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Identification of Mutations in the NFkB Pathway That Predict Velcade Response
By A. Keith Stewart, MD

40% of MM mutations occur in the NF kappa B pathway, which contributes to the growth of myeloma cells. Identifying this cluster of NFkB mutations in patients will predict who will respond to Velcade, an inhibitor of NFkB. The next step will be to develop a clinically applicable test for these mutations.


Promiscuous Mutations Frequently Activate the Non-Canonical NFkB Pathway in Multiple Myeloma (MM). Session Type: Oral Session

Peter Leif Bergsagel, John Carpten, Marta Chesi, Scott VanWier, Jonathan J. Keats, Michael Sebag, Wee-Joo Chng, Roelandt Schop, Angela Baker, Tae-Hoon Chng, Homer Fogle, Yuan Xiao Zhu, Chang-Xin Shi, Laura Kay Bruhn, Michael Barrett, Catherine Mancini, Tammy Price-Troska, Gergory Ahmann, Kim Henderson, Philip R. Greipp, Angela Dispenzieri, Jeff Trent, Keith Stewart, Rafael Fonseca Comprehensive Cancer Center, Mayo Clinic Arizona, Scottsdale, AZ, USA; Hematological Malignancies Research Unit, Translational Genomics, Phoenix, AZ, USA; Agilent Labs, Santa Clara, CA, USA; Division of Hematology and Dept. of Internal Medicine, Mayo Clinic, Rochester, MN, USA

Activation of NFkB has been noted in late B-cell malignancies, but no genetic basis for this activation has been shown except for rare mutations of the NFkB pathway in lymphoma and none have been described in MM. Bortezomib, highly tumoricidal in a subset of MM patients, inhibits NFkB suggesting its role as a therapeutic target. Here we show for the first time the critical importance of mutations that dysregulate this potential survival pathway in human myeloma cell lines (HMCL) and new diagnosis MM patients. We performed high-density oligonucleotide array CGH (Agilent 44k) on CD138+ selected MM cells from 68 patients and 42 unique HMCL. Initially we focused on small loci, bi-allelically deleted, as markers for inactivation of potential tumor suppressor genes. We next developed FISH probes for the identified loci to confirm the bi-allelic deletions seen by aCGH. We next sequenced all samples with monoallelic deletions, and additional unselected patients, and identified additional inactivating mutations. Multiple novel tumor suppressor genes (TSG) were identified and validated, whose loss of function (both in patients and HMCL) leads to activation of the non-canonical NFkB pathway including: TRAF2 (9q34), TRAF3 (14q32), BIRC2/BIRC3 (11q22) and CYLD (16q12). Functional studies showed that HMCL with deletion or mutations in these genes have markedly increased NFkB2 p52/p100 ratios relative to other HMCL (and for BIRC2/BIRC3 relative to an isogenic line that retains one copy of BIRC2/BIRC3), indicating genetic activation of the non-canonical NFkB pathway. Reintroduction of deleted TSG into HMCL inhibited cell growth and resulted in cell death (see data on abstract by J. Keats et al). We next focused our analysis (of combined aCGH and GEP data) on positive regulators of this pathway. Rare IgH translocations of NIK have recently been identified in MM. By aCGH we identified amplification and rearrangements of NIK. We identified dysregulated expression of TNF family receptors that activate the non-canonical pathway: CD40 (translocation), TACI (amplification) and LTBR. All of the HMCL with these mutations also showed increased NFkB2 p52/p100 ratios, consistent with activation of the non-canonical NFkB. These mutations correlate with a gene expression profile of NFkB activation that is detected in one half of patients. In summary, we have determined for the first time the genetic basis for constitutive NFkB activation - present in 19/42 HMCL, and we estimate in at least one quarter of newly diagnosed patients (approximately one half of those with evidence of NFkB activation by GEP). We propose a mechanism in which positive (TACI, CD40, LTBR) and negative regulators (TRAF2, TRAF3, BIRC2/BIRC3, CYLD) of the pathway converge on NIK to mediate the processing of NFKB2 p100 to p52. The preponderance of genetic evidence suggests that drugs that target the non-canonical NFkB pathway, will be most effective in treating the 50% of MM patients with NFkB activation.
Abstract #109 appears in Blood, Volume 108, issue 11, November 16, 2006

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