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Zhang C, Liu F, Zhang Y, Song C. Macrocycles and macrocyclization in anticancer drug discovery: Important pieces of the puzzle. Eur J Med Chem 2024; 268:116234. [PMID: 38401189 DOI: 10.1016/j.ejmech.2024.116234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/10/2024] [Accepted: 02/11/2024] [Indexed: 02/26/2024]
Abstract
Increasing disease-related proteins have been identified as novel therapeutic targets. Macrocycles are emerging as potential solutions, bridging the gap between conventional small molecules and biomacromolecules in drug discovery. Inspired by successful macrocyclic drugs of natural origins, macrocycles are attracting more attention for enhanced binding affinity and target selectivity. Due to the conformation constraint and structure preorganization, macrocycles can reach bioactive conformations more easily than parent acyclic compounds. Also, rational macrocyclization combined with sequent structural modification will help improve oral bioavailability and combat drug resistance. This review introduces various strategies to enhance membrane permeability in macrocyclization and subsequent modification, such as N-methylation, intramolecular hydrogen bonding modulation, isomerization, and reversible bicyclization. Several case studies highlight macrocyclic inhibitors targeting kinases, HDAC, and protein-protein interactions. Finally, some macrocyclic agents targeting tumor microenvironments are illustrated.
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Affiliation(s)
- Chao Zhang
- Laboratory for Food and Medicine Homologous Natural Resources Development and Utilization, Belgorod College of Food Sciences, Dezhou University, Dezhou, 253023, China
| | - Fenfen Liu
- Laboratory for Food and Medicine Homologous Natural Resources Development and Utilization, Belgorod College of Food Sciences, Dezhou University, Dezhou, 253023, China
| | - Youming Zhang
- State Key Laboratory of Microbial Technology, Shandong University, Qingdao, 266237, China.
| | - Chun Song
- Laboratory for Food and Medicine Homologous Natural Resources Development and Utilization, Belgorod College of Food Sciences, Dezhou University, Dezhou, 253023, China; State Key Laboratory of Microbial Technology, Shandong University, Qingdao, 266237, China.
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2
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DeRyckere D, Huelse JM, Earp HS, Graham DK. TAM family kinases as therapeutic targets at the interface of cancer and immunity. Nat Rev Clin Oncol 2023; 20:755-779. [PMID: 37667010 DOI: 10.1038/s41571-023-00813-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 09/06/2023]
Abstract
Novel treatment approaches are needed to overcome innate and acquired mechanisms of resistance to current anticancer therapies in cancer cells and the tumour immune microenvironment. The TAM (TYRO3, AXL and MERTK) family receptor tyrosine kinases (RTKs) are potential therapeutic targets in a wide range of cancers. In cancer cells, TAM RTKs activate signalling pathways that promote cell survival, metastasis and resistance to a variety of chemotherapeutic agents and targeted therapies. TAM RTKs also function in innate immune cells, contributing to various mechanisms that suppress antitumour immunity and promote resistance to immune-checkpoint inhibitors. Therefore, TAM antagonists provide an unprecedented opportunity for both direct and immune-mediated therapeutic activity provided by inhibition of a single target, and are likely to be particularly effective when used in combination with other cancer therapies. To exploit this potential, a variety of agents have been designed to selectively target TAM RTKs, many of which have now entered clinical testing. This Review provides an essential guide to the TAM RTKs for clinicians, including an overview of the rationale for therapeutic targeting of TAM RTKs in cancer cells and the tumour immune microenvironment, a description of the current preclinical and clinical experience with TAM inhibitors, and a perspective on strategies for continued development of TAM-targeted agents for oncology applications.
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Affiliation(s)
- Deborah DeRyckere
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Department of Paediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Justus M Huelse
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Department of Paediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - H Shelton Earp
- Department of Medicine, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
- Department of Pharmacology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Douglas K Graham
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA.
- Department of Paediatrics, Emory University School of Medicine, Atlanta, GA, USA.
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3
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Zhang Y, Wang P, Wang Y, Shen Y. Sitravatinib as a potent FLT3 inhibitor can overcome gilteritinib resistance in acute myeloid leukemia. Biomark Res 2023; 11:8. [PMID: 36691065 PMCID: PMC9872318 DOI: 10.1186/s40364-022-00447-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/29/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Gilteritinib is the only drug approved as monotherapy for acute myeloid leukemia (AML) patients harboring FMS-like tyrosine kinase 3 internal tandem duplication (FLT3-ITD) mutation throughout the world. However, drug resistance inevitably develops in clinical. Sitravatinib is a multi-kinase inhibitor under evaluation in clinical trials of various solid tumors. In this study, we explored the antitumor activity of sitravatinib against FLT3-ITD and clinically-relevant drug resistance in FLT3 mutant AML. METHODS Growth inhibitory assays were performed in AML cell lines and BaF3 cells expressing various FLT3 mutants to evaluate the antitumor activity of sitravatinib in vitro. Immunoblotting was used to examine the activity of FLT3 and its downstream pathways. Molecular docking was performed to predict the binding sites of FLT3 to sitravatinib. The survival benefit of sitravatinib in vivo was assessed in MOLM13 xenograft mouse models and mouse models of transformed BaF3 cells harboring different FLT3 mutants. Primary patient samples and a patient-derived xenograft (PDX) model were also used to determine the efficacy of sitravatinib. RESULTS Sitravatinib inhibited cell proliferation, induced cell cycle arrest and apoptosis in FLT3-ITD AML cell lines. In vivo studies showed that sitravatinib exhibited a better therapeutic effect than gilteritinib in MOLM13 xenograft model and BaF3-FLT3-ITD model. Unlike gilteritinib, the predicted binding sites of sitravatinib to FLT3 did not include F691 residue. Sitravatinib displayed a potent inhibitory effect on FLT3-ITD-F691L mutation which conferred resistance to gilteritinib and all other FLT3 inhibitors available, both in vitro and in vivo. Compared with gilteritinib, sitravatinib retained effective activity against FLT3 mutation in the presence of cytokines through the more potent and steady inhibition of p-ERK and p-AKT. Furthermore, patient blasts harboring FLT3-ITD were more sensitive to sitravatinib than to gilteritinib in vitro and in the PDX model. CONCLUSIONS Our study reveals the potential therapeutic role of sitravatinib in FLT3 mutant AML and provides an alternative inhibitor for the treatment of AML patients who are resistant to current FLT3 inhibitors.
