top2 - targeting drugs ( e . g . doxorubicin , epirubicin , mitoxantrone and etoposide ) are the mainstay of chemotherapy . it is also known that there are two human top2 isozymes , top2α and top2β . however , it has been unclear with respect to whether these two isozymes play different roles in tumor cell killing and in the development of secondary malignancies during the course of top2 - based chemotherapy . applicants have performed various studies that establish that the top2α and top2β isozymes have different roles in the development of secondary malignancies and tumor cell killing . the results of applicants &# 39 ; studies suggest that the top2β isozyme is primarily responsible for vp - 16 - induced carcinogenesis and also vp - 16 - induced dna sequence rearrangements and double - strand breaks ( dsbs ). by contrast , applicants also noted that vp - 16 cytotoxicity in tumor cells appears to be primarily top2α - dependent . applicants also evaluated whether top2β - poisoning by current top2 anticancer drugs leads to tissue toxicities . applicants found that top2β - targeting by doxorubicin in cardiomyocytes is responsible for dna damage and cell death . based on these results , applicants discovered that top2β - poisoning leads to tissue toxicities ( e . g . cardiotoxicity ) and thus is undesirable for top2 anticancer drugs , and that it is highly desirable to develop top2α preferential poisons . thus , one aspect of applicants &# 39 ; invention provides a method for treating a patient with neoplasia comprising administering to the patient a therapeutically effective amount of a top2α preferential poison . for the purpose of this application , the term “ top2α preferential poison ” means a top2 poison that complexes the top2α isozyme at least 10 - fold as effectively as it complexes the top2β isozyme as measured by in vitro dna cleavage assay described in bodley et al . cancer res . 49 , 5969 - 5978 ( 1989 ). accordingly , the term “ top2α preferential poison ” also includes a top2α - specific poison that has very little effect in poisoning the top2β isozyme . the therapeutic methods of the present invention can be used to treat a wide variety types of human neoplasias . such neoplasias include but are not limited to leukemias , colorectal cancer , pancreatic cancer , lung cancer , prostate cancer , wilms &# 39 ; tumor , neuroblastoma , soft tissue sarcoma , bone sarcoma , lymphoma , bladder cancer , breast cancer , stomach cancer , lung cancer , ovarian cancer , thyroid cancer , gastric cancer , testicular cancer , glioblastoma multiforme , hodgkin &# 39 ; s disease , ewing &# 39 ; s sarcoma , bronchogenic carcinoma and multiple myeloma . applicants have identified top2α preferential poisons for use in connection with the present therapeutic methods . in certain embodiments , the top2α preferential poisons include anthracyclines , ellipticines , acridines , carbolines , protoberberines , epipodophyllotoxicins , actinomycins , and their chemical analogs ( i . e . their prodrugs , their metabolites , their protected derivates and their solvates ). in other preferred embodiments , the methods are practiced with top2α preferential poisons selected from compounds of formula ( i ): r 1 is h or — or 5 , wherein r 5 is ( c 1 - 6 ) alkyl optionally substituted from by 1 to 5 radicals independently selected from a group of halo and halo - substituted ( c 1 - 6 ) alkyl ; r 2 is h , — r 5 , or ( c 6 - 12 ) aryl ( c 0 - 6 ) alkyl , wherein r 5 or ( c 6 - 12 ) aryl ( c 0 - 6 ) alkyl is optionally substituted from by 1 to 5 radicals independently selected from a group of halo , ( c 1 - 6 ) alkyl , and halo - substituted ( c 1 - 6 ) alkyl ; r 3 is h , ( c 1 - 6 ) alkyl , or ( c 6 - 12 ) aryl ( c 0 - 6 ) alkyl , wherein ( c 1 - 6 ) allyl or ( c 6 - 12 ) aryl ( c 0 - 6 ) alkyl is optionally substituted from by 1 to 5 radicals independently selected from a group of halo , ( c 1 - 6 ) allyl , and halo - substituted ( c 1 - 6 ) alkyl ; r 4 is h or ( c 6 - 12 ) aryl ( c 0 - 6 ) allyl optionally substituted from by 1 to 5 radicals independently selected from a group of halo , ( c 1 - 6 ) allyl , and halo - substituted ( c 1 - 6 ) alkyl . when we refer to “ c 0 ” ( e . g ., in “( c 6 - 12 ) aryl ( c 0 - 6 ) alkyl ”) we mean that the carbon or the alkyl group in the cited example does not exist . in more preferred embodiments , the top2α preferential poisons of formula ( i ), have r 1 , r 2 , r 3 and r 4 having definitions as follows : r 1 is h , c 4 h 9 o —, ( ch 3 ) 2 chch 2 o — or ( c 2 h 5 ) 2 cho —; r 2 is —( ch 2 ) 3 c 6 h 5 , c 2 h 5 —, — ch 2 ch ( ch 3 ) 2 , — ch 2 c 6 h 4 f , — ch 2 c 6 h 5 , or — c 4 h 9 ; r 3 is h , — ch 3 , — c 6 h 4 cl , or — ch 2 c 6 h 5 ; and r 4 is — ch 2 c 6 h 5 , — ch 2 c 6 h 4 cl , — ch 2 c 6 h 4 f , or —( ch 2 ) 3 c 6 h 5 . in certain preferred embodiments , the top2α preferential poison of the present method is selected from a group of 2 - benzyl - 7 - butoxy - 9 - isobutyl - 1 - methyl - 9h - pyrido [ 3 , 4 - b ] indol - 2 - ium , 2 - benzyl - 7 - isobutoxy - 9 - isobutyl - 1 - methyl - 9h - pyrido [ 3 , 4 - b ] indol - 2 - ium , 2 , 9 - dibenzyl - 1 - chlorophenyl - 9h - pyrido [ 3 , 4 - b ] indol - 2 - ium , 1 , 2 - dibenzyl - 9 - fluorobenzyl - 9h - pyrido [ 3 , 4 - b ] indol - 2 - ium , and 9 - butyl - 1 - chlorobenzyl - 2 -( 3 - phenylpropyl )- 9h - pyrido [ 3 , 4 - b ] indol - 2 - ium . various β - carboline derivatives of compounds of formula i above were evaluated for their antineoplastic activities and for their ability to preferentially poison top2 isozymes . these compounds ( i . e . those in table 1 below ) were also evaluated for top2 isozyme - specific poisoning using the in vitro dna cleavage assay described by bodley et al . in the studies , purified recombinant human top2 isozymes were used . the results of the evaluations are summarized in table 2 below . the above studies have shown that vp - 16 poisons top2α and top2β non - preferentially . in contrast , some of the cytotoxic β - carboline derivatives show preference for top2α poisoning compared to top2β poisoning . in particular , compound nos . 3 , 4 , 8 and 9 show roughly 20 - fold in their activities against top2α compared to their non - detectable activities against top2β . ( table 2 ) and each of them still retains anti - neoplastic activity ( table 1 ). and compound no . 10 roughly shows a 20 - fold in its activity against top2α compared to its 10 - fold activity against the top2β isozyme , and still possesses anti - neoplastic activity ( table 1 ). the top2 cleavage assay employed in the evaluation set forth in table 2 was performed as described in bodley et al . cancer res . 49 , 5969 - 5978 ( 1989 ). briefly , 32 p end - labeled linear dna was incubated ( at 37 ° c . for 30 min ) with the purified recombinant human top2α or top2β ( about 10 ng each ) in a reaction containing 40 mm tris , ph8 . 