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The IRE1α-XBP1 pathway, a key component of the endoplasmic reticulum (ER) stress response, is considered to be a critical regulator for survival of multiple myeloma (MM) cells. Therefore, the availability of small-molecule inhibitors targeting this pathway would offer a new chemotherapeutic strategy for MM. Here, we screened small-molecule inhibitors of ER stress-induced XBP1 activation, and identified toyocamycin from a culture broth of an Actinomycete strain. Toyocamycin was shown to suppress thapsigargin-, tunicamycin- and 2-deoxyglucose-induced XBP1 mRNA splicing in HeLa cells without affecting activating transcription factor 6 (ATF6) and PKR-like ER kinase (PERK) activation. Furthermore, although toyocamycin was unable to inhibit IRE1α phosphorylation, it prevented IRE1α-induced XBP1 mRNA cleavage in vitro. Thus, toyocamycin is an inhibitor of IRE1α-induced XBP1 mRNA cleavage. Toyocamycin inhibited not only ER stress-induced but also constitutive activation of XBP1 expression in MM lines as well as primary samples from patients. It showed synergistic effects with bortezomib, and induced apoptosis of MM cells including bortezomib-resistant cells at nanomolar levels in a dose-dependent manner. It also inhibited growth of xenografts in an in vivo model of human MM. Taken together, our results suggest toyocamycin as a lead compound for developing anti-MM therapy and XBP1 as an appropriate molecular target for anti-MM therapy.
Multiple myeloma (MM) is a hematological malignancy characterized by the accumulation of clonogenic mature plasma cells in bone marrow. Recently, bortezomib (BTZ), a proteasome inhibitor, was approved by the Food and Drug Administration for the treatment of MM. However, BTZ treatment often achieves only very short-duration responses and drug resistance tends to develop rapidly.1, 2 Therefore, there is a need to develop novel molecular targets for new therapeutic approaches.
Recent studies have suggested that XBP1, a basic region/leucine zipper (bZIP) transcription factor of the CREB-ATF family, has an important role in the survival of MM cells. XBP1 is required for the terminal differentiation of B lymphocytes to plasma cells and is essential for immunoglobulin secretion.3, 4 Abundant or deregulated expression of XBP1 has been detected in MM cells5, 6 and in hepatocellular carcinomas.7, 8 Because of the production of abundant immunoglobulins and cytokines, MM cells must be able to survive under conditions of chronic endoplasmic reticulum (ER) stress. This involves the unfolded protein response (UPR) including activation of the IRE1α-XBP1 pathway. In addition, MM cells are located in the bone marrow milieu, which is usually considered hypoxic compared with other organs.9, 10 Therefore, MM cells have to survive and grow even at low oxygen, with poor nutrition and adverse pH in vivo. Thus, MM cells need to possess mechanisms to protect against ER stress. Among the UPR in MM cells, the IRE1α-XBP1 pathway has been implicated in the proliferation and survival of MM cells to a greater extent than in monoclonal gammopathy of undetermined significance or normal plasma cells.11 It has been reported to be a prognostic factor12 and could be a target for immunotherapy13 or chemotherapy.14 Based on previous reports, it is proposed that an inhibitor of IRE1α-XBP1 activation should be a potent therapeutic agent for MM.
