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group_5_presentation_2_-_chronic_myeloid_leukemia [2016/03/11 23:15] dmellonr |
group_5_presentation_2_-_chronic_myeloid_leukemia [2018/01/25 15:18] (current) |
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| {{:cml.jpg|}} | {{:cml.jpg|}} | ||
| + | Powerpoint: | ||
| + | {{:group_5_chronic_myeloid_leukemia.pptx|}} | ||
| ====== CHRONIC MYELOID LEUKEMIA ====== | ====== CHRONIC MYELOID LEUKEMIA ====== | ||
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| ===== Therapeutics ===== | ===== Therapeutics ===== | ||
| - | ==== Options: ==== | + | === Options: === |
| The only truly curative treatment is bone marrow transplant or allogeneic stem cell transplant. However, these treatments can be invasive and hence other treatment options include tyrosine kinase inhibitors. | The only truly curative treatment is bone marrow transplant or allogeneic stem cell transplant. However, these treatments can be invasive and hence other treatment options include tyrosine kinase inhibitors. | ||
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| **Figure 9**: Curative treatment options for CML | **Figure 9**: Curative treatment options for CML | ||
| - | ==== Inhibiting Bcr-Abl as a potential drug target: ==== | + | === Inhibiting Bcr-Abl as a potential drug target: === |
| CML is caused by the reciprocal translocation between chromosome 9 (location of Abl1 gene) and 22 (location of BCR gene) which creates the Philadelphia chromosome. This molecular pathogenesis generates the Bcr-Abl fusion protein which has elevated tyrosine kinase activity. The Bcr-Abl fusion protein is found predominately in CML cells and thus provides the desired specificity (minimized systemic toxicity) for an inhibitor or therapeutic to interfere with this fusion protein’s function (Deininger, Goldman, Melo 2000). It is easy to target the ATP pocket of this fusion protein (something common to kinase proteins) than other protein-protein interactions as ATP pockets are well defined and mimicking ATP is an easy starting point for drug development (Deininger, Goldman, Melo 2000). | CML is caused by the reciprocal translocation between chromosome 9 (location of Abl1 gene) and 22 (location of BCR gene) which creates the Philadelphia chromosome. This molecular pathogenesis generates the Bcr-Abl fusion protein which has elevated tyrosine kinase activity. The Bcr-Abl fusion protein is found predominately in CML cells and thus provides the desired specificity (minimized systemic toxicity) for an inhibitor or therapeutic to interfere with this fusion protein’s function (Deininger, Goldman, Melo 2000). It is easy to target the ATP pocket of this fusion protein (something common to kinase proteins) than other protein-protein interactions as ATP pockets are well defined and mimicking ATP is an easy starting point for drug development (Deininger, Goldman, Melo 2000). | ||
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| **Figure 10**: Bcr-Abl kinase being inhibited by a compound, imatinib, in red | **Figure 10**: Bcr-Abl kinase being inhibited by a compound, imatinib, in red | ||
| - | ==== Gleevec: a tyrosine kinase inhibitor ===== | + | === Gleevec: a tyrosine kinase inhibitor === |
| Gleevec (imatinib mesylate) is a therapeutic that was FDA approved for CML treatment in 2001. It is now used to treat gastrointestinal stroll tumours (Pray, 2008). Though at first the rationale was that Gleevec would compete with ATP in the active Bcr-Abl conformer, however that wasn't the case. Gleevec doesn’t compete with ATP, instead it just keeps the kinase in a closed state preventing ATP from binding to the conformer. There has been vast improvement seen for CML patient survival over other therapeutics. However, there is acquired drug resistance seen too. Drug resistance is common for chemotherapies due to prolonged exposure to drugs. In particular, some CML cell populations survive due to a genetic mutation in Bcr-Abl, giving rise to a new population of Bcr-Abl CML cells that are resistant to Gleevec. This mutation is at Thr315Ile location and it pushed Gleevec out of its pocket (Pray, 2008). | Gleevec (imatinib mesylate) is a therapeutic that was FDA approved for CML treatment in 2001. It is now used to treat gastrointestinal stroll tumours (Pray, 2008). Though at first the rationale was that Gleevec would compete with ATP in the active Bcr-Abl conformer, however that wasn't the case. Gleevec doesn’t compete with ATP, instead it just keeps the kinase in a closed state preventing ATP from binding to the conformer. There has been vast improvement seen for CML patient survival over other therapeutics. However, there is acquired drug resistance seen too. Drug resistance is common for chemotherapies due to prolonged exposure to drugs. In particular, some CML cell populations survive due to a genetic mutation in Bcr-Abl, giving rise to a new population of Bcr-Abl CML cells that are resistant to Gleevec. This mutation is at Thr315Ile location and it pushed Gleevec out of its pocket (Pray, 2008). | ||
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| **Figure 11**: Pharmacodynamics of imatinib, Gleevec | **Figure 11**: Pharmacodynamics of imatinib, Gleevec | ||
| - | ==== Results from tyrosine kinase inhibitors: ==== | + | === Results from tyrosine kinase inhibitors: === |
| In the study by Deininger, Goldman, Lydon and Melo (1997), Bcr-Abl positive CML cells were exposed to tyrosine kinase inhibitor CGP57148B. Of all the cell lines examined, most showed a drastic reduction showing that tyrosine kinase inhibitors were effective in treating CML cells. Two cells that were resistant to the initial 1.0uM were treated with 10uM of the inhibitor. | In the study by Deininger, Goldman, Lydon and Melo (1997), Bcr-Abl positive CML cells were exposed to tyrosine kinase inhibitor CGP57148B. Of all the cell lines examined, most showed a drastic reduction showing that tyrosine kinase inhibitors were effective in treating CML cells. Two cells that were resistant to the initial 1.0uM were treated with 10uM of the inhibitor. | ||
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| **Figure 12**: Results from study showing effectiveness of tyrosine kinase inhibitors on Bcr-Abl positive CML cells | **Figure 12**: Results from study showing effectiveness of tyrosine kinase inhibitors on Bcr-Abl positive CML cells | ||
| - | ==== Implications of treatment: ==== | + | === Implications of treatment: === |
| One strategy to overcome resistance is to develop new inhibitors of Bcr-Abl. For example, Dasatinib inhibits most Bcr-Abl mutants, except for the Thr351Ile mutant. Also Ponatinib is able to inhibit the T35I mutant (Shah, Tran, Lee, Chen, Norris, Sawyers 2004). | One strategy to overcome resistance is to develop new inhibitors of Bcr-Abl. For example, Dasatinib inhibits most Bcr-Abl mutants, except for the Thr351Ile mutant. Also Ponatinib is able to inhibit the T35I mutant (Shah, Tran, Lee, Chen, Norris, Sawyers 2004). | ||
