GATA2 links stemness to chemotherapy resistance in acute myeloid leukemia
Stemness-associated cell states are linked to chemotherapy resistance in acute myeloid leukemia (AML). We uncovered a direct mechanistic link between expression of the stem cell transcription factor GATA2 and drug resistance. The GATA-binding protein 2 (GATA2) plays a central role in blood stem cell generation and maintenance. We find substantial intrapatient and interpatient variability in GATA2 expression across samples from patients with AML. GATA2 expression varies by molecular subtype and has been linked to outcome. In a murine model, KMT2A-MLL3-driven AML originating from a stem cell or immature progenitor cell population has higher Gata2 expression and is more resistant to the standard AML chemotherapy agent doxorubicin. Deletion of Gata2 resulted in a more robust induction of p53 after exposure to doxorubicin. Chromatin immunoprecipitation sequencing, RNA sequencing, and functional studies revealed that GATA2 regulates the expression of RASSF4, a modulator of the p53 inhibitor MDM2 (mouse double minute 2). GATA2 and RASSF4 are anticorrelated in human cell lines and in bulk and single-cell expression data sets from patients with AML. Knockdown of Rassf4 in Gata2-low cells resulted in doxorubicin or nutlin-3 resistance. Conversely, overexpression of Rassf4 results in sensitization of cells expressing high levels of Gata2. Finally, doxorubicin and nutlin-3 are synergistic in Gata2-high murine AML and in samples from patients with AML. We discovered a previously unappreciated role for GATA2 in dampening p53-mediated apoptosis via transcriptional regulation of RASSF4, a modulator of MDM2. This role for GATA2 directly links the expression of a stemness-associated transcription factor to chemotherapy resistance.
Authors
- Kai Tan (ORCID: https://orcid.org/0000-0002-9104-5567)
- Taylor Yamauchi
- Hongbo Xie (ORCID: https://orcid.org/0000-0003-2223-0029)
- Mabel M. Jung (ORCID: https://orcid.org/0000-0001-7258-2888)
- Declan R. Barrett (ORCID: https://orcid.org/0000-0002-7194-2201)
- David T. Teachey (ORCID: https://orcid.org/0000-0001-7373-8987)
- Fatemeh Alikarami (ORCID: https://orcid.org/0000-0002-3600-9192)
- Emery H. Bresnick (ORCID: https://orcid.org/0000-0002-1151-5654)
- Alexandra Lenard
- Junwei Shi (ORCID: https://orcid.org/0000-0002-8427-6316)
- Etienne Danis (ORCID: https://orcid.org/0000-0002-5651-8111)
- Changya Chen (ORCID: https://orcid.org/0000-0003-4421-2462)
- Hua Huang (ORCID: https://orcid.org/0000-0001-7317-8983)
- Simone S. Riedel (ORCID: https://orcid.org/0000-0002-9941-1920)
- Kathrin M. Bernt (ORCID: https://orcid.org/0000-0002-0691-356X)
- Leila Mahdavi (ORCID: https://orcid.org/0000-0003-0621-7940)
- Tobias Neff (ORCID: https://orcid.org/0000-0002-0188-8393)
- Vu L. Tran (ORCID: https://orcid.org/0000-0001-5320-3280)
- Haley Goodrow
- Yapeng Li (ORCID: https://orcid.org/0000-0002-5042-6881)
- Zhendong Cao
Institutions
- Children's Hospital of Philadelphia (US)
- University of Wisconsin–Madison (US)
- California Institute for Regenerative Medicine (US)
- Chinese Academy of Medical Sciences & Peking Union Medical College (CN)
- National Jewish Health (US)
- University of Wisconsin Carbone Cancer Center (US)
- Translational Therapeutics (United States) (US)
- University of Colorado Cancer Center (US)
- Institute of Hematology & Blood Diseases Hospital (CN)
- University of Colorado Anschutz Medical Campus (US)
- University of Pennsylvania (US)
- University of Colorado Denver (US)
Publication Details
- Journal
- Blood
- Published
- 2025-01-22
- DOI
- https://doi.org/10.1182/blood.2024025761
- Citations
- 11
- Primary Topic
- Acute Myeloid Leukemia Research
- Type
- article
- Field-Weighted Citation Impact
- 19.47
Funders
- Children's Hospital of Philadelphia
- University of Pennsylvania
- Agios Pharmaceuticals
- Syndax Pharmaceuticals
- Emerson Collective
- National Institutes of Health
- National Cancer Institute