Paper highlight: 'Hi-JAK-ing' cancer by inhibiting Jak2 <<
"The drug worked whether they had the mutation or not"
"Can lead to low {*filter*} counts"
"Main side effect is lowered {*filter*} cell counts in some patients"
JAK inhibitor provides rapid, durable relief for myelofibrosis
patients
September 15, 2010 An {*filter*}medication produces significant and lasting
relief for patients with myelofibrosis, a debilitating and lethal bone
marrow disorder, researchers at The University of Texas MD Anderson
Cancer Center report in the Sept. 16 New England Journal of Medicine.
Myelofibrosis is caused by the accumulation of malignant bone marrow
cells that trigger an inflammatory response, scarring the bone marrow
and limiting its ability to produce {*filter*}, causing anemia.
"The problem with myelofibrosis is the lack of available therapies for
patients - there are none approved for this disease today," said
principal investigator Srdan Verstovsek, M.D., Ph.D., associate
professor in M. D. Anderson's Department of Leukemia. Average life
expectancy for people with this disease is 5 to 7 years. Available
therapies approved for other diseases provide little response and are
mainly palliative.
"This experimental drug is the first to target one of the underlying
abnormalities in the malignant cells that cause myelofibrosis,"
Verstovsek said. "It provides unprecedented reduction of enlarged
spleens that are a central characteristic of the disease, and relieves
pain, fatigue and other symptoms, improving quality of life."
Swollen spleens cause pain, malnutrition
"Interestingly, other organs, mainly the spleen, attempt to take over
the production of {*filter*} cells. Bone marrow forms in the spleen,"
Verstovsek said. Malignant cells also accumulate there. "The growing
spleen causes significant problems for the patient, and not just
because it's painful. It compresses the stomach and bowels, so
patients suffer malnutrition and lose weight. The ability to walk and
to bend is affected, and the body deteriorates overall."
End-stage patients resemble the severely malnourished, with bloated
abdomens and thin limbs. Patients on the study gained weight while on
the medication.
The phase I/II clinical trial of INCB018424, a JAK1 and JAK2 inhibitor
developed by Incyte Corp., established maximum tolerated doses and
then optimal dosing regimens for the drug, which targets abnormal
signaling caused by a specific mutation in the JAK2 gene that was
discovered in 2005 in patients with myelofibrosis.
The clinical trial began in June 2007 at MD Anderson and the Mayo
Clinic and enrolled 153 patients, all of whom had either advanced
disease or were newly diagnosed with high intermediate- or high-risk
myelofibrosis. Clinical responses have been maintained and 115
patients (75 percent) remain on the trial.
Most patients benefited, with those on optimal doses experiencing:
A median reduction in spleen volume, as measured by magnetic resonance
imaging, of 33 percent at six months, with 48 percent enjoying
reductions of 35 percent or higher. This equals a median reduction of
52 percent in the length of the spleen below the ribcage, measured by
palpation, which is how spleen size is typically measured in clinical
practice.
Swift and lasting spleen reduction; 70 percent to 82 percent of
patients on the three optimal dosing regimens had spleen reduction of
at least 25 percent that occurred within the first two months of
therapy and lasted beyond a year.
Rapid and lasting improvement in symptom score, with 51 percent of
patients achieving a 50 percent reduction at one month, and 58 percent
maintaining that reduction at six months.
Greater exercise capacity as measured in a six-minute walk. Patients
increased their distance by a median of 34 meters at one month and 71
meters at six months.
Median weight gain ranging from 14.5 pounds to 20.6 lbs after one
year.
Symptom improvement coincided with a quick and sustained reduction in
a variety of inflammatory cytokines involved in disease biology.
The main side effect is lowered {*filter*} cell counts in some patients,
which can be remedied by lower doses or temporarily halting therapy.
"The JAK2V617F mutation is one of several involved in myelofibrosis.
It's the most prevalent, found in about half of patients. But it's not
the sole cause of the disease," Verstovsek noted. "Myelofibrosis is
too complex to be eliminated by a single drug. It will probably take
combination therapies to cure it."
Normally, JAK2 is turned on by various growth factors to make new
{*filter*} cells as needed. The JAK2V617F mutation leaves the JAK2 enzyme
permanently turned on, which causes the overgrowth of bone marrow
cells at the heart of myelofibrosis.
While the JAK2 inhibitor was expected to help patients with JAK2
mutations, the drug worked whether they had the mutation or not. "This
suggests that patients who do not have specific mutations still have a
very active JAK signaling pathway and can benefit from JAK
inhibition," Verstovsek said. "However, because the drug also inhibits
normal JAK2, it can lead to low {*filter*} counts that can limit dosing."
