| Term 
 
        | miscellaneous anticancer agents |  | Definition 
 
        | PROTEASOME INHIBITORS: 
 bortezomib
 
 inhibit proteasome and thereby increase levels of certain regulatory proteins that can kill cancer cells
 
 INHIBITORS OF DAN METHYL TRANSFERASES (DNMT):
 
 azacytidine and decitabine
 
 methyltransferase inhibitors actually block the hypermethylation of DNA
 
 hypermethylation of DNA can result in the recruitment of certain trascriptional gene suppressors
 
 by blocking hypermethylation of trascriptional suppressors, DNA methyltransferase inhibitors block the effect of gene silencing
 
 INHIBITORS OF HISTONE DEACETYLASE (HDAC):
 
 vorinostat, romidepsin
 
 histones are proteins that are found in nucleosomes
 
 the tails of histones are subject to epigenetic modifications
 
 acethylation of histone tails loosen chromatin and allow the approach and binding of certain transcription factors that lead to the expression of tumor suppressor and proapoptotic genes
 
 THALIDOMIDE AND LENALIDOMIDE
 
 numerous pharmacological effects
 
 these compounds are known to have antiangiogenic activity and they can induce apoptosis
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        |  | 
        
        | Term 
 
        | protein degradation essential for the cell |  | Definition 
 
        | free supply of amino acids for protein synthesis 
 remove excess or unneeded proteins:
 excess enzymes
 transcription factors that are damaged or no longer required
 
 structures responsible for protein degradation:
 
 lysosomes - proteolytic action on extracellular proteins and transmembrane proteins
 
 proteasomes - proteolytic action on endogenous proteins found in cytoplasm and nucleus
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        |  | 
        
        | Term 
 
        | structure of the 26 S proteasome |  | Definition 
 
        | [image] 
 the 26S proteasome consists of a catalytic 20S subunit that is composed of 28 subunits consisting of 4 concentric rings
 
 there are 2 caps on each end of proteasome
 
 the caps are composed of 17 proteins includine 6 ATPases
 
 the role of the 26S proteasome is to degrade tagged proteins
 
 these tagged proteins prevent the degradation of necessary proteins
 
 in order for proteasome to degrade the protein the protein is first ubiquitinylated
 
 ubiquitin is a protein
 
 these tagged proteins are then degraded by proteasome to yield polypeptides
 
 the small peptides are further degraded by the action of exopeptidases
 
 the polyubiquitinylated protein is broken down by enzymes that split the individual ubiquitin subunits
 
 in this manner, ubiquitin is regenerated
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        |  | 
        
        | Term 
 
        | ubiquitin cycle and protein degradation |  | Definition 
 
        | [image] 
 this is a further explanation of the action of the 26S proteasome
 
 an activating enzyme first activated ubiquitin through its C-terminal glycine amino acid
 
 this is followed by a conjugating enzyme in which additional ubiquitin subunits are attached
 
 finally a ligating enzyme attaches the polyubiquitinylated chain to the protein to be degraded
 
 the ubiquitin subunits are recycled through degrading enzyme to free the individual ubiquiting
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        |  | 
        
        | Term 
 
        | significance of proteasome inhibition |  | Definition 
 
        | blocking proteasome results in an accumulation of a various regulatory proteins, which lead to cell death by a variety of mechanisms (block cell cycle and apoptosis) 
 proteolytic action of proteasome (hydrolysis of peptide bond):
 
 [image]
 
 by inhibiting proteasome, levels of certain regulatory proteins rise
 
 these proteins are involved in cell death by a variety of mechanisms
 
 compounds that inhibit the action of proteasome alter the mechanism shown above
 
 a key Thr amino acid is found on the N-terminal end of proteasome
 
 the key to this reaction is the attack of the Thr OH group on the peptide bond of proteasome
 
 the Thr residue is then attached to the enzyme (proteasome)
 
 the final step is hydrolysis of the N-terminal ester bond and regeneration of the enzyme
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        |  | 
        
        | Term 
 | Definition 
 
        | [image] 
 bortezomib is a boronic acid that is formulated as a boronate with mannitol
 
 in solution it reverts to the boronic acid
 
 in the structure of bortezomib are 2 peptide bonds
 
 bortezomib competes with the substrate for the active site of proteasome, resulting in a stable but reversible complex
 
 BORONIC ACID IS THE KEY TO INHIBITING PROTEASOME
 
 inhibition of proteasome by bortezomib
 
 [image]
 
 boron readily accepts lone pair on oxygen through its empty p-orbital
 
 note that the N terminal Thr OH attacks the boron
 
 this results in a stable, but reversible complex in which the enzyme is inhibited
 
