Histone deacetylase inhibitor vorinostat suppresses the growth of uterine sarcomas in vitro and in vivo
- Andelko Hrzenjak†1, 2Email author,
- Farid Moinfar1,
- Marie-Luise Kremser1,
- Bettina Strohmeier1,
- Edgar Petru3,
- Kurt Zatloukal1 and
- Helmut Denk†1
© Hrzenjak et al; licensee BioMed Central Ltd. 2010
Received: 10 September 2009
Accepted: 4 March 2010
Published: 4 March 2010
Uterine sarcomas are very rare malignancies with no approved chemotherapy protocols. Histone deacetylase (HDAC) inhibitors belong to the most promising groups of compounds for molecular targeting therapy. Here, we described the antitumor effects of suberoylanilide hydroxamic acid (SAHA; vorinostat) on MES-SA uterine sarcoma cells in vitro and in vivo. We investigated effects of vorinostat on growth and colony forming ability by using uterine sarcoma MES-SA cells. We analyzed the influence of vorinostat on expression of different HDACs, p21WAF1 and activation of apoptosis. Finally, we examined the antitumor effects of vorinostat on uterine sarcoma in vivo.
Vorinostat efficiently suppressed MES-SA cell growth at a low dosage (3 μM) already after 24 hours treatment. Decrease of cell survival was even more pronounced after prolonged treatment and reached 9% and 2% after 48 and 72 hours of treatment, respectively. Colony forming capability of MES-SA cells treated with 3 μM vorinostat for 24 and 48 hours was significantly diminished and blocked after 72 hours. HDACs class I (HDAC2 and 3) as well as class II (HDAC7) were preferentially affected by this treatment. Vorinostat significantly increased p21WAF1 expression and apoptosis. Nude mice injected with 5 × 106 MES-SA cells were treated for 21 days with vorinostat (50 mg/kg/day) and, in comparison to placebo group, a tumor growth reduction of more than 50% was observed. Results obtained by light- and electron-microscopy suggested pronounced activation of apoptosis in tumors isolated from vorinostat-treated mice.
Our data strongly indicate the high therapeutic potential of vorinostat in uterine sarcomas.
Uterine sarcomas are uncommon, representing approx. 5% of all uterine malignancies . These tumors are often diagnosed in advanced stages and carry an unfavorable prognosis. The final diagnosis is based upon histological and immunohistochemical analyses of tumor tissue obtained by biopsy or surgical excision . Due to the low incidence of uterine sarcomas, data concerning both molecular mechanisms of their pathogenesis and therapeutic approaches are quite limited and further information is needed. Since uterine sarcomas are rare, they are also not uniformly treated. The mechanisms involved in the tumorigenesis are only in the beginning of being elucidated. Thus, the establishment of in vivo systems for basic investigations and testing therapeutic approaches in uterine sarcomas is particularly important. Cell lines originating from these malignancies are rare and so are in vivo systems. The usefulness of some uterine sarcoma cell lines is limited by the fact that the vast majority of them are not tumorigenic in nude mice. This is also the case for cell lines isolated from low grade endometrial stromal sarcomas, e.g., ESS-1 cells . For some other cell lines details regarding tumorigenicity in nude mice are missing. In a recent publication Kakuno et al reported the establishment of a new cell line (OMC-9) originated from a human endometrial stromal sarcoma . According to the authors, these cells are tumorigenic in nude mice and could, therefore, be useful for development of an in vivo system. Unfortunately, this cell line was not commercially available till now. Since MES-SA cells established by Harker and coauthors are tumorigenic in nude mice, we decided to use them both for in vitro and for in vivo experiments in order to test the efficacy of suberoylanilide hydroxamic acid (SAHA; vorinostat).
Vorinostat is a potent inhibitor of HDACs class I and II. These enzymes are responsible for deacetylation of histones and some other proteins and consequently control the expression of different regulatory genes which are responsible for cell growth, proliferation, apoptosis, autophagy and for regulation of other mechanisms involved in the tumor development and growth [5–11]. Our recent data, both published and unpublished, strongly suggest that some HDACs are deregulated in endometrial stromal sarcomas and other uterine tumors of mesenchymal origin [12, 13]. The therapeutic utility of vorinostat is supported by the fact that it has been recently approved by FDA for therapy of cutaneous T-cell lymphoma. Moreover, vorinostat is used in clinical trials in patients with other solid tumors, such as mesothelioma, medulloblastoma, prostate and thyroid cancer [14–16]. Our in vitro and in vivo data suggest that vorinostat is an active drug potentially suitable for targeted treatment of uterine sarcomas.