Provided by University of Texas M. D. Anderson Cancer Center
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Quote:
> September 13, 2010 Myeloproliferative neoplasms (MPN) comprise a
> family of {*filter*} cancers characterized by clonal expansion of a single
> {*filter*} cell type.
> Untreated, these cancers can progress to bone marrow failure and acute
> myeloid leukemia.
> Several groups have identified activating mutations in the JAK2 gene
> as associated with MPN; JAK2 inhibition has therefore emerged as
> approach to MPN therapy. Thus far, however, JAK2 inhibition strategies
> have had limited efficacy and have been accompanied by significant
> toxicity.
> In this paper, Ross Levine and his group at the Memorial Sloane
> Kettering Cancer Center, New York, describe an indirect approach to
> reducing JAK2 activity by pharmacologically targeting HSP90, a protein
> that stabilizes JAK2.
> Inhibiting HSP90 normalized {*filter*} counts and improved survival in two
> mouse models of MPN, and the treatment promoted JAK2 degradation in
> samples from MPN patients.
> The authors believe that targeting HSP90, perhaps in combination with
> JAK2 inhibition, may be the way forward in the treatment of patients
> with MPN.
> More information: HSP90 is a therapeutic target in JAK2-dependent
> myeloproliferative neoplasms in mice and humans: http://www.***.com/
> 4ce9ffed3af0
> Provided by Journal of Clinical Investigation
> --------------------
> Resveratrol induces apoptosis in K562 (chronic myelogenous leukemia)
> cells by targeting a key survival protein, heat shock protein 70
> Authors: Chakraborty, Prabir K.1; Mustafi, Soumyajit Banerjee1;
> Ganguly, Sudipto2; Chatterjee, Mitali2; Raha, Sanghamitra
> Source: Cancer Science, Volume 99, Number 6, June 2008 , pp.
> 1109-1116(8)
> Publisher: Blackwell Publishing
> Abstract:
> Chronic myelogenous leukemia (CML) is a myeloproliferative disease
> associated with a characteristic chromosomal translocation called the
> Philadelphia chromosome.
> This results in the expression of the Bcr-Abl fusion protein, a
> constitutively active protein tyrosine kinase.
> Although there are a few treatment options with Bcr-Abl kinase
> inhibitors, drug resistance is often encountered.
> One of the major obstacles in overcoming drug resistance in CML is the
> high endogenous levels of heat shock protein 70 (Hsp70). Resveratrol
> is a phytoalexin produced by several plants.
> We studied the chemotherapeutic effects and mode of action of
> resveratrol on K562 (CML) cells.
> Resveratrol induced apoptosis in K562 cells in a time-dependent
> manner.
> This was established by increased annexin V binding, corroborated with
> an enhanced caspase-3 activity and a rise in the sub-G0/G1
> population.
> Resveratrol treatment also caused suppression of Hsp70 both in mRNA
> and protein levels.
> The downregulation of Hsp70 by resveratrol exposure was correlated
> with a diminished presence of heat shock factor 1 (HSF1) in the
> nucleus, and the downregulation of transcriptional activity of HSF1.
> High endogenous levels of Hsp70 have been found to be a deterrent for
> sensitivity to chemotherapy.
> We show here that resveratrol could considerably enhance the apoptosis
> induction in K562 cells by 17-allylamino-17-demethoxygeldanamycin, an
> anticancer agent that inhibits Hsp90 but augments Hsp70 levels.
> We conclude that resveratrol significantly downregulated Hsp70 levels
> through inhibition of HSF1 transcriptional activity and appreciably
> augmented the pro-apoptotic effects of 17-allylamino-17-
> demethoxygeldanamycin. (Cancer Sci 2008; 99: 1109-1116)
> Document Type: Research article
> DOI: 10.1111/j.1349-7006.2008.00809.x
> Affiliations: 1: Crystallography and Molecular Biology Division, Saha
> Institute of Nuclear Physics, 1/AF Bidhan Nagar, Kolkata-700064; 2:
> Department of Pharmacology, Institute of Post Graduate Medical
> Education and Research, 244B Acharya JC Bose Road, Kolkata-700020,
> India
> -----------------
> Researchers Show Resveratrol
> Works In The Brain By Metal Chelating Effects
> Researchers now convincingly show that, via its iron-chelating
> effects, resveratrol is able to cross barriers that protect the brain
> from entry of toxins ({*filter*}/brain barrier) and reduce oxidation
> (spoilage) of fats and increase the activity of protective
> antioxidant
> enzymes in the brain of healthy rodents.
> The research has application for age-related brain disorders such as
> Alzheimer's and Parkinson's disease.
> Resveratrol decreased malondialdehyde (an end product of oxidation of
> fats) in brain tissues by -300%. Doses ranging (in human equivalents)
> from 87.5 to 875
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