Combined inhibition of NAD synthesis and C-terminal binding protein cooperatively induces cell death and inhibits growth of high grade serous ovarian carcinoma

The transcriptional scaffolds C-terminal Binding Proteins (CtBP) 1 and 2 are overexpressed and act as oncogenic dependencies in multiple cancers but importantly encode a chemically targetable dehydrogenase domain. CtBP promotes survival of high grade serous ovarian carcinoma (HGSOC) cells by repressing expression of Death Receptors (DR) 4 and 5, which activate caspase 8-dependent apoptosis. We have previously developed a series of substrate competitive CtBP dehydrogenase inhibitors active in multiple cell and preclinical solid tumor models. In the current study, we validated CtBP1 and 2 overexpression in a longitudinal series of primary and metastatic/recurrent HGSOC cases. Our lead CtBP dehydrogenase inhibitor, JW-98, induced apoptosis and exhibited variable single agent IC₅₀ values in HGSOC cell lines. Importantly, depletion of nicotinamide adenine dinucleotide (NAD) species using the NAD synthesis inhibitor GMX1778 strikingly sensitized HGSOC cells to JW-98 treatment. Mechanistically, the JW-98/GMX1778 combination effectively abrogated CtBP dimerization that requires stoichiometric levels of intracellular NAD and is required for CtBP's oncogenic transcriptional activities. Highlighting translational potential in late-stage HGSOC, combined JW-98/GMX1778 treatment of platinum-resistant OVCAR3 HGSOC mouse xenografts abrogated tumor growth without observable toxicity. Combined inhibition of CtBP and NAD synthesis represents a novel therapeutic strategy that could improve outcomes in chemoresistant HGSOC.