Patent Application
20220218725
This document relates to methods and materials involved in treating cancer. For example, this document provides methods and materials for using one or more inhibitors of a chromosomal maintenance 1 (CRM1) polypeptide in combination with one or more salicylates to treat cancer in a mammal (e.g., a human).
Cancer cells can use nucleo-cytoplasmic trafficking of macromolecules to sustain proliferation and survival. Chromosome region maintenance 1 (CRM1), also known as Exportin-1 (XPO1), is a transport receptor that mediates nuclear efflux of proteins having a leucine-rich nuclear export sequence (NES). Tumors with increased expression of CRM1 polypeptides can export tumor suppressive polypeptides out of the nucleus to the cytoplasm and thus can disable the cells' tumor suppressor activities. Therefore, drugs that target CRM1 polypeptides have become attractive as a therapeutic option for cancer, and selinexor (KPT-330) has been used in phase 1, 2 and 3 clinical trials in patients with multiple myeloma (MM) and non-Hodgkin lymphoma (NHL). Although selinexor has shown promising antitumor effects at high concentrations, the drug related adverse effects hinder its potential in becoming a potent anticancer drug in patients with hematologic malignancies.
This document provides methods and materials involved in treating cancer. For example, one or more inhibitors of a CRM1 polypeptide in combination with one or more salicylates can be used as described herein to treat cancer in a mammal (e.g., a human). In some cases, an inhibitor of a CRM1 polypeptide can be administered to a mammal (e.g., a human) having a cancer in a low concentration (e.g., a low dose). A low concentration of an inhibitor of a CRM1 polypeptide (e.g., selinexor) refers to any concentration of an inhibitor of a CRM1 polypeptide that is less than about 160 mg/week (e.g., about 80 mg twice weekly), less than about 45 mg/m2 body area twice weekly, or less than about 1.25 μM plasma concentration.
As demonstrated herein, antitumor effects of low concentrations of an inhibitor of a CRM1 polypeptide (e.g., selinexor and leptomycin B) can be enhanced when the inhibitor of a CRM1 polypeptide is administered in combination with one or more salicylates (e.g., aspirin, choline salicylate, and/or sodium salicylate). Having the ability to treat a mammal (e.g., a human) having cancer with one or more inhibitors of a CRM1 polypeptide in combination with one or more salicylates provides an opportunity for the mammal to benefit from the antitumor effects of the inhibitor(s) of a CRM1 polypeptide without experiencing drug related adverse effects. For example, using one or more inhibitors of a CRM1 polypeptide in combination with one or more salicylates can allow the inhibitor(s) of a CRM1 polypeptide to be administered to a mammal (e.g., a human) having cancer at lower concentrations, making inhibitor(s) of a CRM1 polypeptide more tolerable and appealing option for treating a mammal having cancer.
In general, one aspect of this document features methods for treating a mammal having cancer. The methods can include, or consist essentially of, administering (a) an inhibitor of a chromosomal maintenance 1 (CRM1) polypeptide and (b) a salicylate to the mammal to reduce the number of cancer cells in the mammal. The mammal can be a human.
The cancer can be a hematologic cancer. The cancer can be diffuse large B-cell lymphoma (DLBCL), a T-cell lymphoma (TCL), a mantle cell lymphoma (MCL), a non-Hodgkin lymphoma (NHL), multiple myeloma (MM), Hodgkin lymphoma, small lymphocytic lymphoma, lymphoplasmacytic lymphoma, chronic lymphocytic leukemia, chronic lymphocytic leukemia, acute myelogenous leukemia, chronic myelogenous leukemia, myeloproliferative syndromes, or myelodysplastic syndromes. The inhibitor of a CRM1 polypeptide can be selinexor, leptomycin B, KPT-185, KPT-276, eltanexor, piperlongumine, verdinexor, valtrate, or ratjadone C. The inhibitor of a CRM1 polypeptide can result in a plasma concentration within the mammal of from about 0.01 nM to about 1.25 μM (e.g., from about 0.25 μM to about 1.24 μM). The salicylate can be aspirin, choline salicylate, sodium salicylate, acetyl salicylate, or choline magnesium trisalicylate. The salicylate can result in a plasma concentration within the mammal of from about 0.1 μM to about 10 mM.
In another aspect, this document features methods for treating a mammal having cancer. The methods can include, or consist essentially of, administering (a) an inhibitor of a CRM1 polypeptide and (b) a salicylate to the mammal to arrest the cell cycle of a cancer cell in the mammal. The cell cycle can be arrested at a S phase. The mammal can be a human. The cancer can be a hematologic cancer. The cancer can be diffuse large B-cell lymphoma (DLBCL), a T-cell lymphoma (TCL), a mantle cell lymphoma (MCL), a non-Hodgkin lymphoma (NHL), multiple myeloma (MM), Hodgkin lymphoma, small lymphocytic lymphoma, lymphoplasmacytic lymphoma, chronic lymphocytic leukemia, chronic lymphocytic leukemia, acute myelogenous leukemia, chronic myelogenous leukemia, myeloproliferative syndromes, or myelodysplastic syndromes. The inhibitor of a CRM1 polypeptide can be selinexor, leptomycin B, KPT-185, KPT-276, eltanexor, piperlongumine, verdinexor, valtrate, or ratjadone C. The inhibitor of a CRM1 polypeptide can result in a plasma concentration within the mammal of from about 0.01 nM to about 1.25 μM (e.g., from about 0.25 μM to about 1.24 μM). The salicylate can be aspirin, choline salicylate, sodium salicylate, acetyl salicylate, or choline magnesium trisalicylate. The salicylate can result in a plasma concentration within the mammal of from about 0.1 μM to about 10 mM.
In another aspect, this document features methods for treating a mammal having a viral infection. The methods can include, or consist essentially of, administering (a) an inhibitor of a chromosomal maintenance 1 (CRM1) polypeptide and (b) a salicylate to the mammal to reduce the number of viral particles in the mammal. The mammal can be a human. The viral infection can be caused by a coronavirus. The coronavirus can be a betacoronavirus. The virus can be SARS-CoV-2. The inhibitor of a CRM1 polypeptide can be selinexor, leptomycin B, KPT-185, KPT-276, eltanexor, piperlongumine, verdinexor, valtrate, or ratjadone C. The inhibitor of a CRM1 polypeptide can result in a plasma concentration within the mammal of from about 0.01 nM to about 1.25 μM. The salicylate can be aspirin, choline salicylate, sodium salicylate, acetyl salicylate, or choline magnesium trisalicylate.
Unless otherwise defined, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this invention pertains. Although methods and materials similar or equivalent to those described herein can be used to practice the invention, suitable methods and materials are described below. All publications, patent applications, patents, and other references mentioned herein are incorporated by reference in their entirety. In case of conflict, the present specification, including definitions, will control. In addition, the materials, methods, and examples are illustrative only and not intended to be limiting.
The details of one or more embodiments of the invention are set forth in the accompanying drawings and the description below. Other features, objects, and advantages of the invention will be apparent from the description and drawings, and from the claims.
This document provides methods and materials involved in treating cancer. For example, one or more inhibitors of a CRM1 polypeptide and one or more salicylates (e.g., a composition including one or more inhibitors of a CRM1 polypeptide and one or more salicylates) can be administered to a mammal (e.g., a human) having cancer to treat the mammal. In some cases, one or more inhibitors of a CRM1 polypeptide and one or more salicylates can be administered to a mammal having cancer to reduce the severity of the cancer, to reduce one or more symptoms of the cancer, and/or to reduce the number of cancer cells present within the mammal. For example, one or more inhibitors of a CRM1 polypeptide and one or more salicylates can be administered to a mammal having cancer to reduce one or more symptoms of the cancer by, for example, 10, 20, 30, 40, 50, 60, 70, 80, 90, 95, or more percent. For example, one or more inhibitors of a CRM1 polypeptide and one or more salicylates can be administered to a mammal having cancer to reduce the number of cancer cells present within the mammal by, for example, 10, 20, 30, 40, 50, 60, 70, 80, 90, 95, or more percent.
Alternatively, the methods and materials described herein can be used for treating having, or at risk of developing, a viral infection (e.g., a coronavirus infection) and/or bacterial infection. In some cases, one or more inhibitors of a CRM1 polypeptide and one or more salicylates can be administered to a mammal having, or at risk of developing, a viral infection (e.g., a coronavirus infection) to reduce the number of viral particles within the mammal by, for example, 10, 20, 30, 40, 50, 60, 70, 80, 90, 95, or more percent. In some cases, one or more inhibitors of a CRM1 polypeptide and one or more salicylates can be administered to a mammal having, or at risk of developing, a viral infection (e.g., a coronavirus infection) and/or bacterial infection to reduce one or more symptoms of the viral infection and/or the bacterial infection by, for example, 10, 20, 30, 40, 50, 60, 70, 80, 90, 95, or more percent. In some cases, one or more inhibitors of a CRM1 polypeptide and one or more salicylates can be administered to a mammal having, or at risk of developing, a viral infection (e.g., a coronavirus infection) to reduce viral shedding by the mammal by, for example, 10, 20, 30, 40, 50, 60, 70, 80, 90, 95, or more percent.
Alternatively, the methods and materials described herein can be used for treating having a disease or disorder associated with inflammation (e.g., associated with a pro-inflammatory state). Examples of diseases and disorders associated with inflammation include, without limitation, acute respiratory distress syndrome (ARDS), infections (e.g., viral infections), and autoimmune conditions such as but not limited to rheumatoid arthritis, inflammatory bowel disease, multiple sclerosis, myasthenia gravis and autoimmune cytopenia. In some cases, one or more inhibitors of a CRM1 polypeptide and one or more salicylates can be administered to a mammal having disease or disorder associated with inflammation to reduce the inflammation within the mammal by, for example, 10, 20, 30, 40, 50, 60, 70, 80, 90, 95, or more percent. In some cases, one or more inhibitors of a CRM1 polypeptide and one or more salicylates can be administered to a mammal having disease or disorder associated with inflammation to reduce a level of one or more pro-inflammatory cytokines within the mammal by, for example, 10, 20, 30, 40, 50, 60, 70, 80, 90, 95, or more percent.
