Effective drug treatment identified by in vivo screening in a transplantable patient-derived xenograft model of chronic myelomonocytic leukemia

Leukemia. 2020 Nov;34(11):2951-2963. doi: 10.1038/s41375-020-0929-3. Epub 2020 Jun 24.

Abstract

To establish novel and effective treatment combinations for chronic myelomonocytic leukemia (CMML) preclinically, we hypothesized that supplementation of CMML cells with the human oncogene Meningioma 1 (MN1) promotes expansion and serial transplantability in mice, while maintaining the functional dependencies of these cells on their original genetic profile. Using lentiviral expression of MN1 for oncogenic supplementation and transplanting transduced primary mononuclear CMML cells into immunocompromised mice, we established three serially transplantable CMML-PDX models with disease-related gene mutations that recapitulate the disease in vivo. Ectopic MN1 expression was confirmed to enhance the proliferation of CMML cells, which otherwise did not engraft upon secondary transplantation. Furthermore, MN1-supplemented CMML cells were serially transplantable into recipient mice up to 5 generations. This robust engraftment enabled an in vivo RNA interference screening targeting CMML-related mutated genes including NRAS, confirming that their functional relevance is preserved in the presence of MN1. The novel combination treatment with azacitidine and the MEK-inhibitor trametinib additively inhibited ERK-phosphorylation and thus depleted the signal from mutated NRAS. The combination treatment significantly prolonged survival of CMML mice compared to single-agent treatment. Thus, we identified the combination of azacitidine and trametinib as an effective treatment in NRAS-mutated CMML and propose its clinical development.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Antineoplastic Agents / administration & dosage
  • Antineoplastic Agents / adverse effects
  • Antineoplastic Agents / pharmacology*
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Azacitidine / pharmacology
  • Clonal Evolution
  • Disease Models, Animal
  • Drug Evaluation, Preclinical* / methods
  • Drug Evaluation, Preclinical* / standards
  • Drug Synergism
  • Female
  • GTP Phosphohydrolases / genetics
  • Humans
  • Leukemia, Myelomonocytic, Chronic / drug therapy*
  • Leukemia, Myelomonocytic, Chronic / genetics
  • Leukemia, Myelomonocytic, Chronic / mortality
  • Leukemia, Myelomonocytic, Chronic / pathology
  • Membrane Proteins / genetics
  • Mice
  • Mutation
  • Protein Kinase Inhibitors / pharmacology
  • Protein Kinase Inhibitors / therapeutic use
  • Pyridones / pharmacology
  • Pyridones / therapeutic use
  • Pyrimidinones / pharmacology
  • Pyrimidinones / therapeutic use
  • RNA, Small Interfering / genetics
  • Receptor, Notch1 / genetics
  • Xenograft Model Antitumor Assays* / methods

Substances

  • Antineoplastic Agents
  • Membrane Proteins
  • NOTCH1 protein, human
  • Protein Kinase Inhibitors
  • Pyridones
  • Pyrimidinones
  • RNA, Small Interfering
  • Receptor, Notch1
  • trametinib
  • GTP Phosphohydrolases
  • NRAS protein, human
  • Azacitidine