Neuroblastoma is the most common extra-cranial
malignancy in childhood and accounts for ∼15% of childhood
cancer deaths. Amplification of MYCN in
neuroblastoma is associated with aggressive disease and predicts for poor prognosis. Novel therapeutic approaches are therefore essential to improving patient outcomes in this setting. The
histone deacetylases are known to interact with N-Myc and regulate numerous cellular processes via epigenetic modulation, including differentiation. In this study, we used the TH-MYCN mouse model of
neuroblastoma to investigate the antitumor activity of the pan-
HDAC inhibitor,
panobinostat. In particular we sought to explore the impact of long term, continuous
panobinostat exposure on the epigenetically driven differentiation process. Continuous treatment of
tumor bearing TH-MYCN transgenic mice with
panobinostat for nine weeks led to a significant improvement in survival as compared with mice treated with
panobinostat for a three-week period.
Panobinostat induced rapid
tumor regression with no regrowth observed following a nine-week treatment period. Initial
tumor response was associated with apoptosis mediated via upregulation of BMF and BIM. The process of terminal differentiation of
neuroblastoma into benign
ganglioneuroma, with a characteristic increase in S100 expression and reduction of N-Myc expression, occurred following prolonged exposure to the drug.
RNA-sequencing analysis of
tumors from treated animals confirmed significant upregulation of gene pathways associated with apoptosis and differentiation. Together our data demonstrate the potential of
panobinostat as a novel therapeutic strategy for high-risk
neuroblastoma patients.