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Affiliation(s)
- Yvyin Zhang
- grid.412277.50000 0004 1760 6738Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine (Shanghai), Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| | - Peihong Wang
- Department of Hematology, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, 510000 China
| | - Yang Wang
- grid.412277.50000 0004 1760 6738Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine (Shanghai), Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| | - Yang Shen
- grid.412277.50000 0004 1760 6738Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine (Shanghai), Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
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4
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Dumas PY, Raffoux E, Bérard E, Bertoli S, Hospital MA, Heiblig M, Desbrosses Y, Bonmati C, Pautas C, Lambert J, Orvain C, Banos A, Pasquier F, Peterlin P, Marchand T, Uzunov M, Frayfer J, Turlure P, Cluzeau T, Jourdan E, Himberlin C, Tavernier E, Villate A, Haiat S, Chretien ML, Carre M, Chantepie S, Vaida I, Wemeau M, Chebrek S, Guillerm G, Guièze R, Debarri H, Gehlkopf E, Laribi K, Marcais A, Santagostino A, Béné MC, Mineur A, Pigneux A, Dombret H, Récher C. Gilteritinib activity in refractory or relapsed FLT3-mutated acute myeloid leukemia patients previously treated by intensive chemotherapy and midostaurin: a study from the French AML Intergroup ALFA/FILO. Leukemia 2023; 37:91-101. [PMID: 36376378 DOI: 10.1038/s41375-022-01742-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/12/2022] [Accepted: 10/20/2022] [Indexed: 11/16/2022]
Abstract
The real-world efficacy and safety of gilteritinib was assessed in an ambispective study that included 167 R/R FLT3-mutated AML patients. Among them, 140 received gilteritinib as single agent (cohort B), including 67 previously treated by intensive chemotherapy and midostaurin (cohort C). The main differences in patient characteristics in this study compared to the ADMIRAL trial were ECOG ≥ 2 (83.6% vs. 16.6%), FLT3-TKD mutation (21.0% vs. 8.5%), primary induction failure (15.0% vs. 40.0%) and line of treatment (beyond 2nd in 37.1% vs. 0.0%). The rates of composite complete remission, excluding those that occurred after hematopoietic stem cell transplantation (HSCT), were similar at respectively 25.4% and 27.5% in cohorts B and C. Median overall survival (OS) for these two groups was also similar at respectively 6.4 and 7.8 months. Multivariate analyses for prognostic factors associated with OS identified female gender (HR 1.61), adverse cytogenetic risk (HR 2.52), and allogenic HSCT after gilteritinib (HR 0.13). Although these patients were more heavily pretreated, these real-world data reproduce the results of ADMIRAL and provide new insights into the course of patients previously treated by intensive chemotherapy and midostaurin and beyond the 2nd line of treatment who can benefit from treatment in an outpatient setting.
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Affiliation(s)
- Pierre-Yves Dumas
- CHU Bordeaux, Service d'Hématologie Clinique et de Thérapie Cellulaire, F-33000, Bordeaux, France.
