bims-tremyl Biomed News
on Therapy resistance biology in myeloid leukemia
Issue of 2021‒11‒14
twenty-one papers selected by
Paolo Gallipoli
Barts Cancer Institute, Queen Mary University of London
  1. Momelotinib is a highly potent inhibitor of FLT3-mutant AML.
  2. Enasidenib-induced differentiation promotes sensitivity to venetoclax in IDH2-mutated acute myeloid leukemia.
  3. MYC overexpression is associated with an early disease progression from MDS to AML.
  4. Targeting CD38 in acute myeloid leukemia interferes with leukemia trafficking and induces phagocytosis.
  5. Identification of a highly efficient dual type I/II FMS-like tyrosine kinase inhibitor that disrupts the growth of leukemic cells.
  6. Oral Azacitidine (CC-486) for the Treatment of Myeloid Malignancies.
  7. The IL-3, IL-5, and GM-CSF common receptor beta chain mediates oncogenic activity of FLT3-ITD-positive AML.
  8. Acute myeloid leukemia maturation lineage influences residual disease and relapse following differentiation therapy.
  9. Demethylating therapy increases anti-CD123 CAR T cell cytotoxicity against acute myeloid leukemia.
  10. Discovery of putative tumor suppressors from CRISPR screens reveals rewired lipid metabolism in acute myeloid leukemia cells.
  11. TET2 mutations as a part of DNA dioxygenase deficiency in myelodysplastic syndromes.
  12. The GPI-anchored protein CD109 protects hematopoietic progenitor cells from undergoing erythroid differentiation induced by TGF-β.
  13. TCP1 increases drug resistance in acute myeloid leukemia by suppressing autophagy via activating AKT/mTOR signaling.
  14. Neutrophil and platelet increases with luspatercept in lower-risk MDS: secondary endpoints from the MEDALIST trial.
  15. Cotargeting of Bcl-2 and Mcl-1 Shows Promising Antileukemic Activity against AML Cells Including those with Acquired Cytarabine Resistance.
  16. Diverse alterations associated with resistance to KRAS(G12C) inhibition.
  17. Coping Strategies in Patients with Acute Myeloid Leukemia.
  18. The Similarity of Class II HLA Genotypes Defines Patterns of Autoreactivity in Idiopathic Bone Marrow Failure Disorders.
  19. Germline GATA1s generating mutations predispose to leukemia with acquired trisomy 21 and Down syndrome-like phenotype.
  20. Mutation in Abl kinase with altered drug-binding kinetics indicates a novel mechanism of imatinib resistance.
  21. Dietary palmitic acid promotes a prometastatic memory via Schwann cells.
  1. Blood Adv. 2021 Nov 12. pii: bloodadvances.2021004611. [Epub ahead of print]
    Momelotinib is a highly potent inhibitor of FLT3-mutant AML.
    Mohammad Azhar, Zachary Kincaid, Meenu Kesarwani, Arhama Ahmed, Mark Wunderlich, Tahir Latif, Daniel Starczynowski, Mohammad Azam.
      Kinase activating mutation in FLT3 is the most frequent genetic lesion associated with poor prognosis in acute myeloid leukemia (AML). Therapeutic response to FLT3 tyrosine kinase inhibitor (TKI) therapy is dismal, and many patients relapse even after allogenic stem cell transplantation. Despite the introduction of more selective FLT3 inhibitors, remissions are short-lived, and patients show progressive disease after an initial response. Acquisition of resistance-conferring genetic mutations and growth factor signaling are two principal mechanisms that drive relapse. FLT3 inhibitors targeting both escape mechanisms could lead to a more profound and lasting clinical responses. Here we show that the JAK2 inhibitor, momelotinib, is an equipotent type-1 FLT3 inhibitor. Momelotinib showed potent inhibitory activity on both mouse and human cells expressing FLT3-ITD, including clinically relevant resistant mutations within the activation loop at residues, D835, D839, and Y842. Additionally, momelotinib efficiently suppressed the resistance mediated by FLT3 ligand (FL) and hematopoietic cytokine activated JAK2 signaling. Interestingly, unlike gilteritinib, momelotinib inhibits the expression of MYC in leukemic cells. Consequently, concomitant inhibition of FLT3 and downregulation of MYC by momelotinib treatment showed better efficacy in suppressing the leukemia in a preclinical murine model of AML. Altogether, these data provide evidence that momelotinib is an effective type-1 dual JAK2/FLT3 inhibitor and may offer an alternative to gilteritinib. Its ability to impede the resistance conferred by growth factor signaling and activation loop mutants suggests that momelotinib treatment could provide a deeper and durable response; thus, warrants its clinical evaluation.
    DOI:  https://doi.org/10.1182/bloodadvances.2021004611
  2. Leukemia. 2021 Nov 06.
    Enasidenib-induced differentiation promotes sensitivity to venetoclax in IDH2-mutated acute myeloid leukemia.
    Severine Cathelin, David Sharon, Amit Subedi, Dan Cojocari, Darren C Phillips, Joel D Leverson, Kyle J MacBeth, Brandon Nicolay, Rohini Narayanaswamy, Sebastien Ronseaux, Guowen Liu, Steven M Chan.
