Abstract 4157: Prodrug development of Cyclo-Creatine: Enhancing permeability and reducing toxicity for HER2+ breast cancer treatment

Abstract HER2+ breast cancer is an aggressive subtype of cancer that often develops resistance to the current first-line therapy, Trastuzumab. In our previous work, we demonstrated that HER2 signaling activates mitochondrial creatine kinase 1 (MtCK1), which enhances mitochondrial energy metabolism for rapid proliferation of breast cancer cells. However, pharmacological blockage of MtCK1 with a creatine analog, Cyclo-Creatine (CCr), requires millimolar concentration to inhibit breast cancer cell proliferation and is associated with brain toxicity, limiting its clinical application. This brain toxicity may result from the inhibition of the creatine transporter SLC6A8 by CCr, which decreases to transport creatine into brain. In this study, we took a prodrug development approach to identify and optimize protection groups for CCr, designed to bypass the SLC6A8 transporter, enhancing bioavailability and reducing toxicity. Liquid chromatography-mass spectrometry (LC-MS) was utilized to analyze drug uptake and creatine metabolites in cells treated with the prodrugs. Prodrug C, which is our lead prodrug candidate, demonstrated a seven-fold increase in cellular uptake and more than a hundred-fold improvement in cell-killing effects as compared to CCr in an MtCK1 specific manner in breast cancer cells. This approach offers a promising therapeutic strategy to inhibit HER2+ breast cancer cell by disrupting mitochondrial energy metabolism. Future investigations will focus on validating this prodrug’s pharmacokinetics (PK) and pharmacodynamics (PD) through further preclinical studies. Citation Format: Ya Li, Yetong Huang, Puja Dey, Sadae Hitosugi, Sarah A. Buhrow, Joel M. Reid, Taro Hitosugi. Prodrug development of Cyclo-Creatine: Enhancing permeability and reducing toxicity for HER2+ breast cancer treatment [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 4157.