orludodstat (BAY2402234) / Bayer - LARVOL DELTA

KDM6 enzymes are the mechanistic targets of mutant IDH that dictate replication stress sensitivity (EANO 2026) - "However, the underlying molecular mechanisms of mutant IDH-driven hypersensitivity to replication stress are unclear.Material and We performed forward genetic screens targeting all 2-oxoglutarate-dependent enzymes using two drugs (the Ataxia-telangiectasia and Rad3-related [ATR] inhibitor ceralasertib, and the dihydroorotate dehydrogenase [DHODH] inhibitor BAY 2402234) that induce replication stress through independent, non-overlapping mechanisms. Our work reveals KDM6 enzymes as the mechanistic targets of R2HG that link IDH oncogenes with replication stress hypersensitivity. Moreover, our studies reveal KDM6 demethylase activity as a fundamental and pan-cancer determinant of replication stress. Lastly, we introduce a novel DHODH inhibitor, GLIO-1, that is well-positioned for clinical translation in IDH-mutant gliomas and other brain tumors that are vulnerable to replication stress."

Bladder Cancer • Brain Cancer • Genito-urinary Cancer • Glioma • Oncology • Solid Tumor • Urothelial Cancer • KDM6A

Harnessing programmed cell death and metabolic vulnerabilities to enhance therapy in medulloblastoma (ISPNO 2026) - "In a panel of five MB cell lines, the BCL-XL inhibitor A1331852 or the MCL-1 inhibitor S63845 significantly enhanced tumour cell death when combined with cyclophosphamide or BAY-2402234. A CRISPR-Cas12 knockout screen in D425 MB cells identified potential resistance and sensitizer genes contributing to BAY-2402234 induced killing independent of BAK/BAX. Together, these findings support a novel combination treatment paradigm integrating BH3-mimetics with chemotherapy or metabolic inhibition, and highlight programmed cell death-based strategies as promising therapeutic avenues for medulloblastoma."

Brain Cancer • Medulloblastoma • Solid Tumor • BCL2 • BCL2L1 • CASP3

De novo pyrimidine synthesis is a druggable vulnerability for chemotherapy resistant nasopharyngeal carcinoma with wild type IDH1 (AACR 2024) - "DHODH inhibitor, BAY2402234 significantly sensitized NPC cells to gemcitabine plus cisplatin chemotherapy. Collectively, these results reveal that wtIDH1-induced increase in de novo pyrimidine nucleotide represents a metabolic vulnerability that can be exploited pharmacologically, highlighting BAY2402234 as a promising strategy to enhance the efficacy of chemotherapy against NPC."

Nasopharyngeal Carcinoma • Oncology • Solid Tumor • ALKBH5 • IDH1

Inhibition of pyrimidine synthesis and the cell cycle in mesothelioma (AACR 2025) - "BAY2402234 is an extremely potent inhibitor of cell growth in multiple mesothelioma cell lines and 59-1,881 times more potent than brequinar; 2) BAY2402234 and dinaciclib act synergistically, suggesting an interaction between pyrimidine biosynthesis and one or more of the following CDKs: CDK1, CDK2, CDK5, and/or CDK9; and 3) BAY2402234 results in increased PD-L1 expression and increased cytokine pathway mRNA expression, suggesting the potential for enhancement of immune checkpoint blockade."

IO biomarker • Mesothelioma • Oncology • Solid Tumor • CCNA1 • CCND1 • CDK1 • CDK2 • CDK9 • CDKN1A • PD-L1

Structure-function mapping of DHODH shows deviations in protein structure (AACR 2024) - "We performed saturating mutagenesis screens to identify mutations in DHODH that confer resistance to brequinar and BAY2402234, two highly potent DHODH inhibitors. We found that the structure of DCU-bound DHODH differs from previously published DHODH structures in two important ways: (1) there appears to be a second point of ingress into the active site of DHODH next to the CoQ tunnel that may be able to accommodate a highly non-polar molecule such as CoQ/DCU and (2) the 'flap' covering the DHO/orotate ingress/egress region of DHODH, which is 'closed' in inhibitor-bound DHODH, is 'open' in DCU-bound DHODH. We are currently working to solve the crystal structure of DHODH A58T bound to inhibitor and DCU to ask if DCU can access the active site of DHODH through an alternative hydrophobic tunnel and if DHODH A58T remains in the 'open' configuration when bound to drug."

