Diversity Supplement for R37 Grant - Summary/Abstract
Leukemia stem cells (LSCs) promote therapeutic resistance and poor clinical outcomes in acute myeloid
leukemia (AML). Central to the function of LSCs is a capacity for aberrant self-renewal, but the mechanisms
underlying this activity are not well understood. The long-term goal is to identify these mechanisms to develop
new therapies that can eradicate LSCs to improve clinical outcomes. The overall objectives in this application
are to (i) determine if LSCs from specific genetic subtypes of AML are dependent on regulation of protein
synthesis, (ii) determine whether LSCs in high-risk hematopoietic stem cell (HSC)-like AMLs are more dependent
on regulated protein synthesis, and (iii) test a novel therapeutic strategy inhibiting protein synthesis in LSCs. The
central hypothesis is that LSCs aberrantly self-renew by adopting from normal HSCs a dependence on tightly
regulated protein synthesis. The rationale for this project is based on the finding that the cell surface marker
CD99 is selectively overexpressed on LSCs and serves to regulate protein synthesis to promote LSC function.
This offers a strong scientific framework by which new strategies to deplete LSCs can be developed. The central
hypothesis will be tested by pursuing three specific aims: 1) Determining the role of regulated protein synthesis
in promoting LSC function; 2) Determining if the cell-of-origin of AML influences the dependence of LSCs on
regulated protein synthesis; and 3) Determining if inhibition of protein synthesis can deplete LSCs in high-risk
AML. In the first aim, genetically engineered mice will be used to generate models of AML lacking CD99, to test
if this leads to dysregulated protein synthesis that impairs LSC self-renewal. LSCs from these models will be
evaluated to determine if they require low protein synthesis rates to prevent induction of tumor suppressors, the
unfolded protein response, and the integrated stress response. Ribosome profiling will be performed to identify
key LSC regulators selectively translated in the context of regulated protein synthesis. In the second aim, we will
generate a mouse model of HSC-like AML which mimics high-risk human AML. We will assess if LSCs in HSC-
like AML exhibit heightened sensitivity to dysregulated protein synthesis. These studies will be complemented
with an evaluation of protein synthesis in HSC-like human LSCs to determine if they also require maintenance
of low levels of protein synthesis. The third aim will test if the combination of a ribosome biogenesis-inhibitor with
a BCL2-inhibitor currently used to treat AML can eradicate LSCs in high-risk HSC-like AML. The proposal is
innovative, in the applicant’s opinion, because it aims to leverage a novel LSC-specific cell surface marker to
establish a new paradigm for understanding mechanisms underlying LSC self-renewal. The proposed research
is significant because it is expected to provide a strong scientific justification for the development of therapies
inhibiting protein synthesis to overcome therapeutic resistance in patients with high-risk AML. Ultimately, the
knowledge gained from these studies may offer insights into the mechanisms that promote the function of cancer
stem cells in general, opening up opportunities for the development of new strategies to treat cancer.