U.S. patent application number 11/096566 was filed with the patent office on 2005-09-29 for medical compositions for intravesical treatment of bladder cancer.
This patent application is currently assigned to Spectrum Pharmaceuticals, Inc.. Invention is credited to Beijnen, Jos H., Nuijen, Bastiaan, Pfadenhauer, Ernie.
Application Number | 20050215615 11/096566 |
Document ID | / |
Family ID | 23350584 |
Filed Date | 2005-09-29 |
United States Patent
Application |
20050215615 |
Kind Code |
A1 |
Nuijen, Bastiaan ; et
al. |
September 29, 2005 |
Medical compositions for intravesical treatment of bladder
cancer
Abstract
Anti-cancer coating compositions comprising
3-hydroxymethyl-5-aziridinyl-1- -1-methyl-2-[1
H-indole-4,7-dione]propenol (E09) are disclosed. More specifically,
the coating compositions comprise EO9 and a formulation vehicle.
The formulation vehicle improves the solubility and stability of
EO9. Additionally, the coating compositions can include coating
agents that provide better adhesion of the coating composition to
the bladder wall during intravesical delivery of the coating
composition.
Inventors: |
Nuijen, Bastiaan;
(Amsterdam, NL) ; Pfadenhauer, Ernie; (Irvine,
CA) ; Beijnen, Jos H.; (Amsterdam, NL) |
Correspondence
Address: |
PRESTON GATES & ELLIS LLP
1900 MAIN STREET, SUITE 600
IRVINE
CA
92614-7319
US
|
Assignee: |
Spectrum Pharmaceuticals,
Inc.
Irvine
CA
|
Family ID: |
23350584 |
Appl. No.: |
11/096566 |
Filed: |
April 1, 2005 |
Related U.S. Patent Documents
|
|
|
|
|
|
Application
Number |
Filing Date |
Patent Number |
|
|
11096566 |
Apr 1, 2005 |
|
|
|
10285783 |
Nov 1, 2002 |
|
|
|
6894071 |
|
|
|
|
60344446 |
Nov 1, 2001 |
|
|
|
Current U.S.
Class: |
514/414 |
Current CPC
Class: |
A61P 35/04 20180101;
A61K 9/127 20130101; Y10S 514/908 20130101; A61P 35/00 20180101;
A61K 9/19 20130101; A61K 31/404 20130101; A61P 13/10 20180101; Y10S
514/952 20130101; A61K 9/0034 20130101; Y10S 514/97 20130101 |
Class at
Publication: |
514/414 |
International
Class: |
A61K 031/404 |
Claims
What is claimed is:
1. An anti-cancer formulation comprising: an indolequinone having a
pH within a range of approximately 9 and approximately 9.5, a
refractive index within a range of approximately 1.393 to
approximately 1.406, and a relative density of within a range of
approximately 0.94 to approximately 0.95.
2. The anti-cancer formulation of claim 1 wherein the indolequinone
is 3-hydroxymethyl-5-azirid inyl-1-1-methyl-2-[1H-indole4,7-d
ione]propenol.
3. The anti-cancer formulation of claim 2 further comprising a
coating composition.
4. The anti-cancer formulation of claim 3 wherein the coating
composition is selected from the group consisting of propylene
glycol, hydroxypropylcellulose, carboxymethylcellulose, chitosan
hydrochloride, lectin, and polycarbophil.
Description
CROSS REFERENCE TO RELATED APPLICATIONS
[0001] This application is a divisional of U.S. patent application
Ser. No. 10/285,783 filed Nov. 1, 2002 which claims the benefit of
U.S. Provisional Application No. 60/344,446, filed Nov. 1, 2001,
the entire contents of which are hereby incorporated by
reference.
BACKGROUND OF THE INVENTION
[0002] Bladder cancer accounts for approximately 2% of all
malignant cancers and is the fifth and tenth most common cancer in
men and women, respectively. The American Cancer Society estimated
that 54,500 new cases and 11,700 deaths would have occurred in
1997. Superficial bladder cancers (pTa, pT1 and CIS) account for
70-80% of cancers at first presentation. Management of superficial
bladder cancer may be achieved by endoscopic surgical resection
often followed by a course of adjuvant intravesical chemotherapy or
immunotherapy with the aim of both eradicating remaining tumor
cells and preventing tumor recurrence (Herr H W (1987) Intravesical
therapy-a critical review. Urol Clin N Am 14:399-404). Both
anti-neoplastics (Mitomycin C [MMC], epirubicin and thioTEPA) and
immunotherapy (BCG) administered intravesically are effective at
reducing tumor recurrence rates although it is unclear whether
disease progression to muscle invasive tumors is prevented (Newling
D (1990) Intravesical therapy in the management of superficial
transitional cell carcinoma of the bladder: the experience of the
EORTC GU group, Br J Cancer 61:497-499; Oosterlink et al. (1993) A
prospective European Organization for Research and Treatment of
Cancer Genitourinary Group randomized trial comparing transurethral
resection followed by a single instillation of epirubicin or water
in single stage Ta, T1 papillary carcinoma of the bladder. J Urol
149:749-752). This observation in conjunction with the fact that
mortality from bladder cancer is still high underscores the need to
develop more effective therapeutic agents (Oosterlink et al.
1993).
[0003] One such therapeutic agent is MMC which belongs to a class
of compounds known as bioreductive drugs (Workman 1994). MMC
represents one of the antineoplastic agents used to treat
superficial bladder cancers (Maffezzini et al, 1996, Tolley et al,
1996). MMC is activated to a cytotoxic species by cellular
reductases although the role of specific reductase enzymes involved
in bioreductive activation remains poorly defined and controversial
(Cummings et al, 1998a). This is particularly true for the enzyme
NQO1 (NAD(P)H:Quinone oxidoreductase, EC 1.6.99.2) which is a
cytosolic flavoprotein which catalyses the two electron reduction
of various quinone based compounds using either NADH or NADPH as
electron donors (Schlager and Powis, 1988, Siegel et al, 1990). The
structurally related compound E09 (5-aziridinyl-3-hydroxymethyl-1
methyl-2-[1H-indole4,7-dione]prop-(3-en-a-ol), is however a much
better substrate for NQO1 than MMC (Walton et al, 1991) and a good
correlation exists between NQOL activity and chemosensitivity in
vitro under aerobic conditions (Robertson et al, 1994, Fitzsimmons
et al, 1996, Smitkamp-Wilms et al, 1994). Under hypoxic conditions
however, E09's properties are markedly different with little or no
potentiation of E09 toxicity observed in NQO1 rich cells (Plumb and
Workman, 1994). In NQO1 deficient cell lines however, large hypoxic
cytotoxicity ratios have been reported (Workman, 1994). Therefore,
E09 has the potential to exploit the aerobic fraction of NQO1 rich
tumors or the hypoxic fraction of NQO1 deficient tumors (Workman,
1994).
[0004] EO9 has been clinically evaluated but despite reports of
three partial remissions in phase I clinical trials, no activity
was seen against NSCLC, gastric, breast, pancreatic and colon
cancers in subsequent phase 11 trials (Schellens et al, 1994, Dirix
et al, 1996). These findings are particularly disappointing in view
of the preclinical studies (Hendriks et al, 1993) together with
reports that several tumor types have elevated NQ01 levels
(Malkinson et al, 1992, Smitkamp-Wilms et al, 1995, Siegel et al,
1998). Several possible explanations have been proposed to explain
E09's lack of clinical efficacy (Connors, 1996, Phillips et al,
1998). Recent studies have demonstrated that the failure of E09 in
the clinic may not be due to poor pharmacodynamic interactions but
may be the result of poor drug delivery to tumors (Phillips et al,
1998). The rapid plasma elimination of E09 (tl/z=10 min in humans)
in conjunction with poor penetration through multicell layers
suggests that E09 will not penetrate more than a few microns from a
blood vessel within its pharmacokinetic lifespan (Schellens et al,
1994, Phillips et al, 1998). Intratumoural administration of E09 to
NQ01 rich and deficient tumors produced significant growth delays
(although a distinction between damage to the aerobic or hypoxic
fraction was not determined) suggesting that if E09 can be
delivered to tumors, therapeutic effects may be achieved (Cummings
et al, 1998b). While these undesirable characteristics are a
serious setback for the treatment of systemic disease,
paradoxically they may be advantageous for treating cancers which
arise in a third compartment such as superficial bladder cancer. In
this scenario, drug delivery is not problematical via the
intravesical route and the penetration of E09 into avascular tissue
can be increased by maintenance of therapeutically relevant drug
concentrations within the bladder (using a one hour instillation
period for example). While this method of instilling EO9 within the
bladder may be useful, there still remains a need for drug delivery
vehicles that are capable of delivering an effective amount of EO9
within the bladder.
