title: The tetravalent guanylhydrazone CNI-1493 blocks the toxic effects of interleukin-2 without diminishing antitumor efficacy.
abstract: The use of interleukin 2 (IL-2) as an antineoplastic agent has been limited by the serious toxicities that accompany the doses necessary for a tumor response. Elevation of nitric oxide (NO) and tumor necrosis factor (TNF) both have been implicated in IL-2 toxicities. CNI-1493, a tetravalent guanylhydrazone, is an inhibitor of macrophage activation including the synthesis of TNF and other cytokines. Doses of CNI-1493 as low as 1 mg/kg/day conferred complete protection against fatal toxicity of IL-2 with IL-2 doses tenfold higher than the safely tolerated level in Sprague-Dawley rats. Moreover, typical pathologic changes in the lungs, kidneys, and the liver caused by IL-2 infusion were blocked by cotreatment with CNI-1493. When animals bearing established hepatomas were given IL-2 and CNI-1493 combination therapy, 10 of 10 hepatomas regressed from 1 cm3 to <1 mm3. Intracytoplasmic TNF levels were increased in normal tissues from IL-2 treated animals, and treatment with CNI-1493 maintained TNF at control levels. The degree of apoptosis measured by terminal deoxynucleotidyltransferase-mediated dUTP-biotin nick end labeling staining of tumors following IL-2 therapy was not reduced compared with IL-2 cotreated with CNI-1493. In contrast, apoptosis in the liver and lung parenchyma following IL-2 therapy was blocked completely by cotreatment with CNI-1493. Taken together, these data showed that low and infrequent doses of CNI-1493 markedly protected animals from IL-2 systemic toxicities whereas not affecting tumor response to IL-2 therapy. With the protection afforded by CNI-1493 treatment, IL-2 therapy dose levels could be increased to provide significant antitumor effects in animals with established hepatomas.
authors.affiliation: Department of Surgical Oncology, North Shore University Hospital, New York University School of Medicine, 300 Community Drive, Manhasset, NY 11030, USA.
authors.forename: M M
authors.initials: MM
authors.lastname: Kemeny
authors.forename: G I
authors.initials: GI
authors.lastname: Botchkina
authors.forename: M
authors.initials: M
authors.lastname: Ochani
authors.forename: M
authors.initials: M
authors.lastname: Bianchi
authors.forename: C
authors.initials: C
authors.lastname: Urmacher
authors.forename: K J
authors.initials: KJ
authors.lastname: Tracey
mesh_terms: D000818:Animals; D017209:Apoptosis / Q000187:drug effects; D002843:Chromatin / Q000187:drug effects / Q000473:pathology / Q000648:ultrastructure; D006499:Hepatic Artery; D006801:Humans; D006835:Hydrazones / Q000008:administration & dosage / Q000494:pharmacology*; D007150:Immunohistochemistry; D007261:Infusions, Intra-Arterial; D007262:Infusions, Intravenous; D007376:Interleukin-2 / Q000008:administration & dosage / Q000037:antagonists & inhibitors / Q000627:therapeutic use* / Q000633:toxicity*; D007601:Jugular Veins; D007668:Kidney / Q000187:drug effects / Q000473:pathology; D008099:Liver / Q000187:drug effects / Q000473:pathology; D008114:Liver Neoplasms, Experimental / Q000473:pathology / Q000628:therapy*; D008168:Lung / Q000187:drug effects / Q000473:pathology; D051381:Rats; D017207:Rats, Sprague-Dawley; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000627:therapeutic use / Q000633:toxicity; D015996:Survival Rate; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis; D000813:Anilides; D006146:Guanidines
chemical_list: D002843:Chromatin; D006835:Hydrazones; D007376:Interleukin-2; D011994:Recombinant Proteins; D014409:Tumor Necrosis Factor-alpha; C097256:semapimod; D000813:Anilides; D006146:Guanidines