bims-tremyl Biomed News
on Therapy resistance biology in myeloid leukemia
Issue of 2022‒01‒16
23 papers selected by
Paolo Gallipoli
Barts Cancer Institute, Queen Mary University of London
  1. Genetic and Transcriptional Contributions to Relapse in Normal Karyotype Acute Myeloid Leukemia.
  2. Effective Menin inhibitor-based combinations against AML with MLL rearrangement or NPM1 mutation (NPM1c).
  3. Single-cell analysis reveals selection of TP53-mutated clones after MDM2 inhibition.
  4. SCP4-STK35/PDIK1L complex is a dual phospho-catalytic signaling dependency in acute myeloid leukemia.
  5. BCOR and BCORL1 mutations drive epigenetic reprogramming and oncogenic signaling by unlinking PRC1.1 from target genes.
  6. Machine Learning of Bone Marrow Histopathology Identifies Genetic and Clinical Determinants in Patients with MDS.
  7. Clinical relevance of proteomic profiling in de novo pediatric acute myeloid leukemia: a Children's Oncology Group study.
  8. Genome-wide DNA Methylation Analysis in Pediatric Acute Myeloid Leukemia.
  9. Beyond Survival: The US Food and Drug Administration Confirms Surrogate End Points for Patients With Newly Diagnosed Acute Myeloid Leukemia Treated With Intensive Chemotherapy.
  10. PD-L1 Overexpression Correlates with JAK2-V617F Mutational Burden and Is Associated with 9p Uniparental Disomy in Myeloproliferative Neoplasms.
  11. Azacitidine maintenance in AML post induction and posttransplant.
  12. Genetic diversity within leukemia-associated immunophenotype-defined subclones in AML.
  13. Differential roles of BAF and PBAF subunits, Arid1b and Arid2, in MLL-AF9 leukemogenesis.
  14. Metabolic adaptations in cancers expressing isocitrate dehydrogenase mutations.
  15. Eliminating chronic myeloid leukemia stem cells by IRAK1/4 inhibitors.
  16. Geriatric assessment predicts non-fatal toxicities and survival for intensively treated older adults with AML.
  17. Pembrolizumab and decitabine for refractory or relapsed acute myeloid leukemia.
  18. A Randomized, Phase 3, Trial of Interferon-α versus Hydroxyurea in Polycythemia Vera and Essential Thrombocythemia.
  19. Oncogenic TYK2P760L kinase is effectively targeted by combinatorial TYK2, mTOR and CDK4/6 kinase blockade.
  20. GATA2 deficiency elevates Interferon Regulatory Factor-8 to subvert a progenitor cell differentiation program.
  21. Genome-wide association study on 13,167 individuals identifies regulators of blood CD34+ cell levels.
  22. CEBPA mutants down-regulate AML cell susceptibility to NK-mediated lysis by disruption of the expression of NKG2D ligands, which can be restored by LSD1 inhibition.
  23. Role of cardiolipins, mitochondria, and autophagy in the differentiation process activated by all-trans retinoic acid in acute promyelocytic leukemia.
  1. Blood Cancer Discov. 2022 Jan;3(1): 32-49
    Genetic and Transcriptional Contributions to Relapse in Normal Karyotype Acute Myeloid Leukemia.
    Allegra A Petti, Saad M Khan, Ziheng Xu, Nichole Helton, Catrina C Fronick, Robert Fulton, Sai M Ramakrishnan, Sridhar Nonavinkere Srivatsan, Sharon E Heath, Peter Westervelt, Jacqueline E Payton, Matthew J Walter, Daniel C Link, John DiPersio, Christopher Miller, Timothy J Ley.
      To better understand clonal and transcriptional adaptations after relapse in patients with acute myeloid leukemia (AML), we collected presentation and relapse samples from six normal karyotype AML cases. We performed enhanced whole-genome sequencing to characterize clonal evolution, and deep-coverage single-cell RNA sequencing on the same samples, which yielded 142,642 high-quality cells for analysis. Identifying expressed mutations in individual cells enabled us to discriminate between normal and AML cells, to identify coordinated changes in the genome and transcriptome, and to identify subclone-specific cell states. We quantified the coevolution of genetic and transcriptional heterogeneity during AML progression, and found that transcriptional changes were significantly correlated with genetic changes. However, transcriptional adaptation sometimes occurred independently, suggesting that clonal evolution does not represent all relevant biological changes. In three cases, we identified cells at diagnosis that likely seeded the relapse. Finally, these data revealed a conserved relapse-enriched leukemic cell state bearing markers of stemness, quiescence, and adhesion. SIGNIFICANCE: These data enabled us to identify a relapse-enriched leukemic cell state with distinct transcriptional properties. Detailed case-by-case analyses elucidated the complex ways in which the AML genome, transcriptome, and immune microenvironment interact to evade chemotherapy. These analyses provide a blueprint for evaluating these factors in larger cohorts.This article is highlighted in the In This Issue feature, p. 1.
    DOI:  https://doi.org/10.1158/2643-3230.BCD-21-0050
  2. Blood Cancer J. 2022 Jan 11. 12(1): 5
    Effective Menin inhibitor-based combinations against AML with MLL rearrangement or NPM1 mutation (NPM1c).
    Warren Fiskus, Steffen Boettcher, Naval Daver, Christopher P Mill, Koji Sasaki, Christine E Birdwell, John A Davis, Koichi Takahashi, Tapan M Kadia, Courtney D DiNardo, Qi Jin, Yuan Qi, Xiaoping Su, Gerard M McGeehan, Joseph D Khoury, Benjamin L Ebert, Kapil N Bhalla.
