Previous Article | Next Article 
Antimicrobial Agents and Chemotherapy, January 2009, p. 123-128, Vol. 53, No. 1
0066-4804/09/$08.00+0 doi:10.1128/AAC.00650-07
Copyright © 2009, American Society for Microbiology. All Rights Reserved.
Activity of Indenoisoquinolines against African Trypanosomes
Rahul P. Bakshi,1
Dongpei Sang,1
Andrew Morrell,2
Mark Cushman,2 and
Theresa A. Shapiro1*
Division of Clinical Pharmacology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205,1
Department of Medicinal Chemistry and Molecular Pharmacology and the Purdue Cancer Center, Purdue University, West Lafayette, Indiana 479072
Received 17 May 2007/
Returned for modification 26 August 2007/
Accepted 21 September 2008

ABSTRACT
African trypanosomiasis (sleeping sickness), caused by protozoan
Trypanosoma brucei species, is a debilitating disease that is
lethal if untreated. Available drugs are antiquated, toxic,
and compromised by emerging resistance. The indenoisoquinolines
are a class of noncamptothecin topoisomerase IB poisons that
are under development as anticancer agents. We tested a variety
of indenoisoquinolines for their ability to kill
T. brucei.
Indenoisoquinolines proved trypanocidal at submicromolar concentrations
in vitro. Structure-activity analysis yielded motifs that enhanced
potency, including alkylamino substitutions on N-6, methoxy
groups on C-2 and C-3, and a methylenedioxy bridge between C-8
and C-9. Detailed analysis of eight water-soluble indenoisoquinolines
demonstrated that in trypanosomes the compounds inhibited DNA
synthesis and acted as topoisomerase poisons. Testing these
compounds on L1210 mouse leukemia cells revealed that all eight
were more effective against trypanosomes than against mammalian
cells. In preliminary in vivo experiments one compound delayed
parasitemia and extended survival in mice subjected to a lethal
trypanosome challenge. The indenoisoquinolines provide a promising
lead for the development of drugs against sleeping sickness.

INTRODUCTION
African trypanosomiasis (sleeping sickness), caused by the protozoan
parasite
Trypanosoma brucei, is a devastating disease transmitted
by tsetse flies and is prevalent throughout sub-Saharan Africa.
Lethal if untreated, this infection is responsible for substantial
morbidity and mortality (
40). The impact of the disease is exacerbated
by the paucity of effective drugs, their toxicity, and the emergence
of drug resistance (
14). This is exemplified by the fact that
melarsoprol, an organoarsenical that is the only drug effective
against the central nervous system stage of both East and West
African sleeping sickness, itself causes 5% mortality and has
a disturbing failure rate (
14). There is a pressing need to
develop new drugs as well as to identify molecular targets for
new therapies.
DNA topoisomerases have proven to be effective drug targets in prokaryotic and eukaryotic systems (16, 24, 34). These enzymes catalyze topological changes in DNA and have vital roles in many aspects of nucleic acid metabolism. Based on their mechanism of action, topoisomerases can be classified as type I enzymes, which break a single strand of the DNA helix during the catalytic cycle, and type II enzymes, which make double-stranded breaks. On the basis of primary sequence and reaction mechanism, type I topoisomerases are further subdivided into type IA and type IB (21, 38). Type IB topoisomerases are clinically relevant by virtue of being the target of anticancer camptothecins. The latter are exquisitely specific for topoisomerase IB (38) and belong to a class of agents collectively known as topoisomerase "poisons." The poisons are a distinct subgroup of topoisomerase inhibitors that bind to and stabilize a normally transient DNA-topoisomerase catalytic intermediate termed the cleavable complex. Persistence of such complexes leads to strand breaks in DNA and cell death, making topoisomerase poisons effective antiproliferative agents (22).
Kinetoplastid topoisomerases have been a focus of much study with a view toward their utilization as drug targets (4, 11, 13). The type IB topoisomerase of T. brucei (and Leishmania donovani, a related kinetoplastid pathogen) is an enzyme singularly distinct from its mammalian counterpart. While all other described type IB topoisomerases are single polypeptide moieties, the enzyme from kinetoplastids is heteromultimeric, composed of two distinct proteins encoded by two independent genes (7). Knock-down studies have revealed that this enzyme is essential for trypanosomes (5), validating its status as a potential drug target. Camptothecin kills trypanosomes by targeting topoisomerase IB (9), and structure-activity studies with camptothecin analogs have illuminated the possibility of generating agents that can selectively target the trypanosomal enzyme (10). Taken together, these aspects make topoisomerase IB poisons a promising source of lead compounds for antitrypanosomal drug development.
