8-Chloro-Adenosine

Cholangiocarcinoma is a lethal cancer, and current chemotherapeutic drugs are not very effective. Recent studies reported that cholangiocarcinoma cells were sensitive to adenosine. One adenosine analog, 8-chloroadenosine (8-CA), was shown to be more potent than adenosine and induced apoptosis in leukemia cells. This study examined effects of 8-CA in cholangiocarcinoma cells and immortalized cholangiocytes.

Cell growth was examined by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. Cell invasion was examined by transwell assay. Cell cycle and cell death were evaluated by flow cytometry. Colorimetric absorbance assay was used to assessed RNA and protein synthesis as well as mitochondrial membrane potential. Protein levels were examined by western blot analysis. Animal experiment was performed in Balb/cAJcl-Nu mice.

8-CA reduced cholangiocarcinoma cell growth, prevented colony formation and caused endoplasmic reticulum stress and cell-cycle arrest. Eventually, apoptosis was induced. However, treatment with 8-CA did not interfere with RNA synthesis or protein synthesis and did not alter mitochondrial membrane potential. Combination of 8-CA with several chemotherapeutic drugs in vitro was less effective than 8-CA alone and the drugs alone, except for the combination of 8-CA with hydroxychloroquine, which had an additive effect on RMCCA-1 cells. However, further in vivo study showed that treatment with 8-CA alone inhibited tumor growth more than treatment with a combination of 8-CA with hydroxychloroquine.

8-Chloroadenosine inhibited CCA cells by inducing endoplasmic reticulum stress and apoptosis. In vivo study showed that 8-CA inhibited cholangiocarcinoma tumor growth better when administered alone as compared to a combination with hydroxychloroquine.

BCL‐2 inhibition through venetoclax (VEN) targets acute myeloid leukemia (AML) blast cells and leukemic stem cells (LSCs). Although VEN-containing regimens yield 60–70% clinical response rates, the vast majority of patients inevitably suffer disease relapse, likely because of the persistence of drug-resistant LSCs. We previously reported preclinical activity of the ribonucleoside analog 8-chloro-adenosine (8-Cl-Ado) against AML blast cells and LSCs. Moreover, our ongoing phase I clinical trial of 8-Cl-Ado in patients with refractory/relapsed AML demonstrates encouraging clinical benefit. Of note, LSCs uniquely depend on amino acid-driven and/or fatty acid oxidation (FAO)-driven oxidative phosphorylation (OXPHOS) for survival. VEN inhibits OXPHOS in LSCs, which eventually may escape the antileukemic activity of this drug. FAO is activated in LSCs isolated from patients with relapsed AML.

Using AML cell lines and LSC-enriched blast cells from pre-treatment AML patients, we evaluated the effects of 8-Cl-Ado, VEN and the 8-Cl-Ado/VEN combination on fatty acid metabolism, glycolysis and OXPHOS using liquid scintillation counting, a Seahorse XF Analyzer and gene set enrichment analysis (GSEA). Western blotting was used to validate results from GSEA. HPLC was used to measure intracellular accumulation of 8-Cl-ATP, the cytotoxic metabolite of 8-Cl-Ado. To quantify drug synergy, we created combination index plots using CompuSyn software. The log-rank Kaplan–Meier survival test was used to compare the survival distributions of the different treatment groups in a xenograft mouse model of AML.

We here report that VEN and 8-Cl-Ado synergistically inhibited in vitro growth of AML cells. Furthermore, immunodeficient mice engrafted with MV4-11-Luc AML cells and treated with the combination of VEN plus 8-Cl-Ado had a significantly longer survival than mice treated with either drugs alone (p ≤ 0.006). We show here that 8-Cl-Ado in the LSC-enriched population suppressed FAO by downregulating gene expression of proteins involved in this pathway and significantly inhibited the oxygen consumption rate (OCR), an indicator of OXPHOS. By combining 8-Cl-Ado with VEN, we observed complete inhibition of OCR, suggesting this drug combination cooperates in targeting OXPHOS and the metabolic homeostasis of AML cells.

Taken together, the results suggest that 8-Cl-Ado enhances the antileukemic activity of VEN and that this combination represents a promising therapeutic regimen for treatment of AML.