Combination of the ABL kinase inhibitor imatinib with the Janus kinase 2 inhibitor TG101348 for targeting residual BCR-ABL-positive cells.
BACKGROUND
The ABL kinase inhibitor imatinib is highly effective in treating most, but not all, patients with chronic myeloid leukemia (CML). This is because residual CML cells are generally present in the bone marrow microenvironment and are refractory to imatinib. Hematopoietic cytokine receptor signaling is mediated by Janus kinases (JAKs) and their downstream transcription factor, signal transducer and activator of transcription (STAT). TG101348 (SAR302503) is an oral inhibitor of JAK2.


METHODS
We investigated the efficacy of imatinib and TG101348 using the break point cluster region-c-Abelson (BCR-ABL)-positive cell line and primary CML samples wherein leukemia cells were protected by a feeder cell line (HS-5).


RESULTS
Imatinib treatment resulted in partial inhibition of cell growth in HS-5-conditioned medium. Furthermore, combined treatment with imatinib and TG101348 abrogated the protective effects of HS-5-conditioned medium on K562 cells. Phosphorylation of Crk-L, a BCR-ABL substrate, decreased considerably, while apoptosis increased. In addition, the combined treatment of CD34-positive primary samples resulted in considerably increased cytotoxicity, decreased Crk-L phosphorylation, and increased apoptosis. We also investigated TG101348 activity against feeder cells and observed that STAT5 phosphorylation, granulocyte macrophage colony-stimulating factor, and interleukin 6 levels decreased, indicating reduced cytokine production in HS-5 cells treated with TG101348.


CONCLUSIONS
These results showed that JAK inhibitors may enhance the cytotoxic effect of imatinib against residual CML cells and that a combined approach may be a powerful strategy against the stroma-associated drug resistance of Philadelphia chromosome-positive cells.
First Department of Internal Medicine, Tokyo Medical University, Shinjuku-ku, Tokyo 160-0023, Japan. okabe@tokyo-med.ac.jp.
Seiichi
S
Okabe
Tetsuzo
T
Tauchi
Seiichiro
S
Katagiri
Yuko
Y
Tanaka
Kazuma
K
Ohyashiki
D048868:Adaptor Proteins, Signal Transducing / Q000378:metabolism; D000818:Animals; D017209:Apoptosis / Q000187:drug effects; D001549:Benzamides / Q000494:pharmacology*; D002460:Cell Line; D002470:Cell Survival / Q000187:drug effects; D018920:Coculture Techniques; D016207:Cytokines / Q000378:metabolism; D004357:Drug Synergism; D061252:Feeder Cells / Q000187:drug effects / Q000378:metabolism; D005260:Female; D006801:Humans; D000068877:Imatinib Mesylate; D015151:Immunoblotting; D053614:Janus Kinase 2 / Q000037:antagonists & inhibitors* / Q000235:genetics / Q000378:metabolism; D020014:K562 Cells; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology; D008807:Mice, Inbred BALB C; D008819:Mice, Nude; D018365:Neoplasm, Residual; D009687:Nuclear Proteins / Q000378:metabolism; D010766:Phosphorylation / Q000187:drug effects; D010879:Piperazines / Q000494:pharmacology*; D047428:Protein Kinase Inhibitors / Q000494:pharmacology; D016315:Proto-Oncogene Proteins c-abl / Q000037:antagonists & inhibitors* / Q000378:metabolism; D011743:Pyrimidines / Q000494:pharmacology*; D011759:Pyrrolidines / Q000494:pharmacology*; D034622:RNA Interference; D050799:STAT5 Transcription Factor / Q000378:metabolism; D013449:Sulfonamides / Q000494:pharmacology*; D000096926:Benzenesulfonamides
D048868:Adaptor Proteins, Signal Transducing; D001549:Benzamides; D016207:Cytokines; D000068877:Imatinib Mesylate; D053614:Janus Kinase 2; D009687:Nuclear Proteins; D010879:Piperazines; D047428:Protein Kinase Inhibitors; D016315:Proto-Oncogene Proteins c-abl; D011743:Pyrimidines; D011759:Pyrrolidines; D050799:STAT5 Transcription Factor; D013449:Sulfonamides; C082869:CRKL protein; C528327:fedratinib; D000096926:Benzenesulfonamides