School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; Centre for Clinical Haematology, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom;
School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom;
Blood. 2016 Feb 4;127(5):582-95. doi: 10.1182/blood-2015-05-644872. Epub 2015 Nov 12.
TP53 and ataxia telangiectasia mutated (ATM) defects are associated with genomic instability, clonal evolution, and chemoresistance in chronic lymphocytic leukemia (CLL). Currently, therapies capable of providing durable remissions in relapsed/refractory TP53- or ATM-defective CLL are lacking. Ataxia telangiectasia and Rad3-related (ATR) mediates response to replication stress, the absence of which leads to collapse of stalled replication forks into chromatid fragments that require resolution through the ATM/p53 pathway. Here, using AZD6738, a novel ATR kinase inhibitor, we investigated ATR inhibition as a synthetically lethal strategy to target CLL cells with TP53 or ATM defects. Irrespective of TP53 or ATM status, induction of CLL cell proliferation upregulated ATR protein, which then became activated in response to replication stress. In TP53- or ATM-defective CLL cells, inhibition of ATR signaling by AZD6738 led to an accumulation of unrepaired DNA damage, which was carried through into mitosis because of defective cell cycle checkpoints, resulting in cell death by mitotic catastrophe. Consequently, AZD6738 was selectively cytotoxic to both TP53- and ATM-defective CLL cell lines and primary cells. This was confirmed in vivo using primary xenograft models of TP53- or ATM-defective CLL, where treatment with AZD6738 resulted in decreased tumor load and reduction in the proportion of CLL cells with such defects. Moreover, AZD6738 sensitized TP53- or ATM-defective primary CLL cells to chemotherapy and ibrutinib. Our findings suggest that ATR is a promising therapeutic target for TP53- or ATM-defective CLL that warrants clinical investigation.
TP53 和共济失调毛细血管扩张症突变(ATM)缺陷与慢性淋巴细胞白血病(CLL)中的基因组不稳定性、克隆进化和化疗耐药有关。目前,缺乏能够在复发/难治性 TP53 或 ATM 缺陷 CLL 中提供持久缓解的疗法。共济失调毛细血管扩张症和 Rad3 相关(ATR)介导对复制应激的反应,缺乏这种反应会导致停滞的复制叉崩溃成染色单体片段,这些片段需要通过 ATM/p53 途径来解决。在这里,我们使用新型 ATR 激酶抑制剂 AZD6738,研究了 ATR 抑制作为一种合成致死策略,以靶向具有 TP53 或 ATM 缺陷的 CLL 细胞。无论 TP53 或 ATM 状态如何,诱导 CLL 细胞增殖都会上调 ATR 蛋白,然后 ATR 蛋白在复制应激时被激活。在 TP53 或 ATM 缺陷的 CLL 细胞中,AZD6738 抑制 ATR 信号导致未修复的 DNA 损伤积累,由于细胞周期检查点缺陷,这些损伤在有丝分裂中传递,导致有丝分裂灾难导致细胞死亡。因此,AZD6738 对 TP53 和 ATM 缺陷的 CLL 细胞系和原代细胞均具有选择性细胞毒性。这在使用 TP53 或 ATM 缺陷的 CLL 的原代异种移植模型中得到了证实,在该模型中,AZD6738 治疗导致肿瘤负荷降低和具有这些缺陷的 CLL 细胞比例减少。此外,AZD6738 使 TP53 或 ATM 缺陷的原代 CLL 细胞对化疗和依鲁替尼敏感。我们的研究结果表明,ATR 是 TP53 或 ATM 缺陷 CLL 的一个有前途的治疗靶点,值得进一步的临床研究。