Indenoisoquinolines, a noncamptothecin class of synthetic compounds (Fig. 1), were originally identified in a search for anticancer agents. In the 60-cell-line National Cancer Institute anticancer drug screen, indenoisoquinolines demonstrated a cell-line-specific cytotoxicity profile consistent with topoisomerase IB poisons, and they can trap topoisomerase IB-DNA covalent complexes (19, 20, 36). Some of the indenoisoquinolines have the ability to bind and intercalate into DNA in the absence of the enzyme (30, 35, 36), and others may even interact directly with the mammalian topoisomerase IB protein at high drug concentrations (29). We have evaluated a battery of indenoisoquinolines (26-28, 30) against T. brucei and we find that they have potent antitrypanosomal activities in vitro, inhibit nucleic acid synthesis in the parasite, act as topoisomerase poisons within the cell, and show preliminary evidence of efficacy in mice challenged with trypanosomes.

MATERIALS AND METHODS
Cells, culture conditions, and test compounds.
Bloodstream-form
Trypanosoma brucei brucei 427 cells (doubling
time, 6 to 8 h) were maintained in HMI-9 medium containing 10%
fetal bovine serum and 10% Serum Plus. Mouse leukemia L1210
cells (ATCC; doubling time, 20 to 24 h) were maintained in RPMI
1640 containing 15% fetal bovine serum. Parasites and mammalian
cells were cultured at 37°C with 5% CO
2. Logarithmically
growing cells (densities of 1
x 10
5 to 5
x 10
5 cells/ml) were
used for all assays. Test compounds were stored desiccated at
–20°C and were dissolved in dimethyl sulfoxide (DMSO)
or water just prior to use. Diminazene aceturate (Berenil) was
purchased from Sigma (St. Louis, MO).
Cytotoxicity assay for trypanosomes and L1210 cells.
Cytotoxicity was measured using an acid phosphatase-based 96-well plate assay (8). Briefly, T. brucei cells (100 µl; 2 x 105 cells/ml) were incubated with 100 µl medium containing solvent or drug for 24 h. Final DMSO concentrations did not exceed 0.1%. Acid phosphatase activity was measured by adding 20 µl lysis buffer (20 mg/ml p-nitrophenyl phosphate in 1 M sodium acetate, pH 5.5, 1% Triton X-100) and incubating for 5 h at 37°C. Reactions were terminated with 10 µl 1 N NaOH, and absorbance was measured at 405 nm. Lethality was confirmed by microscopic examination of drug-treated cells prior to addition of lysis/substrate solution. L1210 cells (100 µl; 1.4 x 105 cells/ml) were incubated with 100 µl medium containing drug or solvent for 48 h in 96-well plates (8) and processed as described above. Prior to lysis, aliquots of drug-treated cells were subjected to the trypan blue exclusion test to confirm lethality (12). Each concentration was assayed in quadruplicate. Curve fitting and 50% effective concentration (EC50) determinations were performed using the Emax model (17).
Thymidine incorporation assay.
Trypanosomes (500 µl; 2 x 106 cells/ml) were incubated for 3 h with [3H]thymidine (100 µCi/ml; 20 Ci/mmol) in the presence of drug or solvent in thymidine-free HMI-9 (9). Cells were deposited onto filter paper (blotting paper 703; VWR Scientific Products), and nucleic acids were precipitated using ice-cold 5% trichloroacetic acid. Filters were washed with ethanol, and radioactivity was quantified by liquid scintillation. Camptothecin (10 µM) was used as a positive control. Inhibition of DNA synthesis was measured via the percent inhibition of [3H]thymidine incorporation (disintegrations per minute [dpm]), expressed as follows: [1 – (dpmdrug/dpmcontrol)] x 100. The solvents (water for the indenoisoquinolines and DMSO for camptothecin) had no effect on [3H]thymidine incorporation. Experiments were run in triplicate.
Assay for cleavable complexes.
