sirolimus and Burkitt-Lymphoma

Sinusoidal obstruction syndrome (SOS) is a potentially life-threatening complication that can be observed after allogeneic hematopoietic cell transplantation (HCT). Inotuzumab ozogamicin is an anti-CD22 monoclonal antibody-drug conjugate that has demonstrated high efficacy in relapsed/refractory (R/R) acute lymphoblastic leukemia (ALL) but is associated with an increased risk of SOS in HCT recipients. Here we aimed to examine the incidence and outcomes of SOS in 47 adult patients with R/R ALL who received inotuzumab therapy and subsequently underwent HCT at our institution. All patients received prophylactic therapy with ursodiol, and continuous low-dose heparin also was administered to patients receiving myeloablative conditioning (MAC). SOS occurred in 12 patients (26%) post-HCT, at a median onset of 11 days (range, 3 to 41 days). SOS was graded as very severe in 50% (n = 6), severe in 25% (n = 3), and mild in 25% (n = 3). All patients diagnosed with SOS received treatment with defibrotide for a median of 21 days (range, 3 to 34 days), with resolution of SOS occurring in 8 patients (67%). Mortality from SOS was 33% (n = 4) and occurred at a median of 10 days from diagnosis (range, 3 to 31 days) in patients graded as very severe (n = 3) or severe (n = 1). There were no significant differences between patients who developed SOS and those who did not develop SOS in the median time from the last dose of inotuzumab to transplantation (46 days versus 53 days; P = .37), use of an MAC regimen (42% versus 49%; P = .75), number of lines of therapy prior to inotuzumab (P = .79), median number of administered cycles of inotuzumab (2 versus 2; P = .14), or receipt of inotuzumab as the last therapy prior to HCT (67% versus 66%; P = 1.0). Sirolimus-based graft-versus-host disease (GVHD) prophylaxis was used more frequently in the SOS group (75% versus 29%; P < .01), but there was no between-group difference in the peak sirolimus level (P = .81) or the median time to peak sirolimus level (7 days versus 3.5 days; P = .39). In univariable analysis, only the use of sirolimus-based GVHD prophylaxis was significantly associated with an increased risk of SOS (hazard ratio [HR], 7.50; 95% confidence interval [CI], 1.7 to 33.6; P < .01). In the SOS group, the 100-day mortality rate was 33% (n = 4), and median overall survival (OS) post-HCT was 4.3 months (range, 0.2 to 57.2 months). In the group without SOS, the 100-day mortality rate was 14% (n = 5) and the median OS post-HCT

Topics: Adult; Burkitt Lymphoma; Graft vs Host Disease; Hepatic Veno-Occlusive Disease; Humans; Inotuzumab Ozogamicin; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma; Sirolimus

Increasing evidence indicates that rapamycin could be used as a potential glucocorticoid (GC) sensitizer in lymphoblastic malignancies via genetic prevention of 4E-BP1 phosphorylation. Interestingly, we found that combined rapamycin with dexamethasone can effectively reverse GC resistance in 4E-BP1 null lymphoma cells. In this study, we investigated the potential link between mTOR/p70S6K signaling pathway, glycolysis, autophagy and GC resistance.. Antitumor effects of the combination of rapamycin and dexamethasone were evaluated on cell viability by MTT assay and in vivo studies, on cell cycle and apoptosis by flow cytometry, on autophagy by western blot, MDC staining and transmission electron microscopy and on cell signaling by western blot. Moreover, to test whether inhibiting glycolysis is the core mechanism in rapamycin restoring GC sensitivity, we took glycolysis inhibitor 2-deoxyglucose to replace rapamycin and then evaluated the antitumor effects in vitro.. Raji cells are resistant to rapamycin (IC50 > 1000 nM) or dexamethasone (IC50 > 100 μM) treatment alone. The combination of rapamycin and dexamethasone synergistically inhibited the viability of Raji cells in vitro and in vivo by inducing caspase-dependent and -independent cell death and G0/G1 cell cycle arrest. These effects were achieved by the inhibition of mTOR/p70S6K signaling pathway, which led to the inhibition of glycolysis and the induction of autophagy. Pretreatment with pan-caspase inhibitor z-VAD-fmk or autophagy inhibitor 3-MA failed to protect the cells from combined treatment-induced death. Glycolysis inhibitor combined with dexamethasone produced a similar antitumor effects in vitro.. Inhibition of mTOR/p70S6K/glycolysis signaling pathway is the key point of therapy in reversing GC resistant in Burkitt lymphoma patients.

