Research Papers:

Increased resistance to proteasome inhibitors in multiple myeloma mediated by cIAP2 - implications for a combinatorial treatment

Charlotte Fristedt Duvefelt, Susanne Lub, Prasoon Agarwal, Linda Arngården, Anna Hammarberg, Ken Maes, Els Van Valckenborgh, Karin Vanderkerken and Helena Jernberg Wiklund _

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Oncotarget. 2015; 6:20621-20635. https://doi.org/10.18632/oncotarget.4139

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Charlotte Fristedt Duvefelt1,*, Susanne Lub2,*, Prasoon Agarwal1, Linda Arngården1, Anna Hammarberg1, Ken Maes2, Els Van Valckenborgh2, Karin Vanderkerken2 and Helena Jernberg Wiklund1

1 Science for Life Laboratory, Department of Immunology, Genetics and Pathology, Rudbeck Laboratory, Uppsala University, Uppsala Sweden

2 Department of Hematology and Immunology, Myeloma Center Brussels, Vrije Universiteit Brussel, (VUB) Brussels, Belgium

* These authors have contributed equally to this work

Correspondence to:

Helena Jernberg Wiklund, email:

Keywords: multiple myeloma, cellular inhibitor of apoptosis protein 2, proteasome inhibitors, drug resistance, antagonist of inhibitors of apoptosis proteins

Received: December 30, 2014 Accepted: April 23, 2015 Published: May 14, 2015


Despite the introduction of new treatment options for multiple myeloma (MM), a majority of patients relapse due to the development of resistance. Unraveling new mechanisms underlying resistance could lead to identification of possible targets for combinatorial treatment. Using TRAF3 deleted/mutated MM cell lines, we evaluated the role of the cellular inhibitor of apoptosis 2 (cIAP2) in drug resistance and uncovered the plausible mechanisms underlying this resistance and possible strategies to overcome this by combinatorial treatment. In MM, cIAP2 is part of the gene signature of aberrant NF-κB signaling and is heterogeneously expressed amongst MM patients. In cIAP2 overexpressing cells a decreased sensitivity to the proteasome inhibitors bortezomib, MG132 and carfilzomib was observed. Gene expression analysis revealed that 440 genes were differentially expressed due to cIAP2 overexpression. Importantly, the data imply that cIAPs are rational targets for combinatorial treatment in the population of MM with deleted/mutated TRAF3. Indeed, we found that treatment with the IAP inhibitor AT-406 enhanced the anti-MM effect of bortezomib in the investigated cell lines. Taken together, our results show that cIAP2 is an important factor mediating bortezomib resistance in MM cells harboring TRAF3 deletion/mutation and therefore should be considered as a target for combinatorial treatment.

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