The impact of medical education and networking on the outcome of leukemia treatment in developing countries. The experience of International Consortium on Acute Promyelocytic Leukemia (IC-APL)

Objectives: Several clinical trials conducted in Europe and US reported favorable outcomes of patients with APL treated with the combination of all trans retinoic acid (ATRA) and anthracyclines. Nevertheless, the results observed in developing countries with the same regimen was poorer, mainly due to high early mortality mainly due bleeding. The International Consortium on Acute Promyelocytic Leukemia (IC-APL) is an initiative of the International Members Committee of the ASH and the project aims to reduce this gap through the establishment of international network, which was launched in Brazil, Mexico and Uruguay. Methods: The IC-APL treatment protocol is similar to the PETHEMA 2005, but changing idarubicin to daunorubicin. All patients with a suspected diagnosis of APL were immediately started on ATRA, while bone marrow samples were shipped to a national central lab where genetic verification of the diagnosis was performed. The immunofluorescence using an anti-PML antibody allowed a rapid confirmation of the diagnosis and, the importance of supportive measures was reinforced. Results: The interim analysis of 97 patients enrolled in the IC-APL protocol showed that complete remission (CR) rate was 83% and the 2-year overall survival and disease-free survival were 80% and 90%, respectively. Of note, the early mortality rate was reduced to 7.5%. Discussion: The results of IC-APL demonstrate the impact of educational programs and networking on the improvement of the leukemia treatment outcome in developing countries.

Identifizierung und interindividuelle Expressionsvariabilität der hepatischen Doxorubizin-Reduktase im Menschen

Die in dieser Arbeit beschriebenen Untersuchungen befassen sich mit der Identifizierung des haupt-metabolisierenden Enzyms für die Reaktion von dem Zytostatikum Doxorubizin zu dem Alkohol-Metaboliten Doxorubizinol in humanem Leberzytosol. Der Metabolismus dieser Reaktion wurde in einer humanen Leberbank analysiert, welcher eine große interindividuelle Variabilität zeigte. Da die maximale Umsatzrate häufig proportional zu der Expression des umsetzenden Enzyms in Leber ist, wurden in dieser Arbeit die Expressionsmuster der Kandidatenenzyme, verschiedene Carbonyl reduzierende Enzyme (AKRs und CBRs), ermittelt und des Weiteren der Umsatz von Doxorubizin zu Doxorubizinol in verschiedenen humanen Organen gemessen. Die metabolische Clearance der Reaktion als auch die Affinität zu Doxorubizin war am höchsten in Dünndarm, Leber und Niere, während die anderen Organe wesentlich geringere Werte zeigten. Dies steht im Einklang mit der prominenten Rolle dieser Organe in der Detoxifizierung von Fremdstoffen. Auch der Umsatz von Doxorubizin zu Doxorubizinol wurde von den verschiedenen Enzymen in sehr unterschiedlichem Maß katalysiert. AKR1C3 und CBR1 zeigten einen ausgeprägten Metabolismus von Doxorubizin während AKR1A1, AKR1B1, AKR1B10 und AKR1C4 nur geringen Maximalumsatz zeigten. Auch die Affinität von CBR1 und AKR1C3 zu Doxorubizin war wesentlich höher als die der anderen Enzyme. Inhibitoruntersuchungen zeigten weiterhin, dass ein spezifischer CBR1-Inhibitor die untersuchte Reaktion durch CBR1 als auch durch humanes Leberzytosol in gleichem Maße hemmte. Dieses Ergebnis deutet auf CBR1 als Haupt-Doxorubizin-Reduktase hin. Dies wurde in anfangs erwähnter humaner Leberbank weiter untersucht. Der Gehalt von CBR1-Protein wurde bestimmt und mit der gemessenen spezifischen Aktivität korreliert. Der Proteingehalt korrelierte mit der gemessenen spezifischen Aktivität in sechs von neun Western Blots. Dieses Ergebnis unterstützt die Vermutung, dass CBR1 als Haupt-Doxorubizin-Reduktase in humaner Leber betrachtet werden kann. Die Analyse des CBR1-Gens zeigte zwei Haplotypen, die einen signifikant verschiedenen Km-Wert zeigten als die übrigen Haplotypen. Diese Haplotypen konnten jedoch nur einen geringen Teil der Variabilität des Doxorubizin-Metabolismus erklären. Da aber ein starker interindividueller Doxorubizin-Metabolismus in humaner Leber beobachtet wird, deutet dies auf eine starke epigenetische Regulation des CBR1-Gens hin. Analysen der Promoterregion zeigten viele Bindungsstellen für Transkriptionsfaktoren; eine Aktivierung durch xenobiotische Substanzen kann vermutet werden. Der Metabolismus von Doxorubizin kann zu einer Deaktivierung des Medikaments und damit zu einer verminderten chemotherapeutischen Wirkung führen. Durch die Charakterisierung der humanen Doxorubizin-Reduktase in Leber ist die gezielte Suche nach Hemmstoffen für dieses Enzym möglich. Dies eröffnet die Möglichkeit, die Bildung von Doxorubizin zu Doxorubizinol zu verringern und die Inaktivierung der antineoplastischen Wirkung zu vermeiden. Eine Dosisverminderung und bessere Verträglichkeit des Medikaments kann erreicht, die schweren Nebenwirkungen reduziert werden. Die Identifizierung der verantwortlichen hepatischen Doxorubizin-Reduktase im Menschen kann somit einen wichtigen Beitrag leisten, die Krebstherapie in Zukunft verträglicher und nebenwirkungsfreier zu gestalten und Resistenzbildungen vorzubeugen.

