PIM serine/threonine kinases are overexpressed, translocated, or amplified in multiple B-cell lymphoma types. We have explored the frequency and relevance of PIM expression in different B-cell lymphoma types and investigated whether PIM inhibition could be a rational therapeutic approach. Increased expression of PIM2 was detected in subsets of mantle cell lymphoma, diffuse large B-cell lymphoma (DLBLC), follicular lymphoma, marginal zone lymphoma-mucosaassociated lymphoid tissue type, chronic lymphocytic leukemia, and nodal marginal zone lymphoma cases. Increased PIM2 protein expression was associated with an aggressive clinical course in activated B-like-DLBCL patients. Pharmacologic and genetic inhibition of PIM2 revealed p4E-BP1(Thr37/46) and p4E-BP1(Ser65) as molecular biomarkers characteristic of PIM2 activity and indicated the involvement of PIM2 kinase in regulating mammalian target of rapamycin complex 1. The simultaneous genetic inhibition of all 3 PIM kinases induced changes in apoptosis and cell cycle. In conclusion, we show that PIM2 kinase inhibition is a rational approach in DLBCL treatment, identify appropriate biomarkers for pharmacodynamic studies, and provide a new marker for patient stratification. (Blood. 2011;118(20):5517-5527)
IntroductionDiffuse large B-cell lymphoma (DLBCL) is the most common type of adult non-Hodgkin lymphoma (NHL), accounting for approximately 40% of all NHL cases. 1 Rather than being a simple entity, it encompasses a constellation of different disorders with varying clinical presentations, molecular pathogenesis, and responses to therapy. 1 Expression-profile studies have revealed the existence of several DLBCL categories, 2 reflecting their origin from discrete B-cell differentiation stages, or the coregulated expression of transcriptional signatures that reflect features of the cell of origin, molecular pathogenesis, or the microenvironment. 1,3,4 Three main subtypes can be distinguished on the basis of the cell-of-origin classification: GCB-DLBCL that express germinal center (GC) genes, activated B-like DLBCL (ABC-DLBCL) with a signature including plasma cell and NF-B-expressed genes, and primary mediastinal DLBCL. 5,6 The standard first-line therapy for treating DLBCL patients is a combination of chemotherapeutical agents (cyclophosphamide, doxorubicin, vincristine, and prednisone [CHOP]) with the rituximab (R) chimeric CD20 monoclonal antibody. 7 Despite this therapy, the disease remains fatal in 30% to 40% of patients. 8 Novel therapeutic opportunities have been proposed based on molecular profiles, suggesting essential regulatory pathways in lymphomas (NF-B pathway, B-cell receptor signaling, B-cell lymphoma 2, B-cell lymphoma 6, and tumor microenvironment) as candidate targets. 9 Although there is a considerable amount of information about the molecular pathogenesis of DLBCL, relatively little progress has been made in developing therapies using compounds that target mutated genes or deregulated pathways. The improved knowledge about the molecular pathogenesis ...