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Efficacy of ALK5 inhibition in myelofibrosis
Lanzhu Yue, Matthias Bartenstein, Wanke Zhao, Wanting Tina Ho, Ying Han, Cem Murdun, Adam W. Mailloux, Ling Zhang, Xuefeng Wang, Anjali Budhathoki, Kith Pradhan, Franck Rapaport, Huaquan Wang, Zonghong Shao, Xiubao Ren, Ulrich Steidl, Ross L. Levine, Zhizhuang Joe Zhao, Amit Verma, Pearlie K. Epling-Burnette
Lanzhu Yue, Matthias Bartenstein, Wanke Zhao, Wanting Tina Ho, Ying Han, Cem Murdun, Adam W. Mailloux, Ling Zhang, Xuefeng Wang, Anjali Budhathoki, Kith Pradhan, Franck Rapaport, Huaquan Wang, Zonghong Shao, Xiubao Ren, Ulrich Steidl, Ross L. Levine, Zhizhuang Joe Zhao, Amit Verma, Pearlie K. Epling-Burnette
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Research Article Hematology

Efficacy of ALK5 inhibition in myelofibrosis

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Abstract

Myelofibrosis (MF) is a bone marrow disorder characterized by clonal myeloproliferation, aberrant cytokine production, extramedullary hematopoiesis, and bone marrow fibrosis. Although somatic mutations in JAK2, MPL, and CALR have been identified in the pathogenesis of these diseases, inhibitors of the Jak2 pathway have not demonstrated efficacy in ameliorating MF in patients. TGF-β family members are profibrotic cytokines and we observed significant TGF-β1 isoform overexpression in a large cohort of primary MF patient samples. Significant overexpression of TGF-β1 was also observed in murine clonal MPLW515L megakaryocytic cells. TGF-β1 stimulated the deposition of excessive collagen by mesenchymal stromal cells (MSCs) by activating the TGF-β receptor I kinase (ALK5)/Smad3 pathway. MSCs derived from MPLW515L mice demonstrated sustained overproduction of both collagen I and collagen III, effects that were abrogated by ALK5 inhibition in vitro and in vivo. Importantly, use of galunisertib, a clinically active ALK5 inhibitor, significantly improved MF in both MPLW515L and JAK2V617F mouse models. These data demonstrate the role of malignant hematopoietic stem cell (HSC)/TGF-β/MSC axis in the pathogenesis of MF, and provide a preclinical rationale for ALK5 blockade as a therapeutic strategy in MF.

Authors

Lanzhu Yue, Matthias Bartenstein, Wanke Zhao, Wanting Tina Ho, Ying Han, Cem Murdun, Adam W. Mailloux, Ling Zhang, Xuefeng Wang, Anjali Budhathoki, Kith Pradhan, Franck Rapaport, Huaquan Wang, Zonghong Shao, Xiubao Ren, Ulrich Steidl, Ross L. Levine, Zhizhuang Joe Zhao, Amit Verma, Pearlie K. Epling-Burnette

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Figure 1

TGF-β1 is overexpressed in human primary myelofibrosis samples and MPLW515L mice.

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TGF-β1 is overexpressed in human primary myelofibrosis samples and MPLW5...
(A and B) Neutrophils derived from myeloproliferative neoplasm (MPN) patients were evaluated for expression of TGFβ family members by gene expression analysis (using Gapdh as reference gene). *P < 0.05 by unpaired Student’s t test. (A) Analysis of TGFβ1, TGFβ2, and TGFβ3 mRNA expression in an MPN cohort compared with healthy donors (Control). *P < 0.05 as compared with control group by unpaired Student’s t test. (B) TGFβ1 mRNA expression was determined in MPN patients stratified by disease subtype including essential thrombocytosis (ET, n = 47), polycythemia vera (PV, n = 28), and myelofibrosis (MF, n = 18). Data represent values relative to healthy control cells (Control). (C) qRT-PCR was performed for Tgfb1 mRNA using bone marrow mononuclear cells from MPLWT and MPLW515L mice (n = 6). ****P < 0.0001 by unpaired 2-sided Student’s t test with Welch’s correction. (D) Normal mouse bone marrow cells were directly transduced with retroviruses overexpressing either MPLWT or MPLW515L, following which cells were collected and Tgfb1 mRNA was measured by qRT-PCR. ****P < 0.0001 by unpaired 2-sided Student’s t test. (E–H) Representative contour flow cytometry plots of cells stained with antibodies against CD41 (clone HIP8) and CD42 (clone 1C2). GFP was simultaneously determined by flow cytometry and represents expression of GFP+ retroviral constructs (y axis, G and H). The total CD41+ cells (E and F) and GFP+CD41+ cells (G and H) in MPLW515L spleens compared to MPLWT controls. (I) Graph represents percentage of each population (CD41+, GFP–, and GFP+) among live cells in the sample. Graphs (I and J) represent cells from spleens of 5 individual mice with the mean of the population indicated as a line (n = 5 MPLWT and n = 5 MPLW515L). Statistical significance determined using the Holm-Sidak method, with α = 5.000%. ****P < 0.0001. (J) Fold change in normalized Tgfβ1 mRNA expression of CD41+GFP+ cells vs. Tgfβ1 expression in CD41+GFP– population from the same mouse (n = 3 MPLWT and n = 3 MPLW515L). *P < 0.05 by unpaired 2-sided Student’s t test. All error bars indicate the mean ± SD.

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