| | - Emmanuel Raffoux
- Hôpital Saint Louis, APHP, service d'hématologie adultes, Paris, France
| | - Emilie Bérard
- Centre Hospitalier Universitaire de Toulouse, Service d'Epidémiologie, CERPOP, Inserm, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Sarah Bertoli
- Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Université Toulouse III Paul Sabatier, Toulouse, France
| | | | - Maël Heiblig
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service d'Hématologie clinique, Pierre Bénite, France
| | | | - Caroline Bonmati
- Service d'Hématologie, CHU Nancy Brabois, 54500, Vandoeuvre les Nancy, France
| | - Cécile Pautas
- CHU Henri-Mondor, Service d'Hématologie Clinique et de Thérapie Cellulaire; 1, rue Gustave Eiffel, 94010, Créteil, France
| | - Juliette Lambert
- Centre hospitalier de Versailles, Service Hématologie, Le Chesnay, France
| | - Corentin Orvain
- Service des maladies du sang, CHU d'Angers, France/Fédération hospitalo-universitaire « Grand Ouest against Leukemia »/Université d'Angers, Inserm UMR 1307, CNRS UMR 6075, Nantes Université, CRCI2NA, F-49000, Angers, France
| | - Anne Banos
- Service Hématologie, Centre Hospitalier de la Côte Basque, 64100, Bayonne, France
| | - Florence Pasquier
- Département d'Hématologie, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Pierre Peterlin
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Tony Marchand
- Service d'hématologie Clinique, CHU de Rennes, 35000, Rennes, France
| | - Madalina Uzunov
- Hôpital Pitié Salpetrière, Service d'hématologie, Paris, France
| | | | - Pascal Turlure
- CHU limoges, Service d'Hématologie Clinique et de Thérapie Cellulaire, F-87000, Limoges, France
| | - Thomas Cluzeau
- Université Cote d'Azur, CHU de Nice, Département d'hématologie clinique, Nice, France
| | - Eric Jourdan
- Department of Hematology, Nîmes University Hospital, Nîmes, France
| | - Chantal Himberlin
- Centre Hospitalier Universitaire de Reims, Hôpital Robert Debré, Reims, France
| | - Emmanuelle Tavernier
- CHU Saint Etienne. Service d'hématologie clinique et thérapie cellulaire, 42 000, Saint Etienne, France
| | - Alban Villate
- Hématologie et thérapie cellulaire, CHRU de Tours, Tours, France
| | - Stephanie Haiat
- Centre hospitalier Sud francilien, Service d'hématologie clinique, Corbeil-Essonnes, France
| | | | | | | | - Ioana Vaida
- Centre Hospitalier René Dubos, Service d'hématologie et thérapie cellulaire, Cergy-Pontoise, France
| | - Mathieu Wemeau
- CH Roubaix, service d'hématologie, F-59100, Roubaix, France
| | - Safia Chebrek
- CH Avignon, service d'onco-hématologie, Avignon, France
| | - Gaelle Guillerm
- CHU Brest, Hôpital Morvan, Service de cancérologie-hématologie, Brest, France
| | - Romain Guièze
- Service d'hématologie clinique et de thérapie cellulaire, CHU de Clermont-Ferrand, Clermont-Ferrand, France; EA 7453 (CHELTER), Université Clermont Auvergne, Clermont-Ferrand, France
| | - Houria Debarri
- CHR Metz-Thionville, Hôpital Mercy, service d'hématologie, Metz, France
| | - Eve Gehlkopf
- Hôpital Saint Eloi CHU Montpellier, Service d'Hématologie Clinique, 34295, Montpellier, France
| | - Kamel Laribi
- Department of Haematology, Centre hospitalier Le Mans, Le Mans, France
| | - Ambroise Marcais
- Service Hématologie Adultes, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants Malades, Université Paris Cité, Paris, France
| | | | | | - Ariane Mineur
- CHU Bordeaux, Service d'Hématologie Clinique et de Thérapie Cellulaire, F-33000, Bordeaux, France
| | - Arnaud Pigneux
- CHU Bordeaux, Service d'Hématologie Clinique et de Thérapie Cellulaire, F-33000, Bordeaux, France
| | - Hervé Dombret
- Hôpital Saint Louis, APHP, service d'hématologie adultes, Paris, France
| | - Christian Récher
- Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Université Toulouse III Paul Sabatier, Toulouse, France
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Ohoka N, Suzuki M, Uchida T, Tsuji G, Tsukumo Y, Yoshida M, Inoue T, Demizu Y, Ohki H, Naito M. Development of Gilteritinib-Based Chimeric Small Molecules that Potently Induce Degradation of FLT3-ITD Protein. ACS Med Chem Lett 2022; 13:1885-1891. [DOI: 10.1021/acsmedchemlett.2c00402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Nobumichi Ohoka
- Division of Molecular Target and Gene Therapy Products, National Institute of Health Sciences, Kawasaki, Kanagawa 210-9501, Japan
| | - Masanori Suzuki
- Modality Research Laboratories, Biologics Division, Daiichi Sankyo Co., Ltd., Tokyo 140-8710, Japan
| | - Takuya Uchida
- Medicinal Chemistry Research Laboratories, R&D Division, Daiichi Sankyo Co., Ltd., Tokyo 140-8710, Japan
| | - Genichiro Tsuji
- Division of Organic Chemistry, National Institute of Health Sciences, Kawasaki, Kanagawa 210-9501 Japan
| | - Yoshinori Tsukumo
- Division of Molecular Target and Gene Therapy Products, National Institute of Health Sciences, Kawasaki, Kanagawa 210-9501, Japan
| | - Masayuki Yoshida
- Modality Research Laboratories, Biologics Division, Daiichi Sankyo Co., Ltd., Tokyo 140-8710, Japan
| | - Takao Inoue
- Division of Molecular Target and Gene Therapy Products, National Institute of Health Sciences, Kawasaki, Kanagawa 210-9501, Japan
| | - Yosuke Demizu
- Division of Organic Chemistry, National Institute of Health Sciences, Kawasaki, Kanagawa 210-9501 Japan
| | - Hitoshi Ohki
- Modality Research Laboratories, Biologics Division, Daiichi Sankyo Co., Ltd., Tokyo 140-8710, Japan
| | - Mikihiko Naito
- Division of Molecular Target and Gene Therapy Products, National Institute of Health Sciences, Kawasaki, Kanagawa 210-9501, Japan
- Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo 113-0033, Japan
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6
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Protein tyrosine kinase inhibitor resistance in malignant tumors: molecular mechanisms and future perspective. Signal Transduct Target Ther 2022; 7:329. [PMID: 36115852 PMCID: PMC9482625 DOI: 10.1038/s41392-022-01168-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/08/2022] [Accepted: 08/26/2022] [Indexed: 02/07/2023] Open
Abstract
AbstractProtein tyrosine kinases (PTKs) are a class of proteins with tyrosine kinase activity that phosphorylate tyrosine residues of critical molecules in signaling pathways. Their basal function is essential for maintaining normal cell growth and differentiation. However, aberrant activation of PTKs caused by various factors can deviate cell function from the expected trajectory to an abnormal growth state, leading to carcinogenesis. Inhibiting the aberrant PTK function could inhibit tumor growth. Therefore, tyrosine kinase inhibitors (TKIs), target-specific inhibitors of PTKs, have been used in treating malignant tumors and play a significant role in targeted therapy of cancer. Currently, drug resistance is the main reason for limiting TKIs efficacy of cancer. The increasing studies indicated that tumor microenvironment, cell death resistance, tumor metabolism, epigenetic modification and abnormal metabolism of TKIs were deeply involved in tumor development and TKI resistance, besides the abnormal activation of PTK-related signaling pathways involved in gene mutations. Accordingly, it is of great significance to study the underlying mechanisms of TKIs resistance and find solutions to reverse TKIs resistance for improving TKIs efficacy of cancer. Herein, we reviewed the drug resistance mechanisms of TKIs and the potential approaches to overcome TKI resistance, aiming to provide a theoretical basis for improving the efficacy of TKIs.
