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Abstract
Anti-CD20 monoclonal antibodies (MAbs) have revolutionized the treatment of B-cell leukemia and lymphoma. However, many patients do not respond to such treatment due to either deficiency of the complementary immune response or resistance to apoptosis. Other currently available treatments are often inadequate or induce major side effects. Therefore, there is a constant need for improved therapies. The prostaglandin E2 receptor 4 (EP4) receptor has been identified as a promising therapeutic target for hematologic B-cell malignancies. Herein, we report that EP4 receptor agonists PgE1-OH and L-902688 have exhibited enhanced cytotoxicity when applied together with anti-CD20 MAbs rituximab, ofatumumab and obinutuzumab in vitro in Burkitt lymphoma cells Ramos, as well as in p53-deficient chronic lymphocytic leukemia (CLL) cells MEC-1. Moreover, the enhanced cytotoxic effects of EP4 receptor agonists and MAbs targeting CD20 have been identified ex vivo on primary lymphocytes B obtained from patients diagnosed with CLL. Incubation of cells with PgE1-OH and L-902688 preserved the expression of CD20 molecules, further confirming the anti-leukemic potential of EP4 receptor agonists in combination with anti-CD20 MAbs. Additionally, we demonstrated that the EP4 receptor agonist PgE-1-OH induced apoptosis and inhibited proliferation via the EP4 receptor triggering in CLL. This work has revealed very important findings leading towards the elucidation of the anticancer potential of PgE1-OH and L-902688, either alone or in combination with MAbs. This may contribute to the development of potential therapeutic alternatives for patients with B-cell malignancies.
Highlights
B-cell malignancies represent more than 85% of all non-Hodgkin lymphomas; and their incidence has been rising steadily [1,2]
In the search for innovative therapeutic approaches for B-cell leukemia and lymphoma, we evaluated the potential synergism of prostaglandin E2 receptor 4 (EP4) receptor agonists PgE1-OH and L-902688 with therapeutic monoclonal antibodies (MAbs)
Ofatumumab, and obinutuzumab are therapeutic anti-CD20 antibodies exploited for the treatment in a variety of B-cell malignancies, including chronic lymphocytic leukemia (CLL)
Summary
B-cell malignancies represent more than 85% of all non-Hodgkin lymphomas; and their incidence has been rising steadily [1,2]. Aging of the population and increased life expectancy of the elderly is expected to result in B-cell malignancies, CLL in particular, becoming a progressively more common cause of morbidity and mortality in older individuals. Therapeutic MAbs against B-cell specific antigen CD20 are important players in the treatment of B-cell leukemia and lymphoma [2]. Mabs exert anti-tumor activity by harnessing the body’s own natural immune response, especially antibody-dependent cellular cytotoxicity (ADCC), complement-dependent cytotoxicity (CDC) requiring the activation of the classical complement pathway, and/or inducing apoptosis [3]. The widespread expression of CD20 on B-cells has resulted in the development of numerous antibodies.
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