PAK4-NAMPT dual inhibition as a novel strategy for therapy resistant pancreatic neuroendocrine tumors

Gabriel Mpilla, Amro Aboukameel, Irfana Muqbil, Steve Kim, Rafic Beydoun, Philip A. Philip, Ramzi M. Mohammad, Mandana Kamgar, Vinod Shidham, William Senapedis, Erkan Baloglu, Jing Li, Gregory Dyson, Yue Xue, Bassel El-Rayes, Asfar S. Azmi*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Pancreatic neuroendocrine tumors (PNET) remain an unmet clinical need. In this study, we show that targeting both nicotinamide phosphoribosyltransferase (NAMPT) and p21-activated kinase 4 (PAK4) could become a synthetic lethal strategy for PNET. The expression of PAK4 and NAMPT was found to be higher in PNET tissue compared to normal cells. PAK4-NAMPT dual RNAi suppressed proliferation of PNET cell lines. Treatment with KPT-9274 (currently in a Phase I trial or analogs, PF3758309 (the PAK4 selective inhibitor) or FK866 (the NAMPT inhibitor)) suppressed the growth of PNET cell lines and synergized with the mammalian target of rapamycin (mTOR) inhibitors everolimus and INK-128. Molecular analysis of the combination treatment showed down-regulation of known everolimus resistance drivers. KPT-9274 suppressed NAD pool and ATP levels in PNET cell lines. Metabolomic profiling showed a statistically significant alteration in cellular energetic pathways. KPT-9274 given orally at 150 mg/kg 5 days/week for 4 weeks dramatically reduced PNET sub-cutaneous tumor growth. Residual tumor analysis demonstrated target engagement in vivo and recapitulated in vitro results. Our investigations demonstrate that PAK4 and NAMPT are two viable therapeutic targets in the difficult to treat PNET that warrant further clinical investigation.

Original languageEnglish (US)
Article number1902
Issue number12
StatePublished - Dec 2019


  • KPT-9274
  • MTOR
  • PAK4
  • Pancreatic neuroendocrine tumors

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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