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Fraser CS, Spetz JKE, Qin X, Presser A, Choiniere J, Li C, Yu S, Blevins F, Hata AN, Miller JW, Bradshaw GA, Kalocsay M, Sanchorawala V, Sarosiek S, Sarosiek KA. Exploiting endogenous and therapy-induced apoptotic vulnerabilities in immunoglobulin light chain amyloidosis with BH3 mimetics. Nat Commun 2022; 13:5789. [PMID: 36184661 PMCID: PMC9527241 DOI: 10.1038/s41467-022-33461-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 09/16/2022] [Indexed: 01/11/2023] Open
Abstract
Immunoglobulin light chain (AL) amyloidosis is an incurable hematologic disorder typically characterized by the production of amyloidogenic light chains by clonal plasma cells. These light chains misfold and aggregate in healthy tissues as amyloid fibrils, leading to life-threatening multi-organ dysfunction. Here we show that the clonal plasma cells in AL amyloidosis are highly primed to undergo apoptosis and dependent on pro-survival proteins MCL-1 and BCL-2. Notably, this MCL-1 dependency is indirectly targeted by the proteasome inhibitor bortezomib, currently the standard of care for this disease and the related plasma cell disorder multiple myeloma, due to upregulation of pro-apoptotic Noxa and its inhibitory binding to MCL-1. BCL-2 inhibitors sensitize clonal plasma cells to multiple front-line therapies including bortezomib, dexamethasone and lenalidomide. Strikingly, in mice bearing AL amyloidosis cell line xenografts, single agent treatment with the BCL-2 inhibitor ABT-199 (venetoclax) produces deeper remissions than bortezomib and triples median survival. Mass spectrometry-based proteomic analysis reveals rewiring of signaling pathways regulating apoptosis, proliferation and mitochondrial metabolism between isogenic AL amyloidosis and multiple myeloma cells that divergently alter their sensitivity to therapies. These findings provide a roadmap for the use of BH3 mimetics to exploit endogenous and induced apoptotic vulnerabilities in AL amyloidosis.
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Affiliation(s)
- Cameron S. Fraser
- grid.38142.3c000000041936754XJohn B. Little Center for Radiation Sciences, Harvard TH Chan School of Public Health, Boston, MA 02115 USA ,grid.38142.3c000000041936754XProgram in Molecular and Integrative Physiological Sciences, Harvard TH Chan School of Public Health, Boston, MA 02115 USA ,grid.38142.3c000000041936754XLaboratory of Systems Pharmacology, Harvard Medical School, Boston, 02115 USA
| | - Johan K. E. Spetz
- grid.38142.3c000000041936754XJohn B. Little Center for Radiation Sciences, Harvard TH Chan School of Public Health, Boston, MA 02115 USA ,grid.38142.3c000000041936754XProgram in Molecular and Integrative Physiological Sciences, Harvard TH Chan School of Public Health, Boston, MA 02115 USA ,grid.38142.3c000000041936754XLaboratory of Systems Pharmacology, Harvard Medical School, Boston, 02115 USA
| | - Xingping Qin
- grid.38142.3c000000041936754XJohn B. Little Center for Radiation Sciences, Harvard TH Chan School of Public Health, Boston, MA 02115 USA ,grid.38142.3c000000041936754XProgram in Molecular and Integrative Physiological Sciences, Harvard TH Chan School of Public Health, Boston, MA 02115 USA ,grid.38142.3c000000041936754XLaboratory of Systems Pharmacology, Harvard Medical School, Boston, 02115 USA
| | - Adam Presser
- grid.38142.3c000000041936754XJohn B. Little Center for Radiation Sciences, Harvard TH Chan School of Public Health, Boston, MA 02115 USA ,grid.38142.3c000000041936754XProgram in Molecular and Integrative Physiological Sciences, Harvard TH Chan School of Public Health, Boston, MA 02115 USA ,grid.38142.3c000000041936754XLaboratory of Systems Pharmacology, Harvard Medical School, Boston, 02115 USA
| | - Jonathan Choiniere
- grid.38142.3c000000041936754XJohn B. Little Center for Radiation Sciences, Harvard TH Chan School of Public Health, Boston, MA 02115 USA ,grid.38142.3c000000041936754XProgram in Molecular and Integrative Physiological Sciences, Harvard TH Chan School of Public Health, Boston, MA 02115 USA ,grid.38142.3c000000041936754XLaboratory of Systems Pharmacology, Harvard Medical School, Boston, 02115 USA
| | - Chendi Li