      Treatment with Menin inhibitor (MI) disrupts the interaction between Menin and MLL1 or MLL1-fusion protein (FP), inhibits HOXA9/MEIS1, induces differentiation and loss of survival of AML harboring MLL1 re-arrangement (r) and FP, or expressing mutant (mt)-NPM1. Following MI treatment, although clinical responses are common, the majority of patients with AML with MLL1-r or mt-NPM1 succumb to their disease. Pre-clinical studies presented here demonstrate that genetic knockout or degradation of Menin or treatment with the MI SNDX-50469 reduces MLL1/MLL1-FP targets, associated with MI-induced differentiation and loss of viability. MI treatment also attenuates BCL2 and CDK6 levels. Co-treatment with SNDX-50469 and BCL2 inhibitor (venetoclax), or CDK6 inhibitor (abemaciclib) induces synergistic lethality in cell lines and patient-derived AML cells harboring MLL1-r or mtNPM1. Combined therapy with SNDX-5613 and venetoclax exerts superior in vivo efficacy in a cell line or PD AML cell xenografts harboring MLL1-r or mt-NPM1. Synergy with the MI-based combinations is preserved against MLL1-r AML cells expressing FLT3 mutation, also CRISPR-edited to introduce mtTP53. These findings highlight the promise of clinically testing these MI-based combinations against AML harboring MLL1-r or mtNPM1.
    DOI:  https://doi.org/10.1038/s41408-021-00603-3
  3. Blood Adv. 2022 Jan 14. pii: bloodadvances.2021005867. [Epub ahead of print]
    Single-cell analysis reveals selection of TP53-mutated clones after MDM2 inhibition.
    Nabih Maslah, Emmanuelle Verger, Stéphane Giraudier, Mathias Chea, Ronald Hoffman, John Mascarenhas, Bruno Cassinat, Jean-Jacques Kiladjian.
      The mechanisms of transformation of chronic myeloproliferative neoplasms (MPN) to leukemia are largely unknown but TP53mutations acquisition is considered a key event in this process. P53 is a main tumor suppressor but mutations in this protein per se do not confer a proliferative advantage to the cells and a selection process is needed for the expansion of mutant clones. MDM2 inhibitors may rescue normal p53 from degradation and have been evaluated in a variety of cancers with promising results. However the impact of these drugs on TP53 mutated cells is underexplored. We report herein evidence of a direct effect of MDM2 inhibition on the selection of MPN patients' cells harboring TP53 mutations. To decipher whether these mutations can arise in a specific molecular context we used a DNA single cell approach to determine the clonal architecture of TP53 mutated cells. We observed that TP53 mutations are late events in MPN mainly occurring in the driver clone while clonal evolution frequently consists of sequential branching instead of linear consecutive acquisition of mutations in the same clone. At the single cell level the presence of additional mutations does not influence the selection of TP53 mutant cells by MDM2 inhibitor treatment. Also, we describe an in vitro test allowing to predict the emergence of TP53 mutated clones. Altogether, this is the first demonstration that a drug treatment can directly favor the emergence of TP53-mutated subclones in MPN.
    DOI:  https://doi.org/10.1182/bloodadvances.2021005867
  4. Cell Rep. 2022 Jan 11. pii: S2211-1247(21)01742-3. [Epub ahead of print]38(2): 110233
    SCP4-STK35/PDIK1L complex is a dual phospho-catalytic signaling dependency in acute myeloid leukemia.
    Sofya A Polyanskaya, Rosamaria Y Moreno, Bin Lu, Ruopeng Feng, Yu Yao, Seema Irani, Olaf Klingbeil, Zhaolin Yang, Yiliang Wei, Osama E Demerdash, Lukas A Benjamin, Mitchell J Weiss, Yan Jessie Zhang, Christopher R Vakoc.
      Acute myeloid leukemia (AML) cells rely on phospho-signaling pathways to gain unlimited proliferation potential. Here, we use domain-focused CRISPR screening and identify the nuclear phosphatase SCP4 as a dependency in AML, yet this enzyme is dispensable in normal hematopoietic progenitor cells. Using CRISPR exon scanning and gene complementation assays, we show that the catalytic function of SCP4 is essential in AML. Through mass spectrometry analysis of affinity-purified complexes, we identify the kinase paralogs STK35 and PDIK1L as binding partners and substrates of the SCP4 phosphatase domain. We show that STK35 and PDIK1L function catalytically and redundantly in the same pathway as SCP4 to maintain AML proliferation and to support amino acid biosynthesis and transport. We provide evidence that SCP4 regulates STK35/PDIK1L through two distinct mechanisms: catalytic removal of inhibitory phosphorylation and by promoting kinase stability. Our findings reveal a phosphatase-kinase signaling complex that supports the pathogenesis of AML.
    Keywords:  PDIK1L; SCP4; STK35; acute myeloid leukemia; complex; dependency; kinase; phosphatase
    DOI:  https://doi.org/10.1016/j.celrep.2021.110233
  5. Blood Cancer Discov. 2021 Dec 17. pii: bloodcandisc.0115.2021. [Epub ahead of print]
    BCOR and BCORL1 mutations drive epigenetic reprogramming and oncogenic signaling by unlinking PRC1.1 from target genes.
    Eva J Schaefer, Helen C Wang, Hannah Q Karp, Clifford A Meyer, Paloma Cejas, Micah D Gearhart, Emmalee R Adelman, Iman Fares, Annie Apffel, Klothilda Lim, Yingtian Xie, Christopher J Gibson, Monica Schenone, H Moses Murdock, Eunice S Wang, Lukasz P Gondek, Martin P Carroll, Rahul S Vedula, Eric S Winer, Jacqueline S Garcia, Richard M Stone, Marlise R Luskin, Steven A Carr, Henry W Long, Vivian J Bardwell, Maria E Figueroa, R Coleman Lindsley.
      Polycomb repressive epigenetic complexes are recurrently dysregulated in cancer. Unlike polycomb repressive complex 2 (PRC2), the role of PRC1 in oncogenesis and therapy resistance is not well defined. Here, we demonstrate that highly recurrent mutations of the PRC1 subunits BCOR and BCORL1 in leukemia disrupt assembly of a non-canonical PRC1.1 complex, thereby selectively unlinking the RING-PCGF enzymatic core from the chromatin targeting auxiliary subcomplex. As a result, BCOR-mutated PRC1.1 is localized to chromatin but lacks repressive activity, leading to epigenetic reprogramming and transcriptional activation at target loci. We define a set of functional targets that drive aberrant oncogenic signaling programs in PRC1.1 mutated cells and primary patient samples. Activation of these PRC1.1 targets in BCOR-mutated cells confers acquired resistance to treatment while sensitizing to targeted kinase inhibition. Our study thus reveals a novel epigenetic mechanism that explains PRC1.1 tumor suppressive activity and identifies a therapeutic strategy in PRC1.1 mutated cancer.
