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Oncotarget. 2018 Dec 28;9(102):37777-37789. doi: 10.18632/oncotarget.26540. eCollection 2018 Dec 28.

Genetic biomarkers predict response to dual BCL-2 and MCL-1 targeting in acute myeloid leukaemia cells.

Oncotarget

Martin Grundy, Sahana Balakrishnan, Matthew Fox, Claire H Seedhouse, Nigel H Russell

Affiliations

  1. Clinical Haematology, Nottingham University Hospitals, Nottingham, United Kingdom.
  2. Department of Haematology, Division of Cancer and Stem Cells, University of Nottingham, Nottingham, United Kingdom.

PMID: 30701031 PMCID: PMC6340871 DOI: 10.18632/oncotarget.26540

Abstract

Acute myeloid leukaemia (AML) cells often up-regulate pro-survival members of the BCL-2 protein family, such as BCL-2 and MCL-1, to avoid apoptosis. Venetoclax (ABT-199) targets BCL-2 and has shown promising efficacy in AML but over-expression of MCL-1 can cause resistance. A co-operative approach, targeting both BCL-2 and MCL-1 may therefore prove beneficial. This study investigated the potential synergistic relationship between Venetoclax and the MCL-1 inhibitor S63845 in AML cells. We treated MV4-11 cells and primary AML samples for 4 hours with Venetoclax, S63845 or the combination. We used a short-term flow cytometric technique to assess synergy using cytochrome C release as a read out of response. The combination of Venetoclax and S63845 produced a synergistic apoptotic response in MV4-11 cells and primary samples, including the leukaemia re-populating leukaemic stem cell (LSC) population, in 92% of the samples. Known molecular biomarkers of response to BCL-2 and MCL-1 targeting agents were corroborated, and augmented, with the short-term functional assay. The assay also predicted potential biomarkers of response to the combination of BCL-2 and MCL-1 targeting agents. Primary samples with an IDH2_140 mutation were more sensitive to Venetoclax as a single agent whereas samples with a FLT3-ITD mutation were more resistant. This resistance could be reversed when combined with S63845. All FLT3-ITD and NPM1 mutated samples were sensitive to the combination of drugs. We report that co-operatively targeting BCL-2 and MCL-1 may be beneficial in AML and a short-term

Keywords: AML; BCL-2; MCL-1; S63845; Venetoclax

Conflict of interest statement

CONFLICTS OF INTEREST The authors declare no conflicts of interest.

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