Ursachen der Anthrazyklin-induzierten Kardiotoxizität : Einfluss der individuellen genetischen Ausstattung, des oxidativen Stresses und der Metabolisierung

Doxorubizin (Dox) gehört zur Gruppe der Anthrazykline, welche seit mehreren Jahrzehnten erfolgreich gegen ein breites Spektrum an Tumoren eingesetzt wird. Neben der guten Wirksamkeit besitzt Dox jedoch auch ein sehr hohes Nebenwirkungspotential. Die wohl folgenschwerste Nebenwirkung stellt die irreversible Schädigung des Herzens dar. Zahlreiche Faktoren, wie zum Beispiel die kumulative Dox-Dosis konnten bereits mit einer erhöhten Inzidenz an kardialen Schäden in Verbindung gebracht werden. Bislang ungeklärt war jedoch die Frage, warum Patienten unterschiedlich sensibel auf die Verabreichung von Dox reagierten. rnAn dem Patientenkollektiv der Ricover60-Studie wurde der Einfluss der individuellen genetischen Ausstattung auf die Entstehung der Anthrazyklin-induzierten Herzschädigung untersucht. Alle Patienten mit Dox-induzierten Herzschäden wurden identifiziert und auf das Vorhandensein von genetischen Polymorphismen der NAD(P)H-Oxidase (CYBA, RAC2 und NCF4) und der Anthrazyklin-Transporter (MRP1 und MRP2) untersucht. Sowohl für CYBA als auch für RAC2 konnte eine Anreicherung bestimmter Genotypen (CYBA: CT/TT; RAC2: TA/AA) in der Gruppe der herzgeschädigten Patienten nachgewiesen werden. In der Multivariaten Analyse von RAC2 erreichte diese Anreicherung ein signifikantes Niveau (p=0.028). Damit konnte für diesen Polymorphismus die klinische Relevanz bestätigt werden.rnDie Ursachen der Dox-induzierten Toxizität wurden außerdem an verschiedenen Mäusestämmen und Zelllinien untersucht. Balb/c- und C57BL/6-Mäuse, die bekanntermassen unterschiedlich sensibel auf Dox reagierten, wurden mit Dox behandelt. Anschliessend wurden die Organe Herz, Leber und Blut via HPLC untersucht. Es konnte gezeigt werden, dass sich 1. die Hauptanreicherungsorte für Dox und Doxol (Balb/c: Herz und Blut versus C57BL/6: Leber), 2. die nachgewiesenen Gesamtmengen an Dox+Doxol+Doxon in den drei Organen (MengeC57BL/6 > MengeBalb/c) sowie 3. die An- und Abflutungsgeschwindigkeiten von Dox zwischen den beiden Mäusestämmen unterscheiden. Schlussendlich konnte im Vergleich zu den Balb/c-Mäusen, bei den C57BL/6-Mäusen eine stärkere kardiale Anreicherung von Dox nach der mehrmaligen Dox-Injektion nachgewiesen werden. Somit scheinen der deutlich höhere Dox-Gehalt und die längere Verweilzeit in den Herzen für die stärkere kardiale Schädigung der C57BL/6-Mäuse verantwortlich zu sein. Hingegen verlief die Art der Dox-Metabolisierung in beiden Mäusestämmen ähnlich. rnBei der Betrachtung des oxidativen Stresses konnte gezeigt werden, dass in den Herzen der C57BL/6-Mäusen ein gröβerer oxidativer Stress vorlag, als bei den Balb/c-Mäusen. Ähnlich wie bei der Ricover60-Studie ließ sich auch bei den Mäusen eine Beteiligung der NAD(P)H-Oxidase am Dox-induzierten oxidativen Stress nachweisen. rnMit der HTETOP-Zelllinie konnte gezeigt werden, dass Dox unter physiologischen Bedingungen oxidativen Stress auslösen kann. Die Art und die Konzentration der gebildeten ROS waren abhängig von der Dox-Konzentration, der Einwirkzeit und der Kompensationsfähigkeit der Zellen. Durch die Gabe von Dex ließ sich das Ausmaß des oxidativen Stresses lediglich in den Mäuseherzen reduzieren. In den HTETOP-Zellen zeigte Dex selbst stressauslösende Eigenschaften. Durch die Behandlung mit Dex / DOXY konnte gezeigt werden, dass die Hemmung der Topo IIα selbst oxidativen Stress in den HTETOP-Zellen auslöst. Jedoch scheint weder die Topo IIalpha-Hemmung, noch der Dox-induzierte oxidative Stress bei physiologischen Dox-Konzentrationen (< 1 µM) eine entscheidende Rolle für die Toxizität zu spielen. rnIn der Mikroarray-Analyse der HTETOP-Zellen konnten verschiedene Gene identifiziert werden, die in den oxidativen Stress involviert sind und die durch die Gabe von Dox differentiell reguliert werden. Durch die Komedikation mit Dex / DOXY ließen sich diese Veränderungen teilweise modulieren. rn

