Figure S1. The PDE5 inhibitor sildenafil interacts with celecoxib to kill cancer cell lines. (A) Hepatoma

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1 Figure S1. The PDE5 inhibitor sildenafil interacts with celecoxib to kill cancer cell lines. (A) Hepatoma cells were treated with celecoxib ( 5.0 M) and/or sildenafil (, 2.0 M). ls were isolated after 24h and viability determined by trypan blue exclusion (n = 3, +/- SEM) p < 0.05 greater than corresponding value in icle control. (B) Colon cancer cells were treated with celecoxib ( 5.0 M) and/or sildenafil (, 2.0 M). ls were isolated after 24h and viability determined by trypan blue exclusion (n = 3, +/- SEM) p < 0.05 greater than corresponding value in icle control. (C-F) GBM cells, selected GBM stem cells and freshly-isolated primary GBM cells were treated with celecoxib ( 5.0 M) and/or sildenafil (, 2.0 M). ls were isolated after 24h and viability determined by trypan blue exclusion (n = 3, +/- SEM) p < 0.05 greater than corresponding value in icle control. (G) Parental GBM12 cells were cultured in Steml Technologies NeuroCult NS-A Basal Medium supplemented with 20 g/ml bfgf, 20 g/ml EGF and 2 mm heparin. CD133+ glioma cells from this population were isolated by fluorescence-activated cell sorting analysis. ls grew as neurospheres and were characterized for stem cell markers compared to parental GBM12 cells: CD36; integrin 6; CD133; Nestin; CD15; SOX2; CD44; MAP-2; GFAP (n = 3).

2 Figure S2. denafil and celecoxib interact to kill freshly-isolated activated human microglia. (A) Activated microglia were isolated from GBM tumors freshly delivered from the OR, as described in Methods (three patients: pt1; pt2; pt3). ls were plated in 96 well plates (10,000 cells / well) and were treated with celecoxib ( 5.0 M) and/or sildenafil (, 2.0 M). ls were isolated after 24h and viability determined using a live-dead assay (red cells = dead; green cells = alive) (n = 8 wells of a 96 well plate per condition, +/- SEM) p < 0.05 greater than corresponding value in icle control. (B) Microglia were plated in 96 well plates (10,000 cells / well) and were treated with celecoxib ( 5.0 M) and/or sildenafil (, 2.0 M). ls were isolated after 24h and fixed to the plate. Immunohistochemistry was performed to detect expression of interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF ). The expression level of IL-6 and TNF was determined using Wisoft software in triplicate for each patient sample and the data presented are the mean of data from three patient samples (+/- SEM).

3 Figure S3. denafil and celecoxib treatment activates CD95 and causes cell killing in part by activation of ceramide synthase 6. (A) BT549 cells were pre-treated with icle or the pan-ceramide synthase inhibitor fumonisin B1 (2.5 M) and then were then treated with celecoxib ( 5.0 M) and/or sildenafil (, 2.0 M). Twenty four h after drug treatment cells were isolated and viability determined by trypan blue exclusion assay (n = 3 +/- SEM). p < 0.05 less than corresponding value in icle cells. (B) BT549 cells were pretreated with icle or fumonisin B1 (25 M) and then were then treated with celecoxib ( 5.0 M) and/or sildenafil (, 2.0 M). Upper Images: Six h after treatment cells were fixed to the plate and immunohistochemistry performed to determine the plasma membrane levels of CD95. The upper images obtained using the Hermes Wiscan imaging system is representative of the data. The intensity of CD95 immunostaining was determined using the Wisoft data analysis package (n = 3 +/- SEM). p < 0.05 value greater than celecoxib treatment alone. Lower immunoblot: Six h after treatment cells were isolated and subjected to SDS PAGE and immunoblotting to determine the phosphorylation of JNK. (C) - (H) BT549 cells were pre-treated with icle control or the nitric oxide synthase inhibitor L- (1 M) and 30 min later treated with icle control or with celecoxib ( 5.0 M) and/or sildenafil (, 2.0 M). Six h after treatment cells were isolated and bioactive lipids extracted. Multiple bioactive lipid species were analyzed using GC/MS techniques (n = 2 in triplicate +/- SEM). p < 0.05 greater than corresponding value in cells; p < 0.05 less than corresponding value in treatment; % p < 0.05 greater than value in celecoxib alone treatment. (I) BT549 cells were transfected as indicated to with a scrambled sirna (siscr) or sirna molecules to knock down expression of ceramide synthase 2 (silass2) or ceramide synthase 6 (silass6). Thirty six h after transfection cells were then treated with icle or with celecoxib ( 5.0 M) and sildenafil (, 2.0 M). Twenty four h after drug treatment cells were isolated and viability determined by trypan blue exclusion assay (n = 3 +/- SEM). p < 0.05 less than corresponding value in siscr transfected cells. (J) BT549 cells were treated with icle control or with FTY720 (fingolimod) (FTY, 0.05 M). Six h after treatment cells were isolated and bioactive lipids extracted. Multiple bioactive lipid species were analyzed using GC/MS techniques (n = 2 in triplicate +/- SEM). p < 0.05 greater than corresponding value in cells. (K) and (L)