Oncology

Mechanistic deconvolution reveals DHODH as the key target of the KDM4 inhibitor QC6352 (LCC 2026) - "We discovered that Zavondemstat, the clinical derivative of QC6352, antiproliferative efficacy is likely due to DHODH inhibition, and has even greater potency than other extensively studied DHODH inhibitors including brequinar and BAY2402234. Thus, this discovery has profound implications on future clinical trials using Zavondemstat"

Brain Cancer • Glioblastoma • Solid Tumor

DHODH as a Targetable Metabolic Achilles' Heel for chemo-resistant B-ALL. (PubMed, Blood) - "BAY-2402234, a DHODH inhibitor, effectively kills pS6+ cells in vitro, with IC50 values correlating with pS6 signaling strength across 14 B-ALL patient-derived xenografts (PDX). In vivo, DHODH inhibition prolongs survival and reduces leukemia burden in pS6+ B-ALL models. These findings link active signaling to pyrimidine dependency and relapse risk, highlighting DHODH inhibition as a promising therapeutic strategy for chemo-resistant B-ALL."

Journal • Acute Lymphocytic Leukemia • B Acute Lymphoblastic Leukemia • Hematological Malignancies • Leukemia • Oncology • DHODH

IDH1 Reprograms Nucleotide Metabolism by Inducing Chromatin Remodeling and DHODH Transcription to Drive Chemoresistance in Nasopharyngeal Carcinoma. (PubMed, Cancer Res) - "Using proteomics and transcriptomic profiles, we identified wild-type IDH1 as a crucial metabolic enzyme upregulated in gemcitabine plus cisplatin chemotherapy (GP)-resistant NPC...The DHODH inhibitor BAY2402234 markedly sensitized NPC cells to chemotherapy. Clinically, a prognostic model based on DDR and ferroptosis signatures effectively predicted disease relapse risk post-chemotherapy in NPC. This study links DDR to ferroptosis defense via the IDH1/α-KG/ALKBH5/DHODH axis, suggesting DHODH inhibition as a promising therapeutic strategy to overcome chemoresistance in tumors harboring wild-type IDH1."

Journal • Nasopharyngeal Carcinoma • Oncology • Solid Tumor • ALKBH5 • HNRNPC • IDH1

Targeting DHODH Reveals a Metabolic Vulnerability in AR-positive and AR-negative Prostate Cancer Cells via Pyrimidine Synthesis and Metabolic Crosstalk with the TCA and Urea Cycles. (PubMed, Mol Metab) - "Consequently, combination therapies targeting DHODH and glutamine metabolism were synergistic in impairing PCa cell proliferation. Altogether, these results highlight DHODH as a metabolic vulnerability of AR-positive and AR-negative PCa cells by regulating central carbon and nitrogen metabolism."

Journal • Castration-Resistant Prostate Cancer • Genito-urinary Cancer • Oncology • Prostate Cancer • Solid Tumor • AR

Developing Topics. (PubMed, Alzheimers Dement) - "Overall, our study demonstrated that the restoration of mitochondrial dynamics by inhibition of mitochondrial fragmentation can protect against neurodegeneration in 5xFAD mouse model and mitochondrial dynamic could be a promising therapeutic target for AD."

Journal • Alzheimer's Disease • CNS Disorders • Cognitive Disorders • Inflammation • Metabolic Disorders • MFN2 • NLRP3

Recurrent Breast Cancer Cells Depend on De novo Pyrimidine Biosynthesis to Suppress Ferroptosis. (PubMed, bioRxiv) - "Pharmacologic inhibition of the rate-limiting enzyme DHODH with BAY-2402234 selectively impaired the growth of recurrent tumor cells, while primary tumor cells were relatively resistant...Stable isotope tracing and nutrient depletion experiments showed that primary cells can compensate for DHODH inhibition through nucleotide salvage, whereas recurrent cells exhibit impaired salvage capacity, likely due to reduced expression of Slc28 / Slc29 nucleoside transporters. Together, these findings reveal that breast cancer recurrence is associated with increased dependence on de novo pyrimidine synthesis to suppress ferroptosis, highlighting a therapeutically actionable metabolic vulnerability in recurrent disease."

Journal • Breast Cancer • HER2 Breast Cancer • HER2 Positive Breast Cancer • Oncology • Solid Tumor • HER-2

TP53-dependent antitumor effects of DHODH Inhibition in nasopharyngeal carcinoma. (PubMed, Discov Oncol) - "Importantly, the low mutation rate of TP53 in NPC suggests that BAY2402234 may be particularly effective in this cancer type. These findings provide the first comprehensive evidence that nucleic acid metabolism plays a crucial role in NPC progression and that the targeting of DHODH represents a promising therapeutic strategy, particularly via TP53-dependent mechanisms."