In some cases, an inhibitor of a CRM1 polypeptide can be administered to a mammal (e.g., a human) having a cancer in a low concentration (e.g., a low dose). A low concentration of an inhibitor of a CRM1 polypeptide can refer to any concentration of an inhibitor of a CRM1 polypeptide that is less than about 160 mg/week (e.g., about 80 mg twice weekly). A low concentration of an inhibitor of a CRM1 polypeptide (e.g., selinexor) can refer to any concentration of an inhibitor of a CRM1 polypeptide that is less than about 45 mg/m2 body area twice weekly. A low concentration of an inhibitor of a CRM1 polypeptide (e.g., selinexor) can refer to any concentration of an inhibitor of a CRM1 polypeptide that is less than about 1.25 μM (e.g., less than about 1.24 μM) plasma concentration. In some cases, a low concentration of an inhibitor of a CRM1 polypeptide (e.g., selinexor) that can be used as described herein can be from about 0.00001 μM (0.01 nM) to about 1 μM plasma concentration (e.g., from about 0.01 nM to about 0.75 μM, from about 0.01 nM to about 0.5 μM, from about 0.01 nM to about 0.25 μM, from about 0.01 nM to about 1 μM, from about 0.01 nM to about 0.5 μM, from about 0.05 nM to about 1 μM, from about 1 nM to about 1 μM, from about 0.1 μM to about 1 μM, from about 1 μM to about 1 μM, from about 0.25 μM to about 1 μM, from about 0.5 μM to about 1 μM, from about 0.75 μM to about 1 μM, from about 0.1 μM to about 0.8 μM, from about 0.25 μM to about 0.75 μM, from about 0.25 μM to about 0.5 μM, from about 0.25 μM to about 0.3 μM, from about 0.3 μM to about 1 μM, from about 0.4 μM to about 1 μM, from about 0.5 μM to about 1 μM, from about 0.7 μM to about 1 μM, or from about 0.4 μM to about 0.8 μM plasma concentration). For example, when an inhibitor of a CRM1 polypeptide is selinexor, a low concentration selinexor can be from about 0.25 μM to about 1.24 μM.
Any appropriate mammal having cancer and/or having, or at risk of developing, a viral infection (e.g., a coronavirus infection) and/or bacterial infection can be treated as described herein. For example, humans and other primates such as monkeys having cancer and/or having, or at risk of developing, a viral infection (e.g., a coronavirus infection) and/or bacterial infection can be treated with one or more inhibitors of a CRM1 polypeptide and one or more salicylates. In some cases, dogs, cats, horses, cows, pigs, sheep, mice, and rats having cancer and/or having, or at risk of developing, a viral infection (e.g., a coronavirus infection) and/or bacterial infection can be treated with one or more inhibitors of a CRM1 polypeptide and one or more salicylates as described herein.
When treating a mammal (e.g., a human) having a cancer as described herein, the cancer can be any appropriate cancer. In some cases, a cancer can include one or more solid tumors. In some cases, a cancer can be a hematologic cancer. Examples of cancers that can be treated as described herein include, without limitation, diffuse large B-cell lymphomas (DLBCLs), T-cell lymphomas (TCLs; e.g., mycosis fungoides), mantle cell lymphomas (MCLs), NHLs, plasmacytomas, Hodgkin lymphomas, MM, lymphoplasmacytic lymphomas, sarcomas (e.g., synovial sarcomas and liposarcomas), small lymphocytic lymphomas, chronic lymphocytic leukemias, acute myelogenous leukemias (AMLs), chronic myelogenous leukemias, myeloproliferative syndromes, myelodysplastic syndromes, splenic marginal zone lymphomas, MALT lymphomas, acute lymphoblastic leukemias (ALLs), chronic myelomonocytic leukemias, plasmacytic leukemias, NK cell leukemias, monoclonal gammopathies of undetermined significance, monoclonal b cell lymphocytoses, LGL leukemias, neutrophilic leukemias, myelofibrosis, polycythemia veras, myeloproliferative syndromes (e.g., essential thrombocythemias), dendritic cell cancers, histiocytic neoplasms (e.g., Langerhans cell histiocytosis), myelodysplastic syndromes (e.g., Erdheim Chester disease and Rosai-Dorfman diseas), CNS lymphomas, Bing Neel syndromes, head and neck cancers, lung cancers, breast cancers, pancreatic cancers, esophageal cancers, gastric cancers, small intestinal cancers, colon cancers, rectal cancers, anal cancers, melanomas (e.g., mucosal melanomas), skin cancers (e.g., squamous cell carcinomas and basal cell carcinomas), sarcomas, lipomas, liposarcomas, brain cancers (e.g., oligodendrogliomas, glioblastoma multiformes, and meningiomas), ovarian cancers, fallopian tube cancers, uterine cancers, cervical cancers, vaginal cancers, kidney cancers, prostate cancers, penile cancers, testicular cancers, leydig cell cancers, hepatocellular carcinomas, gallbladder cancers, biliary duct system cancers, heart cancers (e.g., angiosarcoma, and myxoma, rhabdomyosarcoma, mesothelioma, leiomyosarcoma, angiosarcoma, and angiomyolipoma), connective tissue cancers, thyroid cancers, parathyroid cancers, pituitary gland cancers, adrenal gland cancers, neuroendocrine cancers, carcinoid cancers, pheochromocytoma, insulinoma, gastrinoma, neuroblastoma, endocrine gland cancers, and exocrine gland cancers.
Any appropriate method can be used to identify a mammal (e.g., a human) having cancer. For example, imaging techniques and/or biopsy techniques can be used to identify mammals (e.g., humans) having cancer.
Once identified as having a cancer, a mammal (e.g., a human) can be administered, or instructed to self-administer, one or more inhibitors of a CRM1 polypeptide and one or more salicylates.
When treating a mammal (e.g., a human) having, or at risk of developing, a viral infection (e.g., a coronavirus infection) as described herein, the viral infection can be caused by any type of virus. In some cases, a virus whose infections can be treated as described herein can be a coronavirus (e.g., a beta-coronavirus). Examples of viruses whose infections can be treated as described herein include, without limitation, SARS-CoV, HCoV NL63, HKU1, MERS-CoV, SARS-CoV-2, influenza viruses (e.g., influenza A, influenza B, influenza C, and influenza D), respiratory syncytial viruses (RSV), human immunodeficiency viruses (HIV), and those described in Table 3-1 of “Learning from SARS: Preparing for the Next Disease Outbreak: Workshop Summary.” Institute of Medicine (US) Forum on Microbial Threats; Knobler S, Mahmoud A, Lemon S, et al., editors. Washington (DC): National Academies Press (US); 2004.
Any appropriate method can be used to identify a mammal as having, or as being at risk of developing, a viral infection (e.g., a coronavirus infection) (and/or a bacterial infection). In some cases, the presence or absence of nucleic acid from a viral genome (e.g., a coronavirus genome) in a sample obtained from a mammal can be used to identify the mammal as having, or as being at risk of developing, a viral infection. For example, the presence of nucleic acid from a viral genome in a sample obtained from a mammal can indicate that the mammal has, or is at risk of developing, a viral infection. In some cases, the presence or absence of one or more polypeptides encoded by nucleic acid in a viral genome (e.g., a coronavirus genome) in a sample obtained from a mammal can be used to identify the mammal as having, or as being at risk of developing, a viral infection. For example, the presence of one or more polypeptides encoded by nucleic acid from a viral genome in a sample obtained from a mammal can indicate that the mammal has, or is at risk of developing, a viral infection. Any appropriate sample can be used to detect the presence or absence of nucleic acid in a viral genome and/or the presence or absence of one or more polypeptides encoded by nucleic acid in a viral genome. In some cases, a sample can be a biological sample. In some cases, a sample can contain one or more cells. In some cases, a sample can contain one or more biological molecules (e.g., nucleic acids such as DNA and RNA, polypeptides, carbohydrates, lipids, hormones, and/or metabolites). Examples of samples that can be obtained from a mammal and can be used to detect the presence or absence of nucleic acid in a coronavirus genome and/or the presence or absence of one or more polypeptides encoded by nucleic acid in a coronavirus genome as described herein include, without limitation, tissue samples (e.g., lung tissues such as those obtained by biopsy), fluid samples (e.g., whole blood, serum, plasma, urine, and saliva), and cellular samples (e.g., nasopharyngeal samples, and buccal samples). A sample can be a fresh sample or a fixed sample (e.g., a formaldehyde-fixed sample or a formalin-fixed sample). In some cases, a sample can be a processed sample (e.g., an embedded sample such as a paraffin or OCT embedded sample). In some cases, one or more biological molecules can be isolated from a sample. For example, nucleic acid (e.g., DNA and RNA such as messenger RNA (mRNA)) can be isolated from a sample and can be used to detect the presence or absence of nucleic acid in a coronavirus genome and/or the presence or absence of one or more polypeptides encoded by nucleic acid in a coronavirus genome. For example, one or more polypeptides can be isolated from a sample and can be used to detect the presence or absence of nucleic acid in a coronavirus genome and/or the presence or absence of one or more polypeptides encoded by nucleic acid in a coronavirus genome. Any appropriate method can be used to detect the presence or absence of nucleic acid in a coronavirus genome and/or the presence or absence of one or more polypeptides encoded by nucleic acid in a coronavirus genome. In some cases, polymerase chain reaction (PCR)-based techniques such as quantitative reverse transcription (RT)-PCR (qPCR) techniques, RNA in situ hybridization (ISH), and/or RNA sequencing can be used to detect the presence or absence of nucleic acid in a coronavirus genome. In some cases, immunoassays (e.g., immunohistochemistry (IHC) techniques, and western blotting techniques), mass spectrometry techniques (e.g., proteomics-based mass spectrometry assays or targeted quantification-based mass spectrometry assays), and/or enzyme-linked immunosorbent assays (ELISAs) can be used to detect the presence or absence of one or more polypeptides encoded by nucleic acid in a coronavirus genome.
