Abstract B176: Synergistic induction of apoptosis by the histone-deacetylase inhibitor, Panobinostat, combined with ABT-737 or rhTRAIL, in multiple myeloma
Authors: Matthews Geoffrey M. , Shortt Jake , Banks Kellie M. , Stanley Kym , Faulkner David , Bergsagel Leif , Chesi Marta , Atadja Peter , Johnstone Ricky W. 
Published: June 2012

Abstract
Introduction:The histone deacetylase inhibitor (HDACi) Panobinostat (LBH-589, Novartis Pharmaceutical Corp) belongs to a new class of chemotherapeutics with demonstrated anticancer activities in laboratory studies and within the clinic. Using pre-clinical models of leukemia and lymphoma we have demonstrated that HDACi mediate their therapeutic effects via the intrinsic apoptosis pathway. Here we investigated the ability of Panobinostat to induce apoptosis in human multiple myeloma (MM) cell lines, alone and in combination with agents that target pro-survival Bcl-2 proteins (ABT-737) and the extrinsic apoptosis pathway (rhTRAIL). Moreover, we have used the Vk*myc murine model of MM to demonstrate the therapeutic efficacy of Panobinostat and its ability to induce apoptosis in MM cells in vivo.
Methods: JJN3, OPM-2, RPMI-8226 and U266 MM cell lines were incubated with Panobinostat, ABT-737 or rhTRAIL alone or in combination. Cell viability and cell cycle were assessed using flow cytometry. Histone acetylation was assessed by western blot. C57BL/6 mice (n = 32) bearing transplanted Vk*myc MM (2 months post-transplant) were treated with Panobinostat (25mg/kg, 4 days; 15mg/kg 5 days/week, 3 weeks) or vehicle (D5W). Serum paraprotein levels were assessed weekly in all mice. Mice were sacrificed at various time points to measure apoptotic and therapeutic effects.
Results: Treatment of MM cell lines with Panobinostat resulted in time- and dose-dependent induction of apoptosis associated with G1 phase arrest and histone H3/H4 acetylation. Combinations of Panobinostat with ABT-737 or rhTRAIL synergised to mediate robust and rapid apoptosis in the human MM cells. Serum paraprotein in mice bearing Vk*myc MM cells was significantly reduced after 4 days of high dose (25mg/ml) Panobinostat compared with vehicle treated mice (p&lt;0.01) and remained at this reduced level for the treatment period (≤60% reduction compared with vehicle treated mice). This was associated with a significant induction of apoptosis and a reduction in CD-138+ plasma cells within the bone marrow. Removal of treatment was associated with increased paraprotein levels, progression of extramedullary disease and death endpoints. Overall, Panobinostat induced a significant survival advantage compared with vehicle (median=36.5 vs. 16 days, p&lt;0.01).
Conclusions: These results suggest that the HDACi Panobinostat has single agent activity against MM cell lines in vitro and provides a significant therapeutic benefit to mice bearing syngeneic MM tumors. Moreover, combination therapies consisting of HDAC inhibitors with agents that target pro-survival Bcl-2 proteins or the TRAIL apoptosis pathway may provide a rational approach to the treatment of MM. Future studies will investigate the molecular events underpinning the effects mediated by Panobinostat, ABT-737 and TRAIL in the Vk*myc MM model.
Citation Information: Mol Cancer Ther 2009;8(12 Suppl):B176.