Exploiting Metabolic Vulnerabilities for Personalized Therapy in Acute Myeloid Leukemia Lucille Stuani, Marie Sabatier, Jean-Emmanuel Sarry

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Exploiting Metabolic Vulnerabilities for Personalized Therapy in Acute Myeloid Leukemia Lucille Stuani, Marie Sabatier, Jean-Emmanuel Sarry Exploiting metabolic vulnerabilities for personalized therapy in acute myeloid leukemia Lucille Stuani, Marie Sabatier, Jean-Emmanuel Sarry To cite this version: Lucille Stuani, Marie Sabatier, Jean-Emmanuel Sarry. Exploiting metabolic vulnerabilities for per- sonalized therapy in acute myeloid leukemia. BMC Biology, BioMed Central, 2019, 17 (1), pp.57. 10.1186/s12915-019-0670-4. inserm-02441720 HAL Id: inserm-02441720 https://www.hal.inserm.fr/inserm-02441720 Submitted on 16 Jan 2020 HAL is a multi-disciplinary open access L’archive ouverte pluridisciplinaire HAL, est archive for the deposit and dissemination of sci- destinée au dépôt et à la diffusion de documents entific research documents, whether they are pub- scientifiques de niveau recherche, publiés ou non, lished or not. The documents may come from émanant des établissements d’enseignement et de teaching and research institutions in France or recherche français ou étrangers, des laboratoires abroad, or from public or private research centers. publics ou privés. Stuani et al. BMC Biology (2019) 17:57 https://doi.org/10.1186/s12915-019-0670-4 REVIEW Open Access Exploiting metabolic vulnerabilities for personalized therapy in acute myeloid leukemia Lucille Stuani*, Marie Sabatier and Jean-Emmanuel Sarry* Therefore, more specific and safe therapeutics are ur- Abstract gently needed. One area of high interest and potential is Changes in cell metabolism and metabolic adaptation targeting metabolic and mitochondrial pathways that are are hallmark features of many cancers, including important in AML biology and that may constitute an leukemia, that support biological processes involved Achilles heel of AML cells. This review focuses on meta- into tumor initiation, growth, and response to bolic pathways dysregulated in AML, and especially in therapeutics. The discovery of mutations in key several cytogenetically defined patient subgroups, and metabolic enzymes has highlighted the importance of how targeting these metabolic dependencies impacts metabolism in cancer biology and how these changes proliferation and cell survival in this disease. might constitute an Achilles heel for cancer treatment. In this Review, we discuss the role of metabolic and Major metabolic dysregulations in acute myeloid mitochondrial pathways dysregulated in acute leukemia myeloid leukemia, and the potential of therapeutic Metabolism is altered in most, if not all, cancer cells, re- intervention targeting these metabolic dependencies gardless of the tumor type [4]. A key alteration in cancer on the proliferation, differentiation, stem cell function metabolism is the increase in glucose uptake required to and cell survival to improve patient stratification and satisfy energetic and anabolic demands. It is now well outcomes. established that the metabolic reprogramming under- gone by transformed cells extends far beyond glycolysis and the Warburg effect, and changes in cell metabolism Acute myeloid leukemia (AML) is a heterogeneous have fundamental implications for tumor biology and group of hematological malignancies and represents the therapy [5, 6]. most frequent cause of leukemia-related deaths [1]. It arises from genetic abnormalities in hematopoietic stem Glucose metabolism or progenitor cells, inducing uncontrolled growth and Higher aerobic glycolysis in cancer cells, reported almost an accumulation of abnormal myeloblasts, leading to one century ago by Otto Warburg and known as the bone marrow failure and often death. For the past three Warburg effect [7, 8], has sparked debate over the role decades, standard intensive induction therapy involved a of glycolysis and oxidative phosphorylation in normal combination of cytarabine plus anthracycline cytotoxic and cancer cells. Since Warburg’s discovery and espe- – chemotherapy. Despite a high rate (70 80%) of complete cially during the past 20 years, considerable efforts have remission after standard front-line chemotherapy, the been made to better understand glucose utilization in prognosis remains poor, especially for older patients. cancer cells, in particular to determine if inhibiting This mainly results from the high frequency of distant glycolysis or other glucose-dependent pathways could relapses caused by tumor regrowth initiated by chemore- represent promising therapeutic approaches. It has been sistant