Small-molecule OPA1 inhibitors reverse mitochondrial adaptations to overcome therapy resistance in acute myeloid leukemia
Acute myeloid leukemia (AML) is the most prevalent and deadliest adult leukemia. Its frontline treatment uses the BH3 mimetic venetoclax to trigger mitochondria-dependent apoptosis. However, drug resistance nearly always develops, calling for therapies to circumvent it. Advanced microscopy and genome-wide CRISPRi screen analyses pinpointed mitochondrial adaptations primarily mediated by the master regulator of cristae shape optic atrophy 1 (OPA1) as critical for BH3 mimetics resistance. Resistant AML cells up-regulate OPA1 to modify their mitochondrial structure and evade apoptosis. MYLS22 and Opitor-0, two specific and nontoxic OPA1 inhibitors, promote apoptotic cristae remodeling and cytochrome <i>c</i> release, synergizing with venetoclax in AML cells and xenografts derived from AML patients ex vivo and in vivo. Mechanistically, OPA1 loss renders AML cells dependent on glutamine and sensitizes them to ferroptosis by activating ATF4-regulated integrated stress responses. Overall, our data clarify how OPA1 up-regulation allows AML cells' metabolic flexibility and survival and nominates specific OPA1 inhibitors as efficacious tools to overcome venetoclax resistance in leukemia.
Authors
- Anna Pellattiero (ORCID: https://orcid.org/0000-0002-9793-3493)
- Saurav Doshi (ORCID: https://orcid.org/0000-0002-1081-0969)
- Matthew T. Witkowski (ORCID: https://orcid.org/0000-0003-1434-4288)
- Amit Verma (ORCID: https://orcid.org/0000-0002-5408-1673)
- Christina Glytsou (ORCID: https://orcid.org/0000-0002-6260-338X)
- Luca Scorrano (ORCID: https://orcid.org/0000-0002-8515-8928)
- Kira Gritsman (ORCID: https://orcid.org/0000-0002-1367-1167)
- Andrea Mattarei (ORCID: https://orcid.org/0000-0002-2023-0749)
- Kristina Ames (ORCID: https://orcid.org/0000-0002-6845-0898)
- Xiaoyang Su (ORCID: https://orcid.org/0000-0001-8081-1396)
- Iannis Aifantis (ORCID: https://orcid.org/0000-0001-6857-1035)
- Federico Magrin (ORCID: https://orcid.org/0000-0002-5217-0904)
- Kleopatra Avrampou (ORCID: https://orcid.org/0009-0008-4422-5064)
- Sofia La Vecchia
- Petros Antonoglou
- Tanima Kundu (ORCID: https://orcid.org/0000-0001-8129-6912)
- Wafa Al Santli
Institutions
- Rutgers, The State University of New Jersey (US)
- Albert Einstein College of Medicine (US)
- Montefiore Medical Center (US)
- University of Padua (IT)
- Johnson University (US)
- Veneto Institute of Molecular Medicine (IT)
- University of Colorado Anschutz Medical Campus (US)
- New York University (US)
Publication Details
- Journal
- Science Advances
- Published
- 2025-10-15
- DOI
- https://doi.org/10.1126/sciadv.adx8662
- Citations
- 3
- Primary Topic
- Mitochondrial Function and Pathology
- Type
- article
- Field-Weighted Citation Impact
- 2.42