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Dipyridamole as a Perioperatively Safe Aurora Kinase A Inhibitor for Neoadjuvant Therapy in Esophageal Squamous Cell
1Shanghai Fengxian District Central Hospital, Shanghai, China.
Introduction:
Aurora kinase A (AURKA) is overexpressed in esophageal squamous cell carcinoma (ESCC) and correlates with chemoresistance and poor prognosis. Dedicated AURKA inhibitors show potent target engagement but cause severe myelosuppression incompatible with perioperative esophagectomy. We aimed to identify a compound with meaningful AURKA-binding activity and an established perioperative safety profile through drug repurposing.
Methods:
We screened ~2500 FDA-approved drugs against the AURKA co-crystal structure (PDB: 5EW9) using hierarchical Glide docking with MM-GBSA rescoring, followed by 200-ns molecular dynamics simulations, normal mode analysis, and ADMET profiling. The top candidate was validated using NanoBRET target engagement assays and CCK-8 viability assays in three ESCC cell lines (KYSE-150, TE-1, EC109) and normal esophageal epithelial cells (Het-1A).
Results:
Dipyridamole, an established antiplatelet agent, ranked first with an MM-GBSA binding energy of -77.11 kcal/mol, exceeding all other drugs by >15 kcal/mol. MD simulations confirmed stable complex formation over 200 ns. NanoBRET assays validated direct AURKA binding in intact living cells (IC50 ≈ 2.8 μM). CCK-8 assays demonstrated selective antiproliferative activity (IC50: KYSE-150 = 12.4 μM; TE-1 = 18.7 μM; EC109 = 25.3 μM at 48 h) with a selectivity index of 6.3 versus normal cells (Het-1A IC50 = 78.5 μM).
Conclusion:
Dipyridamole is an AURKA-engaging compound with an established perioperative safety profile, validated cellular target engagement, and selective anti-ESCC activity, warranting further preclinical investigation as a potential neoadjuvant adjunct.
