PROJECT ABSTRACT
This application is focused development of a new therapeutic for pediatric high-grade glioma (HGG), including a
rare subset known as Diffuse Intrinsic Pontine Glioma (DIPG). DIPG is a rare brain cancer primarily affecting
children, with approximately 200-300 new annual cases in the United States, less than 2 percent survival at 2
years, and with a limited response to therapeutic radiation (RT). Recently published studies in preclinical glioma
models have revealed that RT results in a progressive accumulation of monocyte derived macrophages (MDMs)
and activated microglia, and that inhibition of the recruitment of MDMs delays glioma recurrence. There is
substantial evidence demonstrating a key role for chemokine (C-C motif) ligand 2 or ‘CCL2’ also known as
monocyte chemoattractant protein-1 (MCP-1) in RT-induced inflammation, including the recruitment of MDMs
into the brain and tumor microenvironment (TME). These studies not only show that RT induces a transient and
selective upregulation of CCL2 within hours of exposure, but also demonstrate disruption of CCL2 signaling
during this time frame alone is sufficient to attenuate chronic microglial activation and to allow the recovery of
neurogenesis in the weeks following radiation. However, there is a desperate need for new agents that are not
only potent inhibitors of CCL2 production and signaling, but that are also safe for administration in combination
with RT. The synthetic oleanane triterpenoids (SOTs) evaluated in this application meet these criteria. The
research team pursues ground-breaking, high-risk, high-gain studies that address our central hypothesis that
chronic, systemic oral administration of a newly developed SOT (CDDO-2P-Im or ‘2P-Im’) will enhance the
radiation response of DIPG through mechanisms that include suppression of RT-induced recruitment and
activation myeloid cells in the brain, with potential to also limit RT-related toxicity. Preliminary data show 900
nanomoles of 2P-Im/kg of brain at 6 hours after a 1 µmole dose, given either by intraperitoneal injection or by
oral gavage in mice, and that 2P-Im inhibits CCL2 production by activated human macrophages at picomolar
concentrations in vitro. The project is organized around three specific aims that: (1) define the effect of 2P-Im
(both alone and in combination with RT) on in vitro clonogenic survival of DIPG cell lines, including those
harboring the histone H3.3 Lys 27-to-methionine (K27M) mutation, and the relationship to direct molecular
targets of 2P-Im (AIM 1); (2) determine the dose- and time-dependent effects of 2P-Im on RT-induced recruitment
of MDMs and on microglial activation (AIM 2); and (3)
demonstrate the in vivo efficacy and activity of
2P-Im
(administered in rodent diet) in established, orthotopic PDX models of DIPG, including the capacity of 2P-Im to
enhance the radiation response of DIPG xenografts in vivo, (AIM 3). Data generated in this proposal will position
2P-Im for advancement to critical, IND-enabling studies, and as a novel, orally bioavailable therapy for a highly
aggressive, refractory rare childhood cancer.