Repurposing FDA‐Approved Drugs for Temozolomide‐Resistant IDH1 Mutant Glioma Using High‐Throughput Miniaturized Screening on Droplet Microarray Chip

Abstract To address the challenge of drug resistance and limited treatment options for recurrent gliomas with IDH1 mutations, a highly miniaturized screening of 2208 FDA‐approved drugs is conducted using a high‐throughput droplet microarray (DMA) platform. Two patient‐derived temozolomide‐resistant tumorspheres harboring endogenous IDH1 mutations (IDH1 mut ) are utilized. Screening identifies over 20 drugs, including verteporfin (VP), that significantly affected tumorsphere formation and viability. Proteomics analysis reveals that nuclear pore complex may be a potential VP target, suggesting a new mechanism of action independent of its known effects on YAP1. Knockdown experiments exclude YAP1 as a drug target in tumorspheres. Pathway analysis shows that NUP107 is a potential upstream regulator associated with VP response. Analysis of publicly available genomic datasets shows a significant correlation between high NUP107 expression and decreased survival in IDH1 mut astrocytoma, suggesting NUP107 may be a potential biomarker for VP response. This study demonstrates a miniaturized approach for cost‐effective drug repurposing using 3D glioma models and identifies nuclear pore complex as a potential target for drug development. The findings provide preclinical evidence to support in vivo and clinical studies of VP and other identified compounds to treat IDH1 mut gliomas, which may ultimately improve clinical outcomes for patients with this challenging disease.