    DOI:  https://doi.org/10.1158/2643-3230.BCD-21-0115
  6. Blood Cancer Discov. 2021 May;2(3): 238-249
    Machine Learning of Bone Marrow Histopathology Identifies Genetic and Clinical Determinants in Patients with MDS.
    Oscar E Brück, Susanna E Lallukka-Brück, Helena R Hohtari, Aleksandr Ianevski, Freja T Ebeling, Panu E Kovanen, Soili I Kytölä, Tero A Aittokallio, Pedro M Ramos, Kimmo V Porkka, Satu M Mustjoki.
      In myelodysplastic syndrome (MDS) and myeloproliferative neoplasm (MPN), bone marrow (BM) histopathology is assessed to identify dysplastic cellular morphology, cellularity, and blast excess. Yet, other morphologic findings may elude the human eye. We used convolutional neural networks to extract morphologic features from 236 MDS, 87 MDS/MPN, and 11 control BM biopsies. These features predicted genetic and cytogenetic aberrations, prognosis, age, and gender in multivariate regression models. Highest prediction accuracy was found for TET2 [area under the receiver operating curve (AUROC) = 0.94] and spliceosome mutations (0.89) and chromosome 7 monosomy (0.89). Mutation prediction probability correlated with variant allele frequency and number of affected genes per pathway, demonstrating the algorithms' ability to identify relevant morphologic patterns. By converting regression models to texture and cellular composition, we reproduced the classical del(5q) MDS morphology consisting of hypolobulated megakaryocytes. In summary, this study highlights the potential of linking deep BM histopathology with genetics and clinical variables. SIGNIFICANCE: Histopathology is elementary in the diagnostics of patients with MDS, but its high-dimensional data are underused. By elucidating the association of morphologic features with clinical variables and molecular genetics, this study highlights the vast potential of convolutional neural networks in understanding MDS pathology and how genetics is reflected in BM morphology.See related commentary by Elemento, p. 195.
    DOI:  https://doi.org/10.1158/2643-3230.BCD-20-0162
  7. Haematologica. 2022 Jan 13.
    Clinical relevance of proteomic profiling in de novo pediatric acute myeloid leukemia: a Children's Oncology Group study.
    Fieke W Hoff, Anneke D Van Dijk, Yihua Qiu, Chenyue W Hu, Rhonda E Ries, Andrew Ligeralde, Gaye N Jenkins, Robert B Gerbing, Alan S Gamis, Richard Aplenc, E Anders Kolb, Todd A Alonzo, Soheil Meshinchi, Amina A Qutub, Eveline S J M De Bont, Terzah M Horton, Steven M Kornblau.
      Pediatric acute myeloid leukemia (AML) remains a fatal disease for at least 30% of patients, stressing the need for improved therapies and better risk stratification. As proteins are the unifying feature of (epi)genetic and environmental alterations, and are often targeted by novel chemotherapeutic agents, we studied the proteomic landscape of pediatric AML. Protein expression and activation levels were measured in 500 bulk leukemic patient samples and 30 control CD34+ samples, using the reverse phase protein arrays with 296 strictly validated antibodies. The multi-step "MetaGalaxy" analysis methodology was applied and identified nine protein expression signatures (PrSIG), based on strong recurrent protein expression patterns. PrSIGs were associated with cytogenetics and mutational state, and with both favorable or unfavorable prognosis. Analysis based on treatment (i.e., ADE vs. ADE plus bortezomib (ADEB)) identified three PrSIGs that did better with ADEB vs. ADE. When PrSIGs were studied in the context of genetic subgroups, PrSIGs were independently prognostic after multivariate analysis, suggesting a potential value for proteomics in combination with current classification systems. Proteins with universally increased (n=7) or decreased (n=17) expression were observed across PrSIGs. Expression of certain proteins significantly differentially expressed from normal could be identified, forming a hypothetical platform for personalized medicine.
    DOI:  https://doi.org/10.3324/haematol.2021.279672
  8. Blood Adv. 2022 Jan 10. pii: bloodadvances.2021005381. [Epub ahead of print]
    Genome-wide DNA Methylation Analysis in Pediatric Acute Myeloid Leukemia.
    Genki Yamato, Tomoko Kawai, Norio Shiba, Junji Ikeda, Yusuke Hara, Kentaro Ohki, Shin-Ichi Tsujimoto, Taeko Kaburagi, Kenichi Yoshida, Yuichi Shiraishi, Satoru Miyano, Nobutaka Kiyokawa, Daisuke Tomizawa, Akira Shimada, Manabu Sotomatsu, Hirokazu Arakawa, Souichi Adachi, Takashi Taga, Keizo Horibe, Seishi Ogawa, Kenichiro Hata, Yasuhide Hayashi.
      We investigated genome-wide DNA methylation patterns in 64 pediatric patients with acute myeloid leukemia (AML). Based on unsupervised clustering with 567 most variably methylated CpG sites, patients were categorized into four clusters associated with genetic alterations. Clusters 1 and 3 were characterized by the presence of known favorable prognostic factors, such as RUNX1-RUNX1T1 fusion and KMT2A rearrangement with low MECOM expression, and biallelic CEBPA mutations (all 8 patients), respectively. Clusters 2 and 4 comprised patients exhibiting molecular features associated with adverse outcomes, namely FLT3-ITD, KMT2A-PTD, and high PRDM16 expression. Depending on the methylation values of the 1243 CpG sites that were significantly different between FLT3-ITD positive and negative AML, patients were categorized into three clusters: A, B, and C. The STAT5-binding motif was most frequently found close to the 1,243 CpG sites. All eight patients with FLT3-ITD in Cluster A harbored high PRDM16 expression and experienced adverse events, whereas only one of seven patients with FLT3-ITD in the other clusters experienced adverse events. PRDM16 expression levels were also related to DNA methylation patterns, which were drastically changed at the cutoff value of PRDM16/ABL1 = 0.10. The assay for transposase-accessible chromatin sequencing of AMLs supported enhanced chromatin accessibilities around genomic regions, such as HOXB cluster genes, SCHIP1, and PRDM16, which were associated with DNA methylation changes in AMLs with FLT3-ITD and high PRDM16 expression. Our results suggest that DNA methylation levels at specific CpG sites are useful to support genetic alterations and gene expression patterns of patients with pediatric AML.
