1. Mitochondrial inhibitors circumvent adaptive resistance to venetoclax and cytarabine combination therapy in acute myeloid leukemia
- Author
-
Jean-Emmanuel Sarry, Thomas Farge, Eléonore Kaphan, Emeline Boet, Francois Vergez, Marie Sabatier, Jérôme Kluza, Nathalie Nicot, Yujue Wang, Andrew H. Wei, Aurélie Bousard, Noémie Gadaud, Pierre-Luc Mouchel, Ambrine Sahal, Nesrine Aroua, Ing Soo Tiong, Nathaniel Polley, Lucille Stuani, Mathilde Gotanègre, Quentin Fovez, Tony Kaoma, Laura Poillet-Perez, Claudie Bosc, Estelle Saland, Marie Tosolini, Guillaume Cognet, Rafael J. Argüello, Florian Rambow, Jean-Jacques Fournié, Christian Recher, Carine Joffre, Clément Larrue, Xiaoyang Su, Jean-Christophe Marine, Jerome Tamburini, Céline Mazzotti, Muriel Picard, Hervé Avet-Loiseau, Florence Cabon, Latifa Jarrou, Centre de Recherches en Cancérologie de Toulouse (CRCT), Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), LabEx Toucan, LabEx Toucan - Toulouse, Leuven Center for Cancer Biology (VIB-KU-CCB), Catholic University of Leuven - Katholieke Universiteit Leuven (KU Leuven)-Vlaams Instituut voor Biotechnologie [Ghent, Belgique] (VIB), Université Toulouse III Paul Sabatier - Faculté de médecine Purpan (UTPS), Université de Toulouse (UT)-Université de Toulouse (UT), Institut Universitaire du Cancer de Toulouse - Oncopole (IUCT Oncopole - UMR 1037), Université de Toulouse (UT)-Université de Toulouse (UT)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de recherche Cardio-Thoracique de Bordeaux [Bordeaux] (CRCTB), Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-Institut National de la Santé et de la Recherche Médicale (INSERM), Pôle Anesthésie Réanimation [CHU de Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Luxembourg Institute of Health (LIH), Rutgers cancer institute of New Jersey [Newark, NJ], Cancer Heterogeneity, Plasticity and Resistance to Therapies - UMR 9020 - U 1277 (CANTHER), Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Centre National de la Recherche Scientifique (CNRS), Centre d'Immunologie de Marseille - Luminy (CIML), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université de Genève = University of Geneva (UNIGE), and The Alfred Hospital and Monash University - Department of Clinical Haematology - Melbourne
- Subjects
Cancer Research ,Combination therapy ,[SDV]Life Sciences [q-bio] ,Cell ,Oxidative phosphorylation ,chemistry.chemical_compound ,In vivo ,hemic and lymphatic diseases ,Medicine ,Humans ,ComputingMilieux_MISCELLANEOUS ,Sulfonamides ,business.industry ,Venetoclax ,Cytarabine ,Myeloid leukemia ,Pyruvate dehydrogenase complex ,Bridged Bicyclo Compounds, Heterocyclic ,carbohydrates (lipids) ,Leukemia, Myeloid, Acute ,medicine.anatomical_structure ,Oncology ,chemistry ,Cancer research ,Azacitidine ,business ,medicine.drug - Abstract
Therapy resistance represents a major clinical challenge in acute myeloid leukemia (AML). Here we define a ‘MitoScore’ signature, which identifies high mitochondrial oxidative phosphorylation in vivo and in patients with AML. Primary AML cells with cytarabine (AraC) resistance and a high MitoScore relied on mitochondrial Bcl2 and were highly sensitive to venetoclax (VEN) + AraC (but not to VEN + azacytidine). Single-cell transcriptomics of VEN + AraC-residual cell populations revealed adaptive resistance associated with changes in oxidative phosphorylation, electron transport chain complex and the TP53 pathway. Accordingly, treatment of VEN + AraC-resistant AML cells with electron transport chain complex inhibitors, pyruvate dehydrogenase inhibitors or mitochondrial ClpP protease agonists substantially delayed relapse following VEN + AraC. These findings highlight the central role of mitochondrial adaptation during AML therapy and provide a scientific rationale for alternating VEN + azacytidine with VEN + AraC in patients with a high MitoScore and to target mitochondrial metabolism to enhance the sensitivity of AML cells to currently approved therapies. Sarry and colleagues demonstrate that adaptive resistance to venetoclax + cytarabine therapy in acute myeloid leukemia relies on mitochondrial respiration and show that combination with electron transport chain complex inhibitors delays relapse in patient-derived xenograft models in vivo.
- Published
- 2021