Faculty, Staff and Student Publications

Publication Date

6-18-2024

Journal

Cell Reports Medicine

DOI

10.1016/j.xcrm.2024.101585

PMID

38781960

PMCID

PMC11228590

PubMedCentral® Posted Date

May 2024

PubMedCentral® Full Text Version

Post-print

Abstract

RAS pathway mutations, which are present in 30% of patients with chronic myelomonocytic leukemia (CMML) at diagnosis, confer a high risk of resistance to and progression after hypomethylating agent (HMA) therapy, the current standard of care for the disease. Here, using single-cell, multi-omics technologies, we seek to dissect the biological mechanisms underlying the initiation and progression of RAS pathway-mutated CMML. We identify that RAS pathway mutations induce transcriptional reprogramming of hematopoietic stem and progenitor cells (HSPCs) and downstream monocytic populations in response to cell-intrinsic and -extrinsic inflammatory signaling that also impair the functions of immune cells. HSPCs expand at disease progression after therapy with HMA or the BCL2 inhibitor venetoclax and rely on the NF-κB pathway effector MCL1 to maintain survival. Our study has implications for the development of therapies to improve the survival of patients with RAS pathway-mutated CMML.

Keywords

Leukemia, Myelomonocytic, Chronic, Myeloid Cell Leukemia Sequence 1 Protein, Humans, Apoptosis, Animals, Mutation, Mice, Signal Transduction, Hematopoietic Stem Cells, Disease Progression, Sulfonamides, NF-kappa B, DNA Methylation, Bridged Bicyclo Compounds, Heterocyclic, Blast Crisis

Published Open-Access

yes

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