Chemicals and cell lines
All chemicals and media were purchased from Sigma (SIGMA-ALDRICH Handels GmbH, Vienna, Austria), unless otherwise specified. Vorinostat was purchased from Alexis Biochemicals (Lausen, Switzerland). The human uterine sarcoma cell line MES-SA, established by Harker et al, was purchased from ATCC (ATCC Nr. CRL-1976). The original specimen was characterized as poorly differentiated uterine sarcoma and the cells were isolated after hysterectomy of a 56 years old Caucasian woman. It has been also shown that these cells are highly tumorigenic in nude mice. All experiments were performed according to local ethical guidelines.
For in vitro experiments a 10 mM vorinostat stock solution was prepared with DMSO and stored at -20°C. Since it is well known that DMSO can cause different inflammatory reactions when injected intraperitoneally for a longer period of time, we wanted to avoid this solvent for our in vivo experiments. Therefore, we prepared a solution of vorinostat in HOP-β-CD (2-hydroxypropyl-β-cyclodextrin) as already described by Hockly et al. Briefly, vorinostat was dissolved in 5 molar equivalents of HOP-β-CD in water, it was heated until fully dissolved, rapidly cooled on ice to room temperature and stored at -20°C. A fresh solution was prepared every week and administered to the mice by intraperitoneal injection in a total volume of approx. 300 μl, so that the final concentration for each animal was 50 mg/kg/day.
In vivo experiments
The animal experiments were approved by the Austrian ministry of education and science according to the regulations for animal experimentation. Athymic Nude-Foxn1nu/nu mice used in the present study were purchased from Harlan (Harlan Italy, San Pietro al Natisone, Italy). They were housed at 22°C at a constant light-dark cycle (12-h light, 12-h dark) and had free access to water and rodent chow (4-5% fat, 21% protein; Sniff, Soest, Germany). All animals used in this study were kept under standardized, pathogen-free living conditions in the animal facility of our department.
Twelve weeks old male mice (n = 14) were anesthetized with Isofluran (Pharmacia & Upjohn SA, Guyancourt, France) and 5 × 106 MES-SA cells were injected subcutaneously into the right flank of the animal. Mice from a control group received placebo containing 300 μl of empty HOP-β-CD (2-hydroxypropyl-β-cyclodextrin) vesicles. Another group of mice received vorinostat dissolved in HOP-β-CD at a concentration of 50 mg/kg/day. Both, empty vesicles and vorinostat were administered intraperitoneally, starting on the day 4 after the injection of MES-SA tumor cells. Mice body weight and tumor size (w2 × l × 0.52; measured by caliper) were estimated twice a week. All mice were treated for 21 days and afterwards sacrificed by cervical dislocation. Each tumor was isolated as a whole and different tumor parameters (weight, volume, size and macroscopic appearance) were determined. Finally, tumor slices were cryo preserved and formalin fixed (4%) for further analyses.
Western blot analysis
Cell lysates were prepared by using RIPA buffer (25 mM Tris-HCl pH 7.6, 150 mM NaCl, 1% NP-40, 1% sodium deoxycholate, 0.1% SDS), and the protein concentration was determined by Bio-Rad DC Protein Assay (Bio-Rad Laboratories, Hercules, CA). Protein lysates were separated by SDS-PAGE and transferred to nitrocellulose membrane (Bio-Rad). Following antibodies and dilutions were used: rabbit anti HDAC1 (1 μg/ml) (Labvision, Fremont, CA, USA); rabbit anti HDAC2 (1 μg/ml) (Zymed, San Francisco, CA, USA); rabbit anti HDAC3 (9 μg/ml) (Novus biologicals, Littleton, CO, USA); rabbit anti HDAC7 (3 μg/ml) (Abcam, Cambridge, UK); mouse anti p21WAF1 (0.5 μg/ml) (Zymed). As secondary antibodies we used rabbit anti-mouse and swine anti-rabbit HRP-coupled antibodies at a final concentration of 1 μg/ml (DAKO, Copenhagen, Denmark). An overnight incubation at 4°C was used for all primary antibodies, followed by washing and 2-hours incubation at RT with secondary antibodies. Specific protein bands were visualized by enhanced chemiluminescence assay (ECL; Amersham Biosciences, Buckinghamshire, England). To demonstrate equal loading of protein samples all western blots were probed for β-tubulin.
