Combined immune and DDR pathway classifier: A novel pathway-based classification aimed at tailoring personalized therapies for acute myeloid leukemia patients

Acute myeloid leukemia (AML) constitutes a group of lethal hematological malignancies with high heterogeneity, resulting in widely variable outcomes of targeted therapy and immunotherapy. A better basic understanding of the molecular pathways of AML would help greatly in tailoring treatments to patients. Here, we propose a novel subtyping protocol for AML combination therapy. Three datasets, namely, the TCGA-LAML, BeatAML and Leucegene datasets, were used in this study. Single-sample GSEA (ssGSEA) was performed to calculate the expression scores of 15 pathways, including immune-related, stromal-related, DNA damage repair (DDR)-related and oncogenic pathways. The consensus clustering was used to classify AML based on pathway score data. We identified four phenotypic clusters-IM+DDR-, IM-DDR-, IM-DDR+ and IM+DDR+-representing distinct pathway expression profiles. The IM+DDR- subtype exhibited the most robust immune function, and patients of IM+DDR- subtype were likely to derive the greatest benefit from immunotherapy. Patients in IM+DDR+ subtype had the second highest immune scores and the highest DDR scores, suggesting that combination therapy (immune + DDR-targeted therapy) is the optimal treatment. For patients of IM-DDR- subtype, we recommend the combination of venetoclax and PHA-665752. A-674563 and dovitinib could be combined with DDR inhibitors to treat patients in IM-DDR+ subtype. Moreover, single-cell analysis revealed that there are more immune cells clustered in the IM+DDR- subtype and higher number of monocyte-like cells, which exert immunosuppressive effects, in the IM+DDR+ subtype. These findings can be applied for molecular stratification of patients and might contribute to the development of personalized targeted therapies for AML.

DNA and histone modifications as potent diagnostic and therapeutic targets to advance non-small cell lung cancer management from the perspective of 3P medicine

Lung cancer has a very high mortality in females and males. Most (~ 85%) of lung cancers are non-small cell lung cancers (NSCLC). When lung cancer is diagnosed, most of them have either local or distant metastasis, with a poor prognosis. In order to achieve better outcomes, it is imperative to identify the molecular signature based on genetic and epigenetic variations for different NSCLC subgroups. We hypothesize that DNA and histone modifications play significant roles in the framework of predictive, preventive, and personalized medicine (PPPM; 3P medicine). Epigenetics has a significant impact on tumorigenicity, tumor heterogeneity, and tumor resistance to chemotherapy, targeted therapy, and immunotherapy. An increasing interest is that epigenomic regulation is recognized as a potential treatment option for NSCLC. Most attention has been paid to the epigenetic alteration patterns of DNA and histones. This article aims to review the roles DNA and histone modifications play in tumorigenesis, early detection and diagnosis, and advancements and therapies of NSCLC, and also explore the connection between DNA and histone modifications and PPPM, which may provide an important contribution to improve the prognosis of NSCLC. We found that the success of targeting DNA and histone modifications is limited in the clinic, and how to combine the therapies to improve patient outcomes is necessary in further studies, especially for predictive diagnostics, targeted prevention, and personalization of medical services in the 3P medicine approach. It is concluded that DNA and histone modifications are potent diagnostic and therapeutic targets to advance non-small cell lung cancer management from the perspective of 3P medicine.