Synergy between the NAMPT inhibitor GMX1777(8) and pemetrexed in non-small cell lung cancer cells is mediated by PARP activation and enhanced NAD consumption

GMX1778 and its pro-drug GMX1777 represent a new class of cancer drugs that target nicotinamide phosphoribosyltransferase (NAMPT), as a new strategy to interfere with biosynthesis of the key enzymatic co-factor NAD, which is critical for a number of cell functions including DNA repair. Using a genome-wide synthetic lethal siRNA screen, we identified the folate pathway related genes deoxyuridine triphosphate and dihydrofolate reductase, the silencing of which sensitized non-small cell lung carcinoma (NSCLC) cells to the cytotoxic effects of GMX. Pemetrexed is an inhibitor of dihydrofolate reductase currently used to treat patients with non-squamous NSCLC. We found that combining pemetrexed with GMX1777 produced a synergistic therapeutic benefit in A549 and H1299 NSCLC cells in vitro and in a mouse A549 xenograft model of lung cancer. Pemetrexed is known to activate poly-ADP ribose polymerases (PARP) thereby accelerating NAD consumption. Genetic or pharmacologic
blockade of PARP activity inhibited this effect, impairing cell death by pemetrexed either alone or in combination with GMX1777. Conversely, inhibiting the base excision repair pathway accentuated NAD decline in response to GMX and the cytotoxicity of both agents either alone or in combination. These findings provide a mechanistic rationale for combining GMX1777 with pemetrexed as an effective new therapeutic strategy to treat non-squamous NSCLC.