Preclinical evaluation of SWI/SNF targeting agents in multiple myeloma including t(4;14) subtypes Free

Introduction: Despite remarkable advances in treatment, patients with multiple myeloma (MM) continue to suffer relapse. Therefore, the development of novel therapeutic strategies is required. The SWI/SNF chromatin remodeling complex, especially its core ATPase subunits SMARCA2/4, is essential for super-enhancer function and MM cell survival. Furthermore, NSD2, which is overexpressed in t(4;14)-positive MM, has been reported to interact with SMARCA2/4, suggesting differential sensitivity to SMARCA2/4 inhibition. While ATPase inhibitors and PROTAC degraders targeting SMARCA2/4 have demonstrated promising preclinical efficacy in MM and other malignancies, their broader therapeutic relevance remains to be clarified.

Methods: To support the clinical development of mSWI/SNF antagonists for MM, we first performed PRISM-based profiling of the anti-proliferative effects of both an mSWI/SNF ATPase PROTAC degrader and a catalytic inhibitor across a panel of 888 cancer cell lines from diverse lineages. Lineage enrichment analysis identified plasma cell myeloma as one of the most sensitive malignancies, with the PROTAC degrader demonstrating particularly potent effects. These were followed by in-depth studies in 35 human myeloma cell lines (HMCLs) using FHD-286 (SMARCA2/4 ATPase inhibitor), AU-24118 (CRBN-based degrader), and AU-15330 (VHL-based degrader). Cell viability was assessed after 5-day treatment by flow cytometry with Annexin V and Live/Dead staining. Additional assays were performed in hCRBN-engineered murine plasmacytoma cell lines and Vk*MYC^hCRBN MM mouse models. Chromatin profiling employed CUT&Tag with SMARCA2/4 and IKZF1/3 antibodies.

Results: FHD-286 and AU-24118 showed potent anti-myeloma activity across most cell lines (median IC₅₀: 4.5 nM and 5.9 nM, respectively). HMCLs with t(4;14), as compared to those without, were more sensitive to FHD-286 (p= 0.0064), with a similar trend for AU-24118 (p=0.09). AU-24118 log₂ IC₅₀ values correlated with those of FHD-286 (r=0.62, p=0.0002) and with pomalidomide (r=0.61, p=0.0002), suggesting a shared biology. Indeed, CUT&Tag analysis for SMARCA2/4 and the pomalidomide targets IKZF1/3 showed these factors co-localized at most sites throughout the genome in MM.1S cells, including at DUSP22/IRF4, POU2AF1, and IgH super-enhancers. Treatment with AU-15330, depleted SMARCA2/4 off chromatin at >80% of sites within 8 hours (FDR <0.01), and somewhat surprisingly also depleted IKZF1/3 off chromatin at 70% of bound regions, indicating IKZF1/3 function is dependent upon SWI/SNF. Resultantly, combination studies of SWI/SNF targeting agents and pomalidomide showed a lack of synergy and in some cases antagonism, highlighting the importance of careful evaluation when considering combination with pomalidomide.

We and others have demonstrated that murine cells are IMiDs resistant due to species-specific differences in CRBN. Using three distinct mouse plasmacytoma cell lines (+/-hCRBN), hCRBN-expressing cells showed a 100-fold greater sensitivity to AU-24118 compared hCRBN- cell lines. In vivo safety testing of AU-24118 using hCRBN transgenic mice exhibited early mortality within 7 days at doses ≥1.875 mpk and within 3 days at doses ≥7.5 mpk, accompanied by rapid body weight loss. In contrast, a preliminary efficacy study using de novo Vk*MYC^hCRBN mice, AU-24118 administered at 1 mpk three times per week was well tolerated and led to approximately 40% reduction in serum M-protein within 2 weeks (p<0.05), with no notable weight loss, demonstrating a therapeutic window.

Conclusions: Broad PRISM profiling confirms lineage-specific vulnerability of MM to SWI/SNF inhibition, with in vitro and in vivo validation supporting selective efficacy in high-risk t(4;14)-positive subtypes. FHD-286, AU-15330, and AU-24118 demonstrated strong in vitro activity, particularly in t(4;14)-positive HMCLs. This activity was due, in part, to chromatin compaction and decommissioning of lineage and oncogenic enhancers as well as eviction of IKZF1/3 off chromatin. AU-24118 showed high selectivity, with picomolar range IC₅₀ in sensitive HMCLs. Due to species-specific CRBN differences, accurate toxicity evaluation of AU-24118 requires hCRBN-expressing models, and preliminary data indicate in vivo efficacy in the highly predictive Vk*MYC^hCRBN model. These findings support the potential of SMARCA2/4 targeting agents, especially AU-24118, as promising therapies for MM, particularly in high-risk t(4;14)-positive cases.