leukemic clones after chemotherapy [2, 3]. suggested that AML patients exhibit a high glycolytic metabolism at diagnosis that is potentially associated * Correspondence: [email protected]; [email protected] with favorable outcomes [9], even if the number of Centre de Recherches en Cancérologie de Toulouse, UMR1037, Inserm, patients in this study remains small. Another study re- Université de Toulouse 3 Paul Sabatier, Equipe Labellisée LIGUE 2018, ported that a six-metabolite signature (including F-31037 Toulouse, France © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Stuani et al. BMC Biology (2019) 17:57 Page 2 of 17 pyruvate and lactate) related to the crosstalk between glutamine by the SLC7A5/3A2 transporter and leucine is glycolysis and mitochondria was specifically enriched in required for Rheb-mediated mTOR activation at the lyso- the serum of patients at diagnosis compared to healthy somal surface [73, 74]. Glutamine is a non-essential amino controls and demonstrated prognostic value in cytoge- acid and one of the major carbon sources used by cancer netically normal AML (CN-AML) patients as it could cells for proliferation in vitro [75, 76]. It is also an import- predict poor survival for these patients [10]. Interest- ant nitrogen donor for amino acids and nucleotides and a ingly, deletions of the two glycolytic enzymes PKM2 and major substrate for TCA cycle intermediates as well as LDHA, which catalyze the production of cytosolic pyru- glutamate and aspartate [77–79](Fig.1). Dependence of vate and lactate, respectively, inhibit leukemia initiation leukemic cells on glutamine for tumor growth has been in vivo in AML mice models while preserving normal reported, and knockdown of the glutamine transporter hematopoietic stem cell function [11] (Fig. 1). SLC1A5 abrogates tumor development in mice [72]. Glucose metabolism is also involved in other crucial An approach to extend therapeutic opportunities metabolic pathways such as the pentose phosphate path- beyond glycolysis and glutaminolysis may be found way (PPP) coupled to NADPH production, glutathione/ in the identification of auxotrophic amino acids re- redox recycling, and nucleotide biosynthesis (Fig. 1). quired by AML cells. It has been reported that most Overexpression of glucose-6-phosphate dehydrogenase AML patients are deficient in arginosuccinate (G6PD) has been reported to correlate with an adverse synthetase-1 (ASS1), an enzyme that allows the con- prognosis in an AML cohort [12]. Moreover, in vitro version of citrulline and aspartate into the arginine and in vivo inhibition of 6-phosphogluconate dehydro- precursor argininosuccinate [29](Fig.1). The loss of genase (6PGD) and G6PD demonstrated anti-leukemic ASS1 has been reported in other tumor types where activities and synergized with cytarabine [12–15]. Inhib- it is required to support cell proliferation and nu- ition of 6PGD leads to impaired lipogenesis through re- cleotide synthesis by sustaining the intracellular as- activation of LKB1-AMPK signaling [14]. Sensitivity to partate level [80]. A decrease in ASS1 can also lead G6PD inhibition is driven by mTORC1 activity as to a dependence on arginine, which has been ex- mTORC1 activation leads to glucose addiction in AML. plored as a potential vulnerability in different cancer Inhibition of mTORC1 induces a switch toward oxida- types, including AML [29]. tive metabolism and survival of AML cells [12]. Further- more, the anti-leukemic effects of mTOR inhibitors are Lipid and sterol metabolism enhanced when combined with anti-glycolytic agents, De novo lipid biosynthesis is another metabolic pathway underscoring the strong interconnection between mTOR highly reprogrammed in cancer and leukemic cells, in activity and leukemic metabolism [16]. Better particular to increase biomass. Numerous studies sup- characterization of mTOR-associated metabolic alter- port targeting lipid synthesis for therapeutic benefit [81, ations would help in the design of new combinatory 82]. Inhibition of key lipogenic enzymes, fatty acid syn- therapeutic approaches and/or help distinguish patients thase (FASN) [83] and stearoyl CoA desaturase 1 who could better benefit from these treatments. This (SCD1) [68], have been shown to disrupt lipid synthesis will be even more important since no clear evidence of and induce apoptosis in AML (Fig. 1). SCD1 inhibition clinical efficacy has been found by several clinical trials was obtained through treatment with BaP, a combination of agents targeting mTOR kinase in myeloid leukemia of lipid-regulating bezafibrate and the sex hormone [17–22] (Table 1). This modest efficacy is due
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