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7
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Zhang WN, Li XP, Wang PF, Zhu L, Xiao XH, Dai YJ. Comprehensive Analysis of the Novel Omicron Receptor AXL in Cancers. Comput Struct Biotechnol J 2022; 20:3304-3312. [PMID: 35782741 PMCID: PMC9234055 DOI: 10.1016/j.csbj.2022.06.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/23/2022] [Accepted: 06/23/2022] [Indexed: 11/25/2022] Open
Abstract
The SARS-CoV-2 is constantly mutating, and the new coronavirus such as Omicron has spread to many countries around the world. Anexelekto (AXL) is a transmembrane protein with biological functions such as promoting cell growth, migration, aggregation, metastasis and adhesion, and plays an important role in cancers and coronavirus disease 2019 (COVID-19). Unlike angiotensin-converting enzyme 2 (ACE2), AXL was highly expressed in respiratory system cells. In this study, we verified the AXL expression in cancer and normal tissues and found AXL expression was strongly correlated with cancer prognosis, tumor mutation burden (TMB), the microsatellite instability (MSI) in most tumor types. Immune infiltration analysis also demonstrated that there was an inextricable link between AXL expression and immune scores in cancer patients, especially in BLCA, BRCA and CESC. The NK-cells, plasmacytoid dendritic cells, myeloid dendritic cells, as one of the important components of the tumor microenvironment, were highly expressed AXL. In addition, AXL-related tumor neoantigens were identified and might provide the novel potential targets for tumor vaccines or SARS-Cov-2 vaccines research in cancer patients.
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8
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Pfeiffer A, Franciosa G, Locard-Paulet M, Piga I, Reckzeh K, Vemulapalli V, Blacklow SC, Theilgaard-Mönch K, Jensen LJ, Olsen JV. Phosphorylation of SHP2 at Tyr62 enables acquired resistance to SHP2 allosteric inhibitors in FLT3-ITD-driven AML. Cancer Res 2022; 82:2141-2155. [PMID: 35311954 DOI: 10.1158/0008-5472.can-21-0548] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 12/17/2021] [Accepted: 03/17/2022] [Indexed: 11/16/2022]
Abstract
The protein tyrosine phosphatase SHP2 is crucial for oncogenic transformation of acute myeloid leukemia (AML) cells expressing mutated receptor tyrosine kinases (RTK). SHP2 is required for full RAS-ERK activation to promote cell proliferation and survival programs. Allosteric SHP2 inhibitors act by stabilizing SHP2 in its auto-inhibited conformation and are currently being tested in clinical trials for tumors with overactivation of the RAS/ERK pathway, alone and in various drug combinations. In this study, we established cells with acquired resistance to the allosteric SHP2 inhibitor SHP099 from two FLT3-ITD-positive AML cell lines. Label-free and isobaric labeling quantitative mass spectrometry-based phosphoproteomics of these resistant models demonstrated that AML cells can restore phosphorylated ERK (pERK) in the presence of SHP099, thus developing adaptive resistance. Mechanistically, SHP2 inhibition induced tyrosine phosphorylation and feedback-driven activation of the FLT3 receptor, which in turn phosphorylated SHP2 on tyrosine 62. This phosphorylation stabilized SHP2 in its open conformation, preventing SHP099 binding and conferring resistance. Combinatorial inhibition of SHP2 and MEK or FLT3 prevented pERK rebound and resistant cell growth. The same mechanism was observed in a FLT3-mutated B-ALL cell line and in the inv(16)/KitD816Y AML mouse model, but allosteric inhibition of Shp2 did not impair the clonogenic ability of normal bone marrow progenitors. Together, these results support the future use of SHP2 inhibitor combinations for clinical applications.
