Malignant Transformation Involving
CXXC4 Mutations Identified in a Leukemic Progression Model of Severe Congenital Neutropenia.
CELL REPORTS MEDICINE 2020;
1:100074. [PMID:
33205068 PMCID:
PMC7659587 DOI:
10.1016/j.xcrm.2020.100074]
[Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/22/2020] [Accepted: 07/24/2020] [Indexed: 12/17/2022]
Abstract
Severe congenital neutropenia (SCN) patients treated with CSF3/G-CSF to alleviate neutropenia frequently develop acute myeloid leukemia (AML). A common pattern of leukemic transformation involves the appearance of hematopoietic clones with CSF3 receptor (CSF3R) mutations in the neutropenic phase, followed by mutations in RUNX1 before AML becomes overt. To investigate how the combination of CSF3 therapy and CSF3R and RUNX1 mutations contributes to AML development, we make use of mouse models, SCN-derived induced pluripotent stem cells (iPSCs), and SCN and SCN-AML patient samples. CSF3 provokes a hyper-proliferative state in CSF3R/RUNX1 mutant hematopoietic progenitors but does not cause overt AML. Intriguingly, an additional acquired driver mutation in Cxxc4 causes elevated CXXC4 and reduced TET2 protein levels in murine AML samples. Expression of multiple pro-inflammatory pathways is elevated in mouse AML and human SCN-AML, suggesting that inflammation driven by downregulation of TET2 activity is a critical step in the malignant transformation of SCN.
Combinatorial CSF3R and RUNX1 mutations seen in SCN-AML do not result in AML in mice
An additional mutation in Cxxc4 causes AML development in CSF3R/RUNX1 mutant mice
Mutant CXXC4 protein is more stable than wild-type and reduces TET2 protein levels
CXXC4 mutations are also found in de novo AML patients
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