Combined inhibition of BCR-ABL1 and the proteasome as a potential novel therapeutic approach in BCR-ABL positive acute lymphoblastic leukemia

PLoS One. 2022 Oct 4;17(10):e0268352. doi: 10.1371/journal.pone.0268352. eCollection 2022.

Abstract

Acute lymphoblastic leukemia (ALL) is a disease of lymphoid progenitor cells with an often aggressive course and is commonly caused by the BCR-ABL fusion gene t(9;22) in adults. This fusion gene encodes a constitutively active tyrosine kinase that can be effectively inhibited by tyrosine kinase inhibitors (TKIs), with imatinib being the paradigmatic agent of this class. However, BCR-ABL+ ALL cells rapidly develop mutations against many of the available TKIs, and consecutive disease relapse still results in an overall unfavorable prognosis for patients with this disease. To date, allogeneic stem cell transplantation is the only known curative therapeutic option for the mostly elderly patients with BCR-ABL+ ALL. The discrepancy between the limited therapeutic armamentarium and the growing therapeutic need in an aging population is therefore a reason to test drug combinations against BCR-ABL+ ALL. In this study, we demonstrate that the combination of TKIs with proteasome inhibitors efficiently and under certain conditions synergistically exerts cytotoxic effects in BCR-ABL+ ALL cells in vitro with respect to the induction of apoptosis. Both sole and combined treatment of BCR-ABL+ ALL with the proteasome inhibitors bortezomib and ixazomib, respectively, and TKI causes a significantly greater reduction in cell viability than TKI treatment alone in both BCR-ABL+ cell lines TOM-1 and BV-173. In BV-173 cells, we observed a significant reduction in cell viability to only 1.26%±0.46% with bortezomib treatment and 1.57±0.7% with combination treatment, whereas cells treated with dasatinib alone still had a viable percentage of 40.58±2.6%. Similar results were obtained when ixazomib was applied to both cell lines, and apoptosis was induced in both cases (93.36%±2.7% apoptotic BV-173 cells when treated with ixazomib and TKI). The combination of TKI and proteasome inhibitor is efficient in vitro, potentially expanding the spectrum of therapeutic options for patients with BCR-ABL+ ALL.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Boron Compounds
  • Bortezomib / pharmacology
  • Bortezomib / therapeutic use
  • Dasatinib / pharmacology
  • Dasatinib / therapeutic use
  • Drug Resistance, Neoplasm / genetics
  • Fusion Proteins, bcr-abl / metabolism
  • Glycine / analogs & derivatives
  • Humans
  • Imatinib Mesylate / therapeutic use
  • Leukemia, Myelogenous, Chronic, BCR-ABL Positive* / drug therapy
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma* / drug therapy
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma* / genetics
  • Proteasome Endopeptidase Complex
  • Proteasome Inhibitors / pharmacology
  • Proteasome Inhibitors / therapeutic use
  • Protein Kinase Inhibitors / pharmacology
  • Protein Kinase Inhibitors / therapeutic use

Substances

  • Boron Compounds
  • Proteasome Inhibitors
  • Protein Kinase Inhibitors
  • Bortezomib
  • ixazomib
  • Imatinib Mesylate
  • Fusion Proteins, bcr-abl
  • Proteasome Endopeptidase Complex
  • Dasatinib
  • Glycine

Grants and funding

IA gratefully received funding from the German Cancer Aid (Deutsche Krebshilfe, fund no. 70111714) and from the RWTH Aachen University “Habilitationsstipendium für Frauen”. This work was part of the M.D. thesis of SM. MV received funding from the German research foundation (Deutsche Forschungs-Gemeinschaft, project CRU344, number 428857858) and from Aachener Krebs- und Leukämiehilfe (AKLH). For this project, funding was received from non-commercial as well as commercial sources. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.