Cancer therapy-associated cardiotoxicity and signaling in the myocardium

The cardiotoxic potential of cytotoxic cancer chemotherapy is well known. Prime examples are the anthracyclines, which are highly efficacious agents for hemopoietic malignancies and solid tumors, but their clinical use is limited primarily by cardiotoxicity. Besides the conventional chemotherapeutics, new cancer drugs were developed in the last decade with the goal to specifically inhibit selected molecular targets such as growth factor receptors or intracellular tyrosine kinases in cancer cells. However, the outcome of combining conventional and newer cancer therapies could have unexpected side effects not anticipated so far and the long-term outcome is not known. Sometimes, however, unexpected side effects also shed light on previously unknown physiological functions. For example, the anti-HER2 cancer therapeutic trastuzumab (Herceptin), which can induce cardiac dysfunction, has demonstrated the importance of the ErbB/neuregulin signaling system in the adult heart. Subsequently, the role of endothelial-myocardial communication in maintaining phenotype and survival of adult cardiomyocytes has increasingly been recognized.

Impact of treatment characteristics on response of different breast cancer phenotypes: pooled analysis of the German neo-adjuvant chemotherapy trials

Pathological complete response (pCR) to neoadjuvant treatment correlates with outcome in breast cancer. We determined whether characteristics of neoadjuvant therapy are associated with pCR. We used multi-level models, which accounted for heterogeneity in pCR across trials and trial arms, to analyze individual patient data from 3332 women included in 7 German neoadjuvant trials with uniform protocols. PCR was associated with an increase in number of chemotherapy cycles (odds ratio [OR] 1.2 for every two additional cycles; P = 0.009), with higher cumulative anthracycline doses (OR 1.6; P = 0.002), higher cumulative taxane doses (OR 1.6; P = 0.009), and with capecitabine containing regimens (OR 1.62; P = 0.022). Association of pCR with increase in number of cycles appeared more pronounced in hormone receptor (HR)-positive tumors (OR 1.35) than in HR-negative tumors (OR 1.04; P for interaction = 0.046). Effect of anthracycline dose was particularly pronounced in HER2-negative tumors (OR 1.61), compared to HER2-positive tumors (OR 0.83; P for interaction = 0.14). Simultaneous trastuzumab treatment in HER2-positive tumors increased odds of pCR 3.2-fold (P < 0.001). No association of pCR and number of trastuzumab cycles was found (OR 1.20, P = 0.39). Dosing characteristics appear important for successful treatment of breast cancer. Longer treatment, higher cumulative doses of anthracyclines and taxanes, and the addition of capecitabine and trastuzumab are associated with better response. Tailoring according to breast cancer phenotype might be possible: longer treatment in HR-positive tumors, higher cumulative anthracycline doses for HER2-negative tumors, shorter treatment at higher cumulative doses for triple-negative tumors, and limited number of preoperative trastuzumab cycles in HER2-positive tumors.

Cancer therapy modulates VEGF signaling and viability in adult rat cardiac microvascular endothelial cells and cardiomyocytes

