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Axitinib and Sorafenib Are Potent in Tyrosine Kinase Inhibitor Resistant

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Axitinib and Sorafenib Are Potent in Tyrosine Kinase Inhibitor Resistant Halbach et al. Cell Communication and Signaling (2016) 14:6 DOI 10.1186/s12964-016-0129-y SHORTREPORT Open Access Axitinib and sorafenib are potent in tyrosine kinase inhibitor resistant chronic myeloid leukemia cells Sebastian Halbach1,2,3, Zehan Hu4,6, Christine Gretzmeier4,6, Julia Ellermann1,2, Franziska U. Wöhrle1,2,3,5, Jörn Dengjel4,5,6* and Tilman Brummer1,5,7* Abstract Background: Chronic myeloid leukemia (CML) is driven by the fusion kinase Bcr-Abl. Bcr-Abl tyrosine kinase inhibitors (TKIs), such as imatinib mesylate (IM), revolutionized CML therapy. Nevertheless, about 20 % of CMLs display primary or acquired TKI resistance. TKI resistance can be either caused by mutations within the Bcr-Abl kinase domain or by aberrant signaling by its effectors, e.g. Lyn or Gab2. Bcr-Abl mutations are frequently observed in TKI resistance and can only in some cases be overcome by second line TKIs. In addition, we have previously shown that the formation of Gab2 complexes can be regulated by Bcr-Abl and that Gab2 signaling counteracts the efficacy of four distinct Bcr-Abl inhibitors. Therefore, TKI resistance still represents a challenge for disease management and alternative therapies are urgently needed. Findings: Using different CML cell lines and models, we identified the clinically approved TKIs sorafenib (SF) and axitinib (AX) as drugs overcoming the resistance mediated by the Bcr AblT315I mutant as well as the one mediated by Gab2 and LynY508F. In addition, we demonstrated that AX mainly affects the Bcr-Abl/Grb2/Gab2 axis, whereas SF seems to act independently of the fusion kinase and most likely by blocking signaling pathways up- and downstream of Gab2. Conclusion: We demonstrate that SF and AX show potency in various and mechanistically distinct scenarios of TKI resistance, including Bcr-AblT315I as well as Lyn- and Gab2-mediated resistances. Our data invites for further evaluation und consideration of these inhibitors in the treatment of TKI resistant CML. Keywords: Chronic myeloid leukemia, CML, TKI resistance, Imatinib, Sorafenib, Axitinib, Ponatinib, Gab2, Hyperactive Lyn, Bcr-Abl Findings inhibitors (TKIs), such as Imatinib mesylate (IM), revolu- Chronic myeloid leukemia (CML) represents about 20 % tionized CML therapy. Nevertheless, about 20 % of CMLs of all cases of adult leukemia and is caused by a chromo- display primary or acquired TKI resistance, which repre- somal translocation between chromosomes 9 and 22 lead- sents a challenge for disease management [2]. TKI resist- ing to the expression of the fusion kinase Bcr-Abl [1]. ance is often, but not exclusively, caused by mutations This oncogenic tyrosine kinase generates its own signaling within the kinase domain of Bcr-Abl [3] (Fig. 1a) and can network with various components such as the Src kinase in some cases be overcome by second generation TKIs, Lyn or the docking protein Gab2. Bcr-Abl tyrosine kinase like dasatinib (DST), nilotinib (NL), or ponatinib (PO). In the case of the gatekeeper mutation T315I, PO is the only clinically approved inhibitor showing a therapeutic effect. * Correspondence: [email protected]; tilman.brummer@ zbsa.uni-freiburg.de However, cardio-vascular side-effects often accompany 4Freiburg Institute for Advanced Studies (FRIAS), and Center for Biological PO treatment [4] and therefore alternative therapies are Systems Analysis (ZBSA), University of Freiburg, Freiburg, Germany urgently needed. In addition, about 40 % of resistances are 1Institute of Molecular Medicine and Cell Research (IMMZ), Faculty of Medicine, University of Freiburg, Freiburg, Germany Bcr-Abl mutation-independent [5] and still ill-defined at Full list of author information is available at the end of the article © 2016 Halbach et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Halbach et al. Cell Communication and Signaling (2016) 14:6 Page 2 of 7 Fig. 1 (See legend on next page.) Halbach et al. Cell Communication and Signaling (2016) 14:6 Page 3 of 7 (See figure on previous page.) Fig. 1 Sorafenib and axitinib can overcome TKI resistance. a Overview of resistance mechanisms in CML. b/c KBM5 and KBM5-T315I cells were exposed to the indicated inhibitors or DMSO for 48 h. Cells were stained with 7-AAD and assessed for viability (b) or metabolic activity (MTT assay) (c). d KBM5 and KBM5-T315I cells were exposed to the indicated inhibitors or DMSO for 4 h. Cells were analyzed by western blotting using the indicated antibodies. e/f K562tet Gab2 cells, exposed to 1 μg/ml doxycycline 48 h prior to the treatment or non-induced cells were treated with the indicated inhibitors