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Splicing modulation sensitizes chronic lymphocytic leukemia cells to venetoclax by remodeling mitochondrial apoptotic dependencies
Elisa ten Hacken, Rebecca Valentin, Fara Faye D. Regis, Jing Sun, Shanye Yin, Lillian Werner, Jing Deng, Michaela Gruber, Jessica Wong, Mei Zheng, Amy L. Gill, Michael Seiler, Peter Smith, Michael Thomas, Silvia Buonamici, Emanuela M. Ghia, Ekaterina Kim, Laura Z. Rassenti, Jan A. Burger, Thomas J. Kipps, Matthew L. Meyerson, Pavan Bachireddy, Lili Wang, Robin Reed, Donna Neuberg, Ruben D. Carrasco, Angela N. Brooks, Anthony Letai, Matthew S. Davids, Catherine J. Wu
Elisa ten Hacken, Rebecca Valentin, Fara Faye D. Regis, Jing Sun, Shanye Yin, Lillian Werner, Jing Deng, Michaela Gruber, Jessica Wong, Mei Zheng, Amy L. Gill, Michael Seiler, Peter Smith, Michael Thomas, Silvia Buonamici, Emanuela M. Ghia, Ekaterina Kim, Laura Z. Rassenti, Jan A. Burger, Thomas J. Kipps, Matthew L. Meyerson, Pavan Bachireddy, Lili Wang, Robin Reed, Donna Neuberg, Ruben D. Carrasco, Angela N. Brooks, Anthony Letai, Matthew S. Davids, Catherine J. Wu
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Research Article Hematology Therapeutics

Splicing modulation sensitizes chronic lymphocytic leukemia cells to venetoclax by remodeling mitochondrial apoptotic dependencies

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Abstract

The identification of targetable vulnerabilities in the context of therapeutic resistance is a key challenge in cancer treatment. We detected pervasive aberrant splicing as a characteristic feature of chronic lymphocytic leukemia (CLL), irrespective of splicing factor mutation status, which was associated with sensitivity to the spliceosome modulator, E7107. Splicing modulation affected CLL survival pathways, including members of the B cell lymphoma-2 (BCL2) family of proteins, remodeling antiapoptotic dependencies of human and murine CLL cells. E7107 treatment decreased myeloid cell leukemia-1 (MCL1) dependence and increased BCL2 dependence, sensitizing primary human CLL cells and venetoclax-resistant CLL-like cells from an Eμ-TCL1–based adoptive transfer murine model to treatment with the BCL2 inhibitor venetoclax. Our data provide preclinical rationale to support the combination of venetoclax with splicing modulators to reprogram apoptotic dependencies in CLL for treating venetoclax-resistant CLL cases.

Authors

Elisa ten Hacken, Rebecca Valentin, Fara Faye D. Regis, Jing Sun, Shanye Yin, Lillian Werner, Jing Deng, Michaela Gruber, Jessica Wong, Mei Zheng, Amy L. Gill, Michael Seiler, Peter Smith, Michael Thomas, Silvia Buonamici, Emanuela M. Ghia, Ekaterina Kim, Laura Z. Rassenti, Jan A. Burger, Thomas J. Kipps, Matthew L. Meyerson, Pavan Bachireddy, Lili Wang, Robin Reed, Donna Neuberg, Ruben D. Carrasco, Angela N. Brooks, Anthony Letai, Matthew S. Davids, Catherine J. Wu

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Figure 6

Splicing modulation overcomes venetoclax resistance in vivo in the Eμ-TCL1–based transplant model of CLL.

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Splicing modulation overcomes venetoclax resistance in vivo in the Eμ-TC...
(A) Schema of adoptive transfer of Eμ-TCL1–derived splenocytes into immunocompetent CD45.1 or immunodeficient NSG recipients. (B) Representative spleens of 5 vehicle control-treated and 5 E7107-treated animals, as harvested at the end of treatment. Scale bar: 1 cm. P value was calculated by Mann Whitney U test. (C) Flow cytometry analysis of peripheral blood (PB), spleen (SP), peritoneum (PC), and bone marrow (BM) to measure the percentage of B220+CD5+Igκ+ CLL cells from mice treated with vehicle control or with 2 mg/kg E7107. P values were calculated by Mann Whitney U test. (D) Western blot analysis of MCL1 protein levels in the splenocytes of 3 CD45.1 animals/group, as analyzed at the end of treatment with 2 mg/kg E7107. β-Actin is used as loading control. Molecular weights (in kDa) are indicated. (E) Representative spleens of 3 CD45.1 mice per group treated with vehicle control, single-agent 100 mg/kg venetoclax, single-agent 1 mg/kg E7107, or the combination of both, as harvested at the end of treatment (n = 7/group). Scale bar: 1 cm. Reported P values were calculated by 1-way ANOVA with Scheffé’s correction for multiple comparisons. (F) Flow cytometry analysis of the percentage of B220+CD5+Igκ+ CLL cells in spleens from mice belonging to the 4 treatment groups, as analyzed at the end of treatment. Reported P values were calculated by 1-way ANOVA with Scheffé’s correction. (G) Representative spleen sections (1 mouse/group) of CD45.1 transplants stained with H&E, anti-PAX5 (brown), and anti-CD5 (red) antibodies or anti-Ki67 at the end of a 2-week treatment with E7107 or venetoclax alone or in combination, as indicated in the figure. White dotted lines demarcate CD5+PAX5– T cell areas. The CLL infiltrate is composed of cells coexpressing cytoplasmic CD5 and nuclear PAX5. The first and second rows display images captured using a ×5 objective (scale bar: 1 cm), the third and fourth display images captured using a ×40 objective (scale bar: 100 μM). (H) Survival curve of NSG mice transplanted with TCL1 splenocytes and then treated with vehicle control (n = 11), 25–50 mg/kg venetoclax (n = 10), 2 mg/kg E7107 (n = 10), or the combination of venetoclax and E7107 (n = 11) for 2 weeks, followed by observation for survival. P values were calculated using the log-rank test with Bonferroni correction. The gray shaded area indicates treatment period.

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