This work was motivated by the incomplete characterization of the role of vascular endothelial growth factor-A (VEGF-A) in the stressed heart in consideration of upcoming cancer treatment options challenging the natural VEGF balance in the myocardium. We tested, if the cytotoxic cancer therapy doxorubicin (Doxo) or the anti-angiogenic therapy sunitinib alters viability and VEGF signaling in primary cardiac microvascular endothelial cells (CMEC) and adult rat ventricular myocytes (ARVM). ARVM were isolated and cultured in serum-free medium. CMEC were isolated from the left ventricle and used in the second passage. Viability was measured by LDH-release and by MTT-assay, cellular respiration by high-resolution oxymetry. VEGF-A release was measured using a rat specific VEGF-A ELISA-kit. CMEC were characterized by marker proteins including CD31, von Willebrand factor, smooth muscle actin and desmin. Both Doxo and sunitinib led to a dose-dependent reduction of cell viability. Sunitinib treatment caused a significant reduction of complex I and II-dependent respiration in cardiomyocytes and the loss of mitochondrial membrane potential in CMEC. Endothelial cells up-regulated VEGF-A release after peroxide or Doxo treatment. Doxo induced HIF-1α stabilization and upregulation at clinically relevant concentrations of the cancer therapy. VEGF-A release was abrogated by the inhibition of the Erk1/2 or the MAPKp38 pathway. ARVM did not answer to Doxo-induced stress conditions by the release of VEGF-A as observed in CMEC. VEGF receptor 2 amounts were reduced by Doxo and by sunitinib in a dose-dependent manner in both CMEC and ARVM. In conclusion, these data suggest that cancer therapy with anthracyclines modulates VEGF-A release and its cellular receptors in CMEC and ARVM, and therefore alters paracrine signaling in the myocardium.

Effects of doxorubicin cancer therapy on autophagy and the ubiquitin-proteasome system in long-term cultured adult rat cardiomyocytes

The clinical use of anthracyclines in cancer therapy is limited by dose-dependent cardiotoxicity that involves cardiomyocyte injury and death. We have tested the hypothesis that anthracyclines affect protein degradation pathways in adult cardiomyocytes. To this aim, we assessed the effects of doxorubicin (Doxo) on apoptosis, autophagy and the proteasome/ubiquitin system in long-term cultured adult rat cardiomyocytes. Accumulation of poly-ubiquitinated proteins, increase of cathepsin-D-positive lysosomes and myofibrillar degradation were observed in Doxo-treated cardiomyocytes. Chymotrypsin-like activity of the proteasome was initially increased and then inhibited by Doxo over a time-course of 48 h. Proteasome 20S proteins were down-regulated by higher doses of Doxo. The expression of MURF-1, an ubiquitin-ligase specifically targeting myofibrillar proteins, was suppressed by Doxo at all concentrations measured. Microtubule-associated protein 1 light chain 3B (LC3)-positive punctae and both LC3-I and -II proteins were induced by Doxo in a dose-dependent manner, as confirmed by using lentiviral expression of green fluorescence protein bound to LC3 and live imaging. The lysosomotropic drug chloroquine led to autophagosome accumulation, which increased with concomitant Doxo treatment indicating enhanced autophagic flux. We conclude that Doxo causes a downregulation of the protein degradation machinery of cardiomyocytes with a resulting accumulation of poly-ubiquitinated proteins and autophagosomes. Although autophagy is initially stimulated as a compensatory response to cytotoxic stress, it is followed by apoptosis and necrosis at higher doses and longer exposure times. This mechanism might contribute to the late cardiotoxicity of anthracyclines by accelerated aging of the postmitotic adult cardiomyocytes and to the susceptibility of the aging heart to anthracycline cancer therapy.

