Drug Information

Drug (ID: DG00130) and It's Reported Resistant Information
Name
Ibrutinib
Synonyms
PCI-32765; Ibrutinib (BTK inhibitor)
    Click to Show/Hide
Indication
In total 6 Indication(s)
Mature B-cell lymphoma [ICD-11: 2A85]
Approved
[1]
Diffuse large B-cell lymphoma [ICD-11: 2A81]
Phase 3
[1]
Follicular lymphoma [ICD-11: 2A80]
Phase 3
[1]
Malignant haematopoietic neoplasm [ICD-11: 2B33]
Phase 3
[1]
Pancreatic cancer [ICD-11: 2C10]
Phase 3
[1]
Solid tumour/cancer [ICD-11: 2A00-2F9Z]
Phase 2
[1]
Structure
Drug Resistance Disease(s)
Disease(s) with Clinically Reported Resistance for This Drug (2 diseases)
Chronic lymphocytic leukemia [ICD-11: 2A82]
[2]
Mature B-cell neoplasms/lymphoma [ICD-11: 2A85]
[3]
Disease(s) with Resistance Information Discovered by Cell Line Test for This Drug (3 diseases)
Chronic lymphocytic leukemia [ICD-11: 2A82]
[4]
Diffuse large B-cell lymphoma [ICD-11: 2A81]
[4]
Mature B-cell neoplasms/lymphoma [ICD-11: 2A85]
[5]
Target Tyrosine-protein kinase BTK (ATK) BTK_HUMAN [1]
Click to Show/Hide the Molecular Information and External Link(s) of This Drug
Formula
C25H24N6O2
IsoSMILES
C=CC(=O)N1CCC[C@H](C1)N2C3=NC=NC(=C3C(=N2)C4=CC=C(C=C4)OC5=CC=CC=C5)N
InChI
1S/C25H24N6O2/c1-2-21(32)30-14-6-7-18(15-30)31-25-22(24(26)27-16-28-25)23(29-31)17-10-12-20(13-11-17)33-19-8-4-3-5-9-19/h2-5,8-13,16,18H,1,6-7,14-15H2,(H2,26,27,28)/t18-/m1/s1
InChIKey
XYFPWWZEPKGCCK-GOSISDBHSA-N
PubChem CID
24821094
ChEBI ID
CHEBI:76612
TTD Drug ID
D09KTS
VARIDT ID
DR01270
INTEDE ID
DR0843
DrugBank ID
DB09053
Type(s) of Resistant Mechanism of This Drug
  ADTT: Aberration of the Drug's Therapeutic Target
  EADR: Epigenetic Alteration of DNA, RNA or Protein
  MRAP: Metabolic Reprogramming via Altered Pathways
  UAPP: Unusual Activation of Pro-survival Pathway
Drug Resistance Data Categorized by Their Corresponding Diseases
ICD-02: Benign/in-situ/malignant neoplasm
Click to Show/Hide the Resistance Disease of This Class
Diffuse large B-cell lymphoma [ICD-11: 2A81]
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Drug Resistance Data Categorized by Their Corresponding Mechanisms
  Metabolic Reprogramming via Altered Pathways (MRAP) Click to Show/Hide
Key Molecule: Tumor protein p53 (TP53) [6]
Metabolic Type Redox metabolism
Resistant Disease Diffuse large B-cell lymphoma [ICD-11: 2A81.0]
 Disease Info 
Molecule Alteration Expression
Down-regulation
 Molecule Info 
Experimental Note Revealed Based on the Cell Line Data
In Vitro Model CD40L cells Blood Homo sapiens (Human) N.A.
Jeko-1 cells Blood Homo sapiens (Human) CVCL_1865
Mino cells Peripheral blood Homo sapiens (Human) CVCL_UW35
OCI-LY10 cells Blood Homo sapiens (Human) CVCL_8795
OCI-LY18 cells Blood Homo sapiens (Human) CVCL_1880
OCI-LY19 cells Bone marrow Homo sapiens (Human) CVCL_1878
OCI-LY3 cells Blood Homo sapiens (Human) CVCL_8800
SUDHL10 cells Blood Homo sapiens (Human) CVCL_1889
SUDHL4 cells Blood Homo sapiens (Human) CVCL_0539
SUDHL6 cells Blood Homo sapiens (Human) CVCL_2206
U-2932 cells Blood Homo sapiens (Human) CVCL_1896
Val cells Bone marrow Homo sapiens (Human) CVCL_1819
Experiment for
Molecule Alteration		 Western blot analysis
Experiment for
Drug Resistance		 Cell viability assay
Mechanism Description Treatment with AZD5991 restricted growth of DLBCL cells independent of cell of origin and overcame ibrutinib resistance in MCL cells. Mcl-1 inhibition led to mitochondrial dysfunction as manifested by mitochondrial membrane depolarization, decreased mitochondrial mass, and induction of mitophagy. This was accompanied by impairment of oxidative phosphorylation. TP53 and BAX were essential for sensitivity to Mcl-1, and oxidative phosphorylation was implicated in resistance to Mcl-1 inhibition.
Key Molecule: BCL2 associated X protein (BAX) [6]
Metabolic Type Redox metabolism
Resistant Disease Diffuse large B-cell lymphoma [ICD-11: 2A81.0]
 Disease Info 
Molecule Alteration Expression
Down-regulation
 Molecule Info 
Experimental Note Revealed Based on the Cell Line Data
In Vitro Model CD40L cells Blood Homo sapiens (Human) N.A.
Jeko-1 cells Blood Homo sapiens (Human) CVCL_1865
Mino cells Peripheral blood Homo sapiens (Human) CVCL_UW35
OCI-LY10 cells Blood Homo sapiens (Human) CVCL_8795
OCI-LY18 cells Blood Homo sapiens (Human) CVCL_1880
OCI-LY19 cells Bone marrow Homo sapiens (Human) CVCL_1878
OCI-LY3 cells Blood Homo sapiens (Human) CVCL_8800
SUDHL10 cells Blood Homo sapiens (Human) CVCL_1889
SUDHL4 cells Blood Homo sapiens (Human) CVCL_0539
SUDHL6 cells Blood Homo sapiens (Human) CVCL_2206
U-2932 cells Blood Homo sapiens (Human) CVCL_1896
Val cells Bone marrow Homo sapiens (Human) CVCL_1819
Experiment for
Molecule Alteration		 Western blot analysis
Experiment for
Drug Resistance		 Cell viability assay
Mechanism Description Treatment with AZD5991 restricted growth of DLBCL cells independent of cell of origin and overcame ibrutinib resistance in MCL cells. Mcl-1 inhibition led to mitochondrial dysfunction as manifested by mitochondrial membrane depolarization, decreased mitochondrial mass, and induction of mitophagy. This was accompanied by impairment of oxidative phosphorylation. TP53 and BAX were essential for sensitivity to Mcl-1, and oxidative phosphorylation was implicated in resistance to Mcl-1 inhibition.
Key Molecule: Myeloid cell leukemia 1 (Mcl-1) [6]
Metabolic Type Redox metabolism
Resistant Disease Diffuse large B-cell lymphoma [ICD-11: 2A81.0]
 Disease Info 
Molecule Alteration Expression
Up-regulation
 Molecule Info 
Experimental Note Revealed Based on the Cell Line Data
In Vitro Model CD40L cells Blood Homo sapiens (Human) N.A.
