Department of Leukemia, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA.
Blood. 2011 Sep 29;118(13):3603-12. doi: 10.1182/blood-2011-05-352492. Epub 2011 Jul 29.
In lymphocytes, the phosphoinositide 3'-kinase (PI3K) isoform p110δ (PI3Kδ) transmits signals from surface receptors, including the B-cell receptor (BCR). CAL-101, a selective inhibitor of PI3Kδ, displays clinical activity in CLL, causing rapid lymph node shrinkage and a transient lymphocytosis. Inhibition of pro-survival pathways, the presumed mechanism of CAL-101, does not explain this characteristic pattern of activity. Therefore, we tested CAL-101 in assays that model CLL-microenvironment interactions in vitro. We found that CAL-101 inhibits CLL cell chemotaxis toward CXCL12 and CXCL13 and migration beneath stromal cells (pseudoemperipolesis). CAL-101 also down-regulates secretion of chemokines in stromal cocultures and after BCR triggering. CAL-101 reduces survival signals derived from the BCR or from nurse-like cells, and inhibits BCR- and chemokine-receptor-induced AKT and MAP kinase (ERK) activation. In stromal cocultures, CAL-101 sensitizes CLL cells toward bendamustine, fludarabine, and dexamethasone. These results are corroborated by clinical data showing marked reductions in circulating CCL3, CCL4, and CXCL13 levels, and a surge in lymphocytosis during CAL-101 treatment. Thus, CAL-101 displays a dual mechanism of action, directly decreasing cell survival while reducing interactions that retain CLL cells in protective tissue microenvironments. These data provide an explanation for the clinical activity of CAL-101, and a roadmap for future therapeutic development.
在淋巴细胞中,磷酸肌醇 3-激酶(PI3K)同工型 p110δ(PI3Kδ)从表面受体传递信号,包括 B 细胞受体(BCR)。CAL-101 是 PI3Kδ 的选择性抑制剂,在 CLL 中显示出临床活性,导致淋巴结迅速缩小和短暂的淋巴细胞增多。抑制生存途径,即 CAL-101 的推测机制,不能解释这种特征性的活性模式。因此,我们在体外模拟 CLL-微环境相互作用的测定中测试了 CAL-101。我们发现 CAL-101 抑制 CLL 细胞向 CXCL12 和 CXCL13 的趋化性和向基质细胞(假性游走)下的迁移。CAL-101 还下调基质共培养物和 BCR 触发后的趋化因子分泌。CAL-101 减少来自 BCR 或类滋养细胞的存活信号,并抑制 BCR 和趋化因子受体诱导的 AKT 和 MAP 激酶(ERK)激活。在基质共培养物中,CAL-101 使 CLL 细胞对苯达莫司汀、氟达拉滨和地塞米松敏感。这些结果得到临床数据的证实,表明循环 CCL3、CCL4 和 CXCL13 水平显著降低,并且在 CAL-101 治疗期间淋巴细胞增多。因此,CAL-101 具有双重作用机制,直接降低细胞存活,同时减少将 CLL 细胞保留在保护性组织微环境中的相互作用。这些数据为 CAL-101 的临床活性提供了解释,并为未来的治疗发展提供了路线图。