The transcriptional activity of XBP1 is regulated by ER-located transmembrane kinase/endoribonuclease (RNase) protein IRE1α. Recent studies have proposed a model of ER stress-induced IRE1α activation and subsequent XBP1 activation as follows: (1) accumulation of unfolded proteins triggers oligomerization of luminal domains of IRE1α.15 (2) Oligomerization of IRE1α causes trans-auto-phosphorylation of the kinase activation loop domain, which leads to a conformational change.16, 17, 18, 19 (3) This conformational change permits cofactor (ADP) binding,16, 20 promoting back-to-back dimer configuration of cytosolic domains.21 (4) The oligomerization of cytosolic domains activates the RNase activity of IRE1α which subsequently cleaves XBP1 mRNA at two sites to initiate an unconventional splicing reaction.21 (5) IRE1α-induced cleavage of XBP1 mRNA results in the removal of a 26-nucleotide intron and the 5′ and 3′ fragments are subsequently joined by RNA ligase activity. This unconventional splicing reaction creates a translational frame shift to produce an active XBP1 transcription factor.22, 23
Previously, we reported a novel screening system for inhibitors of XBP1 activation, using luciferase reporter signals in HeLa/XBP1-luc cells.24 In the present study, we identified toyocamycin25 as an XBP1 inhibitor in the culture broth of an Actinomycete strain using this screening system (Figure 1a). We observed that toyocamycin inhibited IRE1α-induced ATP-dependent XBP1 mRNA cleavage in vitro without affecting IRE1α auto-phosphorylation. Moreover, this compound markedly inhibited not only ER stress-induced but also constitutively activated IRE1α-XBP1 pathway both in MM cell lines and primary MM cells, resulting in strong cytotoxic activity.
Human epithelial adenocarcinoma HeLa cells and previously generated HeLa/XBP1-luc cells24 were cultured in DMEM supplemented with 10% FBS. Human MM and other hematological cell lines were cultured in RPMI-1640 supplemented with 10% FBS. Human fibrosarcoma HT1080 was cultured in EMEM supplemented with 2m glutamine, 1% non-essential amino acids and 10% FBS. A BTZ-resistant MM cell lines, KMS-11/BTZ and OPM-2/BTZ, were established from the parental line, KMS-11 and OPM-2, respectively, under continuous exposure to BTZ over a half year.26 Toyocamycin, sangivamycin, tubercidin, tunicamycin, 2-deoxyglucose and 5-fluorouracil were purchased from Sigma-Aldrich (St Louis, MO, USA). Thapsigargin was purchased from Santa Cruz Biotechnology (Santa Cruz, CA, USA). BTZ was purchased from Toronto Research Chemicals (North York, ON, Canada).
Nine primary MM specimens derived from eight patients with symptomatic MM were obtained after written informed consent at Nagoya City University Hospital. The assay protocols using patient samples were approved by the Institutional Ethical Committee. MM cells were purified from the marrow mononuclear cell fraction or pleural effusion using anti-CD138 antibody-coated beads with the aid of an automatic magnetic cell sorting system (Miltenyi Biotec, Auburn, CA, USA).26
The culture broth (3l) of Streptmyces sp. 1893-56 was extracted with EtOAc, filtered and concentrated in vacuo. This suspension was extracted with hexane, and the insoluble fraction concentrated. The active fractions were then collected and further isolated by silica gel column chromatography (Silica gel 60, 60–230μm; Merck, Darmstadt, Germany) using a CHCl3-MeOH stepwise system. As a result, we obtained 5mg of active compound. The UV spectrum, HRESI-MS measurement, and 1H NMR spectra of this active compound confirmed its identity as toyocamycin.
As previously reported,24 HeLa/XBP1-luc cells were seeded into 96-well plates at 2 × 104cells/well, and then incubated with 0.1μ of thapsigargin together with or without test compounds. After 24h of incubation, the cells were lysed in Passive lysis buffer (Promega, Madison, WI, USA), and luciferase activity measured using the luciferase assay system (Promega) and a luminometer (Wallac, PerkinElmer, Waltham, MA, USA). IC50 values were determined from the dose–response curves of the inhibition of XBP1-luciferase activity, setting the result of thapsigargin treatment as 100%.
HeLa cells and MM cell lines were incubated with test compounds for 4 or 6h together with the ER stress inducers thapsigargin, tunicamycin, or 2-deoxyglucose. Briefly, total RNA was extracted from HeLa cells using TRIzol reagent (Invitrogen, Carlsbad, CA, USA). Aliquots of 2μg of total RNA were treated with M-MLV reverse transcriptase (Promega) to produce first-strand complementary DNA (cDNA). For RT-PCR analysis, this first-strand cDNA was subjected to PCR with KOD plus polymerase (Toyobo, Osaka, Japan) using a pair of primers corresponding to nucleotides 505–525 and 609–629 of XBP1 cDNA. The amplified products were separated by electrophoresis on an 8% polyacrylamide gel and visualized by ethidium bromide staining.
