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Background. Recent pathomolecular studies on the MLL-AF4 fusion protein revealed that the murinized version of MLL-AF4, the MLL-Af4 fusion protein, was able to induce leukemia when expressed in murine or human hematopoietic stem/progenitor cells (Lin et al. in Cancer Cell 30:737–749, 2016). In parallel, a group from Japan demonstrated that the pSer domain of the AF4 protein, as well as the pSer domain of the MLL-AF4 fusion is able to bind the Pol I transcription factor complex SL1 (Okuda et al. in Nat Commun 6:8869, 2015). Here, we investigated the human MLL-AF4 and a pSer-murinized version thereof for their functional properties in mammalian cells. Gene expression profiling studies were complemented by intracellular localization studies and functional experiments concerning their biological activities in the nucleolus.
Results: Based on our results, we have to conclude that MLL-AF4 is predominantly localizing inside the nucleolus, thereby interfering with Pol I transcription and ribosome biogenesis. The murinized pSer-variant is localizing more to the nucleus, which may suggest a different biological behavior. Of note, AF4-MLL seems to cooperate at the molecular level with MLL-AF4 to steer target gene transcription, but not with the pSer-murinized version of it.
Conclusion: This study provides new insights and a molecular explanation for the described differences between hMLL-hAF4 (not leukemogenic) and hMLL-mAf4 (leukemogenic). While the human pSer domain is able to efficiently recruit the SL1 transcription factor complex, the murine counterpart seems to be not. This has several consequences for our understanding of t(4;11) leukemia which is the most frequent leukemia in infants, childhood and adults suffering from MLL-r acute leukemia.
The KMT2A (MLL) gene rearrangements (KMT2A-r) are associated with a diverse spectrum of acute leukemias. Although most KMT2A-r are restricted to nine partner genes, we have recently revealed that KMT2A-USP2 fusions are often missed during FISH screening of these genetic alterations. Therefore, complementary methods are important for appropriate detection of any KMT2A-r. Here we use a machine learning model to unravel the most appropriate markers for prediction of KMT2A-r in various types of acute leukemia. A Random Forest and LightGBM classifier was trained to predict KMT2A-r in patients with acute leukemia. Our results revealed a set of 20 genes capable of accurately estimating KMT2A-r. The SKIDA1 (AUC: 0.839; CI: 0.799–0.879) and LAMP5 (AUC: 0.746; CI: 0.685–0.806) overexpression were the better markers associated with KMT2A-r compared to CSPG4 (also named NG2; AUC: 0.722; CI: 0.659–0.784), regardless of the type of acute leukemia. Of importance, high expression levels of LAMP5 estimated the occurrence of all KMT2A-USP2 fusions. Also, we performed drug sensitivity analysis using IC50 data from 345 drugs available in the GDSC database to identify which ones could be used to treat KMT2A-r leukemia. We observed that KMT2A-r cell lines were more sensitive to 5-Fluorouracil (5FU), Gemcitabine (both antimetabolite chemotherapy drugs), WHI-P97 (JAK-3 inhibitor), Foretinib (MET/VEGFR inhibitor), SNX-2112 (Hsp90 inhibitor), AZD6482 (PI3Kβ inhibitor), KU-60019 (ATM kinase inhibitor), and Pevonedistat (NEDD8-activating enzyme (NAE) inhibitor). Moreover, IC50 data from analyses of ex-vivo drug sensitivity to small-molecule inhibitors reveals that Foretinib is a promising drug option for AML patients carrying FLT3 activating mutations. Thus, we provide novel and accurate options for the diagnostic screening and therapy of KMT2A-r leukemia, regardless of leukemia subtype.
The human 5-lipoxygenase (5-LO), encoded by the ALOX5 gene, is the key enzyme in the formation of pro-inflammatory leukotrienes. ALOX5 gene transcription is strongly stimulated by calcitriol (1α, 25-dihydroxyvitamin D3) and TGFβ (transforming growth factor-β). Here, we investigated the influence of MLL (activator of transcript initiation), AF4 (activator of transcriptional elongation) as well as of the leukemogenic fusion proteins MLL-AF4 (ectopic activator of transcript initiation) and AF4-MLL (ectopic activator of transcriptional elongation) on calcitriol/TGFβ-dependent 5-LO transcript elongation. We present evidence that the AF4 complex directly interacts with the vitamin D receptor (VDR) and promotes calcitriol-dependent ALOX5 transcript elongation. Activation of transcript elongation was strongly enhanced by the AF4-MLL fusion protein but was sensitive to Flavopiridol. By contrast, MLL-AF4 displayed no effect on transcriptional elongation. Furthermore, HDAC class I inhibitors inhibited the ectopic effects caused by AF4-MLL on transcriptional elongation, suggesting that HDAC class I inhibitors are potential therapeutics for the treatment of t(4;11)(q21;q23) leukemia.
