Didymin: an orally active citrus flavonoid for targeting neuroblastoma

Sharad S. Singhal, Sulabh Singhal, Preeti Singhal, Jyotsana Singhal, David Horne and Sanjay Awasthi _

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Oncotarget. 2017; 8:29428-29441. https://doi.org/10.18632/oncotarget.15204

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Sharad S. Singhal1, Sulabh Singhal2, Preeti Singhal3, Jyotsana Singhal1, David Horne1 and Sanjay Awasthi4

1 Department of Molecular Medicine, Beckman Research Institute of the City of Hope, Comprehensive Cancer Center and National Medical Center, Duarte, CA, USA

2 University of California at San Diego, La Jolla, San Diego, CA, USA

3 University of Texas Health, San Antonio, TX, USA

4 Texas Tech University Health Sciences Center, Lubbock, TX, USA

Correspondence to:

Sharad S. Singhal, email:

Keywords: neuroblastoma, p53, didymin, N-Myc, RKIP

Received: December 30, 2016 Accepted: January 27, 2017 Published: February 08, 2017


Neuroblastoma, a rapidly growing yet treatment responsive cancer, is the third most common cancer of children and the most common solid tumor in infants. Unfortunately, neuroblastoma that has lost p53 function often has a highly treatment-resistant phenotype leading to tragic outcomes. In the context of neuroblastoma, the functions of p53 and MYCN (which is amplified in ~25% of neuroblastomas) are integrally linked because they are mutually transcriptionally regulated, and because they together regulate the catalytic activity of RNA polymerases. Didymin is a citrus-derived natural compound that kills p53 wild-type as well as drug-resistant p53-mutant neuroblastoma cells in culture. In addition, orally administered didymin causes regression of neuroblastoma xenografts in mouse models, without toxicity to non-malignant cells, neural tissues, or neural stem cells. RKIP is a Raf-inhibitory protein that regulates MYCN activation, is transcriptionally upregulated by didymin, and appears to play a key role in the anti-neuroblastoma actions of didymin. In this review, we discuss how didymin overcomes drug-resistance in p53-mutant neuroblastoma through RKIP-mediated inhibition of MYCN and its effects on GRK2, PKCs, Let-7 micro-RNA, and clathrin-dependent endocytosis by Raf-dependent and -independent mechanisms. In addition, we will discuss studies supporting potential clinical impact and translation of didymin as a low cost, safe, and effective oral agent that could change the current treatment paradigm for refractory neuroblastoma.

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