Topics: Animals; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Apoptosis; Burkitt Lymphoma; Cell Cycle; Cell Line, Tumor; Deoxyglucose; Dexamethasone; Drug Resistance, Neoplasm; Drug Synergism; Glucocorticoids; Glycolysis; Humans; Mice; Ribosomal Protein S6 Kinases, 70-kDa; Signal Transduction; Sirolimus; Xenograft Model Antitumor Assays

Neoplastic processes, tumor growth, and tumor cell proliferation and survival are often due to the altered activation of different signaling pathways. The increased activity of PI3K/AKT/mTOR signaling has been shown to be an important regulator of tumor growth in several solid tumors and in mantle cell lymphomas. The active form of mTOR kinase (mammalian target of rapamycin) is a key signaling molecule, and it exists in two different complexes, mTORC1 and mTORC2. In the present work, mTOR activity was investigated in different lymphoma types, in parallel with clinical data. We also examined in Hodgkin lymphomas (HL) the role of mTOR activity in survival mechanisms such as antiapoptotic protein expression and alterations in the microenvironment. We determined which lymphoma types display characteristic high mTOR activity in our TMA (tissue microarray) study. We observed that mTOR activity is increased in mitotic lymphoid cells compared to interphasic cells. The number of diffuse large B cell lymphoma (DLBCL) and HL cases was extended in a further set of TMA. We observed significantly higher mTOR activity in the non-centrum germinativum derived subtype of DLBCL than in the centrum germinativum derived subtype, which was a prognostic marker; 63% of mTOR active cases showed Rictor overexpression, indicating mTORC2 activity. High mTOR activity was also established in 92% of HL cases, which was linked to mTORC1. This finding was not a prognostic marker, however, it can be useful in targeted therapy. We observed the overexpression of the antiapoptotic protein BCL-xL and NFκB-p50 in the majority of mTOR active HLs. HLs showed high numbers of regulatory T cells in the microenvironment and high expression of galectin-1 in tumor cells and in the extracellular matrix, when compared to reactive lymph nodes. We confirmed that mTOR inhibition had significant antiproliferative and antiapoptotic effects in lymphoma cell lines and in lymphoma xenografts (HL, DLBCL, Burkitt lymphoma). We also showed that rapamycin was able to augment the effect of chemotherapeutic agents and TGF-β. Taken together, mTOR activity may be a potential therapeutic target in different lymphoma types. However, patient and inhibitor selection criteria must be carefully considered. The combination of mTOR inhibitors with other agents will probably offer the highest efficiency for achieving the best clinical response, and may also allow dose reduction in order to decrease late treatment toxicity in th. A neopláziás folyamatok kialakulása, a daganat növekedése, a daganatsejtek proliferációja és túlélése hátterében gyakran különbözõ jelutak magváltozott aktivitása áll. A PI3K/AKT/mTOR jelút fokozott aktivitása szolid daganatokban és köpenysejtes lymphomákban a daganatkialakulás és -növekedés fontos szabályozója. Az aktív mTOR (mammalian target of rapamycin) kináz két komplex (mTORC1, mTORC2) meghatározó eleme. Az mTOR-aktivitás szerepét vizsgáltuk különbözõ humán lymphomákban, összefüggéseket keresve a betegek klinikai adataival. Hodgkin-lymphomákban (HL) tanulmányoztuk, hogy a magas mTOR-aktivitás milyen, a daganat túlélésében fontos folyamatokban vesz részt (antiapoptotikus mechanizmusok és mikrokörnyezeti változások). Meghatároztuk azokat a humán lymphomatípusokat, amelyekre magas mTOR-aktivitás jellemzõ. Kimutattuk, hogy a mitotikus lymphoid sejtek mTOR-aktivitása magasabb, mint a nem osztódó sejteké. Nagyobb esetszámot tartalmazó TMA-blokkokon (tissue microarray) tovább vizsgáltuk a diffúz nagy B-sejtes lymphoma (DLBCL) és a HL eseteket. Szignifikáns összefüggést mutattunk ki DLBCL-s betegek altípusmegoszlása (csíraközpont-eredetû és nem csíraközpont-eredetû DLBCL-ek) és az mTOR-aktivitás között. DLBCL-ban a fokozott mTOR-aktivitás negatív prognosztikus markernek bizonyult. A HL-ek 92%-a magas mTOR-aktivitást mutatott (mTORC1-hez köthetõ), ami prognosztikus faktorként nem, viszont terápiás célpontként felhasználható. A HL-ek mikrokörnyezetének vizsgálata szerint a regulátor T-sejtek mennyisége a mikrokörnyezetben, valamint a galektin-1-expresszió a tumorsejtekben és az extracelluláris mátrixban emelkedett. A magas mTOR-aktivitás és a galektin-1-expresszió között kapcsolatot találtunk in vitro kísérleteinkben, ahol az mTOR gátlása transzlációs szinten csökkentette a galektin-1-expressziót. Az mTOR-gátlás jelentõségét – proliferációgátló és apoptotikus hatását – humán lymphoma xenograftokban (HL, DLBCL, Burkitt-lymphoma) bizonyítottuk. In vitro kombinációs kezelésekben a rapamycin apoptotikus hatást fokozó szerepét igazoltuk. Munkánkban meghatároztuk azokat a lymphomatípusokat, amelyekben az mTOR-gátlás célzott terápiaként alkalmazható lehet. Eredményeink alapján annak meghatározása, hogy melyik komplexhez köthetõ az mTOR-aktivitás, nagyon fontos a megfelelõ mTOR-gátló (klasszikus vagy kettõs gátlók) kiválasztásában. A jövõben a magas mTOR-aktivitást mutató lymphomákban várhatóan kombinációs kezelésben az mTOR-gátlók használata hozzájárulhatna a jobb t