Jeko-1 cells Blood Homo sapiens (Human) CVCL_1865
Mino cells Peripheral blood Homo sapiens (Human) CVCL_UW35
OCI-LY10 cells Blood Homo sapiens (Human) CVCL_8795
OCI-LY18 cells Blood Homo sapiens (Human) CVCL_1880
OCI-LY19 cells Bone marrow Homo sapiens (Human) CVCL_1878
OCI-LY3 cells Blood Homo sapiens (Human) CVCL_8800
SUDHL10 cells Blood Homo sapiens (Human) CVCL_1889
SUDHL4 cells Blood Homo sapiens (Human) CVCL_0539
SUDHL6 cells Blood Homo sapiens (Human) CVCL_2206
U-2932 cells Blood Homo sapiens (Human) CVCL_1896
Val cells Bone marrow Homo sapiens (Human) CVCL_1819
Experiment for
Molecule Alteration		 Western blot analysis
Experiment for
Drug Resistance		 Cell viability assay
Mechanism Description Treatment with AZD5991 restricted growth of DLBCL cells independent of cell of origin and overcame ibrutinib resistance in MCL cells. Mcl-1 inhibition led to mitochondrial dysfunction as manifested by mitochondrial membrane depolarization, decreased mitochondrial mass, and induction of mitophagy. This was accompanied by impairment of oxidative phosphorylation. TP53 and BAX were essential for sensitivity to Mcl-1, and oxidative phosphorylation was implicated in resistance to Mcl-1 inhibition.
  Unusual Activation of Pro-survival Pathway (UAPP) Click to Show/Hide
Key Molecule: Myeloid differentiation primary response protein MyD88 (MYD88) [4]
Resistant Disease Diffuse large B-cell lymphoma [ICD-11: 2A81.0]
 Disease Info 
Molecule Alteration Missense mutation
p.L265P
 Molecule Info 
Experimental Note Revealed Based on the Cell Line Data
Mechanism Description Furthermore, within ABC DLBCL, responses were significantly different depending on the specific genetic lesions. Ibrutinib-resistant tumours carry mutant MYD88 and WT CD79A/B whereas all other genotypic combinations (CD79A/BWT + MYD88WT, CD79A/Bmutant + MYD88WT and CD79A/Bmutant + MYD88mutant) were responsive to ibrutinib therapy. It is foreseeable why ibrutinib therapy is less effective in MYD88-mutated ABC-DLBCL patients because MYD88 activates NFkappa-B through a parallel pathway independent of BTK. However, it is unclear why MYD88 mutations alone are associated with ibrutinib resistance whereas the MYD88 mutations in conjunction with CD79A/B mutations appears to render ABC DLBCL ibrutinib-sensitive.
Chronic lymphocytic leukemia [ICD-11: 2A82]
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Drug Resistance Data Categorized by Their Corresponding Mechanisms
  Aberration of the Drug's Therapeutic Target (ADTT) Click to Show/Hide
Key Molecule: Tyrosine-protein kinase BTK (BTK) [2]
Resistant Disease Chronic lymphocytic leukemia [ICD-11: 2A82.0]
 Disease Info 
Molecule Alteration Missense mutation
p.C481S
 Molecule Info 
Wild Type Structure Method: X-ray diffraction Resolution: 1.40  Å
PDB: 6VXQ
Mutant Type Structure Method: X-ray diffraction Resolution: 1.33  Å
PDB: 8FLN
   Download The Information of Sequence       Download The Structure File   
RMSD: 0.82
TM score: 0.96927
Amino acid change:
C481S
 : Wild Type Structure
 : Mutant Type Structure
  Mutation site(s) have been marked in red
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640
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650
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Click to Show/Hide the Structure
Experimental Note Identified from the Human Clinical Data
Cell Pathway Regulation Cell apoptosis Activation hsa04210
Cell proliferation Inhibition hsa05200
NF-kB signaling pathway Inhibition hsa04218
In Vivo Model A retrospective survey in conducting clinical studies Homo sapiens
Experiment for
Molecule Alteration		 Sanger sequencing assay; Next-generation sequencing assay
Experiment for
Drug Resistance		 Flow cytometry assay; Bone marrow biopsy assay; Lymph node biopsy assay; Physical and laboratory examinations assay; Computed tomography imaging assay
Mechanism Description All patients except one had an early on-treatment sample available that tested negative for BTk and PLCG2 mutations, indicating expansion of subclones carrying drug-resistant mutations during treatment. Most cases of ibrutinib-resistant CLL were due to mutations in BTk and,or PLCG2 and often composed of multiple independent subclones.
Key Molecule: Tyrosine-protein kinase BTK (BTK) [4]
Resistant Disease Chronic lymphocytic leukemia [ICD-11: 2A82.0]
 Disease Info 
Molecule Alteration Missense mutation
p.C481S
 Molecule Info 
Wild Type Structure Method: X-ray diffraction Resolution: 1.40  Å
PDB: 6VXQ
Mutant Type Structure Method: X-ray diffraction Resolution: 1.33  Å
PDB: 8FLN
   Download The Information of Sequence       Download The Structure File   
RMSD: 0.82
TM score: 0.96927
Amino acid change:
C481S
 : Wild Type Structure
 : Mutant Type Structure
  Mutation site(s) have been marked in red
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Click to Show/Hide the Structure
Experimental Note Revealed Based on the Cell Line Data
Mechanism Description Efforts have been made to understand the functional consequences of the BTK mutation. On a structural level, the C481S mutation disrupts covalent binding, allowing for reversible, instead of strong irreversible, binding of BTK by ibrutinib. The critical biochemical role of covalent-bond formation was revealed when fluorescently tagged-ibrutinib labelled the wild-type (WT) BTK, but not the BTKC481S mutant.
Key Molecule: Tyrosine-protein kinase BTK (BTK) [2]
Resistant Disease Chronic lymphocytic leukemia [ICD-11: 2A82.0]
 Disease Info 
Molecule Alteration Missense mutation
p.C481R
 Molecule Info 
Experimental Note Identified from the Human Clinical Data
Cell Pathway Regulation Cell apoptosis Activation hsa04210
Cell proliferation Inhibition hsa05200
NF-kB signaling pathway Inhibition hsa04218
In Vivo Model A retrospective survey in conducting clinical studies Homo sapiens
Experiment for
Molecule Alteration		 Sanger sequencing assay; Next-generation sequencing assay
Experiment for
Drug Resistance		 Flow cytometry assay; Bone marrow biopsy assay; Lymph node biopsy assay; Physical and laboratory examinations assay; Computed tomography imaging assay
Mechanism Description All patients except one had an early on-treatment sample available that tested negative for BTk and PLCG2 mutations, indicating expansion of subclones carrying drug-resistant mutations during treatment. Most cases of ibrutinib-resistant CLL were due to mutations in BTk and,or PLCG2 and often composed of multiple independent subclones.
Key Molecule: AKT serine/threonine kinase (AKT) [7]
Resistant Disease Chronic lymphocytic leukemia [ICD-11: 2A82.0]
 Disease Info 
Molecule Alteration Phosphorylation
Up-regulation
 Molecule Info 
Experimental Note Revealed Based on the Cell Line Data
In Vitro Model CD5+19+ cells Blood Homo sapiens (Human) N.A.
