Epigenetic regulation of protein translation in KMT2A-rearranged AML
2019
Inhibition of the
histone methyl-transferase
DOT1L(KMT4) has shown encouraging activity in preclinical models of
KMT2A(MLL)-rearranged leukemia. The
DOT1Linhibitor pinometostat (EPZ5676) was well tolerated in early phase clinical trials and showed modest clinical activity, including occasional complete responses (CRs) as single agent. These studies support the development of combinatorial therapies for
KMT2A-rearranged leukemias. Here, we investigated two novel combinations: dual inhibition of the
histone methyltransferases
DOT1Land
EZH2, and the combination of a
DOT1Linhibitor with the
protein synthesis inhibitor
homoharringtonine(HHR).
EZH2is the catalytic
histone methyltransferasein the polycomb repressive complex 2 (
PRC2), and inhibition of
EZH2has reported preclinical activity in
KMT2A-rearranged leukemia. We found that the H3K79 and H3K27 methyl marks are not dependent on each other, and that
DOT1Land
EZH2inhibition affect largely distinct
gene expression programs. In particular, the
KMT2A/
DOT1Ltarget HOXA9, which is commonly de-repressed as a consequence of
PRC2loss or inhibition in other contexts, was not re-activated upon dual
DOT1L/
EZH2knockout or inhibition. Despite encouraging data in murine
KMT2A-MLLT3 transformed cells suggesting synergy between
DOT1Land
EZH2inhibition, we found both synergistic and antagonistic effects on a panel of human
KMT2Arearranged cell lines. Combinatorial inhibition of
DOT1Land
EZH2is thus not a promising strategy. We identified opposing effects on ribosomal gene transcription and
protein translationby
DOT1Land
EZH2as a mechanism that is partially responsible for observed antagonistic effects. The effects of
DOT1Linhibition on ribosomal gene expression prompted us to evaluate the combination of EPZ5676 with a
protein translationinhibitor. EPZ5676 was synergistic with the
protein translationinhibitor
homoharringtonine(HHR), supporting further preclinical/clinical development of this combination.
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