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Review Article Open Access
Volume 4 | Issue 1 | DOI: https://doi.org/10.33696/Signaling.4.085

Augmenting Venetoclax Activity Through Signal Transduction in AML

  • 1Virginia Commonwealth University Massey Cancer Center, Division of Hematology and Oncology, Department of Internal Medicine, 1300 E. Marshall St., Richmond, VA, USA
  • #Both authors contributed equally
+ Affiliations - Affiliations

Corresponding Author

Ian Michael Bouligny, Ian.Bouligny@vcuhealth.org

Received Date: December 10, 2022

Accepted Date: January 06, 2023

Abstract

Venetoclax, a small-molecule B-cell lymphoma 2 (BCL-2) inhibitor, selectively eradicates leukemic stem cells (LSCs). While venetoclax has revolutionized the treatment of acute myeloid leukemia (AML), treatment failure and disease relapse are common. Mechanisms underlying venetoclax resistance are surprisingly heterogeneous. Venetoclax resistance encompasses a spectrum of genetic and epigenetic changes, with numerous pathways contributing to the upregulation of additional anti-apoptotic proteins. In this review, we address the mechanisms of venetoclax resistance in the context of signal transduction. We emphasize how aberrant cell signaling impairs apoptosis and predisposes to venetoclax failure.

Commonly activated pathways, such as FLT3, PI3K/AKT/mTOR, and RAS, contribute to upregulated anti-apoptotic mediators and are frequently responsible for refractory disease or disease relapse. We highlight novel combination strategies aimed at disabling constitutively active signal transduction to augment response and overcome venetoclax resistance.

Keywords

Acute myeloid leukemia, Akt pathway, Apoptotic pathways, B-cell lymphoma 2, FMS-like tyrosine kinase 3, Isocitrate dehydrogenase 1, Isocitrate dehydrogenase 2, MAPK pathway cell signaling, Signal transduction cascades

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