MEC1 cells Blood Homo sapiens (Human) CVCL_1870
HS-5 cells Bone marrow Homo sapiens (Human) CVCL_3720
In Vivo Model NSG mice model Mus musculus
Experiment for
Molecule Alteration		 Immunoblotting assay
Experiment for
Drug Resistance		 Flow cytometry assay
Mechanism Description Induction of transcription factor FoxO1 during ibrutinib therapy upregulates Rictor, an mTORC2 assembly protein, leading to phosphorylation of Akt, an essential molecule supporting CLL cell survival
Key Molecule: Forkhead box protein O1/Rapamycin-insensitive companion of mTOR (FOXO1/RICTOR) axis [7]
Resistant Disease Chronic lymphocytic leukemia [ICD-11: 2A82.0]
 Disease Info 
Molecule Alteration Expression
p.Y537N
 Molecule Info 
Experimental Note Revealed Based on the Cell Line Data
In Vitro Model CD5+19+ cells Blood Homo sapiens (Human) N.A.
MEC1 cells Blood Homo sapiens (Human) CVCL_1870
HS-5 cells Bone marrow Homo sapiens (Human) CVCL_3720
In Vivo Model NSG mice model Mus musculus
Experiment for
Molecule Alteration		 Immunoblotting assay
Experiment for
Drug Resistance		 Flow cytometry assay
Mechanism Description Induction of transcription factor FoxO1 during ibrutinib therapy upregulates Rictor, an mTORC2 assembly protein, leading to phosphorylation of Akt, an essential molecule supporting CLL cell survival
  Unusual Activation of Pro-survival Pathway (UAPP) Click to Show/Hide
Key Molecule: Phosphoinositide phospholipase C-gamma-2 (PLCG2) [2]
Resistant Disease Chronic lymphocytic leukemia [ICD-11: 2A82.0]
 Disease Info 
Molecule Alteration Missense mutation
p.S707Y
 Molecule Info 
Experimental Note Identified from the Human Clinical Data
Cell Pathway Regulation Cell apoptosis Activation hsa04210
Cell proliferation Inhibition hsa05200
NF-kB signaling pathway Inhibition hsa04218
In Vivo Model A retrospective survey in conducting clinical studies Homo sapiens
Experiment for
Molecule Alteration		 Sanger sequencing assay; Next-generation sequencing assay
Experiment for
Drug Resistance		 Flow cytometry assay; Bone marrow biopsy assay; Lymph node biopsy assay; Physical and laboratory examinations assay; Computed tomography imaging assay
Mechanism Description All patients except one had an early on-treatment sample available that tested negative for BTk and PLCG2 mutations, indicating expansion of subclones carrying drug-resistant mutations during treatment. Most cases of ibrutinib-resistant CLL were due to mutations in BTk and,or PLCG2 and often composed of multiple independent subclones.
Key Molecule: Phosphoinositide phospholipase C-gamma-2 (PLCG2) [2]
Resistant Disease Chronic lymphocytic leukemia [ICD-11: 2A82.0]
 Disease Info 
Molecule Alteration Missense mutation
p.P664W
 Molecule Info 
Experimental Note Identified from the Human Clinical Data
Cell Pathway Regulation Cell apoptosis Activation hsa04210
Cell proliferation Inhibition hsa05200
NF-kB signaling pathway Inhibition hsa04218
In Vivo Model A retrospective survey in conducting clinical studies Homo sapiens
Experiment for
Molecule Alteration		 Sanger sequencing assay; Next-generation sequencing assay
Experiment for
Drug Resistance		 Flow cytometry assay; Bone marrow biopsy assay; Lymph node biopsy assay; Physical and laboratory examinations assay; Computed tomography imaging assay
Mechanism Description All patients except one had an early on-treatment sample available that tested negative for BTk and PLCG2 mutations, indicating expansion of subclones carrying drug-resistant mutations during treatment. Most cases of ibrutinib-resistant CLL were due to mutations in BTk and,or PLCG2 and often composed of multiple independent subclones.
Key Molecule: Phosphoinositide phospholipase C-gamma-2 (PLCG2) [2]
Resistant Disease Chronic lymphocytic leukemia [ICD-11: 2A82.0]
 Disease Info 
Molecule Alteration Missense mutation
p.P664S
 Molecule Info 
Experimental Note Identified from the Human Clinical Data
Cell Pathway Regulation Cell apoptosis Activation hsa04210
Cell proliferation Inhibition hsa05200
NF-kB signaling pathway Inhibition hsa04218
In Vivo Model A retrospective survey in conducting clinical studies Homo sapiens
Experiment for
Molecule Alteration		 Sanger sequencing assay; Next-generation sequencing assay
Experiment for
Drug Resistance		 Flow cytometry assay; Bone marrow biopsy assay; Lymph node biopsy assay; Physical and laboratory examinations assay; Computed tomography imaging assay
Mechanism Description All patients except one had an early on-treatment sample available that tested negative for BTk and PLCG2 mutations, indicating expansion of subclones carrying drug-resistant mutations during treatment. Most cases of ibrutinib-resistant CLL were due to mutations in BTk and,or PLCG2 and often composed of multiple independent subclones.
Key Molecule: Phosphoinositide phospholipase C-gamma-2 (PLCG2) [2]
Resistant Disease Chronic lymphocytic leukemia [ICD-11: 2A82.0]
 Disease Info 
Molecule Alteration Missense mutation
p.L845F
 Molecule Info 
Experimental Note Identified from the Human Clinical Data
Cell Pathway Regulation Cell apoptosis Activation hsa04210
Cell proliferation Inhibition hsa05200
NF-kB signaling pathway Inhibition hsa04218
In Vivo Model A retrospective survey in conducting clinical studies Homo sapiens
Experiment for
Molecule Alteration		 Sanger sequencing assay; Next-generation sequencing assay
Experiment for
Drug Resistance		 Flow cytometry assay; Bone marrow biopsy assay; Lymph node biopsy assay; Physical and laboratory examinations assay; Computed tomography imaging assay
Mechanism Description All patients except one had an early on-treatment sample available that tested negative for BTk and PLCG2 mutations, indicating expansion of subclones carrying drug-resistant mutations during treatment. Most cases of ibrutinib-resistant CLL were due to mutations in BTk and,or PLCG2 and often composed of multiple independent subclones.
Key Molecule: Phosphoinositide phospholipase C-gamma-2 (PLCG2) [4]
Resistant Disease Chronic lymphocytic leukemia [ICD-11: 2A82.0]
 Disease Info 
Molecule Alteration Mutation
p.R665W+p.L845F+p.S707Y
 Molecule Info 
Experimental Note Revealed Based on the Cell Line Data
Mechanism Description In contrast to the BTKC481S mutation, which causes eventual loss of BTK inhibition by ibrutinib, PLCG2 mutations are all potentially gain-of-function mutations. Situated downstream from BTK, PLCG2 mutations allow for continued signalling regardless of BTK activity. After stimulation with anti-IgM antibody, cells with either the PLCG2R665W or PLCG2L845F mutations were found to have sustained BCR signalling that was not inhibited by ibrutinib, as measured by calcium-flux assays and phosphorylation of ERK and AKT.