BRIEF SUMMARY OF THE INVENTION
[0005] In a broad aspect, the present invention is directed to
compositions for treating cancer. More specifically, the
compositions of the present invention comprise pharmaceutical
products formulated for intravesical instillation to treat bladder
cancer. The pharmaceutical products comprise bioredutive alkylating
indoloquinone with anti-tumor effects such as, but not limited to,
3-hydroxymethyl-5-aziridinyl-1-1-met-
hyl-2-[1H-indole-4,7-dione]propenol (E09) and a formulation
vehicle. The formulation vehicles of the present invention improves
the physical characteristics of the solution such as solubility,
lyophilization, and ease of reconstitution of the lyophilized
solution.
[0006] According to one embodiment of the present invention, the
composition of the present invention comprises
3-hydroxymethyl-5-aziridin-
yl-1-1-methyl-2-[1H-indole-4,7-dione]propenol (EO9) and a
formulation vehicle. According to one embodiment, the formulation
vehicle is a mixture of tert-butanol and water. In another
embodiment, the formulation vehicle is a mixture of ethanol and
water. In yet another embodiment, the formulation vehicle is
2-hydroxypropyl-.beta.-cyclodextrin. These composition embodiments
of the present invention can be lyophilized by techniques known or
developed in the art. The lyophilized compositions of the present
invention are.
[0007] According to another embodiment of the present invention,
the composition of the present invention comprises EO9 and a
coating agent. The coating agent allows for better adhesion of the
composition to the bladder wall. Consequently, the composition and,
in particular, the EO9 contacts and may be able to penetrate the
avascular tissue that comprises for a time sufficient to treat the
bladder cancer. In one embodiment of the present invention, the
coating agent is propylene glycol. In other exemplary embodiments
of the present invention, the coating agent can be selected from
the group consisting of hydroxypropylcellulose,
carboxymethylcellulose, chitosan hydrochloride, lectin, or
polycarbophil. In yet another embodiment of the present invention,
the compositions of the present invention can be delivered to the
bladder wall by a liposome. In another embodiment, the compositions
of the present invention can be delivered to the bladder wall by a
microsphere. In another embodiment, the compositions of the present
invention can be delivered to a patient intravenously.
DETAILED DESCRIPTION OF THE INVENTION
[0008] The embodiments of the present invention are directed to
compositions for treating bladder cancer via intravesical
instillation. According to one embodiment, the composition of the
present invention comprises
3-hydroxymethyl-5-aziridinyl-1-1-methyl-2-[1H-indole-4,7-dione]-
propenol (EO9) and a formulation vehicle. The formulation vehicles
of the present invention are solvents that improves the solubility
and stability of EO9. In a broad aspect of the present invention,
the formulation vehicles of the present invention can be a mixture
of an alcohol and water. According to the various embodiments of
the present invention, EO9 dissolves in the formulation vehicles
without physical manipulation such as grinding. Because the
compositions of the present invention are capable of dissolving
greater amounts of EO9, additional flexibility with respect to
dosage units is achieved. According to one embodiment, a content of
8.0 mg of EO9 per dosage unit is contemplated. In other
embodiments, instillation doses range from approximately 0.5 mg to
approximately 16 mg in a total volume of 40 mL.
[0009] In addition to improving the solubility of EO9, the
formulation vehicles of the present invention are good
lyophilization vehicles. For example, the formulation vehicles of
the present invention minimizes the time to lyophilize the
compositions of the present invention. Accordingly, in one
embodiment of the present invention, it is possible to lyophilize
the compositions of the present invention in less than
approximately 4.5 days. Furthermore, the compositions of the
present invention are stable after undergoing lyophilization (see
table 4). It is believed that the formulation vehicles of the
present invention minimize the crystallization of EO9 during the
lyophilization process. Consequently, by reducing the amount of
crystallization of EO9, a smaller volume of fluid is required to
reconstitute the compositions of the present invention. As a
result, a larger batch size can be achieved due to the reduced
reconstitution volumes for the lyophilized composition.
[0010] According to one embodiment, the composition of the present
invention comprises EO9 and a formulation vehicle comprising
tert-butanol. According to another embodiment of the present
invention, the formulation vehicle comprises mixture of ethanol and
water. In yet another embodiment, the formulation vehicle is
2-hydroxypropyl-.beta.-cyc- lodextrin. In one exemplary embodiment,
the formulation vehicle comprises 40% tert-butanol in water. As
those skilled in the art will appreciate, the amount of
tert-butanol may be varied. The tert-butanol solution better
dissolves E09 as compared to water. By utilizing a tert-butanol
formulation vehicle, solubility of EO9 is at least 9.5 mg/ml
whereas the solubility of EO9 is approximately 0.2 mg/ml in water.
Consequently, a smaller volume of the tert-butanol is required to
dissolve a given amount of EO9. Additionally, a greater amount of
EO9 may be dissolved in a given solution. That is, the compositions
of the present invention will have a higher concentration of EO9 as
compared to a solution where EO9 is dissolved in water.
[0011] According to another embodiment of the present invention,
the composition comprises, EO9, a formulation vehicle, and a
bulking agent. In one exemplary embodiment, lactose can be utilized
as the bulking agent. As those skilled in the art will appreciate,
it is contemplated that other bulking agents known or developed in
the art may be utilized. According to another exemplary embodiment,
the composition of the present invention can be buffered. In one
embodiment, the composition is buffered to a pH ranging from
approximately 9 to approximately 9.5. The composition can be
buffered with any known or developed buffering agents. The
compositions of the present invention can either be compounded for
intravesical delivery or lyophilized. As those skilled in the art
will appreciate, the compositions of the present invention can be
lyophilized by those methods known or developed in the art. The
lyophilized compositions can be reconstituted by a reconstitution
vehicle. According to one exemplary embodiment, the reconstitution
vehicle comprises 2% sodium bicarbonate, 0.02% disodium edetate and
propylene glycol: water (60:40 VN). This reconstitution vehicle
dissolves the lyophilized composition of the present invention and
produces a stable solution for administration for up to 24 hours.
Additionally, the reconstitution vehicle of the present invention
provides an ampoule having an extractable volume of 5 mL of
reconstituted EO9 comprising propylene glycol/water/sodium
bicarbonate/sodium edetate 60/40/2/0.02% v/v/w/w.
[0012] In another aspect of the present invention, the compositions
of the present invention also comprises coating agents. The coating
agents of the present invention provide better adhesion of the
composition to the bladder wall. Consequently, the composition and,
in particular, the EO9 contacts and may be able to penetrate the
avascular tissue that comprises for a time sufficient to treat the
bladder cancer. In one embodiment of the present invention, the
coating agent is propylene glycol. In other exemplary embodiments
of the present invention, the coating agent can be selected from
the group consisting of hydroxypropylcellulose,
carboxymethylcellulose, chitosan hydrochloride, lectin, or
polycarbophil.
