Resistance Mechanisms to SYK Inhibition in Acute Myeloid Leukemia

Abstract

Spleen tyrosine kinase (SYK) is a nonmutated therapeutic target in acute myeloid leukemia (AML). Attempts to exploit SYK therapeutically in AML have shown promising results in combination with chemotherapy, likely refl ecting induced mechanisms of resistance to single-agent treatment in vivo . We conducted a genome-scale open reading frame (ORF) resistance screen and identifi ed activation of the RAS–MAPK–ERK pathway as one major mechanism of resistance to SYK inhibitors. This fi nding was validated in AML cell lines with innate and acquired resistance to SYK inhibitors. Furthermore, patients with AML with select mutations activating these pathways displayed early resistance to SYK inhibition. To circumvent SYK inhibitor therapy resistance in AML, we demonstrate that a MEK and SYK inhibitor combination is synergistic in vitro and in vivo . Our data provide justifi cation for use of ORF screening to identify resistance mechanisms to kinase inhibitor therapy in AML lacking distinct mutations and to direct novel combination-based strategies to abrogate these.

Publication
Resistance Mechanisms to SYK Inhibition in Acute Myeloid Leukemia
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