Key Molecule: Tyrosine-protein kinase BTK (BTK) [8]
Resistant Disease Chronic lymphocytic leukemia [ICD-11: 2A82.0]
 Disease Info 
Molecule Alteration Missense mutation
Down-regulation
 Molecule Info 
Experimental Note Revealed Based on the Cell Line Data
Cell Pathway Regulation Rho GTPases signaling pathway Regulation N.A.
MAPK signaling pathway Activation hsa04010
WNT/beta-catenin signaling pathway Regulation N.A.
NOTCH signaling pathway Activation hsa04330
In Vitro Model HG-3 CLL cells Blood Homo sapiens (Human) N.A.
OSU-CLL cells Blood Homo sapiens (Human) CVCL_Y382
Experiment for
Molecule Alteration		 Immunoblotting assay
Experiment for
Drug Resistance		 RNA sequencing assay; ROS assay; Ferroptosis assay; Flow cytometry assay
Mechanism Description Clinically, most ibrutinib-resistant patients (~80%) harbor a C481S mutation in the BTK protein, blocking ibrutinib from covalently binding to BTK, and/or a gain of function mutation in PLCgamma2, activating downstream BCR signaling independent of BTK inhibition. Resistance is also mediated through alternative survival pathways, such as the activation of PI3K/AKT/ERK signaling .
Mature B-cell neoplasms/lymphoma [ICD-11: 2A85]
Click to Show/Hide
Drug Resistance Data Categorized by Their Corresponding Mechanisms
  Aberration of the Drug's Therapeutic Target (ADTT) Click to Show/Hide
Key Molecule: Tyrosine-protein kinase BTK (BTK) [9]
Resistant Disease Mantle cell lymphoma [ICD-11: 2A85.0]
 Disease Info 
Molecule Alteration Missense mutation
p.C481S
 Molecule Info 
Wild Type Structure Method: X-ray diffraction Resolution: 1.40  Å
PDB: 6VXQ
Mutant Type Structure Method: X-ray diffraction Resolution: 1.33  Å
PDB: 8FLN
   Download The Information of Sequence       Download The Structure File   
RMSD: 0.82
TM score: 0.96927
Amino acid change:
C481S
 : Wild Type Structure
 : Mutant Type Structure
  Mutation site(s) have been marked in red
-
G
-
P
-
L
-
370
|
G
-
S
-
R
-
L
-
K
-
Y
-
P
-
V
-
S
-
Q
-
380
|
Q
-
N
-
K
-
N
-
A
-
P
-
S
-
T
G
A
M
G
G
390
|
L
L
G
G
Y
Y
G
G
S
S
W
W
E
E
I
I
D
D
P
P
400
|
K
K
D
D
L
L
T
T
F
F
L
L
K
K
E
E
L
L
G
G
410
|
T
T
G
G
Q
Q
F
F
G
G
V
V
V
V
K
K
Y
Y
G
G
420
|
K
K
W
W
R
R
G
G
Q
Q
Y
Y
D
D
V
V
A
A
I
I
430
|
K
K
M
M
I
I
K
K
E
E
G
G
S
S
M
M
S
S
E
E
440
|
D
D
E
E
F
F
I
I
E
E
E
E
A
A
K
K
V
V
M
M
450
|
M
M
N
N
L
L
S
S
H
H
E
E
K
K
L
L
V
V
Q
Q
460
|
L
L
Y
Y
G
G
V
V
C
C
T
T
K
K
Q
Q
R
R
P
P
470
|
I
I
F
F
I
I
I
I
T
T
E
E
Y
Y
M
M
A
A
N
N
480
|
G
G
C
S
L
L
L
L
N
N
Y
Y
L
L
R
R
E
E
M
M
490
|
R
R
H
H
R
R
F
F
Q
Q
T
T
Q
Q
Q
Q
L
L
L
L
500
|
E
E
M
M
C
C
K
K
D
D
V
V
C
C
E
E
A
A
M
M
510
|
E
E
Y
Y
L
L
E
E
S
S
K
K
Q
Q
F
F
L
L
H
H
520
|
R
R
D
D
L
L
A
A
A
A
R
R
N
N
C
C
L
L
V
V
530
|
N
N
D
D
Q
Q
G
G
V
V
V
V
K
K
V
V
S
S
D
D
540
|
F
F
G
G
L
L
S
S
R
R
Y
Y
V
V
L
L
D
D
D
D
550
|
E
E
Y
Y
T
T
S
S
S
S
V
V
G
G
S
S
K
K
F
F
560
|
P
P
V
V
R
R
W
W
S
S
P
P
P
P
E
E
V
V
L
L
570
|
M
M
Y
Y
S
S
K
K
F
F
S
S
S
S
K
K
S
S
D
D
580
|
I
I
W
W
A
A
F
F
G
G
V
V
L
L
M
M
W
W
E
E
590
|
I
I
Y
Y
S
S
L
L
G
G
K
K
M
M
P
P
Y
Y
E
E
600
|
R
R
F
F
T
T
N
N
S
S
E
E
T
T
A
A
E
E
H
H
610
|
I
I
A
A
Q
Q
G
G
L
L
R
R
L
L
Y
Y
R
R
P
P
620
|
H
H
L
L
A
A
S
S
E
E
K
K
V
V
Y
Y
T
T
I
I
630
|
M
M
Y
Y
S
S
C
C
W
W
H
H
E
E
K
K
A
A
D
D
640
|
E
E
R
R
P
P
T
T
F
F
K
K
I
I
L
L
L
L
S
S
650
|
N
N
I
I
L
L
D
D
V
V
M
M
D
D
E
E
E
E
S
S
Click to Show/Hide the Structure
Experimental Note Identified from the Human Clinical Data
In Vitro Model Mantle cell lymphoma isolates Peripheral blood Homo sapiens (Human) N.A.
Experiment for
Molecule Alteration		 Whole-exome sequencing assay; Whole-transcriptome sequencing assay
Mechanism Description This mutation enhanced BTK and AKT activation and tissue-specific proliferation of resistant MCL cells driven by CDK4 activation. It was absent, however, in patients with primary-resistance or progression following transient response to ibrutinib, suggesting alternative mechanisms of resistance.