      
    DOI:  https://doi.org/10.1038/s41375-021-01468-y
  3. Leuk Res. 2021 Oct 21. pii: S0145-2126(21)01734-3. [Epub ahead of print]111 106733
    MYC overexpression is associated with an early disease progression from MDS to AML.
    David Gajzer, Constantine N Logothetis, David A Sallman, Gregoire Calon, Abida Babu, Onyee Chan, Nicole D Vincelette, Virginia O Volpe, Najla H Al Ali, Pukhraz Basra, Chetasi Talati, Andrew T Kuykendall, Qianxing Mo, Eric Padron, Kendra Sweet, Rami S Komrokji, Jeffrey E Lancet, Seongseok Yun, Ling Zhang.
      Recent studies demonstrated that MYC epigenetically regulates AML cell survival and differentiation by suppressing IDH1/2-TET2-5hmC signaling and that MYC overexpression is associated with poor survival outcomes in multiple AML patient cohorts. However, the oncogenic roles of MYC in MDS remain to be explored. A total of 41 patients with de novo MDS were retrospectively identified using the Total Cancer Care database at the Moffitt Cancer Center. A total of 61 % of patients had low MYC expression and 39 % of patients had high MYC expression defined as MYC reactivity by immunohistochemical staining in ≥5% of bone marrow (BM) cells at the time of MDS diagnosis. The median MDS-to-AML progression free survival (PFS) was significantly shorter in the high MYC group (median PFS 9.3 vs. 17.7 months, HR = 2.328, p = 0.013). Further, overall survival (OS) was also shorter in the high MYC patients (median OS 19.7 vs. 51.7 months, HR = 2.299, p = 0.053). Multivariate analyses demonstrated that high MYC expression is an independent poor prognostic factor for the MDS-to-AML progression (HR = 2.275, p = 0.046). Our observations indicate that MYC may play a crucial role in MDS transformation to AML and the underlying mechanisms of MYC-driven MDS clonal expansion and leukemic transformation require further investigation.
    Keywords:  AML; MDS; MYC
    DOI:  https://doi.org/10.1016/j.leukres.2021.106733
  4. Sci Rep. 2021 Nov 11. 11(1): 22062
    Targeting CD38 in acute myeloid leukemia interferes with leukemia trafficking and induces phagocytosis.
    Meike Farber, Yiyang Chen, Lucas Arnold, Michael Möllmann, Eva Boog-Whiteside, Yu-An Lin, H Christian Reinhardt, Ulrich Dührsen, Maher Hanoun.
      Targeting the interaction between leukemic cells and the microenvironment is an appealing approach to enhance the therapeutic efficacy in acute myeloid leukemia (AML). AML infiltration induces a significant release of inflammatory cytokines in the human bone marrow niche which accelerates leukemogenesis. As the transmembrane glycoprotein CD38 has been shown to regulate cytokine release, we assessed the anti-leukemic potential of CD38 inhibition in AML. CD38 expression in AML cells proved to depend on microenvironmental cues and could be significantly enforced through addition of tretinoin. In fact, the anti-CD38 antibody daratumumab showed significant cytostatic efficacy in a 3D in vitro triple-culture model of AML, but with modest cell-autonomous cytotoxic activity and independent of CD38 expression level. In line with a predominantly microenvironment-mediated activity of daratumumab in AML, CD38 inhibition significantly induced antibody-dependent phagocytosis and showed interference with AML cell trafficking in vivo in a xenograft transplantation model, but overall lacked robust anti-leukemic effects.
    DOI:  https://doi.org/10.1038/s41598-021-01300-8
  5. Cell Chem Biol. 2021 Nov 09. pii: S2451-9456(21)00475-X. [Epub ahead of print]
    Identification of a highly efficient dual type I/II FMS-like tyrosine kinase inhibitor that disrupts the growth of leukemic cells.
    Mandy Beyer, Sven J Henninger, Patricia S Haehnel, Al-Hassan M Mustafa, Ece Gurdal, Bastian Schubert, Markus Christmann, Andreas Sellmer, Siavosh Mahboobi, Sebastian Drube, Wolfgang Sippl, Thomas Kindler, Oliver H Krämer.
      Internal tandem duplications (ITDs) in the FMS-like tyrosine kinase-3 (FLT3) are causally linked to acute myeloid leukemia (AML) with poor prognosis. Available FLT3 inhibitors (FLT3i) preferentially target inactive or active conformations of FLT3. Moreover, they co-target kinases for normal hematopoiesis, are vulnerable to therapy-associated tyrosine kinase domain (TKD) FLT3 mutants, or lack low nanomolar activity. We show that the tyrosine kinase inhibitor marbotinib suppresses the phosphorylation of FLT3-ITD and the growth of permanent and primary AML cells with FLT3-ITD. This also applies to leukemic cells carrying FLT3-ITD/TKD mutants that confer resistance to clinically used FLT3i. Marbotinib shows high selectivity for FLT3 and alters signaling, reminiscent of genetic elimination of FLT3-ITD. Molecular docking shows that marbotinib fits in opposite orientations into inactive and active conformations of FLT3. The water-soluble marbotinib-carbamate significantly prolongs survival of mice with FLT3-driven leukemia. Marbotinib is a nanomolar next-generation FLT3i that represents a hybrid inhibitory principle.