For real-time RT-PCR analysis, the synthesized first-strand cDNA was amplified in triplicate using SYBR Premix ExTaq (TaKaBaBio, Shiga, Japan), and the products were detected on a MiniOpticon system (Bio-Rad, San Diego, CA, USA). PCRs were incubated for 10s at 95°C followed by 45 amplification cycles with 3s denaturing at 95°C, 10s annealing at 60°C and 10s extension at 72°C. The primers designed for quantitative real-time RT-PCR analysis were as follows: for GRP78, 5′-GCGCATGAAGGAGAAAGAAC-3′ and 5′-TCACCATTCGGTCAATCAGA-3′ for ERdj4, 5′-AAAATAAGAGCCCGGATGCT-3′ and 5′-CGCTTCTTGGATCCAGTGTT-3′ for EDEM, 5′-TGGACTGCAGGTGCTGATAG-3′ and 5′-GGATTCTTGGTTGCCTGGTA-3′ and for GAPDH, 5′-AGGTCGGAGTCAACGGATTT-3′ and 5′-TAGTTGAGGTCAATGAAGGG-3′. Specificity of the PCR was evaluated by analyzing melting curves and sequences of the amplicons.
For the detection of spliced XBP1 isoform or all forms (spliced and unspliced), primer sets and Taqman probes were purchased from Applied Biosystems (Foster City, CA, USA). Quantitative PCR was performed using Taqman Gene Expression Assays and a StepOnePlus real-time PCR instrument according to the manufacturer's instructions.
Western blotting was performed as described.27 Primary antibodies used were: anti-KDEL from Enzo LifeScience (Farmingdale, NY, USA); anti-ATF6, anti-actin and anti-XBP1 from Santa Cruz Biotechnology; anti-phospho-eIF2α (Ser51) and anti-eIF2α and anti-IRE1α from Cell Signaling (Boston, MA, USA); anti-tubulin and anti-FLAG (M2) from Sigma (St Louis, MO, USA); anti-phospho-Ser724-IRE1α from Novus Biologicals (Littleton, CO, USA).
In vitro XBP1 mRNA cleavage assays were performed as described previously.28 Briefly, 337-nucleotide RNA substrate (XBP1(266-602) RNA) consisting of the XBP1 intron (26 nucleotides) flanked on both sides by truncated exon sequences (228 nucleotides on the 5′ side and 83 nucleotides on the 3′ side), which contained the minimum sequence for ER stress-induced XBP1 splicing, was prepared by in vitro transcription using T7 RNA polymerase. N-terminally FLAG-tagged human IRE1α(467-977) was prepared by immunoprecipitation with anti-FLAG antibody from 293T cells transiently transfected with pCAX-FLAG-IRE1α(467-977) plasmid. The IRE1α(467-977)-induced XBP1(206-602) mRNA cleavage reaction was performed in the presence of 100μ ATP. RNA fragments were resolved on a 7 urea 6% PAGE gel and stained with ethidium bromide.
After exposure to toyocamycin or BTZ, apoptotic cells were evaluated using the Annexin V-FITC Apoptosis Detection Kit I (BD Pharmingen, Franklin Lakes, NJ, USA). The cell proliferation assay has been described previously.26 The percentage of specific apoptosis was calculated as follows: % specific apoptosis=(% AnnexinV-positive cells−% spontaneous AnnexinV-positive cells)/(100−% spontaneous positive cells) × 100.
Cell proliferation assays of the MM cell lines, primary MM cells from patients and peripheral blood mononuclear cell (PBMC) from healthy individuals exposed to various concentrations of toyocamycin for 24h were performed using the CEllTiter 96 AQueous One Solution Cell Proliferation Assay Kit (Promega) as described previously.26 The mean of three determinations at each concentration of BTZ was calculated, and IC50 values were obtained using XLfit 4.2 curve fitting software for Excel (ID Business Solutions Inc., Alameda, CA, USA).
