Research Papers:

The BIM deletion polymorphism: A paradigm of a permissive interaction between germline and acquired TKI resistance factors in chronic myeloid leukemia

Tun Kiat Ko _, Hui San Chin, Charles T.H. Chuah, John W.J. Huang, King-Pan Ng, Seong Lin Khaw, David C.S. Huang and S. Tiong Ong

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Oncotarget. 2016; 7:2721-2733. https://doi.org/10.18632/oncotarget.5436

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Tun Kiat Ko1, Hui San Chin2,3, Charles T.H. Chuah1,4, John W.J. Huang1,8, King-Pan Ng1,9, Seong Lin Khaw2,3,5, David C.S. Huang2,3,5, S. Tiong Ong1,4,6,7

1Cancer and Stem Cell Biology Program, Duke-NUS Graduate Medical School, Singapore

2The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia

3Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia

4Department of Haematology, Singapore General Hospital, Singapore

5Royal Children's Hospital, Parkville, VIC, Australia

6Department of Medical Oncology, National Cancer Centre, Singapore

7Department of Medicine, Duke University Medical Center, Durham, NC, USA

8Present address: Singapore Institute for Clinical Sciences (SICS), Brenner Centre for Molecular Medicine, Singapore

9Present address: Cancer Science Institute of Singapore, National University of Singapore, Singapore

Correspondence to:

S. Tiong Ong, e-mail: [email protected]

Keywords: BIM deletion polymorphism, CML, TKI resistance, BH3 mimetic, BCR-ABL1

Received: August 18, 2015     Accepted: October 16, 2015     Published: October 28, 2015


Both germline polymorphisms and tumor-specific genetic alterations can determine the response of a cancer to a given therapy. We previously reported a germline deletion polymorphism in the BIM gene that was sufficient to mediate intrinsic resistance to tyrosine kinase inhibitors (TKI) in chronic myeloid leukemia (CML), as well as other cancers [1]. The deletion polymorphism favored the generation of BIM splice forms lacking the pro-apoptotic BH3 domain, conferring a relative resistance to the TKI imatinib (IM). However, CML patients with the BIM deletion polymorphism developed both partial and complete IM resistance. To understand the mechanisms underlying the latter, we grew CML cells either with or without the BIM deletion polymorphism in increasing IM concentrations. Under these conditions, the BIM deletion polymorphism enhanced the emergence of populations with complete IM resistance, mimicking the situation in patients. Importantly, the combined use of TKIs with the BH3 mimetic ABT-737 overcame the BCR-ABL1-dependent and -independent resistance mechanisms found in these cells. Our results illustrate the interplay between germline and acquired genetic factors in confering TKI resistance, and suggest a therapeutic strategy for patients with complete TKI resistance associated with the BIM deletion polymorphism.

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