH2)nCO2R1, —(CH2)nCO2R4; hydroxy(C1-6)alkyl-; alkenyl (including but not limited to vinyl, allyl, and CH3CH═CH—CH2-CH2); alkyl(CO2H), alkenyl(CO2H), alkynyl(CO2H), or aryl, wherein the aryl group can be substituted as described above, notably, for example, with a NO2, CH3, t-butyl, CO2H, halo, or p-OH group; or R2 and R3 can together constitute a bridge such as —(CH2)m—, wherein m is 3, 4, 5, 6, 7, 8, 9 or 10, and wherein R4 is alkyl, aryl, alkaryl, or aralkyl, including acetyl, propionyl, and butyryl.

[0096] In yet another embodiment, B can be a heterocyclic or alkylheterocyclic group. The heterocycle can be optionally partially or totally hydrogenated. Nonlimiting examples are those listed above, including phenazine, phenothiazine, pyridine and dihydropyridine.

[0097] In still another embodiment, B is the residue of a pharmaceutically-active compound or drug. The term drug, as used herein, refers to any substance used internally or externally as a medicine for the treatment, cure or prevention of a disease or disorder. The —C(S)SA group can be directly attached to the drug, or attached through any suitable linking moiety.

[0098] In another embodiment, the dithiocarbamate is an amino acid derivative of the structure AO2C—R9—NR10—C(S)SA, wherein R9 is a divalent B moiety, a linking moiety, or the internal residue of any of the naturally occurring amino acids (for example, CH3CH for alanine, CH2 for glycine, CH(CH2)4NH2 for lysine, etc.), and R10 is hydrogen or lower alkyl.

[0099] B can also be a polymer to which one or more dithiocarbamate groups are attached, either directly, or through any suitable linking moiety. The dithiocarbamate is preferably released from the polymer under in vivo conditions over a suitable time period to provide a therapeutic benefit. In a preferred embodiment, the polymer itself is also degradable in vivo. The term biodegradable or bioerodible, as used herein, refers to a polymer that dissolves or degrades within a period that is acceptable in the desired application (usually in vivo therapy), usually less than five years, and preferably less than one year, on exposure to a physiological solution of pH 6-8 having a temperature of between 25 and 37° C. In a preferred embodiment, the polymer degrades in a period of between 1 hour and several weeks, according to the application.

[0100] A number of degradable polymers are known. Nonlimiting examples are peptides, proteins, nucleoproteins, lipoproteins, glycoproteins, synthetic and natural polypeptides and polyamino acids, including but not limited to polymers and copolymers of lysine, arginine, asparagine, aspartic acid, cysteine, cystine, glutamic acid, glutamine, hydroxylysine, serine, threonine, and tyrosine; polyorthoesters, including poly(a-hydroxy acids), for example, polylactic acid, polyglycolic acid, poly(lactide-co-glycolide), polyanhydrides, albumin or collagen, a polysaccharide containing sugar units such as lactose, and polycaprolactone. The polymer can be a random or block copolymer.

[0101] B can also be a group that enhances the water solubility of the dithiocarbamate, for example, -lower alkyl-O—R8, wherein R8 is —PO2(OH)−M+ or PO3(M+)2 wherein M+ is a pharmaceutically acceptable cation; —C(O)(CH2)2CO2−M+, or —SO3−M+; -lower alkylcarbonyl-lower alkyl; -carboxy lower alkyl; -lower alkylamino-lower alkyl; N,N-di-substituted amino lower alkyl-, wherein the substituents each independently represent lower alkyl; pyridyl-lower alkyl-; imidazolyl-lower alkyl-; imidazolyl-Y-lower alkyl wherein Y is thio or amino; morpholinyl-lower alkyl; pyrrolidinyl-lower alkyl; thiazolinyl-lower alkyl-; piperidinyl-lower alkyl; morpholinyl-lower hydroxyalkyl; N-pyrryl; piperazinyl-lower alkyl; N-substituted piperazinyl-lower alkyl, wherein the substituent is lower alkyl; triazolyl-lower alkyl; tetrazolyl-lower alkyl; tetrazolylamino-lower alkyl; or thiazolyl-lower alkyl.

[0102] In an alternative embodiment, a dimer such as B—C(S)S—SC(S)—B can be administered.

[0103] The term “alkyl,” as used herein, unless otherwise specified, refers to a saturated straight, branched, or cyclic (in the case of C5 or greater) hydrocarbon of C1 to C10 (or lower alkyl, i.e., C1 to C5), which specifically includes methyl, ethyl, propyl, isopropyl, butyl, isobutyl, t-butyl, pentyl, cyclopentyl, isopentyl, neopentyl, hexyl, isohexyl, cyclohexyl, cyclohexylmethyl, 3-methylpentyl, 2,2-dimethylbutyl, and 2,3-dimethylbutyl. The alkyl group can be optionally substituted on any of the carbons with one or more moieties selected from the group consisting of hydroxyl, amino, or mono- or disubstituted amino, wherein the substituent group is independently alkyl, aryl, alkaryl or aralkyl; aryl, alkoxy, aryloxy, nitro, cyano, sulfonic acid, sulfate, phosphonic acid, phosphate, or phosphonate, either unprotected, or protected as necessary, as known to those skilled in the art, for example, as taught in Greene, et al., “Protective Groups in Organic Synthesis,” John Wiley and Sons, Second Edition, 1991.

[0104] The term “alkenyl,” as referred to herein, and unless otherwise specified, refers to a straight, branched, or cyclic hydrocarbon of C2 to C10 with at least one double bond.

[0105] The term “alkynyl,” as referred to herein, and unless otherwise specified, refers to a C2 to C10 straight or branched hydrocarbon with at least one triple bond.

[0106] The term “aralkyl” refers to an aryl group with at least one alkyl substituent.

[0107] The term “alkaryl” refers to an alkyl group that has at least one aryl substituent.

[0108] The term “halo (alkyl, alkenyl, or alkynyl)” refers to an alkyl, alkenyl, or alkynyl group in which at least one of the hydrogens in the group has been replaced with a halogen atom.

[0109] The term “aryl,” as used herein, and unless otherwise specified, refers to phenyl, biphenyl or napthyl, and preferably phenyl. The aryl group can be optionally substituted with one or more moieties selected from the group consisting of alkyl, hydroxyl, amino, alkylamino, arylamino, alkoxy, aryloxy, nitro, cyano, sulfonic acid, sulfate, phosphonic acid, phosphate, or phosphonate, CO2H, or its pharmaceutically acceptable salt, CO2(alkyl, aryl, alkaryl or aralkyl), or glucamine, either unprotected, or protected as necessary, as known to those skilled in the art, for example, as taught in Greene, et al., “Protective Groups in Organic Synthesis,” John Wiley and Sons, Second Edition, 1991.

[0110] The term “alkoxy,” as used herein, and unless otherwise specified, refers to a moiety of the structure —O-alkyl.

[0111] The term “acyl” as used herein, refers to a group of the formula C(O)R′, wherein R′ is an alkyl, aryl, alkaryl or aralkyl group.

[0112] The term “heterocyclic” as used herein, refers to an aromatic moiety that includes at least one sulfur, oxygen or nitrogen in the aromatic ring. Nonlimiting examples are phenazine, phenothiazine, furyl, pyridyl, pyrimidyl, thienyl, isothiazolyl, imidazolyl, tetrazolyl, pyrazinyl, benzofuranyl, benzothiophenyl, quinolyl, isoquinolyl, benzothienyl, isobenzofuryl, pyrazolyl, indolyl, isoindolyl, benzimidazolyl, purinyl, morpholinyl, carbozolyl, oxazolyl, thiazolyl, isothiazolyl, 1,2,4-thiadiazolyl, isooxazolyl, pyrrolyl, pyrazolyl, quinazolinyl, pyridazinyl, pyrazinyl, cinnolinyl, phthalazinyl, quinoxalinyl, xanthinyl, hypoxanthinyl, pteridinyl, 5-aza-cytidinyl, 5-azauracilyl, triazolopyridinyl, imidazolopyridinyl, pyrrolopyrimidinyl, pyrazolo-pyrimidinyl, adenine, N6-alkylpurines, N6-benzylpurine, N6-halopurine, N6-vinylpurine, N6-acetylenic purine, N6-acyl purine, N6-hydroxyalkyl purine, N6-thioalkyl purine, thymine, cytosine, 6-azapyrimidine, 2-mercaptopyrmidine, uracil, N5-alkylpyrimidines, N5-benzylpyrimidines, N5-halopyrimidines, N5-vinylpyrimidine, N5-acetylenic pyrimidine, N5-acyl pyrimidine, N5-hydroxyalkyl purine, and N6-thioalkyl purine, and isoxazolyl. The heterocyclic group can be optionally substituted as described above for aryl. The heterocyclic group can be partially or totally hydrogenated as desired. As a nonlimiting example, dihydropyridine can be used in place of pyridine. Functional oxygen and nitrogen groups on the heterocyclic base can be protected as necessary or desired during the reaction sequence. Suitable protecting groups are well known to those skilled in the art, and include trimethylsilyl, dimethylhexylsilyl, t-butyldimethylsilyl, and t-butyldiphenylsilyl, tritylmethyl, alkyl groups, acyl groups such as acetyl and propionyl, methylsulfonyl, and p-toluylsulfonyl.

