NOTCH1 promotes T cell leukemia-initiating activity by RUNX-mediated regulation of PKC-θ and reactive oxygen species

Reactive oxygen species (ROS), a byproduct of cellular metabolism, damage intracellular macromolecules and, when present in excess, can promote normal hematopoietic stem cell differentiation and exhaustion(1-3). However, mechanisms that regulate the amount of ROS in leukemia-initiating cells (LICs) and the biological role of ROS in these cells are largely unknown. We show here that the ROSlow subset of CD44(+) cells in T cell acute lymphoblastic leukemia (T-ALL), a malignancy of immature T cell progenitors, is highly enriched in the most aggressive LICs and that ROS accumulation is restrained by downregulation of protein kinase C theta (PKC-theta). Notably, primary mouse T-ALLs lacking PKC-theta show improved LIC activity, whereas enforced PKC-theta expression in both mouse and human primary T-ALLs compromised LIC activity. We also show that PKC-theta is regulated by a new pathway in which NOTCH1 induces runt-related transcription factor 3 (RUNX3), RUNX3 represses RUNX1 and RUNX1 induces PKC-theta. NOTCH1, which is frequently activated by mutation in T-ALL4-6 and required for LIC activity in both mouse and human models(7,8), thus acts to repress PKC-theta. These results reveal key functional roles for PKC-theta and ROS in T-ALL and suggest that aggressive biological behavior in vivo could be limited by therapeutic strategies that promote PKC-theta expression or activity, or the accumulation of ROS.