Journal
NATURE MEDICINE
Volume 24, Issue 12, Pages 1859-+Publisher
NATURE PUBLISHING GROUP
DOI: 10.1038/s41591-018-0233-1
Keywords
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Funding
- University of Colorado Department of Medicine Outstanding Early Career Scholar Program
- University of Colorado RNA Bioscience Initiative
- American Cancer Society [25A5072]
- Colorado Clinical and Translational Sciences Institute [AEF CCTSI YR9 CO 2301425]
- Webb-Waring Early Career award 2017 - Boettcher Foundation
- Nancy Carroll Allen Chair in Hematology Research
- NIH [R01CA200707]
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Acute myeloid leukemia (AML) is the most common acute leukemia in adults. Leukemia stem cells (LSCs) drive the initiation and perpetuation of AML, are quantifiably associated with worse clinical outcomes, and often persist after conventional chemotherapy resulting in relapse(1-5). In this report, we show that treatment of older patients with AML with the B cell lymphoma 2 (BCL-2) inhibitor venetoclax in combination with azacitidine results in deep and durable remissions and is superior to conventional treatments. We hypothesized that these promising clinical results were due to targeting LSCs. Analysis of LSCs from patients undergoing treatment with venetoclax + azacitidine showed disruption of the tricarboxylic acid (TCA) cycle manifested by decreased alpha-ketoglutarate and increased succinate levels, suggesting inhibition of electron transport chain complex II. In vitro modeling confirmed inhibition of complex II via reduced glutathionylation of succinate dehydrogenase. These metabolic perturbations suppress oxidative phosphorylation (OXPHOS), which efficiently and selectively targets LSCs. Our findings show for the first time that a therapeutic intervention can eradicate LSCs in patients with AML by disrupting the metabolic machinery driving energy metabolism, resulting in promising clinical activity in a patient population with historically poor outcomes.
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