AKT-pathway inhibition in chronic lymphocytic leukemia reveals response relationships defined by TCL1.

Cell survival in chronic lymphocytic leukemia (CLL) largely depends on B-cell receptor-induced AKT activation. Gain-of-function genomic lesions of PI3K-AKT-mTOR pathway components are usually absent in CLL. We previously established that a BCR-mediated growth response in CLL is determined by the oncogene T-cell leukemia 1 (TCL1) through a sensitizer effect on AKT phospho-activation. Despite high clinical response rates following AKT-cascade inhibition in CLL, resistances in a substantial proportion of patients call for reliable pre- and post-exposure strata to better predict compound responses. Using a panel of inhibitors with differential vertical affinities in the PI3K-AKT-mTOR axis, we describe distinct patterns and determinants of sensitivities in 75 CLL samples. The compounds specifically impacted the BCR-induced physical TCL1-AKT interaction. In general, there was an efficient and tumor-selective abrogation of cell survival in suspension or protective stromal-cell cultures. However, biochemical and survival responses were heterogeneous across CLL and showed only incomplete overlap across inhibitors. Sensitivity clusters could be defined by differential responses to selective pan-PI3K inhibition vs. compounds acting more down-stream. An elevated PI3K/AKT/mTOR activation state conferred sensitivity or resistance, depending on the applied inhibitor. In fact, down-stream interception by mTOR or dual mTOR/PI3K inhibition appears more efficient in cases expressing the BCR-response and poor-risk determinants of ZAP70 or TCL1. Finally, exploiting the TCL1-AKT interaction, peptide-based TCL1-interphase mimics were potent in steric AKT antagonization and in reducing CLL cell survival. Overall, this study provides informative response relationships in AKT-pathway interception that can help refining predictive models in BCR-pathway inhibition in CLL.

Pharmacologic interception in T-cell leukemia 1A associated pathways as a treatment rationale for chronic lymphocytic leukemia.

Recent therapeutic advances in chronic lymphocytic leukemia (CLL) are reflected by high response rates in most subsets of patients. However, refractory disease remains a problem, and virtually all of even the most sensitive tumors eventually recur. Therefore, ongoing efforts aim at the development of optimized interventional designs that more specifically target the strong pro-survival signature of the transformed B cell. Stimuli from the CLL microenvironment are considered the predominant force that sets this high anti-apoptotic threshold. We introduce here our concept that the oncogene T-cell leukemia 1A (TCL1A), which induces CLL-like disease in transgenic mice, significantly enhances such milieu-derived signaling, propagates associated resistance, and therefore represents a targetable pathway in CLL. We discuss inhibitory strategies that are based on TCL1A's activation of the growth modulating kinase AKT and on influences that regulate TCL1A expression. Respective preliminary data indicate that differential response categories of CLL exist. Future studies will test TCL1A's inherent predictive information.