CrbnI391V is sufficient to confer in vivo sensitivity to thalidomide and its derivatives in mice

Thalidomide and its derivatives, lenalidomide and pomalidomide, are clinically effective treatments for multiple myeloma and myelodysplastic syndrome with del(5q). These molecules lack activity in murine models, limiting investigation of their therapeutic activity or toxicity in vivo. Here, we report the development of a mouse model that is sensitive to thalidomide derivatives because of a single amino acid change in the direct target of thalidomide derivatives, cereblon (Crbn). In human cells, thalidomide and its analogs bind CRBN and recruit protein targets to the CRL4(CRBN) E3 ubiquitin ligase, resulting in their ubiquitination and subsequent degradation by the proteasome. We show that mice with a single I391V amino acid change in Crbn exhibit thalidomide-induced degradation of drug targets previously identified in human cells, including Ikaros (Ikzf1), Aiolos (Ikzf3), Zfp91, and casein kinase 1a1 (Ck1 alpha), both in vitro and in vivo. We use the Crbn(I391V) model to demonstrate that the in vivo therapeutic activity of lenalidomide in del(5q) myelodysplastic syndrome can be explained by heterozygous expression of Ck1 alpha in del(5q) cells. We found that lenalidomide acts on hematopoietic stem cells with heterozygous expression of Ck1 alpha and inactivation of Trp53 causes lenalidomide resistance. We further demonstrate that Crbn(I391V) is sufficient to confer thalidomide-induced fetal loss in mice, capturing a major toxicity of this class of drugs. Further study of the Crbn(I391V) model will provide valuable insights into the in vivo efficacy and toxicity of this class of drugs.