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Affiliation(s)
| | | | | | - Ilaria Piga
- Istituto Oncologico Veneto IOV - IRCCS, Italy
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9
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Lopez-Millan B, Costales P, Gutiérrez-Agüera F, Díaz de la Guardia R, Roca-Ho H, Vinyoles M, Rubio-Gayarre A, Safi R, Castaño J, Romecín PA, Ramírez-Orellana M, Anguita E, Jeremias I, Zamora L, Rodríguez-Manzaneque JC, Bueno C, Morís F, Menendez P. The Multi-Kinase Inhibitor EC-70124 Is a Promising Candidate for the Treatment of FLT3-ITD-Positive Acute Myeloid Leukemia. Cancers (Basel) 2022; 14:cancers14061593. [PMID: 35326743 PMCID: PMC8946166 DOI: 10.3390/cancers14061593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 03/11/2022] [Indexed: 12/17/2022] Open
Abstract
Simple Summary Patients with AML harboring constitutively active mutations in the FLT3 receptor generally have a poor prognosis (FLT3-ITDMUT). Despite the fact that several FLT3 inhibitors have been developed, clinical responses are commonly partial or not durable, highlighting the need for new molecules targeting FLT3-ITDMUT. Here, we tested EC-70124, a hybrid indolocarbazole analog from the same chemical space as midostaurin (a well-known FLT3 inhibitor). Our in vitro and in vivo experiments showed that EC-70124 exerts a robust and specific antileukemia activity against FLT3-ITDMUT AML cells while sparing healthy hematopoietic cells. Collectively, EC-70124 is a promising and safe agent for the treatment of this aggressive type of AML. Abstract Acute myeloid leukemia (AML) is the most common acute leukemia in adults. Patients with AML harboring a constitutively active internal tandem duplication mutation (ITDMUT) in the FMS-like kinase tyrosine kinase (FLT3) receptor generally have a poor prognosis. Several tyrosine kinase/FLT3 inhibitors have been developed and tested clinically, but very few (midostaurin and gilteritinib) have thus far been FDA/EMA-approved for patients with newly diagnosed or relapse/refractory FLT3-ITDMUT AML. Disappointingly, clinical responses are commonly partial or not durable, highlighting the need for new molecules targeting FLT3-ITDMUT AML. Here, we tested EC-70124, a hybrid indolocarbazole analog from the same chemical space as midostaurin with a potent and selective inhibitory effect on FLT3. In vitro, EC-70124 exerted a robust and specific antileukemia activity against FLT3-ITDMUT AML primary cells and cell lines with respect to cytotoxicity, CFU capacity, apoptosis and cell cycle while sparing healthy hematopoietic (stem/progenitor) cells. We also analyzed its efficacy in vivo as monotherapy using two different xenograft models: an aggressive and systemic model based on MOLM-13 cells and a patient-derived xenograft model. Orally disposable EC-70124 exerted a potent inhibitory effect on the growth of FLT3-ITDMUT AML cells, delaying disease progression and debulking the leukemia. Collectively, our findings show that EC-70124 is a promising and safe agent for the treatment of AML with FLT3-ITDMUT.
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Affiliation(s)
- Belen Lopez-Millan
- Department of Biomedicine, Josep Carreras Leukemia Research Institute, School of Medicine, University of Barcelona, 08036 Barcelona, Spain; (F.G.-A.); (R.D.d.l.G.); (H.R.-H.); (M.V.); (A.R.-G.); (R.S.); (J.C.); (P.A.R.); (L.Z.); (C.B.)
- GENYO, Centre for Genomics and Oncological Research, Pfizer, Universidad de Granada, Junta de Andalucía, 18016 Granada, Spain;
- Red Española de Terapias Avanzadas (TERAV), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain;
- Correspondence: (B.L.-M.); (P.M.)
| | | | - Francisco Gutiérrez-Agüera
- Department of Biomedicine, Josep Carreras Leukemia Research Institute, School of Medicine, University of Barcelona, 08036 Barcelona, Spain; (F.G.-A.); (R.D.d.l.G.); (H.R.-H.); (M.V.); (A.R.-G.); (R.S.); (J.C.); (P.A.R.); (L.Z.); (C.B.)
| | - Rafael Díaz de la Guardia
- Department of Biomedicine, Josep Carreras Leukemia Research Institute, School of Medicine, University of Barcelona, 08036 Barcelona, Spain; (F.G.-A.); (R.D.d.l.G.); (H.R.-H.); (M.V.); (A.R.-G.); (R.S.); (J.C.); (P.A.R.); (L.Z.); (C.B.)
- GENYO, Centre for Genomics and Oncological Research, Pfizer, Universidad de Granada, Junta de Andalucía, 18016 Granada, Spain;
| | - Heleia Roca-Ho
- Department of Biomedicine, Josep Carreras Leukemia Research Institute, School of Medicine, University of Barcelona, 08036 Barcelona, Spain; (F.G.-A.); (R.D.d.l.G.); (H.R.-H.); (M.V.); (A.R.-G.); (R.S.); (J.C.); (P.A.R.); (L.Z.); (C.B.)
| | - Meritxell Vinyoles
- Department of Biomedicine, Josep Carreras Leukemia Research Institute, School of Medicine, University of Barcelona, 08036 Barcelona, Spain; (F.G.-A.); (R.D.d.l.G.); (H.R.-H.); (M.V.); (A.R.-G.); (R.S.); (J.C.); (P.A.R.); (L.Z.); (C.B.)
- Red Española de Terapias Avanzadas (TERAV), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain;
| | - Alba Rubio-Gayarre
- Department of Biomedicine, Josep Carreras Leukemia Research Institute, School of Medicine, University of Barcelona, 08036 Barcelona, Spain; (F.G.-A.); (R.D.d.l.G.); (H.R.-H.); (M.V.); (A.R.-G.); (R.S.); (J.C.); (P.A.R.); (L.Z.); (C.B.)
- GENYO, Centre for Genomics and Oncological Research, Pfizer, Universidad de Granada, Junta de Andalucía, 18016 Granada, Spain;
| | - Rémi Safi
- Department of Biomedicine, Josep Carreras Leukemia Research Institute, School of Medicine, University of Barcelona, 08036 Barcelona, Spain; (F.G.-A.); (R.D.d.l.G.); (H.R.-H.); (M.V.); (A.R.-G.); (R.S.); (J.C.); (P.A.R.); (L.Z.); (C.B.)
