MAP4K2 Inhibition Reinforces the Iberdomide Sensitivity in MM Cells By Inducing IKZF1 Degradation through a CRBN Independent Mechanism

MAP4K2 is predominantly and highly expressed in the germinal center of B cells, also called Germinal Center Kinase (GCK). Recently we have shown that MAP4K2 knockdown in K- or N-RAS mutated MM cells induces MM cell growth inhibition, associated with the downregulation of critical transcriptional factors including IKZF1/3, BCL-6, and c-MYC proteins. IKZF1 is a critical transcriptional factor regulating IRF4 and c-MYC transcription in MM, therefore we expect that IKZF1 degradation is one of the major mechanisms that contribute to the inhibition of MAP4K2 induced MM cell death.

To address the role of IKZF1 degradation in MAP4K2 inhibition induced cytotoxicity in MM, we generated a mutant IKZF1 by substituting Glutamine Q146 to Histidine, which abrogates IKZF1 ubiquitination induced by CRBN. MM.1S cells were transduced with lentiviral constructs to overexpress flag-IKZF1^WT or flag-IKZF1^Q146H. Lenalidomide failed to induce a complete IKZF1-degradation in IKZF1^Q146H MM.1S cells, indicating IMiDs induced IKZF1-degradation is mediated by CRBN binding and subsequent ubiquitination. In contrast, IKZF1 mutation did not rescue MM.1S from MAP4K2 inhibitor (TL4-12) induced IKZF1 downregulation. Proliferation assays further confirmed that IKZF1^Q146H MM.1S cells were resistant to LEN induced cell growth inhibition, but not MAP4K2 inhibitor, demonstrating that MAP4K2 inhibition causes the degradation of IKZF1 and cell growth inhibition through a mechanism different from that of lenalidomide in myeloma cells. We further evaluated the effects of MAP4K2 silencing in IKZF1^Q146H MM.1S cells. MAP4K2 knockdown resulted in significant inhibition of cell proliferation and increase of apoptotic cells in both cell lines (flag-IKZF1^WT or flag-IKZF1^Q146H MM.1S). Flag-IKZF1^WT or flag-IKZF1^Q146H were also overexpressed in IMiDs resistant (RPMI-8266) MM cell line by lentiviral infection, and no differences of MAP4K2 knockdown induced change of IKZF1 levels, cell proliferation, or apoptosis were observed between two cell lines. These data suggest that MAP4K2 inhibition induces anti-MM effects by targeting IKZF1 via an CRBN independent mechanism and subsequently overcomes IMiDs resistance.

Our recent work also showed that the combination of iberdomide and MAP4K2 silencing led to synergetic anti-MM effects in vitro. In previous biochemical and structural studies, it was demonstrated that iberdomide binds to cereblon with a higher affinity than lenalidomide or pomalidomide. To investigate the combined effects of Iberdomide with MAP4K2 silencing on MM tumor growth, we generated subcutaneous MM xenografts in non-obese diabetic severe combined immunodeficient (NOD/SCID) mice using the inducible MAP4K2 shRNA MM.1S cells. Combination of Iberdomide with MAP4K2 silencing further enhanced tumor inhibition compared to the single treatment. Furthermore, we found that combination treatment significantly prolonged mice survival, compared to the single treatment.

Taken together, our findings demonstrate that MAP4K2 is a novel therapeutic target to bypass IMiDs resistance in RAS mutated MM. Combination of MAP4K2 inhibition with Iberdomide results in synergetic anti-cancer effects in MM, therefore will provide a novel strategy to manage the relapsed or refractory patients with multi-drug resistance.

Mapara:Ossium Health: Consultancy, Research Funding. Marcireau:Sanofi: Current Employment. Lentzsch:Clinical Care Options: Speakers Bureau; Prothena: Honoraria; Peerview: Speakers Bureau; Caelum Bioscience: Consultancy, Other: Stock ownership; Zentalis: Research Funding; Oncopeptides: Consultancy; Sanofi: Consultancy, Research Funding; GlaxoSmithKline: Consultancy; Janssen: Consultancy; Nataea: Consultancy; Takeda: Consultancy; Pfizer: Consultancy; Poseida: Other: Equity ownership; Magenta: Other: Equity Ownership.