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Catalano G, Zaza A, Banella C, Pelosi E, Castelli G, de Marinis E, Smigliani A, Travaglini S, Ottone T, Divona M, Del Principe MI, Buccisano F, Maurillo L, Ammatuna E, Testa U, Nervi C, Venditti A, Voso MT, Noguera NI. MCL1 regulates AML cells metabolism via direct interaction with HK2. Metabolic signature at onset predicts overall survival in AMLs' patients. Leukemia 2023; 37:1600-1610. [PMID: 37349598 DOI: 10.1038/s41375-023-01946-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 05/31/2023] [Accepted: 06/14/2023] [Indexed: 06/24/2023]
Abstract
We characterize the metabolic background in distinct Acute Myeloid Leukemias (AMLs), by comparing the metabolism of primary AML blasts isolated at diagnosis with that of normal hematopoietic maturing progenitors, using the Seahorse XF Agilent. Leukemic cells feature lower spare respiratory (SRC) and glycolytic capacities as compared to hematopoietic precursors (i.e. day 7, promyelocytes). According with Proton Leak (PL) values, AML blasts can be grouped in two well defined populations. The AML group with blasts presenting high PL or high basal OXPHOS plus high SRC levels had shorter overall survival time and significantly overexpressed myeloid cell leukemia 1 (MCL1) protein. We demonstrate that MCL1 directly binds to Hexokinase 2 (HK2) on the outer mitochondrial membrane (OMM). Overall, these results suggest that high PL and high SRC plus high basal OXPHOS levels at disease onset, arguably with the concourse of MCL1/HK2 action, are significantly linked with shorter overall survival time in AML. Our data describe a new function for MCL1 protein in AMLs' cells: by forming a complex with HK2, MCL1 co-localizes to VDAC on the OMM, thus inducing glycolysis and OXPHOS, ultimately conferring metabolic plasticity and promoting resistance to therapy.
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Affiliation(s)
- Gianfranco Catalano
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- Santa Lucia Foundation, I.R.C.C.S. Via del Fosso di Fiorano, Rome, Italy
| | - Alessandra Zaza
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- Santa Lucia Foundation, I.R.C.C.S. Via del Fosso di Fiorano, Rome, Italy
| | - Cristina Banella
- Santa Lucia Foundation, I.R.C.C.S. Via del Fosso di Fiorano, Rome, Italy
- Department of Health Sciences, University of Florence and Meyer Children's University Hospital, Florence, Italy
| | - Elvira Pelosi
- Department of Hematology, Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Germana Castelli
- Department of Hematology, Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Elisabetta de Marinis
- Department of Medical and Surgical Sciences and Biotechnologies, University of Roma La Sapienza, Rome, Italy
| | - Ariela Smigliani
- Santa Lucia Foundation, I.R.C.C.S. Via del Fosso di Fiorano, Rome, Italy
| | - Serena Travaglini
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- Santa Lucia Foundation, I.R.C.C.S. Via del Fosso di Fiorano, Rome, Italy
| | - Tiziana Ottone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- Santa Lucia Foundation, I.R.C.C.S. Via del Fosso di Fiorano, Rome, Italy
| | - Mariadomenica Divona
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | - Francesco Buccisano
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Luca Maurillo
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Emanuele Ammatuna
- Department of Hematology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ugo Testa
- Department of Hematology, Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Clara Nervi
- Department of Hematology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Adriano Venditti
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Maria Teresa Voso
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
- Santa Lucia Foundation, I.R.C.C.S. Via del Fosso di Fiorano, Rome, Italy.
| | - Nelida Ines Noguera
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
- Santa Lucia Foundation, I.R.C.C.S. Via del Fosso di Fiorano, Rome, Italy.
