1. The delta isoform of PI3K predominates in chronic myelomonocytic leukemia and can be targeted effectively with umbralisib and ruxolitinib
- Author
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Villaume, Matthew T., Arrate, M. Pia, Ramsey, Haley E., Sunthankar, Kathryn I., Jenkins, Matthew T., Moyo, Tamara K., Smith, Brianna N., Fischer, Melissa A., Childress, Merrida A., Gorska, Agnieszka E., Ferrell, P. Brent, and Savona, Michael R.
- Subjects
Cell Survival ,Class I Phosphatidylinositol 3-Kinases ,Drug Synergism ,Leukemia, Myelomonocytic, Chronic ,Heterocyclic Compounds, 4 or More Rings ,Article ,Pyrimidines ,hemic and lymphatic diseases ,Cell Line, Tumor ,Nitriles ,Humans ,Pyrazoles ,Molecular Targeted Therapy ,Phosphoinositide-3 Kinase Inhibitors - Abstract
Chronic myelomonocytic leukemia (CMML) is a myelodysplastic syndrome/myeloproliferative neoplasm overlap syndrome characterized by monocytic proliferation in the presence of dysplastic bone marrow changes, inflammatory symptoms, and propensity for transformation to acute myeloid leukemia (AML), with a poor prognosis and limited treatment options. Unlike the α and β isoforms, the phosphatidylinositol-3-kinase (PI3K)-δ signaling protein is predominantly expressed by hematopoietic cells and therefore has garnered interest as a potential target for the treatment of lymphomas and leukemias. We revealed a pattern of increased PIK3CD:PIK3CA ratio in monocytic M5 AML patients and cell lines, and this ratio correlated with responsiveness to pharmacological PI3K-δ inhibition in vitro. Because CMML is a disease defined by monocytic clonal proliferation, we tested the PI3K-δ inhibitor umbralisib as a single agent and in combination with the JAK1/2 inhibitor ruxolitinib, in CMML. Our ex vivo experiments with primary CMML patient samples revealed synergistic inhibition of viability and clonogenicity with this combination. Phospho-specific flow cytometry revealed that dual inhibition had the unique ability to decrease STAT5, ERK, AKT, and S6 phosphorylation simultaneously, which offers a mechanistic hypothesis for the enhanced efficacy of the combination treatment. These preclinical data indicate promising activity by co-inhibition of PI3K-δ and JAK1/2 and support the use of ruxolitinib + umbralisib combination therapy in CMML under active clinical investigation.
- Published
- 2021