0 , 10 mm mgcl 2 , 1 mm atp , 100 mm kcl , 1 mm edta , 1 mm dtt , 30 μg / ml b sa and various concentrations of β - carbolines or vp - 16 . reactions were terminated with sds ( final 1 %) and digested with proteinase k ( 100 μg / ml at 50 ° c . for 1 hr ). after adding gel loading solution , the reaction mixtures were analyzed by agarose gel electrophoresis . gel was dried and exposed to x - ray films for visualization . in human therapy , a dose of approximately 10 - 200 mg / m2 would be recommended for such top2α preferential β - carboline poisons in another aspect , the present invention is a method for treating a patient with neoplasia through a combination of administering a therapeutically effective amount of a top2 inhibitor to the patient , followed by the administration of a therapeutically effective amount of a non - preferential top2 poison ( e . g ., etoposide , doxorubicin , epirubicin or mitoxantrone ), in which the non - preferential top2 poison is administered at least 2 hours after the administration of the top2 inhibitor . by “ inhibitor ,” we mean an agent that can stabilize the top2 enzyme in a conformation that leads to enzyme degradation by proteases . in certain embodiments , the therapeutic methods of the present invention are performed through : ( a ) administering to the patient a therapeutically effective amount of a top2 inhibitor that preferentially inhibits top2β isozyme over top2α isozyme ; ( b ) administrating a therapeutically effective amount of a non - preferential top2 anticancer drug (“ poison ”) to the patient ; wherein the top2 inhibitor is administrated at least 2 hours prior to the administration of the top2 poison . in general , the therapeutic methods of this invention reduce or eliminate top2β - damaging effects of non - preferential top2 poisons by using the top2 inhibitors , while preserving the efficacy of such poisons . it is contemplated that this pretreatment method can be practiced with existing non - preferential top2 poisons , which can be administered in recommended dosages described in the 2008 physician &# 39 ; s desk reference , 62 nd edition . in certain embodiments of this invention the top2 poisons used in the present methods include anthracyclines , ellipticines , acridines , carbolines , protoberberines , epipodophyllotoxicins , actinomycins , and their chemical analogs . in certain embodiments , the top2 inhibitors of the present methods are used to eliminate top2β isozyme in target tissues . it is contemplated that all compounds that can induce top2β degradation or elimination can be used in connection with the present methods . additionally , compounds with enhanced selectivity toward top2β ( i . e . no or minimal activity toward top2α ) are expected to be better top2 inhibitors that can be used to degrade top2β without an effect on top2α . in certain preferred embodiments , compounds used as the top2 inhibitors to induce top2β degradation include icrf - 193 , icrf - 187 ( a / k / a dexrazoxane or cardioxan ), icrf - 154 and icrf - 159 . these icrf compounds are bis ( 2 , 6 - dioxopiperazine ) derivatives . it is also contemplated that prodrugs and metabolites of icrf - 193 , icrf - 187 , icrf - 154 and icrf - 159 can be used as top2β inhibitors in this sense . such top2β inhibitors also include protected derivates and solvates of all these compounds . another aspect of this invention is a method for treating a patient with neoplasia comprising : co - administering a therapeutically effective amount of a top2 poison and a therapeutically effective amount of a proteasome inhibitor to said patient . proteasome inhibitors include mg132 ( i . e ., n -[( phenylmethoxy ) carbonyl ]- l - leucyl - n -[( 1s )- 1 - formyl - 3 - methylbutyl ]- l - leucinamide ), bortezomib ( velcade ), lactacystin , salinosporamide a , omuralide and npi - 0052 ( as described in cancer cell , volume 8 , issue 5 , pages 407 - 419 d . chauhan ). preferably , the proteasome inhibitor comprises bortezomib . in human therapy , a dose of approximately 0 . 5 - 20 mg / m 2 of mg132 or 0 . 1 to 5 . 0 mg / m 2 of bortezomib or 0 . 2 to 10 mg / m 2 of lactacystin would be recommended in this combination therapy method of this invention . a dose of approximately 0 . 1 to 10 mg / m 2 of the other proteasome inhibitors mentioned above would be recommended for such combination therapy . as to the co - administration embodiment , the top2 poison can be administered in recommended dosages described in the 2008 physician &# 39 ; s desk reference , 62 nd edition . proteasome inhibitors block transformation of top2β cleavage complexes into dna double - strand breaks ( dsbs ). our studies demonstrated that a proteasome pathway is involved in the transformation of top2β cleavage complexes ( induced by non - preferential top2 - targeting anticancer drugs ) into dna double - strand breaks . proteasome inhibitors can effectively block the formation of dsbs and thus prevent secondary malignancies and tissue toxicities associated with current top2 drug - based therapy . another aspect of the present invention provides methods of identifying anti - neoplastic compounds , which preferentially poison the top2α isozymes over the top2β isozymes . such methods can be practiced through screening of known top2 poisons , their chemical analogs and also chemical libraries of compounds of other types . in certain embodiments , the methods of identifying top2α preferential poisons can be performed by : ( a ) evaluating the compound for its ability to poison top2α isozyme ; ( b ) evaluating the compound for its ability to poison top2β isozyme ; and ( c ) selecting a compound that preferentially poisons the top2α isozyme over the top2β isozyme . further , methods can also be performed by evaluating a compound &# 39 ; s ability to poison top2β isozyme prior to the evaluation against the top2α isozyme , which may eliminate the need to perform the latter evaluation if the former evaluation establishes that the compound has significant ability to poison top2β isozyme . in certain embodiments , the methods of identifying top2α preferential poisons are practiced through high - throughput screening . in other certain embodiments , the methods of identifying top2α preferential poisons include computer modeling and the use of structural activity relationship studies , either to be used alone , or in combination . yet in certain embodiments , the methods for identifying top2α preferential poisons include using in vitro and / or in vivo top2 isozyme - specific assays . in some preferred embodiments , the methods are performed by using multiple in vitro and in vivo top2 isozyme - specific assays . in certain preferred embodiments , the methods for identifying top2α preferential poisons include using in vitro dna cleavage assays . in the in vitro dna cleavage assay , compounds as potential top2 poisons are tested for their isozyme specificities through this assay using purified recombinant human top2α (“ htop2α ”) and human top2β (“ h top2β ”) isozymes . in this assay , the ability of various top2 poisons to induce top2 isozyme - mediated dna cleavage of 32 p end - labeled linearized plasmid dna was assessed . thus , the relative specificity of various top2 poisons against top2 isozymes can be qualitatively determined based on the depletion of band intensities and / or the intensities of bands representing the cleavage products . in some preferred embodiments , the methods for identifying top2α preferential poisons also include using band depletion assays using tumor cells . this assay is used for further testing on top2 isozyme - specific poisons identified by in vitro dna cleavage assay by using breast cancer zr - 75 - 1 cells . in the assay , cells are treated with the test compound for a short time ( e . g . typically 15 - 30 min ) and then lysed with 1 % sds . cell lysates will then be analyzed by immunoblotting using htop2 isozyme - specific antibodies . top2 isozyme - specific targeting is revealed by specific depletion of the immunoreactive bands corresponding to the two top2 isozymes . for example , top2α isozyme - specific compound is expected to specifically