IRS2 silencing increases apoptosis and potentiates the effects of ruxolitinib in JAK2^V617F-positive myeloproliferative neoplasms

The recurrent V617F mutation in JAK2 (JAK2^V617F) has emerged as the primary contributor to the pathogenesis of myeloproliferative neoplasms (MPN). However, the lack of complete response in most patients treated with the JAK1/2 inhibitor, ruxolitinib, indicates the need for identifying pathways that cooperate with JAK2. Activated JAK2 was found to be associated with the insulin receptor substrate 2 (IRS2) in non-hematological cells. We identified JAK2/IRS2 binding in JAK2^V617F HEL cells, but not in the JAK2WT U937 cell line. In HEL cells, IRS2 silencing decreased STAT5 phosphorylation, reduced cell viability and increased apoptosis; these effects were enhanced when IRS2 silencing was combined with ruxolitinib. In U937 cells, IRS2 silencing neither reduced cell viability nor induced apoptosis. IRS1/2 pharmacological inhibition in primary MPN samples reduced cell viability in JAK2^V617F-positive but not JAK2^WT specimens; combination with ruxolitinib had additive effects. IRS2 expression was significantly higher in CD34⁺ cells from essential thrombocythemia patients compared to healthy donors, and in JAK2^V617F MPN patients when compared to JAK2WT. Our data indicate that IRS2 is a binding partner of JAK2^V617F in MPN. IRS2 contributes to increased cell viability and reduced apoptosis in JAK2-mutated cells. Combined pharmacological inhibition of IRS2 and JAK2 may have a potential clinical application in MPN.