Targeting SHP-1,2 and SHIP pathways – a novel strategy for cancer treatment?

Well balanced levels of tyrosine phosphorylation, maintained by the reversible and coordinated actions of protein tyrosine kinases (PTKs) and protein tyrosine phosphatases (PTPs), are critical for a wide range of cellular processes including growth, differentiation, metabolism, migration, and survival. Aberrant tyrosine phosphorylation, as a result of a perturbed balance between the activities of PTKs and PTPs, however, is linked to the pathogenesis of numerous human diseases, including cancer, suggesting that PTPs may be innovative molecular targets for cancer treatment. Two PTPs that have an important inhibitory role in lymphocytes and other haematopoietic cells are SHP-1 and SHP-2 (SH2 domain-containing phosphatases 1 and 2), SHP-1,2 have been shown to promote cell growth and act by both upregulating positive signaling pathways and by downregulating negative signaling pathways. SHIP (SH2 domain-containing inositol phosphatase) is another inhibitory phosphatase that is rather specific for the inositol phospholipid phosphatidylinositol-3,4,5-trisphosphate (PIP3). SHIP acts as a negative regulator of immune response by hydrolysing PIP3, and, as a result, a SHIP defiency results in myeloproliferation and B cell lymphoma in mice. This strong validation of SHP-1,2 and SHIP as oncology targets has generated considerable interest in the development of small molecule inhibitors as potential therapeutic agents for haematologic malignancies and solid tumours, however, SHP-1,2 and SHIP have proven to be an extremely difficult target for drug discovery, due primarily to the highly conserved and positively charged nature of its PTP active site. The majority of reported PTP inhibitors lack either appropriate selectivity or membrane permeability, limiting their utility in modulating the activity of the intracellular PTPs. In order to overcome these caveats novel techniques have been employed to synthesise new inhibitors that specifically attentuate the PTP-dependent signaling inside the cell and amongst them some are already in clinical development (e.g., SHP-1 inhibitor sodium stibogluconate; SHP-2 inhibitor TNO155; SHIP-1 activator AQX-1125). In this review the mechanisms of action and the clinical development of newly available SHP-1,2 and SHIP inhibitors and activators are decribed and the major issues facing this rapidly evolving field are discussed

Acute myeloid leukaemia in its niche: the bone marrow microenvironment in acute myeloid leukaemia

Purpose of Review Acute myeloid leukaemia (AML) is a heterogeneous malignancy for which treatment options remain suboptimal. It is clear that a greater understanding of the biology of the AML niche will enable new therapeutic strategies to be developed in order to improve treatment outcomes for patients. Recent Findings Recent evidence has highlighted the importance of the bone marrow microenvironment in protecting leukaemia cells, and in particular leukaemic stem cells from chemotherapy-induced cell death. This includes mesenchymal stem cells supporting growth and preventing apoptosis, and altered action and secretion profiles of other niche components including adipocytes, endothelial cells and T cells. Summary Here, we provide a detailed overview of the current understanding of the AML bone marrow microenvironment. Clinical trials of agents that mobilise leukaemic stem cells from the bone marrow are currently ongoing and show early promise. Future challenges will involve combining these novel therapies targeted at the AML niche with conventional chemotherapy treatment

Chloroquine and COVID-19 – a potential game changer?

The novel coronavirus SARS-CoV-2, causing the disease COVID-19, first emerged in Wuhan, China in December 2019 and has now spread to 203 countries or territories, infected over 2 million people and caused over 133,000 deaths. There is an urgent need for specific treatments. One potential treatment is chloroquine and its derivatives, including hydroxychloroquine, which have both antiviral and anti-inflammatory effects. These compounds are effective against SARS-CoV-2 in vitro, but in vivo data are lacking. Although some encouraging outcomes have been reported, and these results have been received enthusiastically, we recommend careful and critical evaluation of current evidence only when all methods and data are available for peer review. Chloroquine is safe and cheap. However, further evidence from coordinated multicentre trials is required before it can be confidently said whether it is effective against the current pandemic

The Renin-Angiotensin system – a therapeutic target in COVID-19?