Animal studies were performed in conformity with the UK Coordinating Committee on Cancer Research Guidelines for the Welfare of Animals in Experimental Neoplasia (second edition). The study method was described previously.29 Briefly, 0.5 × 107 RPMI8226 cells were inoculated subcutaneously into SCID mice previously administered with rabbit antiasialo-GM1 intraperitoneally (Wako Pure Chemical Industries, Osaka, Japan) 1 day before tumor inoculation. At 10 days after tumor inoculation, the tumor-bearing mice were divided into four groups of five mice each, such that the mean tumor volumes were approximately equal in the four groups. Tumor volume was calculated by the following formula: tumor volume (mm3)=0.5 × (major diameter) × (minor diameter)2. Mice were treated by intraperitoneal injection of 0.5mg/kg toyocamycin twice weekly, 1.0mg/kg toyocamycin once weekly, or 1.0mg/kg BTZ twice weekly for 2 weeks. Volumes of tumors in toyocamycin-treated mice were compared with untreated or BTZ-treated animals during the treatment period.
The significance of differences in tumor volume between toyocamycin-treated mice and others were examined with the Mann–Whitney U-test. Data were analyzed with the aid of StatView software ver. 5.0 (SAS Institute, Cary, NC, USA). In this study, P<0.05 was considered significant.
Previously, we established a screening system for inhibitors of ER stress-induced XBP1 activation and identified the new active small molecules trierixin and quinotrierixin.24, 30 In the course of further screening for an inhibitor of ER stress-induced XBP1 activation, we isolated toyocamycin25 from a culture broth of an Actinomycete strain (Figure 1a). As shown in Figure 1b, 0.1μ thapsigargin, an inhibitor of the ER calcium pump (SERCA), elevated XBP1-luciferase activity about 2.5-fold more than the control in HeLa/XBP1-luc cells. Toyocamycin suppressed thapsigargin-induced XBP1-luciferase activation in a dose-dependent manner with an IC50 value of 0.08μ. To examine whether toyocamycin also inhibited thapsigargin-induced endogenous XBP1 mRNA splicing in HeLa cells, we next performed RT-PCR analysis of RNA isolated from toyocamycin-treated or -untreated HeLa cells. As shown in Figure 1c, toyocamycin suppressed thapsigargin-induced XBP1 mRNA splicing in a dose-dependent manner with an IC50 value of 0.18μ. Furthermore, toyocamycin also suppressed tunicamycin, a N-glycosylation inhibitor, or 2-deoxyglucose, a hypoglycemia-mimicking agent, -induced XBP1 mRNA splicing with an IC50 value of 0.13μ and 0.11μ, respectively (Figure 1c). These results show that toyocamycin inhibits ER stress-induced XBP1 mRNA splicing.
Because previous studies have reported that toyocamycin inhibits RNA synthesis in mammalian cells,31, 32 we tested whether its inhibitory activity on ER stress-induced XBP1 mRNA splicing was due to the inhibition of RNA synthesis. As shown in Figure 1d, toyocamycin suppressed incorporation of [3H]-uridine into the macromolecular fraction of HeLa cells in a dose-dependent manner with an IC50 value of 12μ without affecting incorporation of [3H]-thymidine or [3H]-leucine. This indicates that toyocamycin inhibits RNA synthesis in HeLa cells. However, the IC50 value of toyocamycin for RNA synthesis is much higher than for ER stress-induced XBP1 mRNA splicing. On the other hand, actinomycin D, a well-known RNA synthesis inhibitor, also blocked the incorporation of [3H]-uridine into HeLa cells in a dose-dependent manner with an IC50 value of 0.06μ. However, as shown in Figure 1e, actinomycin D did not suppress thapsigargin-induced XBP1 mRNA splicing even at 0.1μ (which caused 80% inhibition of RNA synthesis). These results indicate that actinomycin D does not inhibit ER stress-induced XBP1 mRNA splicing. Therefore, we conclude that the inhibitory activity of toyocamycin on ER stress-induced XBP1 mRNA splicing is not due to the inhibition of RNA synthesis.