Topics: Animals; Antineoplastic Agents; Apoptosis; Apoptosis Regulatory Proteins; bcl-X Protein; Burkitt Lymphoma; Cell Line; Drug Synergism; Galectin 1; Gene Expression Regulation, Neoplastic; Hodgkin Disease; Humans; Immunosuppressive Agents; Interphase; Lymphoma; Lymphoma, Large B-Cell, Diffuse; Mechanistic Target of Rapamycin Complex 1; Mechanistic Target of Rapamycin Complex 2; Mitosis; Multiprotein Complexes; NF-kappa B p50 Subunit; Signal Transduction; Sirolimus; T-Lymphocytes, Regulatory; Tissue Array Analysis; TOR Serine-Threonine Kinases; Transforming Growth Factor beta; Up-Regulation; Xenograft Model Antitumor Assays

Burkitt leukemia/lymphoma is a major subtype of aggressive B-cell lymphoma. Biological targeted therapies on this disease need to be further investigated and may help to improve the clinical outcome of the patients.. This study examined the anti-tumor activity of the histone deacetylases (HDAC) inhibitor valproic acid (VPA) combined with the mammalian target of rapamycin (MTOR) inhibitor temsirolimus in Burkitt leukemia/lymphoma cell lines, as well as in primary tumor cells and a murine xenograft model.. Co-treatment of VPA and temsirolimus synergistically inhibited the tumor cell growth and triggered the autophagic cell death, with a significant inhibition of MTOR signaling and MYC oncoprotein. Functioned as a class I HDAC inhibitor, VPA potentiated the effect of temsirolimus on autophagy through inhibiting HDAC1. Molecular silencing of HDAC1 using small interfering RNA (siRNA) attenuated VPA-mediated regulation of CDKN1A, CDKN1B and LC3-I/II, regression of tumor cell growth and induction of autophagy. Meanwhile, VPA counteracted temsirolimus-induced AKT activation via HDAC3 inhibition. HDAC3 siRNA abrogated the ability of VPA to modulate AKT phosphorylation, to suppress tumor cell growth and to induce autophagy. Strong antitumor effect was also observed on primary tumor cells while sparing normal hematopoiesis ex vivo. In a murine xenograft model established with subcutaneous injection of Namalwa cells, dual treatment efficiently blocked tumor growth, inhibited MYC and induced in situ autophagy.. These findings confirmed the synergistic effect of the HDAC and MTOR inhibitors on Burkitt leukemia/lymphoma, and provided an insight into clinical application of targeting autophagy in treating MYC-associated lymphoid malignancies.