Cleavable complex formation in situ was measured as described previously (9, 37), with the following modification. After addition of KCl, the reaction mixture was incubated on ice for 60 min. The precipitate was harvested by filtering on glass fiber paper (GF/C; Brandel Inc., MD) prewetted with wash buffer (10 mM Tris-HCl, pH 8, 1 mM EDTA, 100 mM KCl), washed (three times with 4 ml of wash buffer), and air dried. Total incorporation of radioactivity into DNA was measured by spotting 50 µl of labeled cell suspension onto filter paper, precipitating nucleic acids using 5% trichloroacetic acid, and counting by liquid scintillation. All assays included 10 µM camptothecin and solvent controls. Cleavable complex formation, as a percentage of total labeled DNA, was calculated as follows: [(dpm in K-SDSdrug – dpm in K-SDSsolvent)/(dpmtotal incorporation)] x 100 (K-SDS is the K-sodium dodecyl sulfate assay). Each experiment was run in triplicate.
Efficacy in vivo.
This work was conducted with approval of the Johns Hopkins University Institutional Animal Care and Use Committee. Groups of two 6-week-old female CD1 mice were untreated or injected intraperitoneally with (i) a single dose of 50 mg/kg test indenoisoquinoline (4 mg/ml for compounds 20 and 23 and 2 mg/ml for compound 12, all in 0.9% saline) (27) or (ii) 3.5 mg/kg Berenil (0.7 mg/ml in 0.9% saline) (41). Three h after dosing, mice were challenged with 5 x 105 Trypanosoma brucei (5 x 106 cells/ml, intraperitoneal) (2). Parasitemia was monitored every 24 h by sampling tail vein blood and quantifying parasites in a hemocytometer. Mice in evident distress were euthanized and considered to have succumbed to the challenge.

RESULTS AND DISCUSSION
Activity of indenoisoquinolines against trypanosomes.
We tested a spectrum of compounds with various substitutions
on a core indenoisoquinoline nucleus (Fig.
1) for their ability
to kill
T. brucei. Results from the cytotoxicity assay revealed
that the test compounds were trypanocidal, with micromolar or
submicromolar EC
50s (see Tables
1,
2, and
3). Such potency compares
favorably with that of camptothecin (EC
50, 1.5 µM) and
to the clinically utilized antitrypanosomal drugs pentamidine
(EC
50, 0.014 µM) and Berenil (EC
50, 0.094 µM) (
8).
Structure-activity relationships in trypanocidal indenoisoquinolines.
We examined the EC
50s for trypanocidal indenoisoquinolines in
the context of molecular structure. Initial characterization
revealed that while the core moiety (Fig.
1) was essentially
inactive (<20% kill at 10 µM), the single modification
of an alkylamine substituent at N-6 conferred robust activity
(Table
1, compound 2). Substitution of electron-withdrawing
groups on other ring positions of the N-6-substituted core further
improved activity. Potency was markedly enhanced by an 8,9-methylenedioxy
bridge (compare compound 3 versus compound 7 and compound 2
versus compound 9). The importance of the methylenedioxy bridge
is reminiscent of its role in boosting the potency of camptothecin
analogs (
10) and is consistent with the notion that indenoisoquinolines
act via topoisomerase IB. The presence of methoxy groups at
C-2, C-3, and C-9 also contribute to trypanosome-killing activity
(compare compound 2 versus 11, compound 3 versus 5, and compound
8 versus 12).
Replacement of the terminal NH2 on the N-6 substituent with an imidazole ring reduced potency (compound 16 versus 2). However, the general structure-activity relationships deduced from the N-6-aminopropyl series also held true in the N-6-(3-imidazolyl-1-propyl) series (Table 2). The nature of the N-6 substituent influenced trypanocidal activity, such that the 3-aminopropyl-substituted N-6 compound (number 15) was more active than analogs with other varied alkylamine repeats (Table 3).
All 2,3-dimethoxy-substituted compounds were water soluble to an appreciable extent; in fact, the motif was predictive of aqueous solubility. Water solubility is a desirable quality for a molecule in the context of drug development. We therefore utilized this characteristic to select a subset of analogs for further analysis. Eight water-soluble compounds (limit of solubility varying from 2.5 mM to 10 mM) (Table 4), with antitrypanosomal EC50s ranging widely from 1.5 µM to 50 nM, were selected for detailed characterization.