deplete the top2α immunoband but not top2β immunoband . in certain preferred embodiments , the methods for identifying top2α preferential poisons also include using in vivo complex of enzyme ( ice ) assay . the ice assay is quite sensitive to signals , since the assay is based on the increase of a signal from a low background . yet in another aspect , this invention also provides methods for identifying a top2 inhibitor which preferentially inhibits the top2β isozyme over the top2α isozyme . in certain embodiments , the methods include high - throughput screening and specific inhibitor design . in certain preferred embodiments , the methods are practiced by using computer modeling and / or structural activity relationship studies . in certain embodiments , the methods are used to identify prodrugs and metabolites of the inhibitors . the studies that form the foundation for this invention are summarized below and in the accompanying figures and examples described below . mouse strains . skin - specific top2β knockout mice and their top2β + controls were derived from the top2β +/ flox2 and top2β flox2 / flox2 lines previously reported . the top2β flox2 allele contains two loxp sites flanking three top2β exons that encode a region of topiiβ containing the active - site tyrosyl residue ; this allele expresses wild - type topiiβ , but is converted to a null allele top2β δ2 upon exposure to cre recombinase . skin - specific deletion within the floxed top2β allele is achieved by crossing the top2β flox2 lines with mice expressing cre recombinase from the keratin 14 promoter ( kindly provided by andrew p . mcmahon , harvard university ). the k14 - cre transgenic mouse line expresses cre in the keratinocytes of the epidermis and the hair follicles during prenatal and postnatal development . mice with the genotype k14 - cre top2β flox2 / flox2 , k14 - cre top2β +/ flox2 , top2β flox2 / flox2 and top2β +/ flox2 were generated and used in this study ; with the exception of k14 - cre top2β flox2 / flox2 mice , which lack topiiβ in skin cells , all the others are phenotypically top2β + in all tissues . the k14 - cre top2β flox2 / flox2 skin - specific top2β knockout mice exhibit a normal lifespan and show no skin abnormality other than cyclic alopecia ; detailed description of these mice will be reported elsewhere . genotyping . mouse genomic dna samples were isolated from mouse tails using the dneasy blood & amp ; tissue kit ( qiagen ). the appearance of the top2β flox2 and top2β δ2 alleles was confirmed by pcr analysis of the samples using respectively primer pairs pr2 ( 5 ′- tcattgggaggccagagcatc - 3 ′) and pr3 ( 5 ′- atatggtacagcaacaaagcatttgacata - 3 ′), and pr3 and pr7 ( 5 ′- gaattgtttgctgtggatgcatgta - 3 ′). pcr reactions using primers pr2 and pr3 were also used to generate a unique fragment from the wild - type top2β + allele . the presence of the k14 - cre allele was confirmed by pcr analysis using primers k14crer ( 5 ′- ttcctcaggagtgtcttcgc - 3 ′) and k14cref ( 5 ′- gtccatgtccttcctgaagc - 3 ′). carcinogenesis assay using a mouse skin model . seven - week old skin - specific top2β knockout mice and their top2β + controls were used in the study . the back of each mouse was shaved two days prior to treatment . the tumor initiator dmba ( 1 μmol in 100 μl of dmso ) was applied once in the first week , followed by various treatments ( two applications per week ) for six groups of animals : group 1 , dmso ( 100 μl ), 5 applications ; group 2 , vp - 16 ( 10 μmol in 100 μl dmso ), 5 applications ; group 3 , vp - 16 ( 20 μmol in 200 μl of dmso ), 3 applications ; group 4 , the tumor promoter tpa ( phorbol 12 - tetradecanoate 13 - acetate , 17 nmol in 100 μl dmso ), 8 applications ; group 5 , vp - 16 ( 5 mmol in 100 μl dmso ), 5 application ; group 6 , vp - 16 ( 5 μmol in 100 μl dmso ), 10 applications . mice were examined every week for appearance of melanomas on their skins . the number of melanomas visibly notable was scored at the end of the 16 th week . the average numbers of tumors induced in different treatment groups were compared using student &# 39 ; s t - test . histochemical and immunohistochemical analyses . skin samples were dissected from euthanized mice and processed for embedding in the oct compound ( tissue tek ). for cryopreservation , samples were fixed in 4 % paraformaldehyde in 1 × pbs for 3 hr at 4 ° c . after washing with ice - cold pbs for 30 min , samples were immersed overnight in 30 % sucrose solution in pbs at 4 ° c ., followed by embedding in oct . for immunohistochemical analysis , cryosections ( 8 - 10 μm thick ) were fixed in 4 % paraformaldehyde for 10 min at room temperature , and washed four times in pbs ( 2 min each ). antigen retrieval was performed by incubation in 1 % sds at room temperature for 5 min , followed by washing four times in pbs ( 2 min each ). for melanin bleaching , tissue sections were exposed to potassium permanganate ( 2 . 5 g / l ) for 10 min and then oxalic acid ( 5 g / l ) for 3 min at room temperature . after washing in pbs , sections were incubated in adb solution ( 0 . 05 % triton x - 100 , 10 % goat serum and 3 % bsa in pbs ) for 30 min . mouse melanoma cocktail antibody ( 1 : 100 dilution , abcam ) or rabbit anti - topiiiβ antibody ( 1 : 100 dilution , santa cruz ) was applied to skin sections and incubated overnight in a humidified chamber at 4 ° c . after four washes ( 5 min each ) in tbst ( tris - buffered saline , 0 . 1 % tween 20 ), skin sections were incubated with cy3 - or cy2 - conjugated secondary antibodies ( jackson immunoresearch ) for 30 min at 37 ° c . after washing in tbst ( four times , 5 min each ), slides were mounted with gel / mount ( biomeda corp .). images were visualized under a fluorescence microscope and photographed with a charge - coupled - device ( ccd ) camera . cells . primary mefs were isolated from e13 . 5 top2β +/+ , top2β +/ δ2 and top2β δ2 / δ2 mouse embryos , as described ( the top2β δ2 allele contains a deletion in the coding region of the active - site tyrosyl residue ). sv40 - transformed mefs were obtained by transformation with pan2 dna as described . cells were maintained in dmem supplemented with 10 % fetalplex animal serum complex ( gemini bio - products ), l - glutamine ( 2 mm ), penicillin ( 100 units / ml ), and streptomycin ( 100 μg / ml ) in a 37 ° c . incubator with 5 % co 2 . pc12 cells were first clonally selected and then used to generate top2β - shrna and control - shrna knockdown cells . a rat top2β - shrna sequence ( 5 ′- gcccccgttatatcttcac - 3 ′) was generated based on the 643 - bp partial rat topiiβ cdna sequence ( genbank ™ accession number d14046 ). duplex ( 5 ′- tgcccccgttatatcttcacttcaagagagtgaagatataacgggggctttttc - 3 ′) dna was made and cloned into the lentilox 3 . 7 vector ( obtained from dr . van parijs , mit ). the control - shrna sequence ( 5 ′- gc g c g cgtta a atcttcac - 3 ′) was created by altering three nucleotides in the rat top2β - shrna sequence ( underlined ). the duplex ( 5 ′- tgcgcgcgttaaatcttcacttcaagagagtgaagatttaacgcgcgctttitc - 3 ′) dna was cloned into the lentilox 3 . 7 vector . the shrna expressing lentilox 3 . 