 [image]
 
 a crystal structure between bortezomib and the N terminal Thr on proteasome is shown
 
 the peptide chain has significant H bonds at the active site of proteasome
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        |  | 
        
        | Term 
 
        | epigenetic therapy of caner |  | Definition 
 
        | epigenetic - alterations in gene expression that are not associated with changes in DNA sequences 
 DNA methylation
 
 Histone tail modification
 
 histones are proteins that are found associated with nucleosomes; their tails can undergo acetylation and thereby affect gene expression
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        |  | 
        
        | Term 
 
        | DNA methyl transferase (DNMT) |  | Definition 
 
        | methylate C5 of cytosine - mechanism of long term silencing of gene expression 
 methylation close to a transcription start site - block binding of transcription factors, recruitment of transcription repressors (methyl binding proteins)
 
 goal of epigenetic chemotherapy:
 
 prevent hypermethylation of DNA that could lead to long term silencing of genes crucial to normal cell function (usually tumor suppressor genes)
 
 methylation of cytosine nucleotides by SAM and DNA methyl transferase:
 
 [image]
 
 the methyl group is introduced at the 5 position of the ring
 
 the methyl group donor in this reaction is S-adenosyl methionine
 
 certain nucleosides such as azacytidine can be incorporated into DNA or RNA and inhibit DNA methyl transferases
 
 the net result is that hypermethylation of DNA and gene silencing is prevented
 
 inhibitor of DNMT (azacitidine) - the only difference is the presence of N at position 5
 
 methylation of cytosine by DNMT (SAM methyl group donor):
 
 [image]
 
 this shows the mechanism by which DNA methyl transferases methylate cytosine bases
 
 the first step in the process is reaction of the SH group at the active site of the methyltransferases with the C-6 position of the cytosine base
 
 the electron pair of this intermediate attacks the reactive methyl group on SAM
 
 this methyl group is adjacent to a positively charged sulfur atom
 
 thus, the cofactor is displaced and the methyl group is transferred to cytosine
 
 the DNA methyl transferase is displaced by the loss of a H+ at position 5
 
 this last step is ESSENTIAL in the action of the methyl transferase
 
 in the absence of this proton at C5 the DNA methyl transferase is inhibited (bound to DNA) and is subject to degradation
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        |  | 
        
        | Term 
 
        | nucleoside inhibitors of DNMT |  | Definition 
 
        | [image] 
 incorporate into DNA (decitabine) and DNA/RNA (azacytadine)
 
 form covalent intermediate complex with DNMT
 
 DNMT trapped and cannot dissociate (degraded)
 
 may also damage DNA by a DNMT-independent pathway
 
 [image]
 
 inhibition of DNMT by azacytidine
 
 note the process is exactly as shown for the normal substrate
 
 after methylation of N5 on azacytidine, there is no proton at the 5 position to be eliminated
 
 thus, the enzyme is inhibited
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        |  | 
        
        | Term 
 
        | inhibitors of histone deacetylase |  | Definition 
 
        | chromatin (nucleus) complex of DNA and protein that make up chromosomes 
 nucleosomes - smallest structural unit of chromatin; 200 DNA base pairs and 8 DNA associated proteins (histones)
 
 histones - N terminal ends protrude from nucleosomes and are subject to epigenetic changes that regulate gene expression
 
 histone deacetylase plays an important role in how tightly chromatin is packed
 
 inhibitors of this enzyme loosen chromatin and allow expression of key suppressor gene such as tumor suppressor gene
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        |  | 
        
        | Term 
 
        | modification of histone:  ACETYLATION |  | Definition 
 
        | [image] 
 there is a balance between HAT and HDAC
 
 the acetyltransferase produces the acetylation of Lys residues on the histone tails
 
 this causes less association between the Lys residue and the negatively charged phosphate groups in the DNA backbone
 
 the enzyme histone deacetylase catalyzes the hydroxylsis of the amide bond
 
 once in the protonated form, the positively charged amino groups on the Lys side chain associated much more tightly with the negatively charged phosphate groups on the DNA backbone
 
 actions of HAT and HDAC are opposed:
 
 HAT RELAXES CHROMATIN permitting various transcription factors to interact with DNA - PROMOTES TRANSCRIPTION
 
 HDAC CONDENSES CHROMATIN preventing access of various transcription factors - LEADS TO TRANSCRIPTION REPRESSION
 