Activity against L1210 cells.
To provide a uniform basis for comparison in these studies,
we assayed the water-soluble compounds against mouse leukemia
L1210 cells. These cells are highly susceptible to camptothecin,
have been used extensively for studying topoisomerase IB-targeting
agents, and are a benchmark for comparative screening of antitrypanosomal
candidates (
10,
23,
39). Although all eight compounds were active
against L1210 cells, they were systematically, if modestly,
more potent against trypanosomes (Table
4). The structure-activity
relationships governing antitrypanosomal potency appear to be
paralleled in L1210 cells. It has been demonstrated that nonmalignant
cells are generally less susceptible to topoisomerase-targeting
agents than are cancer cells (
32,
33), suggesting that the selectivity
of these indenoisoquinolines for trypanosomes will be greater
compared to normal cells. Furthermore, the indenoisoquinoline
derivatives tested here were originally synthesized with the
aim of maximizing mammalian cell killing. The presence of consistent,
albeit low, selectivity toward trypanosomes in this biased sample
suggests that screening a naïve indenoisoquinoline library
may yield agents with much greater efficacy against parasites
compared to mammalian cells.
Inhibition of trypanosome DNA synthesis by indenoisoquinolines.
Inhibition of nucleic acid synthesis is a consequence of targeting topoisomerase IB in trypanosomes (9). We tested the ability of the water-soluble indenoisoquinolines to inhibit DNA synthesis in trypanosomes and found that the series effectively inhibited [3H]thymidine incorporation (Table 4). Additionally, cytotoxicity correlated with inhibition of DNA synthesis (Fig. 2). This is consistent with the notion that inhibition of DNA synthesis, perhaps by targeting of topoisomerase IB, is a mediator of cell killing. Notably, the indenoisoquinolines were more potent than camptothecin in both cytotoxicity and inhibition of DNA synthesis. The apparent maximum inhibition of
70% for these compounds may reflect ongoing topoisomerase IB-independent DNA processes, such as repair or mitochondrial DNA synthesis.
Formation of cleavable complexes by indenoisoquinolines.
We utilized the K-SDS method to assess the ability of indenoisoquinolines
to poison topoisomerase in situ (
18). In this method, intracellular
topoisomerase-DNA cleavable complexes are trapped by the addition
of SDS, then detergent and accompanying denatured proteins are
precipitated with potassium, and radiolabeled DNA in the precipitate
indicates the presence of covalent protein-DNA adducts. In trypanosomes
the indenoisoquinolines are indeed topoisomerase poisons (Table
4). Surprisingly, however, their potency in this assay did not
exceed

12% (Table
4; camptothecin control, 61%). Based on their
general superiority to camptothecin in both the cytotoxicity
and DNA inhibition assays, this value was unexpectedly low.
Furthermore, although dose-response analysis for compound 20
revealed an increase in cleavable complex formation as drug
concentration increased up to 5 µM (data not shown), the
ability of these compounds to trap complexes did not correlate
with their ability to inhibit DNA synthesis (Fig.
3). Curiously,
in fact, for seven of eight compounds tested, the ability to
form cleavable complexes correlated inversely with inhibition
of nucleic acid synthesis (Fig.
3; compound 13, with an ester
substituent at C-9, does not follow this trend). The disproportionately
low poisoning activity and lack of coincidence between poisoning
and cytotoxicity suggest that the stabilization of topoisomerase
IB-DNA complexes is not the sole determinant of killing. Perhaps
the direct interaction of indenoisoquinolines with DNA (
30,
35) prevents the topoisomerase from binding to its substrate,
thus abrogating their effectiveness as poisons. This phenomenon
was previously demonstrated with minor groove binders and mammalian
topoisomerase IB (
25). We tested this hypothesis by assaying
the ability of camptothecin to promote cleavable complex formation
in situ after the cells were preincubated with indenoisoquinoline
compound 15 and found that indenoisoquinoline pretreatment blocked
the poisoning activity of camptothecin (Fig.
4).
