Preclinical activity of a novel CRM1 inhibitor in acute myeloid leukemia by Parvathi Ranganathan, Xueyan Yu, Caroline Na, Ramasamy Santhanam, Sharon Shacham,

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Preclinical activity of a novel CRM1 inhibitor in acute myeloid leukemia by Parvathi Ranganathan, Xueyan Yu, Caroline Na, Ramasamy Santhanam, Sharon Shacham, Michael Kauffman, Alison Walker, Rebecca Klisovic, William Blum, Michael Caligiuri, Carlo M. Croce, Guido Marcucci, and Ramiro Garzon Blood Volume 120(9):1765-1773 August 30, 2012 ©2012 by American Society of Hematology

KPT-SINE significantly inhibits proliferation and induces cell-cycle arrest and apoptosis of AML cell lines and primary AML blasts. KPT-SINE significantly inhibits proliferation and induces cell-cycle arrest and apoptosis of AML cell lines and primary AML blasts. (A) WST-1 assays in MV4-11, Kasumi-1, MOLM-13, and OCI-AML-3. (B) Cell-cycle assessment using propidium iodine (PI) detection by flow cytometry at 24 hours. (C) Apoptosis as measured by annexin V/PI staining using FACS at 48 hours. (D) Colony assays in Kasumi-1, MV4-11, and OCI-AML3 cells after KPT-185 treatment at 24, 48, and 72 hours. (E) Apoptosis as measured by annexin V/PI staining using FACS at 48 hours in primary AML samples. (F) WST-1 assays in primary AML samples. Parvathi Ranganathan et al. Blood 2012;120:1765-1773 ©2012 by American Society of Hematology

KPT-SINE treatment causes decrease of CRM1 protein level, accumulation of CRM1 cargo proteins in the nucleus, and down-regulation of FLT3 and KIT oncoproteins. KPT-SINE treatment causes decrease of CRM1 protein level, accumulation of CRM1 cargo proteins in the nucleus, and down-regulation of FLT3 and KIT oncoproteins. (A) Top panel: CRM1 protein expression as measured by Western blotting in MV4-11, Kasumi-1, and OCI-AML3 cells after KPT-185 treatment or control (DMSO) after 24 hours. Loading control is actin. Bottom panel: CRM1 protein expression as measured by Western blotting in 3 primary AML blasts after KPT-185 treatment or control. (B) Confocal microscopy of p53 in MV4-11 and OCI-AML3 cells treated with KPT-185 or control at 24 hours. Left panel: DAPI staining (cell nucleus). Middle panel: p53 staining. Right panel: merge of p53 and DAPI staining. Note the increase in the p53 expression in the nucleolus. (C) Whole-cell p53 protein expression in MV4-11 and OCI-AML3 cells (top panel) or primary AML blasts (n = 3) after KPT-185 or control treatment at 2 and 24 hours. (D) Confocal microscopy of NPM1 in OCI-AML3 cells and in a primary AML blast from a patient with CN-AML and NPM1 mutation treated with KPT-185 or control at 24 hours. Left panel: DAPI staining (cell nucleus). Middle panel: NPM1 staining. Right panel: merge of NPM1 and DAPI staining. The arrows indicate the localization of NPM1 in the cytoplasm (NPMc+) in the untreated samples and the elimination of the cytoplasmic signal on treatment with the drug, being detected exclusively in the nucleus. (E) FLT3 protein expression in MV4-11, Kasumi-1, and OCI-AML3 cells as measured by Western blotting after KPT-185 treatment or control at 24 hours. (F) FLT3 protein expression in primary AML blasts as measured by Western blotting after KPT-185 treatment or control at 24 hours: patient 1, CN-AML NPM1 WT, FLT3 ITD+; patient 2, CN-AML, NPM1 mutated, FLT3 WT; and patient 3, CN-AML, NPM1 mutated, FLT3 WT. (G) c-KIT expression in Kasumi-1 and OCI-AML3 cells after KPT-185 treatment or control at 24 hours. Parvathi Ranganathan et al. Blood 2012;120:1765-1773 ©2012 by American Society of Hematology

CRM1 inhibition induces differentiation of AML cell lines. CRM1 inhibition induces differentiation of AML cell lines. (A) CD11b measurement by FACS in AML cell lines after KPT-185 treatment at 72 hours. (B) Giemsa stain of cytospins of Kasumi-1 and MV4-11 cells treated with KPT-185 or controls. Magnification, 40×. Arrows indicate nuclear condensation. (C) CEBPA protein expression in MV4-11 cells and OCI-AML3 cells after KPT-185 treatment or controls for 24 and 48 hours. Loading control is actin. (D) GCSFR and lysozyme mRNA expression after KPT-185 treatment or controls in MV4-11 cells and OCI-AML3 cells. Results are shown as fold change after normalization with 18s and 2ΔCt calculations. (E) CEBPA protein expression after p53 siRNA or scramble oligonucleotide transfection in OCI-AML3 cells subsequently treated with KPT-185 or controls for 24 hours. Protein expression of p21 was measured as control for successful p53 inhibition. (F) CD11b expression in OCI-AML3 cells after transfection with scramble or p53 antisense oligonucleotides and treatment with DMSO or KPT-185 at 72 hours. (G) Apoptosis as measured by annexin V/PI staining using FACS at 48 hours after scramble or p53 antisense oligonucleotides and treatment with DMSO or KPT-185. Parvathi Ranganathan et al. Blood 2012;120:1765-1773 ©2012 by American Society of Hematology

CRM1 inhibitor increases survival in a human leukemia xenograft model. CRM1 inhibitor increases survival in a human leukemia xenograft model. (A) Survival of MV4-11 xenograft mice after treatment with KPT-276 150 mg/kg (n = 12) or vehicle control (n = 11). Survival comparison was made with log-rank test. (B) White blood cell count (in thousands) in KPT-treated mice versus vehicle control (n = 8) at 21 days. P values obtained using t test. (C) Spleen weights (mg) in KPT-treated mice versus vehicle control (n = 7). P values obtained using t test. (D) Spleen photographs of 3 representative cases (KPT-276 n = 3; vehicle n = 3) at 21 days. (E) FLT3 protein expression in mouse spleen cells as measured by Western blotting after KPT-276 treatment or vehicle control at 21 days. Parvathi Ranganathan et al. Blood 2012;120:1765-1773 ©2012 by American Society of Hematology