Purine analog-like properties of bendamustine underlie rapid activation of DNA damage response and synergistic effects with pyrimidine analogues in lymphoid malignancies

PLoS One. 2014 Mar 13;9(3):e90675. doi: 10.1371/journal.pone.0090675. eCollection 2014.

Abstract

Bendamustine has shown considerable clinical activity against indolent lymphoid malignancies as a single agent or in combination with rituximab, but combination with additional anti-cancer drugs may be required for refractory and/or relapsed cases as well as other intractable tumors. In this study, we attempted to determine suitable anti-cancer drugs to be combined with bendamustine for the treatment of mantle cell lymphoma, diffuse large B-cell lymphoma, aggressive lymphomas and multiple myeloma, all of which are relatively resistant to this drug, and investigated the mechanisms underlying synergism. Isobologram analysis revealed that bendamustine had synergistic effects with alkylating agents (4-hydroperoxy-cyclophosphamide, chlorambucil and melphalan) and pyrimidine analogues (cytosine arabinoside, gemcitabine and decitabine) in HBL-2, B104, Namalwa and U266 cell lines, which represent the above entities respectively. In cell cycle analysis, bendamustine induced late S-phase arrest, which was enhanced by 4-hydroperoxy-cyclophosphamide, and potentiated early S-phase arrest by cytosine arabinoside (Ara-C), followed by a robust increase in the size of sub-G1 fractions. Bendamustine was able to elicit DNA damage response and subsequent apoptosis faster and with shorter exposure than other alkylating agents due to rapid intracellular incorporation via equilibrative nucleoside transporters (ENTs). Furthermore, bendamustine increased the expression of ENT1 at both mRNA and protein levels and enhanced the uptake of Ara-C and subsequent increase in Ara-C triphosphate (Ara-CTP) in HBL-2 cells to an extent comparable with the purine analog fludarabine. These purine analog-like properties of bendamustine may underlie favorable combinations with other alkylators and pyrimidine analogues. Our findings may provide a theoretical basis for the development of more effective bendamustine-based combination therapies.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antineoplastic Agents, Alkylating / administration & dosage
  • Antineoplastic Agents, Alkylating / chemistry*
  • Antineoplastic Combined Chemotherapy Protocols / chemistry
  • Bendamustine Hydrochloride / administration & dosage
  • Bendamustine Hydrochloride / chemistry*
  • Cell Cycle
  • Cell Line, Tumor / drug effects
  • Cell Proliferation
  • Cyclophosphamide / administration & dosage
  • Cyclophosphamide / analogs & derivatives
  • Cytarabine / administration & dosage
  • DNA Damage*
  • Dose-Response Relationship, Drug
  • Drug Screening Assays, Antitumor
  • Drug Synergism
  • Humans
  • Inhibitory Concentration 50
  • Lymphoma / pathology
  • Lymphoma, Large B-Cell, Diffuse / pathology
  • Lymphoma, Mantle-Cell / pathology
  • Multiple Myeloma / pathology
  • Pyrimidines / chemistry*
  • Rituximab / administration & dosage

Substances

  • Antineoplastic Agents, Alkylating
  • Pyrimidines
  • Cytarabine
  • Rituximab
  • Cyclophosphamide
  • Bendamustine Hydrochloride
  • pyrimidine
  • perfosfamide

Grants and funding

This work was supported in part by the High-Tech Research Center Project for Private Universities: Matching Fund Subsidy from MEXT, a Grant-in-Aid for Scientific Research from JSPS (to J.K. and Y.F.), and research grants from Japan Leukemia Research Fund, Takeda Science Foundation (to J.K.), The Naito Foundation, The Yasuda Medical Foundation, and The Uehara Memorial Foundation (to Y.F.). YF received research funding from Eisai Co., Janssen Pharmaceutical K.K., and Novartis Pharmaceuticals Co. N.H. is a winner of the Young Scientist Award of Jichi Medical University. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.