MES-SA cells were seeded in ∅ 6 cm culture dishes (300 cells/dish) and treated with 3 μM vorinostat for 24, 48 and 72 hours. Afterwards fresh medium was added and the cells were cultured for another 14 days followed by fixation with butanol:acetic acid (3:1) and staining with 0.5% crystal violet.
Cryo-preserved tumor tissue was fixed with ice-cold glutaraldehyde (2.5% in 0.1 M cacodylate buffer, pH 7.4) for 30 minutes. After fixation, the samples were postfixed in 1% OsO4 in the same buffer for 30 min, washed twice with cacodylate A buffer and rehydrated through series of increasing alcohol concentrations (70, 80, 90, 95% ethanol, 10 min each). Tissue was incubated in prophylenoxid - epoxid resin (1:1) for 1 hour and afterwards with epoxid resin over night at 4°C. Ultrathin sections were stained with uranyl acetate and lead citrate and viewed with a Philips CM100 transmission electron microscope. Photographs were made with Kodak Electron Image Film SO-163 (Kodak, Vienna, Austria) and developed following the procedure recommended by producer.
MES-SA cells were treated with medium containing 3 μM vorinostat for indicated time periods. After harvesting the cells were fixed in 2% formaldehyde for 10 min at 37°C, followed by permeabilization with methanol (90%). Staining was performed by Cleaved Caspase-3 (Asp175) antibody conjugated with Alexa Fluor 488 (Cell Signaling Technology, #9669) for 60 minutes at room temperature. Measurements were performed on FACSCalibur™ (BD Biosciences). Staurosporine-treated cells (1 μM for 4 hours) were used as positive and untreated MES-SA cells as negative controls.
If not stated otherwise, all values represent means of at least three independent experiments ± SD. Values were compared using Student's t test. P ≤ 0.05 was considered statistically significant.
Vorinostat inhibits cell growth and colony formation in vitro
For colony forming assay, 300 MES-SA cells were seeded per ∅ 6 cm dish. After the treatment with vorinostat for 24, 48 and 72 hours they were grown for another 14 days and finally stained with crystal violet. As can be seen in Fig. 1C, there was a pronounced difference in the colony formation ability between untreated and treated MES-SA cells. This reduced number of colonies showed that vorinostat efficiently killed the cells in a time dependent-manner.
Immunohistochemical characterization of MES-SA cells and comparison to the endometrial stromal sarcoma cell line ESS-1
+ (5-10%; cytoplasmic)
Vorinostat deregulates expression of HDACs and p21WAF1
The expression of a cyclin-dependent kinase inhibitor p21WAF1 in vorinostat treated MES-SA cells was significantly upregulated already 24 hours after starting the treatment and continuously increased during the following 48 hours. These data are in agreement with previous results obtained with ESS-1 cells, suggesting a typical G1 arrest caused by the vorinostat treatment .
Vorinostat inhibits tumor growth in xenograft mice
After 21 days of treatment the animals were sacrificed and different organs, i.e. liver, spleen, lung, heart and intestine, were checked for pathological changes and tumor metastases. No structural changes were found in analyzed organs. Tumors were isolated and tumor size, volume and weight were determined. Most tumors were encapsulated and well circumscribed. On day 21, there was a tumorous ulceration in one placebo case. Although the surface area of the tumor was well supplied with blood vessels, we observed tumors larger then 800 mm3 to be most often necrotic in their center. However, this can be expected from the rapid tumor growth and inadequate blood supply of deeper tumor portions. In Fig. 3B the representative samples of two different tumors from each group (placebo and vorinostat-treated, respectively) are shown. Although the standard deviation of tumor size within groups, both placebo and treated one, was noticeable all over the treatment duration, at the end of treatment there was a significant difference (P = 0.044) in tumor volume between placebo and vorinostat-treated group. The average tumor volume in untreated mice was 2304.7 mm3, whereas in vorinostat-treated mice it was 1135.4 mm3. This difference represented a more than 50% reduction in comparison to the placebo group (Fig. 3C).