[0013] In yet another embodiment of the present invention, the
compositions of the present invention can be delivered to the
bladder wall by a liposome. According to one embodiment of the
present invention, the liposomes used are unilamellar or
multilamellar and contain at least one cationic phospholipid such
as stearylamine, 1,2-diacyl-3-trimethylamm- onium-propane (TAP) or
1,2-triacyl-3-dimethylammonium-propane (DAP). In another embodiment
of the present invention, the surface liposomes may be coated with
polyethylene glycol to prolong the circulating half-life of the
liposomes. In yet another embodiment of the present invention,
neutrally charged liposomes such as, but not limited to,
phosphatidylcholine and cholesterol can also be used for liposomal
entrapment of the compositions of the present invention. In another
embodiment, the compositions of the present invention can be
delivered to the bladder wall by a microsphere such as those known
or developed in the art.
[0014] In yet another embodiment, the compositions of the present
invention can be delivered to a patient intravenously. The
lyophilized composition of the present invention can be
reconstituted using the formulation vehicles of the present
invention. The reconstituted composition can then be diluted to a
desired concentration and delivered to a patient intravenously.
[0015] The following experiments were conducted to determine the
activity of NQ01 in a series of human bladder tumors and normal
bladder tissue by both enzymatic and immunohistochemical
techniques. Furthermore, the following experiments evaluate
strategies for reducing possible system toxicity arising from
intravesical therapy based upon the fact that the aerobic activity
of EO9 against cell lines is enhanced under mild acidic conditions
(Phillips et al., 1992). Administration of EO9 in an acidic vehicle
would result in greater activity within the bladder and any drug
absorbed into the blood stream would become relatively inactive due
to the rise in extracellular pH. The following experiments also
determine the role of NQ01 in the activation of EO9 under acidic
conditions.
[0016] Collection of tumor and normal bladder specimens. Ethical
approval for tissue collection was obtained from the Local Research
Ethical Committee (Bradford NHS Trust) and samples taken from
patients following informed consent. A total of 17 paired cold
pinch biopsies were taken from bladder tumors and macroscopically
normal looking bladder mucosa at cystoscopy, immediately prior to
formal transurethral resection of the tumor. Three specimens were
taken from patients undergoing cystectomy and tumor and normal
samples dissected by pathologists within one hour of surgical
removal. Specimens were flash frozen in liquid nitrogen and
transported for NQOI enzyme analysis. Further biopsies were taken
of the normal bladder mucosa immediately adjacent to the previous
biopsy site and sent at the end of the procedure, along with the
resected tumor, in formalin for routine histological analysis. In
this way bladder tumor and normal bladder urothelium enzymology
could be directly correlated with the appropriate tissue histology
in each patient. Immunohistochemistry was performed from the
subsequently archived wax blocks prepared for histology.
[0017] Biochemical determination of NQOI activity. Cell cultures in
exponential growth were trypsinised, washed twice with Hanks
balanced salt solution (HBSS) and sonicated on ice (3.times.30sec
bursts at 40% duty cycle and output setting 4 on a Semat 250 cell
sonicator). NQO1 activity and protein concentration was determined
as described below. Tissues were homogenised (10% w/v homogenate)
in sucrose (0.25M) using a 1 ml tissue homogeniser (Fisher
Scientific). Cytosolic fractions were prepared by centrifugation of
the homogenate at 18,000 g for 4 min followed by further
centrifugation of the supernatant at 110,000 g for 1 h at 4.degree.
C. in a Beckman Optima TL ultracentrifuge. Activity of NQO1 in the
supernatant was determined spectrophotometrically (Beckman DU650
spectrophotometer) by measuring the dicumarol sensitive reduction
of dichlorophenolindophenol (DCPIP, Sigma Aldrich, UK) at 600 nm
(Traver et al, 1992). This assay has been extensively validated for
use in measuring NQO1 activity in both tissue and cell homogenates
and has been shown to be preferable to other assays for NQO1
activity (Hodnick and Sartorelli, 1997). Each reaction contained
NADH (200 IzM), DCPIP (40/iM, Sigma Aldrich, UK), Dicumarol (20 uM,
when required, Sigma Aldrich, UK), cytosolic fraction of tissues
(50 p,l per assay) in a final volume of 1 ml Tris HCl buffer (50
mM, pH 7.4) containing bovine serum albumin (0.7 mg ml.sup.-1,
Sigma Aldrich, UK). Rates of DCPIP reduction were calculated from
the initial linear part of the reaction curve (30 s) and results
were expressed in terms of nmol DCPIP reduced/min/mg protein using
a molar extinction coefficient of 21 mNT' cm.sup.-1 for DCPIP.
Protein concentration was determined using the Bradford assay
(Bradford, 1976).
[0018] Immunohistochemistry. Polyclonal antibodies (raised in
rabbits) to purified rat NQO1 were a gift from Professor Richard
Knox (Enact Pharma Plc). Validation of the antibody for use in
immunohistochemistry studies was performed by Western blot analysis
using both purified human recombinant NQO1 and cell extracts
derived from a panel of cell lines of human origin. These cell
lines included H460 (human NSCLC), RT112 (human bladder carcinoma),
HT-29 (human colon carcinoma), BE (human colon carcinoma), MT1
(human breast) and DLD-1 (human colon carcinoma). The BE cell line
has been genotyped for the C609T polymorphic variant of NQOI and is
a homozygous mutant (and therefore devoid of NQO1 enzyme activity)
with respect to this polymorphism (Traver et al, 1992). Cells were
washed in ice cold phosphate buffered saline and lysed by
sonication (30 seconds on ice) in Tris HCl (50 mM, pH 7.5)
containing 2 mM EGTA, 2 mM PMSF and 25 Ftg ml.sup.-1 leupeptin.
Protein concentration was estimated using the Bradford assay
(Bradford, 1976) and a total of 12.5 .mu.g of protein (in Lamelli
sample loading buffer) applied to a 12% SDS-PAGE gel. Following
electrophoretic transfer to nitrocellulose paper, membranes were
blocked in TBS/Tween 20 (0.1%) containing 5% non-fat dry milk for 1
h at room temperature. Membranes were washed in TBS/Tween 20 (0.1%)
prior to the addition of rabbit anti-rat NQO1 antibody (1:100
dilution) and incubated at room temperature for 1 h. Membranes were
extensively washed in TBS/Tween 20 (0.1%) followed by the addition
of anti-rabbit IgG horseraddish peroxidase conjugated secondary
antibody (1:5000 dilution in TBS/Tween 20). Proteins were
visualised by ECL based chemiluminescence as described by the
manufacturer (Amersham Pharmacia Biotech, Bucks, UK).
[0019] For immunohistochemical studies, all tissues (both tumor and
normal bladder mucosa) were fixed in 10% formalin, processed
routinely and embedded in paraffin wax. Two sections of each tissue
block were placed on one slide, one section served as the test and
the other as a negative control (no primary antibody). A total of 5
sections from each sample were stained for NQ01 (plus negative
controls) and tumor and normal samples from a total of 17 patients
were analysed. Sections (5 .mu.m) were dewaxed, rehydrated and
incubated with primary antibody (1:400 dilution) for 4 hours.
Sections were then washed and incubated with biotinylated mouse
anti rabbit IgG for 30 min prior to immunoperoxidase staining using
VECTASTAIN ABC reagents and DAB (Vector Laboratories Ltd,
Peterborough, UK). Sections were counterstained with haematoxylin
according to standard procedures.