Journal • Nasopharyngeal Carcinoma • Oncology • Solid Tumor • TP53

Uridine Synthesis Is the Metabolic Vulnerability in Relapse-Associated B-ALL Cells with Active Pre-BCR Signaling (ASH 2023) - "To target this dependency, we treated the cells with the dihydroorotate dehydrogenase (DHODH) inhibitor (BAY-2402234), which disrupts a crucial step in uridine synthesis...Together, we found that preBCRhigh B-ALL cells are associated with relapse and are highly energetic, relying uniquely on glucose for survival to fuel the PPP and uridine synthesis. Inhibition of uridine synthesis is a novel strategy to target these treatment resistant and relapse-associated cells."

Acute Lymphocytic Leukemia • Hematological Malignancies • Leukemia • Metabolic Disorders • Oncology • ENO1 • LDHA • PFKFB4

TP53 Aberrant B-Cell Precursor Acute Lymphoblastic Leukemia (BCP-ALL) Are Uniquely Sensitive to a Combination of Pyrimidine De Novo Synthesis Blockade and Replication Checkpoint Inhibition (ASH 2023) - "Preliminary results from in vivo experiments using p53 deficient patient derived xenografts indicate that the combination of Orludodstat and Berzosertib is well tolerated, while significantly delaying leukemic growth (Figure 1 B). ConclusionTogether, our findings suggest that the combined targeting of de novo pyrimidine synthesis and ATR signaling may present a specific and non-genotoxic vulnerability for TP53 aberrant ALL."

Checkpoint inhibition • Acute Lymphocytic Leukemia • Hematological Malignancies • Leukemia • Oncology • Solid Tumor • T Acute Lymphoblastic Leukemia • CHEK1 • TP53

Akt mitigates ER stress-instigated cardiac dysfunction via regulation of ferroptosis and mitochondrial integrity in a DHODH-dependent manner. (PubMed, Life Sci) - "ER stress-induced myocardial anomalies were reversed by the newly identified PI3K activator triptolide, DHODH activator menaquinone-4 and pyrimidine booster coenzyme Q. In vitro experiment revealed that Akt activation- or triptolide-evoked beneficial responses against tunicamycin-induced cardiomyocyte anomalies were cancelled off by DHODH inhibitor BAY2402234 or ferroptosis inducer erastin. These findings support that chronic Akt activation rescues ER stress-evoked myocardial derangements through DHODH-dependent control of ferroptosis and mitochondrial homeostasis."

Journal • Fibrosis • Immunology • DDIT3 • GPX4 • HSPA5 • SLC7A11

Metabolic profiling of patient-derived organoids reveals nucleotide synthesis as a metabolic vulnerability in malignant rhabdoid tumors. (PubMed, Cell Rep Med) - "Treatment of MRT tumoroids with de novo nucleotide synthesis inhibitors methotrexate (MTX) and BAY-2402234 lowers nucleotide levels in MRT tumoroids and induces apoptosis. Lastly, we demonstrate in vivo efficacy of MTX in MRT patient-derived xenograft (PDX) mouse models. Our study reveals nucleotide biosynthesis as an MRT-specific metabolic vulnerability, which can ultimately lead to better treatment options for children suffering from this lethal pediatric malignancy."

Journal • Genito-urinary Cancer • Kidney Cancer • Oncology • Pediatrics • Renal Cell Carcinoma • Rhabdoid Tumor • Sarcoma • Solid Tumor

Metabolic Plasticity of Glioblastoma Cells in Response to DHODH Inhibitor BAY2402234 Treatment. (PubMed, Metabolites) - "Furthermore, BAY2402234 reduced the abundance of signaling lipid species in EGFRWT glioblastoma. This study elucidates genetic mutation-specific metabolic plasticity and efficacy in glioblastoma cells in response to drug treatment, offering insights into therapeutic avenues for precision medicine approaches."

Journal • Brain Cancer • CNS Tumor • Glioblastoma • Metabolic Disorders • Oncology • Solid Tumor

Discovery and development of HOSU-53 as a potential best-in-class DHODH inhibitor for treating cancer (ACS-Fall 2024) - "Initial hits were generated by undergraduate students at Hendrix College using the brequinar scaffold (h-DHODH IC50 = 1.8 nM; AML MOLM-13 cellular avg...Head-to-head comparison using an AML MOLM-13 in vivo model validated that HOSU-53 (median survival of 63 days vs. 17 days for vehicle control) provided superior survival benefit over the lead clinical comparator BAY2402234 (median survival of 51 days, h-DHDOH IC50 = 0.5 nM; AML MOLM-13 cellular IC50 = 1.5 nM)...A first-in-human, Phase I clinical trial in solid and hematological malignancies is expected to start in the second half of 2024. This collaboration to discover and develop HOSU-53 is a true “bench-to-bedside” story that is all too often elusive in academia."