Once (a) identified as having, or as being at risk of developing, a viral infection (e.g., a coronavirus infection) (and/or a bacterial infection), a mammal (e.g., a human) can be administered, or instructed to self-administer, one or more inhibitors of a CRM1 polypeptide and one or more salicylates.
In some cases, administering one or more inhibitors of a CRM1 polypeptide in combination with one or more salicylates can be effective to arrest the cell cycle of a cell (e.g., a cell in a mammal such as a human). For example, administering one or more inhibitors of a CRM1 polypeptide in combination with one or more salicylates can be effective to arrest the cell cycle of a cell at the G0-G1 phase. For example, administering one or more inhibitors of a CRM1 polypeptide in combination with one or more salicylates can be effective to arrest the cell cycle of a cell at the S phase. For example, one or more inhibitors of a CRM1 polypeptide in combination with one or more salicylates can be used to reduce proliferation of a cell (e.g., a cell in a mammal such as a human) by, for example, 10, 20, 30, 40, 50, 60, 70, 80, 90, 95, or more percent.
In some cases, administering one or more inhibitors of a CRM1 polypeptide in combination with one or more salicylates can be effective to reduce a level of one or more polypeptides associated with a DNA damage repair pathway within a cell (e.g., a cell in a mammal such as a human). For example, one or more inhibitors of a CRM1 polypeptide in combination with one or more salicylates can be administered to a mammal in need thereof (e.g., a mammal having cancer) to reduce a level of one or more polypeptides associated with a DNA damage repair pathway within a cell (e.g., a cell in a mammal such as a human) by, for example, 10, 20, 30, 40, 50, 60, 70, 80, 90, 95, or more percent. A DNA damage repair pathway can be any appropriate DNA damage repair pathway (e.g., DNA homologous recombination (HR)). Examples of polypeptides associated with a DNA damage repair pathway whose level can be reduced by administering one or more inhibitors of a CRM1 polypeptide in combination with one or more salicylates include, without limitation, Rad51 polypeptides, BRCA1 polypeptides, BRCA2 polypeptides, CDK12 polypeptides, CHEK1 polypeptides, PALB2 polypeptides, TP53 polypeptides, ATM polypeptides, ATR polypeptides, RAD51AP1, BLM, and RAD9A.
In some cases, administering one or more inhibitors of a CRM1 polypeptide in combination with one or more salicylates can be effective to reduce a level of one or more cytokines within a cell (e.g., a cell in a mammal such as a human). For example, one or more inhibitors of a CRM1 polypeptide in combination with one or more salicylates can be administered to a mammal in need thereof (e.g., a mammal having cancer) to reduce a level of one or more cytokines within a cell (e.g., a cell in a mammal such as a human) by, for example, 10, 20, 30, 40, 50, 60, 70, 80, 90, 95, or more percent. A cytokine can be any appropriate cytokine (e.g., chemokine, interferon, interleukin, lymphokine, or tumour necrosis factor). In some cases, a cytokine can be an inflammatory cytokine. Examples of cytokines whose level can be reduced by administering one or more inhibitors of a CRM1 polypeptide in combination with one or more salicylates include, without limitation, interleukin 1 beta (IL-1beta), interleukin 10 (IL-10), granulocyte macrophage colony-stimulating factor (GM-CSF), interleukin 8 (IL-8), interleukin 5 (IL-5), interferon gamma (IFN-gamma), tumor necrosis factor alpha (TNF-alpha), interleukin 2 (IL-2), interleukin 4 (IL-4), and interleukin 6 (IL-6).
An inhibitor of a CRM1 polypeptide can be any appropriate inhibitor of a CRM1 polypeptide. An inhibitor of a CRM1 polypeptide can be an inhibitor of CRM1 polypeptide expression or an inhibitor of CRM1 polypeptide activity. Examples of compounds that can reduce polypeptide activity include, without limitation, antibodies (e.g., neutralizing antibodies) and small molecules. Examples of compounds that can reduce polypeptide expression include, without limitation, nucleic acid molecules designed to induce RNA interference (e.g., a siRNA molecule or a shRNA molecule), antisense molecules, and miRNAs. In some cases, an inhibitor of a CRM1 polypeptide can inhibit nuclear export (e.g., leucine-rich nuclear export signal (NES)-dependent nuclear export) of one or more biological molecules (e.g., proteins, rRNAs, snRNAs, and mRNAs) from a cell. In some cases, an inhibitor of a CRM1 polypeptide can be a selective inhibitor of nuclear exports (SINE). In some cases, an inhibitor of a CRM1 polypeptide can bind (e.g., covalently bind) to a CRM1 polypeptide. Examples of inhibitors of a CRM1 polypeptide that can be used in combination with one or more salicylates as described herein include, without limitation, selinexor (KPT-330), leptomycin B, KPT-185, KPT-276, eltanexor (KPT-8602), piperlongumine, verdinexor (KPT-335), valtrate, and ratjadone C. In some cases, an inhibitor of a CRM1 polypeptide can be as described in Table 1.
In cases where an inhibitor of a CRM1 polypeptide is an inhibitor of CRM1 polypeptide activity, administering one or more inhibitors of a CRM1 polypeptide in combination with one or more salicylates can be effective to reduce or eliminate the level of CRM1 polypeptides in a cell (e.g., a cell in a mammal such as a human). A reduced level of CRM1 polypeptides refers to any level of CRM1 polypeptides that is lower than the median level of CRM1 polypeptides typically observed in a cell (e.g., a control cell) from one or more healthy mammals (e.g., healthy humans). Control cells can include, without limitation, cells from mammals that do not have cancer, cell lines originating from mammals that do not have cancer, and non-tumorigenic cell lines. An eliminated level of CRM1 polypeptides refers to any non-detectable level of CRM1 polypeptides. Any appropriate method can be used to determine whether or not a cell has a reduced or eliminated level of CRM1 polypeptides. For example, western blotting, reverse-transcription polymerase chain reaction (RT-PCR), spectrometry methods (e.g., high-performance liquid chromatography (IPLC) and liquid chromatography-mass spectrometry (LC/MS)), enzyme-linked immunosorbent assay (ELISA), immunohistochemistry, immunofluorescence microscopy, CO-Detection by indEXing (CODEX) imaging, and/or mass cytometry (CyTOF) can be used to determine whether or not a cell contains a reduced or eliminated levels of CRM1 polypeptides. For example, administering one or more inhibitors of a CRM1 polypeptide in combination with one or more salicylates can be effective to reduce the expression level of CRM1 polypeptides in a cell (e.g., a cell in a mammal such as a human) by, for example, 10, 20, 30, 40, 50, 60, 70, 80, 90, 95, or more percent.
A salicylate can be any appropriate salicylate. A salicylate (e.g., a salt or an ester of a salicylic acid) can include any appropriate type of salicylic acid (e.g., acetylsalicylic acid). In some cases, a salicylate can be a compound that includes compound which has a salicylate moiety. In some cases, a salicylate can have nonsteroidal anti-inflammatory drug (NSAID) activity. Examples of salicylates that can be used in combination with one or more inhibitors of a CRM1 polypeptide as described herein include, without limitation, aspirin, choline salicylate, sodium salicylate, acetyl salicylate, choline magnesium salicylate (e.g., choline magnesium trisalicylate), and salts thereof.
One or more inhibitors of a CRM1 polypeptide and one or more salicylates can be administered to a mammal having a cancer at the same time or independently. When one or more inhibitors of a CRM1 polypeptide and one or more salicylates are administered at the same time, one or more inhibitors of a CRM1 polypeptide and one or more salicylates can be administered as separate compositions administered at the same time or can be present in a single composition.
In some cases, one or more inhibitors of a CRM1 polypeptide and one or more salicylates can be administered to a mammal having a cancer as the sole active ingredients used to treat a cancer.
In some cases, one or more inhibitors of a CRM1 polypeptide and one or more salicylates can be administered to a mammal having a cancer as a combination therapy with one or more additional cancer treatments used to treat a cancer. For example, a combination therapy used to treat a cancer can include administering to the mammal (e.g., a human) one or more inhibitors of a CRM1 polypeptide and one or more salicylates described herein and one or more cancer treatments such as surgery, chemotherapy, radiation, targeted therapy (e.g., PARP inhibitors such as olaparib, rucaparib, niraparib, talazoparib, veliparib, pamiparib, and iniparib), and/or immunotherapy. In cases where one or more inhibitors of a CRM1 polypeptide and one or more salicylates described herein are used in combination with one or more additional cancer treatments, the one or more additional cancer treatments can be administered at the same time or independently. For example, one or more inhibitors of a CRM1 polypeptide and one or more salicylates described herein can be administered first, and the one or more additional cancer treatments can be administered second, or vice versa.
