ABSTRACT
Multiple myeloma (MM) is a plasma cell cancer that causes an overabundance of malignant, terminally
developed B cells in the bone marrow. The result of MM patients is improving dramatically because to amazing
advancements in innovative medications such as proteasome inhibitors, immunomodulatory agents, and
immunological treatment. Unfortunately, racial inequities persist; African Americans have a higher death rate
than Whites and have not achieved the same survival gains over time. One possible explanation for this
conundrum is the concept of MM stem-like cells (MMSCs). ALDH is a class of NAD (P)-dependent intracellular
enzymes involved in retinoic acid metabolism whose activity is elevated in MMSCs. In MM patients, ALDH
overexpression is related with chemo-resistance, clonogenic potential, and a poor prognosis. Furthermore,
ALDH shields MMSCs against the toxicity of chemotherapeutic medicines. We anticipate that regulating the
ALDH pathway would be a viable technique for combating relapse and refraction in MM. Recently, we created
the isatin-based small molecule inhibitor KS100, which targets many ALDH isoforms. The rationale for this
project is to evaluate the ALDH isoforms responsible for the clonogenic potential and stem-like properties of
MMSCs, determine whether KS100 effectively kills ALDH overexpressing MMSCs, and whether this multi-
isoform ALDH inhibitor could be combined with a traditional proteasome inhibitor (bortezomib) to more
effectively treat MM. To achieve this purpose, we propose the following Specific Aims. Aim 1, Determine the
effect of ALDH inhibition on bortezomib resistance in a MM xenograft model. We intend to look into the
influence of nano-KS100 (a liposomal version of KS100) on the growth and stemness of MM tumors. To
evaluate the preclinical potential of nano-KS100, we will employ the NOD-SCID-IL2R gamma null (NSG)
mouse model. We will investigate if nano-KS100 could be utilized in combination with bortezomib because
combination regimens are an important aspect of MM treatment. Aim2, Determine the role of ALDH
isoforms in maintaining the resistance and stemness of MMSCs. We will investigate the role of ALDH
isoforms (ALDH1A1, ALDH2, and ALDH 3A1) in the aggressive phenotype of MMSCs. We will overexpress
specific ALDH isoforms and study their impact on resistance and stemness. Finally, we will determine the
extent to which KS100 affects the MMSC phenotype. These noteworthy discoveries would illustrate the
usefulness of targeting ALDH enzymes in MM and other malignancies for regulating relapse, providing the
requisite preclinical confirmation for clinical translation. This contribution will be significant since it is expected
to have broad translational significance in the treatment of MM. Furthermore, this project will strengthen the
research and education infrastructure at Cooper Medical School of Rowan University (CMSRU), providing
underserved minority students with biochemical and biomedical research experiences that they would not have
otherwise.