High-Throughput Drug Library Screening in Primary <i>KMT2A</i>-Rearranged Infant ALL Cells Favors the Identification of Drug Candidates That Activate P53 Signaling

oleh: Priscilla Wander, Susan T. C. J. M. Arentsen-Peters, Kirsten S. Vrenken, Sandra Mimoso Pinhan̉«os, Bianca Koopmans, M. Emmy M. Dolman, Luke Jones, Patricia Garrido Castro, Pauline Schneider, Mark Kerstjens, Jan J. Molenaar, Rob Pieters, Christian Michel Zwaan, Ronald W. Stam

Format: Article
Diterbitkan: MDPI AG 2022-03-01

Deskripsi

<i>KMT2A</i>-rearranged acute lymphoblastic leukemia (ALL) in infants (<1 year of age) represents an aggressive type of childhood leukemia characterized by a poor clinical outcome with a survival chance of <50%. Implementing novel therapeutic approaches for these patients is a slow-paced and costly process. Here, we utilized a drug-repurposing strategy to identify potent drugs that could expeditiously be translated into clinical applications. We performed high-throughput screens of various drug libraries, comprising 4191 different (mostly FDA-approved) compounds in primary <i>KMT2A</i>-rearranged infant ALL patient samples (<i>n</i> = 2). The most effective drugs were then tested on non-leukemic whole bone marrow samples (<i>n</i> = 2) to select drugs with a favorable therapeutic index for bone marrow toxicity. The identified agents frequently belonged to several recurrent drug classes, including BCL-2, histone deacetylase, topoisomerase, microtubule, and MDM2/p53 inhibitors, as well as cardiac glycosides and corticosteroids. The in vitro efficacy of these drug classes was successfully validated in additional primary <i>KMT2A</i>-rearranged infant ALL samples (<i>n</i> = 7) and <i>KMT2A</i>-rearranged ALL cell line models (<i>n</i> = 5). Based on literature studies, most of the identified drugs remarkably appeared to lead to activation of p53 signaling. In line with this notion, subsequent experiments showed that forced expression of wild-type p53 in <i>KMT2A</i>-rearranged ALL cells rapidly led to apoptosis induction. We conclude that <i>KMT2A</i>-rearranged infant ALL cells are vulnerable to p53 activation, and that drug-induced p53 activation may represent an essential condition for successful treatment results. Moreover, the present study provides an attractive collection of approved drugs that are highly effective against <i>KMT2A</i>-rearranged infant ALL cells while showing far less toxicity towards non-leukemic bone marrow, urging further (pre)clinical testing.