Malignant Transformation Involving CXXC4 Mutations Identified in a Leukemic Progression Model of Severe Congenital Neutropenia

Cell Rep Med. 2020 Aug 25;1(5):100074. doi: 10.1016/j.xcrm.2020.100074.

Abstract

Severe congenital neutropenia (SCN) patients treated with CSF3/G-CSF to alleviate neutropenia frequently develop acute myeloid leukemia (AML). A common pattern of leukemic transformation involves the appearance of hematopoietic clones with CSF3 receptor (CSF3R) mutations in the neutropenic phase, followed by mutations in RUNX1 before AML becomes overt. To investigate how the combination of CSF3 therapy and CSF3R and RUNX1 mutations contributes to AML development, we make use of mouse models, SCN-derived induced pluripotent stem cells (iPSCs), and SCN and SCN-AML patient samples. CSF3 provokes a hyper-proliferative state in CSF3R/RUNX1 mutant hematopoietic progenitors but does not cause overt AML. Intriguingly, an additional acquired driver mutation in Cxxc4 causes elevated CXXC4 and reduced TET2 protein levels in murine AML samples. Expression of multiple pro-inflammatory pathways is elevated in mouse AML and human SCN-AML, suggesting that inflammation driven by downregulation of TET2 activity is a critical step in the malignant transformation of SCN.

Keywords: AML; CSF3R; CXXC4; RUNX1; TET2; growth factor therapy; leukemia predisposition; pro-inflammatory signaling; severe congenital neutropenia.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Cell Line
  • Cell Line, Tumor
  • Cell Transformation, Neoplastic / genetics*
  • Cell Transformation, Neoplastic / pathology
  • Congenital Bone Marrow Failure Syndromes / genetics*
  • Congenital Bone Marrow Failure Syndromes / pathology*
  • Core Binding Factor Alpha 2 Subunit / genetics
  • DNA-Binding Proteins / genetics*
  • HEK293 Cells
  • Humans
  • Inflammation / genetics
  • Inflammation / pathology
  • K562 Cells
  • Leukemia, Myeloid, Acute / genetics*
  • Leukemia, Myeloid, Acute / pathology*
  • Mice
  • Mutation / genetics*
  • Neutropenia / congenital*
  • Neutropenia / genetics
  • Neutropenia / pathology
  • Signal Transduction / genetics
  • Transcription Factors / genetics*

Substances

  • CXXC4 protein, human
  • Core Binding Factor Alpha 2 Subunit
  • DNA-Binding Proteins
  • Transcription Factors

Supplementary concepts

  • Neutropenia, Severe Congenital, Autosomal Recessive 3