Program: Oral and Poster Abstracts
Session: 604. Molecular Pharmacology and Drug Resistance in Myeloid Diseases: Poster I
Overexpression of the anti-apoptotic Bcl-2 family members is associated with chemoresistance in leukemic cell line models and with poor clinical outcome. Anti-apoptotic Bcl-2 family members, such as Bcl-2, Bcl-xL, and Mcl-1, sequester pro-apoptotic BH3-only proteins, such as Bim, which activate pro-apoptotic proteins Bax and Bak causing mitochondrial outer membrane permeabilization resulting in cytochrome c release and apoptosis. Thus, inhibition of anti-apoptotic Bcl-2 family members represents a promising approach for the treatment of AML. We previously demonstrated preclinical efficacy of a pan-Bcl-2 inhibitor, GX15-070, in combination with cytarabine in AML cell lines and primary patient samples. Another promising inhibitor, ABT-263, has shown preclinical efficacy, but has been associated with thrombocytopenia due to inhibition of Bcl-xL, thus much attention has been focused on inhibition of Bcl-2. ABT-199, a Bcl-2 selective inhibitor, has demonstrated encouraging results in AML, acute lymphoblastic leukemia, chronic lymphocytic leukemia, mantle cell lymphoma, multiple myeloma, and breast cancer. We previously demonstrated that ABT-199 has a wide range of activity in AML cells (Niu X, et al. Leukemia. 2014; 28: 1557-1560.) However, it has limited efficacy in Bcl-xL and Mcl-1 dependent malignancies. Thus, intrinsic drug resistance remains a concern. Understanding the molecular mechanisms of resistance to ABT-199 will allow for rationally designed combination regimens to increase its antileukemic efficacy.
In this study, we investigated the molecular mechanism underlying intrinsic resistance to ABT-199 in AML cells. Immunoprecipitation of Bim from ABT-199 treated cells demonstrated decreased association with Bcl-2, but increased association with Mcl-1, without corresponding change in mitochondrial outer membrane potential. ABT-199 treatment resulted in increased levels of Mcl-1 protein and unchanged or decreased Mcl-1 transcript levels. shRNA knockdown of Bim almost completely abolished ABT-199 treatment-induced increase of Mcl-1 protein levels, suggesting that the association with Bim plays an important role in stabilizing Mcl-1 protein. AML cells treated with ABT-199 in the presence of the protein translation inhibitor cycloheximide resulted in significantly longer Mcl-1 half-life and treatment with the proteasome inhibitor MG-132 resulted in increased Mcl-1 protein level and no further enhancement was detected when treated with combined MG-132 and ABT-199, suggesting that ABT-199 affects Mcl-1 protein stability. Combining conventional chemotherapeutic agent cytarabine or daunorubicin with ABT-199 resulted in increased DNA damage, decreased Mcl-1 protein levels, decreased association of Mcl-1 with Bim, and synergistic induction of cell death compared to ABT-199 alone, in both AML cell lines and primary patient samples obtained from AML patients at diagnosis independent of their sensitivities to ABT-199, thus providing evidence that screening for ABT-199 resistance is not necessary.
Our results demonstrate that sequestration of Bim by Mcl-1 is a mechanism of intrinsic ABT-199 resistance, and this mechanism of resistance can be overcome by combining ABT-199 with daunorubicin or cytarabine in AML cells. Our findings, though in a limited number of primary patient samples, provide new insights into the mechanism of ABT-199 resistance in AML cells and support the clinical development of the combination of daunorubicin or cytarabine and ABT-199 in the treatment of AML.
Disclosures: No relevant conflicts of interest to declare.
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