- grid.32224.350000 0004 0386 9924Massachusetts General Hospital Cancer Center, Charlestown, MA 02129 USA ,grid.38142.3c000000041936754XDepartment of Medicine, Harvard Medical School, Boston, MA 02115 USA
| | - Stacey Yu
- grid.38142.3c000000041936754XJohn B. Little Center for Radiation Sciences, Harvard TH Chan School of Public Health, Boston, MA 02115 USA ,grid.38142.3c000000041936754XProgram in Molecular and Integrative Physiological Sciences, Harvard TH Chan School of Public Health, Boston, MA 02115 USA ,grid.38142.3c000000041936754XLaboratory of Systems Pharmacology, Harvard Medical School, Boston, 02115 USA
| | - Frances Blevins
- grid.239424.a0000 0001 2183 6745Section of Hematology & Medical Oncology, Boston Medical Center, Boston, MA 02118 USA ,grid.189504.10000 0004 1936 7558Amyloidosis Center, Boston University School of Medicine, Boston, MA 02118 USA
| | - Aaron N. Hata
- grid.32224.350000 0004 0386 9924Massachusetts General Hospital Cancer Center, Charlestown, MA 02129 USA ,grid.38142.3c000000041936754XDepartment of Medicine, Harvard Medical School, Boston, MA 02115 USA
| | - Jeffrey W. Miller
- grid.38142.3c000000041936754XDepartment of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA 02115 USA
| | - Gary A. Bradshaw
- grid.38142.3c000000041936754XLaboratory of Systems Pharmacology, Harvard Medical School, Boston, 02115 USA
| | - Marian Kalocsay
- grid.38142.3c000000041936754XLaboratory of Systems Pharmacology, Harvard Medical School, Boston, 02115 USA ,grid.240145.60000 0001 2291 4776Present Address: Department of Experimental Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030 USA
| | - Vaishali Sanchorawala
- grid.239424.a0000 0001 2183 6745Section of Hematology & Medical Oncology, Boston Medical Center, Boston, MA 02118 USA ,grid.189504.10000 0004 1936 7558Amyloidosis Center, Boston University School of Medicine, Boston, MA 02118 USA
| | - Shayna Sarosiek
- grid.239424.a0000 0001 2183 6745Section of Hematology & Medical Oncology, Boston Medical Center, Boston, MA 02118 USA ,grid.189504.10000 0004 1936 7558Amyloidosis Center, Boston University School of Medicine, Boston, MA 02118 USA ,grid.65499.370000 0001 2106 9910Present Address: Dana-Farber Cancer Institute, Harvard Cancer Center, Boston, 02215 USA
| | - Kristopher A. Sarosiek
- grid.38142.3c000000041936754XJohn B. Little Center for Radiation Sciences, Harvard TH Chan School of Public Health, Boston, MA 02115 USA ,grid.38142.3c000000041936754XProgram in Molecular and Integrative Physiological Sciences, Harvard TH Chan School of Public Health, Boston, MA 02115 USA ,grid.38142.3c000000041936754XLaboratory of Systems Pharmacology, Harvard Medical School, Boston, 02115 USA
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Tan D, Lee JH, Chen W, Shimizu K, Hou J, Suzuki K, Nawarawong W, Huang SY, Sang Chim C, Kim K, Kumar L, Malhotra P, Chng WJ, Durie B. Recent advances in the management of multiple myeloma: clinical impact based on resource-stratification. Consensus statement of the Asian Myeloma Network at the 16th international myeloma workshop. Leuk Lymphoma 2018; 59:2305-2317. [PMID: 29390932 DOI: 10.1080/10428194.2018.1427858] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Predicated on our improved understanding of the disease biology, we have seen remarkable advances in the management of multiple myeloma over the past few years. Recently approved drugs have radically transformed the treatment paradigm and improved survivals of myeloma patients. The progress has necessitated revision of the diagnostic criteria, risk-stratification and response definition. The huge disparities in economy, healthcare infrastructure and access to novel drugs among different Asian countries will hinder the delivery of optimum myeloma care to patients managed in resource-constrained environments. In the light of the tremendous recent changes and evolution in myeloma management, it is timely that the resource-stratified guidelines from the Asian Myeloma Network be revised to provide updated recommendations for Asia physicians practicing under various healthcare reimbursement systems. This review will highlight the most recent advances and our recommendations on how they could be integrated in both resource-abundant and resource-constrained facilities.
