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Pirtobrutinib inhibits wild-type and mutant Bruton’s tyrosine kinase-mediated signaling in chronic lymphocytic leukemia

Pirtobrutinib (LOXO-305), a reversible inhibitor of Bruton’s tyrosine kinase (BTK), was designed as an alternative strategy to treat ibrutinib-resistant disease that develops due to C481 kinase domain mutations. The clinical activity of pirtobrutinib has been demonstrated in CLL, but the mechanism o...

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Autores principales: Aslan, Burcu, Kismali, Gorkem, Iles, Lakesla R., Manyam, Ganiraju C., Ayres, Mary L., Chen, Lisa S., Gagea, Mihai, Bertilaccio, Maria Teresa Sabrina, Wierda, William G., Gandhi, Varsha
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group UK 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9123190/
https://www.ncbi.nlm.nih.gov/pubmed/35595730
http://dx.doi.org/10.1038/s41408-022-00675-9
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author Aslan, Burcu
Kismali, Gorkem
Iles, Lakesla R.
Manyam, Ganiraju C.
Ayres, Mary L.
Chen, Lisa S.
Gagea, Mihai
Bertilaccio, Maria Teresa Sabrina
Wierda, William G.
Gandhi, Varsha
author_facet Aslan, Burcu
Kismali, Gorkem
Iles, Lakesla R.
Manyam, Ganiraju C.
Ayres, Mary L.
Chen, Lisa S.
Gagea, Mihai
Bertilaccio, Maria Teresa Sabrina
Wierda, William G.
Gandhi, Varsha
author_sort Aslan, Burcu
collection PubMed
description Pirtobrutinib (LOXO-305), a reversible inhibitor of Bruton’s tyrosine kinase (BTK), was designed as an alternative strategy to treat ibrutinib-resistant disease that develops due to C481 kinase domain mutations. The clinical activity of pirtobrutinib has been demonstrated in CLL, but the mechanism of action has not been investigated. We evaluated pirtobrutinib in 4 model systems: first, MEC-1, a CLL cell line overexpressing BTK(WT), BTK(C481S), or BTK(C481R); second, murine models driven by MEC-1 overexpressing BTK(WT) or BTK(C481S); third, in vitro incubations of primary CLL cells; and finally, CLL patients during pirtobrutinib therapy (NCT03740529, ClinicalTrials.gov). Pirtobrutinib inhibited BTK activation as well as downstream signaling in MEC-1 isogenic cells overexpressing BTK(WT), BTK(C481S), or BTK(C481R). In mice, overall survival was short due to aggressive disease. Pirtobrutinib treatment for 2 weeks led to reduction of spleen and liver weight in BTK(WT) and BTK(C481S) cells, respectively. In vitro incubations of CLL cells harboring wild-type or mutant BTK had inhibition of the BCR pathway with either ibrutinib or pirtobrutinib treatment. Pirtobrutinib therapy resulted in inhibition of BTK phosphorylation and downstream signaling initially in all cases irrespective of their BTK profile, but these effects started to revert in cases with other BCR pathway mutations such as PLCG2 or PLEKHG5. Levels of CCL3 and CCL4 in plasma were marginally higher in patients with mutated BTK; however, there was a bimodal distribution. Both chemokines were decreased at early time points and mimicked BCR pathway protein changes. Collectively, these results demonstrate that pirtobrutinib is an effective BTK inhibitor for CLL harboring wild-type or mutant BTK as observed by changes in CCL3 and CCL4 biomarkers and suggest that alterations in BCR pathway signaling are the mechanism for its clinical effects. Long-term evaluation is needed for BTK gatekeeper residue variation along with pathologic kinase substitution or mutations in other proteins in the BCR pathway.
