The Synergistic Inhibitory Effect of Combining MK-2206 and AZD 6244 in MARIMO Cells Harboring a Calreticulin Gene Mutation

Introduction: Somatic mutations in the calreticulin (CALR) gene occur in most myeloproliferative neoplasm (MPN) patients who lack Janus kinase 2 or Thrombopoietin Receptor (MPL) mutations, but the molecular pathogenesis of MPN with mutated CALR is unclear, which limited the further treatment for CALR gene mutant patients.

Objectives: Previous studies showed that CALR mutations not only activated serine/threonine protein kinase (Akt) in primary mouse bone marrow cells but also mitogen-activated protein kinases (MAPKs) in MARIMO cells harboring a heterozygous 61-bp deletion in CALR exon 9, which were responsible for mutant CALR cell survival, respectively. Hence, we aimed to initially explore the mechanism of Akt activation and observe the synergistic inhibitory effect of combining Akt (MK-2206) and MAPK kinase (AZD 6244) inhibitors in MARIMO cells.

Methods: We detected the expression of phosphorylated Akt in MARIMO cells treated with inhibitors for 24 or 48 h by western blotting and analyzed cell proliferation, cell cycle, and Apoptosis by flow cytometry. We further examined the synergistic inhibitory effect of combining MK-2206 and AZD 6244 in MARIMO cells using the median effect principle of Chou and Talalay.

Results: We found that the Akt was activated in MARIMO cells, and blocking its activity significantly inhibited MARIMO cell growth with downregulation of cyclin D and E, and accelerated cell Apoptosis by decreasing Bcl-2 but increasing Bax and cleaved Caspase-3 levels in a dose-dependent manner. Further analysis showed that Akt activation was dependent on mammalian target of rapamycin but not on the JAK signaling pathway in MARIMO cells, displaying that inhibition of JAK activity by ruxolitinib (RUX) did not decrease the Akt phosphorylation. Furthermore, the combination of MK-2206 and AZD 6244 produced a significantly synergistic inhibitory effect on MARIMO cells.

Conclusions: Akt activation is a feature of MARIMO cells and co-targeting of Akt and MAPKs signaling pathways synergistically inhibits MARIMO cell growth.