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Clinical assessment of the use of topical liquid diclofenac following laser microporation of cutaneous neurofibromas in individuals with neurofibromatosis type 1

Oliveira, Lisa Brauer; Geller, Mauro; Cunha, Karin Soares; Santos, Alessandra; Bernacchi, Allan; Rubenstein, Allan E; Takirambudde, Sanyu; Mezitis, Spyros; de Almeida Ito Brum, Carolina; Darrigo, Luiz Guilherme; Ribeiro, Marcia Gonçalves
Background/UNASSIGNED:Neurofibromatosis type 1 (NF1) is an autosomal dominant genetic disorder with a prevalence of 1:3000 births and a wide variety of clinical manifestations. Cutaneous neurofibromas (cNF) are among the most common visible manifestations of NF1 and present a major clinical burden for patients. NF1 patients with cNF often report decreased quality of life, emotional well-being and physical comfort. Developing effective medical therapies for cNF has been identified as a priority for the majority of adults with NF1. Methods/UNASSIGNED:The study was an open, controlled and prospective proof-of-concept clinical trial. The topical treatment consisted of two steps: cNF microporation using a laser device followed by topical application of one drop of diclofenac 25 mg/mL on the surface of the cNF (T neurofibroma = treatment) or physiological saline (C neurofibroma = control) and reapplied twice daily for 3 days. Neurofibroma assessments included visual and dermatoscopy observations noting color and presence of necrosis, presence of flaccidity, measurements in two dimensions, photographs, and histopathology after excision. The primary efficacy variable was the presence of tissue necrosis. The primary safety variable was the occurrence of treatment-related adverse events. Results/UNASSIGNED:Six patients were included in the study. The treatment resulted in transitory topical changes (healing of the microporation grid with formation of scintillating tissue layer, hyperemia and desquamation), with no statistically significant variation in the dimensions of the T and C neurofibromas in relation to pretreatment measurements. There was no necrosis in the T or C neurofibromas. In the histopathological analysis, there was no significant difference in the distribution of chronic (lymphocytic) inflammatory infiltrate in the papillary reticular dermis (subepithelial), type of infiltrate (diffuse, perivascular, or both), presence of fibrosis, and presence of atrophy among the T and C neurofibromas. No adverse events attributable to the use of diclofenac were reported during the treatment period. Conclusions/UNASSIGNED:Treatment did not result in significant alterations in terms of presence of tissue necrosis, size, or histopathological features in the T neurofibromas or in comparison to the C neurofibromas. Topical diclofenac with laser microporation was well-tolerated, with no adverse events attributable to diclofenac reported. Whether these observations are due to minimal systemic and neurofibroma exposure remain to be explored in dosage studies with larger patient groups. Trial registration/ (NCT03090971) retrospectively registered March 27, 2017.
PMID: 33817379
ISSN: 2405-8440
CID: 4875572

Determination of Vitamin D Levels in Patients With Neurofibromatosis Type 1 in the Pediatric Age Group

Santos, Alessandra; Geller, Mauro; Mezitis, Spyros; Rubenstein, Allan E.; Oliveira, Lisa; Medeiros Lima, Daniel J. M.; Neto, Mendel Suchmacher; Nigri, Rafael; Soares Cunhas, Karin Goncalves; Takirambudde, Sanyu; Ribeiro, Marcia Goncalves
ISSN: 2632-010x
CID: 4678362


Rubenstein, Allan; Reddy, Srinivasa; Sidique, Shyama; Carney, David; Mladek, Ann; Stebbins, Jeffrey; Yang, Li; Lee, Pooi San; Brimberry, Daniel; Ardecky, Robert; Teriete, Peter; Sarkaria, Jann; Cosford, Nicholas; Prasad, Sridhar
ISSN: 1523-5866
CID: 2802462

A novel small molecule HSP90 inhibitor, NXD30001, differentially induces heat shock proteins in nervous tissue in culture and in vivo

Cha, Jieun R C; St Louis, Kyle J H; Tradewell, Miranda L; Gentil, Benoit J; Minotti, Sandra; Jaffer, Zahara M; Chen, Ruihong; Rubenstein, Allan E; Durham, Heather D
Heat shock proteins (HSPs) are attractive therapeutic targets for neurodegenerative diseases, such as amyotrophic lateral sclerosis (ALS), characterized by aberrant formation of protein aggregates. Although motor neurons have a high threshold for activation of HSP genes, HSP90 inhibitors are effective inducers. This study evaluated NXD30001, a novel, small molecule HSP90 inhibitor based on the radicicol backbone, for its ability to induce neuronal HSPs and for efficacy in an experimental model of ALS based on mutations in superoxide-dismutase 1 (SOD1). In motor neurons of dissociated murine spinal cord cultures, NXD30001-induced expression of HSP70/HSPA1 (iHSP70) and its co-chaperone HSP40/DNAJ through activation of HSF1 and exhibited a protective profile against SOD1G93A similar to geldanamycin, but with less toxicity. Treatment prevented protein aggregation, mitochondrial fragmentation, and motor neuron death, important features of mutant SOD1 toxicity, but did not effectively prevent aberrant intracellular Ca2+ accumulation. NXD30001 distributed to brain and spinal cord of wild-type and SOD1G93A transgenic mice following intraperitoneal injection; however, unlike in culture, in vivo levels of SOD1 were not reduced. NXD30001-induced expression of iHSP70 in skeletal and cardiac muscle and, to a lesser extent, in kidney, but not in liver, spinal cord, or brain, with either single or repeated administration. NXD30001 is a very useful experimental tool in culture, but these data point to the complex nature of HSP gene regulation in vivo and the necessity for early evaluation of the efficacy of novel HSP inducers in target tissues in vivo.
PMID: 24092395
ISSN: 1355-8145
CID: 831082