[0113] The term “hydroxyalkyl,” as used herein, refers to a C1 to C6 alkyl group in which at least one of the hydrogens attached to any of the carbon atoms is replaced with a hydroxy group.

[0114] The term “pharmaceutically acceptable derivative” refers to a derivative of the active compound that upon administration to the recipient, is capable of providing directly or indirectly, the parent compound, or that exhibits activity itself.

[0115] The term “pharmaceutically acceptable cation” refers to an organic or inorganic moiety that carries a positive charge and that can be administered in association with a pharmaceutical agent, for example, as a countercation in a salt. Pharmaceutically acceptable cations are known to those of skill in the art, and include but are not limited to sodium, potassium and quaternary amine.

[0116] The term “physiologically cleavable leaving group” refers to a moiety that can be cleaved in vivo from the molecule to which it is attached, and includes but is not limited to an organic or inorganic anion, a pharmaceutically acceptable cation, acyl (including but not limited to (alkyl)C(O), including acetyl, propionyl, and butyryl), alkyl, phosphate, sulfate and sulfonate.

[0117] The term “enantiomerically enriched composition or compound” refers to a composition or compound that includes at least 95%, and preferably at least 97, 98, 99, or 100% by weight of a single enantiomer of the compound.

[0118] The term “amino acid” includes synthetic and naturally occurring amino acids, including but not limited to, for example, alanyl, valinyl, leucinyl, isoleucinyl, prolinyl, phenylalaninyl, tryptophanyl, methioninyl, glycinyl, serinyl, threoninyl, cysteinyl, tyrosinyl, asparaginyl, glutaminyl, aspartoyl, glutaoyl, lysinyl, argininyl, and histidinyl.

[0119] A “linking moiety” as used herein, is any divalent group that links two chemical residues, including but not limited to alkyl, alkenyl, alkynyl, aryl, polyalkyleneoxy (for example, —[(CH2)nO—]n—), —C1-6alkoxy-C1-10alkyl-, —C1-6alkylthio-C1-10alkyl-, —NR3—, and —(CHOH)nCH2OH, wherein n is independently 0, 1, 2, 3, 4, 5 or 6.

[0120] As explained in Chapter 2 of Thorn et al, the preparation of dithiocarbamates is very simple. The compounds of the formula RIR2NCSSH or RIR2NSSNa can be formed by reaction of carbon disulfide with a secondary amine, typically in alcoholic or aqueous solution. The usual practice is to carry out this reaction in the presence of NaOH, so that the sodium dithiocarbamate salt is formed. Thus, for example, sodium dimethyl dithiocarbamate is formed from CS2NaOH and dimethylamine. See Thorn et al, page 14, and the references cited therein. Other typical dithiocarbamic compounds disclosed and characterized in Thorn et al include: N-methyl, N-ethyldithiocarbamates, hexamethylenedithiocarbamic acid, sodium di(beta-hydroxy-ethyl) dithiocarbamate, sodium N-methyl, N-cyclobutylmethyl dithiocarbamate, sodium N-allyl-N-cyclopropylmethyl-dithiocarbamate, cyclohexylamyldithiocarbamates, dibenzyl-dithio-carbamates, sodium dimethylene-dithiocarbamate, various pentamethylene dithiocarbamate salts, sodium pyrrolidine-N-carbodithioate, sodium piperidine-N-carbodithioate, sodium morpholine-N-carbo-dithioate, alpha-furfuryl dithiocarbamates and imidazoline dithiocarbamates.

[0121] B. Probucol and its Derivatives

[0122] Probucol is chemically related to the widely used food additives 2,[3]-tert-butyl-4-hydroxyanisole (BHA) and 2,6-di-tert-butyl-4-methyl phenol (BHT). Its full chemical name is 4,4′-(isopropylidenedithio)bis(2,6-di-tert-butylphenol). U.S. Pat. No. 5,262,439 to Parthasarathy, incorporated herein by reference, discloses soluble analogs of probucol in which one or both of the hydroxyl groups are replaced with ester groups that impart water solubility to the compound. In one embodiment, the soluble derivative is selected from the group consisting of a mono- or di- succinic acid ester, glutaric acid ester, adipic acid ester, suberic acid ester, sebacic acid ester, azelaic acid or maleic acid ester of probucol. In another embodiment, the probucol derivative is a mono- or di- ester in which the ester contains an alkyl or alkenyl group that contains functionality selected from the group consisting of a carboxylic acid group. Any of the compounds described in the '439 patent can be used in this invention.

[0123] U.S. Pat. No. 5,155,250, also incorporated herein by reference, discloses that 2,6-dialkyl-4-silylphenols are antiatherosclerotic agents. The same compounds are disclosed as serum cholesterol lowering agents in PCT Publication No. WO 95/15760, published on Jun. 15, 1995. U.S. Pat. No. 5,608,095, incorporated by reference, discloses that alkylated-4-silyl-phenols inhibit the peroxidation of LDL, lower plasma cholesterol, and inhibit the expression of VCAM-1, and thus are useful in the treatment of atherosclerosis. Any of these compounds can also be used in this invention.

[0124] C. N-Acetyl Cysteine and its Derivatives

[0125] Cysteine is an amino acid with one chiral carbon atom. It exists as an L-enantiomer, a D-enantiomer or a racemic mixture of the L- and D-enantiomers. The L-enantiomer is the naturally occurring configuration.

[0126] N-acetylcysteine (acetamido-mercaptopropionic acid, NAC) is the N-acetylated derivative of cysteine. It also exists as an L-enantiomer, a D-enantiomer, an enantiomerically enriched composition of one of the enantiomers, or a racemic mixture of the L and D enantiomers. The term “enantiomerically enriched composition or compound” refers to a composition or compound that includes at least 95%, and preferably, at least 97% by weight of a single enantiomer of the compound. Any of these forms of NAC can be delivered as an antioxidant in the present invention. In one embodiment, a single isomer of a thioester or thioether of NAC or its salt, and most preferably, the naturally occurring L-enantiomer, is used in the treatment process.

[0127] N-acetylcysteine exhibits antioxidant activity (Smilkstein, Knapp, Kulig and Rumack, N. Engl. J Med. 1988, Vol. 319, pp. 1557-62; Knight, K. R., MacPhadyen, K., Lepore, D. A., Kuwata, N., Eadie, P. A., O'Brien, B. Clinical Sci., 1991, Vol. 81, pp. 31-36; Ellis, E. F., Dodson, L. Y., Police, R. J., J Neurosurg., 1991, Vol. 75, pp. 774-779). The sulfhydryl functional group is a well characterized, highly reactive free radical scavenger. N-acetylcysteine is known to promote the formation of glutathione (a tri-peptide, also known as g-glutamylcysteinylglycine), which is important in maintaining cellular constituents in the reduced state (Berggren, M., Dawson, J., Moldeus, P. FEBS Lett., 1984, Vol. 176, pp. 189-192). The formation of glutathione may enhance the activity of glutathione peroxidase, an enzyme which inactivates hydrogen peroxide, a known precursor to hydroxyl radicals (Lalitha, T., Kerem, D., Yanni, S., Pharmacology and Toxicology, 1990, Vol.66, pp. 56-61) N-acetylcysteine exhibits low toxicity in vivo, and is significantly less toxic than deprenyl (for example, the LD50 in rats has been measured at 1140 and 81 mg/kg intravenously, for N-acetylcysteine and deprenyl, respectively).

[0128] N-acetyl cysteine and derivatives thereof are described, for example, in WO/95/26719. Any of the derivatives described in this publication can be used in accordance with this invention.

[0129] D. Scavengers of Peroxides,

[0130] Scavengers of peroxides include but are not limited to catalase and pyruvate.

[0131] E. Thiols

[0132] Thiols include but are not limited to dithiothreitol and 2-mercaptoethanol.

[0133] F. Antioxidants which are inhibitors of lipid peroxidation,

[0134] Antioxidants which are inhibitors of lipid peroxidation, include but are not limited to Trolox™, BHA, BHT, aminosteroid antioxidants, tocopherol and its analogs, and lazaroids.

[0135] G. Dietary antioxidants

[0136] Dietary antioxidants, include but are not limited to antioxidant vitamins (vitamin C or E or synthetic or natural prodrugs or analogs thereof), either alone or in combination with each other, flavanoids, phenolic compounds, caratenoids, and alpha lipoic acid.

[0137] H. Inhibitors of lipoxygenases and cyclooxygenases Inhibitors of lipoxygenases and cyclooxygenases, include but are not limited to nonsteriodal antinflammatory drugs, COX-2 inhibitors, aspirin-based compounds, and quercetin.

[0138] I. Antioxidants manufactured by the body

[0139] Antioxidants manufactured by the body, include but are not limited to ubiquinols and thiol antioxidants, such as, and including glutathione, Se, and lipoic acid

[0140] J. Synthetic Phenolic Antioxidants

[0141] Synthetic phenolic antioxidants include but are not limited to inducers of Phase I and II drug-metabolizing enzymes.