Topics: Animals; Antineoplastic Combined Chemotherapy Protocols; Autophagy; Burkitt Lymphoma; Cell Line, Tumor; Drug Synergism; Histone Deacetylase Inhibitors; Humans; Mice; Signal Transduction; Sirolimus; TOR Serine-Threonine Kinases; Valproic Acid; Xenograft Model Antitumor Assays

Epstein-Barr virus (EBV) infection and latency has been associated with malignancies, including nasopharyngeal carcinoma and Burkitt's lymphoma. EBV encoded latent membrane protein 2A (LMP2A) is expressed in most EBV-associated malignancies and as such provides a therapeutic target. Burkitt's lymphoma is a hematopoietic cancer associated with the translocation of c-MYC to one of the immunoglobulin gene promoters leading to abnormally high expression of MYC and development of lymphoma. Our laboratory has developed a murine model of EBV-associated Burkitt's lymphoma by crossing LMP2A transgenic mice with MYC transgenic mice. Since LMP2A has been shown to activate the PI3K/Akt/mTOR pathway, we tested the therapeutic efficacy of mTOR inhibitor rapamycin on the tumors and splenomegaly in these double transgenic mice (Tg6/λ-MYC). We found that rapamycin reversed splenomegaly in Tg6/λ-MYC mice prior to tumor formation by targeting B cells. In a tumor transfer model, we also found that rapamycin significantly decreased tumor growth, splenomegaly, and metastasis of tumor cells in the bone marrow of tumor recipients. Our data show that rapamycin may be a valuable candidate for the development of a treatment modality for EBV-positive lymphomas, such as Burkitt's lymphoma, and more importantly, provides a basis to develop inhibitors that specifically target viral gene function in tumor cells that depend on LMP2A signaling for survival and/or growth.

Topics: Animals; Apoptosis; Burkitt Lymphoma; Epstein-Barr Virus Infections; Female; Flow Cytometry; Herpesvirus 4, Human; Homeodomain Proteins; Male; Mice; Mice, 129 Strain; Mice, Inbred C57BL; Mice, Knockout; Mice, Transgenic; Proto-Oncogene Proteins c-myc; Sirolimus; Splenomegaly; Tumor Burden; Viral Matrix Proteins

Despite activity as single agent cancer therapies, Rapamycin (rapa) and its rapalogs may have their greatest effects when combined with other therapeutic modalities. In addition to direct antitumor activity, rapalogs reverse multiple tumor-intrinsic immune evasion mechanisms. These should facilitate tumor-specific T cell activity, but since rapa directly inhibits effector T cells, this potential immune enhancement is lost. We hypothesized that if T cells were rendered resistant to rapa they could capitalize on its downregulation of tumor immune evasion. We therefore modified T cells with a rapa-resistant mutant of mTor, mTorRR, and directed them to B lymphomas by coexpressing a chimeric antigen receptor (CAR) for CD19 (CAR.CD19-28ζ). T cells expressing transgenic mTorRR from a piggyBac transposon maintain mTor signaling, proliferate in the presence of rapa and retain their cytotoxic function and ability to secrete interferon-γ (IFNγ) after stimulation, effector functions that were inhibited by rapa in control T cells. In combination, rapa and rapa-resistant-CAR.CD19-28ζ-expressing T cells produced greater antitumor activity against Burkitt's lymphoma and pre-B ALL cell lines in vitro than CAR.CD19-28ζ T cells or rapa alone. In conclusion, the combination of rapa and rapa-resistant, CAR.CD19-28ζ-expressing T cells may provide a novel therapy for the treatment of B cell malignancies and other cancers.