 HAT inactivity and HDAC overactivity has been associated with TUMORIGENESIS
 
 thus, a histone deacetylase inhibitor can prevent the deacetylation of histone proteins
 
 this will allow the approach of various transcription factors that can promote gene trascription (tumor suppressors and proapoptotic factors)
 
 acetylation destabilizes the nucleosome
 
 allows approach and binding of transcription factors
 
 tumor suppressor and proapoptotic genes are expressed
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        |  | 
        
        | Term 
 | Definition 
 
        | active site of HDAC contains a Zn ion that facilitates the proteolytic cleavage of the acetylated lysine 
 [image]
 
 at the active site of HDAC, there is a key Zn ion that complexes to Asp and His residues at the active site of the enzyme
 
 the Zn activates a water molecule, allowing attack on the peptide bond of the acetylated Lys residue of the histone protein
 
 thus, hydrolysis of the acetyl group is achieved
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        |  | 
        
        | Term 
 
        | vorinostat - a histone deacetylase inhibitor 
 [image]
 |  | Definition 
 
        | [image] 
 vorinostat is a hydroxamic acid that acts as an inhibitor of HDAC
 
 key to its action is the ability of the hydroxamic acid to complex to the Zn ion at the active site of histone deacetylase
 
 it thus inhibits the enzyme
 
 hydroxamic acids are weak acids with pKas around 9
 
 the acidic proton is actually associated with nitrogen rather than oxygen
 
 the reason being is that the resulting anion is stabilized by resonance over the C=O group
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        |  | 
        
        | Term 
 
        | romidepsin (IV prodrug) - inhibitor of HDAC |  | Definition 
 
        | [image] 
 S-S is the key to its action
 
 disulfide undergoes bioreduction and SH groups are generated
 
 SH groups will strongly bind Zn; Zn is tied up and histone deacetylase is inhibited
 
 around the outside there are a lot of H bond donors and acceptors that help stabilize the compound in the active site of the enzyme
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        |  | 
        
        | Term 
 
        | thalidomide and lenalidomide 
 [image]
 |  | Definition 
 
        | [image] 
 undergoes chiral inversion in the body (rare for this to happen)
 
 [image]
 
 can be hydrolyzed on either ring
 
 thalidomide and its derivative presumably act at one or more sites of action:
 
 1)  direct antiapoptotic effect on tumor cells
 
 2)  inhibition adhesion of MM cells partly due to decreased production of IL-6
 
 3)  decreased angiogenesis due to inhibition of growth factors and cytokine release
 
 4)  enhanced T cell production of cytokines and natural killer cells
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        |  | 
        
        | Term 
 | Definition 
 
        | [image] 
 restricted distribution program
 
 lower risk of ADRs compared to thalidomide
 
 compared to thalidomide it is better absorbed b/c of the amino group increasing water solubility
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        |  | 
        
        | Term 
 
        | protein kinase inhibitors |  | Definition 
 
        | regulation of phosphorylation stages of signaling molecules 
 serine - threonine kinases
 
 tyrosine kinases
 
 kinases that are confined to cytoplasms
 
 kinases that tranverse the cell membrane and function as ENZYME and RECEPTOR
 
 [image]
 
 signal transduction involving kinase linked receptors:
 
 binding of a chemical messenger (variety of growth factors and growth hormones) which start the signaling cascade that involved various protein kinases
 
 this process eventually controls transcription of genes in DNA leading to cell growth and cell division
 
 it has been observed that many cancers have an excess of a specific growth hormone or growth factor or a specific protein kinase or protein kinase receptor
 
 since these processes are eventually involved in signal transduction which leads to cell growth and division, it is reasonable to assume that protein kinase inhibition will be useful anticancer agents
 
 growth factor signaling:
 
 binding of agonist ligands to growth factor receptors causes receptor DIMERIZATION and ACTIVATION OF CYTOSOLIC PROTEIN KINASE DOMAINS
 
 kinase activity allows each kinase to autophosphorylate the other enzyme kinase
 
 leading to activation of multiple signaling pathways
 
 their signals regulate PROLIFERATION, METABOLISM, SURVIVAL AND THE SYNTHESIS OF OTHER GROWTH FACTORS
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        |  | 
        
        | Term 
 
        | ATP binding site on a protein kinase |  | Definition 
 
        | [image] 
 all kinases use ATP as the phosphorylating agen
 
 at the active site of the kinase there is a binding site for ATP and a binding site that binds the substrate (growth factors or growth hormones)
 