    Keywords:  Acute myeloid leukemia; FLT3-ITD; FLT3-TKD; FMS-like tyrosine kinase-3; TKi; molecular modeling; next generation tyrosine kinase inhibitor; p27; therapy resistance; tyrosine kinase domain
    DOI:  https://doi.org/10.1016/j.chembiol.2021.10.011
  6. Clin Lymphoma Myeloma Leuk. 2021 Oct 08. pii: S2152-2650(21)02070-X. [Epub ahead of print]
    Oral Azacitidine (CC-486) for the Treatment of Myeloid Malignancies.
    Guillermo Garcia-Manero, Hartmut Döhner, Andrew H Wei, Ignazia La Torre, Barry Skikne, C L Beach, Valeria Santini.
      Epigenetic dysregulation leads to aberrant DNA hypermethylation and is common in acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS). A large number of clinical trials in AML, MDS, and other hematologic malignancies have assessed hypomethylating agents (HMAs), used alone or in combination with other drugs, in the frontline, maintenance, relapsed/refractory, and peritransplant settings. Effective maintenance therapy has long been a goal for patients with AML in remission. Previous large, randomized clinical trials of maintenance with HMAs or other agents had not shown meaningful improvement in overall survival. Oral azacitidine (Oral-AZA [CC-486]) is approved in the United States, Canada, and European Union for treatment of adult patients with AML in first complete remission (CR) or CR with incomplete blood count recovery (CRi) following intensive induction chemotherapy who are ineligible for hematopoietic cell transplant. Regulatory approvals of Oral-AZA were based on outcomes from the randomized, phase III QUAZAR AML-001 trial, which showed a median overall survival advantage of 9.9 months with Oral-AZA versus placebo. Oral-AZA allows convenient extended AZA dosing for 14 days per 28-day treatment cycle, which is not feasible with injectable AZA. Focusing on AML and MDS, this report reviews the rationale for the use of orally bioavailable AZA and its potential use in all-oral combination therapy regimens; the unique pharmacokinetic and pharmacodynamic profile of Oral-AZA compared with injectable AZA; the clinical safety and efficacy of Oral-AZA maintenance therapy in patients with AML in first remission and for treatment of patients with active MDS; and ongoing Oral-AZA clinical trials.
    Keywords:  AML; Hypomethylating agent; MDS; acute myeloid leukemia; maintenance
    DOI:  https://doi.org/10.1016/j.clml.2021.09.021
  7. Leukemia. 2021 Nov 08.
    The IL-3, IL-5, and GM-CSF common receptor beta chain mediates oncogenic activity of FLT3-ITD-positive AML.
    Anne Charlet, Max Kappenstein, Philip Keye, Kathrin Kläsener, Cornelia Endres, Teresa Poggio, Sivahari P Gorantla, Stefanie Kreutmair, Jana Sänger, Anna L Illert, Cornelius Miething, Michael Reth, Justus Duyster, Christoph Rummelt, Nikolas von Bubnoff.
      FLT3-ITD is the most predominant mutation in AML being expressed in about one-third of AML patients and is associated with a poor prognosis. Efforts to better understand FLT3-ITD downstream signaling to possibly improve therapy response are needed. We have previously described FLT3-ITD-dependent phosphorylation of CSF2RB, the common receptor beta chain of IL-3, IL-5, and GM-CSF, and therefore examined its significance for FLT3-ITD-dependent oncogenic signaling and transformation. We discovered that FLT3-ITD directly binds to CSF2RB in AML cell lines and blasts isolated from AML patients. A knockdown of CSF2RB in FLT3-ITD positive AML cell lines as well as in a xenograft model decreased STAT5 phosphorylation, attenuated cell proliferation, and sensitized to FLT3 inhibition. Bone marrow from CSF2RB-deficient mice transfected with FLT3-ITD displayed decreased colony formation capacity and delayed disease onset together with increased survival upon transplantation into lethally irradiated mice. FLT3-ITD-dependent CSF2RB phosphorylation required phosphorylation of the FLT3 juxtamembrane domain at tyrosines 589 or 591, whereas the ITD insertion site and sequence were of no relevance. Our results demonstrate that CSF2RB participates in FLT3-ITD-dependent oncogenic signaling and transformation in vitro and in vivo. Thus, CSF2RB constitutes a rational treatment target in FLT3-ITD-positive AML.
    DOI:  https://doi.org/10.1038/s41375-021-01462-4
  8. Nat Commun. 2021 Nov 11. 12(1): 6546
    Acute myeloid leukemia maturation lineage influences residual disease and relapse following differentiation therapy.
    Steven Ngo, Ethan P Oxley, Margherita Ghisi, Maximilian M Garwood, Mark D McKenzie, Helen L Mitchell, Peter Kanellakis, Olivia Susanto, Michael J Hickey, Andrew C Perkins, Benjamin T Kile, Ross A Dickins.