    DOI:  https://doi.org/10.1182/bloodadvances.2021005381
  9. J Clin Oncol. 2022 Jan 10. JCO2102762
    Beyond Survival: The US Food and Drug Administration Confirms Surrogate End Points for Patients With Newly Diagnosed Acute Myeloid Leukemia Treated With Intensive Chemotherapy.
    Courtney D DiNardo, Daniel A Pollyea.
      
    DOI:  https://doi.org/10.1200/JCO.21.02762
  10. Am J Hematol. 2022 Jan 11.
    PD-L1 Overexpression Correlates with JAK2-V617F Mutational Burden and Is Associated with 9p Uniparental Disomy in Myeloproliferative Neoplasms.
    Jelena D Milosevic Feenstra, Roland Jäger, Fiorella Schischlik, Daniel Ivanov, Gregor Eisenwort, Elisa Rumi, Michael Schuster, Bettina Gisslinger, Sigrid Machherndl-Spandl, Peter Bettelheim, Maria-Theresa Krauth, Felix Keil, Christoph Bock, Mario Cazzola, Heinz Gisslinger, Robert Kralovics, Peter Valent.
      Myeloproliferative neoplasms (MPN) are chronic stem cell disorders characterized by enhanced proliferation of myeloid cells, immune deregulation and drug resistance. JAK2 somatic mutations drive the disease in 50-60% and CALR mutations in 25-30% of cases. Published data suggest that JAK2-V617F-mutated MPN cells express the resistance-related checkpoint PD-L1. By applying RNA-sequencing on granulocytes of 113 MPN patients, we demonstrate that PD-L1 expression is highest among polycythemia vera patients and that PD-L1 expression correlates with JAK2-V617F mutational burden (R=0.52;P<0.0001). SNP-arrays showed that chromosome 9p uniparental disomy (UPD) covers both PD-L1 and JAK2 in all MPN patients examined. MPN cells in JAK2-V617F-positive patients expressed higher levels of PD-L1 if 9pUPD was present compared to when it was absent (P<0.0001). Moreover, haplotype-based association analyses provided evidence for germline genetic factors at PD-L1 locus contributing to MPN susceptibility independently of the previously described GGCC risk haplotype. We also found that PD-L1 is highly expressed on putative CD34+ CD38- disease-initiating stem cells (NSC) in both JAK2 and CALR-mutated MPN. PD-L1 overexpression decreased upon exposure to JAK2 blockers and BRD4-targeting agents, suggesting a role for JAK2-STAT5-signaling and BRD4 in PD-L1 expression. Whether targeting of PD-L1 can overcome NSC resistance in MPN remains to be elucidated in forthcoming studies. This article is protected by copyright. All rights reserved.
    DOI:  https://doi.org/10.1002/ajh.26461
  11. Curr Opin Hematol. 2022 Jan 10.
    Azacitidine maintenance in AML post induction and posttransplant.
    Jan Philipp Bewersdorf, Thomas Prebet, Lohith Gowda.
      PURPOSE OF REVIEW: Disease relapse remains the most common cause of death among patients with acute myeloid leukemia (AML) following induction therapy and allogeneic hematopoietic cell transplant (allo-HCT). Prolonging the duration of remission with minimal nonrelapse mortality risk is an area of unmet need for AML patients.RECENT FINDINGS: In QUAZAR AML-001 study, the oral azacitidine analogue CC-486 demonstrated an overall survival (OS) benefit when given as postremission therapy (PRT) for patients in CR1 that were ineligible to proceed to allo-HCT. Used as maintenance post allo-HCT, CC-486 has also shown safety with encouraging disease-free survival (DFS). Although a recent randomized trial of parenteral azacitidine vs. placebo post allo-HCT failed to show relapse reduction, a subsequent meta-analysis of maintenance studies posttransplant has shown good utility with this approach. Such conflicting results emphasize the need for robust study designs to identify subsets of patients that derive maximal benefits using latest tools to risk stratify relapse risk.
    SUMMARY: PRT with hypomethylating agents is feasible and in select population, there is a survival advantage with CC-486. Better understanding of distinct epigenetic and immunomodulatory properties of azacitidine, holds significant promise to synergize pharmacologic and cellular drivers of disease control as PRT in future AML trials.
    DOI:  https://doi.org/10.1097/MOH.0000000000000700
  12. Ann Hematol. 2022 Jan 13.
    Genetic diversity within leukemia-associated immunophenotype-defined subclones in AML.
    F Tiso, T N Koorenhof-Scheele, E Huys, J H A Martens, A O de Graaf, B A van der Reijden, S M C Langemeijer, F W M B Preijers, L I Kroeze, J H Jansen.
      Acute myeloid leukemia (AML) is a highly heterogeneous disease showing dynamic clonal evolution patterns over time. Various subclones may be present simultaneously and subclones may show a different expansion pattern and respond differently to applied therapies. It is already clear that immunophenotyping and genetic analyses may yield overlapping, but also complementary information. Detailed information on the genetic make-up of immunophenotypically defined subclones is however scarce. We performed error-corrected sequencing for 27 myeloid leukemia driver genes in 86, FACS-sorted immunophenotypically characterized normal and aberrant subfractions in 10 AML patients. We identified three main scenarios. In the first group of patients, the two techniques were equally well characterizing the malignancy. In the second group, most of the isolated populations did not express aberrant immunophenotypes but still harbored several genetic aberrancies, indicating that the information obtained only by immunophenotyping would be incomplete. Vice versa, one patient was identified in which genetic mutations were found only in a small fraction of the immunophenotypically defined malignant populations, indicating that the genetic analysis gave an incomplete picture of the disease. We conclude that currently, characterization of leukemic cells in AML by molecular and immunophenotypic techniques is complementary, and infer that both techniques should be used in parallel in order to obtain the most complete view on the disease.
    Keywords:  AML; Immunophenotype; MRD; Molecular diagnostics
    DOI:  https://doi.org/10.1007/s00277-021-04747-x
  13. Leukemia. 2022 Jan 12.
    Differential roles of BAF and PBAF subunits, Arid1b and Arid2, in MLL-AF9 leukemogenesis.
