University of Salamanca, IBSAL, IBMCC, CSIC, Cancer Research Center, Salamanca, Spain.
Department of Hematology, University Hospital of Salamanca, Salamanca, Spain.
Leukemia. 2020 Jun;34(6):1599-1612. doi: 10.1038/s41375-020-0714-3. Epub 2020 Jan 23.
The deletion of 11q (del(11q)) invariably comprises ATM gene in chronic lymphocytic leukemia (CLL). Concomitant mutations in this gene in the remaining allele have been identified in 1/3 of CLL cases harboring del(11q), being the biallelic loss of ATM associated with adverse prognosis. Although the introduction of targeted BCR inhibition has significantly favored the outcomes of del(11q) patients, responses of patients harboring ATM functional loss through biallelic inactivation are unexplored, and the development of resistances to targeted therapies have been increasingly reported, urging the need to explore novel therapeutic approaches. Here, we generated isogenic CLL cell lines harboring del(11q) and ATM mutations through CRISPR/Cas9-based gene-editing. With these models, we uncovered a novel therapeutic vulnerability of del(11q)/ATM-mutated cells to dual BCR and PARP inhibition. Ex vivo studies in the presence of stromal stimulation on 38 CLL primary samples confirmed a synergistic action of the combination of olaparib and ibrutinib in del(11q)/ATM-mutated CLL patients. In addition, we showed that ibrutinib produced a homologous recombination repair impairment through RAD51 dysregulation, finding a synergistic link of both drugs in the DNA damage repair pathway. Our data provide a preclinical rationale for the use of this combination in CLL patients with this high-risk cytogenetic abnormality.
11q 缺失(del(11q))在慢性淋巴细胞白血病(CLL)中总是包含 ATM 基因。在携带 del(11q)的 CLL 病例中,有 1/3 的病例在剩余的等位基因中发现了该基因的同时突变,ATM 的双等位基因缺失与不良预后相关。尽管引入靶向 BCR 抑制显著改善了 del(11q)患者的预后,但对通过双等位基因失活导致 ATM 功能丧失的患者的反应仍未得到探索,并且越来越多的报道表明对靶向治疗的耐药性,这迫切需要探索新的治疗方法。在这里,我们通过 CRISPR/Cas9 基因编辑生成了携带 del(11q)和 ATM 突变的同源 CLL 细胞系。通过这些模型,我们发现了 del(11q)/ATM 突变细胞对双 BCR 和 PARP 抑制的新的治疗敏感性。在存在基质刺激的情况下对 38 个 CLL 原发性样本进行的离体研究证实了奥拉帕利和伊布替尼联合治疗在 del(11q)/ATM 突变 CLL 患者中的协同作用。此外,我们表明伊布替尼通过 RAD51 失调导致同源重组修复受损,发现这两种药物在 DNA 损伤修复途径中存在协同联系。我们的数据为在具有这种高风险细胞遗传学异常的 CLL 患者中使用该联合治疗提供了临床前依据。