Key Molecule: Tyrosine-protein kinase BTK (BTK) [9]
Resistant Disease Mantle cell lymphoma [ICD-11: 2A85.0]
 Disease Info 
Molecule Alteration Missense mutation
p.C481S
 Molecule Info 
Wild Type Structure Method: X-ray diffraction Resolution: 1.40  Å
PDB: 6VXQ
Mutant Type Structure Method: X-ray diffraction Resolution: 1.33  Å
PDB: 8FLN
   Download The Information of Sequence       Download The Structure File   
RMSD: 0.82
TM score: 0.96927
Amino acid change:
C481S
 : Wild Type Structure
 : Mutant Type Structure
  Mutation site(s) have been marked in red
-
G
-
P
-
L
-
370
|
G
-
S
-
R
-
L
-
K
-
Y
-
P
-
V
-
S
-
Q
-
380
|
Q
-
N
-
K
-
N
-
A
-
P
-
S
-
T
G
A
M
G
G
390
|
L
L
G
G
Y
Y
G
G
S
S
W
W
E
E
I
I
D
D
P
P
400
|
K
K
D
D
L
L
T
T
F
F
L
L
K
K
E
E
L
L
G
G
410
|
T
T
G
G
Q
Q
F
F
G
G
V
V
V
V
K
K
Y
Y
G
G
420
|
K
K
W
W
R
R
G
G
Q
Q
Y
Y
D
D
V
V
A
A
I
I
430
|
K
K
M
M
I
I
K
K
E
E
G
G
S
S
M
M
S
S
E
E
440
|
D
D
E
E
F
F
I
I
E
E
E
E
A
A
K
K
V
V
M
M
450
|
M
M
N
N
L
L
S
S
H
H
E
E
K
K
L
L
V
V
Q
Q
460
|
L
L
Y
Y
G
G
V
V
C
C
T
T
K
K
Q
Q
R
R
P
P
470
|
I
I
F
F
I
I
I
I
T
T
E
E
Y
Y
M
M
A
A
N
N
480
|
G
G
C
S
L
L
L
L
N
N
Y
Y
L
L
R
R
E
E
M
M
490
|
R
R
H
H
R
R
F
F
Q
Q
T
T
Q
Q
Q
Q
L
L
L
L
500
|
E
E
M
M
C
C
K
K
D
D
V
V
C
C
E
E
A
A
M
M
510
|
E
E
Y
Y
L
L
E
E
S
S
K
K
Q
Q
F
F
L
L
H
H
520
|
R
R
D
D
L
L
A
A
A
A
R
R
N
N
C
C
L
L
V
V
530
|
N
N
D
D
Q
Q
G
G
V
V
V
V
K
K
V
V
S
S
D
D
540
|
F
F
G
G
L
L
S
S
R
R
Y
Y
V
V
L
L
D
D
D
D
550
|
E
E
Y
Y
T
T
S
S
S
S
V
V
G
G
S
S
K
K
F
F
560
|
P
P
V
V
R
R
W
W
S
S
P
P
P
P
E
E
V
V
L
L
570
|
M
M
Y
Y
S
S
K
K
F
F
S
S
S
S
K
K
S
S
D
D
580
|
I
I
W
W
A
A
F
F
G
G
V
V
L
L
M
M
W
W
E
E
590
|
I
I
Y
Y
S
S
L
L
G
G
K
K
M
M
P
P
Y
Y
E
E
600
|
R
R
F
F
T
T
N
N
S
S
E
E
T
T
A
A
E
E
H
H
610
|
I
I
A
A
Q
Q
G
G
L
L
R
R
L
L
Y
Y
R
R
P
P
620
|
H
H
L
L
A
A
S
S
E
E
K
K
V
V
Y
Y
T
T
I
I
630
|
M
M
Y
Y
S
S
C
C
W
W
H
H
E
E
K
K
A
A
D
D
640
|
E
E
R
R
P
P
T
T
F
F
K
K
I
I
L
L
L
L
S
S
650
|
N
N
I
I
L
L
D
D
V
V
M
M
D
D
E
E
E
E
S
S
Click to Show/Hide the Structure
Experimental Note Identified from the Human Clinical Data
In Vitro Model Mantle cell lymphoma isolates Peripheral blood Homo sapiens (Human) N.A.
Experiment for
Molecule Alteration		 Whole-exome sequencing assay; Whole-transcriptome sequencing assay
Mechanism Description This mutation enhanced BTK and AKT activation and tissue-specific proliferation of resistant MCL cells driven by CDK4 activation. It was absent, however, in patients with primary-resistance or progression following transient response to ibrutinib, suggesting alternative mechanisms of resistance.
Key Molecule: Tyrosine-protein kinase BTK (BTK) [4]
Resistant Disease Mantle cell lymphoma [ICD-11: 2A85.0]
 Disease Info 
Molecule Alteration Missense mutation
p.C481S
 Molecule Info 
Wild Type Structure Method: X-ray diffraction Resolution: 1.40  Å
PDB: 6VXQ
Mutant Type Structure Method: X-ray diffraction Resolution: 1.33  Å
PDB: 8FLN
   Download The Information of Sequence       Download The Structure File   
RMSD: 0.82
TM score: 0.96927
Amino acid change:
C481S
 : Wild Type Structure
 : Mutant Type Structure
  Mutation site(s) have been marked in red
-
G
-
P
-
L
-
370
|
G
-
S
-
R
-
L
-
K
-
Y
-
P
-
V
-
S
-
Q
-
380
|
Q
-
N
-
K
-
N
-
A
-
P
-
S
-
T
G
A
M
G
G
390
|
L
L
G
G
Y
Y
G
G
S
S
W
W
E
E
I
I
D
D
P
P
400
|
K
K
D
D
L
L
T
T
F
F
L
L
K
K
E
E
L
L
G
G
410
|
T
T
G
G
Q
Q
F
F
G
G
V
V
V
V
K
K
Y
Y
G
G
420
|
K
K
W
W
R
R
G
G
Q
Q
Y
Y
D
D
V
V
A
A
I
I
430
|
K
K
M
M
I
I
K
K
E
E
G
G
S
S
M
M
S
S
E
E
440
|
D
D
E
E
F
F
I
I
E
E
E
E
A
A
K
K
V
V
M
M
450
|
M
M
N
N
L
L
S
S
H
H
E
E
K
K
L
L
V
V
Q
Q
460
|
L
L
Y
Y
G
G
V
V
C
C
T
T
K
K
Q
Q
R
R
P
P
470
|
I
I
F
F
I
I
I
I
T
T
E
E
Y
Y
M
M
A
A
N
N
480
|
G
G
C
S
L
L
L
L
N
N
Y
Y
L
L
R
R
E
E
M
M
490
|
R
R
H
H
R
R
F
F
Q
Q
T
T
Q
Q
Q
Q
L
L
L
L
500
|
E
E
M
M
C
C
K
K
D
D
V
V
C
C
E
E
A
A
M
M
510
|
E
E
Y
Y
L
L
E
E
S
S
K
K
Q
Q
F
F
L
L
H
H
520
|
R
R
D
D
L
L
A
A
A
A
R
R
N
N
C
C
L
L
V
V
530
|
N
N
D
D
Q
Q
G
G
V
V
V
V
K
K
V
V
S
S
D
D
540
|
F
F
G
G
L
L
S
S
R
R
Y
Y
V
V
L
L
D
D
D
D
550
|
E
E
Y
Y
T
T
S
S
S
S
V
V
G
G
S
S
K
K
F
F
560
|
P
P
V
V
R
R
W
W
S
S
P
P
P
P
E
E
V
V
L
L
570
|
M
M
Y
Y
S
S
K
K
F
F
S
S
S
S
K
K
S
S
D
D
580
|
I
I
W
W
A
A
F
F
G
G
V
V
L
L
M
M
W
W
E
E
590
|
I
I
Y
Y
S
S
L
L
G
G
K
K
M
M
P
P
Y
Y
E
E
600
|
R
R
F
F
T
T
N
N
S
S
E
E
T
T
A
A
E
E
H
H
610
|
I
I
A
A
Q
Q
G
G
L
L
R
R
L
L
Y
Y
R
R
P
P
620
|
H
H
L
L
A
A
S
S
E
E
K
K
V
V
Y
Y
T
T
I
I
630
|
M
M
Y
Y
S
S
C
C
W
W
H
H
E
E
K
K
A
A
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Click to Show/Hide the Structure
Experimental Note Identified from the Human Clinical Data
Cell Pathway Regulation PIK3/AKT signaling pathway Activation hsa04211
Mechanism Description Efforts have been made to understand the functional consequences of the BTK mutation. On a structural level, the C481S mutation disrupts covalent binding, allowing for reversible, instead of strong irreversible, binding of BTK by ibrutinib. The critical biochemical role of covalent-bond formation was revealed when fluorescently tagged-ibrutinib labelled the wild-type (WT) BTK, but not the BTKC481S mutant.