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Affiliation(s)
- Daryl Tan
- a Raffles Cancer Center , Raffles Hospital , Singapore.,b Department of Hematology , Singapore General Hospital , Singapore
| | - Jae Hoon Lee
- c Gil Hospital, Gachon University , Incheon , South Korea
| | - Wenming Chen
- d Beijing Chaoyang Hospital, Capital Medical University , Beijing , China
| | - Kazuyuki Shimizu
- e Higashi Nagoya National Hospital , National Hospital Organization , Nagoya , Japan
| | - Jian Hou
- f Department of Haematology , Changzheng Hospital, The Second Military Medical University , Shanghai , China
| | - Kenshi Suzuki
- g Department of Hematology , Japanese Red Cross Medical Center , Tokyo , Japan
| | | | | | - Chor Sang Chim
- j Queen Mary Hospital, University of Hong Kong , Hong Kong , China
| | - Kihyun Kim
- k Samsung Medical Center , Sungkyunkwan University , Seoul , South Korea
| | - Lalit Kumar
- l Department of Medical Oncology , Institute Rotary Cancer Hospital, All India Institute of Medical Sciences , New Delhi , India
| | - Pankaj Malhotra
- m Department of Internal Medicine , Postgraduate Institute of Medical Education and Research , Chandigarh , India
| | - Wee Joo Chng
- n Cancer Science Institute of Singapore , National University of Singapore , Singapore.,o Department of Haematology-Oncology , National University Cancer Institute of Singapore National University Health System , Singapore
| | - Brian Durie
- p Cedars-Sinai Comprehensive Cancer Center , Los Angeles , CA , USA
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5
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Dingli D, Ailawadhi S, Bergsagel PL, Buadi FK, Dispenzieri A, Fonseca R, Gertz MA, Gonsalves WI, Hayman SR, Kapoor P, Kourelis T, Kumar SK, Kyle RA, Lacy MQ, Leung N, Lin Y, Lust JA, Mikhael JR, Reeder CB, Roy V, Russell SJ, Sher T, Stewart AK, Warsame R, Zeldenrust SR, Rajkumar SV, Chanan Khan AA. Therapy for Relapsed Multiple Myeloma: Guidelines From the Mayo Stratification for Myeloma and Risk-Adapted Therapy. Mayo Clin Proc 2017; 92:578-598. [PMID: 28291589 PMCID: PMC5554888 DOI: 10.1016/j.mayocp.2017.01.003] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 12/12/2016] [Accepted: 01/04/2017] [Indexed: 12/13/2022]
Abstract
Life expectancy in patients with multiple myeloma is increasing because of the availability of an increasing number of novel agents with various mechanisms of action against the disease. However, the disease remains incurable in most patients because of the emergence of resistant clones, leading to repeated relapses of the disease. In 2015, 5 novel agents were approved for therapy for relapsed multiple myeloma. This surfeit of novel agents renders management of relapsed multiple myeloma more complex because of the occurrence of multiple relapses, the risk of cumulative and emergent toxicity from previous therapies, as well as evolution of the disease during therapy. A group of physicians at Mayo Clinic with expertise in the care of patients with multiple myeloma regularly evaluates the evolving literature on the biology and therapy for multiple myeloma and issues guidelines on the optimal care of patients with this disease. In this article, the latest recommendations on the diagnostic evaluation of relapsed multiple myeloma and decision trees on how to treat patients at various stages of their relapse (off study) are provided together with the evidence to support them.
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Affiliation(s)
- David Dingli
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
| | | | - P Leif Bergsagel
- Division of Hematology and Oncology, Mayo Clinic, Scottsdale, AZ
| | - Francis K Buadi
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Angela Dispenzieri
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Rafael Fonseca
- Division of Hematology and Oncology, Mayo Clinic, Scottsdale, AZ
| | - Morie A Gertz
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Wilson I Gonsalves
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Susan R Hayman
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Prashant Kapoor
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Taxiarchis Kourelis
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Shaji K Kumar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Robert A Kyle
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Martha Q Lacy
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Nelson Leung
- Division of Nephrology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Yi Lin
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - John A Lust
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Joseph R Mikhael
- Division of Hematology and Oncology, Mayo Clinic, Scottsdale, AZ
| | - Craig B Reeder
- Division of Hematology and Oncology, Mayo Clinic, Scottsdale, AZ
| | - Vivek Roy
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL
| | - Stephen J Russell
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Taimur Sher
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL
| | - A Keith Stewart
- Division of Hematology and Oncology, Mayo Clinic, Scottsdale, AZ
| | - Rahma Warsame
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Stephen R Zeldenrust
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - S Vincent Rajkumar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
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