Stromal-induced epithelial-mesenchymal transition induces targetable drug resistance in acute lymphoblastic leukemia

The bone marrow microenvironment (BME) drives drug resistance in acute lymphoblastic leukemia (ALL) through leukemic cell interactions with bone marrow (BM) niches, but the underlying mechanisms remain unclear. Here, we show that the interaction between ALL and mesenchymal stem cells (MSCs) through integrin b1 induces an epithelial-mesenchymal transition (EMT)-like program in MSC-adherent ALL cells, resulting in drug resistance and enhanced survival. Moreover, single-cell RNA sequencing analysis of ALL-MSC co -culture identifies a hybrid cluster of MSC-adherent ALL cells expressing both B-ALL and MSC signature genes, orchestrated by a WNT/b-catenin-mediated EMT-like program. Blockade of interaction between b-catenin and CREB binding protein impairs the survival and drug resistance of MSC-adherent ALL cells in vitro and results in a reduction in leukemic burden in vivo. Targeting of this WNT/b-catenin-mediated EMT-like program is a potential therapeutic approach to overcome cell extrinsically acquired drug resistance in ALL.

Automated summary

The interactions between acute lymphoblastic leukemia (ALL) and mesenchymal stem cells (MSCs) in the bone marrow microenvironment (BME) drive drug resistance through an epithelial-mesenchymal transition (EMT)-like program in MSC-adherent ALL cells, enhancing their survival. Inhibition of the WNT/b-catenin-mediated EMT-like program may be a promising therapeutic strategy to overcome drug resistance in ALL.