    Theresa Bluemn, Jesse Schmitz, Yongwei Zheng, Robert Burns, Shikan Zheng, Joshua DeJong, Luke Christiansen, Olivia Arnold, Jesus Izaguirre-Carbonell, Demin Wang, Aniruddha J Deshpande, Nan Zhu.
      The Switch/Sugar Non-Fermenting (SWI/SNF) nucleosome remodeling complexes play important roles in normal development and in the development of various cancers. Core subunits of the SWI/SNF complexes have been shown to have oncogenic roles in acute myeloid leukemia. However, the roles of the unique targeting subunits, including that of Arid2 and Arid1b, in AML leukemogenesis are not well understood. Here, we used conditional knockout mouse models to elucidate their role in MLL-AF9 leukemogenesis. We uncovered that Arid2 has dual roles; enhancing leukemogenesis when deleted during leukemia initiation and yet is required during leukemia maintenance. Whereas, deleting Arid1b in either phase promotes leukemogenesis. Our integrated analyses of transcriptomics and genomic binding data showed that, globally, Arid2 and Arid1b regulate largely distinct sets of genes at different disease stages, respectively, and in comparison, to each other. Amongst the most highly dysregulated transcription factors upon their loss, Arid2 and Arid1b converged on the regulation of Etv4/Etv5, albeit in an opposing manner while also regulating distinct TFs including Gata2,Tcf4, Six4, Irf4 and Hmgn3. Our data demonstrate the differential roles of SWI/SNF subunits in AML leukemogenesis and emphasize that cellular context and disease stage are key in determining their functions during this process.
    DOI:  https://doi.org/10.1038/s41375-021-01505-w
  14. Cell Rep Med. 2021 Dec 21. 2(12): 100469
    Metabolic adaptations in cancers expressing isocitrate dehydrogenase mutations.
    Ingvild Comfort Hvinden, Tom Cadoux-Hudson, Christopher J Schofield, James S O McCullagh.
      The most frequently mutated metabolic genes in human cancer are those encoding the enzymes isocitrate dehydrogenase 1 (IDH1) and IDH2; these mutations have so far been identified in more than 20 tumor types. Since IDH mutations were first reported in glioma over a decade ago, extensive research has revealed their association with altered cellular processes. Mutations in IDH lead to a change in enzyme function, enabling efficient conversion of 2-oxoglutarate to R-2-hydroxyglutarate (R-2-HG). It is proposed that elevated cellular R-2-HG inhibits enzymes that regulate transcription and metabolism, subsequently affecting nuclear, cytoplasmic, and mitochondrial biochemistry. The significance of these biochemical changes for tumorigenesis and potential for therapeutic exploitation remains unclear. Here we comprehensively review reported direct and indirect metabolic changes linked to IDH mutations and discuss their clinical significance. We also review the metabolic effects of first-generation mutant IDH inhibitors and highlight the potential for combination treatment strategies and new metabolic targets.
    Keywords:  2-oxoglutarate; IDH inhibition; R-2-HG; R-2-hydoxyglutarate; TCA cycle; cancer metabolism; chromatin modification; histone modification; metabolic target; mutant isocitrate dehydrogenase; redox metabolism
    DOI:  https://doi.org/10.1016/j.xcrm.2021.100469
  15. Nat Commun. 2022 Jan 12. 13(1): 271
    Eliminating chronic myeloid leukemia stem cells by IRAK1/4 inhibitors.
    Yosuke Tanaka, Reina Takeda, Tsuyoshi Fukushima, Keiko Mikami, Shun Tsuchiya, Moe Tamura, Keito Adachi, Terumasa Umemoto, Shuhei Asada, Naoki Watanabe, Soji Morishita, Misa Imai, Masayoshi Nagata, Marito Araki, Hitoshi Takizawa, Tomofusa Fukuyama, Chrystelle Lamagna, Esteban S Masuda, Ryoji Ito, Susumu Goyama, Norio Komatsu, Tomoiku Takaku, Toshio Kitamura.
      Leukemia stem cells (LSCs) in chronic myeloid leukemia (CML) are quiescent, insensitive to BCR-ABL1 tyrosine kinase inhibitors (TKIs) and responsible for CML relapse. Therefore, eradicating quiescent CML LSCs is a major goal in CML therapy. Here, using a G0 marker (G0M), we narrow down CML LSCs as G0M- and CD27- double positive cells among the conventional CML LSCs. Whole transcriptome analysis reveals NF-κB activation via inflammatory signals in imatinib-insensitive quiescent CML LSCs. Blocking NF-κB signals by inhibitors of interleukin-1 receptor-associated kinase 1/4 (IRAK1/4 inhibitors) together with imatinib eliminates mouse and human CML LSCs. Intriguingly, IRAK1/4 inhibitors attenuate PD-L1 expression on CML LSCs, and blocking PD-L1 together with imatinib also effectively eliminates CML LSCs in the presence of T cell immunity. Thus, IRAK1/4 inhibitors can eliminate CML LSCs through inhibiting NF-κB activity and reducing PD-L1 expression. Collectively, the combination of TKIs and IRAK1/4 inhibitors is an attractive strategy to achieve a radical cure of CML.
    DOI:  https://doi.org/10.1038/s41467-021-27928-8
  16. Blood. 2022 Jan 10. pii: blood.2021013671. [Epub ahead of print]
    Geriatric assessment predicts non-fatal toxicities and survival for intensively treated older adults with AML.
    Gi-June Min, Byung-Sik Cho, Sung-Soo Park, Silvia Park, Young-Woo Jeon, Seung-Hwan Shin, Seung-Ah Yahng, Jae-Ho Yoon, Sung-Eun Lee, Ki-Seong Eom, Yoo-Jin Kim, Seok Lee, Chang-Ki Min, Seok-Goo Cho, Dong-Wook Kim, Jong Wook Lee, Hee-Je Kim.