Identifying breast cancer patients at risk for Central Nervous System (CNS) metastases in trials of the International Breast Cancer Study Group (IBCSG)

BACKGROUND: We sought to determine whether a high-risk group could be defined among patients with operable breast cancer in whom a search of occult central nervous system (CNS) metastases was justified. PATIENTS AND METHODS: We evaluated data from 9524 women with early breast cancer (42% node-negative) who were randomized in International Breast Cancer Study Group clinical trials between 1978 and 1999, and treated without anthracyclines, taxanes, or trastuzumab. We identified patients whose site of first event was CNS and those who had a CNS event at any time. RESULTS: Median follow-up was 13 years. The 10-year incidence (10-yr) of CNS relapse was 5.2% (1.3% as first recurrence). Factors predictive of CNS as first recurrence included: node-positive disease (10-yr = 2.2% for > 3 N+), estrogen receptor-negative (2.3%), tumor size > 2 cm (1.7%), tumor grade 3 (2.0%), < 35 years old (2.2%), HER2-positive (2.7%), and estrogen receptor-negative and node-positive (2.6%). The risk of subsequent CNS recurrence was elevated in patients experiencing lung metastases (10-yr = 16.4%). CONCLUSION: Based on this large cohort we were able to define risk factors for CNS metastases, but could not define a group at sufficient risk to justify routine screening for occult CNS metastases.

The role of cell death and myofibrillar damage in contractile dysfunction of long-term cultured adult cardiomyocytes exposed to doxorubicin

In failing hearts cardiomyocytes undergo alterations in cytoskeleton structure, contractility and viability. It is not known presently, how stress-induced changes of myofibrils correlate with markers for cell death and contractile function in cardiomyocytes. Therefore, we have studied the progression of contractile dysfunction, myofibrillar damage and cell death in cultured adult cardiomyocytes exposed to the cancer therapy doxorubicin. We demonstrate, that long-term cultured adult cardiomyocytes, a well-established model for the study of myofibrillar structure and effects of growth factors, can also be used to assess contractility and calcium handling. Adult rat ventricular myocytes (ARVM) were isolated and cultured for a total of 14 days in serum containing medium. The organization of calcium-handling proteins and myofibrillar structure in freshly isolated and in long-term cultured adult cardiomyocytes was studied by immunofluorescence and electron microscopy. Excitation contraction-coupling was analyzed by fura 2 and video edge detection in electrically paced cardiomyocytes forming a monolayer, and cell death and viability was measured by TUNEL assay, LDH release, MTT assay, and Western blot for LC3. Adult cardiomyocytes treated with Doxo showed apoptosis and necrosis only at supraclinical concentrations. Treated cells displayed merely alterations in cytoskeleton organization and integrity concomitant with contractile dysfunction and up-regulation of autophagosome formation, but no change in total sarcomeric protein content. We propose, that myofibrillar damage contributes to contractile dysfunction prior to cell death in adult cardiomyocytes exposed to clinically relevant concentrations of anthracyclines.

Cardiac toxicity with anti-HER-2 therapies: what have we learned so far?

Trastuzumab, a monoclonal antibody that blocks HER-2 receptor, improves the survival of women with HER-2-positive early and advanced breast cancer when given with chemotherapy. Lapatinib, a dual tyrosine kinase inhibitor of EGFR and HER-2, is approved for the treatment of metastatic breast cancer patients after failure of prior anthracycline, taxanes and trastuzumab therapies in combination with capecitabine. Importantly, cardiac toxicity, manifested as symptomatic congestive heart failure or asymptomatic left ventricular ejection fraction decline, has been reported in some of the patients receiving these novel anti-HER-2 therapies, particularly when these drugs are used following anthracyclines, whose cardiotoxic potential has been recognized for decades. This review will focus on the incidence, natural history, underlying mechanisms, management, and areas of uncertainty regarding trastuzumab-and lapatinib-induced cardiotoxicity.