[0142] III. Antineoplastic Agents

[0143] The term “antineoplastic agents,” as used herein, refers to any substance that decreases abnormal cell proliferation. Antineoplastic agents have been described extensively in a number of texts, including Martindale, The Extra Pharmacopoeia, 31st Edition, Royal Pharmaceutical Society (1996).

[0144] Antineoplastic agents include:

[0145] (i) antifolates;

[0146] (ii) antimetabolites (including purine antimetabolites, cytarabine, fudarabine, floxuridine, 6-mercaptopurine, methotrexate, 5-fluoropyrimidine, including 5-fluorouracil, cytidine analogues such as β-L-1,3-dioxolanyl cytidine and 6-thioguanine);

[0147] (iii) hydroxyurea;

[0148] (iv) mitotic inhibitors (including CPT-11, Etoposide (VP-21)), taxol and vincristine;

[0149] (v) alkylating agents (including but not limited to busulfan, chlorambucil, cyclophosphamide, ifofamide, mechlorethamine, melphalan and thiotepa);

[0150] (vi) nonclassical alkylating agents, platinum containing compounds, bleomycin, anti-tumor antibiotics, anthracycline, anthracenedione, topoisomerase 11 inhibitors, hormonal agents (including but not limited to corticosteroids (dexamethasone, prednisone and methylprednisone); and

[0151] (v) androgens such as fluoxymesterone and methyltestosterone, estrogens such as diethylstilbesterol, antiestrogens such as tamoxifen, LHRH analogues such as leuprolide, antiandrogens such as flutamide, aminoglutethimide, megestrol acetate, and medroxyprogesterone), asparaginase, carmustine, lomustine, hexamethyl-melamine, dacarbazine, mitotane, streptozocin, cisplatin, carboplatin, levamasole, and leucovorin.

[0152] A more comprehensive list of antineoplastic agents includes Aceglatone; Aclarubicin; Altretamine; Aminoglutethimide; 5-Aminogleavulinic Acid; Amsacrine; Anastrozole; Ancitabine Hydrochloride; 17-1A Antibody; Antilymphocyte Immunoglobulins; Antineoplaston A10; Asparaginase; Pegaspargase; Azacitidine; Azathioprine; Batimastat; Benzoporphyrin Derivative; Bicalutamide; Bisantrene Hydrochloride; Bleomycin Sulphate; Brequinar Sodium; Broxuridine; Busulphan; Campath-IH; Caracemide; Carbetimer; Carboplatin; Carboquone; Carmofur; Carmustine; Chlorambucil; Chlorozotocin; Chromomycin; Cisplatin; Cladribine; Corynebacterium parvum; Cyclophosphamide; Cyclosporin; Cytarabine; Dacarbazine; Dactinomycin; Daunorubicin Hydrochloride; Decitabine; Diaziquone; Dichlorodiethylsulphide; Didemnin B.; Docetaxel; Doxifluridine; Doxorubicin Hychloride; Droloxifene; Echinomycin; Edatrexate; Elliptinium; Elmustine; Enloplatin; Enocitabine; Epirubicin Hydrochloride; Estramustine Sodium Phosphate; Etanidazole; Ethoglucid; Etoposide; Fadrozole Hydrochloride; Fazarabine; Fenretinide; Floxuridine; Fludarabine Phosphate; Fluorouracil; Flutamide; Formestane; Fotemustine; Gallium Nitrate; Gencitabine; Gusperimus; Homoharringtonine; Hydroxyurea; Idarubicin Hydrochloride; Ifosfamide; Ilmofosine; Improsulfan Tosylate; Inolimomab; Interleukin-2; Irinotecan; JM-216; Letrozole; Lithium Gamolenate; Lobaplatin; Lomustine; Lonidamine; Mafosfamide; Melphalan; Menogaril; Mercaptopurine; Methotrexate; Methotrexate Sodium; Miboplatin; Miltefosine; Misonidazole; Mitobronitol; Mitoguazone Dihydrochloride; Mitolactol; Mitomycin; Mitotane; Mitozanetrone Hydrochloride; Mizoribine; Mopidamol; Multialchilpeptide; Muromonab-CD3; Mustine Hydrochloride; Mycophenolic Acid; Mycophenolate Mofetil; Nedaplatin; Nilutamide; Nimustine Hydrochloride; Oxaliplatin; Paclitaxel; PCNU; Penostatin; Peplomycin Sulphate; Pipobroman; Pirarubicin; Piritrexim Isethionate; Piroxantrone Hydrochloride; Plicamycin; porfimer Sodium; Prednimustine; Procarbazine Hydrochloride; Raltitrexed; Ranimustine; Razoxane; Rogletimide; Roquinimex; Sebriplatin; Semustine; Sirolimus; Sizofiran; Sobuzoxane; Sodium Bromebrate; Sparfosic Acid; Sparfosate Sodium; Sreptozocin; Sulofenur; Tacrolimus; Tamoxifen; Tegafur; Teloxantrone Hydrochloride; Temozolomide; Teniposide; Testolactone; Tetrasodium Meso-tetraphenylporphinesulphonate; Thioguanine; Thioinosine; Thiotepa; Topotecan; Toremifene; Treosulfan; Trimetrexate; Trofosfamide; Tumor Necrosis Factor; Ubenimex; Uramustine; Vinblastine Sulphate; Vincristine Sulphate; Vindesine Sulphate; Vinorelbine Tartrate; Vorozole; Zinostatin; Zolimomab Aritox; and Zorubicin Hydrochloride.

[0153] IV. Abnormal Cell Hyperproliferative Conditions

[0154] Antioxidants can be used to increase the cytotoxicity of antineoplastic agents to disorders of abnormal cellular proliferation, including, but not limited to:

[0155] (i) benign tumors, including, but not limited to papilloma, adenoma, firoma, chondroma, osteoma, lipoma, hemangioma, lymphangioma, leiomyoma, rhabdomyoma, meningioma, neuroma, ganglioneuroma, nevus, pheochromocytoma, neurilemona, fibroadenoma, teratoma, hydatidiform mole, granuosa-theca, Brenner tumor, arrhenoblastoma, hilar cell tumor, sex cord mesenchyme, interstitial cell tumor and thyoma;

[0156] (ii) malignant tumors (cancer), including but not limited to carcinoma, including renal cell carcinoma, prostatic adenocarcinoma, bladder carcinoma,and adenocarcinoma, fibrosarcoma, chondrosarcoma, osteosarcoma, liposarcoma, hemangiosarcoma, lymphangiosarcoma, leiomyosarcoma, rhabdomyosarcoma, myelocytic leukemia, erythroleukemia, multiple myeloma, glioma, meningeal sarcoma, thyoma, cystosarcoma phyllodes, nephroblastoma, teratoma choriocarcinoma, cutaneous T-cell lymphoma (CTCL), cutaneous tumors primary to the skin (for example, basal cell carcinoma, squamous cell carcinoma, melanoma, and Bowen's disease), breast and other tumors infiltrating the skin, Kaposi's sarcoma, and premalignant and malignant diseases of mucosal tissues, including oral, bladder, and rectal diseases, central nervous system tumors (glioblastomas), meningiomas, and astrocytomas; and

[0157] (iii) hyperproliferative and preneoplastic lesions, including mycosis fungoides, psoriasis, dermatomyositis, rheumatoid arthritis, viruses (for example, warts, herpes simplex, and condyloma acuminata), molluscum contagiosum, remalignant and malignant diseases of the female genital tract (cervix, vagina, and vulva).

[0158] Of these, particular conditions that can be treated using this method include colorectal cancer, ovarian cancer, bone cancer, renal cancer, breast cancer, gastric cancer, pancreatic cancer, melanoma, hematopoietic tumors such as lymphoma, leukemia, plasma cell dyscrasias, and multiple meyloma and amylodosis.

[0159] Antioxidants can also be used in combination with antineoplastic agents to treat cardiovascular proliferative disease such as post-angioplasty restenosis and atherosclerosis.

[0160] V. Pharmaceutical Compositions

[0161] A host, including mammals, and specifically humans, suffering from any of the above-described conditions can be treated by the topical or systemic administration to the patient of an effective amount of an antioxidant, optionally in combination with an antineoplastic agent, in the presence of a pharmaceutically acceptable carrier or diluent. The antioxidant can be administered prior to, in combination with, or following treatment with an antineoplastic agent when used to increase the cytotoxic effect of the antineoplstic agent. Methods and dosages for the administration of antineoplastic agents are known to those skilled in the art, and are described in a number of texts, including the The Physician's Desk Reference, Martindale's The Extra Pharmacopeia, and Goodman & Gilman's The Pharmacological Basis of Therapeutics, or can be easily determined using standard methods.

[0162] The antioxidant can be administered subcutaneously, intravenously, intraperitoneally, intramuscularly, parenterally, orally, submucosally, by inhalation, transdermally via a slow release patch, or topically, in an effective dosage range to treat the target condition. Typical systemic dosages for all of the herein described conditions are those ranging from 0.01 mg/kg to 500 mg/kg of body weight per day as a single daily dose or divided daily doses. Typical dosages for topical application are those ranging from 0.001 to 100% by weight of the active compound.

[0163] The compound is administered for a sufficient time period to alleviate the undesired symptoms and the clinical signs associated with the condition being treated.