      Given a few prospective studies with conflicting results, we investigated the prognostic value of multi-parameter geriatric assessment (GA) domains on tolerance and outcomes after intensive chemotherapy in older adults with acute myeloid leukemia (AML). Newly diagnosed AML aged over 60 years who received intensive chemotherapy consisting of cytarabine and idarubicin (n=105) were enrolled prospectively. Pretreatment GA included evaluations for social and nutritional support, cognition, depression, distress, and physical function. The median age was 64 years (range, 60-75), and 93% had an Eastern Cooperative Oncology Group score <2. Between 32.4% and 69.5% of patients met the criteria for impairment for each domain of GA. Physical impairment by the Short Physical Performance Battery (SPPB) and cognitive dysfunction by the Mini-Mental State Examination in the Korean version of the CERAD Assessment Packet (MMSE-KC) were significantly associated with non-fatal toxicities, including grade III-IV infections (SPPB, P=0.024; MMSE-KC, P=0.044), acute renal failure (SPPB, P=0.013), and/or prolonged hospitalization (³40 days) during induction chemotherapy (MMSE-KC, P=0.005). Reduced physical function by SPPB and depressive symptoms by the Korean version of the short form of geriatric depression scales (SGDS-K) were significantly associated with inferior survival (SPPB, P=0.027; SGDS-K, P=0.048). Gait speed or sit-and-stand speed was the single powerful tool to predict survival outcomes. Notably, the addition of SPPB and SGDS-K, gait speed and SGDS-K, or sit-and-stand speed and SGDS-K significantly improved the power of existing survival prediction models. In conclusion, GA improved risk stratification for treatment decisions and may inform interventions to improve outcomes for older adults with AML. This study was registered at the Clinical Research Information Service (KCT0002172).
    DOI:  https://doi.org/10.1182/blood.2021013671
  17. J Immunother Cancer. 2022 Jan;pii: e003392. [Epub ahead of print]10(1):
    Pembrolizumab and decitabine for refractory or relapsed acute myeloid leukemia.
    Meghali Goswami, Gege Gui, Laura W Dillon, Katherine E Lindblad, Julie Thompson, Janet Valdez, Dong-Yun Kim, Jack Y Ghannam, Karolyn A Oetjen, Christin B Destefano, Dana M Smith, Hanna Tekleab, Yeusheng Li, Pradeep Dagur, Thomas Hughes, Jennifer L Marté, Jaydira Del Rivero, Joanna Klubo-Gwiezdzinksa, James L Gulley, Katherine R Calvo, Catherine Lai, Christopher S Hourigan.
      BACKGROUND: The powerful 'graft versus leukemia' effect thought partly responsible for the therapeutic effect of allogeneic hematopoietic cell transplantation in acute myeloid leukemia (AML) provides rationale for investigation of immune-based therapies in this high-risk blood cancer. There is considerable preclinical evidence for potential synergy between PD-1 immune checkpoint blockade and the hypomethylating agents already commonly used for this disease.METHODS: We report here the results of 17 H-0026 (PD-AML, NCT02996474), an investigator sponsored, single-institution, single-arm open-label 10-subject pilot study to test the feasibility of the first-in-human combination of pembrolizumab and decitabine in adult patients with refractory or relapsed AML (R-AML).
    RESULTS: In this cohort of previously treated patients, this novel combination of anti-PD-1 and hypomethylating therapy was feasible and associated with a best response of stable disease or better in 6 of 10 patients. Considerable immunological changes were identified using T cell receptor β sequencing as well as single-cell immunophenotypic and RNA expression analyses on sorted CD3+ T cells in patients who developed immune-related adverse events (irAEs) during treatment. Clonal T cell expansions occurred at irAE onset; single-cell sequencing demonstrated that these expanded clones were predominately CD8+ effector memory T cells with high cell surface PD-1 expression and transcriptional profiles indicative of activation and cytotoxicity. In contrast, no such distinctive immune changes were detectable in those experiencing a measurable antileukemic response during treatment.
    CONCLUSION: Addition of pembrolizumab to 10-day decitabine therapy was clinically feasible in patients with R-AML, with immunological changes from PD-1 blockade observed in patients experiencing irAEs.
    Keywords:  adaptive immunity; immunotherapy; investigational; lymphocyte activation; therapies; translational medical research
    DOI:  https://doi.org/10.1136/jitc-2021-003392
  18. Blood. 2022 01 10. pii: blood.2021012743. [Epub ahead of print]
    A Randomized, Phase 3, Trial of Interferon-α versus Hydroxyurea in Polycythemia Vera and Essential Thrombocythemia.
    John Mascarenhas, Heidi E Kosiorek, Josef T Prchal, Alessandro Rambaldi, Dmitriy Berenzon, Abdulraheem Yacoub, Claire N Harrison, Mary Frances Frances McMullin, Alessandro Maria Vannucchi, Joanne Ewing, Casey L O'Connell, Jean-Jacques Kiladjian, Adam J Mead, Elliott F Winton, David S Leibowitz, Valerio De Stefano, Murat O Arcasoy, Craig M Kessler, Rosalind Catchatourian, Damiano Rondelli, Richard T Silver, Andrea Bacigalupo, Arnon Nagler, Marina Kremyanskaya, Max Fine Levine, Juan Esteban Arango Ossa, Erin M McGovern, Lonette Sandy, Mohamed E Salama, Vesna Najfeld, Joseph Tripodi, Noushin Farnoud, Alex Vincent Penson, Rona Singer Weinberg, Leah Price, Judith D Goldberg, Tiziano Barbui, Roberto Marchioli, Gianni Tognoni, Raajit K Rampal, Ruben A Mesa, Amylou C Dueck, Ronald Hoffman.
      The goal of therapy for essential thrombocythemia (ET) and polycythemia vera (PV) patients is to reduce thrombotic events by normalizing blood counts. Hydroxyurea (HU) and interferon-α (IFN-α) are the most frequently used cytoreductive options for ET and PV patients at high-risk for vascular complications. Myeloproliferative Disorders Research Consortium 112 was an investigator-initiated, phase 3 trial comparing HU to pegylated IFN-α (PEG) in treatment naïve, high-risk ET/PV patients. The primary endpoint was complete response (CR) rate at 12 months. A total of 168 patients were treated for a median of 81.0 weeks. CR for HU was 37% and 35% for PEG (p=0.80) at 12 months. At 24/36 months, CR was 20%/17% for HU and 29%/33% for PEG. PEG led to a greater reduction in JAK2V617F at 24 months, but histopathologic responses were more frequent with HU. Thrombotic events and disease progression were infrequent in both arms, while grade 3/4 adverse events were more frequent with PEG (46% vs. 28%). At 12 months of treatment there was no significant difference in CR rates between HU and PEG. This study indicates that PEG and HU are both effective treatments for PV and ET. With longer treatment PEG was more effective in normalizing blood counts and reducing driver mutation burden, while HU produced more histopathologic responses. Despite these differences, both agents did not differ in limiting thrombotic events and disease progression in high-risk ET/PV patients. (Funded by the National Cancer Institute, 5P01CA108671-09; clinicaltrials.gov number (NCT01259856).
