Inhibition of antigen-dependent B-cell receptor (BCR) signaling is considered a promising therapeutic approach in CLL, but experimental in vivo evidence to support this view is still lacking. We have now investigated whether inhibition of BCR signaling with the selective Syk inhibitor fostamatinib disodium (R788) will affect the growth of the leukemias that develop in the Emu-TCL1 transgenic mouse model of CLL. Similar to human CLL these leukemias express stereotyped BCRs that react with autoantigens exposed on the surface of senescent or apoptotic cells, suggesting that they are antigen-driven. We show that R788 effectively inhibits BCR signaling in vivo, resulting in reduced proliferation and survival of the malignant B-cells and significantly prolonged survival of the treated animals. The growth-inhibitory effect of R788 occurs despite the relatively modest cytotoxic effect in vitro and is independent of basal Syk activity, suggesting that R788 functions primarily by inhibiting antigen-dependent BCR signals. Importantly, the effect of R788 was found to be selective for the malignant clones, as no disturbance in the production of normal B-lymphocytes was observed. Collectively, these data provide further rationale for clinical trials with R788 in CLL and establish the BCR signaling pathway as an important therapeutic target in this disease.
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