Gamma Secretase Inhibitor: Therapeutic Target via NOTCH Signaling in T cell Acute Lymphoblastic Leukemia
Background: : T-cell acute lymphoblastic leukemia (T-ALL) is a disease which affects the bone marrow as well as lymphoblast which are expressed on T-cell immune phenotype. Diagnosis of T-ALL patients have shown that the disease presents large tumour burdens and leukemia cells in peripheral blood which often infiltrates into the central nervous system. Objective: Chemotherapy has been used as the main treatment method for this disease but with the recent research on molecular techniques, the studies have shown that NOTCH1 signalling could be a solution to this disease. NOTCH signalling undergoes non regulation in most T-ALL resulting to mutations in NOTCH1. Gamma-secretase (GS) plays a key role of blocking proteolytic activation of NOTCH receptors which could be a therapy for this kind of leukemia. This study thus aims at outlining the role of γ-secretase inhibitor via NOTCH signalling in T-ALL. Result and Conclusion: The role of GSI (γ-secretase inhibitor) in most T-ALL cell lines has been associate with pathway activity of NOTCH signalling. NOTCH1 mutation has however not served as a predictor of γ-secretase inhibitor sensitivity due to a number of factors including gene expression signature of NOTCH pathway activity which does not correlate. Despite the promise of this approach for NOTCH-1 activated T-ALL, not all patients with this condition would be expected to respond. Long-term therapeutic success in cancer is rarely achieved with monotherapy, and even targeting developmental pathways such as NOTCH will most likely require the development of combination regimens. Ultimately, the best use of these new therapeutic targeted agents, may become the next tools of ‘individualized medicine’.