通过共同靶向 MCL1 增强急性髓系白血病中的 venetoclax 活性。
Enhancing venetoclax activity in acute myeloid leukemia by co-targeting MCL1.
机构信息
Australian Centre for Blood Diseases, Monash University, Alfred Medical Research and Education Precinct, Melbourne, Victoria, Australia.
Department of Clinical Haematology, The Alfred Hospital, Melbourne, Victoria, Australia.
出版信息
Leukemia. 2018 Feb;32(2):303-312. doi: 10.1038/leu.2017.243. Epub 2017 Jul 28.
Targeted therapies are frequently combined with standard cytotoxic drugs to enhance clinical response. Targeting the B-cell lymphoma 2 (BCL-2) family of proteins is an attractive option to combat chemoresistance in leukemia. Preclinical and clinical studies indicate modest single-agent activity with selective BCL-2 inhibitors (for example, venetoclax). We show that venetoclax synergizes with cytarabine and idarubicin to increase antileukemic efficacy in a TP53-dependent manner. Although TP53 deficiency impaired sensitivity to combined venetoclax and chemotherapy, higher-dose idarubicin was able to suppress MCL1 and induce cell death independently of TP53. Consistent with an MCL1-specific effect, cell death from high-dose idarubicin was dependent on pro-apoptotic Bak. Combining higher-dose idarubicin with venetoclax was able to partially overcome resistance in Bak-deficient cells. Using inducible vectors and venetoclax to differentially target anti-apoptotic BCL-2 family members, BCL-2 and MCL1 emerged as critical and complementary proteins regulating cell survival in acute myeloid leukemia. Dual targeting of BCL-2 and MCL1, but not either alone, prolonged survival of leukemia-bearing mice. In conclusion, our findings support the further investigation of venetoclax in combination with standard chemotherapy, including intensified doses of idarubicin. Venetoclax should also be investigated in combination with direct inhibitors of MCL1 as a chemotherapy-free approach in the future.
靶向治疗经常与标准细胞毒药物联合使用,以增强临床反应。靶向 B 细胞淋巴瘤 2(BCL-2)家族蛋白是对抗白血病化疗耐药的一种有吸引力的选择。临床前和临床研究表明,选择性 BCL-2 抑制剂(例如维奈托克)具有适度的单药活性。我们表明,维奈托克与阿糖胞苷和伊达比星协同作用,以依赖 TP53 的方式增加抗白血病疗效。虽然 TP53 缺失会损害对联合维奈托克和化疗的敏感性,但较高剂量的伊达比星能够抑制 MCL1 并独立于 TP53 诱导细胞死亡。与 MCL1 特异性效应一致,高剂量伊达比星诱导的细胞死亡依赖于促凋亡 Bak。联合高剂量伊达比星和维奈托克能够部分克服 Bak 缺陷细胞的耐药性。使用诱导载体和维奈托克来差异靶向抗凋亡 BCL-2 家族成员,BCL-2 和 MCL1 成为调节急性髓细胞白血病细胞存活的关键和互补蛋白。BCL-2 和 MCL1 的双重靶向,而不是单独靶向,延长了携带白血病的小鼠的生存时间。总之,我们的研究结果支持进一步研究维奈托克与标准化疗联合使用,包括增加伊达比星的剂量。维奈托克也应该与 MCL1 的直接抑制剂联合研究,作为未来无化疗的方法。