CXCR4 inhibition enhances efficacy of FLT3 inhibitors in FLT3-mutated AML augmented by suppressed TGF-β signaling

BR Kim, SH Jung, AR Han, G Park, HJ Kim, B Yuan… - Cancers, 2020 - mdpi.com
BR Kim, SH Jung, AR Han, G Park, HJ Kim, B Yuan, VL Battula, M Andreeff, M Konopleva…
Cancers, 2020mdpi.com
Given the proven importance of the CXCL12/CXCR4 axis in the stroma–acute myeloid
leukemia (AML) interactions and the rapid emergence of resistance to FLT3 inhibitors, we
investigated the efficacy and safety of a novel CXCR4 inhibitor, LY2510924, in combination
with FLT3 inhibitors in preclinical models of AML with FLT3-ITD mutations (FLT3-ITD-AML).
Quizartinib, a potent FLT3 inhibitor, induced apoptosis in FLT3-ITD-AML, while LY2510924
blocked surface CXCR4 without inducing apoptosis. LY2510924 significantly reversed …
Given the proven importance of the CXCL12/CXCR4 axis in the stroma–acute myeloid leukemia (AML) interactions and the rapid emergence of resistance to FLT3 inhibitors, we investigated the efficacy and safety of a novel CXCR4 inhibitor, LY2510924, in combination with FLT3 inhibitors in preclinical models of AML with FLT3-ITD mutations (FLT3-ITD-AML). Quizartinib, a potent FLT3 inhibitor, induced apoptosis in FLT3-ITD-AML, while LY2510924 blocked surface CXCR4 without inducing apoptosis. LY2510924 significantly reversed stroma-mediated resistance against quizartinib mainly through the MAPK pathway. In mice with established FLT3-ITD-AML, LY2510924 induced durable mobilization and differentiation of leukemia cells, resulting in enhanced anti-leukemia effects when combined with quizartinib, whereas transient effects were seen on non-leukemic blood cells in immune-competent mice. Sequencing of the transcriptome of the leukemic cells surviving in vivo treatment with quizartinib and LY2510924 revealed that genes related to TGF-β signaling may confer resistance against the drug combination. In co-culture experiments of FLT3-ITD-AML and stromal cells, both silencing of TGF-β in stromal cells or TGF-β-receptor kinase inhibitor enhanced apoptosis by combined treatment. Disruption of the CXCL12/CXCR4 axis in FLT3-ITD-AML by LY2510924 and its negligible effects on normal immunocytes could safely enhance the potency of quizartinib, which may be further improved by blockade of TGF-β signaling.
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