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Acute Myeloid Leukemia

RET-mediated autophagy suppression as targetable co-dependence in acute myeloid leukemia

Leukemia volume 32, pages 2189–2202 (2018)Cite this article

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Abstract

Many cases of AML are associated with mutational activation of receptor tyrosine kinases (RTKs) such as FLT3. However, RTK inhibitors have limited clinical efficacy as single agents, indicating that AML is driven by concomitant activation of different signaling molecules. We used a functional genomic approach to identify RET, encoding an RTK, as an essential gene in multiple subtypes of AML, and observed that AML cells show activation of RET signaling via ARTN/GFRA3 and NRTN/GFRA2 ligand/co-receptor complexes. Interrogation of downstream pathways identified mTORC1-mediated suppression of autophagy and subsequent stabilization of leukemogenic drivers such as mutant FLT3 as important RET effectors. Accordingly, genetic or pharmacologic RET inhibition impaired the growth of FLT3-dependent AML cell lines and was accompanied by upregulation of autophagy and FLT3 depletion. RET dependence was also evident in mouse models of AML and primary AML patient samples, and transcriptome and immunohistochemistry analyses identified elevated RET mRNA levels and co-expression of RET and FLT3 proteins in a substantial proportion of AML patients. Our results indicate that RET-mTORC1 signaling promotes AML through autophagy suppression, suggesting that targeting RET or, more broadly, depletion of leukemogenic drivers via autophagy induction provides a therapeutic opportunity in a relevant subset of AML patients.

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Acknowledgements

The authors thank Ines Brunner, Alexandra Buse, Nicole Labus, Julia Knoch, Stefanie Reinhart, Nicole Sims, and the DKFZ Central Animal Laboratory, Flow Cytometry, and Light Microscopy Facilities for excellent technical assistance; Sophie Rabe and Matea Hajnic for support with statistical analysis; and Patrizia Jensen, Silvia Vega Rubin de Celis, and Samuel Peña-Llopis for helpful discussions. This work was supported by grants from the German José Carreras Leukemia Foundation (DJCLS R 14/12 to SF) and the National Cancer Institute (R00CA158461 to SMS). LB holds a Heisenberg Professorship (BU 1339/8-1) from the German Research Foundation. MDM was supported by the Dietmar Hopp Foundation. SMS was supported by Bob and Jeanne Brennan, the W.W. Smith Foundation, and an American Society of Hematology Junior Scholar Award. CS was the recipient of an Emmy Noether Fellowship from the German Research Foundation.

Author contributions

SR, SF, and CS designed the study and wrote the manuscript; SR, AP, YYC, JH, JME, CB, DDM, and EM performed experiments and/or analyzed data; SG and CW analyzed AML tissue microarrays; CM-T and CL provided human AML specimens; LB analyzed gene expression data; and MDM and SMS provided essential resources.

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Authors and Affiliations

  1. Division of Translational Oncology, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany

    S. Rudat, A. Pfaus, Y. Y. Cheng, J. Holtmann & S. Fröhling

  2. Faculty of Biosciences, Heidelberg University, Heidelberg, Germany

    S. Rudat & Y. Y. Cheng

  3. Department of Pediatric Oncology, Dana-Farber Cancer Institute and Boston Children’s Hospital, Harvard Medical School, Boston, USA

    J. M. Ellegast

  4. Department of Internal Medicine III, Ulm University, Ulm, Germany

    C. Bühler & L. Bullinger

  5. Blood Cell Development and Function Program, Fox Chase Cancer Center, Philadelphia, PA, USA

    D. Di Marcantonio, E. Martinez & S. M. Sykes

  6. Department of Internal Medicine IV, University Hospital of Halle, Halle (Saale), Germany

    S. Göllner & C. Müller-Tidow

  7. Department of Pathology, University Hospital of Halle, Halle (Saale), Germany

    C. Wickenhauser

  8. Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany

    C. Lutz

  9. Experimental Hematology Group, Heidelberg Institute for Stem Cell Technology and Experimental Medicine and DKFZ, Heidelberg, Germany

    M. D. Milsom

  10. German Cancer Consortium, Heidelberg, Germany

    S. Fröhling & C. Scholl

  11. Section for Personalized Oncology, Heidelberg University Hospital, Heidelberg, Germany

    S. Fröhling

  12. Division of Applied Functional Genomics, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany

    C. Scholl

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  1. S. Rudat
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Rudat, S., Pfaus, A., Cheng, Y.Y. et al. RET-mediated autophagy suppression as targetable co-dependence in acute myeloid leukemia. Leukemia 32, 2189–2202 (2018). https://doi.org/10.1038/s41375-018-0102-4

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