Anti-Leukemic Effects of CK1α Degrader As Monotherapy and in Combination with Targeted Drugs

CK1⍺ is a member of casein kinase 1 (CK1) family, a multifunctional serine/threonine kinase conserved in eukaryotes from yeast to humans. Substrates of CK1⍺ include various proteins important in cancer and regulate multiple survival pathways such as p53, Wnt, autophagy and NF-B signaling pathways. In particular, CK1- serves as an upstream regulator of p53 pathway through regulation of MDM2 and MDMX and degradation of CK1- may prevent MDM2 and/or MDMX mediated inactivation of p53 function, thus facilitate cell death. We identified an early hit compound, distinct from known immunomodulatory imide drugs (IMiDs) such as lenalidomide or thalidomide. In order to identify compounds having distinct characteristic with previously published IMiDs, we designed multiple compounds with a wide range of glue effect based on the binding mode analysis and binding structure of CRBN and known IMiDs. Among them, PinA1 (early lead compound) selectively degraded CK1-, in the nanomolar range with the highest potency. PinA1 induced expression of p53 which led to apoptosis in AML cell lines with wild-type TP53 (MV4-11, MOLM-13, and MOLM-14), but not in TP53 mutated cells (KASUMI-1, and KG-1). Of note, in TP53 wild-type cells, expression of MDM2 and p21 increased as well, which may limit p53-induced apoptosis in these cells. PinA1 also induced CK1- degradation and p53-dependent apoptosis in primary AML cells in vitro. On the other hand, PinA1 had marginal effects on the viability of human peripheral blood mononuclear cells and CD34+ cells, with minimal activation of the p53 pathway at an efficacious dose range for MV4-11 compared to MDM2 inhibitors. PinA1 enhanced apoptosis in combination with FLT3, BCL-2, or MDM2 inhibitors in AML cell lines (MV4-11, MOLM-14) and primary AML cells in vitro. To test the efficacy of PinA1 in vivo, we injected MOLM-14/ luc/GFP or MV4-11/ luc/Thy1.1 into nonirradiated NGS mice. Five or Six days after cell injection, mice were randomized into 4 groups: vehicle, PinA1, and PinA1 plus AMG232 (MDM2 inhibitor), venetoclax, or gilteritinib. Bioluminescence imaging (BLI) demonstrated significantly less leukemia burden in all treated groups than vehicles; leukemia progression was lowest with combination therapy. Flow cytometry with sacrificed mice revealed the lowest leukemia burden in combination therapy, consistent with those from BLI. Western blotting with sorted leukemic cells from bone marrow and spleen revealed CK1- degradation in vivo. PinA1- and other single drug-treated mice had prolonged survival compared with vehicles, and combination therapy extended survival even further. Patient-derived xenograft models from two FLT3-ITD-mutated AML patients also showed potent anti-leukemic effects of PinA1 as monotherapy and in combination with gilteritinib. In conclusion, our study showed that PinA1 selectively degrades CK1α, enhancing expression of p53, which then induces apoptosis in TP53-wild-type AML cells, but not in TP53-mutated AML cells, thereby producing anti-leukemic effects as monotherapy or in combination with targeted therapies. The minimal effect of PinA1 on normal hematopoietic cells may positively contribute to safety in future clinical trials. This novel targeting approach may improve the current targeted therapies in combination once validated.