    DOI:  https://doi.org/10.1182/blood.2021012743
  19. Haematologica. 2022 Jan 13.
    Oncogenic TYK2P760L kinase is effectively targeted by combinatorial TYK2, mTOR and CDK4/6 kinase blockade.
    Katharina Woess, Sabine Macho-Maschler, Dorette S Van Ingen Schenau, Miriam Butler, Caroline Lassnig, Daniel Valcanover, Andrea Poelzl, Katrin Meissl, Barbara Maurer, Tania Brandstoetter, Claus Vogl, Anna Koren, Stefan Kubicek, Anna Orlova, Richard Moriggl, Birgit Strobl, Veronika Sexl, Frank N Van Leeuwen, Roland P Kuiper, Mathias Mueller.
      Tyrosine kinase 2 (TYK2) is a member of the Janus kinase/signal transducer and activator of transcription pathway, which is central in cytokine signaling. Previously, germline TYK2 mutations have been described in two patients developing de novo T-cell acute lymphoblastic leukemias (T-ALLs) or precursor B-ALLs. The mutations (P760L and G761V) are located within the regulatory pseudokinase domain and lead to constitutive activation of TYK2. We demonstrate the transformation capacity of TYK2P760L in hematopoietic cell systems including primary bone marrow cells. In vivo engraftment of TYK2P760L-expressing cell lines led to development of leukemia. A kinase inhibitor screen uncovered that oncogenic TYK2 acts synergistically with the PI3K/AKT/mTOR and CDK4/6 pathways. Accordingly, the TYK2-specific inhibitor deucravacitinib (BMS986165) reduces cell viability of TYK2P760Ltransformed cell models and ex vivo cultured TYK2P760L-mutated patient-derived xenograft cells most efficiently when combined with mTOR or CDK4/6 inhibitors. Our study thereby pioneers novel treatment options for patients suffering from TYK2-driven acute leukemia.
    DOI:  https://doi.org/10.3324/haematol.2021.279848
  20. Blood Adv. 2022 01 10. pii: bloodadvances.2021006182. [Epub ahead of print]
    GATA2 deficiency elevates Interferon Regulatory Factor-8 to subvert a progenitor cell differentiation program.
    Kirby D Johnson, Alexandra A Soukup, Emery H Bresnick.
      Cell type-specific transcription factors control stem and progenitor cell transitions by establishing networks containing hundreds of genes and proteins. Network complexity renders it challenging to discover essential versus modulatory or redundant components. This scenario is exemplified by GATA2 regulation of hematopoiesis during embryogenesis. Loss of a far upstream Gata2 enhancer (-77) disrupts the GATA2-dependent transcriptome governing hematopoietic progenitor cell differentiation. The aberrant transcriptome includes the transcription factor Interferon Regulatory Factor-8 and a host of innate immune regulators. Mutant progenitors lose the capacity to balance production of diverse hematopoietic progeny. To elucidate mechanisms, we asked if IRF8 is essential, contributory or not required. Reducing Irf8, in the context of the -77 mutant allele, reversed granulocytic deficiencies and the excessive accumulation of dendritic cell committed progenitors. Despite many dysregulated components that control vital transcriptional, signaling and immune processes, the aberrant elevation of a single transcription factor deconstructed the differentiation program.
    DOI:  https://doi.org/10.1182/bloodadvances.2021006182
  21. Blood. 2022 Jan 10. pii: blood.2021013220. [Epub ahead of print]
    Genome-wide association study on 13,167 individuals identifies regulators of blood CD34+ cell levels.
    Aitzkoa Lopez de Lapuente Portilla, Ludvig Ekdahl, Caterina Cafaro, Zain Ali, Natsumi Miharada, Gudmar Thorleifsson, Kristijonas Žemaitis, Antton Lamarca Arrizabalaga, Malte Thodberg, Maroulio Pertesi, Parashar Dhapola, Erik L Bao, Abhishek Niroula, Divya Bali, Gudmundur L Norddahl, Nerea Ugidos Damboriena, Vijay G Sankaran, Göran Karlsson, Unnur Thorsteinsdottir, Jonas Larsson, Kari Stefansson, Björn Nilsson.
      Stem cell transplantation is a cornerstone in the treatment of blood malignancies. The most common method to harvest stem cells for transplantation is by leukapheresis, requiring mobilization of CD34+ hematopoietic stem and progenitor cells (HSPC) from the bone marrow into the blood. Identifying the genetic factors that control blood CD34+ cell levels could expose new drug targets for HSPC mobilization. Here, we report the first large-scale genome-wide association study on blood CD34+ cell levels. Across 13,167 individuals, we identify 9 significant and 2 suggestive associations, accounted for by 8 loci (PPM1H, CXCR4, ENO1-RERE, ITGA9, ARHGAP45, CEBPA, TERT and MYC). Notably, 4 of the identified associations map to CXCR4, demonstrating that bona fide regulators of blood CD34+ cell levels can be identified through genetic variation. Further, the most significant association maps to PPM1H, encoding a serine/threonine phosphatase never previously implicated in HSPC biology. PPM1H is expressed in HSPCs, and the allele that confers higher blood CD34+ cell levels downregulates PPM1H. Through functional fine-mapping, we find that this downregulation is caused by the variant rs772557-A, which abrogates a MYB transcription factor binding site in PPM1H intron 1 that is active in specific HSPC subpopulations, including hematopoietic stem cells, and interacts with the promoter by chromatin looping. Furthermore, PPM1H knockdown increases the proportion of CD34+ and CD34+90+ cells in cord blood assays. Our results provide first large-scale analysis of the genetic architecture of blood CD34+ cell levels, and warrant further investigation of PPM1H as a potential inhibition target for stem cell mobilization.
    DOI:  https://doi.org/10.1182/blood.2021013220
  22. Oncoimmunology. 2022 ;11(1): 2016158
    CEBPA mutants down-regulate AML cell susceptibility to NK-mediated lysis by disruption of the expression of NKG2D ligands, which can be restored by LSD1 inhibition.