The lower-than-expected extent of poisoning of trypanosome topoisomerase
could be attributed to multiple factors. Relative to mammalian
cells, African trypanosomes have a unique heteromultimeric topoisomerase
IB (
7) and a substantially more AT-rich genome (
6) that is packaged
differently (
15). Thus, decreased affinity for the topoisomerase-DNA
binary complex, and/or increased accessibility of the DNA, could
explain this finding. Direct interaction with DNA implies that
the compounds may also interfere with other DNA metabolic processes,
explaining their inhibition of replication. Indeed, although
indenoisoquinolines have been demonstrated to be topoisomerase
IB poisons in mammalian cells (
1,
20), the greater-than-expected
killing activity against
T. brucei makes it formally possible
that cleavable complexes detected in the K-SDS assay may contain
DNA adducts with other topoisomerases. Additionally, while the
N-6-polyamine substituent may well enhance transport into the
trypanosome, the demonstrated activity of other polyamine analogs
against
T. brucei (
31) permits speculation that these N-6-substituted
indenoisoquinolines may also interfere with the polyamine metabolic
pathway, a proven drug target in these parasites (
3).
Preliminary survey of efficacy in mice.
To assess further the potential of indenoisoquinolines as antitrypanosomal agents, three of the water-soluble compounds with a range of activity in vitro (compound 20, EC50 of 1.5 µM; compound 23, EC50 of 0.65 µM; compound 12, EC50 of 0.05 µM) were tested for their ability to protect mice against a lethal T. brucei challenge. As expected, by day 2 after infection the untreated mice developed a rapidly progressing patent infection (2) and the positive controls treated with Berenil developed a transient parasitemia that remained below the limit of detection after day 3 (Fig. 5). Indenoisoquinolines compound 20 and 23 had no apparent effect on progression of the infection. However, treatment with compound 12, the most potent compound in vitro, conferred some protection against trypanosome infection. In these animals, parasites were undetectable in the blood until day 4 postinfection (Fig. 5). Once parasites appeared the infection progressed normally. The drugs themselves caused no apparent ill effects in the animals. This preliminary experiment has a number of obvious limitations, including a sample size that precludes statistical comparison and the almost-certainly suboptimal single-dose regimen. Nevertheless, the results of this proof-of-concept study are promising.
In summary, we found that indenoisoquinolines have potent antitrypanosomal
activity in vitro and demonstrable activity in mice. Their killing
action may involve multiple molecular mechanisms. They clearly
stabilize topoisomerase-DNA complexes in situ and may also impede
topoisomerase binding to DNA. These agents markedly inhibit
DNA synthesis by interfering with topoisomerase and possibly
other DNA-metabolizing enzymes. Multiple mechanisms of action
against trypanosomes would be an attractive feature, since the
potential for drug resistance is reduced. Indenoisoquinolines
are a promising lead for development of a new, much-needed,
antitrypanosomal therapy.

ACKNOWLEDGMENTS
The assistance of Chad Slawson and other members of the Hart
laboratory is gratefully acknowledged. We thank Suji Xie for
technical support, Paul Englund and So Hee Lee for assistance
with animal experiments, and Jane Scocca and David Meyers for
their thoughtful comments on the manuscript.
This study was funded by NIH grants AI028855 and UO1 CA89566.

FOOTNOTES
* Corresponding author. Mailing address: Johns Hopkins University School of Medicine, 301 Hunterian Building, 725 N. Wolfe Street, Baltimore, MD 21205. Phone: (410) 955-1889. Fax: (410) 955-2634. E-mail:
rbakshi{at}jhmi.edu 
Published ahead of print on 29 September 2008. 

