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Drug repositioning of antiretroviral ritonavir for combinatorial therapy in glioblastoma

: Rauschenbach, Laurèl; Wieland, Anja; Reinartz, Roman; Kebir, Sied; Till, Andreas; Darkwah Oppong, Marvin; Dobersalske, Celia; Ullrich, Vivien; Ahmad, Ashar; Jabbarli, Ramazan; Pierscianek, Daniela; Fröhlich, Holger; Simon, Matthias; Brüstle, Oliver; Sure, Ulrich; Glas, Martin; Scheffler, Björn


European journal of cancer : EJC 140 (2020), S.130-139
ISSN: 0959-8049
ISSN: 0277-5379
ISSN: 0964-1947
ISSN: 1879-0852
Fraunhofer SCAI ()
Data Science; drug discovery; glioblastoma; ritonavir; Temozolomide; autophagy; repositioning

The protease inhibitor ritonavir (RTV) is a clinical-stage inhibitor of the human immunodeficiency virus. In a drug repositioning approach, we here exhibit the additional potential of RTV to augment current treatment of glioblastoma, the most aggressive primary brain tumour of adulthood.
We explored the antitumour activity of RTV and mechanisms of action in a broad spectrum of short-term expanded clinical cell samples from primary and recurrent glioblastoma and in a cohort of conventional cell lines and non-tumour human neural controls in vitro. To validate RTV efficacy in monotherapeutic and in combinatorial settings, we used patient-derived xenograft models in a series of in vivo studies.
RTV monotherapy induced a selective antineoplastic response and demonstrated cytostatic and anti-migratory activity at clinical plasma peak levels. Additional exposure to temozolomide or irradiation further enhanced the effects synergistically, fostered by mechanisms of autophagy and increased endoplasmic reticulum stress. In xenograft models, we consequently observed increasing overall survival under the combinatorial effect of RTV and temozolomide.
Our data establish RTV as a valuable repositioning candidate for further exploration as an adjunct therapeutic in the clinical care of glioblastoma.