Vorinostat induces apoptosis in MES-SA cells in vitro and in vivo
Uterine sarcomas are very rare malignancies with poor prognosis. Precise diagnosis is usually made late, these tumors frequently grow highly aggressive and are resistant to chemotherapy. Thus, surgical excision is often the only treatment option [18, 19]. Molecularly targeted therapies of different tumor types showed a promising improvement in the last few years. Histone deacetylases, a group of enzymes responsible for epigenetic changes of histones and some other proteins, belong to the most promising targets. Some inhibitors of these enzymes are already used in preclinical and clinical trials. Vorinostat efficiently inhibits HDACs class I and II by binding to the active site of the enzyme . However, vorinostat seems to have different effects depending on the cell line used. While in most experimental systems vorinostat caused apoptotic changes, there are also data showing that autophagic processes are activated by vorinostat [13, 21–23]. Vorinostat has been already approved by FDA for the therapy for cutaneous T-cell lymphoma . That makes it also an interesting candidate for the treatment of other malignancies. However, data concerning gynecological malignancies in general and uterine sarcoma in particular are missing.
Here we attempted to establish a uterine sarcoma cell model for testing vorinostat in vitro and in vivo. For this purpose MES-SA cell line was used since it has been shown that these cells are tumorigenic in nude mice . In fact, after injecting 5 × 106 MES-SA cells into nude mice, tumor growth has been induced with 100% efficiency. Our intention was also to use this model as an alternative for endometrial stromal sarcoma. Immunohistochemical comparison of MES-SA and ESS-1 cells proved that these two cell lines are quite similar regarding different cell markers.
In our experiments, both cell lines (MES-SA and ESS-1) expressed different HDACs and responded similarly to the treatment with vorinostat. That might make endometrial stromal sarcomas and uterine sarcomas in general potential candidates for treatment with vorinostat and/or other HDAC inhibitors. Both our in vitro and in vivo data clearly indicate that vorinostat is able to significantly reduce MES-SA cell-growth already after a short treatment period and at a dose range used therapeutically in the clinic. Moreover, it has been shown by others that in this concentration range vorinostat is well tolerated and causes only minor side effects in patients . In our experiments we did not observe any pathological changes in the main organs in mice, suggesting that vorinostat may have no pronounced toxic effects during treatment over 21-days. These data correlate well with data from long-term studies in humans, in which vorinostat has been used as a therapeutic agent for cutaneous T-cell lymphoma and some other solid tumors. Reduction of tumor volume for more than 50% in comparison to the placebo group shows the potential of vorinostat in the therapy of uterine sarcomas. Our data also suggest that this reduction of tumor size is not so much the effect of diminished tumor cell proliferation but mainly due to specific apoptotic cell death caused by vorinostat. Descriptions of mechanisms involved in the cell death caused by vorinostat treatment of different cell lines are somehow contradictory and seem to depend on the cell model used. However, it seems obvious that apoptosis as well as autophagy play important roles. Thus, further studies should clarify whether one of these mechanisms excludes the other, or whether they are somehow compensating each other during or after vorinostat treatment.
In summary, we showed that vorinostat efficiently killed tumor cells and impaired the colony forming ability of uterine sarcoma cells in vitro. It also influenced the expression of different HDAC enzymes and p21WAF1. In vivo experiments showed that vorinostat efficiently inhibited tumor growth in nude mice xenografts by activating apoptosis. On the basis of these data and those presented earlier on endometrial stromal sarcoma cells, we conclude that vorinostat might be a promising candidate for therapy of patients with different types of uterine sarcomas.
This work was supported by Lore Saldow Research Fund. All experiments have been performed in the Lore Saldow Research Unit for molecular pathology of gynecologic tumors. We thank Andrea Koschell from the Laboratory for Electron Microscopy, Institute of Pathology, and the team of the core facility for flow cytometry (Center for Medical Research - CMR, Medical University Graz) for excellent technical assistance. This paper is dedicated to the memory of Mrs. Lore Saldow.