4 Tumor cells, as indicated, were treated with icle, FTY720 (0.05 M), celecoxib ( 5.0 M), ATRA (150 nm) and sildenafil (, 2.0 M), or with three drug combinations, as indicated. Twelve h and 24h as indicated after drug treatment cells were isolated and viability determined by live / dead inclusion / exclusion assay (n = 3 +/- SEM). p < 0.05 less than corresponding value in icle treated cells. (M) Tumor cells, as indicated, were treated with icle, 4HPR (0.2 M), celecoxib ( 5.0 M) and sildenafil (, 2.0 M), or with all three drugs. Twelve h after drug treatment cells were isolated and viability determined by live / dead inclusion / exclusion assay (n = 3 +/- SEM). p < 0.05 less than corresponding value in icle treated cells. (N) Tumor cells, as indicated, were treated with icle, ATRA (0.15 M), celecoxib ( 5.0 M) and sildenafil (, 2.0 M), or with all three drugs. Twelve h after drug treatment cells were isolated and viability determined by live / dead inclusion / exclusion assay (n = 3 +/- SEM). (O) Tumor cells were treated with FTY720 (50 nm) and the expression of the death receptor CD95 determined over a 12h time course. (P) Tumor cells were transfected with a scrambled sirna (siscr) or sirna molecules to knock down expression of HDAC1 and HDAC2 (sihdac1 + sihdac2). Thirty six h later cells were isolated and immunoblotting performed to determine the expression of CD95. Lower graph: Tumor cells were transfected with a scrambled sirna (siscr) or an sirna molecule to knock down expression of CD95. Thirty six h later cells were pre-treated with icle or fumonisin B1 (FB1, 25 M) followed by treatment with icle, FTY720 (0.05 M), celecoxib ( 5.0 M) and sildenafil (, 2.0 M) together as indicated. Twelve h after drug treatment cells were isolated and viability determined by trypan blue exclusion assay (n = 3 +/- SEM). p < 0.05 less than corresponding value in icle treated cells. (Q) and (R) Tumor cells were transfected with a scrambled sirna (siscr) or an sirna molecule to knock down expression of CD95. Thirty six h later cells were treated with icle, 4HPR (0.20 M), ATRA (0.15 M), celecoxib ( 5.0 M) and sildenafil (, 2.0 M) together as indicated in the Figure. Twelve h after drug treatment cells were isolated and viability determined by live / dead assay (n = 3 +/- SEM) p < 0.05 less than corresponding value in siscr cells. (S) BT549 cells were treated with icle or with [celecoxib (5 M) + denafil (2 M) + FTY720 (50 nm)] and as indicated, 30 min after drug treatment, were irradiated (4 Gy). l viability was assessed 9h after irradiation by live / dead assay. (T) Tumor cells were pre-

5 treated with fumonisin B1 (25 M, FB1) or myriocin (200 nm, Myr) and then treated with icle, (FTY720, 50 nm and 4HPR, 200 nm) and/or with (celecoxib, 5 M and sildenafil, 2 M). Nine h after drug treatment cells were isolated and viability determined by live / dead inclusion / exclusion assay (n = 3 +/- SEM). p < 0.05 greater than corresponding value in double combination treated cells; p < 0.05 greater than corresponding triple combination cells. (U) GBM6-luciferase cells (0.5 x 10 6 ) were injected into the right caudate putamen (the brain) of athymic mice and tumors permitted to form for 14 days. Animals were segregated into groups with very similar mean tumor volumes. Animals were treated with icle (cremophore), sildenafil (5 mg/kg), celecoxib (10 mg/kg), FTY720 (0.05 mg/kg) or the drugs in combination as indicated simultaneously for 14 days QD. Tumor mass / luciferase activity was measured in an IVIS Xenogen imaging system, as used in our prior studies (150 mg/kg luciferin per mouse).

6 Figure S4. H&E staining of sections of normal tissues / organs from mice treated with celecoxib, sildenafil and FTY720 and ATRA. Mice were treated for 14 days with icle or with celecoxib (25 mg/kg) and sildenafil (10 mg/kg) and FTY720 (0.6 mg/kg) and ATRA (20 mg/kg). Organs were isolated, fixed sectioned and H&E stained (X20 magnification; 100 m bar in each panel).