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spelling pubmed-91231902022-05-22 Pirtobrutinib inhibits wild-type and mutant Bruton’s tyrosine kinase-mediated signaling in chronic lymphocytic leukemia Aslan, Burcu Kismali, Gorkem Iles, Lakesla R. Manyam, Ganiraju C. Ayres, Mary L. Chen, Lisa S. Gagea, Mihai Bertilaccio, Maria Teresa Sabrina Wierda, William G. Gandhi, Varsha Blood Cancer J Article Pirtobrutinib (LOXO-305), a reversible inhibitor of Bruton’s tyrosine kinase (BTK), was designed as an alternative strategy to treat ibrutinib-resistant disease that develops due to C481 kinase domain mutations. The clinical activity of pirtobrutinib has been demonstrated in CLL, but the mechanism of action has not been investigated. We evaluated pirtobrutinib in 4 model systems: first, MEC-1, a CLL cell line overexpressing BTK(WT), BTK(C481S), or BTK(C481R); second, murine models driven by MEC-1 overexpressing BTK(WT) or BTK(C481S); third, in vitro incubations of primary CLL cells; and finally, CLL patients during pirtobrutinib therapy (NCT03740529, ClinicalTrials.gov). Pirtobrutinib inhibited BTK activation as well as downstream signaling in MEC-1 isogenic cells overexpressing BTK(WT), BTK(C481S), or BTK(C481R). In mice, overall survival was short due to aggressive disease. Pirtobrutinib treatment for 2 weeks led to reduction of spleen and liver weight in BTK(WT) and BTK(C481S) cells, respectively. In vitro incubations of CLL cells harboring wild-type or mutant BTK had inhibition of the BCR pathway with either ibrutinib or pirtobrutinib treatment. Pirtobrutinib therapy resulted in inhibition of BTK phosphorylation and downstream signaling initially in all cases irrespective of their BTK profile, but these effects started to revert in cases with other BCR pathway mutations such as PLCG2 or PLEKHG5. Levels of CCL3 and CCL4 in plasma were marginally higher in patients with mutated BTK; however, there was a bimodal distribution. Both chemokines were decreased at early time points and mimicked BCR pathway protein changes. Collectively, these results demonstrate that pirtobrutinib is an effective BTK inhibitor for CLL harboring wild-type or mutant BTK as observed by changes in CCL3 and CCL4 biomarkers and suggest that alterations in BCR pathway signaling are the mechanism for its clinical effects. Long-term evaluation is needed for BTK gatekeeper residue variation along with pathologic kinase substitution or mutations in other proteins in the BCR pathway. Nature Publishing Group UK 2022-05-20 /pmc/articles/PMC9123190/ /pubmed/35595730 http://dx.doi.org/10.1038/s41408-022-00675-9 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as 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 images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Article
Aslan, Burcu
Kismali, Gorkem
Iles, Lakesla R.
Manyam, Ganiraju C.
Ayres, Mary L.
Chen, Lisa S.
Gagea, Mihai
Bertilaccio, Maria Teresa Sabrina
Wierda, William G.
Gandhi, Varsha
Pirtobrutinib inhibits wild-type and mutant Bruton’s tyrosine kinase-mediated signaling in chronic lymphocytic leukemia
title Pirtobrutinib inhibits wild-type and mutant Bruton’s tyrosine kinase-mediated signaling in chronic lymphocytic leukemia
title_full Pirtobrutinib inhibits wild-type and mutant Bruton’s tyrosine kinase-mediated signaling in chronic lymphocytic leukemia
title_fullStr Pirtobrutinib inhibits wild-type and mutant Bruton’s tyrosine kinase-mediated signaling in chronic lymphocytic leukemia
title_full_unstemmed Pirtobrutinib inhibits wild-type and mutant Bruton’s tyrosine kinase-mediated signaling in chronic lymphocytic leukemia
title_short Pirtobrutinib inhibits wild-type and mutant Bruton’s tyrosine kinase-mediated signaling in chronic lymphocytic leukemia
title_sort pirtobrutinib inhibits wild-type and mutant bruton’s tyrosine kinase-mediated signaling in chronic lymphocytic leukemia
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9123190/
https://www.ncbi.nlm.nih.gov/pubmed/35595730
http://dx.doi.org/10.1038/s41408-022-00675-9
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