  Epigenetic Alteration of DNA, RNA or Protein (EADR) Click to Show/Hide
Key Molecule: ROR1 antisense RNA 1 (ROR1-AS1) [5]
Resistant Disease Mantle cell lymphoma [ICD-11: 2A85.0]
 Disease Info 
Molecule Alteration Expression
Up-regulation
 Molecule Info 
Experimental Note Revealed Based on the Cell Line Data
Cell Pathway Regulation Cell proliferation Activation hsa05200
In Vitro Model HEK293T cells Kidney Homo sapiens (Human) CVCL_0063
Granta cells Peripheral blood Homo sapiens (Human) N.A.
JVM2 cells Peripheral blood Homo sapiens (Human) CVCL_1319
Mino cells Peripheral blood Homo sapiens (Human) CVCL_UW35
Z138 cells Peripheral blood Homo sapiens (Human) CVCL_B077
Experiment for
Molecule Alteration		 qRT-PCR
Experiment for
Drug Resistance		 3H-thymidine incorporation assay
Mechanism Description Overexpression of ROR1-AS1 LncRNA promoted growth of MCL cells while decreased sensitivity to the treatment with drugs ibrutinib and dexamethasone.
  Metabolic Reprogramming via Altered Pathways (MRAP) Click to Show/Hide
Key Molecule: Early growth response protein 1 (EGR1) [10]
Metabolic Type Glucose metabolism
Resistant Disease Mantle cell lymphoma [ICD-11: 2A85.0]
 Disease Info 
Molecule Alteration Expression
Up-regulation
 Molecule Info 
Experimental Note Revealed Based on the Cell Line Data
In Vivo Model Mice, with fresh tissue from patient Mice
Experiment for
Molecule Alteration		 RNA seq
Experiment for
Drug Resistance		 Cell viability assay
Mechanism Description The overexpression of EGR1 in ibrutinib-resistant cells is likely to result from the transcription factor TCF4-mediated EGR1 transcription and EGR1 self-regulation. Genetic and pharmacological inhibition of EGR1 restores the sensitivity of the resistant cells to ibrutinib, suggesting a role EGR1 plays in ibrutinib resistance. The underlying mechanism is that EGR1 mediates metabolic reprogramming to mitochondrial OXPHOS by transcriptional activation of PDP1, which increases ATP production.
Key Molecule: DNA (cytosine-5)-methyltransferase 3A (DNMT3A) [11]
Metabolic Type Mitochondrial metabolism
Resistant Disease Mantle cell lymphoma [ICD-11: 2A85.0]
 Disease Info 
Molecule Alteration Expression
Up-regulation
 Molecule Info 
Experimental Note Revealed Based on the Cell Line Data
In Vitro Model Mino cells Peripheral blood Homo sapiens (Human) CVCL_UW35
Experiment for
Molecule Alteration		 qRT-PCR; Western blot analysis
Experiment for
Drug Resistance		 IC50 assay
Mechanism Description We provide evidence that DNMT3A contributes to ibrutinib resistance in MCL by increasing mitochondrial biogenesis and OXPHOS. Recent clinical studies demonstrated the potential of BTKis as a first-line treatment option for MCL.
Key Molecule: DNA (cytosine-5)-methyltransferase 3A (DNMT3A) [11]
Metabolic Type Mitochondrial metabolism
Resistant Disease Mantle cell lymphoma [ICD-11: 2A85.0]
 Disease Info 
Molecule Alteration Expression
Up-regulation
 Molecule Info 
Experimental Note Revealed Based on the Cell Line Data
In Vitro Model Rec-1 cells Lymph Homo sapiens (Human) CVCL_1884
Experiment for
Molecule Alteration		 qRT-PCR; Western blot analysis
Experiment for
Drug Resistance		 IC50 assay
Mechanism Description We provide evidence that DNMT4A contributes to ibrutinib resistance in MCL by increasing mitochondrial biogenesis and OXPHOS. Recent clinical studies demonstrated the potential of BTKis as a first-line treatment option for MCL.
Key Molecule: DNA (cytosine-5)-methyltransferase 3A (DNMT3A) [11]
Metabolic Type Mitochondrial metabolism
Resistant Disease Mantle cell lymphoma [ICD-11: 2A85.0]
 Disease Info 
Molecule Alteration Expression
Up-regulation
 Molecule Info 
Experimental Note Revealed Based on the Cell Line Data
In Vitro Model Jeko-1 cells Blood Homo sapiens (Human) CVCL_1865
Experiment for
Molecule Alteration		 qRT-PCR; Western blot analysis
Experiment for
Drug Resistance		 IC50 assay
Mechanism Description We provide evidence that DNMT5A contributes to ibrutinib resistance in MCL by increasing mitochondrial biogenesis and OXPHOS. Recent clinical studies demonstrated the potential of BTKis as a first-line treatment option for MCL.
Key Molecule: DNA (cytosine-5)-methyltransferase 3A (DNMT3A) [11]
Metabolic Type Mitochondrial metabolism
Resistant Disease Mantle cell lymphoma [ICD-11: 2A85.0]
 Disease Info 
Molecule Alteration Expression
Up-regulation
 Molecule Info 
Experimental Note Revealed Based on the Cell Line Data
In Vitro Model Z138 cells Peripheral blood Homo sapiens (Human) CVCL_B077
Experiment for
Molecule Alteration		 qRT-PCR; Western blot analysis
Experiment for
Drug Resistance		 IC50 assay
Mechanism Description We provide evidence that DNMT6A contributes to ibrutinib resistance in MCL by increasing mitochondrial biogenesis and OXPHOS. Recent clinical studies demonstrated the potential of BTKis as a first-line treatment option for MCL.
Key Molecule: DNA (cytosine-5)-methyltransferase 3A (DNMT3A) [11]
Metabolic Type Mitochondrial metabolism
Resistant Disease Mantle cell lymphoma [ICD-11: 2A85.0]
 Disease Info 
Molecule Alteration Expression
Up-regulation
 Molecule Info 
Experimental Note Revealed Based on the Cell Line Data
In Vivo Model Mouse, with tumor cells Mice
Experiment for
Molecule Alteration		 qRT-PCR; Western blot analysis
Experiment for
Drug Resistance		 Tumor volume assay
Mechanism Description We provide evidence that DNMT7A contributes to ibrutinib resistance in MCL by increasing mitochondrial biogenesis and OXPHOS. Recent clinical studies demonstrated the potential of BTKis as a first-line treatment option for MCL.