REFERENCES
1 - Antony, S., K. K. Agama, Z. H. Miao, K. Takagi, M. H. Wright, A. I. Robles, L. Varticovski, M. Nagarajan, A. Morrell, M. Cushman, and Y. Pommier. 2007. Novel indenoisoquinolines NSC 725776 and NSC 724998 produce persistent topoisomerase I cleavage complexes and overcome multidrug resistance. Cancer Res. 67:10397-10405.[Abstract/Free Full Text]
2 - Bacchi, C. J., M. Vargas, D. Rattendi, B. Goldberg, and W. Zhou. 1998. Antitrypanosomal activity of a new triazine derivative, SIPI 1029, in vitro and in model infections. Antimicrob. Agents Chemother. 42:2718-2721.[Medline]
3 - Bacchi, C. J., and N. Yarlett. 2002. Polyamine metabolism as chemotherapeutic target in protozoan parasites. Mini Rev. Med. Chem. 2:553-563.[CrossRef][Medline]
4 - Bakshi, R. P., and T. A. Shapiro. 2003. DNA topoisomerases as targets for antiprotozoal therapy. Mini Rev. Med. Chem. 3:597-608.[Medline]
5 - Bakshi, R. P., and T. A. Shapiro. 2004. RNA interference of Trypanosoma brucei topoisomerase IB: both subunits are essential. Mol. Biochem. Parasitol. 136:249-255.[CrossRef][Medline]
6 - Berriman, M., E. Ghedin, C. Hertz-Fowler, G. Blandin, H. Renauld, D. C. Bartholomeu, N. J. Lennard, E. Caler, N. E. Hamlin, B. Haas, U. Bohme, L. Hannick, M. A. Aslett, J. Shallom, L. Marcello, L. Hou, B. Wickstead, U. C. Alsmark, C. Arrowsmith, R. J. Atkin, A. J. Barron, F. Bringaud, K. Brooks, M. Carrington, I. Cherevach, T. J. Chillingworth, C. Churcher, L. N. Clark, C. H. Corton, A. Cronin, R. M. Davies, J. Doggett, A. Djikeng, T. Feldblyum, M. C. Field, A. Fraser, I. Goodhead, Z. Hance, D. Harper, B. R. Harris, H. Hauser, J. Hostetler, A. Ivens, K. Jagels, D. Johnson, J. Johnson, K. Jones, A. X. Kerhornou, H. Koo, N. Larke, S. Landfear, C. Larkin, V. Leech, A. Line, A. Lord, A. Macleod, P. J. Mooney, S. Moule, D. M. Martin, G. W. Morgan, K. Mungall, H. Norbertczak, D. Ormond, G. Pai, C. S. Peacock, J. Peterson, M. A. Quail, E. Rabbinowitsch, M. A. Rajandream, C. Reitter, S. L. Salzberg, M. Sanders, S. Schobel, S. Sharp, M. Simmonds, A. J. Simpson, L. Tallon, C. M. Turner, A. Tait, A. R. Tivey, S. Van Aken, D. Walker, D. Wanless, S. Wang, B. White, O. White, S. Whitehead, J. Woodward, J. Wortman, M. D. Adams, T. M. Embley, K. Gull, E. Ullu, J. D. Barry, A. H. Fairlamb, F. Opperdoes, B. G. Barrell, J. E. Donelson, N. Hall, C. M. Fraser, et al. 2005. The genome of the African trypanosome Trypanosoma brucei. Science 309:416-422.[Abstract/Free Full Text]
7 - Bodley, A. L., A. K. Chakraborty, S. Xie, C. Burri, and T. A. Shapiro. 2003. An unusual type IB topoisomerase from African trypanosomes. Proc. Natl. Acad. Sci. USA 100:7539-7544.[Abstract/Free Full Text]
8 - Bodley, A. L., M. W. McGarry, and T. A. Shapiro. 1995. Drug cytotoxicity assay for African trypanosomes and Leishmania species. J. Infect. Dis. 172:1157-1159.[Medline]
9 - Bodley, A. L., and T. A. Shapiro. 1995. Molecular and cytotoxic effects of camptothecin, a topoisomerase I inhibitor, on trypanosomes and Leishmania. Proc. Natl. Acad. Sci. USA 92:3726-3730.[Abstract/Free Full Text]
10 - Bodley, A. L., M. C. Wani, M. E. Wall, and T. A. Shapiro. 1995. Antitrypanosomal activity of camptothecin analogs. Structure-activity correlations. Biochem. Pharmacol. 50:937-942.[CrossRef][Medline]
11 - Burri, C., A. L. Bodley, and T. A. Shapiro. 1996. Topoisomerases in kinetoplastids. Parasitol. Today 12:226-231.[CrossRef][Medline]