      Acute myeloid leukemia (AML) is a malignancy of immature progenitor cells. AML differentiation therapies trigger leukemia maturation and can induce remission, but relapse is prevalent and its cellular origin is unclear. Here we describe high resolution analysis of differentiation therapy response and relapse in a mouse AML model. Triggering leukemia differentiation in this model invariably produces two phenotypically distinct mature myeloid lineages in vivo. Leukemia-derived neutrophils dominate the initial wave of leukemia differentiation but clear rapidly and do not contribute to residual disease. In contrast, a therapy-induced population of mature AML-derived eosinophil-like cells persists during remission, often in extramedullary organs. Using genetic approaches we show that restricting therapy-induced leukemia maturation to the short-lived neutrophil lineage markedly reduces relapse rates and can yield cure. These results indicate that relapse can originate from therapy-resistant mature AML cells, and suggest differentiation therapy combined with targeted eradication of mature leukemia-derived lineages may improve disease outcome.
    DOI:  https://doi.org/10.1038/s41467-021-26849-w
  9. Nat Commun. 2021 Nov 08. 12(1): 6436
    Demethylating therapy increases anti-CD123 CAR T cell cytotoxicity against acute myeloid leukemia.
    Nadia El Khawanky, Amy Hughes, Wenbo Yu, Renier Myburgh, Tony Matschulla, Sanaz Taromi, Konrad Aumann, Jade Clarson, Janaki Manoja Vinnakota, Khalid Shoumariyeh, Cornelius Miething, Angel F Lopez, Michael P Brown, Justus Duyster, Lutz Hein, Markus G Manz, Timothy P Hughes, Deborah L White, Agnes S M Yong, Robert Zeiser.
      Successful treatment of acute myeloid leukemia (AML) with chimeric antigen receptor (CAR) T cells is hampered by toxicity on normal hematopoietic progenitor cells and low CAR T cell persistence. Here, we develop third-generation anti-CD123 CAR T cells with a humanized CSL362-based ScFv and a CD28-OX40-CD3ζ intracellular signaling domain. This CAR demonstrates anti-AML activity without affecting the healthy hematopoietic system, or causing epithelial tissue damage in a xenograft model. CD123 expression on leukemia cells increases upon 5'-Azacitidine (AZA) treatment. AZA treatment of leukemia-bearing mice causes an increase in CTLA-4negative anti-CD123 CAR T cell numbers following infusion. Functionally, the CTLA-4negative anti-CD123 CAR T cells exhibit superior cytotoxicity against AML cells, accompanied by higher TNFα production and enhanced downstream phosphorylation of key T cell activation molecules. Our findings indicate that AZA increases the immunogenicity of AML cells, enhancing recognition and elimination of malignant cells by highly efficient CTLA-4negative anti-CD123 CAR T cells.
    DOI:  https://doi.org/10.1038/s41467-021-26683-0
  10. Nat Commun. 2021 Nov 11. 12(1): 6506
    Discovery of putative tumor suppressors from CRISPR screens reveals rewired lipid metabolism in acute myeloid leukemia cells.
    W Frank Lenoir, Micaela Morgado, Peter C DeWeirdt, Megan McLaughlin, Audrey L Griffith, Annabel K Sangree, Marissa N Feeley, Nazanin Esmaeili Anvar, Eiru Kim, Lori L Bertolet, Medina Colic, Merve Dede, John G Doench, Traver Hart.
      CRISPR knockout fitness screens in cancer cell lines reveal many genes whose loss of function causes cell death or loss of fitness or, more rarely, the opposite phenotype of faster proliferation. Here we demonstrate a systematic approach to identify these proliferation suppressors, which are highly enriched for tumor suppressor genes, and define a network of 145 such genes in 22 modules. One module contains several elements of the glycerolipid biosynthesis pathway and operates exclusively in a subset of acute myeloid leukemia cell lines. The proliferation suppressor activity of genes involved in the synthesis of saturated fatty acids, coupled with a more severe loss of fitness phenotype for genes in the desaturation pathway, suggests that these cells operate at the limit of their carrying capacity for saturated fatty acids, which we confirm biochemically. Overexpression of this module is associated with a survival advantage in juvenile leukemias, suggesting a clinically relevant subtype.
    DOI:  https://doi.org/10.1038/s41467-021-26867-8
  11. Blood Adv. 2021 Nov 12. pii: bloodadvances.2021005418. [Epub ahead of print]
    TET2 mutations as a part of DNA dioxygenase deficiency in myelodysplastic syndromes.
    Carmelo Gurnari, Simona Pagliuca, Yihong Guan, Vera Adema, Courtney E Hershberger, Ying Ni, Hassan Awada, Sunisa Kongkiatkamon, Misam Zawit, Diego Coutinho, Ilana Renault Zalcberg, Jae-Sook Ahn, Hyeoung-Joon Kim, Dennis Dong Hwan Kim, Mark D Minden, Joop H Jansen, Manja Meggendorfer, Claudia Haferlach, Babal K Jha, Torsten Haferlach, Jaroslaw P Maciejewski, Valeria Visconte.
