Cancer Section, Developmental Biology and Cancer Department, UCL Great Ormond Street Institute of Child Health, London.
Department of Paediatric Haematology, Great Ormond Street Hospital for Children, London.
Haematologica. 2024 Apr 1;109(4):1069-1081. doi: 10.3324/haematol.2023.283613.
Advances in the clinical management of pediatric B-cell acute lymphoblastic leukemia (B-ALL) have dramatically improved outcomes for this disease. However, relapsed and high-risk disease still contribute to significant numbers of treatment failures. Development of new, broad range therapies is urgently needed for these cases. We previously reported the susceptibility of ETV6-RUNX1+ pediatric B-ALL to inhibition of signal transducer and activator of transcription 3 (STAT3) activity. In the present study, we demonstrate that pharmacological or genetic inhibition of STAT3 results in p53 induction and that CRISPR-mediated TP53 knockout substantially reverses susceptibility to STAT3 inhibition. Furthermore, we demonstrate that sensitivity to STAT3 inhibition in patient-derived xenograft (PDX) B-ALL samples is not restricted to any particular disease subtype, but rather depends on TP53 status, the only resistant samples being TP53 mutant. Induction of p53 following STAT3 inhibition is not directly dependent on MDM2 but correlates with degradation of MDM4. As such, STAT3 inhibition exhibits synergistic in vitro and in vivo anti-leukemia activity when combined with MDM2 inhibition. Taken together with the relatively low frequency of TP53 mutations in this disease, these data support the future development of combined STAT3/ MDM2 inhibition in the therapy of refractory and relapsed pediatric B-ALL.
儿科 B 细胞急性淋巴细胞白血病 (B-ALL) 的临床管理进展显著改善了该病的预后。然而,复发和高危疾病仍然导致大量治疗失败。对于这些病例,迫切需要开发新的、广泛的治疗方法。我们之前报道了 ETV6-RUNX1+儿科 B-ALL 对信号转导和转录激活因子 3 (STAT3) 活性抑制的敏感性。在本研究中,我们证明了 STAT3 的药理学或遗传抑制导致 p53 诱导,并且 CRISPR 介导的 TP53 敲除可显著逆转对 STAT3 抑制的敏感性。此外,我们证明了 STAT3 抑制在患者来源的异种移植 (PDX) B-ALL 样本中的敏感性不受任何特定疾病亚型的限制,而是取决于 TP53 状态,唯一耐药的样本是 TP53 突变。STAT3 抑制后 p53 的诱导不直接依赖于 MDM2,但与 MDM4 的降解相关。因此,当与 MDM2 抑制联合使用时,STAT3 抑制在体外和体内均表现出协同的抗白血病活性。考虑到这种疾病中 TP53 突变的频率相对较低,这些数据支持未来在难治性和复发性儿科 B-ALL 治疗中联合使用 STAT3/MDM2 抑制。