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Parigger T, Drothler S, Scherhäufl C, Gassner FJ, Schubert M, Steiner M, Höpner JP, Hödlmoser A, Schultheis L, Abu Bakar A, Neureiter D, Pleyer L, Egle A, Greil R, Geisberger R, Zaborsky N. Oncogenic MTOR signaling axis compensates BTK inhibition in a Chronic Lymphocytic Leukemia patient with Richter Transformation: A Case Report and Review of the Literature. Acta Haematol 2024:000537791. [PMID: 38402867 DOI: 10.1159/000537791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 02/08/2024] [Indexed: 02/27/2024]
Abstract
INTRODUCTION Targeting the B cell receptor (BCR) pathway via ibrutinib, a specific inhibitor of Bruton's tyrosine kinase, has shown marked clinical efficacy in treatment of patients with chronic lymphocytic leukemia (CLL), thus becoming a preferred first line option independent of risk factors. However, acquired resistance to ibrutinib poses a major clinical problem and requires the development of novel treatment combinations to increase efficacy and counteract resistance development and clinical relapse rates. CASE PRESENTATION In this study, we performed exome and transcriptome analyses of an ibrutinib resistant CLL patient in order to investigate genes and expression patterns associated with ibrutinib resistance. Here we provide evidence that ibrutinib resistance can be attributed to aberrant mammalian target of rapamycin (MTOR) signaling. CONCLUSION Thus, our study proposes that combined use of MTOR inhibitors with ibrutinib could be a possible option to overcome therapy resistance in ibrutinib treated patients.
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Parigger T, Gassner FJ, Scherhäufl C, Bakar AA, Höpner JP, Hödlmoser A, Steiner M, Catakovic K, Geisberger R, Greil R, Zaborsky N. Evidence for Non-Cancer-Specific T Cell Exhaustion in the Tcl1 Mouse Model for Chronic Lymphocytic Leukemia. Int J Mol Sci 2021; 22:ijms22136648. [PMID: 34206229 PMCID: PMC8268419 DOI: 10.3390/ijms22136648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 11/16/2022] Open
Abstract
The reinvigoration of anti-cancer immunity by immune checkpoint therapies has greatly improved cancer treatment. In chronic lymphocytic leukemia (CLL), patients as well as in the Tcl1 mouse model for CLL, PD1-expressing, exhausted T cells significantly expand alongside CLL development; nevertheless, PD1 inhibition has no clinical benefit. Hence, exhausted T cells are either not activatable by simple PD1 blocking in CLL and/or only an insufficient number of exhausted T cells are CLL-specific. In this study, we examined the latter hypothesis by exploiting the Tcl1 transgenic CLL mouse model in combination with TCR transgene expression specific for a non-cancer antigen. Following CLL tumor development, increased PD1 levels were detected on non-CLL specific T cells that seem dependent on the presence of (tumor-) antigen-specific T cells. Transcriptome analysis confirmed a similar exhaustion phenotype of non-CLL specific and endogenous PD1pos T cells. Our results indicate that in the CLL mouse model, a substantial fraction of non-CLL specific T cells becomes exhausted during disease progression in a bystander effect. These findings have important implications for the general efficacy assessment of immune checkpoint therapies in CLL.
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Affiliation(s)
- Thomas Parigger
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute—Laboratory for Immunological and Molecular Cancer Research (LIMCR), Paracelsus Medical University, 5020 Salzburg, Austria; (T.P.); (F.J.G.); (C.S.); (A.A.B.); (J.P.H.); (A.H.); (M.S.); (K.C.); (R.G.)
- Department of Biosciences, Paris-Lodron-University Salzburg, 5020 Salzburg, Austria
| | - Franz Josef Gassner
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute—Laboratory for Immunological and Molecular Cancer Research (LIMCR), Paracelsus Medical University, 5020 Salzburg, Austria; (T.P.); (F.J.G.); (C.S.); (A.A.B.); (J.P.H.); (A.H.); (M.S.); (K.C.); (R.G.)
| | - Christian Scherhäufl
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute—Laboratory for Immunological and Molecular Cancer Research (LIMCR), Paracelsus Medical University, 5020 Salzburg, Austria; (T.P.); (F.J.G.); (C.S.); (A.A.B.); (J.P.H.); (A.H.); (M.S.); (K.C.); (R.G.)
- Department of Biosciences, Paris-Lodron-University Salzburg, 5020 Salzburg, Austria
| | - Aryunni Abu Bakar
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute—Laboratory for Immunological and Molecular Cancer Research (LIMCR), Paracelsus Medical University, 5020 Salzburg, Austria; (T.P.); (F.J.G.); (C.S.); (A.A.B.); (J.P.H.); (A.H.); (M.S.); (K.C.); (R.G.)
- Department of Biosciences, Paris-Lodron-University Salzburg, 5020 Salzburg, Austria
| | - Jan Philip Höpner
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute—Laboratory for Immunological and Molecular Cancer Research (LIMCR), Paracelsus Medical University, 5020 Salzburg, Austria; (T.P.); (F.J.G.); (C.S.); (A.A.B.); (J.P.H.); (A.H.); (M.S.); (K.C.); (R.G.)
- Department of Biosciences, Paris-Lodron-University Salzburg, 5020 Salzburg, Austria
| | - Alexandra Hödlmoser
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute—Laboratory for Immunological and Molecular Cancer Research (LIMCR), Paracelsus Medical University, 5020 Salzburg, Austria; (T.P.); (F.J.G.); (C.S.); (A.A.B.); (J.P.H.); (A.H.); (M.S.); (K.C.); (R.G.)
| | - Markus Steiner
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute—Laboratory for Immunological and Molecular Cancer Research (LIMCR), Paracelsus Medical University, 5020 Salzburg, Austria; (T.P.); (F.J.G.); (C.S.); (A.A.B.); (J.P.H.); (A.H.); (M.S.); (K.C.); (R.G.)
| | - Kemal Catakovic
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute—Laboratory for Immunological and Molecular Cancer Research (LIMCR), Paracelsus Medical University, 5020 Salzburg, Austria; (T.P.); (F.J.G.); (C.S.); (A.A.B.); (J.P.H.); (A.H.); (M.S.); (K.C.); (R.G.)
| | - Roland Geisberger
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute—Laboratory for Immunological and Molecular Cancer Research (LIMCR), Paracelsus Medical University, 5020 Salzburg, Austria; (T.P.); (F.J.G.); (C.S.); (A.A.B.); (J.P.H.); (A.H.); (M.S.); (K.C.); (R.G.)
- Correspondence: (R.G.); (N.Z.)
| | - Richard Greil
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute—Laboratory for Immunological and Molecular Cancer Research (LIMCR), Paracelsus Medical University, 5020 Salzburg, Austria; (T.P.); (F.J.G.); (C.S.); (A.A.B.); (J.P.H.); (A.H.); (M.S.); (K.C.); (R.G.)
| | - Nadja Zaborsky
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute—Laboratory for Immunological and Molecular Cancer Research (LIMCR), Paracelsus Medical University, 5020 Salzburg, Austria; (T.P.); (F.J.G.); (C.S.); (A.A.B.); (J.P.H.); (A.H.); (M.S.); (K.C.); (R.G.)
- Correspondence: (R.G.); (N.Z.)
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