Impact of the clinically approved BTK inhibitors on the conformation of full-length BTK and analysis of the development of BTK resistance mutations in chronic lymphocytic leukemia

Inhibition of Bruton’s tyrosine kinase (BTK) has proven to be highly effective in the treatment of B-cell malignancies such as chronic lymphocytic leukemia (CLL), autoimmune disorders, and multiple sclerosis. Since the approval of the first BTK inhibitor (BTKi), Ibrutinib, several other inhibitors i...

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Main Authors: Raji E Joseph, Thomas E Wales, Sandrine Jayne, Robert G Britton, D Bruce Fulton, John R Engen, Martin JS Dyer, Amy H Andreotti
Format: Article
Language:English
Published: eLife Sciences Publications Ltd 2024-12-01
Series:eLife
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Online Access:https://elifesciences.org/articles/95488
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author Raji E Joseph
Thomas E Wales
Sandrine Jayne
Robert G Britton
D Bruce Fulton
John R Engen
Martin JS Dyer
Amy H Andreotti
author_facet Raji E Joseph
Thomas E Wales
Sandrine Jayne
Robert G Britton
D Bruce Fulton
John R Engen
Martin JS Dyer
Amy H Andreotti
author_sort Raji E Joseph
collection DOAJ
description Inhibition of Bruton’s tyrosine kinase (BTK) has proven to be highly effective in the treatment of B-cell malignancies such as chronic lymphocytic leukemia (CLL), autoimmune disorders, and multiple sclerosis. Since the approval of the first BTK inhibitor (BTKi), Ibrutinib, several other inhibitors including Acalabrutinib, Zanubrutinib, Tirabrutinib, and Pirtobrutinib have been clinically approved. All are covalent active site inhibitors, with the exception of the reversible active site inhibitor Pirtobrutinib. The large number of available inhibitors for the BTK target creates challenges in choosing the most appropriate BTKi for treatment. Side-by-side comparisons in CLL have shown that different inhibitors may differ in their treatment efficacy. Moreover, the nature of the resistance mutations that arise in patients appears to depend on the specific BTKi administered. We have previously shown that Ibrutinib binding to the kinase active site causes unanticipated long-range effects on the global conformation of BTK (Joseph et al., 2020). Here, we show that binding of each of the five approved BTKi to the kinase active site brings about distinct allosteric changes that alter the conformational equilibrium of full-length BTK. Additionally, we provide an explanation for the resistance mutation bias observed in CLL patients treated with different BTKi and characterize the mechanism of action of two common resistance mutations: BTK T474I and L528W.
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spelling doaj-art-b43d2810ccd043c893cfe4b4c67af1d12025-08-20T02:57:28ZengeLife Sciences Publications LtdeLife2050-084X2024-12-011310.7554/eLife.95488Impact of the clinically approved BTK inhibitors on the conformation of full-length BTK and analysis of the development of BTK resistance mutations in chronic lymphocytic leukemiaRaji E Joseph0https://orcid.org/0009-0000-7122-8553Thomas E Wales1https://orcid.org/0000-0001-6133-5689Sandrine Jayne2https://orcid.org/0000-0003-1870-9782Robert G Britton3D Bruce Fulton4John R Engen5https://orcid.org/0000-0002-6918-9476Martin JS Dyer6https://orcid.org/0000-0002-5033-2236Amy H Andreotti7https://orcid.org/0000-0002-6952-7244Roy J. Carver Department of Biochemistry, Biophysics and Molecular Biology, Iowa State University, Ames, United StatesDepartment of Chemistry and Chemical Biology, Northeastern University, Boston, United StatesThe Ernest and Helen Scott Haematological Research Institute, Leicester Cancer Research Centre, College of Life Sciences, University of Leicester, Leicester, United KingdomThe Ernest and Helen Scott Haematological Research Institute, Leicester Cancer Research Centre, College of Life Sciences, University of Leicester, Leicester, United KingdomRoy J. Carver Department of Biochemistry, Biophysics and Molecular Biology, Iowa State University, Ames, United StatesDepartment of Chemistry and Chemical Biology, Northeastern University, Boston, United StatesThe Ernest and Helen Scott Haematological Research Institute, Leicester Cancer Research Centre, College of Life Sciences, University of Leicester, Leicester, United KingdomRoy J. Carver Department of Biochemistry, Biophysics and Molecular Biology, Iowa State University, Ames, United StatesInhibition of Bruton’s tyrosine kinase (BTK) has proven to be highly effective in the treatment of B-cell malignancies such as chronic lymphocytic leukemia (CLL), autoimmune disorders, and multiple sclerosis. Since the approval of the first BTK inhibitor (BTKi), Ibrutinib, several other inhibitors including Acalabrutinib, Zanubrutinib, Tirabrutinib, and Pirtobrutinib have been clinically approved. All are covalent active site inhibitors, with the exception of the reversible active site inhibitor Pirtobrutinib. The large number of available inhibitors for the BTK target creates challenges in choosing the most appropriate BTKi for treatment. Side-by-side comparisons in CLL have shown that different inhibitors may differ in their treatment efficacy. Moreover, the nature of the resistance mutations that arise in patients appears to depend on the specific BTKi administered. We have previously shown that Ibrutinib binding to the kinase active site causes unanticipated long-range effects on the global conformation of BTK (Joseph et al., 2020). Here, we show that binding of each of the five approved BTKi to the kinase active site brings about distinct allosteric changes that alter the conformational equilibrium of full-length BTK. Additionally, we provide an explanation for the resistance mutation bias observed in CLL patients treated with different BTKi and characterize the mechanism of action of two common resistance mutations: BTK T474I and L528W.https://elifesciences.org/articles/95488kinase inhibitorallosteryresistance mutationsBTKBruton’s tyrosine kinase CLL
spellingShingle Raji E Joseph
Thomas E Wales
Sandrine Jayne
Robert G Britton
D Bruce Fulton
John R Engen
Martin JS Dyer
Amy H Andreotti
Impact of the clinically approved BTK inhibitors on the conformation of full-length BTK and analysis of the development of BTK resistance mutations in chronic lymphocytic leukemia
eLife
kinase inhibitor
allostery
resistance mutations
BTK
Bruton’s tyrosine kinase
CLL
title Impact of the clinically approved BTK inhibitors on the conformation of full-length BTK and analysis of the development of BTK resistance mutations in chronic lymphocytic leukemia
title_full Impact of the clinically approved BTK inhibitors on the conformation of full-length BTK and analysis of the development of BTK resistance mutations in chronic lymphocytic leukemia
title_fullStr Impact of the clinically approved BTK inhibitors on the conformation of full-length BTK and analysis of the development of BTK resistance mutations in chronic lymphocytic leukemia
title_full_unstemmed Impact of the clinically approved BTK inhibitors on the conformation of full-length BTK and analysis of the development of BTK resistance mutations in chronic lymphocytic leukemia
title_short Impact of the clinically approved BTK inhibitors on the conformation of full-length BTK and analysis of the development of BTK resistance mutations in chronic lymphocytic leukemia
title_sort impact of the clinically approved btk inhibitors on the conformation of full length btk and analysis of the development of btk resistance mutations in chronic lymphocytic leukemia
topic kinase inhibitor
allostery
resistance mutations
BTK
Bruton’s tyrosine kinase
CLL
url https://elifesciences.org/articles/95488
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