title: Epigenetic combination therapy as a tumor-selective treatment approach for hepatocellular carcinoma.
abstract: BACKGROUND
  Innovative epigenetic therapeutics comprise histone deacetylase inhibitors (HDAC-I) and demethylating agents (DA). It was recently found that HDAC-I compounds exhibit profound therapeutic activities against hepatocellular carcinoma (HCC). A comprehensive preclinical investigation was performed on the potential of a combined HDAC-I/DA epigenetic regimen for the highly chemotherapy-resistant HCC entity.
  
  
  METHODS
  Human HCC-derived cell lines or primary human hepatocytes (PHH) were treated with HDAC-I compound suberoylanilide hydroxamic acid (SAHA) or DA compound 5-aza-2'-deoxycytidine (5-aza-dC) or both and examined for cellular damage, proliferation, histone acetylation pattern, and DNA methylation. In vivo activities were investigated in a xenograft hepatoma model.
  
  
  RESULTS
  Monotherapeutic application of SAHA or 5-aza-dC was found to induce substantial antiproliferative effects in HCC-derived cells, strongly enhanced by combined SAHA and 5-aza-dC treatment. PHH from different human donors did not exhibit any relevant cellular damage even when applying high doses of the combination regimen, whereas HCC-derived cell lines showed a dose-dependent damage. In vivo testing demonstrated a statistical significant inhibition of hepatoma cell growth for the combined treatment regime.
  
  
  CONCLUSIONS
  Because the combined HDAC-I/DA epigenetic approach was found to produce significant antitumor effects in HCC model systems and did not impair cellular integrity of untransformed hepatocytes, this combination therapy is now considered for further investigation in clinical trials.
authors.affiliation: Department of Internal Medicine I, Medical University Clinic, Tubingen, Germany.
authors.forename: Sascha
authors.initials: S
authors.lastname: Venturelli
authors.forename: Sorin
authors.initials: S
authors.lastname: Armeanu
authors.forename: Anita
authors.initials: A
authors.lastname: Pathil
authors.forename: Chih-Jen
authors.initials: CJ
authors.lastname: Hsieh
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Weiss
authors.forename: Reinhard
authors.initials: R
authors.lastname: Vonthein
authors.forename: Manfred
authors.initials: M
authors.lastname: Wehrmann
authors.forename: Michael
authors.initials: M
authors.lastname: Gregor
authors.forename: Ulrich M
authors.initials: UM
authors.lastname: Lauer
authors.forename: Michael
authors.initials: M
authors.lastname: Bitzer
mesh_terms: D000818:Animals; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000494:pharmacology*; D001374:Azacitidine / Q000031:analogs & derivatives / Q000494:pharmacology; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy / Q000235:genetics / Q000473:pathology*; D045744:Cell Line, Tumor / Q000187:drug effects; D049109:Cell Proliferation / Q000187:drug effects; D019175:DNA Methylation / Q000187:drug effects; D015254:DNA Modification Methylases / Q000494:pharmacology*; D000077209:Decitabine; D004354:Drug Screening Assays, Antitumor; D044127:Epigenesis, Genetic / Q000187:drug effects*; D005260:Female; D056572:Histone Deacetylase Inhibitors; D006801:Humans; D006877:Hydroxamic Acids / Q000494:pharmacology; D008113:Liver Neoplasms / Q000188:drug therapy / Q000235:genetics / Q000473:pathology*; D051379:Mice; D008807:Mice, Inbred BALB C; D009368:Neoplasm Transplantation; D000077337:Vorinostat
chemical_list: D056572:Histone Deacetylase Inhibitors; D006877:Hydroxamic Acids; D000077337:Vorinostat; D000077209:Decitabine; D015254:DNA Modification Methylases; D001374:Azacitidine