- Harker WG, MacKintosh FR, Sikic BI: Development and characterization of a human sarcoma cell line, MES-SA, sensitive to multiple drugs. Cancer Res. 1983, 43: 4943-4950.PubMedGoogle Scholar
- Sleijfer S, Seynaeve C, Verweij J: Gynaecological sarcomas. Curr Opin Onco. 2007, 19: 492-496. 10.1097/CCO.0b013e3282748eaa.View ArticleGoogle Scholar
- Gunawan B, Braun S, Cortes MJ, Bergmann F, Karl C, Füzesi L: Characterization of a newly established endometrial stromal sarcoma cell line. Int J Cancer. 1998, 77: 424-428. 10.1002/(SICI)1097-0215(19980729)77:3<424::AID-IJC19>3.0.CO;2-7View ArticlePubMedGoogle Scholar
- Kakuno Y, Yamada T, Mori H, Narabayashi I: Establishment and characterization of a cell line (OMC-9) originating from a human endometrial stromal sarcoma. Human Cell. 2008, 21: 46-55. 10.1111/j.1749-0774.2008.00050.xView ArticlePubMedGoogle Scholar
- Marks PA, Richon VM, Miller T, Kelly WK: Histone deacetylase inhibitors. Adv Cancer Res. 2004, 91: 137-168. full_textView ArticlePubMedGoogle Scholar
- Xu WS, Parmigiani RB, Marks PA: Histone deacetylase inhibitors: molecular mechanisms of action. Oncogene. 2007, 26: 5541-5552. 10.1038/sj.onc.1210620View ArticlePubMedGoogle Scholar
- Gillenwater AM, Zhong M, Lotan R: Histone deacetylase inhibitor suberoylanilide hydroxamic acid induces apoptosis through both mitochondrial and Fas (Cd95) signalling in head and neck squamous carcinoma cells. Mol Cancer Ther. 2007, 6: 2967-2975. 10.1158/1535-7163.MCT-04-0344View ArticlePubMedGoogle Scholar
- Tong A, Zhang H, Li Z, Gou L, Wang Z, Wie H, Tang M, Liang S, Chen L, Huang C, Wei Y: Proteomic analysis of liver cancer cells treated with suberonylanilide hydroxamic acid. Cancer Chemother Pharmacol. 2008, 61: 791-802. 10.1007/s00280-007-0536-2View ArticlePubMedGoogle Scholar
- Kumagai T, Wakimoto N, Yin D, Gery S, Kawamata N, Takai N, Komatsu N, Chumakov A, Imai Y, Koeffler HP: Histone deacetylase inhibitor, suberoylanilide hydroxamic acid (vorinostat, SAHA) profoundly inhibits the growth of human pancreatic cancer cells. Int J Cancer. 2007, 121: 656-665. 10.1002/ijc.22558View ArticlePubMedGoogle Scholar
- Emanuele S, Lauricella M, Carlisi D, Vassallo B, D'Anneo A, Di Fazio P, Vento R, Tesoriere G: SAHA induces apoptosis in hepatoma cells and synergistically interacts with the proteasome inhibitor Bortezomib. Apoptosis. 2007, 12: 1327-1338. 10.1007/s10495-007-0063-yView ArticlePubMedGoogle Scholar
- Jiang X, Tsang YH, Yu Q: c-Myc overexpression sensitizes Bim-mediated Bax activation for apoptosis induced by histone deacetylase inhibitor suberoylanilide hydroxamic acid (SAHA) through regulating Bcl-2/Bcl-xL expression. Int J Biochem Cell Biol. 2007, 39: 1016-1025. 10.1016/j.biocel.2007.01.024View ArticlePubMedGoogle Scholar
- Hrzenjak A, Moinfar F, Kremser ML, Strohmeier B, Staber PB, Zatloukal K, Denk H: Valproate inhibiton of histone deacetylase 2 affects differentiation and decreases proliferation of endometrial stromal sarcoma cells. Mol Cancer Ther. 2006, 5: 2203-2210. 10.1158/1535-7163.MCT-05-0480View ArticlePubMedGoogle Scholar
- Hrzenjak A, Kremser ML, Strohmeier B, Moinfar F, Zatloukal K, Denk H: SAHA induces caspase-independent, autophagic cell death of endometrial stromal sarcoma cells by influencing the mTOR pathway. J Pathol. 2008, 216: 495-504. 10.1002/path.2434View ArticlePubMedGoogle Scholar