  Unusual Activation of Pro-survival Pathway (UAPP) Click to Show/Hide
Key Molecule: Caspase recruitment domain-containing protein 11 (CARD11) [3]
Resistant Disease Mantle cell lymphoma [ICD-11: 2A85.0]
 Disease Info 
Molecule Alteration Missense mutation
p.Y361C
 Molecule Info 
Experimental Note Identified from the Human Clinical Data
Cell Pathway Regulation BCR/NF-kB signaling pathway Activation hsa05200
In Vitro Model JVM2 cells Peripheral blood Homo sapiens (Human) CVCL_1319
Mino cells Peripheral blood Homo sapiens (Human) CVCL_UW35
Z138 cells Peripheral blood Homo sapiens (Human) CVCL_B077
Jeko-1 cells Blood Homo sapiens (Human) CVCL_1865
Granta-519 cells Blood Homo sapiens (Human) CVCL_1818
Rec-1 cells Lymph Homo sapiens (Human) CVCL_1884
In Vivo Model A retrospective survey in conducting clinical studies Homo sapiens
Experiment for
Molecule Alteration		 Whole-exome sequencing assay
Experiment for
Drug Resistance		 Drug inhibition assay
Mechanism Description Based on in vitro cell line-based experiments, overexpression of CARD11 mutants were demonstrated to confer resistance to the BCR inhibitor ibrutinib and NF-kB-inhibitor lenalidomide.
Key Molecule: Caspase recruitment domain-containing protein 11 (CARD11) [3]
Resistant Disease Mantle cell lymphoma [ICD-11: 2A85.0]
 Disease Info 
Molecule Alteration Missense mutation
p.G123S
 Molecule Info 
Experimental Note Identified from the Human Clinical Data
Cell Pathway Regulation BCR/NF-kB signaling pathway Activation hsa05200
In Vitro Model JVM2 cells Peripheral blood Homo sapiens (Human) CVCL_1319
Mino cells Peripheral blood Homo sapiens (Human) CVCL_UW35
Z138 cells Peripheral blood Homo sapiens (Human) CVCL_B077
Jeko-1 cells Blood Homo sapiens (Human) CVCL_1865
Granta-519 cells Blood Homo sapiens (Human) CVCL_1818
Rec-1 cells Lymph Homo sapiens (Human) CVCL_1884
In Vivo Model A retrospective survey in conducting clinical studies Homo sapiens
Experiment for
Molecule Alteration		 Whole-exome sequencing assay
Experiment for
Drug Resistance		 Drug inhibition assay
Mechanism Description Based on in vitro cell line-based experiments, overexpression of CARD11 mutants were demonstrated to confer resistance to the BCR inhibitor ibrutinib and NF-kB-inhibitor lenalidomide.
Key Molecule: Caspase recruitment domain-containing protein 11 (CARD11) [3]
Resistant Disease Mantle cell lymphoma [ICD-11: 2A85.0]
 Disease Info 
Molecule Alteration Missense mutation
p.D357E
 Molecule Info 
Experimental Note Identified from the Human Clinical Data
Cell Pathway Regulation BCR/NF-kB signaling pathway Activation hsa05200
In Vitro Model JVM2 cells Peripheral blood Homo sapiens (Human) CVCL_1319
Mino cells Peripheral blood Homo sapiens (Human) CVCL_UW35
Z138 cells Peripheral blood Homo sapiens (Human) CVCL_B077
Jeko-1 cells Blood Homo sapiens (Human) CVCL_1865
Granta-519 cells Blood Homo sapiens (Human) CVCL_1818
Rec-1 cells Lymph Homo sapiens (Human) CVCL_1884
In Vivo Model A retrospective survey in conducting clinical studies Homo sapiens
Experiment for
Molecule Alteration		 Whole-exome sequencing assay
Experiment for
Drug Resistance		 Drug inhibition assay
Mechanism Description Based on in vitro cell line-based experiments, overexpression of CARD11 mutants were demonstrated to confer resistance to the BCR inhibitor ibrutinib and NF-kB-inhibitor lenalidomide.
Key Molecule: Caspase recruitment domain-containing protein 11 (CARD11) [3]
Resistant Disease Mantle cell lymphoma [ICD-11: 2A85.0]
 Disease Info 
Molecule Alteration Missense mutation
p.D230N
 Molecule Info 
Experimental Note Identified from the Human Clinical Data
Cell Pathway Regulation BCR/NF-kB signaling pathway Activation hsa05200
In Vitro Model JVM2 cells Peripheral blood Homo sapiens (Human) CVCL_1319
Mino cells Peripheral blood Homo sapiens (Human) CVCL_UW35
Z138 cells Peripheral blood Homo sapiens (Human) CVCL_B077
Jeko-1 cells Blood Homo sapiens (Human) CVCL_1865
Granta-519 cells Blood Homo sapiens (Human) CVCL_1818
Rec-1 cells Lymph Homo sapiens (Human) CVCL_1884
In Vivo Model A retrospective survey in conducting clinical studies Homo sapiens
Experiment for
Molecule Alteration		 Whole-exome sequencing assay
Experiment for
Drug Resistance		 Drug inhibition assay
Mechanism Description Based on in vitro cell line-based experiments, overexpression of CARD11 mutants were demonstrated to confer resistance to the BCR inhibitor ibrutinib and NF-kB-inhibitor lenalidomide.
Key Molecule: Caspase recruitment domain-containing protein 11 (CARD11) [3]
Resistant Disease Mantle cell lymphoma [ICD-11: 2A85.0]
 Disease Info 
Molecule Alteration Expression
Up-regulation
 Molecule Info 
Experimental Note Identified from the Human Clinical Data
Cell Pathway Regulation BCR/NF-kB signaling pathway Activation hsa05200
In Vitro Model JVM2 cells Peripheral blood Homo sapiens (Human) CVCL_1319
Mino cells Peripheral blood Homo sapiens (Human) CVCL_UW35
Z138 cells Peripheral blood Homo sapiens (Human) CVCL_B077
Jeko-1 cells Blood Homo sapiens (Human) CVCL_1865
Granta-519 cells Blood Homo sapiens (Human) CVCL_1818
Rec-1 cells Lymph Homo sapiens (Human) CVCL_1884
In Vivo Model A retrospective survey in conducting clinical studies Homo sapiens
Experiment for
Molecule Alteration		 Western blot analysis
Experiment for
Drug Resistance		 Drug inhibition assay
Mechanism Description Based on in vitro cell line-based experiments, overexpression of CARD11 mutants were demonstrated to confer resistance to the BCR-inhibitor ibrutinib and NF-kB-inhibitor lenalidomide.
Key Molecule: CXC chemokine receptor type 4 (CXCR4) [12]
Resistant Disease Waldenstrom macroglobulinemia [ICD-11: 2A85.4]
 Disease Info 
Molecule Alteration Mutation
.
 Molecule Info 
Experimental Note Identified from the Human Clinical Data
Mechanism Description CXCR4 mutation led to ibrutinib in the waldenstrom macroglobulinemia.