- Red Española de Terapias Avanzadas (TERAV), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain;
| | - Julio Castaño
- Department of Biomedicine, Josep Carreras Leukemia Research Institute, School of Medicine, University of Barcelona, 08036 Barcelona, Spain; (F.G.-A.); (R.D.d.l.G.); (H.R.-H.); (M.V.); (A.R.-G.); (R.S.); (J.C.); (P.A.R.); (L.Z.); (C.B.)
| | - Paola Alejandra Romecín
- Department of Biomedicine, Josep Carreras Leukemia Research Institute, School of Medicine, University of Barcelona, 08036 Barcelona, Spain; (F.G.-A.); (R.D.d.l.G.); (H.R.-H.); (M.V.); (A.R.-G.); (R.S.); (J.C.); (P.A.R.); (L.Z.); (C.B.)
- Red Española de Terapias Avanzadas (TERAV), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain;
| | - Manuel Ramírez-Orellana
- Red Española de Terapias Avanzadas (TERAV), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain;
- Department of Pediatric Hematology and Oncology, Hospital Infantil Universitario Niño Jesús, Instituto de Investigación Sanitaria La Princesa, 28006 Madrid, Spain
| | - Eduardo Anguita
- Servicio de Hematología, Hospital Clínico San Carlos, IdISSC, School of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain;
| | - Irmela Jeremias
- Research Unit Apoptosis in Hematopoietic Stem Cells, Helmholtz Zentrum München, 85764 Munich, Germany;
| | - Lurdes Zamora
- Department of Biomedicine, Josep Carreras Leukemia Research Institute, School of Medicine, University of Barcelona, 08036 Barcelona, Spain; (F.G.-A.); (R.D.d.l.G.); (H.R.-H.); (M.V.); (A.R.-G.); (R.S.); (J.C.); (P.A.R.); (L.Z.); (C.B.)
- Hematology Department, ICO-Hospital Germans Trias i Pujol, 08916 Barcelona, Spain
| | | | - Clara Bueno
- Department of Biomedicine, Josep Carreras Leukemia Research Institute, School of Medicine, University of Barcelona, 08036 Barcelona, Spain; (F.G.-A.); (R.D.d.l.G.); (H.R.-H.); (M.V.); (A.R.-G.); (R.S.); (J.C.); (P.A.R.); (L.Z.); (C.B.)
- Red Española de Terapias Avanzadas (TERAV), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain;
- Centro de Investigación Biomédica en Red–Oncología (CIBERONC), 28029 Madrid, Spain
| | | | - Pablo Menendez
- Department of Biomedicine, Josep Carreras Leukemia Research Institute, School of Medicine, University of Barcelona, 08036 Barcelona, Spain; (F.G.-A.); (R.D.d.l.G.); (H.R.-H.); (M.V.); (A.R.-G.); (R.S.); (J.C.); (P.A.R.); (L.Z.); (C.B.)
- Red Española de Terapias Avanzadas (TERAV), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain;
- Centro de Investigación Biomédica en Red–Oncología (CIBERONC), 28029 Madrid, Spain
- Instituciò Catalana de Recerca i Estudis Avançats (ICREA), 08010 Barcelona, Spain
- Correspondence: (B.L.-M.); (P.M.)
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10
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Dupont M, Huart M, Lauvinerie C, Bidet A, Guitart AV, Villacreces A, Vigon I, Desplat V, El Habhab A, Pigneux A, Ivanovic Z, Brunet De la Grange P, Dumas PY, Pasquet JM. Autophagy Targeting and Hematological Mobilization in FLT3-ITD Acute Myeloid Leukemia Decrease Repopulating Capacity and Relapse by Inducing Apoptosis of Committed Leukemic Cells. Cancers (Basel) 2022; 14:cancers14020453. [PMID: 35053612 PMCID: PMC8796021 DOI: 10.3390/cancers14020453] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 12/19/2022] Open
Abstract
Targeting FLT3-ITD in AML using TKI against FLT3 cannot prevent relapse even in the presence of complete remission, suggesting the resistance and/or the persistence of leukemic-initiating cells in the hematopoietic niche. By mimicking the hematopoietic niche condition with cultures at low oxygen concentrations, we demonstrate in vitro that FLT3-ITD AML cells decrease their repopulating capacity when Vps34 is inhibited. Ex vivo, AML FLT3-ITD blasts treated with Vps34 inhibitors recovered proliferation more slowly due to an increase an apoptosis. In vivo, mice engrafted with FLT3-ITD AML MV4-11 cells have the invasion of the bone marrow and blood in 2 weeks. After 4 weeks of FLT3 TKI treatment with gilteritinib, the leukemic burden had strongly decreased and deep remission was observed. When treatment was discontinued, mice relapsed rapidly. In contrast, Vps34 inhibition strongly decreased the relapse rate, and even more so in association with mobilization by G-CSF and AMD3100. These results demonstrate that remission offers the therapeutic window for a regimen using Vps34 inhibition combined with mobilization to target persistent leukemic stem cells and thus decrease the relapse rate.