      Decrease in DNA dioxygease activity generated by TET2 gene family is crucial in myelodysplastic syndromes (MDS). The general down-regulation of 5-hydroxymethylcytosine (5-hmC) argues for a role of DNA demethylation in MDS beyond TET2 mutations, which albeit frequent, do not convey any prognostic significance. We investigated TETs expression to identify factors which can modulate the impact of mutations and thus 5-hmC levels on clinical phenotypes and prognosis of MDS patients. DNA/RNA-sequencing and 5-hmC data were collected from 1,665 patients with MDS and 91 controls. Irrespective of mutations, a significant fraction of MDS patients exhibited lower TET2 expression, while 5-hmC levels were not uniformly decreased. In searching for factors explaining compensatory mechanisms, we discovered that TET3 was up-regulated in MDS and inversely correlated with TET2 expression in wild-type cases. While TET2 was reduced across all age-groups, TET3 levels were increased in a likely feedback mechanism induced by TET2 dysfunction. This inverse relationship of TET2 and TET3 expression also corresponded to the expression of L-2-hydroxyglutarate dehydrogenase, involved in agonist/antagonist substrate metabolism. Importantly, elevated TET3 levels influenced the clinical phenotype of TET2-deficiency whereby the lack of compensation by TET3 (low TET3 expression) was associated with poor outcomes of TET2 mutant carriers.
    DOI:  https://doi.org/10.1182/bloodadvances.2021005418
  12. Leukemia. 2021 Nov 06.
    The GPI-anchored protein CD109 protects hematopoietic progenitor cells from undergoing erythroid differentiation induced by TGF-β.
    Mikoto Tanabe, Kohei Hosokawa, Mai Anh Thi Nguyen, Noriharu Nakagawa, Kana Maruyama, Noriaki Tsuji, Ryota Urushihara, Luis Espinoza, Mahmoud I Elbadry, Md Mohiuddin, Takamasa Katagiri, Masanori Ono, Hiroshi Fujiwara, Kazuhisa Chonabayashi, Yoshinori Yoshida, Hirohito Yamazaki, Atsushi Hirao, Shinji Nakao.
      Although a glycosylphosphatidylinositol-anchored protein (GPI-AP) CD109 serves as a TGF-β co-receptor and inhibits TGF-β signaling in keratinocytes, the role of CD109 on hematopoietic stem progenitor cells (HSPCs) remains unknown. We studied the effect of CD109 knockout (KO) or knockdown (KD) on TF-1, a myeloid leukemia cell line that expresses CD109, and primary human HSPCs. CD109-KO or KD TF-1 cells underwent erythroid differentiation in the presence of TGF-β. CD109 was more abundantly expressed in hematopoietic stem cells (HSCs) than in multipotent progenitors and HSPCs of human bone marrow (BM) and cord blood but was not detected in mouse HSCs. Erythroid differentiation was induced by TGF-β to a greater extent in CD109-KD cord blood or iPS cell-derived megakaryocyte-erythrocyte progenitor cells (MEPs) than in wild-type MEPs. When we analyzed the phenotype of peripheral blood MEPs of patients with paroxysmal nocturnal hemoglobinuria who had both GPI(+) and GPI(-) CD34+ cells, the CD36 expression was more evident in CD109- MEPs than CD109+ MEPs. In summary, CD109 suppresses TGF-β signaling in HSPCs, and the lack of CD109 may increase the sensitivity of PIGA-mutated HSPCs to TGF-β, thus leading to the preferential commitment of erythroid progenitor cells to mature red blood cells in immune-mediated BM failure.
    DOI:  https://doi.org/10.1038/s41375-021-01463-3
  13. Cell Death Dis. 2021 Nov 08. 12(11): 1058
    TCP1 increases drug resistance in acute myeloid leukemia by suppressing autophagy via activating AKT/mTOR signaling.
    Xiaofang Chen, Xianling Chen, Yiping Huang, Jia Lin, Yong Wu, Yuanzhong Chen.
      T-complex protein 1 (TCP1) is one of the subunits of chaperonin-containing T complex (CCT), which is involved in protein folding, cell proliferation, apoptosis, cell cycle regulation, and drug resistance. Investigations have demonstrated that TCP1 is a factor being responsible for drug resistance in breast and ovarian cancer. However, the TCP1 role in acute myeloid leukemia (AML) remains elusive. In the present study, we discovered that the TCP1 expression was elevated in AML patients and high TCP1 expression was associated with low complete response rate along with poor overall survival. TCP1 showed higher expression in the adriamycin-resistant leukemia cell line HL60/A and K562/A, comparing to their respective parent cells HL60 and K562 cells. TCP1 inhibition suppressed drug resistance in HL60/A and K562/A cells, whereas TCP1 overexpression in HL60 cells incremented drug resistance, both in vitro and in vivo. Mechanistic investigations revealed that TCP1 inhibited autophagy and adriamycin-induced cell apoptosis, and TCP1-mediated autophagy inhibition conferred resistance to adriamycin-induced cell apoptosis. Furthermore, TCP1 interacted with AKT and mTOR to activate AKT/mTOR signaling, which negatively regulates apoptosis and autophagy. Pharmacological inhibition of AKT/mTOR signal particularly activated autophagy and resensitized TCP1-overexpressing HL60 cells to adriamycin. These findings identify a novel role of TCP1 regarding drug resistance in AML, which advise a new strategy for overcoming drug resistance in AML through targeting TCP1/AKT/mTOR signaling pathway.
    DOI:  https://doi.org/10.1038/s41419-021-04336-w
  14. Blood. 2021 Nov 10. pii: blood.2021012589. [Epub ahead of print]
    Neutrophil and platelet increases with luspatercept in lower-risk MDS: secondary endpoints from the MEDALIST trial.
