Division of Blood & Marrow Transplant & Cellular Therapy, Department of Pediatrics, Masonic Cancer Center, University of Minnesota, Minneapolis, MN.
Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA.
Blood. 2022 May 12;139(19):2983-2997. doi: 10.1182/blood.2021014557.
Despite advances in the field, chronic graft-versus-host-disease (cGVHD) remains a leading cause of morbidity and mortality following allogenic hematopoietic stem cell transplant. Because treatment options remain limited, we tested efficacy of anticancer, chromatin-modifying enzyme inhibitors in a clinically relevant murine model of cGVHD with bronchiolitis obliterans (BO). We observed that the novel enhancer of zeste homolog 2 (EZH2) inhibitor JQ5 and the BET-bromodomain inhibitor JQ1 each improved pulmonary function; impaired the germinal center (GC) reaction, a prerequisite in cGVHD/BO pathogenesis; and JQ5 reduced EZH2-mediated H3K27me3 in donor T cells. Using conditional EZH2 knockout donor cells, we demonstrated that EZH2 is obligatory for the initiation of cGVHD/BO. In a sclerodermatous cGVHD model, JQ5 reduced the severity of cutaneous lesions. To determine how the 2 drugs could lead to the same physiological improvements while targeting unique epigenetic processes, we analyzed the transcriptomes of splenic GCB cells (GCBs) from transplanted mice treated with either drug. Multiple inflammatory and signaling pathways enriched in cGVHD/BO GCBs were reduced by each drug. GCBs from JQ5- but not JQ1-treated mice were enriched for proproliferative pathways also seen in GCBs from bone marrow-only transplanted mice, likely reflecting their underlying biology in the unperturbed state. In conjunction with in vivo data, these insights led us to conclude that epigenetic targeting of the GC is a viable clinical approach for the treatment of cGVHD, and that the EZH2 inhibitor JQ5 and the BET-bromodomain inhibitor JQ1 demonstrated clinical potential for EZH2i and BETi in patients with cGVHD/BO.
尽管在该领域取得了进展,但慢性移植物抗宿主病(cGVHD)仍然是异基因造血干细胞移植后发病率和死亡率的主要原因。由于治疗选择仍然有限,我们在具有细支气管闭塞性(BO)的临床相关 cGVHD 小鼠模型中测试了抗癌、染色质修饰酶抑制剂的疗效。我们观察到,新型增强子结合锌指蛋白 2(EZH2)抑制剂 JQ5 和 BET 溴结构域抑制剂 JQ1 均改善了肺功能;抑制了生发中心(GC)反应,这是 cGVHD/BO 发病机制的前提;并且 JQ5 降低了供体细胞中的 EZH2 介导的 H3K27me3。使用条件性 EZH2 敲除供体细胞,我们证明 EZH2 是 cGVHD/BO 起始所必需的。在硬皮病 cGVHD 模型中,JQ5 减少了皮肤损伤的严重程度。为了确定这 2 种药物如何在靶向独特的表观遗传过程的同时导致相同的生理改善,我们分析了用任一药物治疗的移植小鼠脾脏 GCB 细胞(GCB)的转录组。在 cGVHD/BO GCB 中富集的多个炎症和信号通路被这两种药物都减少了。JQ5 处理而非 JQ1 处理的 GCB 细胞富含在仅骨髓移植小鼠的 GCB 中也可见的促增殖途径,这可能反映了它们在未受干扰状态下的基础生物学。结合体内数据,这些发现使我们得出结论,即 GC 的表观遗传靶向是治疗 cGVHD 的可行临床方法,EZH2 抑制剂 JQ5 和 BET 溴结构域抑制剂 JQ1 为 cGVHD/BO 患者的 EZH2i 和 BETi 提供了临床潜力。
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