ROR1 Small Molecule Inhibitor (KAN0441571C) Induced Significant Apoptosis of Mantle Cell Lymphoma (MCL) Cells
Authors: Mellstedt Håkan , Ghaderi Amineh , Aschan Johanna , Mozaffari Fariba , Moshfegh Ali , Sander Birgitta , Schultz Johan , Norin Martin , Olin Thomas , Drakos Elias , Rassidakis George Z. , Österborg Anders , Hojjat-Farsangi Mohammad 
Published: November 2019

Background: ROR1 - a receptor tyrosine kinase (RTK) - is essential for normal embryonic development, but is absent on most normal adult tissues. ROR1 is of importance of cell proliferation, differentiation, survival and metabolism. However, ROR1 is overexpressed in several types of cancer (onco-fetal RTK). MCL is an aggressive and incurable non-Hodgkin lymphoma characterized by translocation (11;14) (q13;q32) and cyclin D overexpression. ROR1 has been described to be highly expressed in MCL cells. We have previously presented results on a small molecule ROR1 inhibitor in CLL (KAN0439834) (Leukemia 32(10):2291, 2018). A second generation ROR1 inhibitor, KAN0441571C, has been developed with improved killing of tumor cells and with longer half-life time (>10h) (PK studies in mice/rats/dogs) compared to KAN0439834.
Aim: In this study we examined effects of the ROR1 small molecule inhibitor KAN0441571C in human MCL cells (Granta-519, Jeko-1, JVM-2, Z138, Mino) as part of a pre-clinical evaluation.
Methods: ROR1 expression was evaluated by flow cytometry and WB. Cytotoxicity was analysed by MTT and apoptosis by Annexin V/P staining and Western Blot for apoptotic proteins. Cytotoxicity (MTT) was also analysed by combining the ROR1 inhibitor with ibrutinib, acalabrutinib, venetoclax and bendamustine. Effects of KAN0441571C on ROR1 inactivation (dephosphorylation) and signaling pathways were evaluated by WB.
Results: All five cell-lines expressed phosphorylated ROR1 (130 kDa) with a varying intensity. Surface expression (flow-cytometry) varied from 0% (JVM-2) to 100% (Mino and JeKo-1). The data indicate expression of also splice variants lacking the extracellular domain. KAN0441571C induced time and dose dependent apoptosis of the five MCL cell-lines which was p53 independent. EC50 varied between 100-250 nM (24h). Apoptosis was confirmed by cleavage of caspase 3 and PARP as well as down-regulation of the MCL-1 and BCL-2 proteins. Moreover, ROR1 was dephosphorylated by KAN0441571C. Downstream of ROR1 both the Wnt canonical and non-canonical pathways were inactivated depending on the cell line.
KAN0441571C had in most cell lines a similar cytotoxic effect as ibrutinib, acalabrutinib and venetoclax while bendamustine was inferior. KAN0441571C had an additive effect to ibrutinib, acalabrutinib and venetoclax respectively and KAN0441571C in combination with either of these three agents induced a complete killing of the cell lines.
Conclusions: KAN0441571C is a second generation of a novel class of ROR1-tyrosine kinase inhibitor. This small molecule was effective in inducing apoptosis of MCL cells with other mechanisms of action than for drugs in clinical use for MCL. Combination of KAN0441571C with other MCL targeting drugs induced a complete killing of the tumor cell population in a preclinical in vitro model. Our results support the further development of ROR1 small molecule inhibitors as a new therapeutic principle in MCL as well as in other B-cell malignancies with an additive effect to existing targeted therapeutics.

Disclosures
Schultz: Kancera AB: Employment, Equity Ownership. Norin:Kancera AB: Employment. Olin:Kancera AB: Employment, Equity Ownership. Österborg:Janssen: Research Funding; Kancera AB: Research Funding; BeiGene: Research Funding; Abbvie: Research Funding; Gilead: Research Funding.