A coding variant in RARG confers susceptibility to anthracycline-induced cardiotoxicity in childhood cancer

Anthracyclines are used in over 50% of childhood cancer treatment protocols, but their clinical usefulness is limited by anthracycline-induced cardiotoxicity (ACT) manifesting as asymptomatic cardiac dysfunction and congestive heart failure in up to 57% and 16% of patients, respectively. Candidate gene studies have reported genetic associations with ACT, but these studies have in general lacked robust patient numbers, independent replication or functional validation. Thus, the individual variability in ACT susceptibility remains largely unexplained. We performed a genome-wide association study in 280 patients of European ancestry treated for childhood cancer, with independent replication in similarly treated cohorts of 96 European and 80 non-European patients. We identified a nonsynonymous variant (rs2229774, p.Ser427Leu) in RARG highly associated with ACT (P = 5.9 × 10(-8), odds ratio (95% confidence interval) = 4.7 (2.7-8.3)). This variant alters RARG function, leading to derepression of the key ACT genetic determinant Top2b, and provides new insight into the pathophysiology of this severe adverse drug reaction.

The mechanism of the pharmacological actions of dexrazoxane on different tissue types

Approximately 6,600 people die from acute myelogenous leukemia (AML) on an annual basis. During the past 10 to 15 years, there has been gradual overall improvements in the therapy of this disease, yet the majority of patients with AML succumb to this disease. In an attempt to improve current therapeutic strategies for AML, we became interested in a commercially available drug, dexrazoxane, which protects against anthracycline-induced cardiotoxicity. We have investigated dexrazoxane's (DEX) effects on different tissue types in an effort to determine its unique mechanism of action. Colony forming assays were used to evaluate stem-cell renewal of myeloid cells in vitro and median effect analysis was used to evaluate antagonism, synergism, or additivity. The anthracyclines, doxorubicin, daunorubicin, and idarubicin were individually combined with DEX in leukemic myeloid models to determine if the combination of the two drugs resulted in a synergistic, additive or antagonistic effect. Etoposide and cytosine arabinoside were also evaluated in combination with DEX using the same in vitro model and evaluated similarly. ^ Dexrazoxane in combination with any of the anthracyclines was schedule dependent. The combination of DEX and anthracycline resulted in a greater antitumor effect than anthracycline alone except for DEX administered 24 hours before doxorubicin or daunorubicin. These data were corroborated through median effect analysis. Etoposide in combination with dexrazoxane was synergistic for all combinations, and the combination of cytosine arabinoside and DEX was schedule dependent. In contrast, using an in vivo gastrointestinal model, DEX in combination with doxorubicin was antagonistic for almost all of the ratios used, except for the highest. A Withers' assay was used to evaluate toxicity on jejunal crypt cells. No effect was apparent for the combination of idarubicin and DEX, however, as seen with RZ, DEX in addition to radiation greatly potentiated the cytotoxic effects of radiation on crypts. These paradoxical effects of dexrazoxane were initially enigmatic, but after additional investigation, we propose a model that explains our findings. We conclude that DEX in combination with anthracyclines produces an additive to synergistic antileukemic response and may have therapeutic potential clinically. Additionally, DEX protects the gastrointestinal tract from doxorubicin toxicity, which could have clinical implications for the administration of greater doses of doxorubicin. ^

Disruption of cellular signaling pathways by daunomycin through destabilization of nonlamellar membrane structures.

