[HTML][HTML] Activation of RAS/MAPK pathway confers MCL-1 mediated acquired resistance to BCL-2 inhibitor venetoclax in acute myeloid leukemia

Q Zhang, B Riley-Gillis, L Han, Y Jia, A Lodi… - Signal transduction and …, 2022 - nature.com
Q Zhang, B Riley-Gillis, L Han, Y Jia, A Lodi, H Zhang, S Ganesan, R Pan, SN Konoplev
Signal transduction and targeted therapy, 2022nature.com
Despite high initial response rates, acute myeloid leukemia (AML) treated with the BCL-2–
selective inhibitor venetoclax (VEN) alone or in combinations commonly acquires
resistance. We performed gene/protein expression, metabolomic and methylation analyses
of isogenic AML cell lines sensitive or resistant to VEN, and identified the activation of
RAS/MAPK pathway, leading to increased stability and higher levels of MCL-1 protein, as a
major acquired mechanism of VEN resistance. MCL-1 sustained survival and maintained …
Abstract
Despite high initial response rates, acute myeloid leukemia (AML) treated with the BCL-2–selective inhibitor venetoclax (VEN) alone or in combinations commonly acquires resistance. We performed gene/protein expression, metabolomic and methylation analyses of isogenic AML cell lines sensitive or resistant to VEN, and identified the activation of RAS/MAPK pathway, leading to increased stability and higher levels of MCL-1 protein, as a major acquired mechanism of VEN resistance. MCL-1 sustained survival and maintained mitochondrial respiration in VEN-RE cells, which had impaired electron transport chain (ETC) complex II activity, and MCL-1 silencing or pharmacologic inhibition restored VEN sensitivity. In support of the importance of RAS/MAPK activation, we found by single-cell DNA sequencing rapid clonal selection of RAS-mutated clones in AML patients treated with VEN-containing regimens. In summary, these findings establish RAS/MAPK/MCL-1 and mitochondrial fitness as key survival mechanisms of VEN-RE AML and provide the rationale for combinatorial strategies effectively targeting these pathways.
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