Chemogenomic Landscape of RUNX1-Mutated AML Reveals Importance of RUNX1 Allele Dosage in Genetics and Glucocorticoid Sensitivity
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Published OnlineFirst August 30, 2017; DOI: 10.1158/1078-0432.CCR-17-1259 Cancer Therapy: Preclinical Clinical Cancer Research Chemogenomic Landscape of RUNX1-mutated AML Reveals Importance of RUNX1 Allele Dosage in Genetics and Glucocorticoid Sensitivity Laura Simon1, Vincent-Philippe Lavallee 1,2, Marie-Eve Bordeleau1, Jana Krosl1, Irene Baccelli1, Genevieve Boucher1, Bernhard Lehnertz1, Jalila Chagraoui1, Tara MacRae1,Rejean Ruel1, Yves Chantigny1,Sebastien Lemieux1,3, Anne Marinier1,4, Josee Hebert 1,2,5,6, and Guy Sauvageau1,2,5,6 Abstract Purpose: RUNX1-mutated (RUNX1mut) acute myeloid leuke- more homogeneous gene expression profile. Chemical screening mia (AML) is associated with adverse outcome, highlighting the revealed that most RUNX1mut specimens are sensitive to gluco- urgent need for a better genetic characterization of this AML corticoids (GCs) and we confirmed that GCs inhibit AML cell subgroup and for the design of efficient therapeutic strategies for proliferation through their interaction with the glucocorticoid this disease. Toward this goal, we further dissected the mutational receptor (GR). We observed that specimens harboring RUNX1 spectrum and gene expression profile of RUNX1mut AML and mutations expected to result in low residual RUNX1 activity are correlated these results to drug sensitivity to identify novel com- most sensitive to GCs, and that coassociating mutations as well as pounds targeting this AML subgroup. GR levels contribute to GC sensitivity. Accordingly, acquired Experimental Design: RNA-sequencing of 47 RUNX1mut pri- glucocorticoid sensitivity was achieved by negatively regulating mary AML specimens was performed and sequencing results were RUNX1 expression in human AML cells. compared to those of RUNX1 wild-type samples. Chemical screens Conclusions: Our findings show the profound impact of were also conducted using RUNX1mut specimens to identify com- RUNX1 allele dosage on gene expression profile and glucocorti- pounds selectively affecting the viability of RUNX1mut AML. coid sensitivity in AML, thereby opening opportunities for pre- Results: We show that samples with no remaining RUNX1 clinical testing which may lead to drug repurposing and improved wild-type allele are clinically and genetically distinct and display a disease characterization. Clin Cancer Res; 1–13. Ó2017 AACR. Introduction heterodimerization (3). The C-terminal region of the protein encompasses domains for nuclear localization and regulation of RUNX1 is a master regulator of definitive hematopoiesis where DNA binding (4), as well as for the interaction with lineage- it regulates the differentiation of myeloid, megakaryocytic, and specific transcription factors, transcriptional coactivators, and lymphocytic lineage progenitors (1, 2). RUNX1 is part of the core corepressors. binding factor (CBF) transcriptional complex, and its transcrip- Anomalies involving the RUNX1 gene or its partner CBFB have tional activity is dependent on the recruitment of its heterodi- been implicated in the pathogenesis of subsets of human myeloid meric partner, CBFB. RUNX1 contains a RUNT domain at its N- and lymphoblastic leukemias (5). The RUNX1 and CBFB genes are terminus that is responsible for both DNA binding and protein involved in the t(8;21)(q22;q22) and inv(16)(p13.1q22) chro- mosomal rearrangements, respectively, and these entities consti- tute the CBF acute myeloid leukemia (AML) subgroup (6, 7). 1The Leucegene Project at Institute for Research in Immunology and Cancer, Universite de Montreal, Montreal, Quebec, Canada. 2Division of Hematology, Prognosis is favorable for patients carrying these cytogenetic Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada. 3Department of anomalies when compared with other AML subtypes (8). In Computer Science and Operations Research, Universite de Montreal, Montreal, addition to chromosomal rearrangements, mutations in the Canada. 4Department of Chemistry, Universite de Montreal, Montreal, Canada. RUNX1 gene are also found in myelodysplastic syndrome (MDS) 5Leukemia Cell Bank of Quebec, Maisonneuve-Rosemont Hospital, Montreal, and in 10%–21% of AMLs where they are associated with French- 6 Canada. Department of Medicine, Faculty of Medicine, Universite de Montreal, American-British (FAB) M0 morphology (9–11). In contrast to Montreal, Canada. CBF AMLs, RUNX1mut AMLs are associated with adverse outcome Note: Supplementary data for this article are available at Clinical Cancer (11–17). In a large proportion of cases, RUNX1mut AMLs harbor Research Online (http://clincancerres.aacrjournals.org/). normal karyotype or noncomplex chromosomal imbalances, Corresponding Authors: Guy Sauvageau, Institute