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Affiliation(s)
- Marine Dupont
- Cellules Souches Hématopoïétiques Normales et Leucémiques, INSERM U1312 BRIC, Université de Bordeaux, Bat TP 4e étage, 146 rue Léo Saignat, 33076 Bordeaux, France; (M.D.); (M.H.); (C.L.); (A.B.); (A.V.G.); (A.V.); (I.V.); (V.D.); (A.E.H.); (A.P.); (Z.I.); (P.B.D.l.G.); (P.-Y.D.)
| | - Mathilde Huart
- Cellules Souches Hématopoïétiques Normales et Leucémiques, INSERM U1312 BRIC, Université de Bordeaux, Bat TP 4e étage, 146 rue Léo Saignat, 33076 Bordeaux, France; (M.D.); (M.H.); (C.L.); (A.B.); (A.V.G.); (A.V.); (I.V.); (V.D.); (A.E.H.); (A.P.); (Z.I.); (P.B.D.l.G.); (P.-Y.D.)
| | - Claire Lauvinerie
- Cellules Souches Hématopoïétiques Normales et Leucémiques, INSERM U1312 BRIC, Université de Bordeaux, Bat TP 4e étage, 146 rue Léo Saignat, 33076 Bordeaux, France; (M.D.); (M.H.); (C.L.); (A.B.); (A.V.G.); (A.V.); (I.V.); (V.D.); (A.E.H.); (A.P.); (Z.I.); (P.B.D.l.G.); (P.-Y.D.)
| | - Audrey Bidet
- Cellules Souches Hématopoïétiques Normales et Leucémiques, INSERM U1312 BRIC, Université de Bordeaux, Bat TP 4e étage, 146 rue Léo Saignat, 33076 Bordeaux, France; (M.D.); (M.H.); (C.L.); (A.B.); (A.V.G.); (A.V.); (I.V.); (V.D.); (A.E.H.); (A.P.); (Z.I.); (P.B.D.l.G.); (P.-Y.D.)
- Service d’Hématologie Biologique, CHU Bordeaux, 33000 Bordeaux, France
| | - Amélie Valérie Guitart
- Cellules Souches Hématopoïétiques Normales et Leucémiques, INSERM U1312 BRIC, Université de Bordeaux, Bat TP 4e étage, 146 rue Léo Saignat, 33076 Bordeaux, France; (M.D.); (M.H.); (C.L.); (A.B.); (A.V.G.); (A.V.); (I.V.); (V.D.); (A.E.H.); (A.P.); (Z.I.); (P.B.D.l.G.); (P.-Y.D.)
| | - Arnaud Villacreces
- Cellules Souches Hématopoïétiques Normales et Leucémiques, INSERM U1312 BRIC, Université de Bordeaux, Bat TP 4e étage, 146 rue Léo Saignat, 33076 Bordeaux, France; (M.D.); (M.H.); (C.L.); (A.B.); (A.V.G.); (A.V.); (I.V.); (V.D.); (A.E.H.); (A.P.); (Z.I.); (P.B.D.l.G.); (P.-Y.D.)
| | - Isabelle Vigon
- Cellules Souches Hématopoïétiques Normales et Leucémiques, INSERM U1312 BRIC, Université de Bordeaux, Bat TP 4e étage, 146 rue Léo Saignat, 33076 Bordeaux, France; (M.D.); (M.H.); (C.L.); (A.B.); (A.V.G.); (A.V.); (I.V.); (V.D.); (A.E.H.); (A.P.); (Z.I.); (P.B.D.l.G.); (P.-Y.D.)
| | - Vanessa Desplat
- Cellules Souches Hématopoïétiques Normales et Leucémiques, INSERM U1312 BRIC, Université de Bordeaux, Bat TP 4e étage, 146 rue Léo Saignat, 33076 Bordeaux, France; (M.D.); (M.H.); (C.L.); (A.B.); (A.V.G.); (A.V.); (I.V.); (V.D.); (A.E.H.); (A.P.); (Z.I.); (P.B.D.l.G.); (P.-Y.D.)
| | - Ali El Habhab
- Cellules Souches Hématopoïétiques Normales et Leucémiques, INSERM U1312 BRIC, Université de Bordeaux, Bat TP 4e étage, 146 rue Léo Saignat, 33076 Bordeaux, France; (M.D.); (M.H.); (C.L.); (A.B.); (A.V.G.); (A.V.); (I.V.); (V.D.); (A.E.H.); (A.P.); (Z.I.); (P.B.D.l.G.); (P.-Y.D.)
| | - Arnaud Pigneux
- Cellules Souches Hématopoïétiques Normales et Leucémiques, INSERM U1312 BRIC, Université de Bordeaux, Bat TP 4e étage, 146 rue Léo Saignat, 33076 Bordeaux, France; (M.D.); (M.H.); (C.L.); (A.B.); (A.V.G.); (A.V.); (I.V.); (V.D.); (A.E.H.); (A.P.); (Z.I.); (P.B.D.l.G.); (P.-Y.D.)
- Service d’Hématologie Clinique et Thérapie Cellulaire, CHU Bordeaux, 33000 Bordeaux, France
| | - Zoran Ivanovic
- Cellules Souches Hématopoïétiques Normales et Leucémiques, INSERM U1312 BRIC, Université de Bordeaux, Bat TP 4e étage, 146 rue Léo Saignat, 33076 Bordeaux, France; (M.D.); (M.H.); (C.L.); (A.B.); (A.V.G.); (A.V.); (I.V.); (V.D.); (A.E.H.); (A.P.); (Z.I.); (P.B.D.l.G.); (P.-Y.D.)
- Etablissement Français du Sang Nouvelle Aquitaine, 33035 Bordeaux, France
| | - Philippe Brunet De la Grange
- Cellules Souches Hématopoïétiques Normales et Leucémiques, INSERM U1312 BRIC, Université de Bordeaux, Bat TP 4e étage, 146 rue Léo Saignat, 33076 Bordeaux, France; (M.D.); (M.H.); (C.L.); (A.B.); (A.V.G.); (A.V.); (I.V.); (V.D.); (A.E.H.); (A.P.); (Z.I.); (P.B.D.l.G.); (P.-Y.D.)