[0020] Cell culture and chemosensitivity studies. E09 was a gift
from NDDO Oncology, Amsterdam and MMC was obtained from the
Department of Pharmacy, St Lukes Hospital, Bradford. H460 (human
NSCLC) cell line was obtained from the American Type Culture
Collection (ATCC). HT-29 (human colon carcinoma), RT112/83 (human
bladder carcinoma epithelial), EJ138 (human bladder carcinoma) and
T24/83 (human bladder transitional cell carcinoma) cell lines were
obtained from the European Collection of Animal Cell Cultures
(ECACC). A2780 (human ovarian carcinoma) and BE (human colon
carcinoma) cells were gifts from Dr T Ward (Paterson Institute,
Manchester, UK). All cell lines were maintained as monolayer
cultures in RPNII 1640 culture medium supplemented with fetal calf
serum (10%), sodium pyruvate (2 mM), L-glutamine (2 mM),
penicillin/streptomycin (50 IU/ml/50 jug/ml) and buffered with
HEPES (25 mK. All cell culture materials were purchased from Gibco
BRL (Paisley, UK). Cells were exposed to MMC or E09 at a range of
doses for one hour and chemosensitivity was assessed following a
five day recovery period using the MTT assay, details of which have
been described elsewhere (Phillips et al, 1992). The pH of the
medium used during drug exposure was adjusted using small aliquots
of concentrated HCl (40,A conc HCl [10.5M] to 20 ml medium gives a
pH of 6.0). Calibration curves were conducted over a broad range of
pH values in culture medium (pH 3.5 to 11) and the stability of the
pH conditions monitored over a one hour incubation period at
37.degree. C. At all pH values, no significant changes in the pH of
the medium was observed over the one hour drug exposure period
(data not presented).
[0021] HT-29 multicell spheroids were prepared by seeding
5.times.10.sup.5 cells into T25 flasks which had been based coated
with agar (1% w/v) and incubated for 24 h at 37.degree. C. Immature
spheroids were then transferred to a spinner flask (Techne)
containing 250 ml of RPMI 1640 growth medium and spheroids were
kept in suspension by stirring at 50 rpm. When spheroids reached a
diameter of approximately 500 Am, they were harvested for
chemosensitivity studies. Multicell spheroids were exposed to a
range of E09 concentrations at pHe 6.0 and 7.4 for one hour at
37.degree. C. Following drug incubation, spheroids were washed
twice in HBSS prior to dissagregation into single cells using
trypsin EDTA. Disaggregated spheroids were then washed in HBSS and
then plated into 96 well plates (1.times.10.sup.3 cells per well)
and incubated at 37.degree. C. for four days. Chemosensitivity was
assessed using the NM assay as described elsewhere (Phillips et al,
1992).
[0022] The role of NQ01 in the activation of E09 at pHe values of
7.4 and 6.0 was evaluated using the NQO1 inhibitor Flavone Acetic
Acid (FAA), details of which are described elsewhere (Phillips,
1999). FAA is a competetive inhibitor of NQ01 with respect to NADH
and at a final concentration of 2 mM, inhibition of NQO1 is >95%
whereas the activity of cytochrome P450 reductase and cytochrome b5
reductase is not substantially altered (<5% inhibition).
Briefly, H460 cells (NQO1 rich) were plated into 96 well plates at
a density of 2.times.10.sup.3 cells per well. Following an
overnight incubation at 37.degree. C., medium was replaced with
fresh medium (pH 7.4) containing a non-toxic concentration of FAA
(2 mM) and incubated for one hour at 37.degree. C. Medium was then
replaced with fresh medium containing E09 (range of drug
concentrations) and FM (2 mM) at either pHe 7.4 or 6.0. Following a
further one hour incubation at 37.degree. C., cells were washed
twice with HBSS and incubated at 37.degree. C. in growth medium for
five days. Chemosensitivity was determined by the NM assay as
described above and results were expressed in terms of IC.sub.50
values, selectivity ratios (ICSO at pHe 7.4/IC50 at pHe 6.0) and
protection ratios (ICSO FAA/E09 combinations/IC50 for E09
alone).
[0023] Substrate specificity. The influence of acidic pHe on
substrate specificity for purified human NQ01 was determined as
described previously (Phillips 1996, Walton et al, 1991). NQ01
mediated reduction of the quinone to the hydroquinone species is
difficult to detect by conventional assays thereby necessitating
the use of a reporter signal generating step. In this assay, the
hydroquinone acts as an intermediate electron acceptor which
subsequently reduces cytochrome c which can readily be detected
spectrophotometrically. Recombinant human NQO1 was derived from E.
coli transformed with the pKK233-2 expression plasimd containing
the full length cDNA sequence for human NQ01 isolated from the
(Beall et al, 1994). Following IPTG induction, NQO1 was purified by
cybacron blue affinity chromatography, details of which are
described elsewhere (Phillips, 1996). The purified protein had a
molecular weight of approximately 31 kDa and a specific activity of
139/Amol DCPIP reduced/min/mg protein (Phillips, 1996). Reduction
of E09 by recombinant human NQO1 was determined at pH 6.0 and 7.4
by measuring the rate of reduction of cytochrome c was measured at
550 nm on a Beckman DU 650 spectrophotometer according to
previously published methods (Phillips, 1996). Results were
expressed in terms of, umol cytochrome c reduced/min/mg protein
using a molar extinction coefficient of 21.1 mM.sup.-1 cm.sup.-1
for cytochrome c.
[0024] Measurement of intracellular pH. Intracellular pH was
determined using the fluorescent pH indicator BCECF
(2,7-bis-(2-carboxy-ethyl)-5-(an- d-6)carboxyfluorescein (Molecular
Probes, Eugene, USA) according to manufacturers instructions.
Confluent flasks of cells were washed with HBSS to remove any
traces of serum containing RPMI medium and then incubated with the
esterified form of BCECF (BCECF-AM) at a concentration of 2 .mu.M
in HBSS for one hour at 37.degree. C. The non-denaturing detergent
Pluronic was added to the probe to aid dispersion. Cells were then
washed to remove all traces of BCECF-AM and then trypsinized before
being suspended in serum-free/phenol red-free RPM1 medium (Gibco
BRL, Paisley, UK) at a concentration of 10.sup.6 cells per ml at pH
6 for one hour. Flourescence measurement was determined in a
Perkin-Elmer fluorescence spectrophotometer in UV grade disposable
4 ml cuvettes (Fischer Scientific) with excitation wavelengths 500
nm and 450 nm (excitation bandpass slit of 10 nm) and emission
wavelength fixed at 530 nm (emission bandpass slit of 2.5 nm).
These were determined to be optimal settings for the machine and
system under study. An in-situ calibration was performed for every
pHi determination with a range of six pH's from 4 to 9 using the
ionophore nigericin at a concentration of 22.8 p,M to equilibrate
pHe with pHi. Calculation of the ratio of fluorescence at 500
nm/450 nm was calculated after subtraction of background
fluorescence from blanks at each pH (serum free, phenol red free
RPMI without cells).
[0025] Activity of NQO1 in tumor and normal bladder specimens. The
biochemical activity of NQO1 in paired samples of tumor
(grade/stage ranging from G2 pTa to G2/G3 T4) and normal bladder
mucosa (with three cystectomy specimens) taken from a series of 20
patients is presented in table 1. Within the tumor specimens, a
broad range of NQO1 activity existed ranging from 571.4 nmoUmin/mg
to undetectable (<0.1 nmol/min/mg). In histologically normal
bladder mucosa specimens, NQOL activity ranged from 190.9 to
<0.1 nmoUmin/mg. In the majority of patients NQO1 activity in
the tumor was greater than in the normal bladder mucosa. Tumor
grade and stage did not correlate with NQO1 activity (table 1).
[0026] Validation of NQO1 antibody and immunohistochemical
localization of NQO1. Western blot analysis demonstrates that
polyclonal anti rat NQO1 antibody cross reacts with human NQO1 with
a single band at approximately 31 kDa observed for both cell
extracts and purified human NQO1. Titration of purified NQO1
results in a decrease in band intensity and in cell extracts, band
intensity was qualitatively consistent with NQO1 enzyme activity.
In addition, the antibody does not detect NQO1 in the BE cell line
which is devoid of NQO1 activity as a result of the C609T
polymorphism. No non-specific bands were observed on Western blots.
