P-373 Melatonin and chemotherapy: does the proposed fertoprotective agent impair the anti-tumor effects of cancer therapy?
Authors: Alley A , Bold C , Letourneau J , Constance J 
Published: July 2024

Abstract

Study question
Does the proposed fertoprotective agent melatonin interfere with the anti-cancer activity of imatinib chemotherapy in a chronic myelogenous leukemia (CML) cell line?

Summary answer
At low concentrations, melatonin demonstrates mild inhibition of imatinib activity, however this is overcome at therapeutic concentrations. Melatonin also shows anti-tumor activity against CML.

What is known already
A harmful consequence of cancer therapy is a resultant loss of fertility. Pharmacologic interventions that reduce radiation or chemotherapy-induced gonadotoxicity are a major unmet medical need. Several ‘fertoprotective’ agents have shown promise in protecting the gonads from injury during treatment, including melatonin. However, melatonin is not currently applied in humans for this purpose. Key safety and efficacy data are needed to move potential fertoprotective agents into clinical trials.

Study design, size, duration
We evaluated the interaction of varying combined concentrations of melatonin and imatinib, a tyrosine kinase inhibitor, within an in-vitro matrix experiment. The interaction was be evaluated within K562, a cell line derived from human chronic myelogenous leukemia (CML). This chemotherapy and cell line were selected due to CML’s dependence on BCR-ABL for survival, which is inhibited by imatinib, permitting direct evaluation of melatonin-imatinib cross-interaction.

Participants/materials, setting, methods
K562 were seeded in 384-well plates into which increasing concentrations of imantinib and melatonin were progressively dispensed. The cells were cultured for 48 hours. Viable cell concentrations were then determined using a cell luminescent assay. Drug interaction was then determined using drug synergy analysis software.The expected drug combination responses were calculated based on ZIP reference model using SynergyFinder 3.0. Deviations between observed and expected responses with positive and negative values denote synergy and antagonism respectively.

Main results and the role of chance
Melatonin demonstrated toxicity to K562 CML cell lines independent of imatinib, with a mean inhibition of cell growth of 74.7% at 1uM, CI [69.6%, 79.7%]. This anti-tumor activity was progressively seen at concentrations &gt;0.1 uM. At low imatinib concentrations (&lt;0.2 uM), melatonin decreased the anti-cancer potency of imatinib. This effect was overcome at higher concentrations of imatinib. The overall mean synergy score was -5.87, CI [-7.145, -4.588].

Limitations, reasons for caution
These experiments were carried out in an in-vitro setting in a tightly controlled environment. In a clinical setting, the complexity of potential interactions between melatonin and chemotherapy will increase (i.e. metabolism, distribution), thus animal models will be a necessary next step of evaluation before clinical safety trials may proceed.

Wider implications of the findings
Melatonin may serve as an inexpensive, well-tolerated adjuvant to help protect the gonad from chemotherapy, while additionally exhibiting its own anti-cancer effects in certain settings. Our preliminary data suggests that the risk of melatonin to impair active imatinib treatment may be low, however continued investigation is necessary.

Trial registration number
Not applicable