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Romidepsin, also known as Istodax, is an anticancer agent used in cutaneous T-cell lymphoma (CTCL) and other peripheral T-cell lymphomas (PTCLs). Romidepsin is a natural product obtained from the bacterium Chromobacterium violaceum, and works by blocking enzymes known as histone deacetylases, thus inducing apoptosis.^[1] It is sometimes referred to as depsipeptide, after the class of molecules to which it belongs. Romidepsin is branded and owned by Gloucester Pharmaceuticals, now a part of Celgene.^[2]

History

Romidepsin was first reported in the scientific literature in 1994, by a team of researchers from Fujisawa Pharmaceutical Company (now Astellas Pharma) in Tsukuba, Japan, who isolated it in a culture of Chromobacterium violaceum from a soil sample obtained in Yamagata Prefecture.^[3] It was found to have little to no antibacterial activity, but was potently cytotoxic against several human cancer cell lines, with no effect on normal cells; studies on mice later found it to have antitumor activity in vivo as well.^[3]

The first total synthesis of romidepsin was accomplished by Harvard researchers and published in 1996.^[4] Its mechanism of action was elucidated in 1998, when researchers from Fujisawa and the University of Tokyo found it to be a histone deacetylase inhibitor with effects similar to those of trichostatin A.^[5]

Clinical trials

Phase I studies of romidepsin, initially codenamed FK228 and FR901228, began in 1997.^[6]Phase II and phase III trials were conducted for a variety of indications. The most significant results were found in the treatment of cutaneous T-cell lymphoma (CTCL) and other peripheral T-cell lymphomas (PTCLs).^[6]

In 2004, romidepsin received Fast Track designation from the FDA for the treatment of cutaneous T-cell lymphoma, and orphan drug status from the FDA and the European Medicines Agency for the same indication.^[6]

The FDA approved romidepsin for CTCL in November 2009^[7] and approved romidepsin for other peripheral T-cell lymphomas (PTCLs) in June 2011.^[8]

Pre-clinical HIV study

In 2014, PLOS Pathogens published a study involving romidepsin in a trial designed to reactivate latent HIV virus in order to deplete the HIV reservoir. Latently infected T-cells were exposed in vitro and ex vivo to romidepsin, leading to an increase in detectable levels of cell-associated HIV RNA. The trial also compared the effect of romidepsin to another histone deacetylase inhibitor, Vorinostat ^[9]

Autism study in animal model

A study involving romidepsin in an animal study that showed that a brief treatment with low amounts of romidepsin could reverse social deficits in a mouse model of autism.^[10]

Mechanism of action

Romidepsin acts as a prodrug with the disulfide bond undergoing reduction within the cell to release a zinc-binding thiol.^[3][11][12] The thiol binds to a zinc atom in the binding pocket of Zn-dependent histone deacetylase to block its activity. Thus it is an HDAC inhibitor. Many HDAC inhibitors are potential treatments for cancer through the ability to epigenetically restore normal expression of tumor suppressor genes, which may result in cell cycle arrest, differentiation, and apoptosis.^[13]

Adverse effects

The use of romidepsin is uniformly associated with adverse effects.^[14] In clinical trials, the most common were nausea and vomiting, fatigue, infection, loss of appetite, and blood disorders (including anemia, thrombocytopenia, and leukopenia). It has also been associated with infections, and with metabolic disturbances (such as abnormal electrolyte levels), skin reactions, altered taste perception, and changes in cardiac electrical conduction.^[14]

References

External links

• 
  Clinical trials of romidepsin at ClinicalTrials.gov
  

Romidepsin

Clinical data
Trade names	Istodax
Synonyms	FK228; FR901228; Istodax
MedlinePlus	a610005
License data	US FDA: Romidepsin
Pregnancy category	US: D (Evidence of risk)
Routes of administration	Intravenous infusion
ATC code	none
Legal status
Legal status	US: ℞-only
Pharmacokinetic data
Bioavailability	Not applicable (IV only)
Protein binding	92–94%
Metabolism	Hepatic (mostly CYP3A4-mediated)
Elimination half-life	3 hours
Identifiers
IUPAC name (1S,4S,7Z,10S,16E,21R)-7-ethylidene-4,21-diisopropyl-2-oxa-12,13-dithia-5,8,20,23-tetrazabicyclo[8.7.6]tricos-16-ene-3,6,9,19,22-pentone
CAS Number	128517-07-7 N
PubChem CID	5352062
IUPHAR/BPS	7006
ChemSpider	10122002
UNII	CX3T89XQBK
ChEBI	CHEBI:61080 N
ChEMBL	ChEMBL1213490 N
ECHA InfoCard	100.211.884
Chemical and physical data
Formula	C24H36N4O6S2
Molar mass	540.695 g/mol g·mol−1
3D model (JSmol)	Interactive image
SMILES C/C=C1/C(=O)N[C@H](C(=O)O[C@H]2CC(=O)N[C@@H](C(=O)N[C@H](CSSCC/C=C2)C(=O)N1)C(C)C)C(C)C
InChI InChI=1S/C24H36N4O6S2/c1-6-16-21(30)28-20(14(4)5)24(33)34-15-9-7-8-10-35-36-12-17(22(31)25-16)26-23(32)19(13(2)3)27-18(29)11-15/h6-7,9,13-15,17,19-20H,8,10-12H2,1-5H3,(H,25,31)(H,26,32)(H,27,29)(H,28,30)/b9-7+,16-6-/t15-,17-,19-,20+/m1/s1 Key:OHRURASPPZQGQM-GCCNXGTGSA-N
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