作者
Marta Larráyoz,María J. García‐Barchino,Jon Celay,Amaia Etxebeste,Maddalen Jiménez,Cristina Pérez,Raquel Ordóñez,César Cobaleda,Cirino Botta,Vicente Fresquet,Sergio Roa,Ibai Goicoechea,Catarina Maia,Miren Lasaga,Marta Chesi,P. Leif Bergsagel,María José Larráyoz,Marı́a José Calasanz,Elena Campos-Sánchez,Jorge Martínez-Cano,Carlos Panizo,Paula Rodríguez‐Otero,Silvestre Vicent,Giovanna Roncador,Patricia González,Satoru Takahashi,Samuel G. Katz,Loren D. Walensky,Shannon M. Ruppert,Elisabeth A. Lasater,Maria Amann,Teresa Lozano,Diana Llópiz,Pablo Sarobe,Juan José Lasarte,Núria Planell,David Gómez-Cabrero,Olga Kudryashova,Anna Kurilovich,María V. Revuelta,Leandro Cerchietti,Xabier Agirre,Jesús F. San Miguel,Bruno Paiva,Felipe Prósper,José A. Martínez-Climent
摘要
Abstract The historical lack of preclinical models reflecting the genetic heterogeneity of multiple myeloma (MM) hampers the advance of therapeutic discoveries. To circumvent this limitation, we screened mice engineered to carry eight MM lesions (NF-κB, KRAS, MYC, TP53, BCL2, cyclin D1, MMSET/NSD2 and c-MAF) combinatorially activated in B lymphocytes following T cell-driven immunization. Fifteen genetically diverse models developed bone marrow (BM) tumors fulfilling MM pathogenesis. Integrative analyses of ∼500 mice and ∼1,000 patients revealed a common MAPK–MYC genetic pathway that accelerated time to progression from precursor states across genetically heterogeneous MM. MYC-dependent time to progression conditioned immune evasion mechanisms that remodeled the BM microenvironment differently. Rapid MYC-driven progressors exhibited a high number of activated/exhausted CD8 + T cells with reduced immunosuppressive regulatory T (T reg ) cells, while late MYC acquisition in slow progressors was associated with lower CD8 + T cell infiltration and more abundant T reg cells. Single-cell transcriptomics and functional assays defined a high ratio of CD8 + T cells versus T reg cells as a predictor of response to immune checkpoint blockade (ICB). In clinical series, high CD8 + T/T reg cell ratios underlie early progression in untreated smoldering MM, and correlated with early relapse in newly diagnosed patients with MM under Len/Dex therapy. In ICB-refractory MM models, increasing CD8 + T cell cytotoxicity or depleting T reg cells reversed immunotherapy resistance and yielded prolonged MM control. Our experimental models enable the correlation of MM genetic and immunological traits with preclinical therapy responses, which may inform the next-generation immunotherapy trials.