7 vectors were then inserted with the pgk - driven ned gene . lentiviral stock was prepared and virus - infected pc12 cells were selected from a two week culture in the presence of 700 μg / ml g418 . single colonies were isolated and characterized , and cultured in a 37 ° c . incubator with 5 % co 2 , in rpmi 1640 medium supplemented with 10 % horse serum , 5 % fetalplex animal serum complex , l - glutamine ( 2 mm ), penicillin ( 100 units / ml ), and streptomycin ( 100 μg / ml ), in flasks coated with collagen type i ( bd biosciences , bedford , mass .). plasmid integration assay . transformed top2β +/ δ2 and top2β δ2 / δ2 mefs were plated in six - well plates ( 4 × 10 5 cells per well ) one day prior to transfection . transfection was performed with ecori - linearized pucsv - bsd plasmid ( containing the blasticidin resistance gene ) using the cellfectin ( invitrogen ) transfection reagent ( 0 . 1 μg dna + 2 μl cellfectin ). vp - 16 was added at the time of transfection . after 6 hr , cells were washed and trypsinized . a small aliquot was removed , reseeded into fresh medium and grown without the selection agent for survival determination . the rest of the cells were reseeded into fresh medium in a 10 cm plate . after 24 hr , the selection agent blasticidin ( 3 μg / ml ) was added . colonies were stained with methylene blue and counted after 10 days . where indicated , the proteasome inhibitor mg132 ( 2 μm ) was added 30 min prior to and during transfection . integration frequency was determined as the ratio of the number of blasticidin - resistant colonies and the number of surviving cells . fig1 . the top2 cleavage complex and the catalytic cycle . a . stabilization of top2 cleavage complexes by various agents and stress conditions . b . catalytic reaction of top2 . dna g - segment and t - segment are represented by two rods . the n - terminal atpase domains of the top2 homodimer are drawn as a pair of jaws with atp binding sites marked by *. there are two classes of top2 inhibitors , those which trap top2 covalent reaction intermediate ( e . g . non - preferential top2poisons such as etoposide and doxorubicin ) and those which inhibit the atpase activity ( e . g . bisdioxopiperazines such as icrf - 193 and icrf - 187 ). the icrf - 187 ( dexrazoxane ) binding site is also in the atpase domain near the atp binding site . fig2 top2β is responsible for etoposide ( vp - 16 )- induced dna double - strand breaks . both wild type and top2β knockout mouse embryonic fibroblasts ( mefs ) were treated with either dmso ( solvent control ) or vp - 16 ( 250 μm ) for 90 min , followed by incubated in drug - free media for 30 min . neutral comet assay was then performed . tail moment ( average from 100 cells ) was determined for each treatment . fig3 vp - 16 induces melanomas in the skin of dmba - initiated mice . ( a ) absence of top2β in the epidermis and hair follicles of skin - specific top2β knockout mice ( top2β − ). 8 - 10 μm thick cryosections of the skin of top2β + and top2β − mice ( epidermis , upper panel ; hair follicle , lower panel ) were stained with hematoxylin and eosin ( labeled he , first column ) or anti - top2β antibody ( labeled 2β , second column )/ dapi ( third column ). the merged images of 2β - and dapi - stained sections are shown in the fourth column ( labeled iiβ / dapi ). ( b ) pcr - based genotyping of top2β + and top2β − mice . genomic dna samples from mouse tails were genotyped by pcr , using respective primer sets specific to the top2β + , top2β flox2 , top2β − or k14 - cre alleles as described in materials and methods . examples of genotyping results are shown here ; top2β +/ flox2 ( lane 1 ), k14 - cre top2β +/ flox2 ( lane 2 ), and k14 - cre top2β flox2 / flox2 ( lane 3 ). skin cells of k14 - cre top2β flox2 / flox2 are phenotypically top2β − , and cells from top2β +/ flox2 and k14 - cre top2β +/ flox2 mice are top2β + . ( c ) vp - 16 - induced melanomas in the skin of top2β + and skin - specific top2β knockout mice ( top2β − ). representative pictures of dmba - initiated mice treated with dmso ( vehicle control ), vp - 16 or tpa are shown . the blue arrow points to a melanoma . ( d ) histological and immunohistochemical analyses of melanomas in the mouse skin . consecutive sections of skin melanomas were stained with either he or melanoma - specific antibodies . representative pictures of he staining ( upper panel ) and melanoma antibody staining ( lower panel ) are shown . the arrow points to the melanoma mass , the blue arrow the epidermis , and the green arrow a hair follicle . scale bars : 10 μm in ( a ) and 100 μm in ( d ). fig4 vp - 16 induces fewer melanomas in the skin of skin - specific top2β knockout mice . ( a ) the number of melanomas in the skin of each mouse of a specific treatment group is plotted . the symbol “ 2β + ” denotes top2β + mice , and “ 2β − ” denotes skin - specific top2β knockout ( top2β − ) mice . the six treatment groups ( see the numbers in parenthesis ) are shown at the bottom of the graph , together with their treatment descriptions . ( b ) the average number of melanomas per mouse for each treatment group is plotted . the treatment groups are labeled group 1 , group 2 , group 3 and group 4 . ( c ) the same as in b except that results from the treatment groups 1 , 5 and 6 are plotted . the difference in the average number of melanomas per mouse between top2β + and top2β − mice is statistically significant ( p & lt ; 0 . 05 ) for groups 2 , 3 , 5 and 6 ( marked with *). the results shown by fig3 and 4 : the studies show that vp - 16 - induced melanomas in the skin of dmba - initiated mice are top2β - dependent . in order to evaluate the role of top2β in vp - 16 - induced carcinogenesis , skin - specific top2β knockout mice ( k14 - cre top2β flox2 / flox2 ) and top2β + controls ( top2β flox2 / flox2 , top2β +/ flox2 , and k14 - cre top2β +/ flox2 ) were generated ( see fig3 b for genotyping examples ). as shown in fig3 a , top2β is absent in both the epidermis ( upper panel ) and hair follicles ( lower panel ) of k14 - cre top2β flox2 / flox2 mice , to be referred to hereafter as the top2β − mice , as evidenced by the absence of top2β immunostaining in dapi - positive nuclei . in addition , cre - mediated deletion of the foxed top2β locus is evidenced by the appearance of the pcr product corresponding to the top2β δ2 allele , to be referred to hereafter as the top2β allele ( see lanes 2 and 3 in fig3 b ). age - matched 7 week - old mice were used for skin carcinogenesis studies . both top2β + and top2β − mice were initiated with a single application of dmba , followed by various treatments ( see the six treatment groups in materials and methods ). under the treatment conditions , these mice developed skin melanomas ( see representative pictures in fig3 c of mice with skin melanomas from different treatment groups ). histology of a typical melanoma in the mouse skin is shown in fig3 d ( upper panel ). the expansive dark brown area , showing aggregation of pigmented cells ( melanin expressing melanocytes ), is indicative of melanoma . immunohistochemical analysis of the tumor with mouse melanoma cocktail antibody also confirmed the presence of melanoma ( fig3 d , lower panel ). the number of melanomas in the skin of each mouse in various treatment groups was recorded and all data are summarized in fig4 a . the average number of melanomas per mouse in different treatment groups is also plotted for each treatment group ( fig4 b and 4c ). as shown in fig4 b ( unfilled bars ), vp - 16 treatment of dmba - initiated top2β + mice ( see groups 2 and 3 for 10 μmol × 5 applications and 20 μmol × 3 applications of vp - 16 , respectively ) show an increase in the average number of melanomas per mouse ( by about 10 % and 60 %, respectively ) when compared to treatment with dmso alone ( group 1 ). surprisingly , vp - 16 treatment of dmba - initiated top2β − mice