Deubiquitinase Inhibitor WP1130 Blocks FLT3-ITD to Induce Apoptosis in Leukemic Cells

FMS-like tyrosine kinase 3 with internal tandem duplication (FLT3-ITD) is the most frequent kinase mutation seen in acute myeloid leukemia (AML). The ITD mutation promotes ligand-independent constitutive activation of FLT3 kinase, resulting in altered downstream signal pathway activation to enhance cell proliferation and prevent cell death. AML with FLT3-ITD is associated with poor prognosis, which neither high-dose chemotherapy nor allogeneic hematopoietic stem cell transplantation can overcome. Several tyrosine kinase inhibitors targeting FLT3 have been developed and tested in clinical trials, but their efficacies are limited so far partly due to resistance to kinase inhibition. Therefore, development of novel treatment strategies with distinct mechanisms to block FLT3 is warranted.

Deubiquitinating enzymes (DUBs) are proteases that remove ubiquitin from target proteins, resulting in changes in protein stability and signaling. WP1130 is an inhibitor for DUBs, which has been reported to inhibit BCR/ABL not through blocking the kinase activity but through promoting ubiquitination and translocation of BCR/ABL protein into perinuclear aggresomes. WP1130 also downregulates JAK2 tyrosine kinase in the same manner. However, the effect of WP1130 against FLT3-ITD has not been reported.

Here we demonstrate that WP1130 exerts anti-leukemic activity against leukemic cell lines and primary AML cells harboring FLT3-ITD. WP1130 efficiently downregulated activated form of FLT3-ITD through translocation of this mutant into aggresomes and activated the mitochondria-mediated intrinsic apoptotic pathway at least partly through accumulation of intracellular reactive oxygen species (ROS).

First, we examined the anti-proliferative effect of WP1130 and found that proliferation of the FLT3-ITD-harboring AML cell line MV4-11 was suppressed in a dose dependent manner with IC₅₀ of 1.3 μM. It was notable that MV4-11 was more susceptible to WP1130 compared with K562 (IC₅₀ = 3.3 μM) and HEL (IC₅₀ = 3.4 μM), leukemic cell lines harboring BCR/ABL and JAK2-V617F aberrant kinases, respectively.

Next, we assessed the effect of WP1130 against FLT3-ITD in MV4-11 cells. WP1130 rapidly downregulated FLT3-ITD to suppress downstream signaling pathways. The aggresomal translocation of FLT3-ITD was confirmed by confocal microscopy and western blot analysis of detergent-insoluble fraction of cellular proteins. Importantly, the downregulation was prominently observed for the activated form of FLT3-ITD autophosphorylated on Y591. Consistent with this, inhibition of FLT3 autophosphorylation by AC220 (quizartinib) resulted in attenuation of WP1130-induced FLT3-ITD downregulation.

Importantly, WP1130 induced apoptosis in MV4-11 cells much more efficiently than in other leukemic cell lines that we examined, including K562 and HEL. WP1130 activated the mitochondria-mediated intrinsic apoptotic pathway as demonstrated by Bax conformation change and loss of mitochondrial membrane potential (MMP). Forced overexpression of Bcl-xL, a member of pro-survival Bcl-2 family proteins that preserve MMP, blocked WP1130-induced apoptosis. Moreover, the apoptosis was synergistically enhanced by inhibition of Bcl-xL using ABT-737 or navitoclax, further supporting the involvement of Bcl-xL in WP1130-induced apoptosis. Interestingly, the apoptosis induction was also enhanced by 17-AAG, an HSP90 inhibitor that we previously demonstrated to disrupt the chaperone association of HSP90 with FLT3-ITD resulting in enhanced ubiquitination of FLT3-ITD. FLT3-ITD down regulation and apoptosis induction by WP1130 were also confirmed using other cell lines expressing FLT3-ITD and primary cells derived from FLT3-ITD positive AML patients.

Finally, since FLT3-ITD has been reported to increase intracellular ROS, we examined if ROS was involved in the anti-leukemic effect of WP1130. Treatment with WP1130 increased ROS levels in MV4-11 cells. Antioxidants N-acetyl-cysteine (NAC) and tert-butylhydroquinone (tBHQ) both attenuated WP1130-induced apoptosis, suggesting that intracellular ROS accumulation may play a role in induction of apoptosis.

Further studies are in progress to elucidate the exact molecular mechanisms involved in WP1130-mediated effects and to develop novel strategies to enhance its anti-leukemic effects in synergistic manners.