COVID-19, caused by infection with SARS-CoV-2, is a disease characterised by cough, fever and fatigue, which progresses to life-threatening lung injury in approximately 5% of patients. The SARS-CoV-2 virus enters the cell via ACE2. ACE2 is a component of the renin–angiotensin system (RAS) which has an important counterregulatory effect on the classical ACE-dependent pathway. Several antihypertensives increase ACE2 expression or activity, leading to concern that this may facilitate SARS-CoV-2 entry and worsen COVID-19 disease. However, ACE2 is protective against lung injury while ANG II (which is catabolised by ACE2) is associated with lung injury both in mice and humans. We propose that medications which inhibit the RAS ACE-dependent pathway may be beneficial in treating COVID-19 and should be explored in animal models and clinical trials. Here we give an overview of the RAS pathway with respect to COVID-19 and argue that strategies which manipulate this pathway might reduce the destructive lung manifestations of COVID-19 and improve patient outcomes

Common genetic variants of fetal hemoglobin modify hematological phenotypes in MDS/MPN/Myeloma patients receiving cytotoxic drugs

Genetic studies identify common variants within the HBS1L-MYB intergenic region (HMIP), BCL11A, and Xmn1-HBG2 as associated with elevated fetal hemoglobin (HbF) levels and other clinically important human hematological traits. Recent studies suggest HbF is a predictor of outcome in MDS/AML patients receiving decitabine. We assessed effects of HbF genetic variants on hematological traits in myeloproliferative neoplasm (MPN), myelodysplastic syndrome (MDS) and myeloma on HbF-inducing therapy to determine potential for variants predicting treatment response. Seven common HbF variants at HMIP, BCL11A, Xmn1-HGB2 loci were genotyped in 89 patients with MPN on Hydroxyurea (HU), myeloma on Lenalidomide, and MDS on Azacytidine. HbF genetic association was seen with rs9494142 (HMIP) in MPN on HU (p = 0.04) and rs1427407 (BCL11A) in myeloma on Lenalidomide (p = 0.002). HMIP variants rs9494142 and rs6920211 influenced baseline platelets (p = 0.04) and hemoglobin treatment response (p = 0.02). rs1427407 (BCL11A) was significantly associated with increased platelets (p = 0.04) negating thrombocytopenic tendency of Lenalidomide. These HbF variants showed significantly discordant minor allele frequencies in MDS/MPN/myeloma compared to wider European population data. This small study findings together suggest the implication of these variants in treatment response and disease biology in MDS/MPN/myeloma warranting larger prospective genotype-phenotype association studies

RETRACTED: Autoimmunity as the Consequence of a Spontaneous Mutation in Rasgrp1

This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy).This article has been retracted at the request of the Authors.The authors have agreed to retract the paper because of the falsification of the Western blot in Figure 6A. The figure shows a defect in Ras activation, labeled as RasGTP, following TCR engagement, in thymocytes isolated from a RasGRP1 lag mutant mouse strain. This data set is one of several that show signaling and functional deficiencies identified for cells with lost of function of RasGRP. The authors stand by the validity of the other figures, results and interpretation in this paper. This matter was investigated by the Massachusetts Institute of Technology and the Office of Research Integrity at the United States Department of Health & Human Services, which found the figure was falsified by Luk Van Parijs, who is solely responsible. The authors deeply regret any inconvenience resulting from the publication of this data