12 - Cook, J. A., and J. B. Mitchell. 1989. Viability measurements in mammalian cell systems. Anal. Biochem. 179:1-7.[CrossRef][Medline]
13 - Das, A., A. Dasgupta, T. Sengupta, and H. K. Majumder. 2004. Topoisomerases of kinetoplastid parasites as potential chemotherapeutic targets. Trends Parasitol. 20:381-387.[CrossRef][Medline]
14 - Docampo, R., and S. N. Moreno. 2003. Current chemotherapy of human African trypanosomiasis. Parasitol. Res. 90(Supp. 1):S10-S13.[Medline]
15 - Ersfeld, K., S. E. Melville, and K. Gull. 1999. Nuclear and genome organization of Trypanosoma brucei. Parasitol. Today 15:58-63.[CrossRef][Medline]
16 - Fortune, J. M., and N. Osheroff. 2000. Topoisomerase II as a target for anticancer drugs: when enzymes stop being nice. Prog. Nucleic Acid Res. Mol. Biol. 64:221-253.[Medline]
17 - Holford, N. H., and L. B. Sheiner. 1981. Understanding the dose-effect relationship: clinical application of pharmacokinetic-pharmacodynamic models. Clin. Pharmacokinet. 6:429-453.[Medline]
18 - Hsiang, Y. H., R. Hertzberg, S. Hecht, and L. F. Liu. 1985. Camptothecin induces protein-linked DNA breaks via mammalian DNA topoisomerase I. J. Biol. Chem. 260:14873-14878.[Abstract/Free Full Text]
19 - Ioanoviciu, A., S. Antony, Y. Pommier, B. L. Staker, L. Stewart, and M. Cushman. 2005. Synthesis and mechanism of action studies of a series of norindenoisoquinoline topoisomerase I poisons reveal an inhibitor with a flipped orientation in the ternary DNA-enzyme-inhibitor complex as determined by X-ray crystallographic analysis. J. Med. Chem. 48:4803-4814.[CrossRef][Medline]
20 - Kohlhagen, G., K. D. Paull, M. Cushman, P. Nagafuji, and Y. Pommier. 1998. Protein-linked DNA strand breaks induced by NSC 314622, a novel noncamptothecin topoisomerase I poison. Mol. Pharmacol. 54:50-58.[Abstract/Free Full Text]
21 - Leppard, J. B., and J. J. Champoux. 2005. Human DNA topoisomerase I: relaxation, roles, and damage control. Chromosoma 114:75-85.[CrossRef][Medline]
22 - Liu, L. F., S. D. Desai, T. K. Li, Y. Mao, M. Sun, and S. P. Sim. 2000. Mechanism of action of camptothecin. Ann. N. Y. Acad. Sci. 922:1-10.[CrossRef][Medline]
23 - Mattern, M. R., S. M. Mong, H. F. Bartus, C. K. Mirabelli, S. T. Crooke, and R. K. Johnson. 1987. Relationship between the intracellular effects of camptothecin and the inhibition of DNA topoisomerase I in cultured L1210 cells. Cancer Res. 47:1793-1798.[Abstract/Free Full Text]
24 - Maxwell, A. 1999. DNA gyrase as a drug target. Biochem. Soc. Trans. 27:48-53.[Medline]
25 - McHugh, M. M., R. D. Sigmund, and T. A. Beerman. 1990. Effects of minor groove binding drugs on camptothecin-induced DNA lesions in L1210 nuclei. Biochem. Pharmacol. 39:707-714.[Medline]
26 - Morrell, A., S. Antony, G. Kohlhagen, Y. Pommier, and M. Cushman. 2004. Synthesis of nitrated indenoisoquinolines as topoisomerase I inhibitors. Bioorg. Med. Chem. Lett. 14:3659-3663.[CrossRef][Medline]
27 - Morrell, A., M. Jayaraman, M. Nagarajan, B. M. Fox, M. R. Meckley, A. Ioanoviciu, Y. Pommier, S. Antony, M. Hollingshead, and M. Cushman. 2006. Evaluation of indenoisoquinoline topoisomerase I inhibitors using a hollow fiber assay. Bioorg. Med. Chem. Lett. 16:4395-4399.[Medline]
28 - Nagarajan, M., A. Morrell, B. C. Fort, M. R. Meckley, S. Antony, G. Kohlhagen, Y. Pommier, and M. Cushman. 2004. Synthesis and anticancer activity of simplified indenoisoquinoline topoisomerase I inhibitors lacking substituents on the aromatic rings. J. Med. Chem. 47:5651-5661.[CrossRef][Medline]