Chromosomal rearrangements of the human MLL (mixed lineage leukemia) gene are associated with high-risk infant, pediatric, adult and therapy-induced acute leukemias. We used long-distance inverse-polymerase chain reaction to characterize the chromosomal rearrangement of individual acute leukemia patients. We present data of the molecular characterization of 1590 MLL-rearranged biopsy samples obtained from acute leukemia patients. The precise localization of genomic breakpoints within the MLL gene and the involved translocation partner genes (TPGs) were determined and novel TPGs identified. All patients were classified according to their gender (852 females and 745 males), age at diagnosis (558 infant, 416 pediatric and 616 adult leukemia patients) and other clinical criteria. Combined data of our study and recently published data revealed a total of 121 different MLL rearrangements, of which 79 TPGs are now characterized at the molecular level. However, only seven rearrangements seem to be predominantly associated with illegitimate recombinations of the MLL gene (~ 90%): AFF1/AF4, MLLT3/AF9, MLLT1/ENL, MLLT10/AF10, ELL, partial tandem duplications (MLL PTDs) and MLLT4/AF6, respectively. The MLL breakpoint distributions for all clinical relevant subtypes (gender, disease type, age at diagnosis, reciprocal, complex and therapy-induced translocations) are presented. Finally, we present the extending network of reciprocal MLL fusions deriving from complex rearrangements.
Background: Acute leukemia in early age (EAL) is characterized by acquired genetic alterations such as MLL rearrangements (MLL-r). The aim of this case-controlled study was to investigate whether single nucleotide polymorphisms (SNPs) of IKZF1, ARID5B, and CEBPE could be related to the onset of EAL cases (<24 months-old at diagnosis).
Methods: The SNPs (IKZF1 rs11978267, ARID5B rs10821936 and rs10994982, CEBPE rs2239633) were genotyped in 265 cases [169 acute lymphoblastic leukemia (ALL) and 96 acute myeloid leukaemia (AML)] and 505 controls by Taqman allelic discrimination assay. Logistic regression was used to evaluate the association between SNPs of cases and controls, adjusted on skin color and/or age. The risk was determined by calculating odds ratios (ORs) with 95% confidence interval (CI).
Results: Children with the IKZF1 SNP had an increased risk of developing MLL-germline ALL in white children. The heterozygous/mutant genotype in ARID5B rs10994982 significantly increased the risk for MLL-germline leukemia in white and non-white children (OR 2.60, 95% CI: 1.09-6.18 and OR 3.55, 95% CI: 1.57-8.68, respectively). The heterozygous genotype in ARID5B rs10821936 increased the risk for MLL-r leukemia in both white and non-white (OR 2.06, 95% CI: 1.12-3.79 and OR 2.36, 95% CI: 1.09-5.10, respectively). Furthermore, ARID5B rs10821936 conferred increased risk for MLL-MLLT3 positive cases (OR 7.10, 95% CI:1.54-32.68). Our data do not show evidence that CEBPE rs2239633 confers increased genetic susceptibility to EAL.
Conclusions: IKZF1 and CEBPE variants seem to play a minor role in genetic susceptibility to EAL, while ARID5B rs10821936 increased the risk of MLL-MLLT3. This result shows that genetic susceptibility could be associated with the differences regarding MLL breakpoints and partner genes.
This report describes the clinical courses of two acute myeloid leukemia patients. Both had MLL translocations, the first a t(10;11)(p11.2;q23) with MLL-AF10 and the second a t(11;19)(q23;p13.1) with MLL-ELL fusion. They achieved a clinical remission under conventional chemotherapy but relapsed shortly after end of therapy. Both had a history of invasive mycoses (one had possible pulmonary mycosis, one systemic candidiasis). Because no HLA-identical donor was available, a haploidentical transplantation was performed in both cases. Using a specially designed PCR method for the assessment of minimal residual disease (MRD), based on the quantitative detection of the individual chromosomal breakpoint in the MLL gene, all patients achieved complete and persistent molecular remission after transplantation. The immune reconstitution after transplantation is described in terms of total CD3+/CD4+, CD3+/CD8+, CD19+, and CD16+/CD56+ cell numbers over time. The KIR and HLA genotypes of donors and recipients are reported and the possibility of a KIR-mediated alloreactivity is discussed. This report illustrates that haploidentical transplantation may offer a chance of cure without chronic graft-versus-host disease in situations where no suitable HLA-identical donor is available even in a high-risk setting and shows the value of MRD monitoring in the pre- and posttransplant setting.
