Combined DNA methyltransferase and histone deacetylase inhibition in the treatment of myeloid neoplasms

Steven D. Gore, Stephen Baylin, Elizabeth Sugar, Hetty Carraway, Carole B. Miller, Michael Carducci, Michael Grever, Oliver Galm, Tianna Dauses, Judith E. Karp, Michelle A. Rudek, Ming Zhao, B. Douglas Smith, Jasper Manning, Anchalee Jiemjit, George Dover, Abbie Mays, James Zwiebel, Anthony Murgo, Li Jun WengJames G. Herman

Research output: Contribution to journalArticle


Optimal reexpression of most genes silenced through promoter methylation requires the sequential application of DNA methyltransferase inhibitors followed by histone deacetylase inhibitors in tumor cell cultures. Patients with myelodysplastic syndrome or acute myeloid leukemia (AML) were treated with the methyltransferase inhibitor 5-azacitidine (aza-CR) followed by the histone deacetylase inhibitor sodium phenylbutyrate. Major responses associated with cytogenetic complete response developed in patients receiving prolonged dosing schedules of aza-CR. Bisulfite sequencing of the p15 promoter in marrow DNA during the first cycle of treatment showed heterogeneous allelic demethylation in three responding patients, suggesting ongoing demethylation within the tumor clone, but no demethylation in two nonresponders. Six of six responding patients with pretreatment methylation of p15 or CDH-1 promoters reversed methylation during the first cycle of therapy (methylation-specific PCR), whereas none of six nonresponders showed any demethylation. Gene demethylation correlated with the area under the aza-CR plasma concentration-time curve. Administration of both drugs was associated with induction of acetylation of histones H3 and H4. This study provides the first demonstration that molecular mechanisms responsible for responses to DNA methyltransferase/histone deacetylase inhibitor combinations may include reversal of aberrant epigenetic gene silencing. The promising percentage of major hematologic responses justifies the testing of such combinations in prospective randomized trials.

Original languageEnglish (US)
Pages (from-to)6361-6369
Number of pages9
JournalCancer Research
Issue number12
StatePublished - Jun 15 2006


ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Gore, S. D., Baylin, S., Sugar, E., Carraway, H., Miller, C. B., Carducci, M., Grever, M., Galm, O., Dauses, T., Karp, J. E., Rudek, M. A., Zhao, M., Smith, B. D., Manning, J., Jiemjit, A., Dover, G., Mays, A., Zwiebel, J., Murgo, A., ... Herman, J. G. (2006). Combined DNA methyltransferase and histone deacetylase inhibition in the treatment of myeloid neoplasms. Cancer Research, 66(12), 6361-6369.