Topics: Animals; Antigens, CD19; Apoptosis; B-Lymphocytes; Blotting, Western; Burkitt Lymphoma; Cell Proliferation; Cells, Cultured; Combined Modality Therapy; Drug Resistance, Neoplasm; Female; Flow Cytometry; Humans; Immunosuppressive Agents; Interferon-gamma; Lymphocyte Activation; Mice; Mice, Inbred NOD; Mice, SCID; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma; Receptors, Antigen; Sirolimus; T-Lymphocytes; TOR Serine-Threonine Kinases

Acute lymphoblastic leukemia (ALL) in adult patients is often resistant to current therapy, making the development of novel therapeutic agents paramount. We investigated whether mTOR inhibitors (MTIs), a class of signal transduction inhibitors, would be effective in primary human ALL. Lymphoblasts from adult patients with precursor B ALL were cultured on bone marrow stroma and were treated with CCI-779, a second generation MTI. Treated cells showed a dramatic decrease in cell proliferation and an increase in apoptotic cells, compared to untreated cells. We also assessed the effect of CCI-779 in a NOD/SCID xenograft model. We treated a total of 68 mice generated from the same patient samples with CCI-779 after establishment of disease. Animals treated with CCI-779 showed a decrease in peripheral-blood blasts and in splenomegaly. In dramatic contrast, untreated animals continued to show expansion of human ALL. We performed immunoblots to validate the inhibition of the mTOR signaling intermediate phospho-S6 in human ALL, finding down-regulation of this target in xenografted human ALL exposed to CCI-779. We conclude that MTIs can inhibit the growth of adult human ALL and deserve close examination as therapeutic agents against a disease that is often not curable with current therapy.

Topics: Adult; Aged; Animals; Apoptosis; Burkitt Lymphoma; Cell Proliferation; Drug Evaluation, Preclinical; Enzyme Inhibitors; Female; Humans; Male; Mice; Mice, Inbred NOD; Mice, SCID; Neoplasm Transplantation; Protein Kinases; Signal Transduction; Sirolimus; TOR Serine-Threonine Kinases; Transplantation, Heterologous; Tumor Cells, Cultured

IFNs are a family of cytokines that are involved in the regulation of immune and inflammatory responses. Clinical use of IFN-alpha/beta encompasses treatment for a variety of diseases; however, prolonged exposure to IFN-alpha/beta results in elevated levels of autoreactive Abs. In this study, we investigated the potential of IFNs to modulate apoptotic signals in B cells. We demonstrate that IFN-alpha or IFN-beta inhibit Ag receptor-mediated apoptosis in a dose-dependent manner. Inhibition of phosphatidylinositol 3' (PI3)-kinase did not abolish the effect of IFN, indicating that the antiapoptotic mechanism is PI3-kinase- and protein kinase B/Akt-independent. Instead, IFN-alpha and IFN-beta, but not IFN-gamma, significantly increase the levels of the survival protein Bcl-2, and to a lesser extent, Bcl-xL expression. Thus, IFN-alpha/beta-mediated inhibition of B cell Ag receptor-triggered apoptosis may offer a model for the process that leads to the escape of self-reactive B cells from negative selection and consequently results in autoantibody production.

Topics: Androstadienes; Antibodies, Anti-Idiotypic; Apoptosis; bcl-X Protein; Burkitt Lymphoma; CD40 Antigens; Enzyme Inhibitors; Genistein; Humans; Immunosuppressive Agents; Interferon-alpha; Interferon-beta; Phosphatidylinositol 3-Kinases; Phosphoinositide-3 Kinase Inhibitors; Proto-Oncogene Proteins c-bcl-2; Receptors, Antigen, B-Cell; Sirolimus; T-Lymphocytes, Helper-Inducer; Tumor Cells, Cultured; Wortmannin