Colorectal Cancer • Gastric Cancer • Gastrointestinal Cancer • Hematological Disorders • Hematological Malignancies • Lung Cancer • Lymphoma • Melanoma • Multiple Myeloma • Oncology • Small Cell Lung Cancer • Solid Tumor

Classical swine fever virus non-structural protein 4A recruits dihydroorotate dehydrogenase to facilitate viral replication. (PubMed, J Virol) - "In this study, three specific DHODH inhibitors, including DHODH-IN-16, BAY-2402234, and Brequinar were found to strongly suppress classical swine fever virus (CSFV) replication. Moreover, NS4A exhibited a strong interaction with DHODH, enhancing its activity to promote efficient CSFV replication. In conclusion, our findings enhance the understanding of the pyrimidine synthesis in CSFV infection and expand the novel functions of CSFV NS4A in viral replication, providing a reference for further exploration of antiviral targets against CSFV."

Journal • Infectious Disease • STAT1

Pivotal role of dihydroorotate dehydrogenase as a therapeutic target in adult T-cell leukemia. (PubMed, Eur J Haematol) - "These findings highlight DHODH as a potential therapeutic target for treating ATL."

Journal • Adult T-Cell Leukemia-Lymphoma • Hematological Malignancies • Infectious Disease • Leukemia • Oncology • CCNA2 • CDK2 • DHODH • MYC • NFKBIA • PTEN

DHODH inhibition represents a therapeutic strategy and improves abiraterone treatment in castration-resistant prostate cancer. (PubMed, Oncogene) - "However, the combination treatment with BAY2402234 and abiraterone decreased intratumoral testosterone levels and induced apoptosis, which inhibited the growth of CWR22Rv1 xenograft tumors and patient-derived xenograft organoids. Taken together, these results establish DHODH as a key player in CRPC and as a potential therapeutic target for advanced prostate cancer."

Journal • Castration-Resistant Prostate Cancer • Genito-urinary Cancer • Oncology • Prostate Cancer • Solid Tumor • DHODH

Cyclin D1 extensively reprograms metabolism to support biosynthetic pathways in hepatocytes. (PubMed, J Biol Chem) - "Pharmacologic inhibition of Cdk4 along with the downstream pyrimidine synthesis enzyme dihydroorotate dehydrogenase synergistically inhibits proliferation and survival of hepatocellular carcinoma cells. These studies demonstrate that cyclin D1 promotes a broad network of biosynthetic pathways in hepatocytes, and this model may provide insights into potential metabolic vulnerabilities in cancer cells."

Journal • Gastrointestinal Cancer • Hepatocellular Cancer • Oncology • Solid Tumor • CCND1 • CDK4 • GAPDH

A potential combinatorial treatment strategy to overcome olaparib resistance in high-grade ovarian cancer (AACR 2023) - "However, in our study, OSU-03012 did not similarly affect cell viability and phenotype on ovarian cancer cell lines as a DHODH inhibitor BAY2402234. Altogether, we identified a potential non-cancer drug for ovarian cancer treatment and to overcome Olaparib resistance. A multidisciplinary approach highlights the importance of drug target profiling and sensitivity signatures scoring to improve treatment stratification."

Oncology • Ovarian Cancer • Ovarian Serous Adenocarcinoma • Solid Tumor • BRCA • BRCA1 • BRCA2 • COL3A1 • PDPK1 • PTPRZ1 • TP53

[VIRTUAL] Activity of DHODH inhibitor BAY2402234 in subcutaneous and intracranial models of SCLC (AACR 2021) - P1 | "The results of this investigation confirm and extend previous preclinical results and indicate that BAY2402234 may represent a novel treatment for SCLC, including patients with brain metastases.RESTRICTED"

Acute Myelogenous Leukemia • Brain Cancer • Lung Cancer • Neuroendocrine Tumor • Oncology • Small Cell Lung Cancer • Solid Tumor • RB1

Discovery of BAY 2402234 by phenotypic screening: A human Dihydroorotate Dehydrogenase (DHODH) inhibitor in clinical trials for the treatment of myeloid malignancies (AACR 2019) - P1; "A clinical phase I study has been initiated in patients with myeloid malignancies. (NCT03404726)"

Clinical • Acute Myelogenous Leukemia • Hematological Malignancies • Leukemia • Lung Cancer • Oncology • Thoracic Cancer