Researchers have discovered new generation of drugs to fight multiple types of leukemia and lymphoma

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UT Health San Antonio researchers, working with collaborators at the University of Florida, have discovered a safe and potent next generation of drugs to fight multiple types of leukemia and lymphoma in adults and children.

The journal Nature Medicine reported the findings Dec. 2.

“This is a new class of drugs called PROTACs that target an essential survival protein in cancer cells called BCL-XL,” said research co-author Robert Hromas, M.D., FACP, professor of medicine and dean of the university’s Joe R. and Teresa Lozano Long School of Medicine.

“The previous drugs that have targeted BCL-XL decrease platelets dangerously, with a high risk of bleeding.

Our drug markedly reduces that risk, and thus would be potentially far more useful in cancer patients.”

The PROTAC reported here would treat T-cell malignancies such as T-cell acute leukemia and T-cell lymphoma, Dr. Hromas, a noted hematologist and oncologist, said.

T cells are produced by a gland in the upper chest called the thymus.

These cells are very important participants in the body’s immune response. When they turn cancerous, they rely on BCL-XL for survival.

Dr. Hromas is joined on the paper by several co-authors from the Greehey Children’s Cancer Research Institute at UT Health San Antonio.

“PROTAC drugs degrade the BCL-XL protein rather than merely inhibiting it,” said Peter Houghton, Ph.D., professor of molecular medicine and director of the Greehey Institute. “Potentially this class of d


There is an urgent need for new therapeutic agents to treat patients with T-cell lymphoma (TCL). Multiple hematologic malignancies evade apoptosis through overexpression of anti-apoptotic proteins in the BCL-2 family, including BCL-2, BCL-XL, and MCL-1.

We and others recently showed that a large fraction of cutaneous and peripheral TCL cell lines, patient-derived xenografts and primary patient samples depend on BCL-XL for survival (Koch et al, Blood. 2019; 133:566-575). These findings suggest that targeted inhibition of BCL-XL could offer therapeutic benefit for some TCL patients.

Currently available small molecule BCL-XL inhibitors have failed during clinical development due to on-target and dose-limiting thrombocytopenia, as platelets depend on BCL-XL for survival. To overcome this toxicity, we developed DT2216, a novel proteolysis-targeting chimera (PROTAC) that targets BCL-XL to the Von Hippel Lindau (VHL) E3 ligase for proteasomal degradation.

We selected the VHL ligase because platelets express very low levels of VHL, suggesting that they would be spared from the pro-apoptotic effects of DT2216. Here we examined the therapeutic potential of DT2216 against different TCL cell lines in vitro and in TCL xenograft mouse models.

We first profiled the expression of different anti-apoptotic BCL-2 family proteins in multiple TCL cell lines (Fig. 1a) and tested their sensitivity to selective inhibitors for different BCL-2 family proteins as well as commonly-used chemotherapeutic agents (Table 1).

The results showed that the TCL cells with higher levels of BCL-XL were more resistant to doxorubicin, etoposide and vincristine. DT2216 was more effective in reducing the viability of BCL-XL-dependent TCLs such as MyLa cells than ABT263 (a dual BCL-2/XL inhibitor).

The EC50 value of DT2216 for MyLa TCL cells was less than 10 nM and DT2216 killed MyLa cells through induction of BCL-XL degradation and cellular apoptosis (Fig. 1b-f). Moreover, DT2216 was less toxic to human platelets than ABT263 in vitro with an EC50 > 3 μM. We further validated the effect and specificity of DT2216 in MJ cells, another BCL-XL-dependent TCL cell line, and demonstrated that its antitumor activity was dependent on proteasome activity.

In vivo, when DT2216 was given to mice with MyLa TCL xenografts by i.p. injections at 10 mpk/q4d, it significantly inhibited tumor growth, whereas ABT263 at the same dose had no significant effect (Fig. 1g). More importantly, after MyLa xenografted mice failed to respond to ABT263 treatment, we subjected the mice to DT2216 (10 mpk/q4d), which induced rapid tumor regression and increased the survival of the mice without causing significant reduction of blood platelets (Fig. 1h). These effects were associated with a significant reduction in BCL-XL expression and activation of caspase cascade in tumor xenografts.

However, some TCLs depend on not only BCL-XL but also BCL-2 or MCL-1 for evasion of apoptosis. Therefore, we next assessed the therapeutic potential of DT2216 in combination with a selective BCL-2 inhibitor using the TCL PDX DFTL-28776, which depends on both BCL-XL and BCL-2 for survival. We found that the combination of DT2216 with ABT199 (a selective BCL-2 inhibitor) could more effectively kill DFTL-28776 TCL cells than either agent alone in cell culture. The effect of the combination treatment on the growth of DFTL-28776 PDX in vivo is under examination.

Collectively, our findings suggest that targeting BCL-XL using DT2216 can selectively kill BCL-XL-dependent TCL cells without causing significant platelet toxicity. Moreover, the combination of DT2216 with an inhibitor targeting other anti-apoptotic BCL-2 family proteins may have broad therapeutic utility against multiple TCL types and other cancers dependent on BCL-XL.

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More information: Sajid Khan et al, A selective BCL-XL PROTAC degrader achieves safe and potent antitumor activity, Nature Medicine (2019). DOI: 10.1038/s41591-019-0668-z

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