Neuroblastoma (NB), the most frequent extracranial solid tumor of children, derives from immature sympathetic neuronal cells. NB accounts for 10% of all childhood cancers and nearly 15% of all childhood cancer mortality.
1-3 These pediatric solid tumors, which begin in early childhood, show extreme heterogeneity at the clinical, histological, and genetic levels. Among the diversity of genetic variations,
MYCN amplification is a genetic hallmark of the disease and an independent marker of dismal prognosis.
4 A panel of prognostic factors, including age at diagnosis, tumor burden, histopathology, DNA index, and
MYCN status, is used to determine risk categories.
5 In a recent study, genome analyses have been used for the genomic stratification of all clinical forms of NB at diagnosis.
6 About half of NBs are considered high risk at diagnosis. These consist of
MYCN-amplified NB as well as stage 4 NB in patients older than 12 months. High-risk NB (HR-NB) patients are characterized by distant metastases and an aggressive course with bleak prognosis. Numerous studies have been conducted to identify the genes involved in the aggressive forms of this disease, but only about 25 genes, including
MYCN, have been proven or are likely to be involved in NB tumorigenesis, invasion, and dissemination.
4,7,8 From a mechanistic viewpoint, HR-NB, albeit harboring wild-type p53,
9 are unable to undergo apoptosis, show a marked defect of caspase 8,
10 and elicit specific survival mechanisms.
11 Most HR-NB patients will have poor prognoses (about 25% overall survival at 5 years) despite intensive high-dose and myeloablative chemotherapy, as well as a rescue therapy involving autologous hematopoietic stem cell transplantation, followed by a maintenance regimen of 13-cis-retinoic acid.
12 As conventional, intensive multimodal therapies are insufficient for HR-NB,
13 there is a strong need for new first-line molecular-based therapeutic approaches.
Among the 518 human kinases, cyclin-dependent kinases (CDKs) have been extensively studied because of their key functions in fundamental cell processes such as regulation of cell division and cell death.
13,14 Numerous abnormalities in the regulation and activity of CDKs have been observed in cancers, and this has encouraged the search for, as well as optimization and detailed characterization of, pharmacological inhibitors of CDKs as potential anticancer agents (reviews in references 14-19). Over 140 CDK inhibitors have been described, and 10 of these are currently undergoing phase 1 or phase 2 clinical investigation.
18,19 Among these, the 2,6,9-trisubstituted purine (R)-roscovitine (CYC202, seliciclib)
20 (reviews in references 21-23) is in late phase 2 trials against non–small cell lung cancer and nasopharyngeal cancer.
24,25 However, its short half-life, its inactivating metabolism,
26-28 and its rather weak potency on CDKs and cell lines and, as a consequence, the large quantities required to treat patients constitute limiting factors in its clinical use. Thus, second-generation analogs of roscovitine, in which improved potency would be combined with the rather good selectivity and limited toxicity of roscovitine, are needed. In this context, we have explored the purine scaffold and its analogs rather extensively. These efforts have led to the identification of the CR8 series, a family of compounds with improved potency at inducing cell death.
29,30 Despite modest improvement in its activity as a CDK inhibitor, (S)-CR8 induces apoptotic cell death with about 50- to 200-fold enhanced potency compared to (R)-roscovitine. Deciphering the molecular mechanism of action of such potent compounds may afford an innovative approach to the treatment of HR-NB, which is well known for being refractory to apoptosis.
Roscovitine and other CDK inhibitors have been shown to trigger rapid down-regulation of the survival factor Mcl-1 (myeloid cell leukemia 1) in chronic lymphocytic leukemia,
31-33 multiple myeloma,
34,35 and nasopharyngeal carcinoma.
36 Mcl-1 is an antiapoptotic Bcl-2 family member that is highly expressed in numerous tumor cells but poorly or not at all expressed in normal cells (reviews in references 37-39). Mcl-1 is a very short-lived protein that is rapidly degraded by an ubiquitin-dependent pathway. Increased levels of the deubiquitinase USP9X and subsequent stabilization of Mcl-1, resulting in abnormally high levels of Mcl-1, strongly contribute to tumor cell survival.
40 Recent observations have shown a correlation between high expression of Mcl-1 and Bcl-2 and HR-NB.
41 RNA interference experiments showed that Mcl-1 knockdown induced apoptosis in NB cell lines and sensitized them to cytotoxic chemotherapy.
41 These results prompted us to investigate the effects of CDK inhibitors on Mcl-1 expression in NB cells. We here report that CDK inhibitors trigger rapid and extensive down-regulation of Mcl-1 expression in NB cells, followed by transient free Noxa up-regulation and cell death. Mcl-1 down-regulation is seen in all NB cell lines investigated, independently of their p53 and MYCN status. Mcl-1 down-regulation by CDK inhibitors may thus constitute a new therapeutic approach to be investigated further in HR-NBs. This is particularly well supported by the recent discovery that inactivation of CDK2 is synthetically lethal to MYCN overexpressing cancer cells.
42