We next investigated whether sangivamycin or tubercidin, a small molecule structurally related to toyocamycin (Figure 1a), also inhibited ER stress-induced XBP1 activation. As shown in Table 1, sangivamycin and tubercidin inhibited thapsigargin-induced XBP1-luciferase activation in a dose-dependent manner with IC50 values of 0.5 and 0.34μ, respectively. Furthermore, sangivamycin and tubercidin also inhibited thapsigargin-induced endogenous XBP1 mRNA splicing evaluated by RT-PCR analysis (data not shown). On the other hand, 5-Aza-2-deoxycytidine (5Aza-C), a cytidine analog, or 5-fluorouridine, a uridine analog, neither inhibited thapsigargin-induced XBP1-luciferase activation nor endogenous XBP1 mRNA splicing even at 100μ (Table 1 and data not shown). These results suggest that the adenine moiety of toyocamycin is important for inhibition of XBP1 activation.
We next examined the effect of toyocamycin on the transcriptional activity of XBP1. Consistent with the regulation of transcription of EDEM and ERdj4 by the IRE1-XBP1 pathway,33, 34 toyocamycin suppressed tunicamycin-increased EDEM and ERdj4 mRNA with an IC50 of 0.079 and 0.172μ, respectively (Figure 2a). These results suggest that toyocamycin might be inhibiting the transcriptional activity of XBP1 due to inhibition of ER stress-induced XBP1 mRNA splicing. On the other hand, because ER stress activates the three ER transmembrane proteins, IRE1, ATF6 and PERK, we also investigated whether toyocamycin inhibited ER stress-induced activation of ATF6 and PERK. ATF6 is constitutively synthesized as a type-II transmembrane protein in the ER.35 This membrane-bounded precursor form, designated as pATF6(P), is transported to the Golgi apparatus in response to ER stress, where it is cleaved by the sequential actions of Site-1 and Site-2 proteases.36, 37, 38, 39 The cytoplasmic region of ATF6 thus liberated from the membrane is translocated into the nucleus, where it functions as an active transcription factor. PERK is a serine–threonine protein kinase that phosphorylates eukaryotic initiation factor-2α (eIF2α) on Ser51.40, 41 Therefore, we assessed ATF6 activation and PERK activation by measuring the amount of the precursor form of ATF6 (pATF6(P)) and the phosphorylation of eIF2α on Ser51, respectively. As shown in Figure 2b, tunicamycin decreased the 90kDa membrane-bound precursor form of ATF6 (pATF6(P)) and phosphorylated eIF2α on Ser51, indicating that it activated both ATF6 and PERK. However, toyocamycin inhibited neither the tunicamycin-induced decrease of pATF6(P) nor phosphorylation of eIF2α on Ser51. These results indicate that toyocamycin selectively inhibits the ER stress-induced activation of the IRE1α-XBP1 pathway.
We next investigated the mechanism by which toyocamycin inhibits ER stress-induced activation of the IRE1α-XBP1 pathway. Overexpression of IRE1α has been reported to lead to IRE1α homo-oligomerization, which occurs without accumulation of unfolded proteins in the ER or GRP78 dissociation from IRE1α.42, 43 Indeed, as shown in Figure 2c, overexpression of IRE1α induced Ser724 phosphorylation and XBP1 mRNA splicing even under normal conditions in 293T cells transiently transfected with pcDNA3-IRE1α-FLAG plasmid. Although toyocamycin did not affect the Ser724 phosphorylation of IRE1α, it inhibited IRE1α overexpression-induced XBP1 mRNA splicing in a dose-dependent manner. On the other hand, toyocamycin inhibited IRE1α (467-977)-induced XBP1 mRNA cleavage in vitro (Figure 2d). Thus, these results indicate that toyocamycin inhibits IRE1α-induced XBP1 mRNA cleavage.
