Erythroid/megakaryocytic differentiation confers BCL-XL dependency and venetoclax resistance in acute myeloid leukemia

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningfagfællebedømt

  • Heikki Kuusanmäki
  • Olli Dufva
  • Markus Vähä-Koskela
  • Aino-Maija Leppä
  • Jani Huuhtanen
  • Ida Maria Vänttinen
  • Petra Johanna Nygren
  • Jay Klievink
  • Jonas Otto Vilhelm Bouhlal
  • Petri Pölönen
  • Qi Zhang
  • Shady Adnan Awad
  • Cristina Mancebo-Pérez
  • Joseph Saad
  • Juho J Miettinen
  • Komal Kumar Javarappa
  • Sofia Aakko
  • Tanja Ruokoranta
  • Samuli Eldfors
  • Merja Heinäniemi
  • Ulla Wartiovaara-Kautto
  • Mikko A I Keränen
  • Kimmo Porkka
  • Marina Konopleva
  • Mika Kontro
  • Caroline A Heckman
  • Satu Mustjoki

Myeloid neoplasms with erythroid or megakaryocytic differentiation include pure erythroid leukemia (PEL), myelodysplastic syndrome (MDS) with erythroid features, and acute megakaryoblastic leukemia (FAB M7) and are characterized by poor prognosis and limited treatment options. Here, we investigate the drug sensitivity landscape of these rare malignancies. We show that acute myeloid leukemia (AML) cells with erythroid or megakaryocytic differentiation depend on the anti-apoptotic protein BCL-XL, rather than BCL-2, using combined ex vivo drug sensitivity testing, genetic perturbation, and transcriptomic profiling. High-throughput screening of > 500 compounds identified the BCL-XL-selective inhibitor A-1331852 and navitoclax as highly effective against erythroid/megakaryoblastic leukemia cell lines. In contrast, these AML subtypes were resistant to the BCL-2 inhibitor venetoclax used clinically in the treatment of AML. Consistently, genome-scale CRISPR-Cas9 and RNAi screening data demonstrated striking essentiality of BCL2L1 encoding BCL-XL, but not BCL2 or MCL1, for the survival of erythroid/megakaryoblastic leukemia cell lines. Single-cell and bulk transcriptomics of patient samples with erythroid and megakaryoblastic leukemias identified high BCL2L1 expression compared to other subtypes of AML and other hematological malignancies, where BCL2 and MCL1 were more prominent. BCL-XL inhibition effectively killed blasts in AML patient samples with erythroid or megakaryocytic differentiation ex vivo and reduced tumor burden in a mouse erythroleukemia xenograft model. Combining BCL-XL inhibitor with the JAK inhibitor ruxolitinib showed synergistic and durable responses in cell lines. Our results suggest targeting BCL-XL as a potential therapy option in erythroid/megakaryoblastic leukemias and highlight an AML subgroup with potentially reduced sensitivity to venetoclax-based treatments.

Udgave nummer13
Sider (fra-til)1610-1625
StatusUdgivet - 2023

Bibliografisk note

Copyright © 2022 American Society of Hematology.

ID: 329097452