29 - Nagarajan, M., A. Morrell, A. Ioanoviciu, S. Antony, G. Kohlhagen, K. Agama, M. Hollingshead, Y. Pommier, and M. Cushman. 2006. Synthesis and evaluation of indenoisoquinoline topoisomerase I inhibitors substituted with nitrogen heterocycles. J. Med. Chem. 49:6283-6289.[CrossRef][Medline]
30 - Nagarajan, M., X. Xiao, S. Antony, G. Kohlhagen, Y. Pommier, and M. Cushman. 2003. Design, synthesis, and biological evaluation of indenoisoquinoline topoisomerase I inhibitors featuring polyamine side chains on the lactam nitrogen. J. Med. Chem. 46:5712-5724.[CrossRef][Medline]
31 - O'Sullivan, M. C., Q. Zhou, Z. Li, T. B. Durham, D. Rattendi, S. Lane, and C. J. Bacchi. 1997. Polyamine derivatives as inhibitors of trypanothione reductase and assessment of their trypanocidal activities. Bioorg. Med. Chem. 5:2145-2155.[Medline]
32 - Pantazis, P., J. A. Early, A. J. Kozielski, J. T. Mendoza, H. R. Hinz, and B. C. Giovanella. 1993. Regression of human breast carcinoma tumors in immunodeficient mice treated with 9-nitrocamptothecin: differential response of nontumorigenic and tumorigenic human breast cells in vitro. Cancer Res. 53:1577-1582.[Abstract/Free Full Text]
33 - Pantazis, P., H. R. Hinz, J. T. Mendoza, A. J. Kozielski, L. J. Williams, Jr., J. S. Stehlin, Jr., and B. C. Giovanella. 1992. Complete inhibition of growth followed by death of human malignant melanoma cells in vitro and regression of human melanoma xenografts in immunodeficient mice induced by camptothecins. Cancer Res. 52:3980-3987.[Abstract/Free Full Text]
34 - Pommier, Y., P. Pourquier, Y. Fan, and D. Strumberg. 1998. Mechanism of action of eukaryotic DNA topoisomerase I and drugs targeted to the enzyme. Biochim. Biophys. Acta 1400:83-105.[Medline]
35 - Staker, B. L., M. D. Feese, M. Cushman, Y. Pommier, D. Zembower, L. Stewart, and A. B. Burgin. 2005. Structures of three classes of anticancer agents bound to the human topoisomerase I-DNA covalent complex. J. Med. Chem. 48:2336-2345.[CrossRef][Medline]
36 - Strumberg, D., Y. Pommier, K. Paull, M. Jayaraman, P. Nagafuji, and M. Cushman. 1999. Synthesis of cytotoxic indenoisoquinoline topoisomerase I poisons. J. Med. Chem. 42:446-457.[CrossRef][Medline]
37 - Trask, D. K., J. A. DiDonato, and M. T. Muller. 1984. Rapid detection and isolation of covalent DNA/protein complexes: application to topoisomerase I and II. EMBO J. 3:671-676.[Medline]
38 - Wang, J. C. 2002. Cellular roles of DNA topoisomerases: a molecular perspective. Nat. Rev. Mol. Cell Biol. 3:430-440.[CrossRef][Medline]
39 - Wani, M. C., A. W. Nicholas, G. Manikumar, and M. E. Wall. 1987. Plant antitumor agents. 25. Total synthesis and antileukemic activity of ring A substituted camptothecin analogues. Structure-activity correlations. J. Med. Chem. 30:1774-1779.[CrossRef][Medline]
40 - Welburn, S. C., and M. Odiit. 2002. Recent developments in human African trypanosomiasis. Curr. Opin. Infect. Dis. 15:477-484.[Medline]
41 - Witola, W. H., N. Inoue, K. Ohashi, and M. Onuma. 2004. RNA-interference silencing of the adenosine transporter-1 gene in Trypanosoma evansi confers resistance to diminazene aceturate. Exp. Parasitol. 107:47-57.[CrossRef][Medline]
Antimicrobial Agents and Chemotherapy, January 2009, p. 123-128, Vol. 53, No. 1
0066-4804/09/$08.00+0 doi:10.1128/AAC.00650-07
Copyright © 2009, American Society for Microbiology. All Rights Reserved.