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Venetoclax with azacitidine disrupts energy metabolism and targets leukemia stem cells in patients with acute myeloid leukemia
- Source :
- Nature Medicine. December, 2018, Vol. 24 Issue 12, 1859
- Publication Year :
- 2018
-
Abstract
- Acute myeloid leukemia (AML) is the most common acute leukemia in adults. Leukemia stem cells (LSCs) drive the initiation and perpetuation of AML, are quantifiably associated with worse clinical outcomes, and often persist after conventional chemotherapy resulting in relapse.sup.1-5. In this report, we show that treatment of older patients with AML with the B cell lymphoma 2 (BCL-2) inhibitor venetoclax in combination with azacitidine results in deep and durable remissions and is superior to conventional treatments. We hypothesized that these promising clinical results were due to targeting LSCs. Analysis of LSCs from patients undergoing treatment with venetoclax + azacitidine showed disruption of the tricarboxylic acid (TCA) cycle manifested by decreased [alpha]-ketoglutarate and increased succinate levels, suggesting inhibition of electron transport chain complex II. In vitro modeling confirmed inhibition of complex II via reduced glutathionylation of succinate dehydrogenase. These metabolic perturbations suppress oxidative phosphorylation (OXPHOS), which efficiently and selectively targets LSCs. Our findings show for the first time that a therapeutic intervention can eradicate LSCs in patients with AML by disrupting the metabolic machinery driving energy metabolism, resulting in promising clinical activity in a patient population with historically poor outcomes. Targeting of mitochondrial metabolism in combination with BCL-2 inhibition eradicates leukemia stem cells and induces long-lasting responses in patients with acute myeloid leukemia.<br />Author(s): Daniel A. Pollyea [sup.1] , Brett M. Stevens [sup.1] , Courtney L. Jones [sup.1] , Amanda Winters [sup.2] , Shanshan Pei [sup.1] , Mohammad Minhajuddin [sup.1] , Angelo D'Alessandro [...]
- Subjects :
- Venetoclax -- Dosage and administration
Energy metabolism -- Analysis
Azacitidine -- Dosage and administration
Stem cells -- Research
Acute myelocytic leukemia -- Drug therapy -- Research
Medical schools
Chemotherapy
Cancer treatment
Lymphomas
Acute leukemia
Antineoplastic agents
Myeloid leukemia
Non-Hodgkin's lymphomas
Elderly patients
Tumors
Biological sciences
Health
Vidaza (Medication) -- Dosage and administration
Venclexta (Medication) -- Dosage and administration
Subjects
Details
- Language :
- English
- ISSN :
- 10788956
- Volume :
- 24
- Issue :
- 12
- Database :
- Gale General OneFile
- Journal :
- Nature Medicine
- Publication Type :
- Academic Journal
- Accession number :
- edsgcl.573242629
- Full Text :
- https://doi.org/10.1038/s41591-018-0233-1