Journal Article

The Combination of Ibrutinib with BH3 Mimetics or Dichloroacetate Is Effective in B-CLL

Palomera, Luis, Villalba, Martín, Marzo, Isabel, Izquierdo, Isabel, Gonzalo, Oscar, Anel, Alberto, Marco-Brualla, Joaquín, Azaceta, Gemma

2025

Overview

Since its discovery, the BTK inhibitor ibrutinib has redefined the standard treatments for hematological cancers, such as chronic lymphocytic leukemia (CLL). However, concerns exist regarding its secondary effects in humans and its occasional lack of efficacy in certain malignancies. Therefore, combined therapies with ibrutinib have emerged as promising new approaches. In this study, we aimed to explore its therapeutic potential through different approaches. For this purpose, we combined this drug with the BH3 mimetics ABT-199 and ABT-737, which inhibit anti-apoptotic members of the Bcl-2 family, and with the PDK1 inhibitor dichloroacetate (DCA), respectively. As cell models, we used ex vivo samples from patients and also selected the in vitro CLL cell line Mec-1, generating two sub-lines overexpressing Bcl-XL and Mcl-1, a common feature in this cancer. Results demonstrated a synergistic effect for both approaches, in all tumor cells tested, for both cytostatic and cytotoxic effects. Mechanistically, the expression of Bcl-2-family proteins was explored, exhibiting increases in pro-apoptotic, but also in anti-apoptotic, proteins upon ibrutinib treatment and a relative increase in the amount of the pro-apoptotic protein PUMA after treatment with DCA. Our data provides new insights into combined therapies with ibrutinib for CLL, which further expands our knowledge and the potential of this drug for cancer treatment.

• Publisher: MDPI AG,MDPI
• Subject: Adenine - analogs & derivatives / Adenine - pharmacology / Analysis / Antimitotic agents / Antineoplastic agents / Antineoplastic Combined Chemotherapy Protocols - pharmacology / Antineoplastic Combined Chemotherapy Protocols - therapeutic use / Apoptosis / Apoptosis - drug effects / B-CLL / Bcl-2 protein / Bcl-x protein / Bcl-XL / BH3 mimetics / Biphenyl Compounds - pharmacology / Biphenyl Compounds - therapeutic use / Bridged Bicyclo Compounds, Heterocyclic - pharmacology / Bridged Bicyclo Compounds, Heterocyclic - therapeutic use / Cancer / Cancer therapies / Care and treatment / Cell culture / Cell death / Cell growth / Cell Line, Tumor / Chronic lymphocytic leukemia / Cytotoxicity / dichloroacetate / Dichloroacetic acid / Dichloroacetic Acid - pharmacology / Dichloroacetic Acid - therapeutic use / Drug Synergism / Drugs / Ethylenediaminetetraacetic acid / Health aspects / Humans / ibrutinib / Immunotherapy / Leukemia / Leukemia, Lymphocytic, Chronic, B-Cell - drug therapy / Leukemia, Lymphocytic, Chronic, B-Cell - metabolism / Leukemia, Lymphocytic, Chronic, B-Cell - pathology / Life Sciences / Malignancy / Mcl-1 / Mcl-1 protein / Metabolism / Monoclonal antibodies / Mutation / Myeloid Cell Leukemia Sequence 1 Protein - metabolism / Nitrophenols - pharmacology / Nitrophenols - therapeutic use / Piperazines / Piperidines - pharmacology / Proteins / Proto-Oncogene Proteins - metabolism / Proto-Oncogene Proteins c-bcl-2 - metabolism / Pyrazoles / Sulfonamides - pharmacology / Sulfonamides - therapeutic use / Tumor cells