Exploiting macropinocytosis for therapeutic intervention in RAS mutant Multiple Myeloma

Roughly 50% of newly diagnosed multiple myeloma (MM) cases harbor KRAS (25%) or NRAS (24%) mutations with an even greater frequency of these mutations observed at relapse. By and large, mutant RAS-driven MM is more resistant to existing therapies including proteasome inhibitors, immunomodulator drugs (IMiDs), and monoclonal anti-CD38 antibodies. In the present study, we demonstrate that mutant RAS-dependent macropinocytosis (MP) can be leveraged for selective delivery of a monobody-drug conjugate (MDC) to mutant RAS MM cells. This MDC delivery platform consists of monobody, a fragment of human fibronectin (FN), used as the carrier to which monomethyl auristatin E (MMAE) is site-specifically conjugated (FN-MMAE). In comparison to standard of care (SoC) therapeutics, FN-MMAE displays a substantially improved anti-tumor effect in vitro and in vivo when administered alone or in combination with SoC treatments. Furthermore, the in vivo safety profile of FN-MMAE is tolerable affording increased drug dosing compared to clinically used ADCs. This MDC platform offers a way of selectively targeting mutant RAS MM and RRMM to potentially improve patient outcomes. Statement of SignificanceRas mutations are present in approximately 50% of MM patients and are associated with poor prognosis and drug resistance. Herein, we describe a novel protein-drug conjugate designed to target selectively mutant RAS harboring MM cells. Our findings uncover a new therapeutic modality for improving the outcomes for patients with mutant Ras MM.