Abstract A30: Alisertib acts synergistically with sonidegib by modulating primary cilia assembly in a pediatric RELA ependymoma cell line
Authors: de Almeida Magalhães Taciani , Cruzeiro Gustavo Alencastro Veiga , Borges Kleiton Silva , Yulu Cherry Liu , de Souza Graziella Ribeiro , da Silva Keteryne Rodrigues , Scridelli Carlos Alberto , Salic Adrian , Tone Luiz Gonzaga 
Published: August 2020

Abstract
Introduction: Recently we found that RELA ependymomas (EPN) demonstrate inappropriate activation of the Hedgehog (Hh) pathway. However, how this activation is modulated remains to be investigated. Primary cilia are essential to positive and negative modulation of Hh signaling and changes in ciliation seem to be linked to Hh drug resistance in pediatric cancers. In contrast, targeting cilia integrity by molecules that prevents ciliary disassembly, such as Aurora-A (AURKA), has been shown to overcome this resistance. However, the role of the Hh pathway and the prevalence and function of cilia in pediatric RELA ependymoma (EPN) subgroup have not been examined. Thus, we explored the effect of Hh inhibitor, sonidegib, alone or in combination with Alisertib, AURKA inhibitor, in EPN RELA cell line.
Methods: Hh pathway activation of RELA cell line (BXD-1425) was evaluated by immunostaining using ARL13B, a marker specific for ciliary membranes, proto-oncogene Smoothened (SMO) and Hh effector, GLI, antibodies in untreated cells or after stimulation with SMO agonist (SAG). Western blot was performed for protein expression of GLI1, GLI2, and full-length (FL) and repressor form (R) of Hh transcriptional program GLI3. Cell proliferation was assessed by CCK8 assay. Cell apoptosis was detected with Annexin V-FITC by flow cytometry.
Results: We showed that EPN RELA cell line is frequently ciliated. Fluorescence intensity showed SMO and GLI recruitment to cilia in both BXD untreated cells and after stimulation with SAG, implicating in activation of Hh signals. Surprisingly, sonidegib treatment reduced ciliary formation in BXD cell line. Cilia loss was followed by increase of GLI recruitment to cilia and GLI2 expression, potentially by reduction of GLI3R. Our results indicate that impaired GLI processing probably by cilia disruption could explain persistent activation of downstream Hh pathway. To test this hypothesis, we targeted the cilia integrity through the combination of sonidegib with alisertib, to see if the cilia maintenance might affect Hh function and overcome sonidegib resistance. The combination prevented the primary cilia disruption followed by upregulation of GLI3R and downregulation of GLI recruitment to cilia, GLI2, and GLI3FL expression. Our data point towards to a synergistic combination that enhances sonidegib efficiency by primary cilia preservation, reducing cell proliferation and increasing apoptosis BXD cells compared to drugs alone treatment.
Conclusion: Our findings suggest a synergistic combination of sonidegib with alisertib that enhances the inhibition of Hh major effectors such as GLIs (GLI2 and GLI3FL) and induces GLI3R expression. Our data suggest that combination of these agents may represent a novel approach for treatment of ST-EPN-RELA tumors to overcome chemoresistance and these mechanisms are potentially mediated by primary cilia, a key regulator for Hh activity.
Citation Format: Taciani de Almeida Magalhães, Gustavo Alencastro Veiga Cruzeiro, Kleiton Silva Borges, Cherry Liu Yulu, Graziella Ribeiro de Souza, Keteryne Rodrigues da Silva, Carlos Alberto Scridelli, Adrian Salic, Luiz Gonzaga Tone. Alisertib acts synergistically with sonidegib by modulating primary cilia assembly in a pediatric RELA ependymoma cell line [abstract]. In: Proceedings of the AACR Special Conference on the Advances in Pediatric Cancer Research; 2019 Sep 17-20; Montreal, QC, Canada. Philadelphia (PA): AACR; Cancer Res 2020;80(14 Suppl):Abstract nr A30.