The molecular target(s) cooperating with proteasome inhibition in multiple myeloma (MM) remain unknown. We therefore measured proliferation in MM cells transfected with 13 984 small interfering RNAs in the absence or presence of increasing concentrations of bortezomib. We identified 37 genes, which when silenced, are not directly cytotoxic but do synergistically potentiate the growth inhibitory effects of bortezomib. To focus on bortezomib sensitizers, genes that also sensitized MM to melphalan were excluded. When suppressed, the strongest bortezomib sensitizers were the proteasome subunits PSMA5, PSMB2, PSMB3, and PSMB7 providing internal validation, but others included BAZ1B, CDK5, CDC42SE2, MDM4, NME7, RAB8B, TFE3, TNFAIP3, TNK1, TOP1, VAMP2, and YY1. The strongest hit CDK5 also featured prominently in pathway analysis of primary screen data. Cyclin
IntroductionBortezomib is a potent and selective proteasome inhibitor used in the treatment of multiple myeloma (MM) and low-grade lymphoma patients. Bortezomib produces significant clinical responses in both newly diagnosed and advanced MM, but only 40% of patients respond to the single agent, 1,2 and the majority of these patients become resistant over time. The mechanism of antimyeloma activity of bortezomib is therefore a subject of intense study with inhibition of the proteasome, autophagy, and activation of the unfolded protein stress response pathway apparently critical. A downstream consequence of proteasome inhibition relevant to MM is blockade of nuclear factor B (NF-B) activity, which may partly mediate bortezomib activity in MM because activating mutations in the NF-B pathway were identified in at least 17% of MM patients and 41% of human myeloma cell lines and appear to mediate accelerated growth and survival of malignant plasma cells. [3][4][5] However, the 35% to 50% response rate to bortezomib cannot be totally interpreted by NF-B abnormality, suggesting that other specific molecular targets, resistance mechanisms, or perhaps unique pharmacokinetics are inherent in patients. Furthermore, resistance to bortezomib therapy often develops even in initially sensitive patients; and although certain mechanisms such as mutations in proteasome subunits have been postulated, 6 the underlying mechanism defining this nonresponsiveness is largely unknown. Understanding the cooperating mechanisms of sensitivity to proteasome inhibition will not only allow more targeted use of proteasome inhibitors but should also make it possible to rationally design synergistic drug combinations and predict patient response to therapy.To begin to address these issues, a druggable genome RNAi screen was used to identify modifiers of bortezomib sensitivity in human MM cells. Through this high-throughput screen, we identified a panel of genes whose loss of expression enhances bortezomib sensitivity (sensitizer). Using shRNA expression systems and a small-molecule inhibitor, we have further validated one of the most potent bortezomib sensitizer genes as cyclin-dependent kinase 5 (...