In some cases, one or more inhibitors of a CRM1 polypeptide and/or one or more salicylates can be formulated into a composition (e.g., pharmaceutically acceptable composition) for administration to a mammal having cancer. For example, a therapeutically effective amount of one or more inhibitors of a CRM1 polypeptide and/or of one or more salicylates can be formulated together with one or more pharmaceutically acceptable carriers (additives) and/or diluents. A pharmaceutical composition can be formulated for administration in any appropriate dosage form. Examples of dosage forms include solid or liquid forms including, without limitation, gums, capsules, tablets (e.g., chewable tablets, and enteric coated tablets), suppository, liquid, enemas, suspensions, solutions (e.g., sterile solutions), sustained-release formulations, delayed-release formulations, pills, powders, gels, creams, ointments, and granules. Pharmaceutically acceptable carriers, fillers, and vehicles that may be used in a pharmaceutical composition described herein include, without limitation, ion exchangers, alumina, aluminum stearate, lecithin, serum proteins such as human serum albumin, buffer substances such as phosphates, glycine, sorbic acid, potassium sorbate, partial glyceride mixtures of saturated vegetable fatty acids, water, salts or electrolytes such as protamine sulfate, disodium hydrogen phosphate, potassium hydrogen phosphate, sodium chloride, zinc salts, colloidal silica, magnesium trisilicate, polyvinyl pyrrolidone, cellulose-based substances, polyethylene glycol such as Vitamin E TPGS, sodium carboxymethylcellulose, polyacrylates, waxes, polyethylene-polyoxypropylene-block polymers, and wool fat.
A composition (e.g., a pharmaceutical composition) containing one or more inhibitors of a CRM1 polypeptide and/or one or more salicylates can be designed for oral or parenteral (including subcutaneous, intratumoral, intramuscular, intravenous, topical, and intradermal) administration. When being administered orally, a pharmaceutical composition containing one or more inhibitors of a CRM1 polypeptide and/or one or more salicylates can be in the form of a pill, syrup, gel, liquid, flavored drink, tablet, or capsule. Compositions suitable for parenteral administration include aqueous and non-aqueous sterile injection solutions that can contain anti-oxidants, buffers, bacteriostats, and solutes which render the formulation isotonic with the blood of the intended recipient; and aqueous and non-aqueous sterile suspensions which may include suspending agents and thickening agents. The formulations can be presented in unit-dose or multi-dose containers, for example, sealed ampules and vials, and may be stored in a freeze dried (lyophilized) condition requiring only the addition of the sterile liquid carrier, for example water for injections, immediately prior to use. Extemporaneous injection solutions and suspensions may be prepared from sterile powders, granules, and tablets.
A composition (e.g., a pharmaceutical composition) containing one or more inhibitors of a CRM1 polypeptide and/or one or more salicylates can be administered locally or systemically. For example, a composition containing one or more inhibitors of a CRM1 polypeptide and/or one or more salicylates can be administered systemically by an oral administration or by injection to a mammal (e.g., a human).
Effective doses of one or more inhibitors of a CRM1 polypeptide and/or one or more salicylates can vary depending on the severity of the cancer, the route of administration, the age and general health condition of the subject, excipient usage, the possibility of co-usage with other therapeutic treatments such as use of other agents, the specific CRM1 inhibitor being used, and/or the judgment of the treating physician.
An effective amount of a composition containing one or more inhibitors of a CRM1 polypeptide and/or one or more salicylates can be any amount that can treat the cancer without producing significant toxicity to the mammal. An effective amount of an inhibitor of a CRM1 polypeptide can be any appropriate amount. In some cases, an effective amount of an inhibitor of a CRM1 polypeptide such as selinexor can be from about 35 mg/kg body weight of a mammal to about 45 mg/kg body weight of a mammal. In some cases, an effective amount of an inhibitor of a CRM1 polypeptide such as selinexor can from about 0.01 nM to about 2.5 μM plasma concentration. For example, an effective amount of selinexor can be from about 0.25 μM to about 1.24 μM. An effective amount of a salicylate can be any appropriate amount. In some cases, an effective amount of a salicylate can be from about 0.0001 mM to about 10 mM plasma concentration. For example, an effective amount of a salicylate can be from about 0.1 μM to about 10 mM (e.g., from about 1 μM to about 3 mM). The effective amount can remain constant or can be adjusted as a sliding scale or variable dose depending on the mammal's response to treatment. Various factors can influence the actual effective amount used for a particular application. For example, the frequency of administration, duration of treatment, use of multiple treatment agents, route of administration, and severity of the condition (e.g., a cancer) may require an increase or decrease in the actual effective amount administered.
The frequency of administration of a composition containing one or more inhibitors of a CRM1 polypeptide and/or one or more salicylates can be any frequency that can treat the cancer without producing significant toxicity to the mammal. For example, the frequency of administration can be from about three times a day to about once a week, from about twice a day to about twice a week, or from about once a day to about twice a week. The frequency of administration can remain constant or can be variable during the duration of treatment. A course of treatment with a composition containing one or more inhibitors of a CRM1 polypeptide and/or one or more salicylates can include rest periods. For example, a composition containing one or more inhibitors of a CRM1 polypeptide and/or one or more salicylates can be administered daily over a two-week period followed by a two-week rest period, and such a regimen can be repeated multiple times. As with the effective amount, various factors can influence the actual frequency of administration used for a particular application. For example, the effective amount, duration of treatment, use of multiple treatment agents, route of administration, and severity of the condition (e.g., a cancer) may require an increase or decrease in administration frequency.
An effective duration for administering a composition containing one or more inhibitors of a CRM1 polypeptide and/or one or more salicylates can be any duration that treat the cancer without producing significant toxicity to the mammal. For example, the effective duration can vary from several days to several weeks, months, or years. In some cases, the effective duration for the treatment of a cancer can range in duration from about one month to about 10 years. Multiple factors can influence the actual effective duration used for a particular treatment. For example, an effective duration can vary with the frequency of administration, effective amount, use of multiple treatment agents, route of administration, and severity of the condition being treated.
In some cases, the number of cancer cells present within a mammal, and/or the severity of one or more symptoms of the cancer being treated can be monitored. Any appropriate method can be used to determine whether or not the number of cancer cells present within a mammal is reduced. For example, imaging techniques can be used to assess the number of cancer cells present within a mammal.
In some cases, the materials and methods described herein also can be used to treat other diseases or disorders that are characterized by increased expression of CRM1 polypeptides and/or increased activity of CRM1 polypeptides.
The invention will be further described in the following examples, which do not limit the scope of the invention described in the claims.
Aspirin and choline salicylate are nonsteroidal anti-inflammatory drugs (NSAID) under the salicylate family and were used to assess the synergy between salicylates and selinexor.
All cell lines were obtained from commercial vendors (ATCC or DSMZ), which includes mantle cell lymphoma (MCL) cell lines: Jeko-1, Mino, JVM-2; T-cell lymphoma (TCL) cell lines: SU-DHL-1, Karpas-299, SR-786 and HUT-78; and diffuse large B-cell lymphoma cell lines: OCI-Ly1, SU-DHL-2, OCI-Ly3, SU-DHL-6; Waldenstrom macroglobulinemia (WM) cell lines: BCWM, MWCL, RPCI; sarcoma cell lines: FUJI, SW872, and pancreatic cancer cell lines: PANC-1.
WM, TCL, and MCL cell lines were cultured in RPMI media supplemented with 10% fetal bovine serum while DLBCL cell lines were cultured in IMDM media with 10% human serum (Sigma). Pancreatic cancer and sarcoma cell lines were cultured in DMEM with 10% fetal bovine serum. All cell lines were assessed for their viability before use in experiments. Only cells with the viability of 85% or greater were used.
After treating with salicylates (concentrations ranging from 1-5 mM) and CRM 1 inhibitors (concentrations ranging from 0.1-2 μM) as monotherapy and in combination for 24 hours, cells were extracted in lysis buffer containing protease inhibitor, PMSF, and HALT phosphatase inhibitor for total cellular proteins. The cell lysates were diluted in Laemmli sample buffer supplemented with beta-mercaptoethanol and the proteins were resolved in a precast 4-15% gradient Mini SDS gels (Bio-Rad) by electrophoresis, and then transferred to PVDF membranes. The membranes were blocked with LI-COR ODB/PBS buffer and probed with primary antibodies to CRM1 and ikB (rabbit antibody from Cell Signaling; catalong number 46249) or mouse antibody for Actin (from santa cruz biotechnology), followed with fluorescent secondary antibodies anti-rabbit IRDye 800CW or anti-mouse IRDye 700CW (LI-COR) for one hour. The membranes were imaged on a LI-Cor Odyssey CLX imager.
To assess apoptosis and cellular proliferation, all cell lines were treated with CRM 1 inhibitors (concentration ranging from 0.05-2 μM) and salicylates at concentrations ranging from (0.001-10 mM) for 48 hours before analysis was performed. DMSO was used to substitute the drug in controls.
After 48 hours incubation, cells were washed with Annexin buffer solution and stained with both propidium iodide (PI) and FITC-Annexin V (Life Technologies), and assayed on a BD Accuri flow cytometer (BD Biosciences). Apoptosis results were analyzed with BD CellQuest software. For cell cycle analysis, Jeko-1 cell line was intubated with CRM 1 inhibitors (concentrations ranging from 0.1-0.5p M) and salicylates (concentration at 3 mM) and Ly-1 cell line was intubated with CRM 1 inhibitors (concentrations ranging from 0.1-2.0 μM) and salicylates (concentration at 0.5-5 mM) for 24 and 48 hours and then fixed with 95% cold ethanol and kept at 4 C° for 24 h and subsequently underwent cell cycle analysis after PI staining and analysis was performed using BD FACS caliber flow cytometer (BD Biosciences) and FlowJo software (Tree Star).