Erratum: A novel small molecule HSP90 inhibitor, NXD30001, differentially induces heat shock proteins in nervous tissue in culture and in vivo (Cell Stress and Chaperones DOI 10.1007/s12192-013-0467-2)

Cha, J R C; St , Louis K J H; Gentil, B J; Tibshirani, M; Tradewell, M L; Minotti, S; Jaffer, Z M; Chen, R; Rubenstein, A E; Durham, H D
ISSN: 1466-1268
CID: 4021422

Therapeutic Potential of HSP90 Inhibition for Neurofibromatosis Type 2

Tanaka, Karo; Eskin, Ascia; Chareyre, Fabrice; Jessen, Walter J; Manent, Jan; Niwa-Kawakita, Michiko; Chen, Ruihong; White, Cory H; Vitte, Jeremie; Jaffer, Zahara M; Nelson, Stanley F; Rubenstein, Allan E; Giovannini, Marco
PURPOSE: The growth and survival of neurofibromatosis type 2 (NF2)-deficient cells are enhanced by the activation of multiple signaling pathways including ErbBs/IGF-1R/Met, PI3K/Akt, and Ras/Raf/Mek/Erk1/2. The chaperone protein HSP90 is essential for the stabilization of these signaling molecules. The aim of the study was to characterize the effect of HSP90 inhibition in various NF2-deficient models. EXPERIMENTAL DESIGN: We tested efficacy of the small-molecule NXD30001, which has been shown to be a potent HSP90 inhibitor. The antiproliferative activity of NXD30001 was tested in NF2-deficient cell lines and in human primary schwannoma and meningioma cultures in vitro. The antitumor efficacy of HSP90 inhibition in vivo was verified in two allograft models and in one NF2 transgenic model. The underlying molecular alteration was further characterized by a global transcriptome approach. RESULTS: NXD30001 induced degradation of client proteins in and suppressed proliferation of NF2-deficient cells. Differential expression analysis identified subsets of genes implicated in cell proliferation, cell survival, vascularization, and Schwann cell differentiation whose expression was altered by NXD30001 treatment. The results showed that NXD30001 in NF2-deficient schwannoma suppressed multiple pathways necessary for tumorigenesis. CONCLUSIONS: HSP90 inhibition showing significant antitumor activity against NF2-related tumor cells in vitro and in vivo represents a promising option for novel NF2 therapies. Clin Cancer Res; 19(14); 3856-70. (c)2013 AACR.
PMID: 23714726
ISSN: 1078-0432
CID: 472032

The novel Hsp90 inhibitor NXD30001 induces tumor regression in a genetically engineered mouse model of glioblastoma multiforme

Zhu, Haihao; Woolfenden, Steve; Bronson, Roderick T; Jaffer, Zahara M; Barluenga, Sofia; Winssinger, Nicolas; Rubenstein, Allan E; Chen, Ruihong; Charest, Al
Glioblastoma multiforme (GBM) has an abysmal prognosis. We now know that the epidermal growth factor receptor (EGFR) signaling pathway and the loss of function of the tumor suppressor genes p16Ink4a/p19ARF and PTEN play a crucial role in GBM pathogenesis: initiating the early stages of tumor development, sustaining tumor growth, promoting infiltration, and mediating resistance to therapy. We have recently shown that this genetic combination is sufficient to promote the development of GBM in adult mice. Therapeutic agents raised against single targets of the EGFR signaling pathway have proven rather inefficient in GBM therapy, showing the need for combinatorial therapeutic approaches. An effective strategy for concurrent disruption of multiple signaling pathways is via the inhibition of the molecular chaperone heat shock protein 90 (Hsp90). Hsp90 inhibition leads to the degradation of so-called client proteins, many of which are key effectors of GBM pathogenesis. NXD30001 is a novel second generation Hsp90 inhibitor that shows improved pharmacokinetic parameters. Here we show that NXD30001 is a potent inhibitor of GBM cell growth in vitro consistent with its capacity to inhibit several key targets and regulators of GBM biology. We also show the efficacy of NXD30001 in vivo in an EGFR-driven genetically engineered mouse model of GBM. Our findings establish that the Hsp90 inhibitor NXD30001 is a therapeutically multivalent molecule, whose actions strike GBM at the core of its drivers of tumorigenesis and represent a compelling rationale for its use in GBM treatment
PMID: 20643786
ISSN: 1538-8514
CID: 134405