7 S1A 40 Percentage cell death HuH7 HEP3B HEPG2 0

8 S1B 40 Percentage cell death HT29 HCT116 SW480 0

9 Percentage cell death S1C GBM5 GBM5 STEM 10 0

10 Percentage cell death S1D GBM6 GBM6 STEM

11 Percentage cell death S1E GBM14 GBM14 STEM 10 0

12 Percentage cell death S1F Primary Glioma 24h 0 pt1 pt2 pt3

13 S1G GBM12 GBM12 stem GBM12 GBM12 stem CD44 CD36 SOX2 Intgn B6 CD133 MAP2 CD15

14 Percentage cell death S2A Activated Microglia 24h pt1 pt2 pt3

15 S2B + IL-6 TNFa Percentage cytokine level h, Pts. 1-3 IL-6 TNFa

16 S3A Percentage cell death FB1

17 Percent Change in surface CD95 Expression vs Vehicle S3B FB % 22% P-JNK JNK FB1

18 S3C pmol dihydro-ceramide % 0 C16:0 C22:0 C24:1 C24:0 C26:1

19 S3D pmol dihydro-hexaceramide C16:0 C18:0 C20:0 C24:1

20 pmol dihydro-s1p S3E L-

21 pmol ceramide S3F C16:0 C22:0 C24:1 C24:0 C24:1

22 pmol hexaceramide S3G C16:0 C22:0 C24:1 C24:0 C24:1

23 pmol S1P S3H L-

24 + + + siscr silass6 silass2 S3I Percentage cell death BT549 24h LASS2 LASS6 GAPDH 0 siscr silass6 silass2

25 FTY FTY FTY FTY FTY FTY FTY FTY S3J 50 nmol dihydro-ceramide C16:0 C22:0 C24:1 C24:0 6h C16:0 C22:0 C24:1 C24:0 12h

26 S3K / FTY / /FTY / FTY / /FTY BT474 HEP3B 2% 15% 3% 52% 2% 10% 12% 38% HCT116 SUM149 3% 4% 4% 29% 1% 3% 5% 31% CON1 GBM6 GBM12 5% 7% 6% 28% 4% 6% 5% 46% HT29 HEPG2 2% 3% 3% 26% 1% 12% 8% 28% 4% 5% 9% 54% HOSS1 6% 12% 6% 30% SW480 3% 19% 3% 63%

27 S3L A549 H460 1% 2% 3% 32% 24h 1% 4% 3% 36% / FTY / /FTY ATRA / /ATRA A549 1% 11% 3% 53% 3% 28% 12h H460 1% 5% 4% 41% 5% 44%

28 S3M / 4HPR / /4HPR / 4HPR / /4HPR BT474 HEP3B 3% 12% 6% 38% 2% 10% 20% 45% HCT116 3% 7% 8% 33% HEPG2 1% 12% 9% 40% CON1 8% 12% 10% 29% GBM6 2% 8% 8% 21% GBM12 4% 7% 18% 21% HOSS1 6% 11% 9% 20% SW480 4% 23% 17% 29%

29 S3N HEPG2 1% 12% 6% 31% HEP3B 1% 10% 5% 25%

30 S3O Time (hours) after 50 nm FTY CD95 GAPDH BT549 CD95 GAPDH BT474

31 S3P CD95 GAPDH siscr sihdac1+2 HDAC1 HDAC2 GAPDH sihdac1+2 siscr 60 Percentage cell death F+C+S FTY720 F+C+S FTY720 F+C+S FTY720 FB1 siscr sicd95 siscr

32 S3Q + 4HPR + + 4HPR ATRA + + ATRA siscr SUM149 2% 4% 6% 51% 5% 31% sicd95 1% 1% 7% 6% 6% 8% siscr GBM6 1% 10% 2% 26% 3% 29% sicd95 1% 3% 2% 6% 2% 16%

33 S3R + 4HPR + + 4HPR ATRA + + ATRA siscr BT474 2% 4% 7% 40% 6% 54% sicd95 1% 3% 5% 11% 4% 7% siscr HEP3B 1% 17% 6% 37% 9% 43% sicd95 1% 2% 2% 9% 3% 13%

34 S3S BT549, 9h FTY FTY Mock exposed 4 Gy

35 S3T //FTY 4HPR 4 DRUG 5% 15% 7% 28% Plus FB1 Plus Myr 6% 8% 7% 7% 5% 8% 8% 17%

36 S3U FTY720 C+S+F Day 0 Day 7 Day 14 Day 28 Dead

37 S4 FTY720 +FTY720 ATRA ATRA+FTY Spleen Lung Liver Kidney Heart Brain