As shown in Figure 3a, most MM cell lines have activated XBP1 protein expression, represented as the overexpression of spliced XBP1 isoform, whereas non-MM cells including other hematological malignant and solid tumor cells have little activation of XBP1. This suggests that the IRE1α-XBP1 pathway is constitutively active in MM cells but not in non-MM cells. Among 10 MM cell lines, 7 MM cells including FR4, RPMI8226, XG7, OPM-2, ILKM2, ILKM8 and AMO1 express high levels of spliced-XBP1, whereas other 3 including U266, KMS-11 and SKMM1 express relatively lower levels.
We next tested the influence of toyocamycin on the constitutive activation of XBP1 in MM cell lines. After treatment with 10n or higher concentrations of toyocamycin, the levels of spliced isoform of XBP1 protein in RPMI8226 cells declined and resulted in caspase activation (Figure 3b). The level of spliced-XBP1 mRNA in RPMI8226 cells decreased at 6h after exposure to 100n toyocamycin (Figure 3c). The protein levels of spliced-XBP1 also decreased by toyocamycin treatment, whereas phosphorylated levels of IRE1α remained unchanged. A similar reduction in the levels of spliced-XBP1 following toyocamycin treatment was also confirmed in two other MM cell lines, such as XG7 and U266, harboring high or low active XBP1 expression at baseline, respectively (Figure 3d). Furthermore, toyocamycin inhibited thapsigargin-induced expression of spliced XBP1 protein without affecting IRE1α phosphorylation on Ser724 (Supplementary Figure 3).
Two MM cell lines with highly expressed spliced-XBP1, including RPMI8226 and XG7, showed robust dose-dependent apoptosis after exposure to various concentrations of toyocamycin for 24h, as assessed by the number of Annexin V-positive cells (Figure 3e). These cells showed marked apoptosis at 30n or higher concentrations of toyocamycin, whereas U266 cells with relatively low spliced-XBP1 expression showed mild apoptosis compared with that of RPMI8226 and XG7.
We then evaluated the growth inhibitory effect of toyocamycin on seven MM cell lines with high spliced-XBP1 expression, three MM cell lines with low spliced-XBP1 expression and four non-MM cell lines. All MM cells with high spliced-XBP1 expression showed remarkable decline in cellular viability at 30n or higher concentrations of toyocamycin (Figure 4a, left) than the other MM cells with low spliced-XBP1 expression (Figure 4a, middle). Most non-MM cells showed the subtle reduction in cellular viability even at the higher concentrations of toyocamycin (Figure 4a, right). The mean IC50 values of toyocamycin on two MM cell groups, each having high or low spliced-XBP1 expression were 17.69±2.78 and 88.57±38.31n, respectively, and this difference was considered statistically significant (P=0.016) (Figure 4b).
Two BTZ-resistant MM cell lines, KMS-11/BTZ and OPM-2/BTZ showed a little apoptosis progression even in the presence of 10 or 30n of BTZ, at which most MM cell lines including parental cells of these resistant ones were induced to marked apoptosis. However, they showed remarkable apoptosis in the presence of 30 or 100n of toyocamycin (Figure 4c).
At suboptimal concentrations toyocamycin mediated a little apoptosis induction (Figure 3e) in MM cells. However, treatment with 5 or 10n toyocamycin together with 6n BTZ-mediated additive or synergistic cytotoxicity in RPMI8226 cells (Figure 4d).
Most freshly prepared primary MM cells had activated XBP1 expression, represented as a high ratio of XBP1-spliced isoform: all isoforms (1.74:3.43; median 2.48), although the mRNA levels are similar to those in healthy donor control PBMC (Figure 5a). The relative amount of spliced-XBP1 mRNA in five MM samples (#2, #4, #5, #8 and #9), which was quantitated by real-time PCR method, decreased after 6h exposure to toyocamycin (Figure 5b). Most of the primary MM cells were sensitive to 10n BTZ (17.1–106.8; median 48.8) and they also showed dose-dependent reduced viability following toyocamycin treatment (Figure 5c). Of nine MM samples, sample no. 4 was derived from the pleural effusion of a patient with MM refractory to BTZ; these tumor cells were resistant to BTZ in vitro. Nonetheless, toyocamycin was also cytotoxic for these cells (Supplementary Figure 4). In contrast, toyocamycin showed little cytotoxicity against healthy PBMC even at higher concentrations for 24h (Figure 5d). Three primary MM samples (#5, #8 and #9) with sufficient cell numbers for protein analysis, showed reduction in activated (spliced) XBP1 protein after 6h treatment with toyocamycin (Figure 5e). As in the MM cell lines, the phosphorylation status of IRE1α was not affected by toyocamycin.