Superficial and invasive tumors with high to intermediate levels of
NQO1 as determined by biochemical assays (patient numbers 1, 4 and
5 in table 1) clearly stained positive for NQO1. Staining was
confined to the cytoplasm of tumor cells with little or no staining
of stromal cells.
[0027] In other tumors with intermediate or low levels of NQOI
activity, staining was heterogeneous with pockets of cells
containing high levels of NQ01 protein. Normal bladder wall
sections were obtained from a patient who underwent cystectomy
(G3pT4 bladder tumor), ureter and urethra were obtained from
another patient who underwent cystectomy (G3 pT3a bladder tumor).
In the bladder wall, no NQO1 staining was observed in the
urothelium although slight staining was present in smooth muscle
layers. The urethra was negative although cells on the luminal
surface of the ureter were positively stained. The basal layers of
the ureter lining were however negatively stained. No evidence of
invasive malignancy or in situ carcinoma were observed in the
ureter and urethra or in the section of bladder wall presented. In
16 other normal bladder biopsy and cystectomy specimens, no
positive staining of the urothelium was observed.
[0028] Influence of pH on substrate specificity and
chemosensitivity. The ability of E09 to serve as a substrate for
NQO1 was not influenced by pH with specific activities of
21.10.+-.2.3 and 21.30.+-.1.5 pmol cytochrome c reduced/min/mg
protein at pH 7.4 and 6.0 respectively. The response of a panel of
cell lines with a range of NQO1 activity (<1.0 to 1,898.+-.276
nmol/min/mg) to E09 and MMC at pHe values of 7.4 and 6.0 is
presented in table 2. At pHe=7.4, a good correlation existed
between NQOL activity and chemosensitivity to E09. In the case of
MMC (table 2), a relationship between NQ01 and chemosensitivity was
apparent (at pHe 7.4) although this relationship was not as
prominent as shown by E09 with a narrow range of IC50 values (range
0.9 to 7.0 ttM) observed in cell lines which cover a broad range of
NQO1 activity (ranging from <1.0 to 1,898 nmol/min/mg). Both MMC
and E09 are preferentially more toxic to cells at pHe values of 6.0
although much greater potentiation of E09 activity is seen with SR
values (SR=selectivity ratio defined as IC.sub.50 pHe 7.4/IC50 pHe
6.0) ranging from 3.92 to 17.21 for E09 compared with 1.02 to 4.50
for MMC (table 2). The activity of E09 was enhanced in both NQO1
rich and deficient cell lines when pHe was reduced to 6.0 and the
relationship between NQO1 and chemosensitivity remained good when
cells were exposed to E09 under acidic conditions. No cell kill was
observed in control cultures when the pHe was decreased to 6.0 (in
the absence of drug) as determined by the MTT assay. The response
of H460 cells to E09 at pHe values of 7.4 and 6.0 in the presence
and absence of FM (2 mM) is presented in table 3. At both pHe
values, the response of H460 cells to E09 was reduced in the
presence of FM. Protection ratios defined as the IC50 for E09 plus
FM divided by the IC50 value for E09 alone were similar for cells
under acidic and physiological pHe values (14.63 and 13.95
respectively, table 3). Selectivity ratios defined as the IC50 at
pHe 7.4 divided by the IC50 at pHe 6.0 in the presence and absence
of FM were also similar with SR values of 6.31 and 6.02 for E09
alone and E09 plus FM respectively (table 3). The response of HT-29
multicell spheroids to E09 demonstrate that spheroids exposed to
E09 at pHe 6.0 were significantly more responsive than at pHe 7.4
with IC50 values of 9.89.+-.0.89 and 24.24.+-.3.29 AM respectively.
Spheroids were significantly less responsive to E09 than the same
cells exposed to E09 as monolayers at both pHe values with ratios
of IC50 values for spheroids to monolayers of 202 and 341 at pHe
values of 7.4 and 6.0 respectively.
[0029] Influence of acidic pHe conditions on pHi. PM values
following a one hour incubation at pHe 6.0 were 6.44.+-.0.04,
6.51.+-.0.02 and 6.42.+-.0.05 in A549, RT112/83 and A2780 cells
respectively. Addition of the ionophore nigericin (after a one hour
incubation at pHe 6.0) resulted in the equilibration of pHe and
p11i.
[0030] In terms of bioreductive drug development, two of the
critical factors which will ultimately determine selectivity are
the enzymology of tumors and the presence of hypoxia (Workman,
1994). As outlined in the introduction, the presence or absence of
NQ01 is central to the design of appropriate E09 based therapeutic
strategies aimed at targeting either the aerobic (NQOL rich cells)
or hypoxic fraction (NQO1 deficient tumors) of tumors. Workman
(1994) has outlined a proposed mechanism for the different
properties of E09 under aerobic and hypoxic conditions based on the
hypothesis that it is the semiquinone (product of one electron
reduction) rather than the hydroquinone which is responsible for
toxicity. In NQO1 deficient cells, the semiquinone produced as a
result of one electron reductases would be relatively non-toxic as
it would rapidly redox cycle back to the parent compound. Free
radical species generated as a result of redox cycling would be
detoxified by superoxide dismutase or catalase but under hypoxic
conditions, the semiquinone would be relatively stable. If this
were the major toxic species, then the activity of E09 against
cells with low NQO1 would be potentiated. In NQO1 rich cells
however, the major product formed would be the hydroquinone.
Aerobic toxicity could be generated as a result of the back
oxidation of the hydroquinone to the semiquinone species or the
parent quinone (Butler et al, 1996) resulting is free radical
generation. Under hypoxic conditions however the hydroquinone will
be more stable and if this is relatively nontoxic, then the
activity of E09 against NQO1 cells under hypoxia would not be
potentiated. Whilst the mechanism of action of E09 under aerobic
and hypoxic conditions is complex, the biological data suggest that
E09 should target the aerobic fraction of NQO1 rich tumors or the
hypoxic fraction of NQO1 deficient tumors (Workman, 1994).
[0031] Analysis of NQO1 activity in tumor and normal bladder
tissues has clearly identified patients whose tumors are either
NQO1 rich or NQO1 deficient (table. 1). Within the subset of NQ01
rich tumors, enzyme activity is elevated relative to the normal
bladder urothelium. Immunohistochemical studies confirm these
biochemical measurements with staining confined to tumor cells as
opposed to normal stromal cells. Within normal bladder tissues,
NQ01 staining was absent from the urothelial lining of the bladder
and the urethra. Faint staining of the superficial layers of the
ureter was observed although the underlying basal layers of the
ureter were negatively stained. Similarly, faint staining of the
smooth muscle layers of the bladder, ureter and urethra were also
observed. These studies suggest that a proportion of patients with
bladder tumors (at various grades and stages of the disease)
exhibit a significant differential in terms of NQO1 activity which
could potentially be exploited by E09 based therapies directed
against the aerobic fraction of tumor cells. With regards to the
ability of E09 to selectively kill hypoxic NQ01 deficient cells, a
subset of patients also exist whose tumors are devoid of NQ01
activity (table 1). It is not known whether or not bladder tumors
contain regions of low oxygen tension and further studies are
required using hypoxia markers such as pimonidazole (Kennedy et al,
1997) to address this issue and to establish the relationship
between NQ01 activity and hypoxia in tumors.
[0032] Whilst biochemical and immunohistochemical studies
demonstrate that a subset of patients exist which have the
appropriate tumor enzymology to activate E09 (under aerobic
conditions), intravesical chemotherapy can result in systemic
toxicity due to the drug entering the blood supply. This study has
also evaluated a potential strategy for minimizing any risk of
systemic toxicity based upon the hypothesis that administration of
E09 in an acidic vehicle would enhance the potency of E09 (Phillips
et al, 1992) within the bladder and that any drug reaching the
blood stream would become relatively inactive due to a rise in pHe.
