Authors

Document Type

Article

Publication Date

9-1-2020

Abstract

With the advent of small molecule inhibitors, sustained responses in chronic lymphocytic leukemia (CLL) patients have been achieved. Ibrutinib, an inhibitor of Bruton’s tyr- osine kinase (BTK), is a particularly potent treatment for CLL, with overall response rates of 82% in treatment-naive and 43% in relapsed-refractory patients [1]. These responses are accompanied by transient lymphocytosis in 50–70% of patients and a concomitant reduction of tumor burden in lymphoid organs [2]. We have recently demonstrated that the high-risk, CD49d-high CLL subgroup [3] displays reduced lymphocytosis and minor lymph node shrinkage upon ibru- tinib treatment [4]. CD49d is the alpha subunit of the integrin VLA-4, which plays an essential role in the tissue retention of cells, orchestrating their adhesion to stromal cells, e.g., follicular dendritic cells (fDCs), which in turn express the VLA-4 ligand VCAM-1. To facilitate this strong adhesion, VLA-4 needs to be activated [5]. We have demonstrated that in CLL the extended, high-affinity conformation of VLA-4 can be triggered by B cell receptor (BCR) stimulation [4]. Notably, upon treatment with ibrutinib, CD49d-high CLL cells maintain residual BCR-mediated inside-out activation of VLA-4, thus explaining the reduced clinical response of CD49d-expressing CLL [4]. Eμ-TCL1-transgenic (TCL1-tg) mice represent a widely used mouse model for CLL [6]. By using this model, here we found that: (i) murine leukemic cells express high levels of surface CD49d; (ii) the BCR-VLA-4 axis in TCL1-tg mice, as investigated upon BCR stimulation and/or expo- sure to BCR inhibitors, resembles that of the human CD49d-high CLL cohort; (iii) the in vivo distribution of TCL1-tg leukemic cells is dependent on VLA-4-mediated interactions with the microenvironment. Our data demon- strate the value of TCL1-tg mice as a model for CD49d- high CLL and corroborate the importance of retained BCR- induced VLA-4 activation in a clinical setting.

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