[0164] The active compound is included in the pharmaceutically acceptable carrier or diluent in an amount sufficient to deliver to a patient a therapeutic amount of compound in vivo in the absence of serious toxic effects.

[0165] The concentration of active compound in the drug composition will depend on absorption, inactivation and excretion rates of the drug as well as other factors known to those of skill in the art. It is to be noted that dosage values will also vary with the severity of the condition to be alleviated. It is to be further understood that for any particular subject, specific dosage regimens should be adjusted over time according to the individual need and the professional judgment of the person administering or supervising the administration of the compositions, and that the dosage ranges set forth herein are exemplary only and are not intended to limit the scope or practice of the claimed composition. The active ingredient may be administered at once, or may be divided into a number of smaller doses to be administered at varying intervals of time.

[0166] A preferred mode of administration of the active compound for systemic delivery is oral. Oral compositions will generally include an inert diluent or an edible carrier. They may be enclosed in gelatin capsules or compressed into tablets. For the purpose of oral therapeutic administration, the active compound, can be incorporated with excipients and used in the form of tablets, troches or capsules. Pharmaceutically compatible binding agents, and/or adjuvant materials can be included as part of the composition.

[0167] The tablets, pills, capsules, troches and the like can contain any of the following ingredients, or compounds of a similar nature: a binder such as microcrystalline cellulose, gum tragacanth or gelatin; an excipient such as starch or lactose, a disintegrating agent such as alginic acid, Primogel or corn starch; a lubricant such as magnesium stearate or Sterotes; a glidant such as colloidal silicon dioxide; a sweetening agent such as sucrose or saccharin; or a flavoring agent such as peppermint, methyl salicylate, or orange flavoring.

[0168] When the dosage unit form is a capsule, it can contain, in addition to material of the above type, a liquid carrier such as a fatty oil. In addition, dosage unit forms can contain various other materials which modify the physical form of the dosage unit, for example, coatings of sugar, shellac, or other enteric agents.

[0169] The compound or its salts can be administered as a component of an elixir, suspension, syrup, wafer, lozenge, chewing gum or the like. A syrup may contain, in addition to the active compounds, sucrose as a sweetening agent and certain preservatives, dyes and colorings and flavors.

[0170] The compound can also be mixed with other active materials that do not impair the desired action, or with materials that supplement the desired action, such as antibiotics, antifungals, antiinflammatories, antivirals, or other immunosuppressive agents.

[0171] Solutions or suspensions used for parenteral, intradermal, subcutaneous, or topical application can include the following components: a sterile diluent such as water for injection, saline solution, fixed oils, polyethylene glycols, glycerine, propylene glycol or other synthetic solvents; antibacterial agents such as benzyl alcohol or methyl parabens; antioxidants such as ascorbic acid or sodium bisulfite; chelating agents such as ethylenediaminetetraacetic acid; buffers such as acetates, citrates or phosphates and agents for the adjustment of tonicity such as sodium chloride or dextrose. pH can be adjusted with acids or bases, such as hydrochloric acid or sodium hydroxide. The parenteral preparation can be enclosed in ampoules, disposable syringes or multiple dose vials made of glass or plastic.

[0172] If administered intravenously, preferred carriers are physiological saline,bacteriostatic water, Cremophor EL™ (BASF, Parsippany, N.J.) or phosphate buffered saline (PBS).

[0173] In a preferred embodiment, the active compounds are prepared with carriers that will protect the compound against rapid elimination from the body, such as a controlled release formulation, including implants and microencapsulated delivery systems. Biodegradable, biocompatible polymers can be used, such as ethylene vinyl acetate, polyanhydrides, polyglycolic acid, collagen, polyorthoesters and polylactic acid. Methods for preparation of such formulations will be apparent to those skilled in the art. The materials can also be obtained commercially from Alza Corporation and Nova Pharmaceuticals, Inc. Liposomal suspensions (including liposomes targeted to infected cells with monoclonal antibodies to viral antigens) are also preferred as pharmaceutically acceptable carriers. These may be prepared according to methods known to those skilled in the art, for example, as described in U.S. Pat. No. 4,522,811 (which is incorporated herein by reference in its entirety). For example, liposome formulations may be prepared by dissolving appropriate lipid(s) (such as stearoyl phosphatidyl ethanolamine, stearoyl phosphatidyl choline, arachadoyl phosphatidyl choline, and cholesterol) in an inorganic solvent that is then evaporated, leaving behind a thin film of dried lipid on the surface of the container. An aqueous solution of the compound is then introduced into the container. The container is then swirled by hand to free lipid material from the sides of the container and to disperse lipid aggregates, thereby forming the liposomal suspension.

[0174] Suitable vehicles or carriers for topical application can be prepared by conventional techniques, such as lotions, suspensions, ointments, creams, gels, tinctures, sprays, powders, pastes, slow-release transdermal patches, suppositories for application to rectal, vaginal, nasal or oral mucosa. In addition to the other materials listed above for systemic administration, thickening agents, emollients and stabilizers can be used to prepare topical compositions. Examples of thickening agents include petrolatum, beeswax, xanthan gum, or polyethylene, humectants such as sorbitol, emollients such as mineral oil, lanolin and its derivatives, or squalene. A number of solutions and ointments are commercially available, especially for ophthalmic applications.

ILLUSTRATIVE EXAMPLES

[0175] The following examples are provided for the purpose of illustrating various embodiments of the invention and are not intended to limit the scope of the present invention.

Example 1

[0176] HCT 116 and HCT 15 human CRC cells were obtained from the American type Culture Collection. p2WAF1/CIP1−/− cancer cells generated from HCT 116 cells by T. Waldman were provided by J. Pietenpol (Vanderbilt University, Tenn.) and HPV E6-transfected HCT 116 by W. S. E1-Deiry (University of Pennsylvania, Pa.) [W. S. El-Deiry et al., Cell 75, 817 (1993)]. All cancer cell lines used in these studies were grown in Dulbecco's modified Eagle's medium (DMEM) (GIBCO BRL) with high glucose and supplemented with 10% heat-activated fetal bovine serum (FBS), non-essential amino acids, L-glutamine, and penicillin G Sodium (100 U/ml) and streptomycin sulfate (100 mg/ml) at 37° C. in 5% CO2 in air.

[0177] To determine the effect of pyrrolidinedithiocarbamate (Sigma Chemical Co., Ma.), a vitamin E analogue (6-hydroxy-2.5,7,8-tetramethylchroman-2-carboxylic acid: vit (E) (Aldrich), 5-FU (Hoffmann-LaRoche Inc. Nutley, N.J.) or doxorubicin (Sigma) on anchorage-independent growth, HCT 15 and HCT 116 cells were plated at 10×103 cells/35 mm plate in DMEM supplemented with 1% FBS and 0.4% agar along with the factor to be tested. The number of colonies was quantified under 10 days using the Omnicon image analyzer. Colonies greater than 50 microns in diameter (approximately 50 cells) were scored as positive after 10 days. Preliminary studies indicated that pyrrolidinedithiocarbamate and vitamin E had no significant effect on CRC cell plating efficiency, at concentrations between 25-200 μM and 0.1-10 mM, respectively. Higher concentrations resulted in non-specific cytotoxicity.

Example 2

[0178] DNA Content of nuclei was determined as described [I. G. Nicoletti et al., J Immunol. Methods. 139, 271 (1991)] by lysing plasma membranes, staining nuclear DNA with propidium iodide (50 mg/ml), and quantitating the relative DNA content of nuclei using the Becton Dickinson FACSORT fluorescence-activated cell sorter. The proportion of nuclei in each phase of the cell cycle was determined using MODFIT-DNA analysis software. Detection of apoptotic cells either by fluorescence microscopy or by flow cytometry was performed using the ApopTag Plus In Situ Apoptosis Detection Kit (Oncor, Gaithersburg, Md.) as described in the manufacturer's protocol. Briefly, gigoxygenin-labeled nucleotides were added to free 3′OH groups of DNA produced by DNA fragmentation during apoptosis by terminal deoxynucleotidyl transferase (TdT). Digoxygenin was detected by a FTC-conjugated anti-digoxygenin antibody. Analysis was carried out using the fluorescence-activated cell sorter and FITC staining visualized using a fluorescence microscope (Zeiss).

Example 3

[0179] Intracellular H2O2 levels were analyzed by flow cytometry using dihydrorhodamine 1234 (DHR) as a specific fluorescent dye probe [G. Rothe, A. Emmendorffer, A. Oser, J. Roesler, G. Valet, J Immun. Methods 138, 133 (1991); J. A. Royall, H. Ischiropoulos, Arch. Biochem. Biophysics 302, 348 (1993)]. CRC cells were grown in DMEM containing 1 mM DHR and pyrrolidinedithiocarbamate (70 μM) or vit E (3 mM) for up to 24 hours. Following trypinization, trypsin activity was quenched with 2% FBS in phosphate buffered saline and cells fixed in 1% paraformaldahyde (Sigma). Cellular rhodamine 123 fluorescence intensity of 1×104 cells was measured for each sample using a Becton-Dickenson FACS Vantage flow cytometer with the excitation source at 488 nm and emission wave length of 580 nm. Histograms were analyzed with the software program PC-Lysis (Becton Dickenson). Background fluorescence from blank wells was subtracted from each reading.