Selectivity for aerobic cells would still be determined by NQO1
activity and therefore it is essential to determine the role that
NQO1 plays in the activation of E09 under acidic pHe conditions. In
a panel of cell lines with a broad spectrum of NQO1 activity,
reducing the pHe to 6.0 enhances the potency of E09 under aerobic
conditions in all cases (with SR values ranging from 3.92 to 17.21,
table 2). In the case of MMC, potency is also enhanced at low pHe
values although the magnitude of the pH dependent increase in
toxicity is reduced (SR values ranging from 1.02 to 4.50, table 2)
compared with E09. With respect to MMC, one explanation for
increased activity under acidic conditions has been attributed to
the fact that MMC becomes a substrate for NQOL under acidic
conditions (Pan et al, 1993, Siegel et al, 1993). This is not the
case with E09 as rates of reduction of E09 by purified human NQOL
are not influenced by pH (21.10.+-.2.30 and 21.30.+-.1.50 limol
cytochrome c reduced/min/mg protein at pH 7.4 and 6.0
respectively). Recent studies have demonstrated that the activity
of E09 is enhanced under acidic conditions (pHe=6.5) but only when
the intracellular pH is reduced (pIli=6.5) by co-incubation with
nigericin (Kuin et al, 1999). The results of this study are in
agreement with this finding as pHi becomes acidic (pHi values range
from 6.42.+-.0.05 to 6.51.+-.0.02 depending on the cell line) when
cells are cultured under pHe 6.0 conditions.
[0033] In the panel of cell lines used in this study, a good
correlation exists between NQO1 activity and chemosensitivity at
both pHe values of 7.4 and 6.0. A strong relationship between NQO1
activity and response under aerobic conditions (at pHe 7.4) has
been established previously by several groups (Robertson et al,
1994, Fitzsimmons et al, 1996, Smitkamp-Wilms et al, 1994) and
there is clear evidence that NQ01 plays a central role in the
mechanism of action of E09 under aerobic conditions (Workman,
1994). The good correlation between NQ01 activity and response at
pHe 6.0, in conjunction with the fact that E09 is still a good
substrate for NQ01 at pH 6.0, suggests that NQO1 plays a
significant role in E09's mechanism of action at acidic pHe values
under aerobic conditions. It is of interest to note however that
the activity of E09 against BE cells (which are devoid of NQ01
activity as a result of the C609T polymorphism, Traver et al, 1992)
is also enhanced under acidic pHe conditions (table 2). This
suggests that there is a NQO1 independent mechanism for the
increased activity of E09 under acidic conditions. This is
confirmed by the use of the NQ01 inhibitor FAA where the
`protection ratios` (defined as the ratio of IC.sub.50 values for
E09 plus FAA divided by the ICSo values for E09) are similar at
both pHe 7.4 and 6.0 (13.95 and 14.63 respectively, table 3). If
NQO1 played a central role in the activation of E09 at pHe 6.0,
then the protection ratio at pHe 6.0 would be significantly greater
than the protection ratio at pHe 7.4. The mechanism behind the NQ01
independent activation of E09 is unclear although it is a well
known fact that the reactivity of aziridine ring structures is
enhanced by protonation resulting in ring opening to the
aziridinium ion which is a potent alkylating species (Mossoba et
al, 1985, Gutierrez, 1989). Alternatively, E09 is a substrate for
other one electron reductases (Maliepaard et al, 1995, Saunders et
al, 2000) and further studies designed to evaluate whether E09's
metabolism by these enzymes is pH dependent needs to be determined.
The potency of E09 can be enhanced further by reducing pHe below
6.0 (Phillips et al, 1992) but these conditions are unlikely to
provide significant clinical benefits as E09 becomes progressively
more unstable when pH is reduced to 5.5 (t'/s=37 min). From a
pharmacological standpoint, administration of E09 in a vehicle at
pH 6.0 would appear desirable. Not only would this result in
significant enhancement of E09 activity but also the stability of
E09 would be sufficient (tlh=2.5 h) to maintain drug exposure
parameters at a therapeutic level.
[0034] With regards to the activity of E09 against three
dimensional culture models in vitro, this study has demonstrated
that reducing the pHe to 6.0 enhances the potency of E09 against
multicell spheroids although the magnitude of this effect is
reduced compared with monolayer cultures. It is not known whether
or not reduction in pHe results in greater cell kill throughout the
spheroid or if it is confined to the surface of the spheroid
exposed to medium. In comparison with MMC, previous studies using
histocultures exposed to MMC demonstrated that no difference in
toxicity exists between physiological and acidic pHe conditions
(Yen et al, 1996). The pH dependent increase in E09 toxicity
against spheroids suggests that manipulation of pHe may not only be
of use in treating a multilayered solid bladder tumor but may offer
an advantage over MMC. It should however be stated that multicell
spheroids are significantly less responsive to E09 than mono]
ayers, presumably because of the poor penetration properties of E09
through avascular tissue (Phillips et al, 1998). E09 can
nevertheless kill >90% of cells in spheroids suggesting that a
higher doses at least, the penetration of E09 is sufficient to
eradicate cells which reside some distance away from the surface of
the spheroid.
[0035] In conclusion, the results of this study have demonstrated
that within a population of patients with bladder tumors at various
stages and grades of the disease, there exists a great
heterogeneity regarding the expression of NQO1. The majority of
patients have tumors possessing elevated levels of NQO 1 while a
small subset of patients appear to be devoid of NQO1 activity. The
heterogeneous nature of NQO1 activity described here is consistent
with several other studies in various tumor types (Malkinson et al,
1992, Smitkamp-Wilms et al, 1995, Siegel et al, 1998). These
findings reinforce the view that `enzyme profiling` of individual
patients could be valuable prior to therapeutic intervention with
bioreductive drugs (Workman, 1994). This is to our knowledge the
first study to characterize NQO1 activity and cellular localization
in bladder tumors and provide strong evidence to support the
evaluation of E09 against superficial and locally invasive bladder
tumors. This study has clearly demonstrated that under aerobic
conditions, E09 is much more potent under acid conditions (pH6.0)
than at physiological pH (pH7.4). The mechanism for this increased
E09 potency appears to be NQ01 independent and whilst this will not
improve (or reduce) selectivity, it may prove beneficial in terms
of reducing the therapeutically effective dose of E09. Dose
reduction in conjunction with the fact that a reduction in the
potency of E09 due to the increased pHe in the blood stream
suggests that systemic toxicity arising from the intravesical
administration of E09 would be low. In addition, this study shows
that under physiological conditions the activity of E09 is much
lower in tissues with "normal" expression of NQO1 compared to
"high" NQO1 expressing tissues (i.e. the tumors). The results of
this study provide strong evidence in support of the proposal that
intravesical administration of E09 may have activity against
bladder tumors.
REFERENCES
[0036] Butler J, Spanswick V J and Cummings J (1996) The
autooxidation of reduced forms of E09. Free Rad Res 25:141-148.
[0037] Bradford M M (1976) A rapid and sensitive method for the
quantification of microgram quantities of protein utilising the
principle of protein-dye binding. Anal Biochem 72: 248-254.
[0038] Connors T A (1996) Bioreductive agents, hypoxic cells and
therapy. Eur J Cancer 32A: 1833-1834.
[0039] Cummings J, Spanswick V J, Tomaz M and Smyth J F (1998a)
Enzymology of MMC metabolic activation in tumor tissue.
Implications for enzyme directed bioreductive drug development.
Biochem Pharmacol 56:405-414.
[0040] Cummings J, Spanswick V J, Gardiner J, Ritchie A and Smyth,
I F (1998b) Pharmacological and biochemical determinants of the
antitumour activity of the indoloquinone E09. Biochem Pharmacol 55:
253-260.
[0041] Dirix L Y, Tonnesen F, Cassidy J, Epelbaum R, Huinink W W T,
Pavlidis N, Sorio R, Gamucci T, Wolff I, Tevelde A, Lan J, and
Verweij J (1996) E09 phase II study in advanced breast, gastric,
pancreatic and colorectal carcinoma by the early clinical studies
group. Eur J Cancer 32A: 2019-2022.
