@article { author = {Iqbal, Zafar and Absar, Muhammad and Mahmood, Amer and Aleem, Aamer and Iqbal, Mudassar and Jameel, Abid and Akhtar, Tanveer and Karim, Sajjad and Rasool, Mahmood and Mirza, Zeenat and Khalid, Muhammad and Akram, Afia and Sabar, Muhammad and Khalid, Ahmad and Aljarrah, Khalid and Iqbal, Janhangir and Khalid, Muhammad and Shah, Ijaz and Alanazi, Nawaf}, title = {Discovery and Protein Modeling Studies of Novel Compound Mutations Causing Resistance to Multiple Tyrosine Kinase Inhibitors in Chronic Myeloid Leukemia}, journal = {Asian Pacific Journal of Cancer Prevention}, volume = {21}, number = {12}, pages = {3517-3526}, year = {2020}, publisher = {West Asia Organization for Cancer Prevention (WAOCP), APOCP's West Asia Chapter.}, issn = {1513-7368}, eissn = {2476-762X}, doi = {10.31557/APJCP.2020.21.12.3517}, abstract = {Objective: BCR-ABL fusion oncogene is the hallmark of chronic myeloid leukemia (CML), causing genomic instability which leads to accumulation of mutations in BCR-ABL as well as other genes. BCR-ABL mutations are the cause of tyrosine kinase inhibitors (TKIs) resistance in CML. Recently, compound BCR-ABL mutations have been reported to resist all FDA approved TKIs. Therefore, finding novel compound BCR-ABL mutations can help and clinically manage CML. Therefore, our objective was to find out novel drug-resistant compound BCR-ABL mutations in CML and carry out their protein modelling studies. Methodology: Peripheral blood samples were collected from ten imatinib resistant CML patients receiving nilotinib treatment. BCR-ABL transcript mutations were investigated by employing capillary sequencing. Patient follow-up was carried out using European LeukemiaNet guidelines. Protein modelingĀ  studies were carried out for new compound mutations using PyMol to see the effects of mutations at structural level. Results: A novel compound mutation (K245N mutation along with G250W mutation) and previously known T351I utation was detected in two of the nilotinib resistance CML patients respectively while in the rest of 8 nilotinib responders, no resistant mutations were detected. Protein modelling studies indicated changes in BCR-ABL mutant protein which may have negatively impacted its binding with nilotinib leading to drug resistance. Conclusion: We report a novel nilotinib resistant BCR-ABL compound mutation (K245N along with G250W mutation) which impacts structural modification in BCR-ABL mutant protein leading to drug resistance. As compound mutations pose a new threat by causing resistance to all FDA approved tyrosine kinase inhibitors in BCR-ABL+ leukemias, our study opens a new direction for in vitro characterization of novel BCR-ABL compound mutations and their resistant to secondĀ  generation and third generation TKIs.}, keywords = {Nilotinib,BCR-ABL Mutation,Chronic myeloid leukemia,tyrosine kinase inhibitors}, url = {https://journal.waocp.org/article_89386.html}, eprint = {https://journal.waocp.org/article_89386_d77fec02bb6fa34f9a228b048dd34c04.pdf} }