Abstract B008: Utilizing pathway incompatibility for synthetic lethality: A therapeutic strategy for B-cell lymphoma
Authors: Knupke Mia , Chan Lai 
Published: June 2024

Abstract
Previous pan-cancer analyses revealed co-occurring mutations exploitable for combination therapies and mutually exclusive mutations assumed to reflect functional redundancy (Mina M et al. 2017; Sanchez-Vega F et al. 2018). However, we recently highlighted an alternative scenario when mutual exclusivity reflects the incapability of two pathways to function together, a phenomenon we term “pathway incompatibility” (Chan LN et al. 2020). We found that STAT5-and ERK-activating genetic lesions were not only mutually exclusive in B-ALL cases, but also reciprocally inhibited each other at the signal transduction level, inducing cell death instead of promoting leukemogenesis. Notably, we demonstrated, for the first time, that pharmacological activation of STAT5 in ERK-driven B-ALL cells and ERK in STAT5-driven B-ALL cells represents a tractable synthetic lethality (Chan LN et al. 2020). We now take the important next step of identifying potential candidates for synthetic lethal genetic interactions resulting from pathway incompatibility in B-cell malignancies more broadly. Diffuse large B-cell lymphoma (DLBCL) is a rapidly growing blood cancer affecting older adults and constituting about 25% of all lymphoma cases in the US. Around 40% of patients develop relapsed or refractory DLBCL (Pfreundschuh M et al. 2006; Ngu H et al. 2022). Thus, there is an unmet need to develop new therapeutic strategies to improve clinical outcomes. Studying 1684 DLBCL cases from published datasets, we found that about 30% of DLBCL cases carry loss-of-function (LOF) CBP or gain-of-function (GOF) MYD88 genetic lesions. CBP encodes a histone acetyltransferase and, together with p300, functions as a transcriptional coactivator and tumor suppressor. Conversely, GOF MYD88 mutations drive lymphomagenesis by regulating kinases and transcription factors. Our analysis revealed that LOF CBP and GOF MYD88 genetic lesions co-occurred less frequently than expected by chance (odds ratio: 0.57, P=0.0), indicating their mutual exclusivity. Experiments with human DLBCL cell lines expressing wild-type MYD88 and CBP showed that CBP/p300 inhibitors did not impact cell viability. However, cells expressing a GOF MYD88 mutant or stimulated with a toll-like receptor (TLR) agonist to activate MYD88 became sensitized to CBP/p300 inhibitors, resulting in cell death. This suggests that LOF CBP and GOF MYD88 are incompatible for cell survival, with their co-occurrence resulting in synthetic lethality. We then tested a synthetic lethality-based therapeutic concept based on CBP-MYD88 incompatibility in DLBCL. We found that MYD88-mutated DLBCL cell lines were more sensitive to pharmacological inhibition of CBP/p300, while CBP-deficient DLBCL cell lines showed increased sensitivity to TLR agonist treatment. In summary, we identified mutual exclusivity between LOF CBP and GOF MYD88 lesions in DLBCL, where their co-occurrence induces cell death. Moreover, we demonstrated the therapeutic potential of synthetic lethality resulting from co-introduction of LOF CBP and GOF MYD88 in DLBCL.
Citation Format: Mia Knupke, Lai Chan. Utilizing pathway incompatibility for synthetic lethality: A therapeutic strategy for B-cell lymphoma [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Expanding and Translating Cancer Synthetic Vulnerabilities; 2024 Jun 10-13; Montreal, Quebec, Canada. Philadelphia (PA): AACR; Mol Cancer Ther 2024;23(6 Suppl):Abstract nr B008.