A majority of B-cell lymphomas arise from germinal center (GC) B-cells including diffuse large B-cell lymphomas (DLBCL) and follicular lymphomas (FL). GCs are transient structures that form in response to T- cell dependent antigen exposure within which B-cells undergo proliferation and somatic hypermutation. We find that the H3K27 histone methyltransferase EZH2 is required for normal B-cells to form GCs. EZH2 plays a dual role in GC B-cells by suppressing proliferation checkpoint genes and genes required for B-cells to exit the GC reaction. EZH2 is widely expressed in DLBCL and FL, but a subset of these tumors acquire EZH2 point mutations which enable this enzyme to more efficiently trimethylate H3K27. Mutant EZH2 induces greater promoter H3K27me3 and more profound silencing of EZH2 targets, resulting in sustained proliferation and differentiation blockade. Therapeutic targeting of EZH2 is now possible thanks to the development of specific small molecule inhibitors. These drugs suppress DLBCL and FL cell lines with both mutant and WT EZH2, suggesting that EZH2 dependence may reflect a GC lineage role of EZH2. However, response to EZH2 inhibitors occurs slowly, likely reflecting the kinetics of reversal of epigenetic silencin. We hypothesize that EZH2 targeted therapy will be effective against DLBCL and FL with specific genetic and epigenetic features. We predict that resistance to these agents may occur due to their slow response kinetics. We hypothesize that EZH2 inhibitors will synergize with standard and experimental anti-lymphoma agents targeting complementary genetically and epigenetically defined pathways, but require rationale studies to achieve optimal combinatorial potency. Hence our proposal will explore the genetic and epigenetic determinants linked to EZH2 dependency in DLBCL and FL patients, will identify mechanisms through which acquired resistance might develop to EZH2 inhibitors, and the optimal manner in which these drugs could be combined with other anti-lymphoma drugs. Finally we will perform state of the art correlative studies in the context of the first in man clinical trial of a potent EZH2 inhibitor for DLBCL patients to validate the pharmacodynamics and tumor background of lymphomas susceptible of EZH2 inhibitors in humans.
Human GC derived lymphomas are largely biological dependent on the EZH2 polycomb protein. Our proposal will take advantage of this finding to translate a novel form of epigenetic targeted therapy to the clinical targeting EZH2 and its effects on chromatin including silencing of bivalent promoters linked to B-cell proliferation and differentiation.