The high anticancer activity of MC2884 109 against hematological, sound and aggressive models of cancer (TET2?/? and p53?/?) and xenograft models (colon cancer, AML and APL), as well as its massive apoptosis induced in human primary leukemia blasts with poor prognosis CpG islands demethylation, and induced remarkable apoptosis.395 Since HDACs and LSD1 are overexpressed in several types of human cancers contributing to the silencing of tumor suppressor genes, also the simultaneous inhibition of these two enzymes can furnish synergistic activity against cancer cell growth, migration and invasion. goal of the multi-epi-target approach consists in the development of small molecules able to simultaneously and (often) reversibly bind different specific epi-targets. To date, two dual HDAC/kinase inhibitors (CUDC-101 and CUDC-907) are in advanced stage of clinical trials. In the last years, the growing interest in polypharmacology motivated the publication of high quality reviews on combination therapy and hybrid molecules. Hence, in order to update Dehydrocorydaline the state-of-art of these therapeutic approaches avoiding redundancy, herein we focused only on multiple medication therapies and multi-targeting compounds exploiting epigenetic plus non-epigenetic drugs reported in literature in 2018. In addition, all the multi-epi-target inhibitors known in literature so far, hitting two or more epigenetic targets, have been included. to release the thiol zinc binding moiety. Romidepsin 4 shows mainly inhibitory activity against class I HDACs rather than pan-inhibition. Belinostat 5 and panobinostat 6 (Table 1) are two other hydroxamate-containing pan-HDAC inhibitors approved by FDA, the first in 2014 for the treatment of refractory peripheral T-cell lymphoma (PTCL), the latter in 2015 for the treatment of refractory or relapsed multiple myeloma (MM). Tucidinostat 7 (chidamide, Table 1) is the first benzamide-type HDACi approved for clinical use. It inhibits HDAC1/2/3/10 and was approved by the Chinese FDA in 2014 for the treatment of PTCL. Sodium valproate (VPA) 8 Dehydrocorydaline (Table 1) is usually a known antiepileptic drug belonging to the short-chain fatty acid series of HDACi. Dehydrocorydaline It selectively inhibits class I HDACs and reduces tumor growth and metastasis formation in various animal models. Entinostat 9 and mocetinostat 10 (Table 1) are two benzamide-containing, class I-selective HDACi currently in clinical trials for the treatment of numerous solid tumors. Abexinostat 11, pracinostat 12, quisinostat 13, resminostat 14, givinostat 15 and rocilinostat 16 (Table 1) are examples of hydroxamates pan-HDACi (with the exception of 16, quite selective for HDAC6) in clinical trials for the treatment of several hematological (11-13, 15 and 16) and solid tumors (14). Among them, pracinostat 12, resminostat 14 and givinostat 15 granted the status of orphan drugs for AML, hepatocellular carcinoma, and Duchenne muscular dystrophy, respectively.18C20 Nicotinamide 17 is SH3RF1 the only sirtuin inhibitor currently used in clinics for the treatment of sound tumors (Table 1). Recently, clinical candidates have been obtained for other epigenetic targets such as lysine methyltransferases (KMTs), arginine methyltransferases (PRMTs), lysine demethylases (KDM) and bromodomains (BRDs). KMTs constitute a large family of enzymes able to catalyze the transfer of one, two and/or three methyl groups to lysine residues using SAM as the methyl donor co-substrate. Similarly, PRMTs perform methylation (single or double, the latter symmetric or asymmetric) at arginine residues of histone and non-histone proteins.21,22 Differently from DNA methylation, lysine methylation can lead to either transcriptional activation or repression, depending on the specific lysine residue modified, and on the extent of methylation (me1, me2, or me3). GSK2816126 18, tazemetostat 19 and CPI-1205 20 (Table 1) are selective, catalytic inhibitors of both wild type (wt) and mutant forms of the methyltransferase EZH2 (enhancer of zeste homolog 2), currently in clinical trials in patients with various lymphomas, multiple myeloma, and solid tumors.23,24 Pinometostat 21 (Table 1) is a picomolar inhibitor of the H3K79 methyltransferase DOT1L (disruptor of telomeric silencing 1-like), with more than 30,000-fold selectivity against other KMTs. When used in rearranged-MLL (mixed-lineage-leukemia) cells and xenograft models, 21 reduced H3K79 methylation level, decreased target gene expression, and induced selective leukemia cell death.25,26 JNJ-64619178 2227 and GSK3326595 2328(Table 1) are two potent and selective PRMT5 inhibitors that induced tumor regression in sound cancers as well as in hematologic malignancies, supporting clinical testing in patients with these kinds of cancer. To date, two families of KDMs have been identified.27,29 The first is the KDM1 family, including LSD1 and LSD2 (lysine-specific histone demethylase 1 and 2), able to remove methyl units through an oxidative amination process using flavin adenine dinucleotide (FAD) as cofactor. Dehydrocorydaline The second KDM family, made up of KDM2C7, is known as Jumonji C (Jmj-C) domain-containing protein family and uses an -ketoglutarate/Fe(II) ion-dependent mechanism to catalyze the hydroxylation of a lysine and several related genes. It is important to underline that this downregulation of these genes was not identified after either HDACi or DNMTi treatment alone.60,61 A lot of preclinical evidences collected in AML or MDS cell lines or in cultured patient cells, such as improved cell growth Dehydrocorydaline arrest, loss of clonogenic potential and DNA synthesis inhibition, support the combination of HDACi with the nucleoside DNMTi azacytidine 1 or decitabine 2.62C64 HDACi were able to sensitize cancer cells to.