[0042] Fitzsimmons S A, Workman P, Grever M, Paull K, Camalier R
and Lewis AD (1996) Reductase enzyme expression across the National
Cancer Institute tumor cell line panel: Correlation with
sensitivity to MMC and E09. J Natl Cancer Inst 88: 259-269
Gutierrez P L (1989) Mechanism of bioreductive alkylation. The
example of diazaquinone (AZQ. Free Radical Bio Med 6:405-445.
[0043] Hendriks H R, Piazo P E, Berger D P, Kooistra K L, Bibby M
C, Boven E, Dreef-Van Der Meulen H C, Henrar-REC, Fiebig H H,
Double J A, Hornstra H W, Pinedo H M, Workman P and Swartsmann G
(1993) E09: A novel bioreductive alkylating indoloquinone with
preferential solid tumor activity and lack of bone marrow toxicity
in preclinical models. Eur J Cancer 29A: 897-906.
[0044] Herr H W (1987) Intravesical therapy--a critical review.
Urology Clinics of N America 14: 399-404.
[0045] Hodnick W F and Sartorelli A C (1997) Measurement of
dicumarol sensitive NADPH: (menadione cytochrome c) oxidoreductase
activity results in an artifactual assay of DT-diaphorase in cell
sonicates. Anal Biochem 252:165-168.
[0046] Kennedy A S, Raleigh J A, Perez G M, Calkins D P, Thrall D
E, Novotny D B, Varia M A (1997) Proliferation and hypoxia in human
squamous cell carcinoma of the cervix: first report of combined
immunohistochemical assays. Int J Radiat Oncol Biol Phys 37:
897-905.
[0047] Kuin A, Alders M, Lamfers M, Van Zuidam D J, Essers M,
Beijnen J H and Smets L A (1999) Potentiation of anti-cancer
activity at low intratumoural pH induced by the mitochondrial
inhibitor m-iodobenzylguanidine (MIBG) and its analogue
benzylguanidine (BG). Br J Cancer 79: 793-801.
[0048] Maffezzini M, Simonata A, Zanon M, Raber M and Carmig ani G
(1996) Up-front chemotherapy for low stage low grade recurrent
bladder cancer. J Urol 155: 91-93. Malkinson A M, Siegel D, Forrest
G L, Gazdar A F, Oie H K, Chan D C, Bunn P A, Mabry M, Dykes D J,
Harrison S D and Ross D (1992) Elevated NQO1 activity and messenger
RNA content in human non small cell lung carcinoma--Relationship to
the response of lung tumor xenografts to MMC. Cancer Res
52:4752-4757.
[0049] Maliepaard M, Wolf A, Groot S E, De Mol N J and Janssen L H
M (1995) Indoloquinone E09: DNA interstrand cross linking upon
reduction by DT-diaphorase or xanthine oxidase. Br J Cancer 71:
836-839.
[0050] Mossoba M M, Alizadeh M and Gutierrez P L (1985) Mechanism
for the reductive activation of diazaquinone. J Pharm Sci
74:1249-1254.
[0051] Newling D (1990) Intravesical therapy in the management of
superficial transitional cell carcinoma of the bladder: the
experience of the EORTC GU group. Br J Cancer 61: 497499.
[0052] Oosterlink W, Kurth K H, Schr6der F, Bultinck J, Hammond B,
Sylvester R, and members of the European Organisation for Research
and Treatment of Cancer Genitourinary Group (1993) A prospective
European Organisation for Research and Treatment of Cancer
Genitourinary Group randomised trial comparing transurethral
resection followed by a single instillation of epirubicin or water
in single stage Ta, T 1 papillary carcinoma of the bladder. J Urol
149: 749-752.
[0053] Pan S S, Yu F and Hipsher C (1993) Enzymatic and pH
modulation of MMC induced DNA damage in MMC resistant HCT 116 human
colon cancer cells. Mol Pharmacol 43: 870-877.
[0054] Phillips R M, Hulbert P B, Bibby M C, Sleigh N R, and Double
J A (1992) In vitro activity of the novel indoloquinone EO-9 and
the influence of pH on cytotoxicity. Br J Cancer 65: 359-364.
[0055] Phillips R M (1996) Bioreductive activation of a series of
analogues of
5-aziridinyl-3hydroxymethyl-1-methyl-2-[1H-indolo-4,7-dione]-
prop-(3-en-a-ol (E09) by human NQO1. Biochem Pharmacol
52:1711-1718.
[0056] Phillips R M, Loadman P M and Cronin B P (1998) Evaluation
of a novel in vitro assay for assessing drug penetration into
avascular regions of tumors. Br J Cancer 77: 2112-2119.
[0057] Phillips R M (1999) Inhibition of DT-diaphorase
(NAD(P)H:quinone oxidoreductase, EC 1.6.99.2) by
5,6-dimethylxanthenone-4-acetic acid (DNIXAA) and flavone-8acetic
acid (FAA): Implications for bioreductive drug development. Biochem
Pharmacol 58: 303-310.
[0058] Plumb J A and Workman P (1994) Unusually marked hypoxic
sensitisation to indoloquinone E09 and MMC in a human colon tumor
cell line that lacks NQOI activity. Int J Cancer 56: 134-139.
[0059] Robertson N, Haigh A, Adams GE and Stratford U (1994)
Factors affecting sensitivity to E09 in rodent and human tumor
cells in vitro: NQ01 activity and hypoxia. Eur J Cancer 30A:
1013-1019.
[0060] Saunders M P, Jaffar M, Patterson A V, Nolan J, Naylor M A,
Phillips R M, Harris A L and Stratford H (2000) The relative
importance of NADPH:cytochrome c (P450) reductase for determining
the sensitivity of human tumor cells to the indoloquinone E09 and
related analogues lacking functionality at the C-2 and C-3
positions. Biochem Pharmacol 59: 993-996.
[0061] Schellens J H M, Planting A S T, Van Acker B A C, Loos W J,
De Boer-Dennert M, Van Der Burg M E L, Koier I, Krediet R T, Stoter
G and Verweij J (1994) Phase I and pharmacologic study of the novel
indoloquinone bioreductive alkylating cytotoxic drug E09. J Natl
Cancer Inst 86: 906-912.
[0062] Schlager J J and Powis G (1988) MMC is not metabolised by
but is an inhibitor of human kidney NAD(P)H:(quinone acceptor)
oxidoreductase. Cancer Chemother Pharmacol 22: 126-130.
[0063] Siegel D, Gibson N W, Preusch P C and Ross D (1990)
Metabolism of MMC by NQ01: Role in MMC induced DNA damage and
cytotoxicity in human colon carcinoma cells. Cancer Res 50:
7483-7489.
[0064] Siegel D, Beall H D, Kasai M, Gibson NW and Ross D (1993) PH
dependent inactivation of NQ01 by MMC and porfiromycin. Mol
Pharmacol 44:1128-1134. Siegel D, Franklin W A and Ross D (1998)
Immunohistochemical detection of NAD(P)H:Quinone oxidoreductase in
human lung and lung tumors. Clin Cancer Res 4: 2065-2070.
[0065] Smitkamp-Wilms E, Peters G J, Pinedo H M, Van Arkotte J and
Giaccone G (1994) Chemosensitivity to the indoloquinone E09 is
correlated with NQ01 activity and gene expression. Biochem
Pharmacol 47: 1325-1332.
[0066] Smitskamp-Wilms E, Giaccone G, Pinedo H M, Van Der Laan B F
A M and Peters G J (1995) NQO1 activity in normal and neoplastic
human tissues: An indicator of sensitivity to bioreductive agents?.
Br J Cancer 72: 917-921.
