Bruton's tyrosine kinase
Bruton's tyrosine kinase, also known as tyrosine-protein kinase BTK, is a tyrosine kinase that is encoded by the BTK gene in humans. BTK plays a crucial role in B cell development.
Structure
BTK contains five different protein interaction domains. These domains include an amino terminal pleckstrin homology domain, a proline-rich TEC homology domain, SRC homology domains SH2 and SH3, as well as a protein kinase domain with tyrosine phosphorylation activity.Part of the TH domain is folded against the PH domain while the rest is intrinsically disordered.
Function
BTK plays a crucial role in B cell development as it is required for transmitting signals from the pre-B cell receptor that forms after successful immunoglobulin heavy chain rearrangement. It also has a role in mast cell activation through the high-affinity IgE receptor.BTK contains a PH domain that binds phosphatidylinositol (3,4,5)-trisphosphate. PIP3 binding induces BTK to phosphorylate phospholipase C, which in turn hydrolyzes PIP2, a phosphatidylinositol, into two second messengers, inositol triphosphate and diacylglycerol, which then go on to modulate the activity of downstream proteins during B-cell signalling.
Clinical significance
Mutations in the BTK gene are implicated in the primary immunodeficiency disease X-linked agammaglobulinemia ; sometimes abbreviated to XLA and selective IgM deficiency. Patients with XLA have normal pre-B cell populations in their bone marrow but these cells fail to mature and enter the circulation. The BTK gene is located on the X chromosome. At least 400 mutations of the BTK gene have been identified. Of these, at least 212 are considered to be disease-causing mutations.BTK is important for the survival and proliferation of leukemic B cells, which motivated efforts to develop BTK inhibitors as treatments for B cell malignancies such as mantle cell lymphoma (MCL) and chronic lymphocytic leukemia (CLL). As BTK is also linked to autoimmune disorders, recent efforts have sought to evaluate BTK inhibition as a therapeutic strategy for treatment of diseases such as multiple sclerosis (MS) and rheumatoid arthritis (RA).
BTK inhibitors
Approved drugs that inhibit BTK:- Acalabrutinib, approved in October 2017 for relapsed mantle cell lymphoma and in October 2019 for Chronic lymphocytic leukemia and Small lymphocytic lymphoma
- Ibrutinib, a selective Bruton's tyrosine kinase inhibitor.
- Orelabrutinib, approved in China for patients with mantle cell lymphoma and chronic lymphocytic leukemia/small lymphocytic lymphoma, who have received at least one treatment in the past.
- Pirtobrutinib, a reversible inhibitor of BTK, for mantle cell lymphoma.
- Remibrutinib, for chronic spontaneous urticaria
- Rilzabrutinib approved for immune thrombocytopenia
- Tirabrutinib, approved in March 2020, in Japan, for the treatment of recurrent or refractory primary central nervous system lymphoma.
- Zanubrutinib for mantle cell lymphoma, chronic lymphocytic leukemia, or small lymphocytic lymphoma. It can be taken by mouth.
- Phase 3:
- * Evobrutinib for multiple sclerosis.
- * Fenebrutinib for multiple sclerosis.
- * Tolebrutinib, for multiple sclerosis.
- Phase 2:
- * ABBV-105 for systemic lupus erythematosus
- * Fenebrutinib for rheumatoid arthritis, systemic lupus erythematosus, multiple sclerosis and chronic spontaneous urticaria.
- Phase 1:
- * Elsubrutinib
- * Poseltinib, for autoimmune diseases, under development by Hanmi Pharmaceutical and Lilly as of 2015
- * Luxeptinib, for CLL, SLL, non-Hodgkin lymphoma, acute myeloid leukaemia, and myelodysplastic syndromes. The inhibitor targets multiple kinase pathways, including BTK and FLT3.
- * Nemtabrutinib
- * Spebrutinib
- * Tirabrutinib, for non-Hodgkin lymphoma and/or CLL. Renamed GS-4059 and now in trial NCT02457598.
- * Vecabrutinib
- * Branebrutinib
- * Catadegbrutinib
- * Bexobrutideg / Bexodegbrutinib
- * Sunvozertinib
- * Avitinib