Example 4

[0180] Male athymic Balb/c nu/nu mice were obtained from the Harlan Sprague-Dawley Company at 4-6 weeks of age and were quarantined for at least 2 weeks before the study. Animal experiments were carried out in accordance with both institutional and federal animal care regulations. HCT 116 and HCT 15 CRC cell lines were grown in DMEM supplemented with 10% FBS as described above. Cells were harvested through two consecutive trypsinizations, centrifuged at 300 g for 5 minutes, washed twice, and resuspended in sterile phosphate buffered saline. One ×106 cells in 0.2 ml were injected subcutaneously between the scapula of 7- to 10-week-old male nude mice.

Example 5

[0181] Tumor volumes were estimated weekly by measuring the maximal length, width, and height. Once tumors reached a mean size of 120 to 150 mm3, animals received either weekly i.p. injections of pyrrolidinedithiocarbamate (70 μM) or vitamin E (3 mM), 5-FU (40 mg/kg) or saline, or a combination of pyrrolidinedithiocarbamate or vitamin E and 5-FU or 6 weeks. In cross-over experiments, animals received the above treatments for three weeks (with the exception of vitamin E), and then were crossed-over to either the combination treatment of pyrrolidinedithiocarbamate and 5-FU (saline, pyrrolidinedithiocarbamate or 5-FU alone) or discontinued treatment pyrrolidinedithiocarbamate and 5-FU) for the remaining three weeks of the experiment. In preliminary experiments, a series of single doses of pyrrolidinedithio-carbamate, vitamin E or 5-FU was administered over a 30 day period to establish LD50 and effective route of administration (data not shown). Tumor volumes were recorded weekly until termination of the study.

Example 6

[0182] Tumor tissues were fixed overnight in 4% (v/v) paraformaldehyde and embedded in paraffin according to standard histological procedures. BrDU staining was performed as described [Holmgren, et al., Nature Med. 1, 149 (1955)]. TdT labeling of fragmented DNA (TUNEL) was performed as described. The proliferative index (BrDU) and the apoptotic index (TUNEL) were estimated by the percentage of cells scored under a microscope at 200-fold magnification. The proliferative indices for HCT 116 and HCT 15-derived tumors (irrespective of treatments) were 53.1±5.2 and 63.1±7.2, respectively.

Example 7

[0183] For Western blot analysis, cells were lysed in 50 mM Tris-Cl. pH7.4, 300 mM NaCl, 2 mM EDTA, 0.5% Nonidet-40, 05 mM phenylmethysulfonyl fluoride aprotinin (1 μg/ml), pepstatin (μg/ml), and leupeptin (2 μg/ml). One hundred mg of extract (as determined by Bradford analysis) was applied to 12% SDS-PAGE gels and transferred to 0.2 μM pore nitrocellulose membranes (Schleicher and Schuell). Blots were probed with antibodies raised against p21 WAF1/CIPI, p53, p27 or C/EBPβ (Santa Cruz) at a final concentration of 0.1 μg/ml. After washing, blots were incubated with donkey-anti-rabbit or goat-anti-mouse IgG-horseradish peroxidase conjugates, and developed using Enhanced Chemiluminescence (Amersham, Arlington Heights, Ill.).

Example 8

[0184] RNA was extracted as described [M. Schwab, K. Alitalo, H. E. Varmus, J. M. Bishop, Nature (Lond.) 303, 497 (1983)]. Poly (A)+ mRNA was separated by electrophoresis through 1% (w/v) agaroseformaldehyde gels, and northern blotting was performed as previously described (Coffey, et al., Cancer Res. 47, 4590 (1987)]. A human p21WAF1/CIP1 cDNA probe was provided by B. Vogelstein (John Hopkins Oncology Center, Baltimore, Md.) and labeled with [32P]dCTP by the random primer extension method. Hybridization and post-hybridization washes were carried out at 43° C. IB315 was used as a control for equivalent loading and transfer [P. E. Danielson, et al., DNA 7, 261 (1988)].

Example 9

[0185] The human p21WAF1/CIP1 promoter construct (WWP-luc) was provided by B. Vogelstein [W. El-Deiry, et al., Cell 75, 817 (1993)]. CRC cell lines were grown to 50% confluence prior to transfection with CELLFECTIN per manufacturer's instructions (GIBCO BRL). For all luciferase assays, total DNA transfected was kept constant with addition of pBSKII+or pCMV-basic. All pCMV-C/EBP expression vectors were provided by L. Sealy (Vanderbilt University, TN). pCMV-CAT was transfected as an internal control for gene expression. At 12 hours post-transfection, selected cells were treated with 70 μM pyrrolidinedithiocarbamate. After 24 hours of treatment, cell lysates were prepared and luciferase activity was assayed as described [A. Misra-Press, C. S. Rim, H. Yao, M. S. Roberson, P. J. S. Stork, J Biol. Chem. 270, 14587 (1995)]. Luciferase activity was normalized to CAT activity, and results were reported as fold activation above basal levels.

Example 10

[0186] The 2.4 kilobase pair genomic fragment containing the p21WAF1/CIP1 cDNA start site at its 3′ end was subcloned into the Hind III site of the luciferase reporter vector, pGL2-basic (Promega). p21WAF1/CIP1 deletion mutants (D2198 to D1138) were generated by PCR using internal p21WAF1/CIP1 primers designed against the published p21WAF1/CIP1 promoter sequence (GenBank). In each case, PCR products were subcloned into pGL2-basic and the sequences verified by double-stranded DNA sequencing. Mutagenesis of the NF_IL6 recognition site was performed using the Muta-Gene M13 In vitro mutagenesis kit (Bio-Rad, Hercules, Calif.).

[0187] The presence of the desired TT to AA base pair change was verified by DNA sequencing.

Example 11

[0188] Complementary oligonucleotides corresponding to bases −1884 through −1904 in the wild type and the NF_IL6 mutant p21WAF1/CIP1 promoter sequence were synthesized {wild type: GTACTTAAGAAATATTGAAT (Sequence ID No. 3) and ATTCAATATTTCTTAAGTAC (Sequence ID No. 4); mutant: GTACAAAAGAAATATTGAAT (Sequence ID No. 3) and ATCAATATTTCTTTTGTAC (Sequence ID No. 3)}. Two hundred ng of each oligo was end-labeled with 200 μCi γ-32P-labeled ATP and T4 polynucleotide kinase. The resulting end-labeled oligos were then annealed and gel purified. Preparation of nuclear extract from CRC cells treated with antioxidants and the conditions for electrophoretic shift mobility assays (EMSA) were as described [Kailoff, et al., Science 253, 786 (1991)]. When antisera were added, nuclear extracts and 2 μL of C/EBP α, β, or δ polyclonal antibody (Santa Cruz) were incubated for 10 minutes at room temperature before the addition of the radiolabeled probe.

Example 12

[0189] Two human colorectal cancer cell lines, HCT 116 (wild type p53) and HCT 15 (mutant p53), were treated with increasing amounts of either pyrrolidinedithiocarbamate or vitamin E in a soft agar ex vivo model of tumorigenicity. Both pyrrolidinedithiocarbamate and vitamin E caused a dose-dependent reduction in anchorage-independent growth of HCT 116 and HCT 15 cells (FIG. 1A). This analysis was extended to a variety of tumor cell lines derived from the colon (HCA-7, Difi, RKO, SW620), breast (MCF-7, MDA-MB231), and stomach (Hs 746T). At these concentrations, both antioxidants were effective in inhibiting anchorage-independent growth of all tumor cell lines tested, independent of their p53 status (Difi, RKO, data not shown).

[0190] Treatment of HCT 116 or HCT 15 CRC cells with either pyrrolidinedithiocarbamate (70 μM) or vitamin E (3 mM) for 24 hours, followed by propidium iodide staining of cells and subsequent flow cytometric analysis, revealed that both compounds induced a significant accumulation of cells in the G1 peak, suggesting that the observed growth inhibitory effects of pyrrolidinedithiocarbamate or vitamin E in soft agar were due to cell cycle arrest and/or apoptosis (FIG. 1B). To determine whether these cell cycle perturbations could be correlated with the antioxidant properties of these compounds, both the intracellular redox status (by endogenous H2O2 levels) and the percentage of cells undergoing G1 cell cycle arrest or apoptosis (by flow 25cytrometric analysis) were quantified over a 24 hour period in antioxidant-treated cells.

[0191] As shown in FIG. 1C, both pyrrolidinedithiocarbamate and vitamin E significantly reduced endogenous H2O2 levels in both cell lines, with pyrrolidinedithiocarbamate being the more effective reducing agent. Furthermore, this decrease in H2O2 levels correlated with the induction of G1 cell cycle arrest and the appearance of TUNEL-positive nuclei in these cells. Treatment of HCT 15 cells with the membrane-permeant antioxidant N-acetyl-L-cysteine (NAC) and the dietary antioxidant, vitamin C, showed a similar reduction in H2O2 levels and the induction of apoptosis (FIG. 1D), supporting a role for reactive oxygen species in cell cycle progression. Since antioxidants may alter the intracellular redox milieu through reactive oxygen species other than H2O2, HCT 15 cells were transiently transfected with an expression plasmid encoding human catalase. Overexpression of catalase markedly reduced H2O2 levels and induced cell cycle arrest and apoptosis in these cells, thus directly implicating H2O2 as an important mediator of the observed cell cycle effects in these antioxidant-treated cells.