Consensus recommendations to accelerate clinical trials for neurofibromatosis type 2

Evans, D Gareth; Kalamarides, Michel; Hunter-Schaedle, Kim; Blakeley, Jaishri; Allen, Jeffrey; Babovic-Vuskanovic, Dusica; Belzberg, Allan; Bollag, Gideon; Chen, Ruihong; DiTomaso, Emmanuelle; Golfinos, John; Harris, Gordon; Jacob, Abraham; Kalpana, Ganjam; Karajannis, Matthias; Korf, Bruce; Kurzrock, Razelle; Law, Meng; McClatchey, Andrea; Packer, Roger; Roehm, Pamela; Rubenstein, Allan; Slattery, William 3rd; Tonsgard, James H; Welling, D Bradley; Widemann, Brigitte; Yohay, Kaleb; Giovannini, Marco
PURPOSE: Neurofibromatosis type 2 (NF2) is a rare autosomal dominant disorder associated primarily with bilateral schwannomas seen on the superior vestibular branches of the eighth cranial nerves. Significant morbidity can result from surgical treatment of these tumors. Meningiomas, ependymomas, and other benign central nervous system tumors are also common in NF2. The lack of effective treatments for NF2 marks an unmet medical need. EXPERIMENTAL DESIGN: Here, we provide recommendations from a workshop, cochaired by Drs. D. Gareth Evans and Marco Giovannini, of 36 international researchers, physicians, representatives of the biotechnology industry, and patient advocates on how to accelerate progress toward NF2 clinical trials. RESULTS: Workshop participants reached a consensus that, based on current knowledge, the time is right to plan and implement NF2 clinical trials. Obstacles impeding NF2 clinical trials and how to address them were discussed, as well as the candidate therapeutic pipeline for NF2. CONCLUSIONS: Both phase 0 and phase II NF2 trials are near-term options for NF2 clinical trials. The number of NF2 patients in the population remains limited, and successful recruitment will require ongoing collaboration efforts between NF2 clinics
PMID: 19671848
ISSN: 1078-0432
CID: 104462

Synthesis of pochoxime prodrugs as potent HSP90 inhibitors

Wang, Cuihua; Barluenga, Sofia; Koripelly, Girish K; Fontaine, Jean-Gonzague; Chen, Ruihong; Yu, Jin-Chen; Shen, Xiaodong; Chabala, John C; Heck, James V; Rubenstein, Allan; Winssinger, Nicolas
Pochoximes are potent inhibitors of heat shock protein 90 (HSP90) based on the radicicol pharmacophores. Herein we present a pharmacokinetics and pharmacodynamics evaluation of this compound series as well as a phosphate prodrug strategy to facilitate formulation and improve oral bioavailability
PMID: 19410458
ISSN: 1464-3405
CID: 104908

In vitro studies of steroid hormones in neurofibromatosis 1 tumors and Schwann cells

Fishbein, Lauren; Zhang, Xuelian; Fisher, Lori B; Li, Hua; Campbell-Thompson, Martha; Yachnis, Anthony; Rubenstein, Allan; Muir, David; Wallace, Margaret R
The most common NF1 feature is the benign neurofibroma, which consists predominantly of Schwann cells. Dermal neurofibromas usually arise during puberty and increase in number throughout adulthood. Plexiform neurofibromas, associated with larger nerves, are often congenital and can be life threatening. Malignant peripheral nerve sheath tumors (MPNST) in NF1 are believed to arise from plexiforms in 5%-10% of patients. There are reports of increased potential for malignant transformation of plexiform tumors and increase in dermal neurofibromas, during pregnancy. These observations suggest that steroid hormones influence neurofibroma growth, and our work is the first to examine steroid hormone receptor expression and ligand-mediated cell growth and survival in normal human Schwann cells and neurofibroma-derived Schwann cell cultures. Immunohistochemistry and real-time PCR showed that estrogen receptors (ERs), progesterone receptor (PR), and androgen receptor are differentially expressed in primary neurofibromas and in NF1 tumor-derived Schwann cell cultures compared to normal Schwann cells. However, there is substantial heterogeneity, with no clear divisions based on tumor type or gender. The in vitro effects of steroid hormone receptor ligands on proliferation and apoptosis of early passage NF1 tumor-derived Schwann cell cultures were compared to normal Schwann cell cultures. Some statistically significant changes in proliferation and apoptosis were found, also showing heterogeneity across groups and ligands. Overall, the changes are consistent with increased cell accumulation. Our data suggest that steroid hormones can directly influence neurofibroma initiation or progression by acting through their cognate receptor, but that these effects may only apply to a subset of tumors, in either gender
PMID: 17393410
ISSN: 0899-1987
CID: 102137