decreases , rather than increases , the average number of melanomas per mouse , by ˜ 50 and 15 % respectively in groups 2 and 3 relative to the group 1 controls treated with dmso alone ( fig4 b , filled bars ). this decrease probably reflects a combination of two factors : the absence of vp - 16 - induced melanomas owing to the absence of top2β , and the antitumor activity of vp - 16 ( which is largely top2α - dependent , to be discussed later ). thus , increasing the number of vp - 16 applications would be expected to further reduce the number of melanomas in top2β − mice . indeed , as shown in fig4 c ( filled bars ), increasing the number of vp - 16 applications ( 5 mol / application ) from 5 ( group 5 ) to 10 ( group 6 ) significantly decreases the average number of melanomas in the skin of top2β − mice , by ˜ 30 % and 87 % respectively relative to dmso treatment alone ( group 1 ). as a positive control , dmba - initiated top2β + and top2β − mice were also treated with tpa ( see fig4 b , group 4 ). accordingly , tpa treatment of the top2β + mice greatly stimulated the average number of melanomas per mouse ( by 130 %) relative to dmso treatment ( fig4 b , unfilled bars ). however , in contrast to vp - 16 treatment , exposure to tpa causes a similar degree of increase ( 150 %) in skin melanoma in top2β − mice ( fig4 b , filled bars ). the effect of top2β on the number of vp - 16 - induced melanomas in mouse skin is more evident by examine the ratio of the average number of melanomas per mouse in top2β + versus that in top2β − mice . for the vp - 16 - treated groups , the ratios are 2 . 0 ( group 5 ), 2 . 8 ( group 3 ), 3 . 3 ( group 2 ) and 13 ( group 6 ). by contrast , the ratios are 1 . 5 and 1 . 3 , respectively , for groups 1 ( vehicle control ) and 4 ( tpa treatment ). the differences in the number of vp - 16 - induced melanomas in top2β + and top2β − mice are statistically significant ( p & lt ; 0 . 05 , see groups marked by * in fig4 b and 4c ). these results demonstrate that vp - 16 but not tpa - promoted melanomas in the mouse skin are primarily top2β - mediated . fig5 vp - 16 poisons both top2 isozymes equally but top2β in the trapped top2β complexes are preferential degraded to reveal the hidden dsbs . ( a ) vp - 16 poisons top2 isozymes equally in vitro . cleavage assays were performed . vp - 16 concentrations used were 2 . 0 , 20 and 200 μm . ( b ) vp - 16 effectively traps both top2α and top2β cleavage complexes in vivo . transformed top2β +/+ mefs were treated with vp - 16 ( 0 , 10 , 50 and 250 μm ) for 15 min and the amounts of top2 ( 2α and 2β ) cleavage complexes were measured by the band depletion assay . the results are quantified and the percent free top2 is plotted for each treatment ( lower panel ). vp - 16 - induced top2 cleavage complexes are also reversed by a further incubation in vp - 16 - free medium for 50 min ( last lane , labeled reversal + 250 μm vp - 16 ). ( c ) vp - 16 induces preferential down - regulation of top2β . transformed top2β +/+ mefs were treated with vp - 16 ( 50 μm , 2 hr ) in the presence or absence of the proteasome inhibitor , mg132 ( 2 μm ). the cleavage complexes in treated cells were reversed by an additional incubation at 37 ° c . for 30 min , following by alkaline lysis and s7 nuclease treatment . the amounts of top2 isozymes were measured by western blotting . studies have demonstrated that in vp - 16 - treated cells the trapped covalent complexes of the top2β isozyme are preferentially degraded over the top2α complexes through a proteasome - dependent pathway , and suggested that preferential proteasomal degradation of vp - 16 - induced top2β cleavage complexes leads to dsb formation . in support of this notion , co - treatment with mg132 is found to abolish vp - 16 - induced dsbs , as evidenced by neutral comet assays ( data not shown ). thus it appears likely that the preferential role of the top2β isozyme in vp - 16 - induced dsbs and dna sequence rearrangements is due to the greater sensitivity of top2β cleavage complexes to proteasome - mediated degradation . indeed , top2β is found to be preferentially degraded over top2α in sv40 - transformed top2α +/+ top2β +/+ mefs treated with vp - 16 ( fig5 c ). top2β contributes minimally to vp - 16 cytotoxicity in transformed cells . the above studies suggest that top2β is primarily responsible for vp - 16 - induced dsbs and dna sequence rearrangements . to test if top2β is also important for vp - 16 cytotoxicity , we determined the ic 50 of vp - 16 in two pairs of transformed top2β knockout / knockdown cells using 4 - day mtt assay ( in triplicates ). the ic 50 values of vp - 16 ( 0 . 038 ± 0 . 007 vs . 0 . 040 ± 0 . 006 μm ) are the same ( p = 0 . 43 , t - test ) for top2β +/− and top2β −/− mefs . the ic 50 values of vp - 16 ( 1 . 9 ± 0 . 1 vs . 1 . 6 ± 0 . 1 μm ) are also about the same ( p = 0 . 19 , t - test ) for control - shrna - pc12 and top2β - snrna - pc12 cells ( top2β protein is reduced about 90 % in top2β - shrna - pc12 cells ). these results suggest that in terms of vp - 16 cytotoxicity in transformed cells , it is top2α , and not top2β , that plays a major role . thus , the two top2 isozymes appear to play very different roles in vp - 16 - promoted carcinogenesis and tumor cell killing . previous studies have also demonstrated that vp - 16 induces papillomas on the skin of dmba - initiated mice in a classical two - stage carcinogenesis model ; furthermore , switching the order of vp - 16 and dmba applications has no effect on the incidence of papillomas , indicating that the drug behaves as a stage i ( convertogenic ) tumor promoter . the convertogenic activity of vp - 16 has been attributed to its induction of dna sequence rearrangements . in the present study , we have used skin - specific top2β knockout mice to evaluate the roles of the two isozymes of dna top2 , top2α and top2β in vp - 16 - induced carcinogenesis . melanomas rather than papillomas are the main tumor type detected in the mouse skin in our studies , plausibly due to genetic background differences of the mouse strains used in these studies : previous studies employed albino mouse strains that probably produce no visible melanoma because of a lack of melanin expression in the skin of these mice , while the mice used in the present studies have a mix genetic background including 129svev ( at least 75 %), various degrees of balb / c , and c57 / bl6 , and express melanin in their skin . vp - 16 is shown to induce 2 - to 13 - fold more melanomas , depending on the dose and schedule of vp - 16 treatment , in the skin of dmba - initiated top2β + mice than in the skin of similarly treated skin - specific top2β knockout mice . by contrast , the classical tumor promoter , tpa , induced about the same number of skin melanomas in dmba - initiated mice whether top2β is expressed in the skin or not . these results suggest that it is the top2β isozyme that plays a predominant role in vp - 16 - induced carcinogenesis . the above conclusion is further supported by studies in tissue culture models . using a plasmid integration assay to monitor dna sequence rearrangements , vp - 16 - stimulated plasmid integration is shown to be top2β - dependent : stimulation of integration frequency by vp - 16 is much more significant in sv40 - transformed mefs derived from top2β +/− mice , which express top2β , than sv40 - transformed mefs derived from top2β −/− mice , which do not . furthermore , the proteasome inhibitor mg132 blocks vp - 16 - stimulated plasmid