According to a standard proliferation procedure, cells were seeded in a 96 well plate with respective concentrations of CRM 1 inhibitors and salicylates as mentioned above. After 48 h of incubation, 3[H] labeled thymidine (CMP) was added. The plate was harvested after another 18 hr of incubation. 3[H]-thymidine uptake was measured on a MicroBeta workstation (Perkin Elmer).
In some cases, the methods can be performed as described elsewhere (see, e.g., Abeykoon et al., Blood Cancer J., 9:24 (2019)).
Antitumor Effect of Selinexor in Combination with Salicylates
Significant enhancement of the antitumor effect in DLBCL cells, MCL cells, and TCL cells were observed at very low concentrations of selinexor; 0.25-0.5 μM (10-20% of the concentration being used in humans in clinical trial setting), when selinexor is combined with salicylates (in human tolerated concentrations ranging from 0.5 mM to 3 mM).
Antitumor effects evaluated included cell viability, cell proliferation, and cell cycle progression. DLBCL cells (Ly-1 cell line) treated for 72 hours with a combination drug treatment including selinexor at 0.01-2.0 μM and CS at 0.1-5 mM showed decreased viability (
A variety of salicylates were also evaluated. Cell viability of DLBCL cells (Ly-1 cell line) treated with selinexor in combination with CS, aspirin, or sodium salicylate was examined. DLBCL cells (Ly-1 cell line) treated for 48, 72, or 96 hours with a combination drug treatment including selinexor at 2.0 μM and CS at 4 mM or aspirin at 2 mM showed decreased viability (
Potency of Selinexor in Combination with Salicylates
The ability of selinexor used in combination with a salicylate to decrease the IC50 was evaluated using different concentrations of selinexor and using 3 mM of CS. MCL cells treated for 72 hours with selinexor alone had an IC50 of 1.3 μM, while a combination drug treatment including selinexor and CS had an IC50 of 0.3 μM (
CRM1 polypeptide expression levels were evaluated in cells treated with selinexor or KPT-185 in combination with CS. The drug combination selectively decreased the expression of CRM1 polypeptides and no such effect was seen with respect to the expression of IkB (
Further investigations also suggested that when selinexor is combined with salicylates, CRM1 protein expression decreased but this decrease expression was not evident with either drug alone.
Selinexor in Combination with Other Non-Salicylate NSAIDS
The specificity of the synergy between selinexor and NSAIDs was evaluated by treating cells with selinexor alone or with selinexor in combination with non-salicylate NSAIDs ketorolac and ibuprofen.
Cell viability of cancer cells treated with selinexor in combination with non-salicylate NSAIDs was examined. MCL cells or DLBCL cells treated with a combination drug treatment including selinexor at 0.5 μM and ketorolac at 2 μM, 4 μM, 20 μM, or 100 μM showed no change in cell viability (
The effect was similar when selinexor was combined both with aspirin or choline salicylate independently at human tolerated concentrations. No synergistic antitumor activity was seen when selinexor or leptomycin B was combined with non-salicylate NSAIDs. These results suggest the synergy is not NSAID drug class specific but it is salicylate specific. Further, salicylates or non-salicylate NSAIDs alone did not impose any antitumor effect in cancer cells.
Selinexor in Combination with Chemotherapeutics
Synergy between selinexor and salicylates was further evaluated by further treating cells with chemotherapeutics.
Cell viability of cancer cells treated with aspirin or choline salicylate in combination with a chemotherapeutic was examined. MCL cells or DLBCL cells treated with a combination drug treatment including aspirin at 2.5 mM and gemcitabine at 1 nM showed no change in cell viability (
These results demonstrate that the synergy of the combination treatments is specific for the selinexor and salicylate combination.
Combination treatments using various concentrations of selinexor, various concentrations of CS, and various treatment times were evaluated. CS concentrations did not exceed 4 mM as higher concentrations are supra-physiologic and would be difficult to achieve in humans.
DLBCL cells treated for 48, 72, or 96 hours with a combination drug treatment including selinexor at 0.5 μM, 1.0 μM, or 2.0 μM and CS at 3 mM or 4 mM each showed decreases in cell viability (
Together these results demonstrate that salicylates (e.g., aspirin or choline salicylate) act synergistically with an inhibitor of CRM1 polypeptides (e.g., Selinexor). Accordingly, one or more salicylates can be used to enhance the antitumor effect of one or more inhibitor(s) of CRM1 polypeptides such that the inhibitor(s) of CRM1 polypeptides can be administered to a mammal (e.g., a human) having cancer (e.g., a hematologic cancer) at lower concentrations thus mitigating adverse effects of inhibitor(s) of CRM1 polypeptides.
KPT-330 and choline salicylate were used via oral gavage in a mantle cell lymphoma NSG (NOD-scid gamma mouse) mouse model.
Mouse groups: Group 1 (control)=4 female mice; Group 2 (CS)=3 male mice; Group 3 (KPT)=4 male mice; Group 4 (KPT+CS)=4 female mice
Four groups of NSG mice with 3-6 mice per group was treated by oral gavage; groups 1-4: (1) placebo (vehicle; 25% of DMSO, 37.5% polyethylene glycol and 37.5% of distal water) given every day 3 weeks, (2) Selinexor at 15 mg/kg (dissolve in the vehicle) given twice a week for 3 weeks, (3) CS at 500 mg/kg given every day 3 weeks, and (4) Selinexor at 15 mg/kg given twice a week for 3 weeks and CS at 500 mg/kg given every day 3 weeks. Each mouse in the study was injected 5×106 cells of Jeko-1, MCL cells. The primary endpoints were assessing the tumor size via nuclear imaging, tumor histopathology for necrosis/apoptosis and adverse effects (AEs). The AEs were monitored based on systemic signs using Body Condition Scoring.
Administering a treatment including selinexor in combination with CS to mice with MCL tumors for 16 days resulted in a reduced tumor size (
These results demonstrate that an inhibitor of CRM1 polypeptides (e.g., selinexor) used in combination with one or more salicylates (e.g., aspirin or choline salicylate) have an antitumor effect, and can be used to a treat a mammal having cancer.
This Example demonstrates that salicylate can increase the potency of KPT-330 or other CRM1 inhibitors when used in combination. This combination induces an inhibitory effect on the nuclear export of proteins and inhibits DNA damage repair, DNA synthesis, and cell cycle progression in both hematologic malignancies and solid tumor cells with minimal effects on normal cells. This constellation of anti-tumor effects is unique with respect to other known classes of anti-cancer agents.
Cell lines were purchased from the cell line repositories ATCC (Manassas, Va.) or DSMZ (Braunschweig, Germany). These included MCL cell lines: JeKo-1, Mino; TCL cell lines: Karpas-299, SR-786; DLBCL cell lines: OCI-Ly1 (LY-1), OCI-Ly3 (LY-3), OCI-Ly19 (LY-19), SU-DHL-6 (DHL-6); MM cell lines: RPMI, U266, OPM2, Xgl, KMS2; ALL cell lines: CRL-1783; non-small cell lung cancer: NCI-H460, A549, HCC827; small cell lung cancer: H1048; sarcoma: Fuji, SW872. Cell lines were cultured according to instruction. Cells used in experiments had viability counts of 90% or greater before treatment.
Primary patient samples were obtained. The mononuclear cells were obtained from bone marrow, spleen, peripheral blood and lymph nodes as follows. Freshly obtained tissue (lymph node, spleen, bone marrow) was placed in mesh screen and using a syringe plunger, the tissue was pressed into a petri dish. Samples were then rinsed through the screen using measured amounts of RPMI until all tissue has been pressed through. If sample had a visibly large presence of red blood cells, it was processed with ACK Lyse. Subsequently the mononuclear cells were isolated via centrifugation in the presence of ficoll and this step was again repeated following washing the cells with RPMI media.
To isolate peripheral blood mononuclear cells (PBMCs), freshly obtained patient blood sample of patients were centrifuged in the present of ficoll and this step was repeated twice following washing the cells with PBS. Following isolating the mononuclear cells, the viability was assessed and ascertained proper viability above 80% prior to conduct respective experiments. Non-malignant cells were confirmed not to have a malignant condition by pathology review of the tissue.
KPT-330 purchased from Selleckchem (cat no: S7252) was dissolved in DMSO while CS (Santa Cruz, Calif.S 2016-36-6), sodium salicylate (Sigma-Aldrich, cat no: S3007), acetyl salicylate (Sigma-Aldrich, cat no: CAS 50-78-2) was diluted in PBS. Ketorolac (Sigma-Aldrich, cat no: 1356665), Bortezomib (Selleckchem, cat no: S1013), gemcitabine (Sigma-Aldrich, cat no: G6423), Leptomycin-B (Sigma-Aldrich, cat no: L2913-2X) and KPT-185 (Selleckchem, cat no: S7125) were dissolved in DMSO. The concentration range of KPT-330 was 0.05-1.0 μM while CS was 1-3 mM were used for ex vivo treatment and incubation time ranged from 24 hours to 72 hours. For the PARP inhibitor assay, olaparib 10 μM (SelleckChem, cat no: AZD2281 Ku-0059436) was used. Q-VD-OPh (MilliporeSigma, cat no: 551476) was used as the pan-caspase inhibitor to assess caspase induced cell death by K+CS.
The viability assessment for cell lines and primary patients samples were conducted with the Annexin V/PI method. In CMML patient sample, the viability was assessed by counting colony-forming units in respective treatment conditions; KPT-330, CS, K+CS and DMSO control.