PS1424 The CRAB score: a simple prognostic tool in multiple myeloma

Background: Current prognostic scoring systems in multiple myeloma lack consensus and are often clinically impractical. The key diagnostic features known as CRAB; hypercalcaemia (C), renal impairment (R), anaemia (A), and bone lesions (B), are known to represent end organ damage in myeloma. Aims: We aimed to produce a simplified and practical prognostic tool for use in multiple myeloma patients as an alternative to current practice, therefore enabling prognostic guidance to be distributed to a wider group of patients. Since the laboratory tests required to calculate CRAB score are routinely undertaken in clinical practice, we proposed a method of predicting outcome based on these results alone, which has not yet been reported. Methods: We examined a combined database of clinical and survival information for 314 patients from Brighton and Worthing, Sussex, UK, over a 6 year period, who were newly diagnosed with myeloma, and represent real-world clinical experience. To determine the presence of a CRAB feature, the cut-off values previously defined by the International Myeloma Working Group (IMWG) were used; serum calcium >2·75 mmol/L, serum creatinine >177 μmol/L, haemoglobin 20 g/L below lower limit of normal), and one or more osteolytic lesion on skeletal radiography, CT, PET-CT or MRI. Patients were stratified into five CRAB score groups by having either 0, 1, 2, 3 or 4 CRAB features at initial presentation, with a score of 0 denoting a diagnosis of smouldering myeloma. We then studied the relationship between CRAB score and overall survival using Kaplan Meier curves plotted by the statistics programme SPSS. Results: Our analysis reveals that each additional CRAB feature confers a stepwise statistically significant poorer outcome in terms of overall survival as shown in Figure 1a. This result was regardless of the treatment regimen the patient received and gave 5-year survival percentages of 81%, 58%, 41%, 22% and 0% for patients with CRAB scores 0–4 respectively. We also found CRAB score to have coherence with the current International Staging System (ISS) scoring system, which combines serum albumin as a measure of general patient health with β2-microglobulin as a measure of tumour bulk to estimate risk. Cytogenetic data required for the revised ISS score was not undertaken for the majority of patients, highlighting the lack of feasibility of this system in practice, although we did observe higher CRAB scores for those patients identified with poor risk chromosomal abnormalities. A trend for higher ISS score with higher CRAB score was observed, further validating the CRAB scoring system (figure 1b). Image Summary/Conclusion: Our study shows that the CRAB score yields accurate prognostic predictions for patients with newly diagnosed multiple myeloma based on simple clinical criteria. It has more prognostic categories than the currently used ISS score (5 versus 3) and superior clinical utility than expensive and time-consuming cytogenetic-based scoring systems that have been recently described. These results indicate that the CRAB score may provide a useful and reliable tool to guide prognostic evaluation in newly diagnosed myeloma patients, requiring only routine laboratory testing to be undertaken, and therefore greater availability to patients in diverse clinical settings

Thrombotic risk in COVID-19: a case series and case-control study

Background: A possible association between COVID-19 infection and thrombosis, either as a direct consequence of the virus or as a complication of inflammation, is emerging in the literature. Data on the incidence of venous thromboembolism (VTE) is extremely limited. Methods: We describe 3 cases of thromboembolism refractory to heparin treatment, the incidence of VTE in an inpatient cohort, and a case-control study to identify risk factors associated with VTE. Results: We identified 274 confirmed (208) or probable (66) COVID-19 patients. 21 (7.7%) were diagnosed with VTE. D-dimer was elevated in both cases (confirmed VTE) and controls (no confirmed VTE) but higher levels were seen in confirmed VTE cases (4.1vs 1.2 µg/mL P <0.001). Conclusion: Incidence of VTE is high in patients hospitalised with COVID-19. Urgent clinical trials are needed to evaluate the role of anticoagulation in COVID-19. Monitoring of D-dimer and anti-factor Xa levels may be beneficial in guiding management

Identification of circulating microRNAs as diagnostic biomarkers for use in multiple myeloma

BACKGROUND: Multiple myeloma is a plasma cell disorder that is characterised by clonal proliferation of malignant plasma cells in the bone marrow, monoclonal paraprotein in the blood or urine and associated organ dysfunction. It accounts for approximately 1% of cancers and 13% of haematological cancers. Myeloma arises from an asymptomatic proliferation of monoclonal plasma cells termed monoclonal gammopathy of undetermined significance (MGUS). METHODS: MicroRNA expression profiling of serum samples was performed on three patient groups as well as normal controls. Validation of the nine microRNAs detected as promising biomarkers was carried out using TaqMan quantitative RT-PCR. MicroRNA levels in serum were normalised using standard curves to determine the numbers of microRNAs per μl of serum. RESULTS: Three serum microRNAs, miR-720, miR-1308 and miRNA-1246, were found to have potential as diagnostic biomarkers in myeloma. Use of miR-720 and miR-1308 together provides a powerful diagnostic tool for distinguishing normal healthy controls, as well as patients with unrelated illnesses, from precancerous myeloma and myeloma patients. In addition, the combination of miR-1246 and miR-1308 can distinguish MGUS from myeloma patients. CONCLUSION: We have developed a biomarker signature using microRNAs extracted from serum which has potential as a diagnostic and prognostic tool for multiple myeloma