 ATP binds loosely at the active site and there are regions that are unoccupied
 
 depending on the kinase, there are amino acid differences that makes it possible to design a relative selective inhibitor of specific kinases
 
 the purine base of ATP binds deep within the binding pocket and forms 3 important hydrogen bonds with the protein backbone of the kinase
 
 the ribose sugar unit is bound in the sugar region and the triphosphate region lies in a cleft leading to the surface of the enzyme
 
 there is also a hydrophobic pocket across from the purine binding site
 
 at the entrance to this pocket is an amino acid residue termed the gatekeeper residue
 
 in some kinases, the gatekeeper residue is large and block access to the pocket
 
 this results in a small backpocket
 
 in other cases, the gatekeeper residue is small and allows access to the backpocket (the backpocket is large)
 
 all kinase inhibitors have something that mimics the purine ring of ATP
 
 hing region on the kinase:  key is there is H bonding between the backbone of the kinase and ATP (help orientate ATP or an inhibitor at the active site of the enzyme)
 
 when the gatekeeper is Thr (smaller) it allows a larger back pocket
 when the gatekeeper is phenylalanine (larger) it has a smaller backpocket
 
 size of the hydrophobic back pocket determined by size of gatekeeper amino acid:
 
 [image]
 
 take home message - not all kinase inhibitors bind the same
 almost all kinase inhibitors have a purine like moiety
 
 kinase inhibitors can have very specific activity on kinases and will be specific for certain cancers
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        |  | 
        
        | Term 
 
        | imatinib, dasatinib, nilotinib - inhibitors of BCR-ABL tyrosine kinase |  | Definition 
 
        | BCR-ABL tyrosine kinase has been implicated in chronic myelogenous leukemia 
 [image]
 
 circled are similar regions that can H bond to the linker region and put them in the right position like ATP
 
 hydrophobic structures that fit in the hydrophobic pocket
 
 solubilized by attaching a tail that binds to an allosteric site (doesn't have effect binding to the active site, but enhances solubility)
 
 binding of imatinib to BCR-ABL kinase:
 
 [image]
 
 important interactions with the BCR-ABL tyrosine kinase:
 
 1.  notice that the pyrimidine ring is attached to the pyrimidine ring undergoes hydrogen bonding in the region of the kinase where the purine ring of ATP binds; hydrophobic binding pocket I remains unoccupied
 
 2.  the anilinogroup attached to the 2 position of the pyrimmidine ring undergoes H bonding with the Thr in the gatekeeper region
 
 3.  2 methylphenyl group fits into hydrophobic pocket II
 
 4.  the N methylpiperazine ring fits into the allosteric site on the kinase; the N methyl piperazine ring is a water solubilizing group that enhances oral bioavailability
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        |  | 
        
        | Term 
 
        | imatinib metabolism 
 [image]
 |  | Definition 
 
        | [image] 
 [image]
 
 predominately metabolized by CYP3A4 to the active des methyl metabolite
 |  | 
        |  | 
        
        | Term 
 | Definition 
 
        | [image] 
 reactive quinoneimine intermediate; this intermediate can undergo conjugation with glutathione to form various adducts
 |  | 
        |  | 
        
        | Term 
 | Definition 
 
        | [image] 
 circled - mimic nucleophils that bind to the kinase via H-bonds
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        |  | 
        
        | Term 
 | Definition 
 
        | multiple pathways of carcinogenesis and cancer metastasis 
 over activity will cause cell proliferation
 
 binding of the ligand to the cytokine receptors causes their dimerization
 
 JAKs then bind to the receptor and undergo transphosphorylation
 
 this causes downstream phosphorylation of STATs (signal transducers and activators of transcription)
 
 the activated STATs dimerize and translocate to the nucleus where they activate or repress gene transcription
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        |  | 
        
        | Term 
 
        | ruxolitinib - inhibits JAK1, JAK2 
 [image]
 |  | Definition 
 
        | [image] 
 metabolism:
 
 [image]
 
 metabolized by CYP3A4 to hydroxy and conjugated metabolites
 
 most kinase inhibitors involve metabolism through CYP3A4 so the possibility of drug interactions is very high!
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        |  | 
        
        | Term 
 
        | mTOR inhibitors:  rapamycin analogues |  | Definition 
 
        | activation of mTORC1 causes phosphorylation of 4EBP this causes 4EBP to lose the ability to inhibit eukaryotic translation inhibition factor 4E to slow metabolism
 
 when mTOR is activated it causes a signalling cascade; if you can inhibit mTORC1 it is effective against tumors
 
 rapamycin:
 
 [image]
 
 temsirolimus:
 
 [image]
 
 metabolized by esterases to rapamycin and also by demethylation
 
 everolimus:
 
 [image]
 
 mTORC1 inhibitor
 
 metabolized by CYP3A4
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