Shoemaker, Robert H.

Abstract Patients diagnosed with germline mutations in MMR genes (Lynch Syndrome, LS) have up to 70-80% lifetime risk of colorectal cancer. Therefore, this high-risk population has the potential to benefit from effective chemopreventive strategies. Naproxen is an NSAID widely used for pain treatment with an excellent safety profile that has demonstrated to be more efficacious preventing colorectal cancer compared to aspirin in vivo using an intestinal tissue-specific mouse model of LS (VC-Msh2-LoxP). The ‘Naproxen trial' was designed to evaluate the modulation of PGE2 levels in colorectal mucosa, evaluate safety and tolerability, and discover novel molecular pathways involved in the chemopreventive activity of naproxen in LS patients. Methods: Participants were randomized to naproxen 440 mg (HD), 220 mg (LD) and placebo by mouth daily for 6 months. Modulation of prostaglandin levels, number of adverse events (AEs) observed in each treatment arm and gene expression profiles by next-generation sequencing (mRNAseq) in normal colorectal mucosa of LS patients after 6 months of intervention were examined. Results: Eighty participants diagnosed with LS were randomized, 25 participants to HD, 27 to LD, and 28 to placebo. From these patients, 54 were considered evaluable per-protocol analysis: 16 in the HD group, 15 in the LD and 23 in placebo. The level of prostaglandin E2 in the colorectal mucosa decreased significantly after treatment with both LD and HD naproxen when compared to placebo (-91.2%±14.1, -93.6%±7.9, and 23.8%±108.4, P-value<0.001, respectively). Moreover, levels of PGE2 urinary metabolite (PGE-M) were significantly changed in both treatment groups when compared to placebo (-47.7%±56.9, -41.1%±40.5, 7.6%±94.3, P-Value<0.018). The intervention was well tolerated, no severe AEs related to treatment were reported, and the total number of AEs was not different across treatment arms. LD and HD naproxen promoted the activity of the immune system by activating different immune cell types without any effect on lymphoid cellularity and changed the expression patterns of the intestinal crypt towards epithelial differentiation and stem cell regulation. Conclusions: Naproxen is a promising strategy for immune interception in LS that induces immune-modulation coupled with changes in the dynamics of the intestinal crypt. We have also discovered naproxen-induced gene expression profiles for their potential use as predictive biomarkers of drug activity. Citation Format: Laura Reyes Uribe, Wenhui Wu, Ozkan Gelincik, Prashant V. Bommi, Alejandro Francisco-Cruz, Luisa M. Solis, Patrick M. Lynch, Ramona Lim, Elena Stoffel, Priyanka Kanth, N. Jewel Samadder, Maureen E. Mork, Melissa W. Taggart, Ginger L. Milne, Lawrence J. Marnett, Lana Vornik, Diane D. Liu, Maria Revuelta, Kyle Chang, Y. Nancy You, Levy Kopelovich, Ignacio I. Wistuba, J. Jack Lee, Shizuko Sei, Robert H. Shoemaker, Eva Szabo, Ellen Richmond, Asad Umar, Marjorie Perloff, Powell H. Brown, Steven M. Lipkin, Eduardo Vilar. Naproxen chemoprevention promotes immune activation in Lynch syndrome colorectal mucosa [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr CT111.

Objective Patients with Lynch syndrome (LS) are at markedly increased risk for colorectal cancer. It is being increasingly recognised that the immune system plays an essential role in LS tumour development, thus making an ideal target for cancer prevention. Our objective was to evaluate the safety, assess the activity and discover novel molecular pathways involved in the activity of naproxen as primary and secondary chemoprevention in patients with LS. Design We conducted a Phase Ib, placebo-controlled, randomised clinical trial of two dose levels of naproxen sodium (440 and 220 mg) administered daily for 6 months to 80 participants with LS, and a co-clinical trial using a genetically engineered mouse model of LS and patient-derived organoids (PDOs). Results Overall, the total number of adverse events was not different across treatment arms with excellent tolerance of the intervention. The level of prostaglandin E2 in the colorectal mucosa was significantly decreased after treatment with naproxen when compared with placebo. Naproxen activated different resident immune cell types without any increase in lymphoid cellularity, and changed the expression patterns of the intestinal crypt towards epithelial differentiation and stem cell regulation. Naproxen demonstrated robust chemopreventive activity in a mouse co-clinical trial and gene expression profiles induced by naproxen in humans showed perfect discrimination of mice specimens with LS and PDOs treated with naproxen and control. Conclusions Naproxen is a promising strategy for immune interception in LS. We have discovered naproxen-induced gene expression profiles for their potential use as predictive biomarkers of drug activity. Trial registration number gov Identifier: NCT02052908

Abstract CHEK2 codes for a serine/threonine kinase (Chk2) activated by ATM in response to DNA double-strand breaks (DSB). CHEK2 has been described as a tumor suppressor with pro-apoptotic, cell cycle checkpoint and mitotic functions. However, Chk2 is also commonly activated (phosphorylated at T68) in cancers and precancerous lesions. In the present report, we characterized CHEK2 across the panel of 60 established cancer cell lines from the NCI Anticancer Tumor Cell Line panel (the NCI-60) using genomic and proteomic analyses including exon-specific mRNA expression, DNA copy number variation (CNV) by aCGH, exome sequencing, as well as Western blotting analyses for total and activated (pT68-Chk2) Chk2. We demonstrate that the high heterogeneity of Chk2 levels in the NCI-60 is primarily due to its inactivation (owing to low gene expression, alternative splicing, point mutations, copy number alterations and premature truncation) or reduction of protein levels. Notably, we also found that a significant percentage of cancer cells (12% of the NCI-60 and the HeLa cervix cell line) display high endogenous Chk2 activation, always associated with p53 loss of function. Notably, all the 12 cancer cell lines characterized as being p53 wild-type showed almost undetectable levels of pT68-Chk2. The potential impact of endogenous Chk2 activation was analyzed by transcriptome profiling of the five highest pT68-Chk2 cell lines, comparing them with five, tissue-matched low pT68-Chk2 and p53-matched deficient cell lines. Two-sided t tests revealed 176 genes differentially expressed with statistical significance (P < 0.01, uncorrected) in the two groups (high vs. low pT68-Chk2). Among the downregulated expressed genes, a significant number codes for proteins involved in DNA recombination, replication and repair (FANCA, FANCG, FANCL, BRCA2, RAD51C, EME1, and RECQL5 being the most relevant), and centromere organization. Several of these downregulated genes were parts of the Fanconi Anemia pathway or related to homologous recombination (HR, P < 0.05 for statistically significant enrichment using Ingenuity Pathway Analysis®). In conclusion, the biology of Chk2 remains complex, multifaceted and fast evolving. Our study provides information on the relationship between different genomic and proteomic parameters related to Chk2 in cancer, and suggests a possible role for activated Chk2 in p53-deficient or HR/Fanconi Anemia-deficient cells. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 2116. doi:1538-7445.AM2012-2116