To evaluate in vivo efficacy of toyocamycin on MM cells, SCID mice subcutaneously inoculated with RPMI8226 were treated with twice- or once-weekly intraperitoneal toyocamycin at either 0.5 or 1.0mg/kg. In addition, the combination treatment of toyocamycin with BTZ was tested. Toyocamycin alone showed robust anti-tumor activity resulting in smaller tumor volumes compared with controls on day 15. This was similar to the effect of BTZ (Figures 6a and b). No obvious difference in tumor inhibitory effect was seen on twice- or once-weekly injection of toyocamycin.
The combination treatment of BTZ with toyocamycin, either at 0.5mg/kg or 1.0mg/kg, showed a trend toward enhancing anti-tumor activity represented as smaller tumor volumes when compared with BTZ or toyocamycin alone (Figures 6a and b).
Several lines of evidence suggest the importance of the IRE1α-XBP1 pathway in tumor progression, adaptation to the hypoxic tumor microenvironment, as a prognostic marker and a potential therapeutic target in both solid tumors and MM. Here, we identified toyocamycin as an inhibitor of both ER stress-induced and constitutive activation of the IRE1α-XBP1 pathway in MM cells, and showed that it exerted synergistic or at least additive anti-tumor effects with BTZ. Furthermore, it induced marked apoptosis of primary MM cells as well as MM cell lines without showing any cytotoxicity to PBMCs from healthy donors. This anti-tumor effect was also confirmed in a mouse model in vivo.
Previously, toyocamycin was reported to inhibit RNA synthesis and ribozyme function.31, 32, 44 This raised the possibility that it inhibited ER stress-induced XBP1 mRNA splicing and transcription of EDEM and ERdj4 genes through RNA synthesis inhibition. However, comparing the IC50 values of toyocamycin on RNA synthesis, ER stress-induced XBP1 mRNA splicing and transcription of UPR target genes revealed that its inhibitory activity on ER stress-induced XBP1 mRNA splicing and transcription of EDEM and ERdj4 genes was much stronger than the RNA synthesis blockade effect. Furthermore, although 100n actinomycin D completely inhibited both RNA synthesis (Figure 1d) and ER stress-induced transcription of GRP78 (Supplementary Figure 1), it did not inhibit ER stress-induced XBP1 mRNA splicing (Figure 2b). These results support the notion that the inhibitory activity of toyocamycin on RNA synthesis is not responsible for inhibition of XBP1 mRNA splicing and transcription of EDEM and ERdj4 genes. On the other hand, toyocamycin has also been reported to inhibit kinase activities, such as PKC,45 cdc246 or PI4K.47 Considering the structure of toyocamycin and its analogs, it was also predicted that it would inhibit IRE1 auto-phosphorylation. However, it inhibited IRE1 phosphorylation on Ser724 not only in IRE1-overexpressing 293T cells (Figure 2c) but also in MM cell lines (Figures 3c and and5e).5e). Recent studies have suggested that the trigger for IRE1 endoribonuclease activity is not phosphorylation but a conformational change in the kinase domain induced by cofactor (ATP or ADP) binding. Therefore, it is likely that toyocamycin inhibits IRE1α-induced XBP1 mRNA cleavage through a cofactor-induced conformational change of IRE1α rather than inhibition of IRE1α auto-phosphorylation.
