Integrated drug profiling and CRISPR screening identify BCR::ABL1-independent vulnerabilities in chronic myeloid leukemia

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  • Shady Adnan Awad
  • Olli Dufva
  • Jay Klievink
  • Ella Karjalainen
  • Aleksandr Ianevski
  • Paavo Pietarinen
  • Daehong Kim
  • Swapnil Potdar
  • Maija Wolf
  • Kourosh Lotfi
  • Tero Aittokallio
  • Wennerberg, Krister
  • Kimmo Porkka
  • Satu Mustjoki

BCR::ABL1-independent pathways contribute to primary resistance to tyrosine kinase inhibitor (TKI) treatment in chronic myeloid leukemia (CML) and play a role in leukemic stem cell persistence. Here, we perform ex vivo drug screening of CML CD34+ leukemic stem/progenitor cells using 100 single drugs and TKI-drug combinations and identify sensitivities to Wee1, MDM2, and BCL2 inhibitors. These agents effectively inhibit primitive CD34+CD38 CML cells and demonstrate potent synergies when combined with TKIs. Flow-cytometry-based drug screening identifies mepacrine to induce differentiation of CD34+CD38 cells. We employ genome-wide CRISPR-Cas9 screening for six drugs, and mediator complex, apoptosis, and erythroid-lineage-related genes are identified as key resistance hits for TKIs, whereas the Wee1 inhibitor AZD1775 and mepacrine exhibit distinct resistance profiles. KCTD5, a consistent TKI-resistance-conferring gene, is found to mediate TKI-induced BCR::ABL1 ubiquitination. In summary, we delineate potential mechanisms for primary TKI resistance and non-BCR::ABL1-targeting drugs, offering insights for optimizing CML treatment.

Original languageEnglish
Article number101521
JournalCell Reports Medicine
Volume5
Issue number5
Number of pages24
ISSN2666-3791
DOIs
Publication statusPublished - 2024

Bibliographical note

Publisher Copyright:
© 2024 The Authors

    Research areas

  • BCR::ABL1-independent resistance, CML, CRISPR-Cas9 screening, drug combination, drug repurposing, drug screening, KCTD5, progenitor, stem cell, TKI

ID: 396938349