NSG™ (NOD.Cg-PrkdcscidIl2rgtm1Wjl/SzJ) NOD SCID gamma, NOD.Cg-PrkdcscidIl2rgtm1Wjl/SzJ) mice were obtained from in-house breeding colony and 3 million cells of Jeko-1 cells were subcutaneously engrafted in the flank. On day 4 following the inoculation of Jeko-1 cells, KPT-330 at 15 mg/kg, CS 500 mg/kg and the combination were used in respective groups (vehicle, KPT-330 monotherapy, CS monotherapy and K+CS), respectively. Oral gavage was commenced for drug administration and KPT-330 was administered twice a week while CS was administered consecutively 6 days per week. Treatment was commenced for total of 24 days. The vehicle of 20% DMSO, 40% polyethylene glycol and 40% water was used for KPT-330 and water was used to dilute CS to make proper concentrations. The respective week was used in the control groups without the drugs were treatment. Tumor growth was monitored by measuring tumor diameter, tumor within height and the volume was calculated by using length×width (2)/2. Toxicity assessment was done by visual inspection and monitoring weight of the animals during the treatment period. Following autopsy, animal carcasses were fixed in formalin for formal pathology analysis of the internal organs.
CMML patient-derived bone marrow samples were first treated with ammonium chloride to deplete red blood cells, washed in RPMI, then plated at a final concentration of 5×104-2×105 cells/mL in addition to drug(s). This solution was immediately inoculated into methylcellulose (StemCell) formulated with recombinant cytokines to support the optimal growth of erythroid progenitor cells, granulocyte-macrophage progenitor cells, and multipotent granulocyte, erythroid, macrophage and megakaryocyte progenitor cells. Plates were incubated with respective treatment conditions at 37° C. and colonies were enumerated on day 10-14.
Synergy Assessment with IC50 and Combination Index (CI)
Jeko-1 and OCI-Ly1 cell lines were used to assess the IC50. Keeping CS at 3 mM, KPT-330 was titrated. Relative IC50 was calculated as described elsewhere (see, e.g., Sebaugh et al., Pharmaceutical statistics 10:128-134 (2011)). The combination index was calculated as described elsewhere (see, e.g., Chou et al., Cancer Res 70:440-446 (2010)).
CRM1 (Cell Signaling, Danvers, Mass.; catalog number: 46249, dilution 1:1000), Rad51 (abeam; catalog number: ab133534, dilution 1:1000), BublB (Cell Signaling, Danvers, Mass.; catalog number: 4116, dilution 1:1000), cyclin B1 (Cell Signaling, Danvers, Mass.; catalog number: 4138, dilution 1:1000), thymidylate synthase (Cell Signaling, Danvers, Mass.; catalog number: 9045, dilution 1:1000), Aurora A (Cell Signaling, Danvers, Mass.; catalog number: 91590, dilution 1:1000), PLK1 (Cell Signaling, Danvers, Mass.; catalog number: 4513, dilution 1:1000) and mouse anti-human beta-actin antibody (Santa Cruz Biotechnology, Dallas, Tex.; catalog number: SC-47778) were used, and were followed with fluorescent secondary antibodies; anti-rabbit IRDye 800CW or anti-mouse IRDye 700 CW (LI-COR). The membranes were imaged on a LI-COR Odyssey CLX imager.
Cells were extracted in lysis buffer containing protease inhibitor, PMSF, and HALT phosphatase inhibitor for total cellular proteins. The cell lysates were diluted in Laemmli sample buffer supplemented with beta-mercaptoethanol. The proteins were resolved in precast 4-15% gradient, or 7.5% or 10% fixed Criterion TGX Midi protein gels (Bio-Rad) by electrophoresis, and then transferred to PVDF membranes. The membranes were blocked with 1:1 LI-COR ODB/PBS buffer and probed with respective primary antibodies followed with fluorescent secondary antibodies.
A GeLC-MS/MS method for identifying and quantifying the proteins present in different drug treatment groups was used. Triplicate cell pellets (containing ˜5 million cells/pellet) from each treatment group were individually washed with PBS and solubilized in 2% SDS/100 mM triethylammonium bicarbonate buffer (pH 8). Solubilized pellets were vortexed for 30 seconds, incubated on ice for 5 minutes, and was repeated twice. Proteins were denatured via heating and shaking for 10 minutes at 85° C. Final protein concentrations were estimated using BCA protein assay (Thermo-Fisher, Waltham, Mass.). Protein mixture with 20 μg of was diluted in SDS buffer (5% β-mercaptoethanol), heated for 5 minutes at 85° C., loaded on a 10% Criterion TGX gel (Bio-Rad Labs), and electrophoresed. Sample lanes were divided into six equal horizontal segments for mass spectrometry analysis (
Gel bands were destained and dehydrated. Proteins in the bands were reduced with 50 mM TCEP for 50 minutes at 60° C., dehydrated with acetonitrile, and alkylated with 25 mM iodoacetamide/50 mM Tris for 50 minutes at room temperature in the dark. Reduced and alkylated proteins were incubated with 80 μL of 0.002 μg/μL trypsin (Promega, Madison, Wis.) overnight at 37° C. Peptides were extracted by incubating the digests with 20 μL of 4% trifluoroacetic acid and 60 μL of acetonitrile at room temperature for 40 minutes. A second acetonitrile extraction was performed and saved with the initial extraction. All extracts were dried and stored at −20° C.
Dried trypsin digested samples were suspended in 0.2% formic acid/0.1% TFA/0.002% zwittergent. A portion of each digest was analyzed by nano-flow liquid chromatography electrospray tandem mass spectrometry (nanoLC-ESI-MS/MS) using a Q-Exactive HF-X mass spectrometer (Thermo-Fisher Scientific, Bremen, Germany) coupled to a Thermo Ultimate 3000 RSLCnano HPLC system. The digest peptide mixture was loaded onto a 330 nL Halo 2.7 ES-C18 trap (Optimize Technologies, Oregon City, Oreg.), eluted on to 100 μm×33 cm column packed with Agilent Poroshell 120 EC C18 packing (Agilent Technologies, Santa Clara, Calif.). Mass spectrometer analyzed the sample for 90-mins in data dependent MS/MS mode.
To analyze the raw data and identify proteins present in the samples and to detect differentially expressed proteins between treatment groups, raw data files were processed using MaxQuant (version 1.6) software configured to use a composite protein sequence database containing Uniprot human reference proteome (downloaded on Mar. 13, 2019) sequences of common contaminants (trypsin, keratin, cotton, wool, etc.). Reversed protein sequences were appended to the database for estimating protein identification false discovery rates (FDRs). The software was configured to use 20 ppm m/z tolerance for precursors and fragments while performing peptide-spectrum matching. MaxQuant inferred semitryptic peptides from the database while looking for the following variable modifications: carbamidomethylation of cysteine, oxidation of methionine and formation of n-terminal pyroglutamic acid. The software filtered peptide and protein identifications at 1% FDR, grouped protein identifications into groups and reported protein group intensities. Protein group intensities were considered as pseudo-quantitative measure of their abundances.
A script written in R programming language performed relative differential expression analysis using protein group intensities. First, protein group intensities of each sample were log 2 transformed and normalized using TMM method. For each protein group, the normalized intensities observed in two groups of samples were modeled using a Gaussian-linked generalized linear model. An ANOVA test was used to detect the differentially expressed protein groups between pairs of experimental groups. Differential expression p-values were FDR corrected using Benjamini-Hochberg procedure. A total of four group comparisons were performed: KPT-330 vs. control, CS vs. control, KPT-330+CS vs. control and CS vs. KPT-330. For each comparison, protein groups with an FDR≤0.05 and an absolute log2 (fold change)≥2.0 were considered as significantly differentially expressed and saved for further analysis.
To analyze gene expression differences between treatment groups, RNA was extracted using the AllPrep DNA/RNA FFPE kit (Qiagen, Germany). Sequencing libraries were prepared using TruSeq RNA Library Prep kit V2 (Illumina, San Diego, Calif.) and analyzed on a HiSeq 4000 sequencer (Illumina, San Diego, Calif.). Sequenced reads were aligned to the hg38 reference using the MAP-RSeq pipeline slightly modified to use the STAR aligner. Gene-level read counts based on Ensembl version 78 were analyzed using edgeR54 to find differentially expressed proteins. For this, gene counts were normalized using TMM method to remove batch effects. Normalized read counts were compared across experimental groups using a negative binomial generalized log-linear model. A total of four group comparisons were performed: KPT-330 vs. control, CS vs. control, K+CS vs. control and CS vs. KPT-330. For each comparison, genes with an adjusted p-value (Benjamini-Hochberg)≤0.05 and an absolute log 2 (fold change)≥2.0 were considered as significantly differentially expressed and saved for further analysis.
The same methods were utilized for performing GSEA and pathway analysis for both proteomics and gene expression data. For proteomics data, a gene symbol was assigned to each protein group based on the constituent protein identifications. For gene expression data, ensemble transcript ID was mapped to its corresponding gene symbol. From here on, GSEA software (version 4.0) from Broad Institute was used for GSEA analysis. A rank was computed, as −1 log 10(p-value)*sign(fold change), for each gene in each proteomics and gene expression comparison. Genes and their corresponding ranks were utilized for GSEA using GSEAPreRanked method. KEGG, Reactome, HALLMARK and BioCarta gene sets were utilized for enrichment analysis. A custom gene set was derived for NFKB response using public literature and also for CRM1 response genes. Gene sets with a corrected p-value<=0.05 were considered as significant. The Ingenuity Pathway Analysis (IPA, Qiagen, Germany) was utilized for detecting differentially expressed pathways. Only significantly differentially expressed genes/proteins in each comparison were uploaded to IPA. Pathways with an adjusted p-value ≤0.05 were considered for interpretation.
