Research Papers:

Acquired resistance to venetoclax (ABT-199) in t(14;18) positive lymphoma cells

Juraj Bodo, Xiaoxian Zhao, Lisa Durkin, Andrew J. Souers, Darren C. Phillips, Mitchell R. Smith and Eric D. Hsi _

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Oncotarget. 2016; 7:70000-70010. https://doi.org/10.18632/oncotarget.12132

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Juraj Bodo1, Xiaoxian Zhao1, Lisa Durkin1, Andrew J. Souers2, Darren C. Phillips2, Mitchell R. Smith3, Eric D. Hsi1

1Department of Laboratory Medicine, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA

2Oncology Discovery, AbbVie, Inc., Chicago, IL, USA

3Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA

Correspondence to:

Eric D. Hsi, email: [email protected]

Keywords: venetoclax, resistance, follicular lymphoma

Received: April 15, 2016     Accepted: August 10, 2016     Published: September 20, 2016


The chromosomal translocation t(14;18) in follicular lymphoma (FL) is a primary oncogenic event resulting in BCL-2 over-expression. This study investigates activity of the BH3 mimetic venetoclax (ABT-199), which targets BCL-2, and mechanisms of acquired resistance in FL.

The sensitivity of FL cells to venetoclax treatment correlated with BCL-2/BIM ratio. Cells with similar expression of anti-apoptotic proteins, but with higher levels of BIM were more sensitive to the treatment. Venetoclax induced dissociation of BCL-2/ BIM complex and a decrease in mitochondrial potential. Interestingly the population of cells that survived venetoclax treatment showed increased p-ERK1/2 and p-BIM (S69), as well as a decrease in total BIM levels. Venetoclax resistant cells initially showed elevated levels of p-AKT and p-Foxo1/3a, a dissociation of BIM/BCL-2/BECLIN1 complex, and a decrease in SQSTM1/p62 level (indicating increased autophagy) together with a slight decline in BIM expression. After stable resistant cell lines were established, a significant reduction of BCL-2 levels and almost total absence of BIM was observed.

The acquisition of these resistance phenotypes could be prevented via selective ERK/AKT inhibition or anti-CD20 antibody treatment, thus highlighting possible combination therapies for FL patients.

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