for Research in Immunology with a frequent association with trisomy 13 (12–15). RUNX1 and Cancer (IRIC), P.O. Box 6128, Downtown Station, Montreal, Quebec H3C 3J7, mutations are also generally mutually exclusive of recurrent Canada. Phone: 514-343-7134; Fax: 514-343-5839; E-mail: translocations in AML, and mutational analyses using targeted [email protected]; and Josee Hebert, [email protected] approaches revealed that RUNX1 mutations cooccur with muta- doi: 10.1158/1078-0432.CCR-17-1259 tions in epigenetic modifiers, such as ASXL1, splicing factors, Ó2017 American Association for Cancer Research. STAG2, BCOR, and PHF6 (14, 17). Microarray analysis has been www.aacrjournals.org OF1 Downloaded from clincancerres.aacrjournals.org on September 28, 2021. © 2017 American Association for Cancer Research. Published OnlineFirst August 30, 2017; DOI: 10.1158/1078-0432.CCR-17-1259 Simon et al. org/iric-soft/km) approaches according to the previously reported Translational Relevance pipeline (23). All variants present in 97 genes mutated in myeloid This study characterized the effect of RUNX1 allele dosage cancers or in acute leukemias were investigated (Supplementary on the gene expression profile and glucocorticoid sensitivity of Table S1). Genes and positions from Supplementary Table S5 primary RUNX1mut AML specimens. Our findings suggest a were also investigated by km approach described previously, using new role for RUNX1 in the glucocorticoid response and a 5% variant allele frequency (VAF) cutoff for missense and support the rationale to evaluate the addition of glucocorti- nonsense mutations as well as for indels confirmed by another coids in preclinical models of RUNX1mut AML. approach, of 10% for other indels. RUNX1 longest isoform (NM_001754/NP_001745.2) was used for representations. Primary AML cell culture and chemical screens RUNX1 – Freshly thawed primary AML specimens were used for chemical used to derive a mutation associated gene expression signature (17), however, a complete assessment of the mutational screens. Cryopreserved cells were thawed at 37 C in Iscove's fi and gene expression landscape of RUNX1mut AML is lacking. modi ed Dulbecco's medium (IMDM) containing 20% FBS and m Two types of mutations in RUNX1 have been described in AML: DNase I (100 g/mL). Cells were resuspended in IMDM supple- missense mutations found in the RUNT domain and nonsense or mented with 15% BIT (BSA, insulin, transferrin; StemCell Tech- frameshift mutations distributed throughout the entire gene. nologies), 100 ng/mL stem cell factor (Shenandoah 100-04), Some frameshift mutations located in the C-terminal region 50 ng/mL FLT3L (Shenandoah), 20 ng/mL IL3 (Shenandoah), À4 b produce elongated versions of the protein with intact DNA- 20 ng/mL G-CSF (Shenandoah), 10 mol/L -mercaptoethanol, m fl m binding activity that retain the ability to heterodimerize with gentamicin (50 g/mL), cipro oxacin (10 g/mL), SR1 CBFB, and that are believed to act as dominant negatives (10, 12, (500 nmol/L, Alichem), and UM729 (500 nmol/L, IRIC) and m 15, 18). Approximately 30% of RUNX1 mutations occur in 5,000 cells were plated per well of 384-well white plates in 50 L. combination (i.e., double heterozygosity) or are associated with Compounds were dissolved in DMSO and diluted in media a loss of heterozygosity, both of which lead to a complete loss of immediately before use. Compounds were added to plated cells fi wild-type RUNX1 in these leukemias (15). In line with this, it has by Biomek automatic pipettor at a nal DMSO concentration of been proposed that the greater the extent of RUNX1 inactivation 0.1%. Glucocorticoids were tested in the exploratory screen at m in hematopoietic cells, the higher the propensity to develop single doses of 2.5 mol/L as described previously (24). In the fi leukemia, suggesting a dependence on RUNX1 protein dosage con rmatory screen, compounds were added in serial dilutions for disease onset (19, 20). (ranging from 10,000 nmol/L to 4.5 nmol/L). Cells were grown in The unique genetic, biological, and clinical features of de novo culture in the presence of compounds for 6 days before deter- AMLs with mutated RUNX1 prompted its suggestion as a distinct mining cell viability using luminescent CellTiter Glo assay entity in the 2016 revision of the World Health Organization (Promega). Absolute IC50 values were calculated using Activity- (WHO) classification of myeloid neoplasms (21). The poor Base SARview Suite. For cases where compounds failed to inhibit outcome of patients suffering from RUNX1mut leukemias high- AML cell survival/proliferation, IC50 values were reported as the lights the need to better understand the genetics of this disease and highest concentration tested (10,000 nmol/L). Compounds that to develop more specific and efficient therapeutic strategies. In this showed more than 50% inhibition