Department of Hematology and Oncology, University Medical Center, Otto-von-Guericke-University, Magdeburg, Germany.
PLoS One. 2012;7(7):e40853. doi: 10.1371/journal.pone.0040853. Epub 2012 Jul 16.
Clinical development of imatinib in CML established continuous target inhibition as a paradigm for successful tyrosine kinase inhibitor (TKI) therapy. However, recent reports suggested that transient potent target inhibition of BCR-ABL by high-dose TKI (HD-TKI) pulse-exposure is sufficient to irreversibly commit cells to apoptosis. Here, we report a novel mechanism of prolonged intracellular TKI activity upon HD-TKI pulse-exposure (imatinib, dasatinib) in BCR-ABL-positive cells. Comprehensive mechanistic exploration revealed dramatic intracellular accumulation of TKIs which closely correlated with induction of apoptosis. Cells were rescued from apoptosis upon HD-TKI pulse either by repetitive drug wash-out or by overexpression of ABC-family drug transporters. Inhibition of ABCB1 restored sensitivity to HD-TKI pulse-exposure. Thus, our data provide evidence that intracellular drug retention crucially determines biological activity of imatinib and dasatinib. These studies may refine our current thinking on critical requirements of TKI dose and duration of target inhibition for biological activity of TKIs.
伊马替尼在 CML 的临床开发确立了连续靶抑制作为成功的酪氨酸激酶抑制剂(TKI)治疗的范例。然而,最近的报告表明,高剂量 TKI(HD-TKI)脉冲暴露对 BCR-ABL 的短暂强烈靶抑制足以不可逆地诱导细胞凋亡。在这里,我们报告了 BCR-ABL 阳性细胞中 HD-TKI 脉冲暴露(伊马替尼、达沙替尼)后延长细胞内 TKI 活性的新机制。全面的机制探索揭示了 TKI 的剧烈细胞内积累,这与诱导细胞凋亡密切相关。通过重复药物冲洗或过度表达 ABC 家族药物转运体,细胞可从凋亡中挽救出来。ABCB1 的抑制恢复了对 HD-TKI 脉冲暴露的敏感性。因此,我们的数据提供了证据表明,细胞内药物保留对伊马替尼和达沙替尼的生物学活性至关重要。这些研究可能会完善我们目前对 TKI 剂量和靶抑制持续时间对 TKI 生物学活性的关键要求的认识。