Vervoort Britt M T, Butler Miriam, Grünewald Kari J T, Schenau Dorette S van Ingen, Tee Trisha M, Lucas Luc, Huitema Alwin D R, Boer Judith M, Bornhauser Beat C, Bourquin Jean-Pierre, Hoogerbrugge Peter M, Van der Velden Vincent H J, Kuiper Roland P, Van der Meer Laurens T, Van Leeuwen Frank N
Princess Máxima Center for Pediatric Oncology, Utrecht, 3584 CS.
Netherlands Cancer Institute, Amsterdam.
Haematologica. 2024 Dec 1;109(12):3904-3917. doi: 10.3324/haematol.2023.284357.
IKZF1 deletions occur in 10-15% of patients with B-cell precursor acute lymphoblastic leukemia (BCP-ALL) and predict a poor outcome. However, the impact of IKZF1 loss on sensitivity to drugs used in contemporary treatment protocols has remained underexplored. Here we show in experimental models and in patients that loss of IKZF1 promotes resistance to cytarabine (AraC), a key component of both upfront and relapsed treatment protocols. We attribute this resistance, in part, to diminished import and incorporation of AraC due to reduced expression of the solute carrier hENT1. Moreover, we found elevated mRNA expression of Evi1, a known driver of therapy resistance in myeloid malignancies. Finally, a kinase directed CRISPR/Cas9-screen identified that inhibition of either mediator kinases CDK8/19 or casein kinase 2 can restore response to AraC. We conclude that this high-risk group of patients could benefit from alternative antimetabolites, or targeted therapies that re-sensitize leukemic cells to AraC.
IKZF1缺失发生在10%至15%的B细胞前体急性淋巴细胞白血病(BCP-ALL)患者中,并预示着预后不良。然而,IKZF1缺失对当代治疗方案中所用药物敏感性的影响仍未得到充分研究。在此,我们在实验模型和患者中表明,IKZF1缺失会促进对阿糖胞苷(AraC)的耐药性,阿糖胞苷是初始治疗和复发治疗方案的关键组成部分。我们将这种耐药性部分归因于溶质载体hENT1表达降低导致阿糖胞苷的摄取和掺入减少。此外,我们发现Evi1的mRNA表达升高,Evi1是髓系恶性肿瘤中已知的治疗耐药驱动因子。最后,一项激酶导向的CRISPR/Cas9筛选确定,抑制介导激酶CDK8/19或酪蛋白激酶2可恢复对阿糖胞苷的反应。我们得出结论,这一高危患者群体可能受益于替代抗代谢物或使白血病细胞对阿糖胞苷重新敏感的靶向治疗。