Department of Pharmacological Sciences, Stony Brook University School of Medicine, Stony Brook, NY 11794.
Institute of Pharmaceutical Chemistry, Goethe University Frankfurt, Frankfurt am Main 60438, Germany.
Proc Natl Acad Sci U S A. 2021 Nov 16;118(46). doi: 10.1073/pnas.2111451118.
Protein kinase inhibitors are potent anticancer therapeutics. For example, the Bcr-Abl kinase inhibitor imatinib decreases mortality for chronic myeloid leukemia by 80%, but 22 to 41% of patients acquire resistance to imatinib. About 70% of relapsed patients harbor mutations in the Bcr-Abl kinase domain, where more than a hundred different mutations have been identified. Some mutations are located near the imatinib-binding site and cause resistance through altered interactions with the drug. However, many resistance mutations are located far from the drug-binding site, and it remains unclear how these mutations confer resistance. Additionally, earlier studies on small sets of patient-derived imatinib resistance mutations indicated that some of these mutant proteins were in fact sensitive to imatinib in cellular and biochemical studies. Here, we surveyed the resistance of 94 patient-derived Abl kinase domain mutations annotated as disease relevant or resistance causing using an engagement assay in live cells. We found that only two-thirds of mutations weaken imatinib affinity by more than twofold compared to Abl wild type. Surprisingly, one-third of mutations in the Abl kinase domain still remain sensitive to imatinib and bind with similar or higher affinity than wild type. Intriguingly, we identified three clinical Abl mutations that bind imatinib with wild type-like affinity but dissociate from imatinib considerably faster. Given the relevance of residence time for drug efficacy, mutations that alter binding kinetics could cause resistance in the nonequilibrium environment of the body where drug export and clearance play critical roles.
蛋白激酶抑制剂是有效的抗癌治疗药物。例如,Bcr-Abl 激酶抑制剂伊马替尼使慢性髓性白血病的死亡率降低了 80%,但仍有 22%至 41%的患者对伊马替尼产生耐药性。约 70%的复发患者在 Bcr-Abl 激酶结构域存在突变,其中已经鉴定出超过 100 种不同的突变。一些突变位于伊马替尼结合位点附近,通过与药物相互作用的改变导致耐药性。然而,许多耐药性突变位于远离药物结合位点的位置,目前尚不清楚这些突变如何导致耐药性。此外,早期对小部分患者来源的伊马替尼耐药性突变的研究表明,这些突变蛋白中的一些实际上在细胞和生化研究中对伊马替尼敏感。在这里,我们使用活细胞中的结合测定法,对 94 种经注释为与疾病相关或导致耐药性的 Abl 激酶结构域突变进行了耐药性调查。我们发现,与 Abl 野生型相比,只有三分之二的突变使伊马替尼亲和力减弱超过两倍。令人惊讶的是,Abl 激酶结构域中的三分之一突变仍然对伊马替尼敏感,并且与野生型结合的亲和力相似或更高。有趣的是,我们鉴定出三种临床 Abl 突变,它们与伊马替尼的结合亲和力与野生型相似,但从伊马替尼解离的速度要快得多。鉴于药物疗效与停留时间有关,改变结合动力学的突变可能会导致在药物外排和清除起关键作用的体内非平衡环境中产生耐药性。