Overcoming mutational complexity in acute myeloid leukemia by inhibition of critical pathways.

Document Type

Article

Publication Date

10-25-2017

JAX Source

Sci Transl Med 2017 Oct 25; 9(413):eaao1214.

Volume

9

Issue

413

ISSN

1946-6242

PMID

29070697

DOI

https://doi.org/10.1126/scitranslmed.aao1214

Abstract

Numerous variant alleles are associated with human acute myeloid leukemia (AML). However, the same variants are also found in individuals with no hematological disease, making their functional relevance obscure. Through NOD.Cg-Prkdc(scid)Il2rg(tmlWjl)/Sz (NSG) xenotransplantation, we functionally identified preleukemic and leukemic stem cell populations present in FMS-like tyrosine kinase 3 internal tandem duplication-positive (FLT3-ITD)(+) AML patient samples. By single-cell DNA sequencing, we identified clonal structures and linked mutations with in vivo fates, distinguishing mutations permissive of nonmalignant multilineage hematopoiesis from leukemogenic mutations. Although multiple somatic mutations coexisted at the single-cell level, inhibition of the mutation strongly associated with preleukemic to leukemic stem cell transition eliminated AML in vivo. Moreover, concurrent inhibition of BCL-2 (B cell lymphoma 2) uncovered a critical dependence of resistant AML cells on antiapoptotic pathways. Co-inhibition of pathways critical for oncogenesis and survival may be an effective strategy that overcomes genetic diversity in human malignancies. This approach incorporating single-cell genomics with the NSG patient-derived xenograft model may serve as a broadly applicable resource for precision target identification and drug discovery. Sci Transl Med 2017 Oct 25; 9(413):eaao1214.

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