The use of site-selective cAMP analogs greatly advanced our understanding of the mechanism of cAMP action in growth control. It was discovered that site-selective cAMP analogs can act as novel biological agents capable of inducing growth inhibition and differentiation in a broad spectrum of human cancer cell lines, including carcinomas, sarcomas, and leukemias, without causing cytotoxicity. 8-Cl-cAMP, the most potent site-selective cAMP analog, was selected as a preclinical Phase I antineoplastic agent of the National Cancer Institute (January 27, 1988). It was the first introduction of a cAMP analog into clinical testing in over 30 years of cAMP research. Significantly, this was the first demonstration that a cAMP analog can induce its biological effect at micromolar concentrations-the physiological concentration of cAMP, as opposed to the millimolar pharmacological or cytotoxic concentrations of cAMP analogs reported in all previous literature. The discovery rendered a critical assessment that the potency of a cAMP analog in growth inhibition depends on the analog's ability to selectively modulate the RI and RII regulatory subunits of cAMP-dependent protein kinase precisely, down-regulation of RI alpha with up-regulation of RIIbeta leading to the restoration of the normal balance of these cAMP transducing proteins in cancer cells. The use of antisense strategy and retroviral vector-mediated gene transfer technology provided direct evidence that two isoforms, the RIalpha and RIIbeta regulatory subunits of cAMP-dependent protein kinase, have opposite roles in cell growth and differentiation; RIalpha being growth stimulatory while RIIbeta is a growth-inhibitory and differentiation-inducing protein. As RIalpha expression is enhanced during chemical or viral carcinogenesis, in human cancer cell lines, in primary human tumors, and in multidrug-resistant (MDR) cancer cells as opposed to non-MDR parental cells, it is a target for cancer diagnosis and therapy. 8- Cl-cAMP and RIalpha antisense oligodeoxynucleotide, those that effectively down-regulate RI and up-regulate RIIbeta provide new approaches toward differentiation therapy and chemoprevention of cancer. A Phase I clinical study of 8-Cl-cAMP has now been completed.