[0192] To demonstrate further that antioxidants enhance the cytotoxic efficacy of 5-FU and doxorubicin, the IC50 value of each drug was determined for HCT 116 and HCT 15 cells grown in soft agar in the presence or absence of 70 μM pyrrolidinedithiocarbamate or 3 mM vitamin E (the approximate IC50 values for these compounds in both cell lines). Pyrrolidinedithio-carbamate or vitamin E decreased the IC50 for both 5-FU and doxorubicin compared to cells treated with either of the individual drugs alone (FIG. 1E). These effects were more pronounced with pyrrolidinedithiocarbamate, perhaps reflecting its more potent reducing ability. Mechanisms of cellular uptake and metabolism of 5-FU and doxorubicin differ significantly. Thus, it is unlikely that pyrrolidinedithiocarbamate or vitamin E modulate the cytotoxicity of 5-FU or doxorubicin via alterations in these pathways.

Example 13

[0193] The therapeutic efficacy of pyrrolidinedithiocarbamate or vitamin E was next examined in vivo by growing HCT 116 or HCT 15 cells as tumor zenografts in athymic mice. After establishment of palable tumors (mean tumor volume 150 mm3), animals either received weekly i.p. injections of pyrrolidinedithiocarbamate, vitamin E, and/or 5-FU or saline as a negative control. The results with HCT 116 cells are shown in FIG. 2A. After 4 weeks, tumor volumes in control mice necessitated sacrifice in accordance with institutional protocol. Individually, pyrrolidinedithiocarbamate, vitamin E and 5-FU significantly reduced tumor volume over the 6-weeks compared to saline-treated controls. Addition of pyrrolidinedithiocarbamate or vitamin E significantly enhanced the effect of 5-FU. In all nine animals with complete abolishment of tumors, no sign of tumor 25regrowth has been observed following discontinuation of combined treatment for 2 months. Similar results were seen in HCT 15-derived xenografts with the exception that the combination regimens were more effective in these mutant p53 CRC cells.

[0194] To further explore the in vivo efficacy of pyrrolidinedithiocarbamate and 5-FU in established HCT 15-derived tumors, mice were crossed over to combined treatment once significant differences in single agent therapies were established (FIG. 2B). Mice that initially received no treatment developed large tumors (2780+257 mm3) by 3 weeks. Treatment of these mice with 5-FU and pyrrolidinedithiocarbamate at this time reduced the size of even these advanced lesions (week 6: 1184+96 mm3). Cross-over to combined treatment (5-FU and pyrrolidinedithiocarbamate) also reduced tumor size in mice initially treated with a single agent. Tumors decreased in size from 1864+190 mm3 to 660+82 mm3 and 1325+210 mm3 to 637+231 mm3, for animals treated initially with 5-FU and pyrrolidinedithiocarbamate alone, respectively. These results complement the in vitro findings, and indicate that antioxidants can significantly enhance the efficacy of 5-FU in CRC cells.

[0195] No signs of agent-induced toxicity were observed in the mice, as judged by changes in body weight or gross anatomical and microscopic examination of major organs. At necropsy, all tumors exhibit central necrosis grossly, irrespective of tumor size or treatment regimen. Since tumors from mice treated with pyrrolidinedithiocarbamate and 5-FU were no longer present, this treatment group was omitted from these analyses. Immunohistochemical analysis of residual tumors demonstrated a high proliferative index, irrespective of the treatment regimen. However, the apoptotic index increased approximately 5-fold following vitamin E, in both xenograft models (FIG. 2C). In contrast, the apoptotic index of 5-FU-treated tumors was markedly higher in cells expressing wild type p53 (HCT 116) compared to mutant p53 (HCT 15), supporting a role for p53-mediated apoptosis in 5-FU cytotoxicity. Combined vitamin E and 5-FU treatment was able to further increase the apoptotic index in these tumors, even in a mutant p53 genetic background. The apparent synergy between vitamin E and 5-FU-induced apoptosis in mutant p53 HCT 15 cells suggests that antioxidants may re-establish the apoptotic signaling pathway.

Example 14

[0196] Regulation of G1 cell cycle arrest and subsequent apoptosis has been attributed to a number of cellular proteins, including p53 and the cyclin-dependent kinase inhibitors, such as p21WAF1/CIP1 and p27. Pyrrolidinedithiocarbamate had no effect on p53 or p27 protein levels in either HCT 116 or HCT 15 cells over a 24 hour period, as determined by Western blot analysis (FIG. 3A). In contrast, p21WAF1/CIP1 protein and mRNA levels increased within one hour after pyrrolidinedithiocarbamate treatment and persisted for 24 hours (FIG. 1B).

[0197] Induction of p21WAF1/CIP1 mRNA by pyrrolidinedithiocarbamate appeared to be p53 independent, as the antioxidant effect was not attenuated in HCT 116 cells expressing human papillomavirus (HPV) E6, which inactivates p53 through ubiquitin-mediated protein degradation (FIG. 3B) (Scheffner, et al, Proc. Natl. Acad. Sci. U.S.A. 88, 5523 (1991); Crook, et al, Oncogene 6, 873 (1991)). Similar increases in p21 WAFI/CIPI expression were observed in HCT 116 and HCT 15 cells treated with vitamin E.

[0198] To confirm that the induction of p21WAF1/CIP1 by antioxidants was required for these cell cycle disruptions, parental HCT 116 cells or cells were treated with a targeted disruption of p21WAF1/CIP1 by pyrrolidinedithiocarbamate or vitamin E for 24 hours (FIG. 3C). In both cells types, there was a significant attenuation of antioxidant-mediated apoptosis, suggesting that p21WAF1/CIP1 plays a pivotal role in antioxidant-mediated cell death.

Example 15

[0199] To confirm that induction of p21WAF1/CIP1 was dependent on the transcriptional activity of antioxidants, HCT 116 and HCT 15 cells were transfected with a 2.4 kilobase pair fragment of the p21WAF1/CIP1 promoter linked to a luciferase reporter gene. Treatment of transfected cells with pyrrolidinedithiocarbamate led to an approximate five-fold induction of the p21WAF1/CIP1 promoter activity in both HCT 116 and HCT 15 cells, again consistent with a p53-independent induction of p21WAF1/CIP1 mRNA and protein (FIG. 4A). Serial deletions of this promoter demonstrated that the pyrrolidinedithiocarbamate responsive element(s) of the p21WAF1/CIP1 promoter was located between nucleotide-2078 and -1874. Disruption of this site by site-directed mutagenesis abolished pyrrolidinedithiocarbamate induction of luciferase activity, demonstrating that the NF_IL6 site is required for pyrrolidinedithiocarbamate-induced p21WAF1/CIP1 transcription.

[0200] The NF_IL6 consensus sequence is recognized by members of the CCAAT/enhancer binding protein (C/EBP) family of transcription factors (S. Akira and T. Kishimoto, Immunol Rev. 127, 25 (1992); Landschulz et al., Genes Dev. 2 786 (1988); Cao, et al., ibid. 5, 1538 (1991); Chang, et al., Mol. Cell. Biol. 10, 6642 (1990); Williams et al., ibid. 5, 1553 (1991); Akira et al., EMBO. J.9, 1897 (1990); Poli, et al., Cell 63, 25 643 (1990)). These factors contain a basic DNA-binding region adjacent to a leucine zipper (bZIP) dimerization domain facilitating the formation of homodimers or heterodimers with other bZIP proteins. Interestingly, C/EBPα has been shown to transcriptionally upregulate p21WAF1/CIP1 and inhibit cellular proliferation in mouse preadipocytes, although no correlation was shown with apoptosis.

[0201] DNA binding activity to the p21WAF1/CIP1 NF_IL6 site was increased following pyrrolidinedithiocarbamate treatment, as determined by electrophoretic mobility shift assays (EMSA) performed with a 32P-labeled oligonucleotide containing the p21WAF1/CIP1 NF_IL6 cis element and nuclear extracts from HCT 116 and HCT 15 cells treated over a 24 hour period (FIG. 4B: left panel). Shifted complexes were competed by 50-fold molar excess of an unlabeled oligonucleotide containing a consensus NF—l IL6 sequence (right panel: lane 2), but not by an oligonucleotide containing a mutated NF_IL6 consensus sequence (lane 3), indicating that the induced complex was specific for the NF_IL6 cis element. Supershift analysis of the induced complex suggested that shifted complexes were due to the interaction of C/EPBβ (lane 5) with the NF_IL6 cis element and not C/EBP≢ (lane 4) or C/EBPδ (lane 6).

[0202] To confirm that C/EBPβ could influence p21WAF1/CIP1 transcriptional activity, a eukaryotic expression plasmid encoding C/EBPα,β or δ was contransfected into either HCT 116 or HCT 15 cells with the full length p21WAF1/CIP1 luciferase promoter construct (FIG. 4C and 4D). Transfection of C/EBPβ strongly activated p21WAF1/CIP1 promoter activity in a dose-dependent manner, and mutation of the NF_IL6 site abolished this stimulation. In contrast, C/EBPα or C/EBPδ failed to stimulate p21 promoter activity.

