Givinostat Inhibition of Sp1-dependent MGMT Expression Sensitizes Glioma Stem Cells to Temozolomide

Anticancer Res. 2023 Mar;43(3):1131-1138. doi: 10.21873/anticanres.16258.


Background/aim: Givinostat is a pan-histone deacetylase (HDAC) inhibitor that has demonstrated excellent tolerability as well as efficacy in patients with polycythemia vera. Accumulating in vitro and in vivo evidence suggests givinostat is also promising as a therapeutic agent targeting glioma stem cells (GSCs), the cancer stem cells of glioblastoma (GBM) considered responsible for its intractable nature. However, it remains to be shown how givinostat impacts the therapeutic effects of temozolomide, a DNA-alkylating agent and the key component of GBM treatment given not only during postoperative radiotherapy but also thereafter as maintenance chemotherapy.

Materials and methods: The effects of givinostat and knockdown of O6-methylguanine-DNA methyltransferase (MGMT) or Sp1 on the mRNA and protein expression of relevant genes in human GSC lines were examined by RT-PCR and western blot analyses. The dye exclusion method was used to evaluate cell viability.

Results: Givinostat enhanced the cytotoxic activity of temozolomide in GSC lines expressing MGMT, in which the MGMT expression was shown to contribute to their temozolomide resistance. Givinostat inhibited MGMT expression in GSCs and, in parallel, the expression of Sp1, a transcription factor involved in the control of MGMT promoter activity. Knockdown experiments demonstrated Sp1 expression was indeed required for MGMT expression in GSCs.

Conclusion: Givinostat, in addition to its own cytotoxic activity, sensitizes GSCs to temozolomide by inhibiting Sp1-dependent MGMT expression in GSCs. Combining givinostat with temozolomide could therefore be a rational therapeutic strategy to effectively eliminate GSCs and thus help overcome the therapy resistance of GBM.

Keywords: Blood-brain barrier; differentiation; epigenetic modulator; tumor-initiating cells.

MeSH terms

  • DNA Modification Methylases / genetics
  • DNA Repair Enzymes / genetics
  • Glioblastoma* / metabolism
  • Glioma* / drug therapy
  • Glioma* / genetics
  • Humans
  • Neoplastic Stem Cells* / drug effects
  • Neoplastic Stem Cells* / metabolism
  • O(6)-Methylguanine-DNA Methyltransferase* / genetics
  • O(6)-Methylguanine-DNA Methyltransferase* / metabolism
  • Sp1 Transcription Factor / antagonists & inhibitors
  • Sp1 Transcription Factor / metabolism
  • Temozolomide* / pharmacology
  • Tumor Suppressor Proteins / genetics


  • DNA Modification Methylases
  • DNA Repair Enzymes
  • givinostat
  • MGMT protein, human
  • O(6)-Methylguanine-DNA Methyltransferase
  • SP1 protein, human
  • Sp1 Transcription Factor
  • Temozolomide
  • Tumor Suppressor Proteins