    Guillermo Garcia-Manero, Ghulam J Mufti Obe, Pierre Fenaux, Rena J Buckstein, Valeria Santini, María Díez-Campelo, Carlo Finelli, Osman Ilhan, Mikkael A Sekeres, Amer M Zeidan, Rodrigo Ito, Jennie Zhang, Anita Rampersad, Daniel Sinsimer, Jay T Backstrom, Uwe Platzbecker, Rami S Komrokji.
      
    DOI:  https://doi.org/10.1182/blood.2021012589
  15. Exp Hematol. 2021 Nov 09. pii: S0301-472X(21)00424-0. [Epub ahead of print]
    Cotargeting of Bcl-2 and Mcl-1 Shows Promising Antileukemic Activity against AML Cells Including those with Acquired Cytarabine Resistance.
    Fangbing Liu, Qiushi Zhao, Yongwei Su, Jing Lv, Yuqing Gai, Shuang Liu, Hai Lin, Yue Wang, Guan Wang.
      Acute myeloid leukemia (AML) remains a clinical challenge. Venetoclax is an effective Bcl-2 selective inhibitor approved by the US FDA for treating AML in patients 75 years or older or who have comorbidities. However, resistance to venetoclax limits its clinical efficacy. Mcl-1 has been identified as one determinant of resistance to venetoclax treatment. In this study, we investigate the Mcl-1 inhibitor S63845 in combination with venetoclax in AML cells. We found that S63845 synergizes with venetoclax in AML cell lines and primary patient samples. Bak/Bax double knockdown and treatment with the pan-caspase inhibitor Z-VAD-FMK demonstrate that the combination induces intrinsic apoptosis in AML cells. Inhibition of Mcl-1 using another Mcl-1 selective inhibitor, AZD5991, also synergistically enhanced apoptosis induced by venetoclax in a caspase dependent manner. Importantly, S63845 in combination with venetoclax can effectively combat AML cells with acquired resistance to the standard chemotherapy drug cytarabine. Taken together, combined inhibition of Mcl-1 and Bcl-2 shows promise against AML cells, including relapse/refractory AML.
    Keywords:  Bcl-2; Mcl-1; Mcl-1 inhibitor; acute myeloid leukemia; venetoclax
    DOI:  https://doi.org/10.1016/j.exphem.2021.10.006
  16. Nature. 2021 Nov 10.
    Diverse alterations associated with resistance to KRAS(G12C) inhibition.
    Yulei Zhao, Yonina R Murciano-Goroff, Jenny Y Xue, Agnes Ang, Jessica Lucas, Trang T Mai, Arnaud F Da Cruz Paula, Anne Y Saiki, Deanna Mohn, Pragathi Achanta, Ann E Sisk, Kanika S Arora, Rohan S Roy, Dongsung Kim, Chuanchuan Li, Lee P Lim, Mark Li, Amber Bahr, Brian R Loomis, Elisa de Stanchina, Jorge S Reis-Filho, Britta Weigelt, Michael Berger, Gregory Riely, Kathryn C Arbour, J Russell Lipford, Bob T Li, Piro Lito.
      Inactive state-selective KRAS(G12C) inhibitors1-8 demonstrate a 30-40% response rate and result in approximately 6-month median progression-free survival in patients with lung cancer9. The genetic basis for resistance to these first-in-class mutant GTPase inhibitors remains under investigation. Here we evaluated matched pre-treatment and post-treatment specimens from 43 patients treated with the KRAS(G12C) inhibitor sotorasib. Multiple treatment-emergent alterations were observed across 27 patients, including alterations in KRAS, NRAS, BRAF, EGFR, FGFR2, MYC and other genes. In preclinical patient-derived xenograft and cell line models, resistance to KRAS(G12C) inhibition was associated with low allele frequency hotspot mutations in KRAS(G12V or G13D), NRAS(Q61K or G13R), MRAS(Q71R) and/or BRAF(G596R), mirroring observations in patients. Single-cell sequencing in an isogenic lineage identified secondary RAS and/or BRAF mutations in the same cells as KRAS(G12C), where they bypassed inhibition without affecting target inactivation. Genetic or pharmacological targeting of ERK signalling intermediates enhanced the antiproliferative effect of G12C inhibitor treatment in models with acquired RAS or BRAF mutations. Our study thus suggests a heterogenous pattern of resistance with multiple subclonal events emerging during G12C inhibitor treatment. A subset of patients in our cohort acquired oncogenic KRAS, NRAS or BRAF mutations, and resistance in this setting may be delayed by co-targeting of ERK signalling intermediates. These findings merit broader evaluation in prospective clinical trials.
    DOI:  https://doi.org/10.1038/s41586-021-04065-2
  17. Blood Adv. 2021 Nov 12. pii: bloodadvances.2021005845. [Epub ahead of print]
    Coping Strategies in Patients with Acute Myeloid Leukemia.