    Meng Liu, Mengbao Du, Jian Yu, Zijun Qian, Yang Gao, Wenjue Pan, Xiujie Zhao, Mowang Wang, Huimin Li, Jiaqi Zheng, Qianshuo Huang, Li-Mengmeng Wang, Haowen Xiao.
      NK group 2, member D (NKG2D) is one of the most critical activating receptors expressed by natural killer (NK) cells. There is growing evidence that acute myeloid leukemia (AML) cells may evade NK cell-mediated cell lysis by expressing low or no ligands for NKG2D (NKG2D-Ls). We hypothesized that CCAAT/enhancer-binding protein α (C/EBPα), one of the most studied lineage-specific transcription factors in hematopoiesis, might influence the expression of NKG2D-Ls. To test this hypothesis, we first examined the endogenous expression of wild-type C/EBPα (C/EBPα-p42) in human AML cell lines and demonstrated that its expression level was highly relevant to the sensitivity of AML cells to NK cell cytotoxicity. Induction of C/EBPα-p42 in the low endogenous CEBPA-expressing AML cell line increased the sensitivity to NK-induced lysis. Moreover, decreased expression of C/EBPα-p42 by RNA interference in AML cells abrogated NK-mediated cytotoxicity. We further showed that the increase in NK susceptibility caused by C/EBPα-p42 occurred through up-regulation of the NKG2D-Ls ULBP2/5/6 in AML cells. More importantly, chromatin immunoprecipitation (ChIP) coupled with high-throughput sequencing captured C/EBPα motif signatures at the enhancer regions of the ULBP 2/5/6 genes. Whilst, the AML-associated C/EBPα C-terminal mutant and N-terminal truncated mutant (C/EBPα-p30) diminished ULBP2/5/6 transcription. Finally, we identified that histone demethylase lysine-specific demethylase 1 (LSD1) inhibition can restore the expression of ULBPs via induction of CEBPA expression in AML cells, which may represent a novel therapeutic strategy for CEBPA-mutated AML. Abbreviations: C/EBPα: CCAAT/enhancer-binding protein α; TF: Transcription factor; AML: Acute myeloid leukemia; TAD: Transactivation domain; FS: Frameshift; NK: Natural killer; NKG2D: NK group 2, member D; NKG2D-Ls: Ligands for NKG2D; MHC: Major histocompatibility complex; MICA: MHC class I-related chain A; ULBP: UL16-binding protein; STAT3: Signal transducer and activator of transcription 3; LSD1: Lysine-specific demethylase 1; Ab: Antibody; PBMC: Peripheral blood mononuclear cell; PBS: Phosphate-buffered saline; CFSE: Carboxyfluorescein diacetate succinimidyl ester; PI: Propidium iodide; shRNA: Short hairpin RNA; ChIP: Chromatin immunoprecipitation; BM: Binding motif; HCNE: Highly conserved noncoding element; TSS: Transcription start site; HMA: Hypomethylating agent; AZA: Azacitidine/5-azacytidine; DAC: Decitabine/5-aza-29-deoxycytidine; 2-PCPA: Tranylcypromine; RBP: RNA-binding protein; MSI2: MUSASHI-2; HDACi: Inhibitor of histone deacetylases; VPA: Valproate; DNMTi: DNA methyl transferase inhibitor; SCLC: Small cell lung cancer.
    Keywords:  CCAAT/enhancer-binding protein α; CEBPA mutation; LSD1 inhibition; NKG2D; ULBPs; acute myeloid leukemia; natural killer cell
    DOI:  https://doi.org/10.1080/2162402X.2021.2016158
  23. Cell Death Dis. 2022 01 10. 13(1): 30
    Role of cardiolipins, mitochondria, and autophagy in the differentiation process activated by all-trans retinoic acid in acute promyelocytic leukemia.
    Maurizio Gianni', Laura Goracci, Anna Schlaefli, Alessandra Di Veroli, Mami Kurosaki, Luca Guarrera, Marco Bolis, Marika Foglia, Monica Lupi, Mario P Tschan, Gabriele Cruciani, Mineko Terao, Enrico Garattini.
      The role played by lipids in the process of granulocytic differentiation activated by all-trans retinoic acid (ATRA) in Acute-Promyelocytic-Leukemia (APL) blasts is unknown. The process of granulocytic differentiation activated by ATRA in APL blasts is recapitulated in the NB4 cell-line, which is characterized by expression of the pathogenic PML-RARα fusion protein. In the present study, we used the NB4 model to define the effects exerted by ATRA on lipid homeostasis. Using a high-throughput lipidomic approach, we demonstrate that exposure of the APL-derived NB4 cell-line to ATRA causes an early reduction in the amounts of cardiolipins, a major lipid component of the mitochondrial membranes. The decrease in the levels of cardiolipins results in a concomitant inhibition of mitochondrial activity. These ATRA-dependent effects are causally involved in the granulocytic maturation process. In fact, the ATRA-induced decrease of cardiolipins and the concomitant dysfunction of mitochondria precede the differentiation of retinoid-sensitive NB4 cells and the two phenomena are not observed in the retinoid-resistant NB4.306 counterparts. In addition, ethanolamine induced rescue of the mitochondrial dysfunction activated by cardiolipin deficiency inhibits ATRA-dependent granulocytic differentiation and induction of the associated autophagic process. The RNA-seq studies performed in parental NB4 cells and a NB4-derived cell population, characterized by silencing of the autophagy mediator, ATG5, provide insights into the mechanisms underlying the differentiating action of ATRA. The results indicate that ATRA causes a significant down-regulation of CRLS1 (Cardiolipin-synthase-1) and LPCAT1 (Lysophosphatidylcholine-Acyltransferase-1) mRNAs which code for two enzymes catalyzing the last steps of cardiolipin synthesis. ATRA-dependent down-regulation of CRLS1 and LPCAT1 mRNAs is functionally relevant, as it is accompanied by a significant decrease in the amounts of the corresponding proteins. Furthermore, the decrease in CRLS1 and LPCAT1 levels requires activation of the autophagic process, as down-regulation of the two proteins is blocked in ATG5-silenced NB4-shATG5 cells.
    DOI:  https://doi.org/10.1038/s41419-021-04476-z
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