Quantitative proteomic analysis reveals maturation as a mechanism underlying glucocorticoid resistance in B lineage ALL and re‐sensitization by JNK inhibition

Glucocorticoid (GC) resistance is a continuing clinical problem in childhood acute lymphoblastic leukaemia (ALL) but the underlying mechanisms remain unclear. A proteomic approach was used to compare profiles of the B‐lineage ALL GC‐sensitive cell line, PreB 697, and its GC‐resistant sub‐line, R3F9, pre‐ and post‐dexamethasone exposure. PAX5, a transcription factor critical to B‐cell development was differentially regulated in the PreB 697 compared to the R3F9 cell line in response to GC. PAX5 basal protein expression was less in R3F9 compared to its GC‐sensitive parent and confirmed to be lower in other GC‐resistant sub‐lines of Pre B 697 and was associated with a decreased expression of the PAX5 transcriptional target, CD19. Gene set enrichment analysis showed that increasing GC‐resistance was associated with differentiation from preB‐II to an immature B‐lymphocyte stage. GC‐resistant sub‐lines were shown to have higher levels of phosphorylated JNK compared to the parent line and JNK inhibition caused re‐sensitization to GC. Exploiting this maturation may be key to overcoming GC resistance and targeting signalling pathways linked to the maturation state, such as JNK, may be a novel approach.