    Hermioni L Amonoo, Monica H Bodd, Matthew J Reynolds, Ashley M Nelson, Richard A Newcomb, Patrick Connor Johnson, Tejaswini M Dhawale, Rachel Plotke, Lauren Heuer, Sabah Gillani, Daniel Yang, Emma C Deary, Elizabeth Daskalakis, Lauren Goldschen, Andrew M Brunner, Amir T Fathi, Thomas W LeBlanc, Areej El-Jawahri.
      Patients diagnosed with acute myeloid leukemia (AML) face sudden-onset life-threatening disease that requires intensive treatments. Although their early disease trajectory is characterized by significant, toxic side effects, there is limited data describing coping strategies among patients with AML and how these inform patient-reported outcomes. We used cross-sectional secondary data analyses to describe coping in 160 patients with newly diagnosed high-risk AML. We used the Brief COPE, Hospital Anxiety and Depression Scale, PTSD Checklist-Civilian Version, and Functional Assessment of Cancer Therapy-Leukemia at time of AML diagnosis to measure coping strategies, psychological distress and quality of life (QOL), respectively. We used the median split method for distribution of coping domains, and multivariate regression models to assess the relationship between coping and patient-reported outcomes. Participants (median age=64.4 years) were mostly non-Hispanic White (86.3%), male (60.0%), and married (73.8%). Most (51.9%) had high utilization of approach-oriented coping strategies whereas 38.8% had high utilization of avoidant coping strategies. At time of diagnosis, use of approach-oriented coping was associated with less psychological distress (anxiety: β=-0.262, p=0.002; depression symptoms β=-0.311, p<0.001; PTSD symptoms: β=-0.596, p=0.006) and better QOL (β=1.491, p=0.003). Use of avoidant coping was associated with more psychological distress (anxiety: β=0.884, p<0.001; depression symptoms: β=0.697, p<0.001; PTSD symptoms: β=3.048, p<0.001) and worse QOL (β=-5.696, p<0.001). Patients with high-risk AML utilize various approach-oriented and avoidant coping strategies at time of diagnosis. Use of approach-oriented coping strategies was associated with less psychological distress and better QOL, suggesting a possible target for supportive oncology interventions.
    DOI:  https://doi.org/10.1182/bloodadvances.2021005845
  18. Blood. 2021 Nov 05. pii: blood.2021012900. [Epub ahead of print]
    The Similarity of Class II HLA Genotypes Defines Patterns of Autoreactivity in Idiopathic Bone Marrow Failure Disorders.
    Simona Pagliuca, Carmelo Gurnari, Hassan Awada, Ashwin Kishtagari, Sunisa Kongkiatkamon, Laila Terkawi, Misam Zawit, Yihong Guan, Thomas LaFramboise, Babal K Jha, Bhumika J Patel, Betty K Hamilton, Navneet S Majhail, Sofie Lundgren, Satu Mustjoki, Yogen Saunthararajah, Valeria Visconte, Timothy Chan, Chao-Yie Yang, Tobias Lenz, Jaroslaw P Maciejewski.
      Idiopathic aplastic anemia (IAA) is a rare autoimmune bone marrow failure disorder initiated by a human leukocyte antigen (HLA)-restricted T cell response to unknown antigens. As for other autoimmune disorders, the predilection for certain HLA profiles seems to represent an etiologic factor, however, the structure-function patterns involved in the self-presentation in this disease remain unclear. Herein we analyzed the molecular landscape of HLA complexes of a cohort of 300 IAA patients and almost 3000 healthy and disease controls, by deeply dissecting their genotypic configurations, functional divergence, self-antigen binding capabilities and T cell receptor (TCR) repertoire specificities. Specifically, analysis of the evolutionary divergence of HLA genotypes (HED) showed that IAA patients carried class II HLA molecules whose antigen binding sites were characterized by a high level of structural homology, only partially explained by specific risk allele profiles. This pattern implies reduced HLA binding capabilities, confirmed by binding analysis of hematopoietic stem cell derived self-peptides. IAA phenotype was associated with the enrichment in a few amino acids at specific positions within the peptide binding groove of DRB1 molecules, affecting the interface HLA-antigen-TCR β and potentially constituting the basis of T-cell dysfunction and autoreactivity. When analyzing associations with clinical outcomes, low HED was associated with risk of malignant progression and worse survival, underlying reduced tumor surveillance in clearing potential neoantigens derived from mechanisms of clonal hematopoiesis. Our data shed light on the immunogenetic risk associated with IAA etiology and clonal evolution, and on general pathophysiological mechanisms potentially involved also in other autoimmune disorders.
    DOI:  https://doi.org/10.1182/blood.2021012900
  19. Blood. 2021 Nov 10. pii: blood.2021011463. [Epub ahead of print]
    Germline GATA1s generating mutations predispose to leukemia with acquired trisomy 21 and Down syndrome-like phenotype.
    Henrik Hasle, Ronald M Kline, Eigil Kjeldsen, Nik F Nik-Abdul-Rashid, Deepa Bhojwani, Jeffrey M Verboon, Stephanie P DiTroia, Katherine R Chao, Klas Raaschou-Jensen, Josefine Palle, C Michel Zwaan, Charlotte Guldborg Nyvold, Vijay G Sankaran, Alan B Cantor.
