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双重SYK/JAK抑制克服慢性淋巴细胞白血病中的依鲁替尼耐药性:西杜替尼而非依鲁替尼可诱导受微环境保护的肿瘤细胞凋亡。

Dual SYK/JAK inhibition overcomes ibrutinib resistance in chronic lymphocytic leukemia: Cerdulatinib, but not ibrutinib, induces apoptosis of tumor cells protected by the microenvironment.

作者信息

Guo Ailin, Lu Pin, Coffey Greg, Conley Pamela, Pandey Anjali, Wang Y Lynn

机构信息

Department of Pathology, Lymphoma Translational Pathology, University of Chicago, Chicago, IL, USA.

Portola Pharmaceuticals, Inc., South San Francisco, CA, USA.

出版信息

Oncotarget. 2017 Feb 21;8(8):12953-12967. doi: 10.18632/oncotarget.14588.

Abstract

Ibrutinib (BTK inhibitor) has generated remarkable responses in CLL. However, the drug, to a large extent, does not cause cell death directly and does not eradicate CLL malignant clones. Inability to eradicate CLL has fostered resistance generation. Once patients become resistant, they do poorly with a median survival of 3-4 months. Novel therapeutic strategies are needed to prevent resistance, improve treatment outcome and ultimately cure the disease. Herein, we explore dual targeting of the BCR and JAK-STAT pathways with a novel single agent, cerdulatinib, which selectively inhibits both SYK (a BCR component) and JAK kinases. We demonstrated that cerdulatinib delivered potent tumor inhibition in 60 primary CLL patient samples, especially in those with poor prognostic indicators. Importantly, cerdulatinib, but not ibrutinib, is able to overcome the support of microenvironment and induces CLL cell death at clinically achievable concentrations. Notably, cerdulatinib blocked proliferation of ibrutinib-resistant primary CLL cells and of BTKC481S-transfected/ibrutinib-resistant lymphoma cells. These anti-tumor effects are well correlated with the inhibition of BCR and JAK-STAT signaling and downstream inhibition of the functions of AKT, ERK and NFκB. Collectively, our results show that simultaneous targeting of BCR and JAK-STAT pathways is a more effective strategy relative to single BTK inhibition.

摘要

依鲁替尼(布鲁顿酪氨酸激酶抑制剂)在慢性淋巴细胞白血病(CLL)中产生了显著疗效。然而,该药物在很大程度上并非直接导致细胞死亡,也无法根除CLL恶性克隆。无法根除CLL导致了耐药性的产生。一旦患者产生耐药,其预后很差,中位生存期为3至4个月。需要新的治疗策略来预防耐药性、改善治疗效果并最终治愈该疾病。在此,我们探索了一种新型单药——塞杜替尼对BCR和JAK-STAT信号通路的双重靶向作用,它能选择性抑制SYK(一种BCR成分)和JAK激酶。我们证明,塞杜替尼在60份原发性CLL患者样本中展现出强大的肿瘤抑制作用,尤其是在那些预后指标较差的样本中。重要的是,塞杜替尼而非依鲁替尼能够克服微环境的支持,并在临床可达到的浓度下诱导CLL细胞死亡。值得注意的是,塞杜替尼可阻断依鲁替尼耐药的原发性CLL细胞以及转染了BTKC481S的依鲁替尼耐药淋巴瘤细胞的增殖。这些抗肿瘤作用与BCR和JAK-STAT信号的抑制以及下游AKT、ERK和NFκB功能的抑制密切相关。总体而言,我们的结果表明,相对于单一抑制BTK,同时靶向BCR和JAK-STAT信号通路是一种更有效的策略。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5564/5355069/fc440b22c9a2/oncotarget-08-12953-g001.jpg

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