The phosphoinositide 3'-kinase delta inhibitor, CAL-101, inhibits B-cell receptor signaling and chemokine networks in chronic lymphocytic leukemia

Blood. 2011 Sep 29;118(13):3603-12. doi: 10.1182/blood-2011-05-352492. Epub 2011 Jul 29.

Abstract

In lymphocytes, the phosphoinositide 3'-kinase (PI3K) isoform p110δ (PI3Kδ) transmits signals from surface receptors, including the B-cell receptor (BCR). CAL-101, a selective inhibitor of PI3Kδ, displays clinical activity in CLL, causing rapid lymph node shrinkage and a transient lymphocytosis. Inhibition of pro-survival pathways, the presumed mechanism of CAL-101, does not explain this characteristic pattern of activity. Therefore, we tested CAL-101 in assays that model CLL-microenvironment interactions in vitro. We found that CAL-101 inhibits CLL cell chemotaxis toward CXCL12 and CXCL13 and migration beneath stromal cells (pseudoemperipolesis). CAL-101 also down-regulates secretion of chemokines in stromal cocultures and after BCR triggering. CAL-101 reduces survival signals derived from the BCR or from nurse-like cells, and inhibits BCR- and chemokine-receptor-induced AKT and MAP kinase (ERK) activation. In stromal cocultures, CAL-101 sensitizes CLL cells toward bendamustine, fludarabine, and dexamethasone. These results are corroborated by clinical data showing marked reductions in circulating CCL3, CCL4, and CXCL13 levels, and a surge in lymphocytosis during CAL-101 treatment. Thus, CAL-101 displays a dual mechanism of action, directly decreasing cell survival while reducing interactions that retain CLL cells in protective tissue microenvironments. These data provide an explanation for the clinical activity of CAL-101, and a roadmap for future therapeutic development.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antineoplastic Agents / therapeutic use
  • Cell Movement / drug effects
  • Cell Survival / drug effects
  • Cells, Cultured
  • Chemokines / antagonists & inhibitors*
  • Chemokines / metabolism
  • Class I Phosphatidylinositol 3-Kinases
  • Down-Regulation / drug effects
  • Drug Evaluation, Preclinical
  • Humans
  • Leukemia, Lymphocytic, Chronic, B-Cell / drug therapy
  • Leukemia, Lymphocytic, Chronic, B-Cell / metabolism
  • Leukemia, Lymphocytic, Chronic, B-Cell / pathology*
  • Metabolic Networks and Pathways / drug effects
  • Metabolic Networks and Pathways / physiology
  • Phosphoinositide-3 Kinase Inhibitors
  • Purines / pharmacology*
  • Purines / therapeutic use
  • Quinazolinones / pharmacology*
  • Quinazolinones / therapeutic use
  • Receptors, Antigen, B-Cell / antagonists & inhibitors*
  • Signal Transduction / drug effects

Substances

  • Antineoplastic Agents
  • Chemokines
  • Phosphoinositide-3 Kinase Inhibitors
  • Purines
  • Quinazolinones
  • Receptors, Antigen, B-Cell
  • Class I Phosphatidylinositol 3-Kinases
  • PIK3CD protein, human
  • idelalisib