Chromosomale Aberrationen des humanen MLL Gens (Mixed Lineage Leukemia) sind mit der Entstehung von akuten Leukämien assoziiert. 5-10% aller akuten myeloischen und lymphatischen Leukämien beruhen auf einer Translokation des MLL Gens mit einem von mehr als 50 bekannten Partnergenen. Die reziproke Translokation t(4;11), die zur Entstehung der zwei Fusionsgene MLL/AF4 und AF4/MLL führt, stellt die häufigste genetische Veränderung des MLL Gens dar und prägt sich in Form einer akuten lymphatischen Leukämie aus. Besonders häufig sind von dieser Erkrankung Kleinkinder und Patienten mit einer Sekundärleukämie betroffen. Aufgrund einer ungewöhnlich hohen Resistenz der leukämischen Blasten gegenüber gängigen Therapie-Protokollen ist diese Erkrankung mit einer schlechten Prognose verbunden. Die beiden erzeugten Fusionsgene der t(4;11) werden als Fusionsproteine MLL/AF4 (der11) und AF4/MLL (der4) exprimiert. Transduktionsexperimente verschiedener MLL Translokationen zeigten, dass in vielen Fällen das jeweilige der11 Fusionsprotein (MLL_N/Translokationspartner) starkes onkogenes Potential besitzt und daher vermutlich ursächlich für die Transformation der betroffenen Zellen ist. Im Fall der Translokation t(4;11) hingegen, konnte für das der11 Fusionsprotein MLL/AF4 nur sehr schwaches onkogenes Potential nachgewiesen werden, während das der4 AF4/MLL Fusionsprotein sich als potentes Onkoprotein herausstellte. Untersuchungen zur Aufklärung des pathologischen Mechanismus des AF4/MLL Fusionsproteins zeigten, dass es, analog zum MLL Wildtyp Protein, einer Prozessierung durch die Taspase 1 unterliegt. Desweiteren ist bekannt, dass die gebildeten Proteinfragmente, der4_N und der4_C (MLL_C), über intramolekulare Interaktionsdomänen des MLL Proteins, in der Lage sind miteinander zu komplexieren. In der unprozessierten Form wird das Fusionsprotein über einen Bereich des AF4 Proteins unter Einsatz der E3-Ligasen SIAH 1/2 dem proteasomalen Abbau zugeführt. Nach der Proteolyse und Komplexbildung findet weiterhin eine Erkennung durch die SIAH Proteine statt, jedoch erfolgt keine Degradation mehr. Auf diese Weise kommt es zur Akkumulation des Komplexes, was letztendlich zur Transformation der betroffenen Zellen führt. Eine Möglichkeit dem onkogenen Charakter des AF4/MLL Fusionsproteins entgegen zu wirken, besteht in der Inhibition der Interaktion der zwei Proteinfragmente der4_N und der4_C (=MLL_C). Für eine mögliche Inhibition stellt die Kenntnis der minimalen Kontaktdomäne des MLL Proteins (und damit gleichermaßen des AF4/MLL Proteins) eine Grundvoraussetzung dar. Die grundlegende Aufgabe der vorliegenden Arbeit bestand daher in der Bestimmung des minimalen intramolekularen Interaktionsinterface. Zu diesem Zweck wurden Interaktionsanalysen verschiedener C-terminaler und N-terminaler MLL Proteinfragmente unter Verwendung des bakteriellen Zwei-Hybrid-Systems sowie eines zellbasierten Protein-Translokation-Biosensor-Systems durchgeführt. Dabei ist es gelungen, die Größe der minimalen Interaktionsdomänen von den bis heute publizierten >150 Aminosäuren auf 58 Aminosäuren im N-terminalen Proteinfragment (FYRN_A3) bzw. 56 Aminosäuren im C-terminalen MLL Fragment (FYRC_B3) einzugrenzen. Eine weitere Verkleinerung führte zu einem Stabilitätsverlust der Interaktion. Eine ungewöhnliche Akkumulation einiger C-terminaler MLL Fragmente, die während der Interaktionsstudien beobachtet wurde, führte zu der Hypothese, dass die generierten Fragmente mit dem zellulären Wildtyp MLL interagieren und möglicherweise als Inhibitor der intramolekularen Interaktion agieren können. Zusätzlich wurde bei diesen Transfektionen eine abnorm hohe Anzahl abgestorbener Zellen festgestellt. Dies wäre damit zu erklären, dass das zelluläre MLL, durch Interaktion mit dem kleinen MLL Fragment, nicht mehr in der Lage ist, seinen natürlichen Funktionen nachzukommen. Der Nachweis der Interaktion des minimierten C-terminalen MLL Proteinfragments FYRC_B3 mit den full length Proteinen MLL sowie AF4/MLL konnte über Co-Immunopräzipitationsversuche erbracht werden. Durchflusscytometrische Analysen transfizierter und Propidiumiodid gefärbter HeLa Zellen sowie t(4;11)-positiver SEM Zellen zeigten eindeutig letale Effekte einiger FYRC-Fragmente auf. Anhand dieser Daten kann postuliert werden, dass die Fragmente FYRB_B3 und FYRC_B1 durch Interaktion mit MLL_N bzw. der4_N die Interaktion der nativen Proteinfragmente MLL_N/der4_N mit MLL_C verhindern und dies in der Folge zum Absterben der Zellen führt. Die Tatsache, dass diese Fragmente einen solch deutlichen Effekt auf die sehr therapieresistenten SEM Zellen haben, zeigt, dass die Inhibierung der intramolekularen Proteininteraktion einen vielversprechenden therapeutischen Ansatz für Leukämien mit einer Translokation t(4;11) darstellt.