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Banella C, Catalano G, Travaglini S, Pelosi E, Ottone T, Zaza A, Guerrera G, Angelini DF, Niscola P, Divona M, Battistini L, Screnci M, Ammatuna E, Testa U, Nervi C, Voso MT, Noguera NI. Ascorbate Plus Buformin in AML: A Metabolic Targeted Treatment. Cancers (Basel) 2022; 14:cancers14102565. [PMID: 35626170 PMCID: PMC9139619 DOI: 10.3390/cancers14102565] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/17/2022] [Accepted: 05/20/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary Acute Myeloid Leukemias (AMLs) are rapidly progressive clonal neoplastic diseases. The overall 5-year survival rate is very poor: less than 5% in older patients aged over 65 years old. Elderly AML patients are often “unfit” for intensive chemotherapy, further highlighting the need of highly effective, well-tolerated new treatment options for AMLs. Growing evidence indicates that AML blasts feature a highly diverse and flexible metabolism consistent with the aggressiveness of the disease. Based on these evidences, we targeted the metabolic peculiarity and plasticity of AML cells with an association of ascorbate, which causes oxidative stress and interferes with hexokinase activity, and buformin, which completely shuts down mitochondrial contributions in ATP production. The ascorbate–buformin combination could be an innovative therapeutic option for elderly AML patients that are resistant to therapy. Abstract In the present study, we characterized the metabolic background of different Acute Myeloid Leukemias’ (AMLs) cells and described a heterogeneous and highly flexible energetic metabolism. Using the Seahorse XF Agilent, we compared the metabolism of normal hematopoietic progenitors with that of primary AML blasts and five different AML cell lines. We assessed the efficacy and mechanism of action of the association of high doses of ascorbate, a powerful oxidant, with the metabolic inhibitor buformin, which inhibits mitochondrial complex I and completely shuts down mitochondrial contributions in ATP production. Primary blasts from seventeen AML patients, assayed for annexin V and live/dead exclusion by flow cytometry, showed an increase in the apoptotic effect using the drug combination, as compared with ascorbate alone. We show that ascorbate inhibits glycolysis through interfering with HK1/2 and GLUT1 functions in hematopoietic cells. Ascorbate combined with buformin decreases mitochondrial respiration and ATP production and downregulates glycolysis, enhancing the apoptotic effect of ascorbate in primary blasts from AMLs and sparing normal CD34+ bone marrow progenitors. In conclusion, our data have therapeutic implications especially in fragile patients since both agents have an excellent safety profile, and the data also support the clinical evaluation of ascorbate–buformin in association with different mechanism drugs for the treatment of refractory/relapsing AML patients with no other therapeutic options.
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Affiliation(s)
- Cristina Banella
- Neurooncoemtology Units, Santa Lucia Foundation, I.R.C.C.S., 00143 Rome, Italy; (C.B.); (G.C.); (S.T.); (T.O.); (A.Z.)
- Department of Health Sciences, Meyer Children’s University Hospital, 50139 Florence, Italy
| | - Gianfranco Catalano
- Neurooncoemtology Units, Santa Lucia Foundation, I.R.C.C.S., 00143 Rome, Italy; (C.B.); (G.C.); (S.T.); (T.O.); (A.Z.)
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Serena Travaglini
- Neurooncoemtology Units, Santa Lucia Foundation, I.R.C.C.S., 00143 Rome, Italy; (C.B.); (G.C.); (S.T.); (T.O.); (A.Z.)
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Elvira Pelosi
- Department of Hematology, Oncology and Molecular Medicine, Istituto Superiore di Sanità, 00161 Rome, Italy; (E.P.); (U.T.)
| | - Tiziana Ottone
- Neurooncoemtology Units, Santa Lucia Foundation, I.R.C.C.S., 00143 Rome, Italy; (C.B.); (G.C.); (S.T.); (T.O.); (A.Z.)
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Alessandra Zaza
- Neurooncoemtology Units, Santa Lucia Foundation, I.R.C.C.S., 00143 Rome, Italy; (C.B.); (G.C.); (S.T.); (T.O.); (A.Z.)
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Gisella Guerrera
- Neuroimmunology and Flow Cytometry Units, Santa Lucia Foundation, I.R.C.C.S., 00143 Rome, Italy; (G.G.); (D.F.A.); (L.B.)
| | - Daniela Francesca Angelini
- Neuroimmunology and Flow Cytometry Units, Santa Lucia Foundation, I.R.C.C.S., 00143 Rome, Italy; (G.G.); (D.F.A.); (L.B.)
| | - Pasquale Niscola
- Hematology Unit, Saint’ Eugenio Hospital, University of Rome Tor Vergata, 00144 Rome, Italy;
| | | | - Luca Battistini
- Neuroimmunology and Flow Cytometry Units, Santa Lucia Foundation, I.R.C.C.S., 00143 Rome, Italy; (G.G.); (D.F.A.); (L.B.)
| | - Maria Screnci
- Banca Regionale Sangue Cordone Ombelicale UOC Immunoematologia e Medicina Trasfusionale, Policlinico Umberto I, 00161 Roma, Italy;
| | - Emanuele Ammatuna
- Department of Hematology, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands;
| | - Ugo Testa
- Department of Hematology, Oncology and Molecular Medicine, Istituto Superiore di Sanità, 00161 Rome, Italy; (E.P.); (U.T.)
| | - Clara Nervi
- Department of Medical and Surgical Sciences and Biotechnologies, University of Roma La Sapienza, 04100 Latina, Italy;
| | - Maria Teresa Voso
- Neurooncoemtology Units, Santa Lucia Foundation, I.R.C.C.S., 00143 Rome, Italy; (C.B.); (G.C.); (S.T.); (T.O.); (A.Z.)
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
- Correspondence: (M.T.V.); (N.I.N.); Tel.: +39-06-501-703-225 (N.I.N.)
| | - Nelida Ines Noguera
- Neurooncoemtology Units, Santa Lucia Foundation, I.R.C.C.S., 00143 Rome, Italy; (C.B.); (G.C.); (S.T.); (T.O.); (A.Z.)
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
- Correspondence: (M.T.V.); (N.I.N.); Tel.: +39-06-501-703-225 (N.I.N.)
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