Multi-agent chemotherapy overcomes glucocorticoid resistance conferred by a BIM deletion polymorphism in pediatric acute lymphoblastic leukemia

PLoS One. 2014 Aug 4;9(8):e103435. doi: 10.1371/journal.pone.0103435. eCollection 2014.

Abstract

A broad range of anti-cancer agents, including glucocorticoids (GCs) and tyrosine kinase inhibitors (TKIs), kill cells by upregulating the pro-apoptotic BCL2 family member, BIM. A common germline deletion in the BIM gene was recently shown to favor the production of non-apoptotic BIM isoforms, and to predict inferior responses in TKI-treated chronic myeloid leukemia (CML) and EGFR-driven lung cancer patients. Given that both in vitro and in vivo GC resistance are predictive of adverse outcomes in acute lymphoblastic leukemia (ALL), we hypothesized that this polymorphism would mediate GC resistance, and serve as a biomarker of poor response in ALL. Accordingly, we used zinc finger nucleases to generate ALL cell lines with the BIM deletion, and confirmed the ability of the deletion to mediate GC resistance in vitro. In contrast to CML and lung cancer, the BIM deletion did not predict for poorer clinical outcome in a retrospective analysis of 411 pediatric ALL patients who were uniformly treated with GCs and chemotherapy. Underlying the lack of prognostic significance, we found that the chemotherapy agents used in our cohort (vincristine, L-asparaginase, and methotrexate) were each able to induce ALL cell death in a BIM-independent fashion, and resensitize BIM deletion-containing cells to GCs. Together, our work demonstrates how effective therapy can overcome intrinsic resistance in ALL patients, and suggests the potential of using combinations of drugs that work via divergent mechanisms of cell killing to surmount BIM deletion-mediated drug resistance in other cancers.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols / pharmacology
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Apoptosis Regulatory Proteins / genetics*
  • Bcl-2-Like Protein 11
  • Cell Line, Tumor
  • Child
  • Child, Preschool
  • Dexamethasone / pharmacology
  • Female
  • Gene Deletion
  • Humans
  • Infant
  • Male
  • Membrane Proteins / genetics*
  • Metabolism, Inborn Errors / drug therapy*
  • Metabolism, Inborn Errors / genetics*
  • Polymorphism, Genetic*
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / drug therapy*
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / genetics*
  • Proto-Oncogene Proteins / genetics*
  • Receptors, Glucocorticoid / deficiency*
  • Receptors, Glucocorticoid / genetics
  • Retrospective Studies

Substances

  • Apoptosis Regulatory Proteins
  • BCL2L11 protein, human
  • Bcl-2-Like Protein 11
  • Membrane Proteins
  • Proto-Oncogene Proteins
  • Receptors, Glucocorticoid
  • Dexamethasone

Supplementary concepts

  • Glucocorticoid Receptor Deficiency

Grants and funding

STO was supported by the Leukemia & Lymphoma Society Translational Research Program Grant (R913-302-026-597) www.lls.org. AEY was supported by the Singapore National Medical Research Council (NMRC/0582/2001, NMRC/CSA/003/2008). www.nmrc.gov.sg, and by A*STAR (SCS-POU98, NMRC/CSI/004/2005). www.a-star.edu.sg, and by Children's Cancer Foundation, Singapore. www.ccf.org.sg, and by VIVA Foundation for Children with Cancer, Singapore. www.viva.sg. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.