Previous studies have suggested that the IRE1α-XBP1 pathway has a critical role in ER stress-induced cytoprotection. 1NM-PP1, a small molecule selectively activating the IRE1α(I642G) mutant,18 protected cells from tunicamycin- or thapsigargin-induced cell death.48, 49 In contrast, overexpression of dominant-negative XBP1 or knockdown of XBP1 has been reported to enhance tunicamycin-induced apoptosis.50 Consistent with previous reports, we also found that toyocamycin synergistically induced cell death in ER-stressed HeLa, HT29 and HCT116 cells (Supplementary Figure 2 and data not shown). More recently, as with toyocamycin, STF-083010 was shown to inhibit IRE1 ndonuclease activity without affecting its kinase activity in vitro.14 However, these compounds mediate their inhibitory activity at 60μ, and show little MM cell apoptosis induction as single agents. STF-083010 also shows anti-tumor activity in human MM xenograft models. However, while toyocamycin suppressed tumor volume to around 50% at 1mg/kg by once-weekly injection, the STF-083010 dose needed to be 30mg/kg by once-weekly injection.14 In our study, adenosine analogs showed potent inhibition of ER stress-induced IRE1α-XBP1 activation at the nanomolar level. Compared with these, toyocamycin induced marked apoptosis in ER-stressed tumor cells and MM cells at much lower concentrations. In addition, it also inhibited the constitutive activation of XBP1 in MM cells even at suboptimal concentrations such as 10n. However, the mechanism by which toyocamycin mediates dose-dependent apoptosis remains unknown. Although three MM cell lines with low active XBP1 expression showed lower sensitivity to toyocamycin treatment than other seven MM cells with high active XBP1 expression, these three cell lines still demonstrated sensitivity to the drug at the nM concentration. It may be speculated that toyocamycin also triggers another stress-inducing factor at higher concentrations, which may induce strong apoptosis under IRE1α-XBP1-suppressed conditions. Further analysis needs be conducted to elucidate the whole picture of its mechanisms of action on MM cells.
An earlier phase I toyocamycin single-agent study also testing possible anti-tumor effects in patients with advanced solid tumors has been reported.51 However, because no apparent clinical responses were observed in that study, further clinical evaluation was not planned. In that study, toyocamycin showed no systemic side effects, such as organ dysfunction and cytopenia, and only local necrosis at the site of infusion was reported to occur when the drug was delivered into the soft tissues. This suggests that toyocamycin adverse events could be manageable if it is infused through central venous catheters. In addition, this study does not exclude potential clinical efficacy of toyocamycin against solid tumors, because it was a phase I trial lacking evaluation of stable disease often applied in more recent clinical trials of molecular-targeting therapies.
In conclusion, we demonstrated that the adenosine analog toyocamycin has a potent IRE1-XBP1 inhibitory effect on ER-stressed tumors and MM cells, as well as triggering dose-dependent apoptosis in these cells. These results provide a preclinical rationale for clinical trials of toyocamycin and other adenosine analogs alone and in combination with BTZ for treating MM.
We thank Dr Masayuki Igarashi, Dr Masaki Hatano, Mrs Naoko Kinoshita and Dr Yoshio Nishimura (Institute of Microbial Chemistry, Tokyo, Japan) for fermentation of Actinomycete strain MK653-101F13, and Ms Chiori Fukuyama (Nagoya City University) for her skillful technical assistance. This study was partly supported by grants from Takeda Science Foundation. This work was partly supported by a Grant-in-Aid for Scientific Research from the Ministry of Education, Culture, Sports, Science and Technology (23791805) and a Grant-in-Aid for Cancer Research from the Ministry of Health, Labor and Welfare (21-8-5), Japan.
Y Shiotsu is an employee of Kyowa Hakko Kirin Co., Ltd, Japan. S Iida received research funding from Kyowa Hakko Kirin and Chugai Pharmaceutical Co., Ltd. S Iida declares honoraria from Janssen Pharmaceutical KK. The other authors declare no conflict of interest.
Supplementary Information accompanies the paper on Blood Cancer Journal website (http://www.nature.com/bcj)