An epigenetic mechanism of resistance to targeted therapy in T cell acute lymphoblastic leukemia

B Knoechel, JE Roderick, KE Williamson, J Zhu… - Nature …, 2014 - nature.com
B Knoechel, JE Roderick, KE Williamson, J Zhu, JG Lohr, MJ Cotton, SM Gillespie
Nature genetics, 2014nature.com
The identification of activating NOTCH1 mutations in T cell acute lymphoblastic leukemia (T-
ALL) led to clinical testing of γ-secretase inhibitors (GSIs) that prevent NOTCH1 activation,,,.
However, responses to these inhibitors have been transient, suggesting that resistance
limits their clinical efficacy. Here we modeled T-ALL resistance, identifying GSI-
tolerant'persister'cells that expand in the absence of NOTCH1 signaling. Rare persisters are
already present in naive T-ALL populations, and the reversibility of their phenotype suggests …
Abstract
The identification of activating NOTCH1 mutations in T cell acute lymphoblastic leukemia (T-ALL) led to clinical testing of γ-secretase inhibitors (GSIs) that prevent NOTCH1 activation,,,. However, responses to these inhibitors have been transient, suggesting that resistance limits their clinical efficacy. Here we modeled T-ALL resistance, identifying GSI-tolerant 'persister' cells that expand in the absence of NOTCH1 signaling. Rare persisters are already present in naive T-ALL populations, and the reversibility of their phenotype suggests an epigenetic mechanism. Relative to GSI-sensitive cells, persister cells activate distinct signaling and transcriptional programs and exhibit chromatin compaction. A knockdown screen identified chromatin regulators essential for persister viability, including BRD4. BRD4 binds enhancers near critical T-ALL genes, including MYC and BCL2. The BRD4 inhibitor JQ1 downregulates expression of these targets and induces growth arrest and apoptosis in persister cells, at doses well tolerated by GSI-sensitive cells. Consistently, the GSI-JQ1 combination was found to be effective against primary human leukemias in vivo. Our findings establish a role for epigenetic heterogeneity in leukemia resistance that may be addressed by incorporating epigenetic modulators in combination therapy.
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