integration , suggesting that vp - 16 - induced dna sequence rearrangements involve the proteasome pathway . this result is consistent with that of a recent study implicating the involvement of the proteasome pathway in processing vp - 16 - induced topiiβ - dna covalent complexes into dsbs . the predominant role of the top2β isozyme in mediating vp - 16 - induced carcinogenesis and dna sequence rearrangements can be attributed to the propensity of the top2β isozyme in dsb formation upon vp - 16 treatment . neutral comet assay indicates that vp - 16 - induced dsbs are top2β - dependent in both primary and sv40 - transformed mefs . furthermore , the predominant role of the top2β isozyme in vp - 16 mediated dsb formation is likely the result of a greater sensitivity of the dna cleavage complexes of top2β , relative to the dna cleavage complexes of top2α , in proteasome - mediated degradation . whereas the two isozymes exhibit comparable propensities in vp - 16 induced covalent complex formation , the top2β - concealed dna breaks in the covalent complexes appear to be more easily converted to dsbs by the proteasome degradation pathway . based on these and other results , a model for the role of top2β in vp - 16 - induced dsbs , dna sequence rearrangements and carcinogenesis is proposed . in this model , vp - 16 stabilizes reversible top2β cleavage complexes . these top2β cleavage complexes are converted into non - reversible top2β - dna covalent complexes in part through transcriptional collisions . top2β - dna covalent complexes then undergo proteasomal degradation , leading to the exposure of the hidden dsbs in them . subsequent processing of these dsbs through non - homologous end - joining ( nhej ) may lead to dna sequence rearrangements and carcinogenesis . it is unclear why the dna cleavage complexes of top2β are more sensitive to proteasome - mediated degradation than their top2α counterparts . because proteasomal degradation of top2 cleavage complexes is partially transcription - dependent , however , the preferential sensitivity of the top2β complexes to proteasomal degradation might be related to the preferential involvement of top2β in transcription . further studies are necessary to establish the molecular pathways in processing the top2 - dna covalent complexes . whereas top23 rather than top2α is shown to have a predominant role in vp - 16 - induced carcinogenesis , our studies of top2β knockout and knockdown cells suggest that the opposite is the case in vp - 16 cytotoxicity against transformed cells . the importance of top2α in vp - 16 cytotoxicity is consistent with results from the previous studies that the top2α gene is mutated in cell lines selected for lower levels of resistance to non - preferential top2 drugs , and the top2β gene is mutated only in top2α mutant cells selected for higher levels of resistance to top2 drugs . it has been suggested that the collision between the replication forks and top2 cleavage complexes plays a major role in vp - 16 cytotoxicity . consequently , the predominant role of top2α in dna replication may lead to more frequent collisions with the replication forks and thus cytotoxicity . fig6 dexrazoxane reduces doxorubicin - induced dna damage . a , 1 . 5 × 10 5 h9c2 cardiomyocytes were treated with 0 , 0 . 1 , 0 . 5 , 1 , 5 and 10 μm doxorubicin ( doxo ) in the absence ( labeled − dexrazoxane ) or presence of dexrazoxane ( 200 μm , labeled + dexrazoxane ) for 1 hr . cell lysates were analyzed by western blotting using anti - γ - h2ax or anti - α - tubulin antibody ( for assessing protein loading ). b , h9c2 cardiomyocytes were treated with 0 . 1 % dmso ( labeled c , for solvent control ), 0 . 1 or 1 μm doxorubicin ( doxo ), 5 μm vp - 16 ( vp ), 10 μm cpt or 100 μm h 2 o 2 , in the absence ( labeled − dexrazoxane ) or presence ( labeled + dexrazoxane ) of dexrazoxane ( 200 μm ) for 1 hr . cells were then lysed and analyzed by western blotting using anti - γ - h2ax or anti - α - tubulin antibody . c , h9c2 cardiomyocytes were treated with 0 . 1 % dmso ( labeled c , for solvent control ), 0 . 5 μm doxorubicin ( labeled doxo ) or 10 μm vp - 16 ( labeled vp ) in the absence ( labeled − icrf - 193 ) or presence ( labeled + icrf - 193 ) of icrf - 193 ( 50 μm ) for 1 hr . cells were then lysed and analyzed by western blotting using anti - γ - h2ax or anti - α - tubulin antibody . as shown in fig6 a , doxorubicin induced the dna damage signal , γ - h2ax ( ser - 139 - phosphorylated h2ax , a key dna damage signal induced by dna double - strand breaks ), in h9c2 cardiomyocytes . doxorubicin - induced γ - h2ax was concentration - dependent up to 1 μm . at higher concentrations of doxorubicin ( 5 and 10 μm ), the γ - h2ax signal was dramatically reduced . this pattern of concentration - dependent inhibition is reminiscent of dose - dependent inhibition of doxorubicin - induced top2 cleavable / cleavage complexes . in the presence of dexrazoxane ( 200 μm ), the doxorubicin - induced γ - h2ax signal was completely blocked . this blocking effect appears to be specific to top2 - directed drugs such as doxorubicin and vp - 16 ( fig6 b ). to test whether the blocking effect of dexrazoxane was due to inhibition of top2 , another well characterized top2 catalytic inhibitor , icrf - 193 , was also tested . as shown in fig5 c , both the doxorubicin ( 0 . 5 μm , labeled doxo )- and the vp - 16 ( 10 μm , labeled vp )- induced dna damage signal , γ - h2ax , was indeed abolished by co - treatment with icrf - 193 ( fig6 c ). fig7 doxorubicin - induced dna damage is proteasome - dependent . a , h9c2 cardiomyocytes were treated with 0 . 1 % dmso ( labeled c , for solvent control ), 0 . 5 μm doxorubicin ( labeled doxo ) or 10 μm vp - 16 ( labeled vp ) for 1 hr in the presence or absence of 100 μg / ml vitamin c ( upper panel ) or 100 μg / ml n - acetyl cysteine ( labeled nac ) ( lower panel ). vitamin c and nac were added 30 min prior to doxorubicin . cell lysates were then analyzed by western blotting using anti - γ - h2ax or anti - α - tubulin antibody . b , 1 . 5 × 10 5 h9c2 cardiomyocytes were treated with 0 . 1 % dmso ( labeled c , solvent control ), doxorubicin ( 0 . 5 μm , labeled doxo ) or vp - 16 ( 10 μm , labeled vp ) for 1 hr , in the absence or presence of either bortezomib ( 1 μm ) or mg132 ( 4 μm ). bortezomib and mg132 were added 30 min prior to doxorubicin or vp - 16 . cell lysates were then analyzed by western blotting ( upper panel ) using anti - γ - h2ax or anti - α - tubulin antibody . quantification of γ - h2ax signals is shown in the lower panel . c , h9c2 cells were treated with 0 . 1 % dmso ( labeled dmso ), bortezomib ( 1 μm ) or mg132 ( 4 μm ) for 30 min , followed by co - treatment with either 0 . 1 % dmso ( labeled control ) or 0 . 5 μm doxorubicin ( labeled doxo ) for 1 . 5 hrs . neutral comet assay was then performed as described in materials and methods . the average comet tail moments were plotted as histograms ( mean ± sem ). * p - value & lt ; 0 . 