- Kelly WK, Richon VM, O'Connor O, Curley T, MacGregor-Curtelli B, Tong W, Klang M, Schwartz L, Richardson S, Rosa E, Drobnjak M, Cordon-Cordo C, Chiao JH, Rifkind R, Marks PA, Scher H: Phase I clinical trial of histone deacetylase inhibitor: suberoylanilide hydroxamic acid administered intravenously. Clin Cancer Res. 2003, 9: 3578-3588.PubMedGoogle Scholar
- Kelly WK, O'Connor OA, Krug LM, Chiao JH, Heaney M, Curley T, MacGregore-Cortelli B, Tong W, Secrist JP, Schwartz L, Richardson S, Chu E, Olgac S, Marks PA, Scher H, Richon VM: Phase I study of an oral histone deacetylase inhibitor, suberoylanilide hydroxamic adic, in patients with advanced cancer. J Clin Oncol. 2005, 23: 3923-3931. 10.1200/JCO.2005.14.167PubMed CentralView ArticlePubMedGoogle Scholar
- Spiller SE, Ravanpay AC, Hahn AW, Olson JM: Suberoylanilide hydroxamic acid is effective in preclinical studies of medulloblastoma. J Neurooncol. 2006, 79: 259-270. 10.1007/s11060-006-9142-0View ArticlePubMedGoogle Scholar
- Hockly E, Richon VM, Woodman B, Smith DL, Zhou X, Rosa E, Sathasivam K, Ghazi-Noori S, Mahal A, Lowden PA, Steffan JS, Marsh JL, Thompson LM, Lewis CM, Marks PA, Bates GP: Suberoylanilide hydroxamic acid, a histone deacetylase inhibitor, ameliorates motor deficits in a mouse model of Huntington's disease. PNAS USA. 2003, 100: 2041-2046. 10.1073/pnas.0437870100PubMed CentralView ArticlePubMedGoogle Scholar
- Dusenbery KE, Potish RA, Judson P: Limitations of adjuvant radiotherapy for uterine sarcomas spread beyond the uterus. Gynecol Oncol. 2004, 94: 191-196. 10.1016/j.ygyno.2004.04.001View ArticlePubMedGoogle Scholar
- Giuntoli RL, Bristow RE: Uterine leiomyosarcoma: present management. Curr Opin Oncol. 2004, 16: 324-327. 10.1097/01.cco.0000127721.55676.f6View ArticlePubMedGoogle Scholar
- Finnin MS, Donigian JR, Cohen A, Richon VM, Rifkind RA, Marks PA, Breslow R, Pavletich NP: Structures of a histone deacetylase homologue bound to the TSA and SAHA inhibitors. Nature. 1999, 401: 188-193. 10.1038/43710View ArticlePubMedGoogle Scholar
- Shao Y, Gao Z, Marks PA, Jiang X: Apoptotic and autophagic cell death induced by histone deacetylase inhibitors. PNAS USA. 2004, 101: 18030-18035. 10.1073/pnas.0408345102PubMed CentralView ArticlePubMedGoogle Scholar
- Carew JS, Nawrocki ST, Kahue CN, Zhang H, Yang C, Chung L, Houghton JA, Huang P, Giles FJ, Cleveland JL: Targeting autophagy augments the anticancer activity of the histone deacetylase inhibitor SAHA to overcome Bcr-Abl-mediated drug resistance. Blood. 2007, 110: 313-322. 10.1182/blood-2006-10-050260PubMed CentralView ArticlePubMedGoogle Scholar
- Yamamoto S, Tanaka K, Sakimura R, Okada T, Nakamura T, Li Y, Takasaki M, Nakabeppu Y, Iwamoto Y: Suberoylanilide hydroxamic acid (SAHA) induces apoptosis or autophagy-associated cell death in chondrosarcoma cell lines. Anticancer Res. 2008, 28: 1585-1591.PubMedGoogle Scholar
- Mann BS, Johnson JR, Cohen MH, Justice R, Pazdur R: FDA approval summary: vorinostat for treatment of advanced primary cutaneous T-cell lymphoma. Oncologist. 2007, 12: 1247-1252. 10.1634/theoncologist.12-10-1247View ArticlePubMedGoogle Scholar
- O'Connor OA, Heaney ML, Schwartz L, Richardson S, Willim R, MacGregor-Cortelli B, Curly T, Moskowitz C, Portlock C, Horwitz S, Zelenetz AD, Frankel S, Richon V, Marks P, Kelly WK: Clinical experience with intravenous and oral formulation of the hovel histone deacetylase inhibitor suberoylanilide hydroxamic acid in patients with advanced hematologic malignancies. J Clin Oncol. 2006, 24: 166-172. 10.1200/JCO.2005.01.9679View ArticlePubMedGoogle Scholar
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.