JAK1/2 and BCL2 inhibitors synergize to counteract bone marrow stromal cell-induced protection of AML

Research output: Contribution to journalJournal articleResearchpeer-review

  • Riikka Karjalainen
  • Tea Pemovska
  • Mihaela Popa
  • Minxia Liu
  • Komal K Javarappa
  • Muntasir M Majumder
  • Bhagwan Yadav
  • David Tamborero
  • Jing Tang
  • Dmitrii Bychkov
  • Mika Kontro
  • Alun Parsons
  • Minna Suvela
  • Mireia Mayoral Safont
  • Kimmo Porkka
  • Tero Aittokallio
  • Olli Kallioniemi
  • Emmet McCormack
  • Bjørn T Gjertsen
  • Jonathan Knowles
  • Caroline A Heckman

The bone marrow (BM) provides a protective microenvironment to support the survival of leukemic cells and influence their response to therapeutic agents. In acute myeloid leukemia (AML), the high rate of relapse may in part be a result of the inability of current treatment to effectively overcome the protective influence of the BM niche. To better understand the effect of the BM microenvironment on drug responses in AML, we conducted a comprehensive evaluation of 304 inhibitors, including approved and investigational agents, comparing ex vivo responses of primary AML cells in BM stroma-derived and standard culture conditions. In the stroma-based conditions, the AML patient cells exhibited significantly reduced sensitivity to 12% of the tested compounds, including topoisomerase II, B-cell chronic lymphocytic leukemia/lymphoma 2 (BCL2), and many tyrosine kinase inhibitors (TKIs). The loss of TKI sensitivity was most pronounced in patient samples harboring FLT3 or PDGFRB alterations. In contrast, the stroma-derived conditions enhanced sensitivity to Janus kinase (JAK) inhibitors. Increased cell viability and resistance to specific drug classes in the BM stroma-derived conditions was a result of activation of alternative signaling pathways mediated by factors secreted by BM stromal cells and involved a switch from BCL2 to BCLXL-dependent cell survival. Moreover, the JAK1/2 inhibitor ruxolitinib restored sensitivity to the BCL2 inhibitor venetoclax in AML patient cells ex vivo in different model systems and in vivo in an AML xenograft mouse model. These findings highlight the potential of JAK inhibitors to counteract stroma-induced resistance to BCL2 inhibitors in AML.

Original languageEnglish
JournalBlood
Volume130
Issue number6
Pages (from-to)789-802
Number of pages14
ISSN0006-4971
DOIs
Publication statusPublished - 10 Aug 2017
Externally publishedYes

    Research areas

  • Animals, Antineoplastic Agents/pharmacology, Bone Marrow Cells/drug effects, Bridged Bicyclo Compounds, Heterocyclic/pharmacology, Cell Line, Drug Resistance, Neoplasm/drug effects, Drug Synergism, Female, Humans, Janus Kinase 1/antagonists & inhibitors, Janus Kinase 2/antagonists & inhibitors, Leukemia, Myeloid, Acute/drug therapy, Mice, Protein Kinase Inhibitors/pharmacology, Proto-Oncogene Proteins c-bcl-2/antagonists & inhibitors, Pyrazoles/pharmacology, STAT Transcription Factors/metabolism, Signal Transduction/drug effects, Stromal Cells/drug effects, Sulfonamides/pharmacology, Tumor Cells, Cultured

ID: 199423236