- Chong, Stephen;
- Zhu, Fen;
- Dashevsky, Olga;
- Mizuno, Rin;
- Lai, Jolin;
- Hackett, Liam;
- Ryan, Christine;
- Collins, Mary;
- Iorgulescu, J;
- Guièze, Romain;
- Penailillo, Johany;
- Carrasco, Ruben;
- Hwang, Yeonjoo;
- Muñoz, Denise;
- Lim, Yaw;
- Wu, Catherine;
- Allan, John;
- Furman, Richard;
- Goh, Boon;
- Pervaiz, Shazib;
- Coppé, Jean-Philippe;
- Mitsiades, Constantine;
- Davids, Matthew;
- Bouhaddou, Mehdi
The B cell leukemia/lymphoma 2 (BCL-2) inhibitor venetoclax is effective in chronic lymphocytic leukemia (CLL); however, resistance may develop over time. Other lymphoid malignancies such as diffuse large B cell lymphoma (DLBCL) are frequently intrinsically resistant to venetoclax. Although genomic resistance mechanisms such as BCL2 mutations have been described, this probably only explains a subset of resistant cases. Using 2 complementary functional precision medicine techniques - BH3 profiling and high-throughput kinase activity mapping - we found that hyperphosphorylation of BCL-2 family proteins, including antiapoptotic myeloid leukemia 1 (MCL-1) and BCL-2 and proapoptotic BCL-2 agonist of cell death (BAD) and BCL-2 associated X, apoptosis regulator (BAX), underlies functional mechanisms of both intrinsic and acquired resistance to venetoclax in CLL and DLBCL. Additionally, we provide evidence that antiapoptotic BCL-2 family protein phosphorylation altered the apoptotic protein interactome, thereby changing the profile of functional dependence on these prosurvival proteins. Targeting BCL-2 family protein phosphorylation with phosphatase-activating drugs rewired these dependencies, thus restoring sensitivity to venetoclax in a panel of venetoclax-resistant lymphoid cell lines, a resistant mouse model, and in paired patient samples before venetoclax treatment and at the time of progression.