[0067] Tolley D A, Parmar M K B, Grigor K M, Lallemand G and the
Medical Research Council superficial bladder cancer working party
(1996) The effect of intravesical
[0068] MMC on recurrence of newly diagnosed superficial bladder
cancer: A further report with 7 years of followup. J Urol 155:
1233-1238.
[0069] Traver R D, Horikoshi T, Dannenberg K D, Stadlbauer T H W,
Dannenberg P V, Ross D and Gibson NW (1992) NAD(P)H:quinone
oxidoreductase gene expression in human colon carcinoma cells:
Characterisation of a mutation which modulates NQ01 activity and
mitomycin sensitivity. Cancer Res 52: 797-802.
[0070] Walton M I, Smith P J and Workman P (1991) The role of
NAD(P)H:quinone reductase (EC 1.6.99.2, NQO1) in the reductive
bioactivation of the novel indoloquinone antitumour agent E09.
Cancer Commun 3: 199-206.
[0071] Workman P (1994) Enzyme directed bioreductive drug
development revisited: A commentary on recent progress and future
prospects with emphasis on quinone anticancer drugs and quinone
metabolising enzymes, particularly NQO1. Oncol Res 6: 461-475.
[0072] Yen W C, Schmittgen T and Au J L (1996) Different pH
dependency of mitomycin C activity in monolayer and three
dimensional cultures. Pharmaceut Res 13:1887-1891.
1TABLE 1 Tumor histology reports and NQO1 activity in paired
samples of bladder tumor and normal bladder mucosa. Ratio of NQO1
Activity NQO1 Activity NQO1 levels Patient Tumor Tumor Normal in
tumor to No. histology (nmol/min/mg) (nmol/min/mg) normal tissue.
1.sup.f,s,i,p G2 pTa 571.4 <0.1 571. 2.sup.m,s,r G3 pT2 273.3
<0.1 273. 3.sup.f,s,i G1pTa 107.80 <0.1 107. 4.sup.m,e,i G3
pT2/3 73.36 <0.1 73.3 5.sup.m,s,i G3pT4 (0' 81.30 4.10 19.8
6.sup.h G2PT1 309.50 25.20 12.1 7.sup.m,n,r,o G3 pT2 10.00 <0.1
10.0 8.sup.f,n,i G3pT2 9.80 <0.1 9.80 9.sup.m,n,i G2 pT2 4.40
<0.1 4.40 10.sup.m,s,c G3 pT2 34.01 8.50 4.00 11.sup.m,s G 1 pTa
69.76 22.20 3.14 12.sup.,,n G1pTa 42.16 15.30 2.73 13.sup.m,n,i G3
pT2 179.6 72.12 2.49 14.sup.m,e,i G2/G3 89.70 63.30 1.41 T4 (C)
15.sup.m,n,r G3 pT2 0.40 <0.1 0.40 16.sup.m,e,c,o G3 PT3 (C)
21.60 61.70 0.35 17.sup.f n,i G2 PTI 58.40 190.90 0.30 18.sup.m,e,o
G2 PTI <0.1 <0.1 0 19.sup.f n,i G2 PT I. <0.1 <0.1 0
20.sup.m,e,c,r G2 pT0 <0.1 <0.1 0 .sup.mMale, .sup.fFemale,
.sup.sSmoker, 'Non-smoker, .sup.eEx-smoker, .sup.oIntravesical
chemotherapy prior to specimen collection, .sup.rRadiotherapy prior
to specimen collection, 'First presentation, P Previous malignancy
other than bladder, .sup.hNo medical history available,
.sup.oPossible occupational carcinogen exposure (i.e., dye industry
worker). (C) denotes cystectomy specimens. In all cases, protein
levels following preparation of the cytosolic fraction were greater
than 0.1 mg/ml.
[0073]
2TABLE 2 The relationship between NQ01 activity and
chemosensitivity to E09 and MMC under physiological and acidic pHe
conditions. NQO1 IC50 pHe IC50 pHe Cell (nmol/ 7.4 6.0 line Drug
min/mg) (nM) (nM) SR* H460 E09 1652 .+-. 142 60 .+-. 10 9.5 .+-. 2
6.31 HT-29 E09 -- 688 .+-. 52 120 .+-. 53 29 .+-. 10 4.13 T24/83
E09 285 .+-. 28 290 .+-. 65 60 .+-. 18 4.83 A2780 E09 159 .+-. 33
200 .+-. 50 51 .+-. 14 3.92 EJ138 E09 83 .+-. 14 310 .+-. 95 39
.+-. 7 7.94 RT112 E09 30 .+-. 3 1050 .+-. 75 61 .+-. 13 17.21 BE
E09 <0.1 5300 .+-. 169 1300 .+-. 75- 4.07 H460 MMC 1652 .+-. 142
900 .+-. 200 220 .+-. 130 4.50 HT-29 MMC 688 .+-. 52 1050 .+-. 210
500 .+-. 240 2.10 T24/83 MMC 285 .+-. 28 2150 .+-. 93 2100 .+-. 800
1.02 A2780 MMC 159 .+-. 33 2400 .+-. 340 1400 .+-. 130 1.71 EJ138
MMC 83 .+-. 14 1600 .+-. 200 1400 .+-. 250 1.14 RT112 MMC 30 .+-. 3
3350 .+-. 250 2000 .+-. 500 1.67 BE MMC <0.1 7000 .+-. 192 4400
.+-. 215 1.59 All results presented are the mean of 3 independent
experiments (SD values omitted in the interests of presentation).
*SR (selectivity ratio) = IC5o at pH 7.4/IC5o at pH 6.0
[0074]
3TABLE 3 Response of H460 cells to E09 in the presence or absence
of FAA (2 mm) at pHe values of 7.4 and 6.0. ICso Drug pHe (nM) SR*
PR** E09 7.4 60.0 .+-. 8.1 ' -- E09 6.0 9.5 .+-. 2.6 6.31 --
E09/FAA 7.4 837 .+-. 45 -- 13.95 E09/FAA 6.0- 139 .+-. 27 6.02
14.63 *SR = Selectivity Ratio defined as the ratio of ICSo values
at pHe = 7.4 divided by the IC.sub.50 at pHe = 6.0. **Plf =
Protection ratio defined as the ratio of IC5.sub.o values for E09
plus FAA divided by the IC5o values for E09 alone. All values
represent the mean .+-. standard deviation for three independent
experiments.
[0075]
4TABLE 4 Neoquin 8 mg/vial lynophilised product time (month)
Storage test item 0 1 2 3 6 5.degree. C. content* 102.7 .+-. 1.2 na
na 103.8 .+-. 0.8 100.6 .+-. 0.6 purity** 99.9 .+-. 0.008 na na
99.5 .+-. 0.03 99.6 .+-. 0.03 residual 6.0% na na 7.0% 6.3%
moisture*** pH after 9.5 na na na 9.4 reconstitution**** 25.degree.
C./60 content 102.7 .+-. 1.2 103.4 .+-. 0.7 102.1 .+-. 0.2 102.6
.+-. 1.3 97.4 .+-. 1.0 % RH purity 99.9 .+-. 0.008 99.9 .+-. 0.05
99.9 .+-. 0.01 99.2 .+-. 0.07 98.7 .+-. 0.2 residual moisture 6.0%
na na 5.9% 5.9% pH after 9.5 na na na 9.4 reconstitution****
40.degree. C./75 content 102.7 .+-. 1.2 102.3 .+-. 1.1 100.4 .+-.
1.3 101.3 .+-. 0.2 86.4 .+-. 2.0 % RH purity 99.9 .+-. 0.008 99.8
.+-. 0.01 99.7 .+-. 0.04 98.4 .+-. 0.07 97.5 .+-. 0.2 residual
moisture 6.0% na na 6.2% 6.3% pH after 9.5 na na na 9.5
reconstitution**** *content as % of labelled content n = 3 **purity
as chromatographic purity n = 3
* * * * *