BTK gatekeeper residue variation combined with cysteine 481 substitution causes super-resistance to irreversible inhibitors acalabrutinib, ibrutinib and zanubrutinib

Leukemia. 2021 May;35(5):1317-1329. doi: 10.1038/s41375-021-01123-6. Epub 2021 Feb 1.

Abstract

Irreversible inhibitors of Bruton tyrosine kinase (BTK), pioneered by ibrutinib, have become breakthrough drugs in the treatment of leukemias and lymphomas. Resistance variants (mutations) occur, but in contrast to those identified for many other tyrosine kinase inhibitors, they affect less frequently the "gatekeeper" residue in the catalytic domain. In this study we carried out variation scanning by creating 11 substitutions at the gatekeeper amino acid, threonine 474 (T474). These variants were subsequently combined with replacement of the cysteine 481 residue to which irreversible inhibitors, such as ibrutinib, acalabrutinib and zanubrutinib, bind. We found that certain double mutants, such as threonine 474 to isoleucine (T474I) or methionine (T474M) combined with catalytically active cysteine 481 to serine (C481S), are insensitive to ≥16-fold the pharmacological serum concentration, and therefore defined as super-resistant to irreversible inhibitors. Conversely, reversible inhibitors showed a variable pattern, from resistance to no resistance, collectively demonstrating the structural constraints for different classes of inhibitors, which may affect their clinical application.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenine / analogs & derivatives*
  • Adenine / physiology
  • Agammaglobulinaemia Tyrosine Kinase / genetics*
  • Animals
  • Benzamides / pharmacology*
  • COS Cells
  • Cell Line
  • Cell Line, Tumor
  • Chickens
  • Chlorocebus aethiops
  • Cysteine / genetics*
  • Drug Resistance, Neoplasm / genetics*
  • HEK293 Cells
  • Humans
  • Mutation / genetics*
  • Piperidines / pharmacology*
  • Protein Kinase Inhibitors / pharmacology
  • Pyrazines / pharmacology*
  • Pyrazoles / pharmacology*
  • Pyrimidines / pharmacology*
  • Threonine / genetics

Substances

  • Benzamides
  • Piperidines
  • Protein Kinase Inhibitors
  • Pyrazines
  • Pyrazoles
  • Pyrimidines
  • ibrutinib
  • Threonine
  • zanubrutinib
  • Agammaglobulinaemia Tyrosine Kinase
  • BTK protein, human
  • acalabrutinib
  • Adenine
  • Cysteine