[0203] Finally, the functional role of C/EBPβ was examined in the apoptotic signaling pathway by generating lines of HCT 15 cells that were stably transfected with the human C/EBPβ cDNA, in both the sense and antisense orientation, under the control of an ecdysone inducible promoter. To avoid the possibility that constitutively expressed C/EBPβ might induce cell death, and ecdysone (muristerone A)-inducible expression system (Invitrogen, Carlsbad, Calif.) was used. Human C/EBPβ cDNA was subcloned into pIND at convenient enzyme cleavage ites. Constructs, containing sense and antisense C/EBPβ sequences were verified by double-stranded DNA sequencing. Before transfection, pIND-C/EBPβ constructs were linearized with Pme I and purified. HCT 15 cells were transfected with 5 μg of pVgRXR (Invitrogen) and 10 μg of pIND-C/EBPβ using CELLFECTIN according to manufacture's instructions. After 24 hours, cells were shifted to medium supplemented with 1 mg/ml Geneticin and 10 mg/ml puromycin (GIBCO BRL) to select for transfectant clones. After 2 weeks, antibiotic-resistant cells were subcloned by limiting dilution. The expression of C/EBPβ protein and the subsequent induction of p21WAF1/CIP1 was determined following induction with 10 μM muristerone A for 24 hours and Western blot analysis. Three independent positive clones were used for all assays with essentially the same results.

[0204] Representative data from clones derived from each of these cell lines is shown in FIG. 4E and 4F. C/EBPβ overexpression elevated p21WAF1/CIP1 protein levels compared to unstimulated basal levels (FIG. 4E: inset). Induction of C/EBPβ also led to an increase in the apoptotic index of these cells in both the presence and absence of antioxidant. In addition, repression of C/EBPβ expression by antisense MRNA induction nearly abolished antioxidant-induced apoptosis in these cells (FIG. 4E). Further evidence that induction of C/EBPβ mediates the effects of antioxidants on colorectal cancer cells was demonstrated by the increased apoptotic index in response to either 5-FU or doxorubicin in the presence of over-expressed C/EBPβ (FIG. 4F). In the absence of C/EBPβ overexpression, 5-FU increased the apoptotic index to 20% whereas doxorubicin did not induce apoptosis. When these cells were induced to overexpress C/EBPβ in the presence of either 5-FU or doxorubicin, apoptosis was increased to 70% and 80%, respectively. Taken together, these data demonstrate that the induction of apoptosis by antioxidants is, at least in part, mediated by a p53-independent induction of p21WAF1/CIP1 via activation of the transcription factor C/EBPβ.

[0205] Another transcription factor, NF-kB, has been shown to confer resistance to TNFα-mediated apoptosis, although a recent report has shown that induction of NF-kB DNA binding activity in kidney epithelial cells precedes apoptosis following serum-withdrawal. NF-kB activity can be downregulated by pyrrolidinedithiocarbamate through inhibition of the phosphorylation and subsequent proteasome-mediated proteolysis of its inhibitors (IkBs). No reduction in NF-kB DNA binding activity was detected in these CRC cells at the doses of pyrrolidinedithiocarbamate used in these studies. In addition, it has recently been demonstrated that induction of p21WAF1/CIP1 can increase NF-kB transcriptional activity, therefore it is unlikely that the antioxidant effect in these cells is mediated by a reduction in NF-kB activity. These studies demonstrate that induction of a transcription factor, C/EBPβ, sensitizes CRC cells to chemotherapeutic agent-mediated apoptosis.

[0206] Activation of C/EBPβ, either directly or indirectly, induced p21WAF1/CIP1 gene expression, leading to G1 cell cycle arrest and apoptosis in two colorectal cancer cell lines. The ability of the antioxidants pyrrolidinedithiocarbamate and vitamin E to induce this transcription factor, independent of functional p53, has important biological consequences on the efficiency of DNA damaging agents. Both 5-FU and doxorubicin exert their cytotoxic effects mainly through the induction of DNA damage. This damage, through undefined mechanism(s), signals the induction of p53, which, in turn, leads to inhibition of cellular proliferation and apoptosis. Since mutations of p53 occur in over 80% of advanced CRC tumors, these mutations may be responsible for the relatively low response rate of advanced colorectal cancer tumors to DNA-damaging agents, such as 5-FU. Although 5-FU is particularly successful in the treatment of local, wild type p53, colorectal cancer tumors, the success rate falls to 15-20% in patients with advanced, frequently mutant p53-containing colorectal cancer tumors. Thus, the ability of antioxidants (used throughout these studies at doses obtainable in humans) to bypass the requirement of p53-mediated apoptosis demonstrates the utility of combined antioxidants and chemotherapeutic agents for advanced colorectal cancer and other solid tumors.

Example 16

[0207]

FIGS. 5

a
and 5b are bar graphs of the BrDU-labeled cells (percent of total cell nuclei) from colorectal cell xenografts derived from athymic mice treated with saline, vitamin E, PDTC, 5-FU, and the combination of vitamin E and 5-FU, as a measure of the effect of the test compound on proliferation of HCT 116 and HCT 15 cells. FIGS. 6a and 6b are bar chart graphs of TUNEL-positive cells (percent of total cell nuclei) also from xenografts derived from athymic mice treated with saline, vitamin E, PDTC, 5-FU, and the combination of vitamin E and 5-FU, as a measure of the effect of the test compound on apoptosis. Tumor tissues were fixed overnight in 4% (v/v) paraformaldehyde and embedded in paraffin according to standard histological procedures. Sections were pretreated with 10 mM citrate buffer (pH 6.0) and incubated with PC10 monoclonal antibody against BrDU (Boehringer Mannheim). TdT labeling of fragmented DNA (TUNEL) was performed according to manufacturer's instructions. The proliferative index (BrDU) and the apoptotic index (TUNEL) were estimated by the precentage of cells scored under a microscope at 200-fold magnification.

Example 17

[0208] As indicated in FIG. 7, PDTC treatment induces C/EBPβ DNA binding activity via a post-translational modification. (A) DKO-1 cell were treated with 70 μM PDTC for the indicated times, nuclear extracts were prepared with a [γ-32P]-labeled p21-NF_IL6 oligonucleotide (Lanes 1-9). Specificity assays: Lanes 10-12, competition controls were performed on a nuclear extract derived from DKO-1 cells treated with PDTC for 3 h (lane 5), with excess unlabeled wild-type (lane 11) and mutant (lane 12) oligonucleotide. Lanes 13-15, supershift analyses were performed with C/EBPα (lane 13), β (lane 14), or δ (lane 15) polyclonal antibodies. (B) Parallel DKO-1 cell cultures were treated with PDTC (70 μM) for the indicated times. Poly(A) was isolated and treatment-related variations in C/EBPβ mRNA levels were evaluated by Northern blot analysis. IB15 is shown as a control for equivalent loading and transfer. (C) Parallel DKO-1 cultures were treated with PDTC (70 μM) in the presence of [32P]orthophosphate. C/EBPβ from cytosolic and nuclear fractions were purified by immunoprecipitation from cells before (time 0) or at the indicated times after PDTC treatment. Treatment-related variations in the localization of C/EBPβ were analyzed by SDS-PAGE followed by autoradiography or Western blot analysis (100 μg of total cellular protein/lane). (D) DKO-1 cells were cultured in the presence of PDTC (70 μM) for 1 hour and then processed for immunocytochemistry to detect treatment-related differences in the compartmentalization of C/EBPβ protein. In all experiments, parallel cultures treated with preimmune sera or primary anti-C/EBPβ antisera that had been preincubated with in vitro translated C/EBPβ protein demonstrated no fluorescent signal after treatment with the secondary Cy3-conjugated antibody. Representative photomicrographs show anti-C/EBPβ stained cells before and after PDTC treatment.

Example 18

[0209]
FIG. 8 illustrates the effect of PDTC on endogenous cAMP levels and PKA activity. DKO-1 cells were treated with 70 μM PDTC for the indicated times. Cell lysates were prepared and assayed for (A) endogenous cAMP levels or (B) PKA activity (see Experimental Procedures). The values are expressed as pmol mean per μg protein+s.e.m. and are representative of three experiments carried out in quadruplicate.

Example 19

[0210]
FIG. 9 illustrates that PDTC phosphorylates C/EBPβ at Ser299. (A) Endogenous C/EBPβ from [32P]orthophosphate-labeled DKO-1 cells (2 mCi/ml. 3 h) that were treated with either 0 μM (lane 1), 70 μM PDTC (lane 2) or 50 μM forskolin were immunoprecipitated with anti C/EBPβ antibodies. Labeled proteins were visualized by SDS-PAGE followed by autoradiography. (B) Tryptic phosphopeptide maps of in vivo labeled epitope-tagged C/EBPβ. Wild type (WT) and mutant (Ala299) C/EBPβ, immunoprecipitated from PDTC treated or untreated DKO-1 cells with the antibody to the FLAG-epitope, were digested with trypsin and the phosphopeptides separated by electrophoresis and thin-layer chromatography and visualized by autoradiography, X1,2 were constitutively phosphorylated. The level of phosphopeptide X3 was increased after PDTC treatment in cells transfected with the wild type, but not mutant, protein. The circle indicates the origin. (C) Comparison of the in vivo phosphorylation of wild type and Ala substitution mutants of C/EBPβ, from untreated cells and cells treated with PDTC. Autoradiography (top) and C/EBPβ immunoblot (bottom) are shown. (D) Phosphorylation of Ser299 within C/EBPβ is essential for protein translocation to the nucleus. DKO-1 cells were transfected with pCMV-C/EBPβ, (WT) or pCMV-C/EBPβ (Ala299), and treated with PDTC for 3 hours. C/EBPβ protein was visualized by immunocytochemistry as described in Experimental Procedures.

