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Mitochondrial inhibitors circumvent adaptive resistance to venetoclax and cytarabine combination therapy in acute myeloid leukemia

机译:线粒体抑制剂规避适应性抵抗venetoclax和阿糖胞苷联合治疗在急性髓系白血病

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Therapy resistance represents a major clinical challenge in acute myeloid leukemia (AMD. 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, pyru-vate dehydrogenase inhibitors or mitochondrial CIpP 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.
机译:代表一个主要临床治疗阻力在急性髓系白血病(AMD的挑战。定义一个“MitoScore”签名,标识高线粒体氧化磷酸化体内和AML患者。与阿糖胞苷(AraC)电阻和高MitoScore依靠线粒体Bcl2和高度敏感venetoclax (VEN) + AraC(但不要VEN + azacytidine)。转录组VEN + AraC-residual细胞数量显示自适应抗与氧化的变化有关电子传递链磷酸化,复杂和TP53的途径。与电子VEN + AraC-resistant AML细胞传递链复杂的抑制剂,pyru-vate脱氢酶抑制剂或CIpP线粒体蛋白酶受体激动剂显著延迟复发后VEN + AraC。线粒体适应的核心作用在AML治疗和提供科学理由交替VEN + azacytidineVEN + AraC高MitoScore和患者针对线粒体代谢增强灵敏度的AML细胞目前批准疗法。

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