Following 24-48 hours incubation of cells with respective treatment conditions, slides were made through cytospin. Subsequently, slides were fixed with 4% paraformaldehyde and stained with primary antibody. The CRM1 antibody was purchased from Cell Signaling (mAB #46249, dilution 1:1500), gamma-H2AX antibody (Cell Signaling, Catalog number. 80312, dilution 1:1000) were used as primary antibodies and incubated overnight followed by 1 hour incubation of respective secondary antibodies. Subsequently the slides were visualized under confocal microscopy on a Zeiss LSM 780 confocal microscope.
Jeko-1 cells and OCI-Ly1 cells were treated with KPT-330, CS, K+CS and DMSO control for 48 hours and comet assay was conducted based on the manufactures protocol (R&D Systems™, catalog no: 4250-050-K). SYBR gold DNA stain was used to stain the DNA under manufactures recommendations. Subsequently focal microscopy was used to image the slides.
Jeko-1 cells were cultured for 5 days with 14365C SAFC EX-CELL® CD CHO Fusion thymidine free media (Millipore Sigma, catalog number: 14365C) in the presence of L-glutamine. After confirming the viability above 90%, cells were treated with the respective drug combinations and single agent treatment with DMSO control for 48 hours in the presence or absence of thymidine (Sigma-Aldrich, cat no: T9250). Subsequently, the viability was assessed via Annexin/PI method as described above.
Jeko-1 and OCI-Ly1 cells were treated with KPT-330, CS, K+CS and DMSO in respective media. Following the incubation of respective time periods, cytospin slides were prepared and stained with Hema 3 staining on the many factors protocol. Subsequently the mitotic index was calculated by the number of mitoses evaluated in 10 high power fields (×400).
Cell Cycle Analysis Following incubation, cells were fixed with 70% cold ethanol and kept at 4 C° for 24 hours, followed by PI staining. Cell cycle analysis was done by using a BD FACS Caliber flow cytometer (BD Biosciences) and analyzed using FlowJo® Software.
A double thymine block was used to synchronize cells at G1 phase of the cell cycle. JeKo-1 cells were cultured in thymidine at 2 mM in RPMI for 9 hours. Subsequently, cells were washed and cultured in RPMI media (RPMI) without additional thymidine for 12 hours and the second block of cell cycle with thymidine (2 mM) was carried out for an additional 9 hours with in RPMI. Following the double thymidine block, cells were released by re-culturing cells in normal RPMI without additional thymidine. The viability of cells at the time of release was >90%. Following the double thymidine block, cells were treated with respective treatment conditions and assess for cell cycle progression.
Assessment of K+CS Activity on Primary Patient Samples with Ovarian Cancer
Since 3D complex multicellular constructs that can self-assemble to recapitulate specific developmental programs, on arrival of fresh ovarian cancer PDX tissue from animal, after removal of debris (i.e., fat and necrotic material), the tumor tissue were cut into 2-4 mm3 pieces and washed with cold sterile phosphate buffered saline (PBS, Life Technologies Inc.), two or three random pieces were snap frozen and stored at −80° C. for DNA isolation, two random pieces were fixed in formalin for histopathological analysis and immunohistochemistry, and the remainder were processed for cryopreservation or isolate single tumor cells for primary 3D culture. Briefly: carefully transfer up to 2 gram fresh tumor tissue into the gentleMACS C Tube (Miltenyi Biotec Cat #130-093-237) containing 5 mL of digestion buffer (MACS human tumor dissociation kit, Miltenyi Biotec, Germany). Tightly close the C Tube and attach it upside down onto the genleMACS Dissociator, run the genleMACS program h_tumor_01. By end of dissociation, add complete culture medium to stop the reaction, centrifuge and re-suspend samples in fresh complete culture medium, and apply the cell suspension to a cell strainer (40 μM) placed on a 50 mL tube, wash cells several times, and re-suspend cell pellet into a final concentration of 10000/well by plating them into a Corning® spheroid microplates ultra-low attachment (ULA) 96 well plates with black/clear round bottom in 90 μl of complete media (CLS4520, Corning Inc., New York, N.Y.) and 24 hours were allowed to form 3D spheroids. All cells were maintained at 37 C°, 5% CO2 in humidified atmosphere, only validated tumor cells were used further for ex vivo study. The cells were treated with compounds at the indicated concentration for another 120 hours. Cell viability was measured using the RealTime-Glo™ MT Cell Viability Assay (Cat. #G9711, Promega, Madison, Wis.) and GloMax® discover system (Promega, Madison, Wis.). Cell viability was calculated for each concentration as an average of three replicates and normalized to untreated vehicle controls after 120 hours of incubation. Thresholds of assay success were set to include minimum Relative Luminescence Units (RLU) values in controls and the dynamic range between vehicles and blanks.
Drug concentrations used:
Treatment-naïve PDX tumor tissues were crushed using the Cellcrusher Tissue Pulverizer (Cell Crusher Limited, Cork, Ireland) on dry ice. DNA was then extracted using the standard protocol for Qiagen DNeasy Blood and Tissue kit (Cat #69504; Qiagen, Venlo, Netherlands). Extracted DNA was assayed using the BROCA Cancer Risk panel (University of Washington, Seattle, Wash., USA) to detect mutational aspects of DNA repair or its regulation, including ATM, ATR, BARD1, BRCA1, BRCA2, CDK12, CHEK1, PALB2, RAD51C, TP53, and 43 others (as described in Walsh et al., Proc Natl Acad Sci USA 107:12629-12633 (2010)) as escribed elsewhere (see, e.g., AlHilli et al., Gynecologic oncology 143:379-388 (2016)). The assay completely sequences all exons, non-repeating introns, selected promoter regions, and detects large deletions, duplications, and mosaicism. All deleterious mutations were confirmed by Sanger sequencing. Only clear loss of function mutations and missense mutations with experimental evidence of functional consequences was considered deleterious.
Assessment of K+CS Activity on Primary Patient Samples with Glioma
Two GBM patient-derived xenograft (PDX) explanted cell lines, GBM6 and GBM12 from the Mayo GBM PDX National Resource, were propagated in StemPro Neural Stem Cell media supplemented with L-glutamine and penicillin/streptomycin. Cells were plated at 2000 (GBM6) or 500 (GBM12) cells per well in tissue culture-treated, black-walled plates in 50 μl of media and incubated overnight before treatment with experimental compounds. Cells were treated at respective concentrations of KPT-330 and CS as single agents or in combination. Experiments were incubated for 14 days before viability was analyzed by Cell Titer GLO 3D according to the manufacturer's instructions.
A GFP reporter construct was made using the backbone of pEGFP-N1 vector. Specifically, the green fluorescence (GFP) was in-frame tagged with 3 consecutive copies of nuclear localization sequence (NLS) of SV40 large T antigen to the N-terminus and 3 consecutive copies of nuclear export sequences (NES) of HIV Rev to the C-terminus. The resulting construct encodes NLS-GFP-NES fusion protein capable of shuttling freely between the nucleus and the cytoplasm. The construct DNA was transfection into U2OS cells using Lipofectamine 2000 reagent (Life Technologies) according to product instruction. Six hours post transfection, the cells were treated with vehicle, CS, KPT-330, and K+CS for 24 hours. Finally, the treated cells were fixed with 4% PFA, and permeabilized, and stained for endogenous expression of CRM1 protein with anti-CRM1 antibody (Cell Signaling, Danvers, Mass.; catalog number: 46249, dilution 1:1500). Cell images were collected on a Zeiss LSM 780 confocal microscope.
Construct pCMV-hCRM1-YFP encoding human CRM1-YFP fusion protein was as described elsewhere (Rodriguez et al., The Journal of biological chemistry 275:38589-38596 (2000)). Hela, U2OS, and HEK293 cells were transfected with the pCMV-hCRM1-YFP construct using Lipofectamine 2000 reagent for 6 hours followed by the treatment of vehicle, CS, KPT-330, and K+CS for 24 hours. Cells were then harvested for Western blotting analysis by probing CRM1 expression with anti-CRM1 antibody (Cell Signaling, Danvers, Mass.; catalog number: 46249, dilution 1:1000). The antibody detects both endogenous CRM1 protein of 120 kDa and CRM1-YFP protein of 145 kDa.
Matched pair analysis and student's t-test was used to compare continuous variables. A p-value of <0.05 was considered statistically significant, and all analyses were performed using JMP 14.0 software (SAS Institute, Cary, N.C.). Combination index of <1 was defined as synergistic and the CI was calculated by using CalcuSyn software.
