Abstract

BackgroundBone destruction is a hallmark of multiple myeloma (MM). It has been reported that proteasome inhibitors (PIs) can reduce bone resorption and increase bone formation in MM patients, but the underlying mechanisms remain unclear.MethodsMesenchymal stem cells (MSCs) were treated with various doses of PIs, and the effects of bortezomib or carfilzomib on endoplasmic reticulum (ER) stress signaling pathways were analyzed by western blotting and real-time PCR. Alizarin red S (ARS) and alkaline phosphatase (ALP) staining were used to determine the osteogenic differentiation in vitro. Specific inhibitors targeting different ER stress signaling and a Tet-on inducible overexpressing system were used to validate the roles of key ER stress components in regulating osteogenic differentiation of MSCs. Chromatin immunoprecipitation (ChIP) assay was used to evaluate transcription factor-promoter interaction. MicroCT was applied to measure the microarchitecture of bone in model mice in vivo.ResultsWe found that both PERK-ATF4 and IRE1α-XBP1s ER stress branches are activated during PI-induced osteogenic differentiation. Inhibition of ATF4 or XBP1s signaling can significantly impair PI-induced osteogenic differentiation. Furthermore, we demonstrated that XBP1s can transcriptionally upregulate ATF4 expression and overexpressing XBP1s can induce the expression of ATF4 and other osteogenic differentiation-related genes and therefore drive osteoblast differentiation. MicroCT analysis further demonstrated that inhibition of XBP1s can strikingly abolish bortezomib-induced bone formation in mouse.ConclusionsThese results demonstrated that XBP1s is a master regulator of PI-induced osteoblast differentiation. Activation of IRE1α-XBP1s ER stress signaling can promote osteogenesis, thus providing a novel strategy for the treatment of myeloma bone disease.

Highlights

  • Multiple myeloma (MM) is a hematological malignancy characterized by the accumulation of clonal plasma cells in the bone marrow and excessive monoclonal immunoglobulin in the serum and urine [1]

  • Proteasome inhibitors induce osteogenic differentiation of Mesenchymal stem cells (MSCs) and MC3T3-E1 cells To validate that proteasome inhibition-induced osteogenesis is not drug-specific, we compared the effects of two different proteasome inhibitors bortezomib and carfilzomib on osteoblast differentiation by performing Alizarin red S (ARS) and alkaline phosphatase (ALP) staining

  • Similar results were observed in low doses of bortezomib and carfilzomib-treated MM patientderived mesenchymal stem cells (MM-MSCs) and human normal MSCs (Supplemental Figure 1)

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Summary

Introduction

Multiple myeloma (MM) is a hematological malignancy characterized by the accumulation of clonal plasma cells in the bone marrow and excessive monoclonal immunoglobulin in the serum and urine [1]. Myeloma bone disease (MBD) is the result of increased destruction of bone and is present in approximately 80% of newly diagnosed MM patients. The introduction of new therapeutic drugs, including proteasome inhibitors (PIs), immunomodulatory agents, histone deacetylase inhibitors, and monoclonal antibodies, have significantly improved the overall survival of MM patients [2, 4]. Among these new drugs, PIs are the most important classes of agents, and three kinds of PIs, bortezomib, carfilzomib, and ixazomib, have been approved for the treatment of MM. It has been reported that proteasome inhibitors (PIs) can reduce bone resorption and increase bone formation in MM patients, but the underlying mechanisms remain unclear

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