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双重靶向 BCL2 和 MCL1 可挽救对与 BAX/BAK 异源二聚体形成相关的 BCL2 和 MCL1 抑制剂耐药的骨髓瘤细胞。

Dual targeting of BCL2 and MCL1 rescues myeloma cells resistant to BCL2 and MCL1 inhibitors associated with the formation of BAX/BAK hetero-complexes.

机构信息

CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes, Nantes, France.

SIRIC ILIAD, Angers, Nantes, France.

出版信息

Cell Death Dis. 2020 May 5;11(5):316. doi: 10.1038/s41419-020-2505-1.

Abstract

Multiple myeloma is a plasma cell malignancy that escapes from apoptosis by heterogeneously over-expressing anti-apoptotic BCL2 proteins. Myeloma cells with a t(11;14) translocation present a particular vulnerability to BCL2 inhibition while a majority of myeloma cells relies on MCL1 for survival. The present study aimed to determine whether the combination of BCL2 and MCL1 inhibitors at low doses could be of benefit for myeloma cells beyond the single selective inhibition of BCL2 or MCL1. We identified that half of patients were not efficiently targeted neither by BCL2 inhibitor nor MCL1 inhibitor. Seventy percent of these myeloma samples, either from patients at diagnosis or relapse, presented a marked increase of apoptosis upon low dose combination of both inhibitors. Interestingly, primary cells from a patient in progression under venetoclax treatment were not sensitive ex vivo to neither venetoclax nor to MCL1 inhibitor, whereas the combination of both efficiently induced cell death. This finding suggests that the combination could overcome venetoclax resistance. The efficacy of the combination was also confirmed in U266 xenograft model resistant to BCL2 and MCL1 inhibitors. Mechanistically, we demonstrated that the combination of both inhibitors favors apoptosis in a BAX/BAK dependent manner. We showed that activated BAX was readily increased upon the inhibitor combination leading to the formation of BAK/BAX hetero-complexes. We found that BCLXL remains a major resistant factor of cell death induced by this combination. The present study supports a rational for the clinical use of venetoclax/S63845 combination in myeloma patients with the potential to elicit significant clinical activity when both single inhibitors would not be effective but also to overcome developed in vivo venetoclax resistance.

摘要

多发性骨髓瘤是一种浆细胞恶性肿瘤,通过异质性过表达抗凋亡 BCL2 蛋白而逃避凋亡。具有 t(11;14)易位的骨髓瘤细胞对 BCL2 抑制特别敏感,而大多数骨髓瘤细胞依赖 MCL1 存活。本研究旨在确定低剂量 BCL2 和 MCL1 抑制剂联合应用是否对骨髓瘤细胞有益,而不仅仅是单一选择性抑制 BCL2 或 MCL1。我们发现,一半的患者既不能被 BCL2 抑制剂有效靶向,也不能被 MCL1 抑制剂有效靶向。这些骨髓瘤样本中,有 70%来自诊断或复发的患者,在两种抑制剂的低剂量联合应用下,凋亡明显增加。有趣的是,来自一名在 venetoclax 治疗下进展的患者的原代细胞对 venetoclax 和 MCL1 抑制剂均不敏感,而两者联合使用则能有效地诱导细胞死亡。这一发现表明,联合用药可能克服 venetoclax 耐药性。该联合用药在对 BCL2 和 MCL1 抑制剂耐药的 U266 异种移植模型中也得到了验证。在机制上,我们证明了两种抑制剂的联合使用以 BAX/BAK 依赖的方式促进细胞凋亡。我们发现,在抑制剂联合使用后,激活的 BAX 很容易增加,导致 BAK/BAX 异源复合物的形成。我们发现,BCLXL 仍然是该联合用药诱导细胞死亡的主要耐药因素。本研究支持 venetoclax/S63845 联合用药在多发性骨髓瘤患者中的临床应用,当两种单药均无效时,该联合用药具有显著的临床活性,而且还可以克服体内 venetoclax 耐药性的产生。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a137/7200824/5b995a1bccf4/41419_2020_2505_Fig1_HTML.jpg

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