- Etablissement Français du Sang Nouvelle Aquitaine, 33035 Bordeaux, France
| | - Pierre-Yves Dumas
- Cellules Souches Hématopoïétiques Normales et Leucémiques, INSERM U1312 BRIC, Université de Bordeaux, Bat TP 4e étage, 146 rue Léo Saignat, 33076 Bordeaux, France; (M.D.); (M.H.); (C.L.); (A.B.); (A.V.G.); (A.V.); (I.V.); (V.D.); (A.E.H.); (A.P.); (Z.I.); (P.B.D.l.G.); (P.-Y.D.)
- Service d’Hématologie Clinique et Thérapie Cellulaire, CHU Bordeaux, 33000 Bordeaux, France
| | - Jean-Max Pasquet
- Cellules Souches Hématopoïétiques Normales et Leucémiques, INSERM U1312 BRIC, Université de Bordeaux, Bat TP 4e étage, 146 rue Léo Saignat, 33076 Bordeaux, France; (M.D.); (M.H.); (C.L.); (A.B.); (A.V.G.); (A.V.); (I.V.); (V.D.); (A.E.H.); (A.P.); (Z.I.); (P.B.D.l.G.); (P.-Y.D.)
- Correspondence: ; Tel.: +33-07-85-42-59-25
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11
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Spohr C, Poggio T, Andrieux G, Schönberger K, Cabezas-Wallscheid N, Boerries M, Halbach S, Illert AL, Brummer T. Gab2 deficiency prevents Flt3-ITD driven acute myeloid leukemia in vivo. Leukemia 2022; 36:970-982. [PMID: 34903841 PMCID: PMC8979819 DOI: 10.1038/s41375-021-01490-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/19/2021] [Accepted: 11/26/2021] [Indexed: 11/09/2022]
Abstract
Internal tandem duplications (ITD) of the FMS-like tyrosine kinase 3 (FLT3) predict poor prognosis in acute myeloid leukemia (AML) and often co-exist with inactivating DNMT3A mutations. In vitro studies implicated Grb2-associated binder 2 (GAB2) as FLT3-ITD effector. Utilizing a Flt3-ITD knock-in, Dnmt3a haploinsufficient mouse model, we demonstrate that Gab2 is essential for the development of Flt3-ITD driven AML in vivo, as Gab2 deficient mice displayed prolonged survival, presented with attenuated liver and spleen pathology and reduced blast counts. Furthermore, leukemic bone marrow from Gab2 deficient mice exhibited reduced colony-forming unit capacity and increased FLT3 inhibitor sensitivity. Using transcriptomics, we identify the genes encoding for Axl and the Ret co-receptor Gfra2 as targets of the Flt3-ITD/Gab2/Stat5 axis. We propose a pathomechanism in which Gab2 increases signaling of these receptors by inducing their expression and by serving as downstream effector. Thereby, Gab2 promotes AML aggressiveness and drug resistance as it incorporates these receptor tyrosine kinases into the Flt3-ITD signaling network. Consequently, our data identify GAB2 as a promising biomarker and therapeutic target in human AML.
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Affiliation(s)
- Corinna Spohr
- grid.5963.9Institute of Molecular Medicine and Cell Research, ZBMZ, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany ,grid.5963.9Faculty of Biology, University of Freiburg, Freiburg, Germany ,grid.5963.9Spemann Graduate School of Biology and Medicine, University of Freiburg, Freiburg, Germany
| | - Teresa Poggio
- grid.5963.9Faculty of Biology, University of Freiburg, Freiburg, Germany ,grid.5963.9Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Geoffroy Andrieux
- grid.5963.9Institute of Medical Bioinformatics and Systems Medicine, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany ,grid.7497.d0000 0004 0492 0584German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Katharina Schönberger
- grid.5963.9Faculty of Biology, University of Freiburg, Freiburg, Germany ,grid.429509.30000 0004 0491 4256Max-Planck-Institute of Immunobiology and Epigenetics, 79108 Freiburg, Germany ,grid.4372.20000 0001 2105 1091International Max Planck Research School for Molecular and Cellular Biology (IMPRS-MCB), Freiburg, Germany
| | - Nina Cabezas-Wallscheid
- grid.429509.30000 0004 0491 4256Max-Planck-Institute of Immunobiology and Epigenetics, 79108 Freiburg, Germany ,Centre for Integrative Biological Signaling Studies (CIBSS), 79104 Freiburg, Germany
| | - Melanie Boerries
- grid.5963.9Institute of Medical Bioinformatics and Systems Medicine, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany ,grid.5963.9Comprehensive Cancer Center Freiburg (CCCF), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany ,grid.7497.d0000 0004 0492 0584German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Sebastian Halbach
- grid.5963.9Institute of Molecular Medicine and Cell Research, ZBMZ, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany
| | - Anna L. Illert
- grid.5963.9Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany ,grid.5963.9Comprehensive Cancer Center Freiburg (CCCF), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany ,grid.7497.d0000 0004 0492 0584German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Tilman Brummer
- Institute of Molecular Medicine and Cell Research, ZBMZ, Faculty of Medicine, University of Freiburg, 79104, Freiburg, Germany. .,Comprehensive Cancer Center Freiburg (CCCF), Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany. .,German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany. .,Center for Biological Signalling Studies BIOSS, University of Freiburg, 79104, Freiburg, Germany.
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