PP2A inhibition sensitizes cancer stem cells to ABL tyrosine kinase inhibitors in BCR-ABL+ human leukemia

D Lai, M Chen, J Su, X Liu, K Rothe, K Hu… - Science translational …, 2018 - science.org
D Lai, M Chen, J Su, X Liu, K Rothe, K Hu, DL Forrest, CJ Eaves, GB Morin, X Jiang
Science translational medicine, 2018science.org
Overcoming drug resistance and targeting leukemic stem cells (LSCs) remain major
challenges in curing BCR-ABL+ human leukemia. Using an advanced drug/proliferation
screen, we have uncovered a prosurvival role for protein phosphatase 2A (PP2A) in tyrosine
kinase inhibitor (TKI)–insensitive leukemic cells, regulated by an Abelson helper integration
site–1–mediated PP2A–β-catenin–BCR-ABL–JAK2 protein complex. Genetic and
pharmacological inhibition of PP2A impairs survival of TKI nonresponder cells and …
Overcoming drug resistance and targeting leukemic stem cells (LSCs) remain major challenges in curing BCR-ABL+ human leukemia. Using an advanced drug/proliferation screen, we have uncovered a prosurvival role for protein phosphatase 2A (PP2A) in tyrosine kinase inhibitor (TKI)–insensitive leukemic cells, regulated by an Abelson helper integration site–1–mediated PP2A–β-catenin–BCR-ABL–JAK2 protein complex. Genetic and pharmacological inhibition of PP2A impairs survival of TKI nonresponder cells and sensitizes them to TKIs in vitro, inducing a dramatic loss of several key proteins, including β-catenin. We also demonstrate that the clinically validated PP2A inhibitors LB100 and LB102, in combination with TKIs, selectively eliminate treatment-naïve TKI-insensitive stem and progenitor cells, while sparing healthy counterparts. In addition, PP2A inhibitors and TKIs act synergistically to inhibit the growth of TKI-insensitive cells, as assessed by combination index analysis. The combination eliminates infiltrated BCR-ABL+ blast cells and drug-insensitive LSCs and confers a survival advantage in preclinical xenotransplant models. Thus, dual PP2A and BCR-ABL inhibition may be a valuable therapeutic strategy to synergistically target drug-insensitive LSCs that maintain minimal residual disease in patients.
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