Example 20

[0211]
FIG. 10 illustrates that PKA phosphorylation of C/EBPβ, is required for nuclear translocation. (A) Parallel DKO-1 cell cultures were treated with PDTC (0 or 70 μM) for 3 hours. Poly(A)+ mRNA and protein were isolated from each group and treatment-related variations in C/EBPβ mRNA and protein levels were evaluated by Northern or Western blot analysis. IB315 is shown as a control for equivalent loading and transfer. (B) DKO-l cells were treated with PDTC (0 or 70 μM) or PDTC and mPKI (myristylated protein kinase A inhibitor; 1 μM) for 3 hours. Cells were fixed with paraformaldehyde and C/EBPβ, protein visualized by immunofluorescence staining. Treatment of cells with mPKI alone failed to induce nuclear translocation of C/EBPβ, (data not shown).

Example 21

[0212]
FIG. 11 illustrates that carboxymethylation of the catalytic subunit of PP2Ac is inhibited by PDTC. DKO-1 cells were incubated in serum-containing media containing [methyl-3H]S-adenosyl methionine and/or 70 μM PDTC for three hours. Cytosolic or nuclear fractions were prepared and C/EBPβ immunoprecipitated using standard methods. Antibody/antigen complexes were resolved by SDS-PAGE and the presence of PP2Ac was detected by fluorography (overnight). PDTC inhibited carboxymethylation of PP2A subunit in nuclear fractions, and to a lesser extent, in cytosolic fractions.

Example 22

[0213]
FIG. 12 illustrates that PDTC inhibits methyltransferase activation of PP2Ac. PP2A (a and c dimer) was incubated in the presence of [methyl-3H]S-adenosyl methionine, increasing concentrations of PDTC and partially purified rat methyltransferase for thirty minutes at 37 degrees C. The reaction was terminated by the addition of SDS-sample buffer. Samples were resolved by SDS-PAGE and the presence of methylated PP2A catalytic subunit visualized by fluorography. PDTC selectively inhibits the ability of methyltransferase to carboxylate the catalytic subunit of PP2A in a dose dependent manner.

Example 23

[0214] To demonstrate a specific and direct inhibitory effect of PDTC on PP2A activity, DKO-1 cells were initially treated with 17 μM PDTC for three hours. Cell lysates were prepared and treated with the following reagents in the presence of phosphorylated C/EBPβ in which the phosphate is radiolabeled, for ten minutes at 37 degrees C: I2 (a selective PP1 inhibitor), okadaic acid (a selective inhibitor of PP2A and PP1), PDTC, I2 and PDTC, and okadaic acid and PDTC. As shown in FIG. 13, PDTC inhibited phosphatase activity in the DKO-1 extract, resulting in maintenance of the C/EBPβ in its phosphorylated state. This effect is reversible following removal of the antioxidant. This result is consistent with PDTC inhibition of the PP2A phosphatase. In contrast, a PP1 phosphastase specific inhibitor, I2, failed to protect C/EBPβ from dephosphorylation under the same conditions. As expected, the nonspecific phosphatase inhibitor okadaic acid inhibited all DKO-1 phosphatase activity, thus protecting the C/EBPβ from dephosphorylation. These results demonstrate that antioxidants such as PDTC are specific inhibitors of a class of phosphatases, such as PP2A, that are involved in the dephosphorylation of C/EBPβ.

Example 24

[0215] The effect of PDTC on cellular proliferation or apoptosis was evaluated in a number of normal and cancer cell lines. The IC50 was measured as the concentration of PDTC that inhibited cellular proliferation. The results are provided in Table 1. As indicated, PDTC did not inhibit the cell growth of normal cells, but did substantially inhibit the growth of breast carcinoma cells, gastric carcinoma cells, osteosarcoma cells and pancreatic carcinoma cells.

1TABLE 1Effect of PDTC on Cell Proliferation (IC50 required to inhibit cellularproliferation or induce apoptosis)IC50Normal cellsKeratinocytes600 μMPrimary colonocytes500 μMPrimary mammary epithelia650 μMNon-transformed rat intestinal epithelial cells450 μMBreast carcinoma cellsMCF-7 13 μMMCF-10WT 5 μMMCF-10HRas 5 μMMDA-MB231 10 μMMDA MB-468 20 μMGastric carcinoma cellsHs746T 35 μMN-87 40 μMOsteosarcomaSaos-2 10 μMPancreatic carcinoma cellsAsPo1 70 μMPANC-1 75 μMBxPc3100 μM

Example 25

[0216] To evaluate whether antioxidants induce apoptosis in normal cells, normal and cancerous cells were incubated with 70 μM PDTC for 24 hours and DNA fragmentation assessed as a percentage of a control. As indicated in Tables 2 and 3, the normal cell line (primary colonocytes) did not exhibit significant DNA fragmentation after 24 hours of exposure to PDTC, whereas cancerous cells (Wild type p53 HCA-7, HCT 116, mutant p53 HCT 15, DLD-1, and DKO-3 cells) exhibited substantial DNA fragmentation.

2TABLE 2PDTC Induces Apoptosis in CRC Cells but not Normal Cells in vitro (I)DNA Fragmentation after PDTCTreatment (70 μM) (% Control)Cell Type3 h6 h12 h24 hPrimary Colonocytes101 ± 10109 ± 9 107 ± 10130 ± 16Wild Type p53 HCA-7111 ± 13126 ± 17154 ± 19302 ± 35HCT 116108 ± 11131 ± 21198 ± 23367 ± 49bold values: significantly different from untreated cells (P < 0.01), as determined by AOVA

[0217]

3

TABLE 3

PDTC Induces Apoptosis in CRC Cells but not Normal Cells in vitro (II)

DNA Fragmentation after PDTC

Treatment (70 μM) (% Control)

Cell Type
3 h
6 h
12 h
24 h

Primary Colonocytes
101 ± 10
109 ± 9
107 ± 10
130 ± 16

Mutant p53 HCT 15
145 ± 12
259 ± 18
673 ± 34
979 ± 34

DLD-1
213 ± 17
296 ± 21
712 ± 34
876 ± 46

DKO-3
223 ± 11
478 ± 16
896 ± 23
1116 ± 54

bold values: significantly different from untreated cells (P < 0.01), as determined by AOVA

Example 26

[0218] As indicated in Tables 4 and 5, PDTC substantially reduces the toxicity of 5-FU in the murine small intestine and the murine colon. These results indicate that PDTC not only increases the cytotoxic effect of antineoplastic agents, it at the same time has a palliative effect on normal cells that are exposed to cytotoxic agents.

Example 27

[0219] Isolation of C/EBPβ,/PP2A methyltransferase complex

[0220] A novel multicomponent complex consisting of C/EBPβ, PP2A and methyltransferase was isolated and initially characterized. This complex appears to play an important role in the regulation of PP2A and downstream transcriptional events including, but not limited to, cell division and apoptosis.

[0221] Co-immunoprecipitation techniques demonstrate for the first time that the transcriptional factor C/EBPβ is complexed with the PP2Ac protein phosphatase. This novel complex appears to play an important role mechanistically in the control of the phosphorylation status of C/EBPβ by PP2A.

[0222] Additionally, the C/EBPβ/PP2Ac complex has also been shown to consist of the methyltransferase which carboxymethylates the catalytic subunit of C/EBPβ. Rat brain soluble extracts were fractionated by phenyl-Sepharose and analyzed for methyltransferase activity using exogenous PP2A heterodiver (AC complex). The peak of methyltransferase activity was further fractionated by Source Q (strong anion exchange), and gel filtration chromatography. The partially purified methyltransferase in FIG. 14 represents the peak methyltransferase activity from the gel filtration column. This peak fraction of methylase activity is taken further to DEAE (weak anion exchange) and MonoQ (a different strong anion exchange resin) columns. Both C/EBPβ and PP2A are detectable following these additional steps. Rat brain extracts are shown as a positive control (C/EBPβ and PP2Ac migrate at approximately 45 and 36 kDa on SDS-PAGE).

[0223] Modifications and variations of the present invention will be obvious to those skilled in the art from the foregoing detailed description. Such modifications and variations are intended to come within the scope of the appended claims.

	Number	Date	Country
Parent	09108609	Jul 1998	US
Child	09779086	Feb 2001	US
Parent	08967492	Nov 1997	US
Child	09108609	Jul 1998	US

	Number	Date	Country
Parent	08886653	Jul 1997	US
Child	08967492	Nov 1997	US

Antioxidant enhancement of therapy for hyperproliferative conditions

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