Overcoming drug resistance using small molecule activators of protein phosphatase 2A

University Of Nebraska Medical Center, Omaha NE

Investigators

Abstract

Uncontrolled cell proliferation resulting from aberrant activity of cell cycle proteins is a hallmark of cancer. Overexpression of the mitogen sensor cyclin D1 is among the most frequent abnormalities in tumors, enhancing the activity of cyclin dependent kinases 4 and 6 (CDK4/6) to drive G1→S phase progression and promote cell survival and chemoresistance. Increased expression of D-type cyclins is required not only for tumorigenesis but also for tumor maintenance and progression. Thus, aberrant cyclin D-CDK4/6 activity represents an actionable target for cancer therapy and D-type cyclin function is among the top therapeutic targets for cancer management. Inhibitors of CDK4/6 activity have shown promise in the clinic and palbociclib, abemaciclib, and ribociclib are FDA-approved for use in patients. Several hundred clinical trials are currently ongoing to evaluate the antitumor effects of these agents in a broad spectrum of cancer types. However, the therapeutic promise of CDK4/6 inhibitors is dampened by inevitable emergence of resistance. Recent seminal studies have identified a novel mechanism of resistance to these agents mediated by deficiency of autophagy and beclin 1 regulator 1 (AMBRA1), an E3 ligase adaptor and master regulator of cyclin D1, D2, and D3 protein stability. Loss or mutation of AMBRA1 is seen in a significant subset of human cancers, in association with poor patient survival. AMBRA1 deficiency promotes the accumulation of D-type cyclins, a hyperproliferative phenotype, and tumorigenesis, while reducing the sensitivity of tumor cells to all three FDA-approved CDK4/6 inhibitors. Evidence that upregulation of D-type cyclins and the formation of non-canonical cyclin D-CDK2 and p27-cyclin D-CDK4 complexes underpins resistance to these agents forms the basis of this proposal. Strategies are proposed to explore the mechanism-driven application of Small Molecule Activators of PP2A (SMAPs) for overcoming resistance to CDK4/6 inhibitors in the context of AMBRA1 deficiency. SMAPs are a novel class of antitumor agents that selectively activate a subset of PP2A holoenzymes for potent tumor suppression in a variety of cancer types. This project builds on our discovery that SMAPs potently downregulate cyclins D1, D2 and D3 in all cell types tested. Importantly, SMAPs act as AMBRA1-independent D-type cyclin ‘degraders,’ promoting rapid proteolysis of these molecules via a proteasome-dependent mechanism that remains functional following loss of AMBRA1. Based on these findings, we hypothesize that combining CDK4/6 inhibitor treatment with a SMAP ‘D-type cyclin degrader’ will enhance antitumor activity and reverse resistance to CDK4/6 inhibitors driven by AMBRA1 deficiency. Proof-of-concept studies will be performed in two Specific Aims: (1) Explore the effects of combining CDK4/6 inhibitors and SMAPS in the context of AMBRA1-deficiency, and (2) Evaluate the effects of SMAP- CDK4/6 inhibitor combinations in tumor models in vivo. Importantly, in addition to addressing consequences of AMBRA1-deficiency, our proof-of-concept findings are anticipated to be broadly applicable to tumors harboring increased levels of D-type cyclins and aberrant CDK activity resulting from other tumor-associated alterations.