Increased Potency of CRM1 Inhibitors when Combined with Salicylates
To evaluate if salicylates could potentiate the antitumor effect of CRM1 inhibitors, the antitumor activity of various CRM1 inhibitors; leptomycin B (LMB), KPT-185, and KPT-330 in combination with well-established salicylate compounds; acetyl salicylate (AS), sodium salicylate (NaS) and CS was assessed. Salicylates alone had no effect on cell viability, while CRM1 inhibitors as single-agents had minimal cytotoxicity at low concentrations (
Given the ex vivo efficacy of K+CS in various cell lines, K+CS was tested on tumor xenografts in NSG (NOD.Cg-Prkdcscid Il2rgtm1Wjl/SzJ) mice subcutaneously engrafted with JeKo-1 cells. Tumor-bearing mice were randomized to treatment with vehicle, low dose KPT-330 (15 mg/kg) or CS (500 mg/kg) alone, or K+CS combination at respective concentrations administrated by oral gavage. Validating our ex vivo results, significant decrease in tumor volume and growth rate were demonstrated in the K+CS group compared to KPT-330 or CS treated groups as single agents or vehicle treated controls in vivo (
To assess AEs of K+CS on normal organs, a toxicology assessment was performed in non-tumor-bearing NSG mice treated with K+CS or vehicle alone. Mice were observed daily for toxicity and autopsied on day 26. The K+CS treatment did not induce any treatment-related morbidity or mortality, and no significant toxicities such as weight loss were evident. No visceral toxicity was noted following independent pathology analysis of the brain, lungs, heart, liver, kidneys, and spleen tissues. Grade I renal tubular hyperplasia was observed in 1/5 control mice and 4/5 mice in the treatment group (
K+CS is a Better Inhibitor of Nuclear Export than KPT-330 Alone
The findings of robust antitumor activity of K+CS combination both ex vivo and in vivo led us to explore the mechanism(s) of this effect. Since KPT-330 is a CRM1 inhibitor, the efficiency of the nuclear export and the spatial expression of CRM1 protein in K+CS treated cells were first examined. To assess nuclear export function, an engineered reporter construct encoding the green fluorescent protein (GFP) carrying the nuclear localized sequence (NLS) and the nuclear export sequence (NES) was transiently transfected into U2OS, a sarcoma cell line in which the nuclear and cytoplasmic compartments are easily visualized. In untreated cells, the reporter protein freely shuttled between the nucleus and cytoplasm (
To further investigate the mechanism of the reduction of CRM1 protein expression in K+CS treated cells, U2OS, HeLa, and HEK293 cells were treated with K+CS for 24 hours followed by immunoblotting for CRM1 protein. Endogenous CRM1 protein expression was decreased with K+CS treatment compared to control. To determine if this was due to suppression of XPO1 (gene encodes CRM1 protein) expression at the transcription level, or increased degradation of CRM1 protein at the protein level, a construct expressing YFP-CRM1 fusion (YFP-CRM1) under a non-native CMV promoter was transfected into U2OS, HeLa, and HEK293 cells and treated with K+CS for 24 hours. It was observed that K+CS treatment reduced the level of CRM1-YFP fusion protein similar to the endogenous CRM1 protein in all cell lines (
The decreased expression of CRM1 protein supported further experiments to determine if other proteins were affected by K+CS. Proteomic analysis by mass spectroscopy (MS) was performed to catalog protein expression changes occurring in JeKo-1 cells with K+CS treatment. A group of about 100 proteins was identified where the expression was uniquely affected by K+CS treatment including Rad51, thymidylate synthase (TYMS), Bub1b, polo-like kinase 1 (PLK1), aurora kinase A (AURKA), and Cyclin B1 (CCNB1) (
To exclude the possibility that the decreased expression of these proteins was mediated by caspases during apoptosis, the role of caspase-induced cell death in the expression of proteins involved in the aforementioned pathways was tested by using a pan-caspase inhibitor, Q-VD-OPh. The presence of Q-VD-OPh rescued cells from K+CS induced cell death (
Data from proteomic analysis was also utilized to test our original hypothesis that K+CS would affect the NFkB signaling pathway. The Ingenuity Pathways Analyses and GSEA determined that the expression of NFkB signaling pathway proteins were not significantly altered (
Whether K+CS treatment may affect cell cycle progression, DNA damage repair and DNA synthesis was evaluated. It was found that K+CS treatment of JeKo-1 cells uniquely blocked the cell cycle in S-phase and induced apoptosis compared to cells treated with KPT-330 or CS alone or controls. The fraction of cells in the G2/M phase was 12%, 15%, 11% and 0.7% in cells treated with DMSO control, KPT-330, CS or K+CS, respectively (
To determine whether some proteins specific to stages outside of S-phase should be under-expressed, especially those specific for G2/M-phase, a protein expression database (cyclebase.org/CyclebaseSearch) was used. More than one third of the downregulated proteins were specific for G2/M including Bub1, Bub1b, AURKA, CDCA3, and PLK1. To validate this, the expression of proteins specific for S-phase (Rad51 and TYMS) or G2/M-phase (AURKA, Bub1b, and PLK1) was profiled by immunoblotting. In untreated JeKo-1 cells, AURKA, Bub1b, and PLK1 were only expressed in G2/M whereas Rad51 and TYMS were expressed throughout the cell cycle (
To investigate the anti-tumor mechanism(s) of K+CS, Rad51 and TYMS were evaluated. In view of the findings that K+CS induced cell cycle arrest in S-phase and caused decreased expression of Rad51 (
To further demonstrate that these γ-H2AX positive DNA foci are the evidence of unproductive DNA repair due to the reduced Rad51 expression, a Comet assay that directly detects the integrity of cellular DNA was performed. K+CS-treated JeKo-1 exhibited DNA fragmentation resulting in a “comet-like” DNA mobility profiles (
The reduced expression of Rad51 with K+CS treatment offers an opportunity to further enhance anti-tumor activity through Rad51 insufficiency. Since Rad51 and BRCA proteins are essential for DNA homologous recombination (HR), and BRCA deficiency can lead to synthetic lethality in malignant cells treated with Poly (ADP-ribose) polymerase (PARP) inhibitors, whether K+CS treated cells would also be sensitive to PARP inhibitors such as olaparib was evaluated. Olaparib alone or with single-agent KPT-330 or CS did not have any antitumor activity (
Given the decrease of TYMS protein expression in cell lines (
Given that gene transcription requires efficient nucleocytoplasmic transport of many regulatory proteins, the effect of K+CS treatment on global or pathway-specific gene expression was investigated. The analysis of the cellular transcriptome by RNA sequencing showed that the transcripts of the respective proteins involved in DNA damage repair, DNA synthesis and cell cycle arrest were uniquely down-regulated with K+CS treatment (
Strong antitumor effects were observed with K+CS compared to single agents or DMSO control in fresh primary patient tumor samples ex vivo (
Having demonstrated the antitumor activity of K+CS on hematologic malignancies and cell lines derived from solid tumors (
Since both KPT-330 and salicylates penetrate the blood-brain barrier, the activity of K+CS was also assessed in gliomas. Two PDX tumor samples-one aggressive fibrillary astrocytoma and one glioblastoma-were tested ex vivo and potent cytotoxicity with K+CS treatment was observed (
These results demonstrate that a KPT-330 and choline salicylate (CS) combination (K+CS) has the potential to change cancer treatment for many tumor types.
To examine the effect of selinexor on viral propagation SARS-CoV2 infected eukaryotic cells, selinexor was administered at concentrations ranging from 10 ηM to 3 μM in two settings: (a) prophylactic (pre-treatment) of cells with selinexor prior to infection and (b) concurrent treatment with selinexor at the time of infection (co-incubation).
For a prophylactic treatment, Vero (immortalized monkey cells) cells were incubated for 6 hours with selinexor at concentrations of 0, 10, 30 and 100 nM prior to viral infection for 1 hour at 37° C. and incubated for 4 days. Following this, viral titers were assessed in a standard plaque assay. For a concurrent treatment, Vero cells were infected for 1 hour at 37° C. in the presence of selinexor (0-100 nM). Cells were then incubated until analysis for 4 days.
To evaluate the immune response, cytokines were measured in cells that were treated in vitro with Selinexor+/−CS. In some experiments, tissues were obtained from a 22-year-old female, and were stimulated for 6 hours (37° C.) with 5 ng/mL PMA and 500 μg/mL ionomycin. In other experiments, cells (2×106 PBMCs) were obtained from a 61-year-old male, and were stimulated for 6 hours (37° C.) with 500 ng/mL PMA and 10 μg/mL ionomycin. Tissues or cells were then treated with KPT-300 for 6 hours (37° C.) in the presence or absence of CS (3 mM). Co-treatment with a combination of KPT-330 and CS reduced cytokine expression in cells (
The combination of selinexor with CS inhibited production of inflammatory cytokines that lead to the development of acute respiratory distress syndrome (ARDS), such as IL-1, GMCSF, TNF-alpha and IL6.
These results demonstrate that the combination of KPT-330+CS can be used to exhibit anti-inflammatory properties, and can thus be used to treat inflammation. In some cases, the combination of KPT-330+CS can be used to treat one or more diseases that are driven by and/or associated with a pro inflammatory state.
Using KPT-330 and CS together (K+CS) as a treatment for COVID-19, inhibits viral replication and decreases cytokine production, thereby simultaneously decreasing the infectivity as well as the pro-inflammatory response.
The SARS-Cov2 nucleocapsid protein is overexpressed in human cells using cDNA constructs, and the infected cells are treated with K+CS to evaluate whether the nucleocapsid protein is localized to the nucleus.
Monkey Vero E6 cells are infected with SARS-Cov2, and the infected are treated with K+CS to evaluate whether co-treatment inhibits the reproduction of the SARS-Cov2 virus.
Two cohorts of patients who are either 1) patients with mild symptoms (cohortl: outpatients), or 2) hospital patients with severe symptoms (cohort 2: patients in the hospital) are treated. Patients receive two weeks of K+CS at a dose of 20 mg three times a day of KPT-330 and 1500 mg of CS three times a day for 14 days. Primary outcome for the cohort 1 is rate of hospital admission and the primary outcome for cohort 2 is days free from respiratory failure. Rate of viral clearance, coagulopathy, antibody formation and economic analysis are also assessed as secondary outcomes.
It is to be understood that while the invention has been described in conjunction with the detailed description thereof, the foregoing description is intended to illustrate and not limit the scope of the invention, which is defined by the scope of the appended claims. Other aspects, advantages, and modifications are within the scope of the following claims.
This application claims the benefit of U.S. Patent Application Ser. No. 62/848,948, filed on May 16, 2019. The disclosure of the prior application is considered part of (and is incorporated by reference in) the disclosure of this application.
| Filing Document | Filing Date | Country | Kind |
|---|---|---|---|
| PCT/US2020/033413 | 5/18/2020 | WO | 00 |
| Number | Date | Country | |
|---|---|---|---|
| 62848948 | May 2019 | US |