or DMSO for 72 h. Cells were stained with PI and assessed for viability (e) or metabolic activity (MTT-assay) (f). g K562tet Vector and Gab2 cells were exposed to 1 μg/ml doxycycline 48 h prior to the treatment with the indicated inhibitors or DMSO for 4 h. Cells were analyzed by western blotting using the indicated antibodies. Relevant statistically significant effects are indicated by asterisks, all statistical data can be found in the supplement (b/c/e/f;Additionalfile8) the molecular level. These resistances are often caused by higher efficacy in downregulating the phosphorylation aberrant signaling of Bcr-Abl effectors such as the docking of ABL (Y245) and CRKL (Y207) in Bcr-Ablwt and Bcr- protein Gab2 [6–8] or the Src kinase Lyn [9] (Fig. 1a). AblT315I cellscomparedtoSFindicatingthatAXhasa Using different CML cell lines and models, we aimed to higher impact on the Bcr-Abl activity (Figs. 1d and identify new approaches to overcome TKI resistance Additional file 2: Figure S2A). However, SF, AX and PO caused by Bcr-Abl mutations or aberrant downstream sig- reduced the phosphorylation of ERK and Gab2 (Y452) naling. Therefore, we screened inhibitors for their ability in Bcr-Ablwt and Bcr-AblT315I expressing cells, whereas to inhibit the activity of T315I mutated Bcr-Abl, or to IM,DSTandNLwereonlyactiveintheformer.Thus, break Gab2- or Lyn-mediated resistance. Our previous SF and AX break T315I mediated resistance (Fig. 1d work on Gab2 mediated TKI resistance in CML cells sug- and Additional file 2: Figure S2A). In addition, these re- gested that this docking protein, due to its position down- sults suggest that the phosphorylation of Gab2 (Y452) stream of both growth factor receptors and Bcr-Abl [7], might serve as a valuable biomarker in CML manage- protects against TKIs as it can be tyrosine phosphorylated ment. Our data is in line with very recent manuscripts by by the former and thereby drive the activation of pro- Pemovska et al. and Okabe et al. demonstrating the leukemogenic pathways in the absence of Bcr-Abl activity. potency of axitinib in Bcr-AblT315I positive Ba/F3 and Therefore, we chose inhibitors of growth factor receptors, patient-derived cells [19, 20]. In contrast to the other in- as they are known to play a role in primary TKI resistance hibitors, SF provoked an upregulation of pAKT (Fig. 1d and to promote Gab2 and Lyn signaling [10, 11]. We iden- and Additional file 2: Figure S2A), which might be ex- tified the clinically approved multikinase inhibitors sorafe- plained by the strong inhibition of the ERK pathway by SF nib (SF) and axitinib (AX) as compounds reducing the and therefore the loss of a negative feedback on the PI3K/ viability and metabolic activity of Bcr-Abl transformed AKT pathway [21]. However, SF effectively kills Bcr-Ablwt Ba/F3 cells (Additional file 1: Figure S1A/B). While SF and Bcr-AblT315I expressing cells (Fig. 1b/c), which is also mainly targets Raf-1 and B-Raf, both compounds in- supported by an independent study showing effects of SF hibit the VEGF receptors 1–3 [12, 13]. Interestingly, on Bcr-Abl positive cells [17]. these inhibitors were significantly less active in non- Bcr-Abl mutation independent TKI resistance repre- transformed Ba/F3 cells, suggesting an inhibition spe- sents an underestimated and mechanistically less-defined cific for Bcr-Abl or its signaling network (Additional problem in CML therapy and accounts for about 40 % of file 1: Figure S1A/B). In contrast, the FLT3/PDGFR TKI refractory disease, thereby representing a serious clin- inhibitors tandutinib (TD) and sunitinib (Sun) [14, 15] ical problem [5]. Therefore, we tested all clinically used displayed activity in Bcr-Abl transformed and non- TKIs of our panel, i.e. IM, DST, NL and PO but also SF transformed Ba/F3 cells (Additional file 1: Figure S1A). and AX, in Lyn- and Gab2-mediated TKI resistance. First, Next, we tested SF and AX in KBM-5 CML cells, either we analyzed K562 cells overexpressing the hyperactive expressing wildtype (wt) or mutant Bcr-Abl (T315I) Lyn mutant Y508F, which displayed IM resistance in an from its endogenous Philadelphia chromosome [16]. independent study [9]. Again, SF and AX reduced the via- Based on previous publications showing titrations of SF bility and metabolic activity in this setting (Additional file in IM resistant CML models [17, 18], we chose a con- 1: Figure S1D/E). Interestingly, DST, NL and PO also centration of 10 μM. For AX, we titrated the optimal overcame LynY508F-mediated resistance (Additional file 1: inhibitor concentration using an MTT assay (Add- Figure S1D/E), suggesting that Lyn-mediated resilience itional file 1: Figure S1C). Both inhibitors overcame represents only a minor and less critical mechanism of TKI resistance imposed by Bcr-AblT315I (Fig.
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