Therapy for treatment-resistant
breast cancer provides limited options and the response rates are low. Therefore, the development of
therapies with alternative chemotherapeutic strategies is necessary. AG311 (5-[(4-methylphenyl)thio]-9H-pyrimido[4,5-b]
indole-2,4-
diamine), a small molecule, is being investigated in preclinical and mechanistic studies for treatment of resistant
breast cancer through
necrosis, an alternative cell death mechanism. In vitro, AG311 induces rapid
necrosis in numerous
cancer cell lines as evidenced by loss of membrane integrity,
ATP depletion,
HMGB1 (high-mobility group
protein B1) translocation, nuclear swelling, and stable membrane blebbing in
breast cancer cells. Within minutes, exposure to AG311 also results in mitochondrial depolarization,
superoxide production, and increased intracellular
calcium levels. Additionally, upregulation of mitochondrial oxidative phosphorylation results in sensitization to AG311. This AG311-induced cell death can be partially prevented by treatment with the
mitochondrial calcium uniporter inhibitor,
Ru360 [(μ)[(HCO2)(NH3)4Ru]2OCl3], or an
antioxidant,
lipoic acid. Additionally, AG311 does not increase apoptotic markers such as cleavage of
poly (ADP-ribose) polymerase (PARP) or
caspase-3 and -7 activity. Importantly, in vivo studies in two orthotopic
breast cancer mouse models (xenograft and allograft) demonstrate that AG311 retards
tumor growth and reduces lung
metastases better than clinically used agents and has no gross or histopathological toxicity. Together, these data suggest that AG311 is a first-in-class antitumor and antimetastatic agent inducing
necrosis in
breast cancer tumors, likely through the mitochondria.