      Individuals with Down syndrome are at increased risk of myeloid leukemia in early childhood associated with acquisition of GATA1 mutations that generate a short GATA1 isoform called GATA1s. Germline GATA1s generating mutations result in congenital anemia in males. We report on two unrelated families harboring germline GATA1s generating mutations in which several members developed acute megakaryoblastic leukemia in early childhood. All evaluable leukemias had acquired trisomy or tetrasomy 21. The leukemia characteristics overlapped those of myeloid leukemia of Down syndrome including age of onset of less than 4 years, unique immunophenotype, complex karyotype, gene expression pattern, and drug sensitivity. These findings demonstrate that the combination of trisomy 21 and GATA1s generating mutations results in a unique myeloid leukemia independent of whether the GATA1 mutation or trisomy 21 is the primary or secondary event and suggest that there is unique functional cooperatively between GATA1s and trisomy 21 in leukemogenesis. The family histories also indicate that germline GATA1s generating mutations should be included among those associated with familial myelodysplastic syndrome and leukemia predisposition.
    DOI:  https://doi.org/10.1182/blood.2021011463
  20. Proc Natl Acad Sci U S A. 2021 Nov 16. pii: e2111451118. [Epub ahead of print]118(46):
    Mutation in Abl kinase with altered drug-binding kinetics indicates a novel mechanism of imatinib resistance.
    Agatha Lyczek, Benedict-Tilman Berger, Aziz M Rangwala, YiTing Paung, Jessica Tom, Hannah Philipose, Jiaye Guo, Steven K Albanese, Matthew B Robers, Stefan Knapp, John D Chodera, Markus A Seeliger.
      Protein kinase inhibitors are potent anticancer therapeutics. For example, the Bcr-Abl kinase inhibitor imatinib decreases mortality for chronic myeloid leukemia by 80%, but 22 to 41% of patients acquire resistance to imatinib. About 70% of relapsed patients harbor mutations in the Bcr-Abl kinase domain, where more than a hundred different mutations have been identified. Some mutations are located near the imatinib-binding site and cause resistance through altered interactions with the drug. However, many resistance mutations are located far from the drug-binding site, and it remains unclear how these mutations confer resistance. Additionally, earlier studies on small sets of patient-derived imatinib resistance mutations indicated that some of these mutant proteins were in fact sensitive to imatinib in cellular and biochemical studies. Here, we surveyed the resistance of 94 patient-derived Abl kinase domain mutations annotated as disease relevant or resistance causing using an engagement assay in live cells. We found that only two-thirds of mutations weaken imatinib affinity by more than twofold compared to Abl wild type. Surprisingly, one-third of mutations in the Abl kinase domain still remain sensitive to imatinib and bind with similar or higher affinity than wild type. Intriguingly, we identified three clinical Abl mutations that bind imatinib with wild type-like affinity but dissociate from imatinib considerably faster. Given the relevance of residence time for drug efficacy, mutations that alter binding kinetics could cause resistance in the nonequilibrium environment of the body where drug export and clearance play critical roles.
    Keywords:  binding kinetics; drug binding; drug resistance; imatinib; protein kinase
    DOI:  https://doi.org/10.1073/pnas.2111451118
  21. Nature. 2021 Nov 10.
    Dietary palmitic acid promotes a prometastatic memory via Schwann cells.
    Gloria Pascual, Diana Domínguez, Marc Elosúa-Bayes, Felipe Beckedorff, Carmelo Laudanna, Claudia Bigas, Delphine Douillet, Carolina Greco, Aikaterini Symeonidi, Inmaculada Hernández, Sara Ruiz Gil, Neus Prats, Coro Bescós, Ramin Shiekhattar, Moran Amit, Holger Heyn, Ali Shilatifard, Salvador Aznar Benitah.
      Fatty acid uptake and altered metabolism constitute hallmarks of metastasis1,2, yet evidence of the underlying biology, as well as whether all dietary fatty acids are prometastatic, is lacking. Here we show that dietary palmitic acid (PA), but not oleic acid or linoleic acid, promotes metastasis in oral carcinomas and melanoma in mice. Tumours from mice that were fed a short-term palm-oil-rich diet (PA), or tumour cells that were briefly exposed to PA in vitro, remained highly metastatic even after being serially transplanted (without further exposure to high levels of PA). This PA-induced prometastatic memory requires the fatty acid transporter CD36 and is associated with the stable deposition of histone H3 lysine 4 trimethylation by the methyltransferase Set1A (as part of the COMPASS complex (Set1A/COMPASS)). Bulk, single-cell and positional RNA-sequencing analyses indicate that genes with this prometastatic memory predominantly relate to a neural signature that stimulates intratumoural Schwann cells and innervation, two parameters that are strongly correlated with metastasis but are aetiologically poorly understood3,4. Mechanistically, tumour-associated Schwann cells secrete a specialized proregenerative extracellular matrix, the ablation of which inhibits metastasis initiation. Both the PA-induced memory of this proneural signature and its long-term boost in metastasis require the transcription factor EGR2 and the glial-cell-stimulating peptide galanin. In summary, we provide evidence that a dietary metabolite induces stable transcriptional and chromatin changes that lead to a long-term stimulation of metastasis, and that this is related to a proregenerative state of tumour-activated Schwann cells.
    DOI:  https://doi.org/10.1038/s41586-021-04075-0
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