The nuclear factor-B (NF-B) pathway has been implicated in tumor B-cell survival, growth, and resistance to therapy. Because tumor cells overcome single-agent antitumor activity, we hypothesized that combination of agents that target differentially NF-B pathway will induce significant cytotoxicity. Therapeutic agents that target proteasome and Akt pathways should induce significant activity in B-cell malignancies as both pathways impact NF-B activity. We demonstrated that perifosine and bortezomib both targeted NF-B through its recruitment to the promoter of its target gene IB using chromatin immunoprecipitation assay. This combination led to synergistic cytotoxicity in Waldenstrom macroglobulinemia (WM) cells that was mediated through a combined reduction of the PI3K/Akt and ERK signaling pathways, found to be critical for survival of
IntroductionWaldenstrom macroglobulinemia (WM) is a low-grade lymphoma characterized by the presence of lymphoplasmacytic cells in the bone marrow (BM) and a serum monoclonal immunoglobulin M protein in the circulation. 1,2 Although indolent, it remains incurable and most patients die of disease progression with a median overall survival of 5 to 6 years. 3 Therefore, there is an urgent need for rationally designed combinations of therapy in WM. Recent genomic and proteomic studies have demonstrated that several signaling pathways play an important role in the pathogenesis of WM compared with normal controls or other B-cell malignancies, including the nuclear factor-B (NF-B) and PI3K/Akt pathways. 4 The NF-B signaling pathway regulates the survival of normal and malignant B cells by controlling the expression of cell death regulatory genes. 5,6 Depending on the cellular context, tumor necrosis factor alpha (TNF␣) signaling and other stimuli activate the NF-B pathway and augment the transcription of NF-B target genes. 5 These NF-B target genes enhance cell survival, inhibit apoptosis, and limit the activity of proapoptotic BCL2 family members, in addition to multiple other effects. 5 The NF-B pathway undergoes a very tight, although complex, regulatory mechanism in which NF-B controls its inhibitor IB␣ transcription and in stabilizing IB proteins. 7,8 The NF-B pathway-central role in plasma cell dyscrasia tumorigenesis has been recognized for a long time, partly through induction of cytokines and growth factors that promote tumor cell growth and survival. 9,10 Data for its role in WM are limited, but there is some evidence to suggest that NF-B is activated in WM cells. 11,12 The PI3K/Akt pathway acts as a critical regulator of cell survival by stimulating cell proliferation and inhibiting apoptosis, [13][14][15] and has been implicated in the pathogenesis of various cancers, including lymphoproliferative disorders. [16][17][18] Akt indirectly activates NF-B through direct phosphorylation and activation of IB kinase alpha (IKK␣), thereby inducing degradation of NF-B inhibitor alpha (IB␣) by the ubiquitineproteasome pathway. 9,10 The degradation of cellular proteins is critical for n...