RARγ activation sensitizes human myeloma cells to carfilzomib treatment through OAS-RNase L innate immune pathway

Qiang Wang, Zhijuan Lin, Zhuo Wang, Lingqun Ye, Miao Xian, Liuling Xiao, Pan Su, Enguang Bi, Yung-Hsing Huang, Jianfei Qian, Lintao Liu, Xingzhe Ma, Maojie Yang, Wei Xiong, Youli Zu, Sai Ravi Pingali, Bing Xu, Qing Yi

Research output: Contribution to journalArticlepeer-review

Abstract

Proteasome inhibitors (PIs) such as bortezomib (Btz) and carfilzomib (Cfz) are highly efficacious for patients with multiple myeloma (MM). However, relapses are frequent and acquired resistance to PI treatment emerges in most patients. Here we performed a high-throughput screen of 1855 FDA-approved drugs and identified all-trans retinoic acid (ATRA), which alone has no antimyeloma effect, as a potent drug that enhanced MM sensitivity to Cfz-induced cytotoxicity and re-sensitized Cfz-resistant MM cells to Cfz in vitro. ATRA activated RARγ and IFN-β response pathway, leading to upregulated expression of IRF1. IRF1 in turn initiated the transcription of OAS1, which synthesized 2-5A upon binding to dsRNA induced by Cfz and resulted in cellular RNA degradation by RNase L and cell death. Similar to ATRA, BMS961, a selective RARγ agonist, could also (re)sensitize MM cells to Cfz in vitro, and both ATRA and BMS961 significantly enhanced the therapeutic effects of Cfz in established MM in vivo. In support of these findings, analyses of large patient's gene-profiling datasets showed a strong and positive correlation between RARγ and OAS1 expression and patient's response to PI treatment. Thus, this study highlights the potential for RARγ agonists to sensitize and overcome MM resistance to Cfz treatment in patients.

Original languageEnglish (US)
JournalBlood
DOIs
StateE-pub ahead of print - Aug 19 2021

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