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Second generation tyrosine kinase inhibitors prevent disease progression in high-risk (high CIP2A) chronic myeloid leukaemia patients.
Lucas, Claire Harris, Robert Holcroft, Alison Scott, Laura Carmell, Natasha McDonald, Elizabeth Polydoros, Fotis Clark, Richard E.
Lucas, Claire
Harris, Robert
Holcroft, Alison
Scott, Laura
Carmell, Natasha
McDonald, Elizabeth
Polydoros, Fotis
Clark, Richard E.
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Publication Date
2015-03-13
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Abstract
High cancerous inhibitor of PP2A (CIP2A) protein levels at diagnosis of chronic myeloid leukaemia (CML) are predictive of disease progression in imatinib-treated patients. It is not known whether this is true in patients treated with second generation tyrosine kinase inhibitors (2G TKI) from diagnosis, and whether 2G TKIs modulate the CIP2A pathway. Here, we show that patients with high diagnostic CIP2A levels who receive a 2G TKI do not progress, unlike those treated with imatinib (P=<0.0001). 2G TKIs induce more potent suppression of CIP2A and c-Myc than imatinib. The transcription factor E2F1 is elevated in high CIP2A patients and following 1 month of in vivo treatment 2G TKIs suppress E2F1 and reduce CIP2A; these effects are not seen with imatinib. Silencing of CIP2A, c-Myc or E2F1 in K562 cells or CML CD34+ cells reactivates PP2A leading to BCR-ABL suppression. CIP2A increases proliferation and this is only reduced by 2G TKIs. Patients with high CIP2A levels should be offered 2G TKI treatment in preference to imatinib. 2G TKIs disrupt the CIP2A/c-Myc/E2F1 positive feedback loop, leading to lower disease progression risk. The data supports the view that CIP2A inhibits PP2Ac, stabilising E2F1, creating a CIP2A/c-Myc/E2F1 positive feedback loop, which imatinib cannot overcome.
Citation
Lucas, C. M., Harris, R. J., Holcroft, A. K., Scott, L. J., Carmell, N., McDonald, E., Polydoros, F. & Clark, R. E. (2015). Second generation tyrosine kinase inhibitors prevent disease progression in high-risk (high CIP2A) chronic myeloid leukaemia patients. Leukemia, 29(7), 1514-1523.
Publisher
Nature
Journal
Leukemia
Research Unit
DOI
10.1038/leu.2015.71
PubMed ID
PubMed Central ID
Type
Article
Language
en
Description
Series/Report no.
ISSN
0887-6924
EISSN
1476-5551