Albeit anthracyclines are widely used in the treatment of solid tumors and leukemias, their mechanism of action has not been elucidated. The present study gives relevant information about the role of nonlamellar membrane structures in signaling pathways, which could explain how anthracyclines can exert their cytocidal action without entering the cell [Tritton, T. R. & Yee, G. (1982) Science 217, 248-250]. The anthracycline daunomycin reduced the formation of the nonlamellar hexagonal (HII) phase (i.e., the hexagonal phase propensity), stabilizing the bilayer structure of the plasma membrane by a direct interaction with membrane phospholipids. As a consequence, various cellular events involved in signal transduction, such as membrane fusion and membrane association of peripheral proteins [e.g., guanine nucleotide-binding regulatory proteins (G proteins and protein kinase C-alpha beta)], where nonlamellar structures (negative intrinsic monolayer curvature strain) are required, were altered by the presence of daunomycin. Functionally, daunomycin also impaired the expression of the high-affinity state of a G protein-coupled receptor (ternary complex for the alpha 2-adrenergic receptor) due to G-protein dissociation from the plasma membrane. In vivo, daunomycin also decreased the levels of membrane-associated G proteins and protein kinase C-alpha beta in the heart. The occurrence of such nonlamellar structures favors the association of these peripheral proteins with the plasma membrane and prevents daunomycin-induced dissociation. These results reveal an important role of the lipid component of the cell membrane in signal transduction and its alteration by anthracyclines.

Blanchaquinone: A new anthraquinone from an Australian Streptomyces sp.

Chemical analysis of an Australian Streptomyces species yielded a range of known anthracyclines and biosynthetically related metabolites, including daunomycin (1), E-rhodomycinone (2), 11-hydroxyauramycinone (3), 11-hydroxysulfurmycinone (4), aklavinone (5), bisanhydro-gamma-rhodomycinone (6), and the anthraquinone 7, as well as the hitherto unreported blanchaquinone (8). The structure assigned to 8 was secured by detailed spectroscopic analysis and correlation to known analogues, such as the anthraquinone 7. This account also represents the first natural occurrence of 3, 4, and 7 and the first spectroscopic characterization of 11-hydroxysulfurmycinone (4).

Glycosylation and Glycodiversification in Polyketide Antibiotics: Unraveling Biosynthetic Steps in Nogalamycin Formation

Soil-dwelling Streptomyces bacteria are known for their ability to produce biologically active compounds such as antimicrobial, immunosuppressant, antifungal and anticancer drugs. S. nogalater is the producer of nogalamycin, a potential anticancer drug exhibiting high cytotoxicity and activity against human topoisomerases I and II. Nogalamycin is an anthracycline polyketide comprising a four-ring aromatic backbone,a neutral deoxy sugar at C7, and an amino sugar attached via an O–C bond at C1 and a C–C bond between C2 and C5´´. This kind of attachment of the amino sugar is unusual thus making the structure of the compound highly interesting. The sugar is also associated with the biological activity of nogalamycin, as it facilitates binding to DNA. Furthermore, the sugar moieties of anthracyclines are often crucial for their biological activity. Together the interesting attachment of the amino sugar and the general reliance of polyketides on the sugar moieties for bioactivity have made the study of the biosynthesis of nogalamycin attractive. The sugar moieties are typically attached by glycosyltransferases, which use two substrates: the donor and the acceptor. The literature review of the thesis is focused on the glycosylation of polyketides and the possibilities to alter their glycosylation patterns. My own thesis work revolves around the biosynthesis of nogalamycin. We have elucidated the individual steps that lead to its rather unique structure. We reconstructed the whole biosynthetic pathway in the heterologous host S. albus using a cosmid and a plasmid. In the process, we were able to isolate new compounds when the cosmid, which contains the majority of the nogalamycin gene cluster, was expressed alone in the heterologous host. The new compounds included true intermediates of the pathway as well as metabolites, which were most likely altered by the endogenous enzymes of the host. The biological activity of the most interesting new products was tested against human topoisomerases I and II, and they were found to exhibit such activities. The heterologous expression system facilitated the generation of mutants with inactivated biosynthetic genes. In that process, we were able to identify the functions of the glycosyltransferases SnogE and SnogD, solve the structure of SnogD, discover a novel C1-hydroxylase system comprising SnoaW and SnoaL2, and establish that the two homologous non-heme α-ketoglutarate and Fe2+ dependent enzymes SnoK and SnoN catalyze atypical reactions on the pathway. We demonstrated that SnoK was responsible for the formation of the additional C–C bond, whereas SnoN is an epimerase. A combination of in vivo and in vitro techniques was utilized to unravel the details of these enzymes. Protein crystallography gave us an important means to understand the mechanisms. Furthermore, the solved structures serve as platforms for future rational design of the enzymes.