The novel dihydroorotate dehydrogenase (DHODH) inhibitor BAY 2402234 triggers differentiation and is effective in the treatment of myeloid malignancies

Leukemia. 2019 Oct;33(10):2403-2415. doi: 10.1038/s41375-019-0461-5. Epub 2019 Apr 2.


Acute myeloid leukemia (AML) is a devastating disease, with the majority of patients dying within a year of diagnosis. For patients with relapsed/refractory AML, the prognosis is particularly poor with currently available treatments. Although genetically heterogeneous, AML subtypes share a common differentiation arrest at hematopoietic progenitor stages. Overcoming this differentiation arrest has the potential to improve the long-term survival of patients, as is the case in acute promyelocytic leukemia (APL), which is characterized by a chromosomal translocation involving the retinoic acid receptor alpha gene. Treatment of APL with all-trans retinoic acid (ATRA) induces terminal differentiation and apoptosis of leukemic promyelocytes, resulting in cure rates of over 80%. Unfortunately, similarly efficacious differentiation therapies have, to date, been lacking outside of APL. Inhibition of dihydroorotate dehydrogenase (DHODH), a key enzyme in the de novo pyrimidine synthesis pathway, was recently reported to induce differentiation of diverse AML subtypes. In this report we describe the discovery and characterization of BAY 2402234 - a novel, potent, selective and orally bioavailable DHODH inhibitor that shows monotherapy efficacy and differentiation induction across multiple AML subtypes. Herein, we present the preclinical data that led to initiation of a phase I evaluation of this inhibitor in myeloid malignancies.

MeSH terms

  • Animals
  • Antineoplastic Agents / pharmacology*
  • Apoptosis / drug effects
  • Cell Differentiation / drug effects*
  • Cell Line, Tumor
  • Dihydroorotate Dehydrogenase
  • Enzyme Inhibitors / pharmacology*
  • Female
  • HL-60 Cells
  • Humans
  • Leukemia, Myeloid, Acute / drug therapy*
  • Leukemia, Myeloid, Acute / metabolism
  • Leukemia, Promyelocytic, Acute / drug therapy
  • Leukemia, Promyelocytic, Acute / metabolism
  • Mice
  • Mice, Inbred NOD
  • Mice, SCID
  • Oxidoreductases Acting on CH-CH Group Donors / antagonists & inhibitors*
  • Pyrimidines / metabolism
  • THP-1 Cells
  • Translocation, Genetic / drug effects


  • Antineoplastic Agents
  • Dihydroorotate Dehydrogenase
  • Enzyme Inhibitors
  • Pyrimidines
  • Oxidoreductases Acting on CH-CH Group Donors
  • pyrimidine