SETD2 mutations confer chemoresistance in acute myeloid leukemia partly through altered cell cycle checkpoints

Leukemia. 2019 Nov;33(11):2585-2598. doi: 10.1038/s41375-019-0456-2. Epub 2019 Apr 9.

Abstract

SETD2, an epigenetic tumor suppressor, is frequently mutated in MLL-rearranged (MLLr) leukemia and relapsed acute leukemia (AL). To clarify the impact of SETD2 mutations on chemotherapy sensitivity in MLLr leukemia, two loss-of-function (LOF) Setd2-mutant alleles (Setd2F2478L/WT or Setd2Ex6-KO/WT) were generated and introduced, respectively, to the Mll-Af9 knock-in leukemia mouse model. Both alleles cooperated with Mll-Af9 to accelerate leukemia development that resulted in resistance to standard Cytarabine-based chemotherapy. Mechanistically, Setd2-mutant leukemic cells showed downregulated signaling related to cell cycle progression, S, and G2/M checkpoint regulation. Thus, after Cytarabine treatment, Setd2-mutant leukemic cells exit from the S phase and progress to the G2/M phase. Importantly, S and G2/M cell cycle checkpoint inhibition could resensitize the Mll-Af9/Setd2 double-mutant cells to standard chemotherapy by causing DNA replication collapse, mitotic catastrophe, and increased cell death. These findings demonstrate that LOF SETD2 mutations confer chemoresistance on AL to DNA-damaging treatment by S and G2/M checkpoint defects. The combination of S and G2/M checkpoint inhibition with chemotherapy can be explored as a promising therapeutic strategy by exploiting their unique vulnerability and resensitizing chemoresistant AL with SETD2 or SETD2-like epigenetic mutations.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Alleles
  • Animals
  • Cell Cycle
  • Cell Cycle Checkpoints*
  • Cell Line, Tumor
  • Cytarabine / pharmacology
  • DNA Damage
  • Drug Resistance, Neoplasm / genetics*
  • Epigenesis, Genetic
  • Female
  • Gene Expression Regulation, Leukemic
  • Heterozygote
  • Histone-Lysine N-Methyltransferase / genetics*
  • Humans
  • Leukemia, Myeloid, Acute / genetics*
  • Male
  • Mice
  • Mice, Transgenic
  • Mutation*
  • Myeloid-Lymphoid Leukemia Protein / genetics
  • Neoplasm Recurrence, Local
  • Nuclear Proteins / genetics
  • Phenotype
  • Signal Transduction

Substances

  • KMT2A protein, human
  • MLLT3 protein, human
  • Mllt3 protein, mouse
  • Nuclear Proteins
  • Cytarabine
  • Myeloid-Lymphoid Leukemia Protein
  • Histone-Lysine N-Methyltransferase
  • Kmt2a protein, mouse
  • SETD2 protein, human