LAUSR

Resistance of tumor cells to the induction of apoptosis is an important reason for the failure of anticancer treatments in patients with gliomas. Several factors working in concert have been implicated as sources of this treatment resistance; therefore, innovative therapeutic approaches that conspire to attack key tumor vulnerabilities are needed. HDAC and proteasome inhibitors are two classes of agents that have shown some benefit in the clinic, but patients often rapidly manifest intrinsic or acquired resistance mechanisms that limits their individual efficacy. We demonstrate that the combination of the HDAC inhibitor panobinostat and the proteasome inhibitor bortezomib synergistically induces apoptosis of human glioma cell lines. However, acquired resistance is observed even with this initially effective combination. To examine the mechanism of this resistance, we performed RNA sequencing and pharmacological screening of resistant compared to sensitive cells. Based on these studies, we present evidence that quinolinic acid phosphoribosyltransferase (QPRT), an enzyme catalyzes a rate determining step in de novo NAD+ biosynthesis, provides a critical adaptive survival mechanism that allows cancer cells to evade an initially effective therapeutic combination. We identified 1004 genes that had a significant change between panobinostat and bortezomib- resistant cells versus inhibitor naive control cells. Furthermore, pathway analysis revealed that the experimental regimen significantly altered metabolic pathways. By silencing QPRT (using siRNA) we demonstrated that we can overcome resistance, thus suggesting QPRT as a crucial crossroad for cancer cell survival and as a new anticancer target. We also showed that treatment of panobinostat and bortezomib resistant cells with FK866, niraparib, selisistat, epacadostat, gemcitabine, 5-fluoruracil, and methotrexate significantly increased cell death highlighting the importance of NAD+ and folate pathway inhibitors in resensitizing the resistant cells. Together, targeting QPRT or NAD+ consuming enzymes hold promise for eliminating recurrent disease in glioma. Citation Format: Esther P. Jane, Daniel R. Premkumar, Sameer Agnihotri, Max Myers, Ansuman Chattopadhyay, D. Lansing Taylor, Mark Schurdak, Andrew Stern, Ian F. Pollack. Gene signatures identify quinolate phosphoribosyltransferase as a key mediator of acquired resistance to Panobinostat and Bortezomib in glioma, and NAD+ biosynthesis as a targetable pathway to reverse treatment resistance [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3014.