Key Molecule: CXC chemokine receptor type 4 (CXCR4) [4]
Resistant Disease Waldenstrom macroglobulinemia [ICD-11: 2A85.4]
 Disease Info 
Molecule Alteration Mutation
p.S338X
 Molecule Info 
Experimental Note Identified from the Human Clinical Data
Cell Pathway Regulation Cell apoptosis Activation hsa04210
Mechanism Description CXCR4 is a transmembrance chemokine receptor that is internalized upon binding to its ligand CXCL12 and subsequently signals through G-proteins to activate the AKT and ERK pathways. The CXCR4 pathway plays an important role in lymphocyte migration and homing. CXCR4WHIM-like are prevalent somatic mutations, present in 30% of patients with WM. It was recently demonstrated that CXCR4S338X, the most common WHIM-like mutation, reduces CXCR4 receptor internalization and allows for sustained enzymatic activity of AKT and ERK and subsequent increased cell survival. When cells are exposed to ibrutinb, CXCR4S338X-carrying WM cells, compared to CXCR4WT cells, exhibit reduced apoptosis.
Drug Sensitivity Data Categorized by Their Corresponding Mechanisms
  Unusual Activation of Pro-survival Pathway (UAPP) Click to Show/Hide
Key Molecule: Myeloid differentiation primary response protein MyD88 (MYD88) [4]
Sensitive Disease Waldenstrom macroglobulinemia [ICD-11: 2A85.4]
 Disease Info 
Molecule Alteration Mutation
p.L265P
 Molecule Info 
Experimental Note Revealed Based on the Cell Line Data
Mechanism Description The mutant, as opposed to MYD88WT, preferentially binds to p-BTK and subsequently activates NFKB. Ibrutinib treatment reduces such binding, therefore blocking downstream NFKB activation. Thus, the oncogenic activity of MYD88L265P is mediated through BTK in WM and renders cells sensitive to ibrutinib's inhibition. The fact that MYD88 mutations function differently in different cells highlight the notion that impact of a particular genetic mutation has to be determined and understood within the particular cellular context.
Prostate cancer [ICD-11: 2C82]
Click to Show/Hide
Drug Sensitivity Data Categorized by Their Corresponding Mechanisms
  Epigenetic Alteration of DNA, RNA or Protein (EADR) Click to Show/Hide
Key Molecule: hsa-mir-214 [1]
Sensitive Disease Prostate cancer [ICD-11: 2C82.0]
 Disease Info 
Molecule Alteration Expression
Up-regulation
 Molecule Info 
Experimental Note Revealed Based on the Cell Line Data
Cell Pathway Regulation Cell apoptosis Activation hsa04210
Cell invasion Inhibition hsa05200
Cell migration Inhibition hsa04670
Cell proliferation Inhibition hsa05200
In Vitro Model DU-145 cells Prostate Homo sapiens (Human) CVCL_0105
LNCaP cells Prostate Homo sapiens (Human) CVCL_0395
PC3 cells Prostate Homo sapiens (Human) CVCL_0035
Experiment for
Molecule Alteration		 RT-qPCR
Experiment for
Drug Resistance		 MTT assay; Flow cytometry assay
Mechanism Description microRNA-214 targets PTk6 to inhibit tumorigenic potential and increase drug sensitivity of prostate cancer cells.
  Unusual Activation of Pro-survival Pathway (UAPP) Click to Show/Hide
Key Molecule: Protein-tyrosine kinase 6 (PTK6) [1]
Sensitive Disease Prostate cancer [ICD-11: 2C82.0]
 Disease Info 
Molecule Alteration Expression
Down-regulation
 Molecule Info 
Experimental Note Revealed Based on the Cell Line Data
Cell Pathway Regulation Cell apoptosis Activation hsa04210
Cell invasion Inhibition hsa05200
Cell migration Inhibition hsa04670
Cell proliferation Inhibition hsa05200
In Vitro Model DU-145 cells Prostate Homo sapiens (Human) CVCL_0105
LNCaP cells Prostate Homo sapiens (Human) CVCL_0395
PC3 cells Prostate Homo sapiens (Human) CVCL_0035
Experiment for
Molecule Alteration		 Western blot analysis
Experiment for
Drug Resistance		 MTT assay; Flow cytometry assay
Mechanism Description microRNA-214 targets PTk6 to inhibit tumorigenic potential and increase drug sensitivity of prostate cancer cells.
References
Ref 1 MicroRNA-214 targets PTK6 to inhibit tumorigenic potential and increase drug sensitivity of prostate cancer cells. Sci Rep. 2019 Jul 5;9(1):9776. doi: 10.1038/s41598-019-46170-3.
Ref 2 Clonal evolution leading to ibrutinib resistance in chronic lymphocytic leukemia. Blood. 2017 Mar 16;129(11):1469-1479. doi: 10.1182/blood-2016-06-719294. Epub 2017 Jan 3.
Ref 3 Genetic heterogeneity in primary and relapsed mantle cell lymphomas: Impact of recurrent CARD11 mutations. Oncotarget. 2016 Jun 21;7(25):38180-38190. doi: 10.18632/oncotarget.9500.
Ref 4 Mechanisms of ibrutinib resistance in chronic lymphocytic leukaemia and non-Hodgkin lymphoma .Br J Haematol. 2015 Aug;170(4):445-56. doi: 10.1111/bjh.13427. Epub 2015 Apr 9. 10.1111/bjh.13427
Ref 5 Long non-coding RNA profile in mantle cell lymphoma identifies a functional lncRNA ROR1-AS1 associated with EZH2/PRC2 complex. Oncotarget. 2017 May 17;8(46):80223-80234. doi: 10.18632/oncotarget.17956. eCollection 2017 Oct 6.
Ref 6 Pharmacologic Targeting of Mcl-1 Induces Mitochondrial Dysfunction and Apoptosis in B-Cell Lymphoma Cells in a TP53- and BAX-Dependent Manner. Clin Cancer Res. 2021 Sep 1;27(17):4910-4922.
Ref 7 FoxO1/Rictor axis induces a nongenetic adaptation to ibrutinib via Akt activation in chronic lymphocytic leukemia. J Clin Invest. 2024 Oct 22;134(23):e173770.
Ref 8 The Novel Anti-Cancer Agent, SpiD3, Is Cytotoxic in CLL Cells Resistant to Ibrutinib or Venetoclax. Hemato. 2024 Sep;5(3):321-339.
Ref 9 Ibrutinib resistance in mantle cell lymphoma: clinical, molecular and treatment aspects .Br J Haematol. 2018 May;181(3):306-319. doi: 10.1111/bjh.15108. Epub 2018 Jan 23. 10.1111/bjh.15108
Ref 10 EGR1-mediated metabolic reprogramming to oxidative phosphorylation contributes to ibrutinib resistance in B-cell lymphoma. Blood. 2023 Nov 30;142(22):1879-1894.
Ref 11 Targeting DNMT3A-mediated oxidative phosphorylation to overcome ibrutinib resistance in mantle cell lymphoma. Cell Rep Med. 2024 Apr 16;5(4):101484.
Ref 12 Genomics, Signaling, and Treatment of Waldenstr m Macroglobulinemia .J Clin Oncol. 2017 Mar 20;35(9):994-1001. doi: 10.1200/JCO.2016.71.0814. Epub 2017 Feb 13. 10.1200/JCO.2016.71.0814

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