001 , t - test . doxorubicin - induced dna damage could be due to either top2 - dna covalent ( cleavable / cleavage ) complexes or ros . as shown in fig7 a , doxorubicin - induced γ - h2ax was unaffected by the known ros scavengers , vitamin c ( 100 μg / ml ) and n - acetyl cysteine ( nac ) ( 100 μg / ml ). by contrast , as shown in fig6 b , the proteasome inhibitors , bortezomib ( 1 μm ) and mg132 ( 4 μm ), significantly reduced ( more than 50 % reduction , see lower panel for quantification ) the γ - h2ax signal induced by doxorubicin and vp - 16 . recent studies have suggested that proteasomal processing of vp - 16 - induced top2 - dna covalent complexes results in the exposure of top2 - concealed dsbs . thus , the involvement of proteasome in doxorubicin - induced γ - h2ax could implicate the involvement of top2 in doxorubicin - induced dna damage . to test whether dsbs were indeed induced by doxorubicin and prevented by proteasome inhibitors , a neutral comet assay was performed . as shown in fig7 c , doxorubicin - induced comet tail moment , which reflects the amount of chromosomal dna dsbs , was significantly reduced by co - treatment with either bortezomib ( p - value & lt ; 0 . 001 , t - test ) or mg132 ( p - value & lt ; 0 . 001 , t - test ). these results suggest that , similar to vp - 16 - induced dsbs , doxorubicin - induced dsbs are also top2 - mediated and proteasome - dependent . fig8 dexrazoxane induces proteasomal degradation of top2β in h9c2 cardiomyocytes . a , dexrazoxane antagonizes the formation of top2α and top2β - dna covalent ( cleavage ) complexes . h9c2 cells were treated with vp - 16 in the presence or absence of dexrazoxane ( 150 μm ) for 15 min . the amount of top2 cleavage complexes was measured by a band depletion assay as described in materials and methods . cells were lysed either immediately or after reversal of the top2 cleavage complexes ( labeled r + 250 ). cell lysates were analyzed by western blotting using anti - top2α / top2β or anti - α - tubulin antibody . b , 1 . 2 × 10 5 h9c2 cells were treated with 100 μm dexrazoxane for indicated times ( 0 , 1 , 2 , 4 and 6 hrs ). cells were then lysed and protein levels of top2α , and top2β isozymes were determined by western blotting . c , h9c2 cells were treated with 0 . 1 % dmso ( labeled c , for solvent control ), dexrazoxane ( 100 μm ) or icrf - 193 ( 50 μm ) for 2 h or 4 h , in the presence or absence of the proteasome inhibitor , bortezomib ( 1 μm ). cell lysates were immunoblotted using anti - top2β antibody . d , h9c2 cells were treated with icrf187 ( 100 μm ) for 4 hrs , followed by treatment with doxorubicin ( doxo , 0 , 0 . 5 and 1 μm ) for 1 . 5 hrs . neutral comet assay was then performed as described in materials and methods . the average comet tail moments were plotted as histograms ( mean ± sem ). * p - value & lt ; 0 . 001 , t - test . recent studies have also shown that icrf - 193 , can efficiently induce proteasome - mediated degradation of top2β . degradation of top2β is also expected to reduce doxorubicin - induced dna damage and doxorubicin cytotoxicity in h9c2 cells . applicants tested the effect of dexrazoxane on the protein level of top2β in h9c2 cardiomyocytes . as demonstrated in fig8 b , treatment of h9c2 cells with 100 μm dexrazoxane induced a time - dependent disappearance of the top2β isozyme , while no significant effect on the level of the top2α isozyme was observed . similar to icrf - 193 - induced degradation of top2β , dexrazoxane - induced degradation of top2β is proteasome - mediated . as shown in fig8 c , co - treatment of h9c2 cardiomyocytes with the proteasome inhibitor , bortezomib , abolished dexrazoxane - induced degradation of top2β . these results suggest that dexrazoxane induces efficient proteasomal degradation of top2β in h9c2 cardiomyocytes . to test whether dexrazoxane - induced top2β degradation could contribute to the protective effect of dexrazoxane on doxorubicin - induced dna damage , h9c2 cardiomyocytes were pre - treated with dexrazoxane for 4 hrs to induce top2β degradation and doxorubicin - induced chromosomal dna dsbs were then measured by the neutral comet assay in the absence of dexrazoxane . as shown in fig8 d , dexrazoxane pre - treatment effectively reduced doxorubicin - induced comet tail moment ( p - values & lt ; 0 . 001 , t - test ). together , these results suggest that dexrazoxane could protect doxorubicin - induced dna damage at least in part through proteasomal degradation of top2β . fig9 homology modeling of the n - terminal atpase domain of human top2α and top2β in complex with dexrazoxane . homology modeled structures of the atpase domain of human top2β and top2α in complex with dexrazoxane are shown in the left and right panel , respectively . the top2 isozyme dimers are symmetric with the separate protein chains indicated in red and blue ( top panels ). adpnp ( in green ) and dexrazoxane ( in cpk coloring ) are shown using space - filling models . the dexrazoxane binding region ( boxed in both top panels ) is composed of residues from both chains at the dimer interface . the lower panels ( both side view and top view ) show the proximal residues in the dexrazoxane binding sites of human top2β ( left panels ) and top2α ( right panels ) in complex with dexrazoxane . dexrazoxane was shown to form a tight complex with the atpase domain of human top2β at the dimer interface . in addition , dexrazoxane forms various interactions with the same conserved amino acid side chains ( see amino acids at the binding sites in fig9 , middle panel ) at the binding site of human top2β atpase domain as those of the yeast top2 atpase domain . we have also performed homology modeling of the human top2α ( atpase domain )- dexrazoxane complex . the overall structure of the complex is very similar to that of the human top2β - dexrazoxane complex . most strikingly , the various interactions between dexrazoxane and the amino acid side chains at the binding sites of the two human isozymes are identical ( fig9 , middle and bottom panels ). these modeling studies suggest that dexrazoxane can form a tight complex with both human top2 isozymes . fig1 two proposed mechanisms for the antagonistic effect of dexrazoxane on doxorubicin - induced dna damage . in this model , only the role of the top2β isozyme is considered , which would mimic the situation in adult heart where top2β , but not top2α , is expressed . top2β is shown to exist in two states , free top2β ( mechanism i ) and dna bound top2β ( mechanism ii ), at equilibrium . dexrazoxane can bind to top2β in either state . for mechanism i , binding of dexrazoxane to free top2β stabilizes the closed - clamp conformation of atp - bound top2β and thus prevents binding of top2β ( closed - clamp ) to chromosomal dna . consequently , doxorubicin is unable to trap top2β into cleavage complexes . for mechanism ii , dexrazoxane binds to dna - bound top2β and stabilizes the closed - clamp conformation of atp - bound top2β , which triggers proteasomal degradation of top2β ( top2β down - regulation ). top2β down - regulation results in depletion of top2β and thus fewer doxorubicin - trapped top2β cleavage complexes . the formation of doxorubicin - trapped top2β cleavage complexes leads to dna double - strand breaks ( dsb ) through proteasome - mediated processing , which , if not repaired , could contribute to cell death and possible tissue toxicity ( e . g . cardiotoxicity ). the studies show that doxorubicin induces γ - h2ax , a key dna damage signal reflecting primarily dna dsbs , in h9c2 cardiomyocytes . using this system , applicants have demonstrated that the doxorubicin - induced dna damage signal is unlikely to be the result of ros - mediated dna damage since vitamin c and nac cannot attenuate this signal . instead , several pieces of evidence suggest that the doxorubicin - induced dna damage signal is primarily due to the formation of top2β - dna covalent complexes . first , doxorubicin - induced γ - h2ax was shown to be specifically abolished by proteasome inhibitors , mg132 