Inhibition of pyrimidine synthesis augments Gemcitabine induced growth inhibition in an immunocompetent model of pancreatic cancer. Author Thuy Phan, Vu Nguyen, Ralf Buettner, Corey Morales, Lifeng Yang, Paul Wong, Weiman Tsai, Marcela Salazar, Ziv Gil, Don Diamond, Joshua Rabinowitz, Steven Rosen, Laleh Melstrom Publication Year 2021 Type Journal Article Abstract Leflunomide (Lef) is an agent used in autoimmune disorders that interferes with DNA synthesis. pyrimidine synthesis is a mechanism of Gemcitabine (Gem) resistance in pancreatic cancer. This study aims to assess the efficacy and changes in the tumor microenvironment of Lef monotherapy and in combination with Gem, in a syngeneic mouse model of pancreatic cancer. MTS proliferation assays were conducted to assess growth inhibition by Gem (0-20 nM), Lef (0-40 uM) and Gem+Lef in KPC (KrasLSL.G12D/+;p53R172H/+; PdxCretg/+) cells . An heterotopic KPC model was used and cohorts were treated with: PBS (control), Gem (75 mg/kg/q3d), Lef (40 mg/kg/d), or Gem+Lef. At d28 post-treatment, tumor burden, proliferation index (Ki67), and vascularity (CD31) were measured. Changes in the frequency of peripheral and intratumoral immune cell subsets were evaluated via FACS. Liquid chromatography-mass spectrometry was used for metabolomics profiling. Lef inhibits KPC cell growth and synergizes with Gem (P<0.05; Combination Index 0.44 (<1 indicates synergy). , Lef alone and in combination with Gem delays KPC tumor progression (P<0.001). CTLA-4+T cells are also significantly decreased in tumors treated with Lef, Gem or in combination (Gem+Lef) compared to controls (P<0.05). Combination therapy also decreased the Ki67 and vascularity (P<0.01). Leflunomide inhibits pyrimidine synthesis both (p<0.0001) and (p<0.05). In this study, we demonstrated that Gem+Lef inhibits pancreatic cancer growth, decrease T cell exhaustion, vascularity and as proof of principle inhibits pyrimidine synthesis. Further characterization of changes in adaptive immunity are necessary to characterize the mechanism of tumor growth inhibition and facilitate translation to a clinical trial. Keywords Animals, Disease Models, Animal, Mice, Cell Proliferation, Mice, Inbred C57BL, Female, Cell Line, Tumor, Tumor Microenvironment, Ki-67 Antigen, Apoptosis, Pancreatic Neoplasms, Immunocompetence, Antimetabolites, Antineoplastic, Deoxycytidine, Gemcitabine Journal Int J Biol Sci Volume 17 Issue 9 Pages 2240-2251 Date Published 2021 ISSN Number 1449-2288 DOI 10.7150/ijbs.60473 Alternate Journal Int J Biol Sci PMCID PMC8241727 PMID 34239352 PubMedPubMed CentralGoogle ScholarBibTeXEndNote X3 XML