Session: 503. Clonal Hematopoiesis, Aging, and Inflammation: Poster III
Hematology Disease Topics & Pathways:
MDS, Chronic Myeloid Malignancies, Diseases, Myeloid Malignancies
Methods: Transcriptomics, proteomics, and phosphoproteomics (bone marrow) were assessed at baseline and week 24 using patient samples from the COMMANDS trial. Genomic DNA was isolated from bone marrow and myeloid-specific 36 somatic genes mutations were identified by targeted next-generation sequencing (400X, sensitivity 3%) at baseline. Murine analog of luspatercept (RAP-536) was used for transverse aortic constriction (TAC)-induced pressure overload study in wild type (WT) and TET2 knockout (TET2-KO) C57BL/6 mice. Cardiac hypertrophy and function were assessed by echocardiography. Serum BNP level and Western blot analysis of heart tissues were done following 7-week treatment with RAP-536.
Results: In all, 85% (123/145) of patients treated with luspatercept from the COMMANDS trial had at least one of the most frequent CH-related mutations (eg, DNMT3A, TET2, ASXL1, SF3B1), with modest myeloid-based expansion at baseline (R=0.3, P ≤ 0.0002). Luspatercept treatment significantly reduced anemia from baseline in patients with CH-related mutations (primary endpoint response 62%, n/N = 76/123) and downregulated NT-proBNP levels (𝚫 median = 590 pg/mL in responders, P = 0.02). In responding patients with CH-related mutations, luspatercept treatment reduced mTORC1 pathway activation and inflammatory signaling at the transcriptomic, proteomic, and phosphoproteomic levels. Consistent with this, we also observed inhibition of GDF11 (one of the Smad2/3 ligands inhibited by luspatercept) mediated mTORC1 activity and activation of autophagy/lysosome markers following luspatercept treatment in human cardiomyocyte cell line. Using a murine model of pressure overload (TAC)-induced heart failure, which has been shown to have elevated mTORC1 and inflammatory signaling, we showed that RAP-536 significantly reduced TAC-induced cardiac hypertrophy (left ventricular [LV] mass reduction by echocardiography) in both WT (21%, P = 0.001) and TET2-KO (16%, P = 0.01) mice. Accordingly, we observed reduction of LV end diastolic volume in both in WT (18%, P = 0.018) and TET2-KO (24%, P = 0.006) mice. Moreover, we also observed reduction of serum BNP levels (WT: 59%, P < 0.0001; TET2-KO: 69%, P = 0.0002) and downregulation of IL-6 (gene and protein level) in heart tissues following RAP-536 treatment, suggesting potential CH-mutation agnostic cardiovascular benefits.
Conclusions: Our reverse and forward translational approach identified novel mechanisms of luspatercept that may have potential implications in patients with CH-related mutations and associated consequences (hematologic and cardiovascular). Moreover, these findings offer insights into how luspatercept treatment can modify cellular and tissue microenvironments, which could be leveraged in tailored therapeutic approaches, either alone or in conjunction.
Disclosures: Hasan: Bristol Myers Squibb: Current Employment, Current equity holder in publicly-traded company. Tannu: Bristol Myers Squibb: Current Employment. Saini: Orum Therapeutics: Current equity holder in publicly-traded company, Ended employment in the past 24 months; Bristol Myers Squibb: Current Employment, Other: BMS stock holder. Ugidos: Bristol Myers Squibb: Current Employment, Current equity holder in private company, Patents & Royalties: PCT Application No. PCT/US2022/019874 filed on March 11, 2022 , entitled METHODS FOR USING A HYPOMETHYLATING AGENT TO TREAT DISEASES AND DISORDERS BASED ON GENE MUTATION PROFILES. Garcia-Manero: Astex: Other: Personal fees; Novartis: Research Funding; Genentech: Research Funding; Aprea: Research Funding; AbbVie: Research Funding; Helsinn: Research Funding; Curis: Research Funding; Merck: Research Funding; Bristol Myers Squibb: Other: Personal fees, Research Funding; Astex: Research Funding; Onconova: Research Funding; H3 Biomedicine: Research Funding; Forty Seven: Research Funding; Helsinn: Other: Personal fees; Janssen: Research Funding; Genentech: Other: Personal fees; Amphivena: Research Funding. Platzbecker: Amgen: Consultancy, Research Funding; BMS: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Travel support, Research Funding; MDS Foundation: Membership on an entity's Board of Directors or advisory committees; Abbvie: Consultancy, Research Funding; Curis: Consultancy, Honoraria, Research Funding; Geron: Consultancy; Janssen: Consultancy, Honoraria, Research Funding; Merck: Research Funding; Novartis: Consultancy, Research Funding. Chang: Bristol Myers Squibb: Current Employment. Gandhi: Bristol Myers Squibb: Current Employment, Current equity holder in publicly-traded company. Garcia: GeneToBe: Current Employment, Current holder of stock options in a privately-held company. Suragani: Bristol Myers Squibb: Current Employment, Current equity holder in publicly-traded company.
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