and bortezomib . this result is suggestive of an involvement of top2 since top2 - dna covalent ( cleavage ) complexes , unlike other dna damages ( e . g . h 2 o 2 - mediated dna damage ), are known to require proteasome for their processing into dna damage ( dsbs ). indeed , doxorubicin is shown to induce chromosomal dna dsbs in a proteasome - dependent manner ( fig7 c and see the lower half of the diagram in fig1 for the model ). second , doxorubicin - induced γ - h2ax is much attenuated in top2β −/− mefs compared to that in top2β +/+ mefs , suggesting the involvement of top2β . together , these results suggest the involvement of both top2 - dna covalent complexes and proteasome in doxorubicin - induced dna damage , which is consistent with the model that proteasome - mediated degradation of top2 - dna covalent complexes exposes top2 - concealed dsbs . the studies also show that dexrazoxane specifically abolished doxorubicin - and vp - 16 - induced , but not cpt - and h 2 o 2 - induced , γ - h2ax in h9c2 cardiomyocytes . since both doxorubicin and vp - 16 , but not cpt and h 2 o 2 , are top2 poisons , this result supports the conclusion that dexrazoxane antagonizes doxorubicin - induced dna damage through its specific interference with top2 . additional support for this conclusion comes from the use of icrf - 193 ( structurally related to dexrazoxane , icrf - 187 ) which is a well characterized top2 catalytic activity inhibitor . icrf - 193 , which is known to be more potent than dexrazoxane in inhibiting top2 , is shown to be highly effective in antagonizing doxorubicin - induced γ - h2ax in h9c2 cardiomyocytes . the fact that both dexrazoxane and icrf - 193 antagonize the doxorubicin - induced dna damage signal suggests not only the involvement of top2 but a potential mechanism for their antagonism . bis ( 2 , 6 - dioxopiperazines ) such as icrf - 193 and icrf - 159 are known to stabilize the closed - clamp conformation of atp - bound top2 . it has been well documented that the closed - clamp conformation of top2 interferes with the formation of top2 cleavage complexes induced by top2 - directed drugs , possibly due to the inability of the closed - clamp form of top2 to access chromosomal dna . consequently , dexrazoxane may antagonize doxorubicin - induced dna damage through preventing the formation of top2 cleavage complexes on chromosomal dna ( due to dexrazoxane - stabilization of the closed - clamp conformation of top2 which is unable to access chromosomal dna ). the identification of top2β as the major target for doxorubicin - induced dna damage has suggested a possible new mechanism for the antagonistic effect of dexrazoxane on doxorubicin - induced dna damage . icrf - 193 is known to induce preferential degradation of the top2β isozyme through a proteasome pathway , referred to as top2β down - regulation . the reduced top2β level in icrf - 193 - treated cells is expected to decrease the amount of doxorubicin - induced top2β cleavage complexes and hence reduce dna damage . indeed , the studies show that dexrazoxane , like icrf - 193 , is highly effective in reducing the level of top2β ( but not top2α ) in h9c2 cardiomyocytes through the activation of a proteasome pathway ( fig8 ). consequently , dexrazoxane is likely to antagonize doxorubicin - induced dna damage through two mechanisms ; 1 ) direct interference with the formation of top2 cleavage complexes and 2 ) top2β down - regulation . the antagonistic effect of dexrazoxane on doxorubicin - induced dna damage in h9c2 cardiomyocytes observed in the current study is relevant to the protective effect of dexrazoxane against doxorubicin cardiotoxicity in patients . it has been shown that the heart might be one of the tissues that prominently express the top2β mrna in adult mice . interestingly , the top2α mrna is completely absent in the heart but still detectable in some other adult tissues such as the spleen and intestine . these findings indicate that top2β is the only top2 isozyme that is present in the adult heart and suggest that top2β - targeting by doxorubicin could contribute to its toxic side effects ( i . e . cardiotoxicity ). in addition , it is known that top2β can be detected in mitochondria and doxorubicin can accumulate in mitochondria that are abundant in the heart . these results suggest that top2β - targeting by doxorubicin in both nuclei and mitochondria of cardiomyocytes could contribute to doxorubicin cardiotoxicity . the current studies , therefore , may have relevance to doxorubicin cardiotoxicity . the two proposed mechanisms ( see fig1 ) for the antagonistic effect of dexrazoxane on doxorubicin - induced dna damage may have interesting clinical implications . in mechanism i , dexrazoxane stabilizes the closed - clamp form of top2 and thus prevents access of top2 to chromosomal dna . consequently , doxorubicin is unable to trap top2 on chromosomal dna to form top2 - dna covalent ( cleavage ) complexes . this mechanism is not top2 isozyme - specific since dexrazoxane can stabilize the closed - clamp forms of both top2α and top2β . in fact , our homology modeling studies of the human top2α and top2β in complex with dexrazoxane have indicated that the dexrazoxane binding sites are the same for the two isozymes , with identical interactions between dexrazoxane and the various amino acid side chains . there are increasing evidence that the antitumor activity of top2 - targeting drugs is primarily due to top2α - targeting in part due to the over - expression of top2α in tumor cells . consequently , dexrazoxane is expected to reduce the antitumor activity of doxorubicin through mechanism i . by contrast , dexrazoxane can down - regulate the top2β isozyme specifically through mechanism ii ( fig1 ). through this mechanism , dexrazoxane is expected not to have a major impact on the top2α isozyme level and hence the antitumor activity of doxorubicin ( and other top2 - targeting drugs ). if indeed , dexrazoxane , used under the current clinical protocol , prevents doxorubicin cardiotoxicity through both mechanisms , strategies should be developed to prevent mechanism i and favor mechanism ii . for example , proper timing of dexrazoxane pretreatment during doxorubicin - based chemotherapy may change the contribution through these two mechanisms . that top2β - targeting is primarily responsible for doxorubicin cardiotoxicity has significant clinical implications . this provides the necessary rationale for developing top2α - specific anticancer drugs to prevent tissue toxicities ( i . e . cardiotoxicity ) in patients receiving top2 - based chemotherapy . it is also noteworthy that the involvement of proteasome in top2β - mediated dna damage is a novel approach for preventing doxorubicin cardiotoxicity through the combined use of bortezomib ( or other proteasome inhibitor ) and doxorubicin .
various methods for treating a patient with neoplasia are disclosed , in particular , methods using topoisomerase ila - preferential poisons , methods using a combination of a topoisomerase illi - preferential inhibitor and a topoisomerase ii poison , and methods using a combination of a topoisomerase ii poison and a proteasome inhibitor are disclosed . novel topoisomerase ila - preferential poisons are disclosed , particularly , several novel 13 - carboline derivatives are identified . methods for identifying the novel topoisomerase ila - preferential poisons and methods for identifying the novel topoisomerase ep - preferential inhibitors are also provided herein .