Direct targeted therapy for MLL-fusion-driven high-risk acute leukaemias

Sandra Cantilena, Luca Gasparoli, Deepali Pal, Olaf Heidenreich, Jan-Henning Klusmann, Joost H A Martens, Alexandre Faille, Alan J Warren, Mawar Karsa, Ruby Pandher, Klaartje Somers, Owen Williams, Jasper de Boer*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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BACKGROUND: Improving the poor prognosis of infant leukaemias remains an unmet clinical need. This disease is a prototypical fusion oncoprotein-driven paediatric cancer, with MLL (KMT2A)-fusions present in most cases. Direct targeting of these driving oncoproteins represents a unique therapeutic opportunity. This rationale led us to initiate a drug screening with the aim of discovering drugs that can block MLL-fusion oncoproteins.

METHODS: A screen for inhibition of MLL-fusion proteins was developed that overcomes the traditional limitations of targeting transcription factors. This luciferase reporter-based screen, together with a secondary western blot screen, was used to prioritize compounds. We characterized the lead compound, disulfiram (DSF), based on its efficient ablation of MLL-fusion proteins. The consequences of drug-induced MLL-fusion inhibition were confirmed by cell proliferation, colony formation, apoptosis assays, RT-qPCR, in vivo assays, RNA-seq and ChIP-qPCR and ChIP-seq analysis. All statistical tests were two-sided.

RESULTS: Drug-induced inhibition of MLL-fusion proteins by DSF resulted in a specific block of colony formation in MLL-rearranged cells in vitro, induced differentiation and impeded leukaemia progression in vivo. Mechanistically, DSF abrogates MLL-fusion protein binding to DNA, resulting in epigenetic changes and down-regulation of leukaemic programmes setup by the MLL-fusion protein.

CONCLUSION: DSF can directly inhibit MLL-fusion proteins and demonstrate antitumour activity both in vitro and in vivo, providing, to our knowledge, the first evidence for a therapy that directly targets the initiating oncogenic MLL-fusion protein.

Original languageEnglish
Article numbere933
Pages (from-to)1-19
Number of pages19
JournalClinical and Translational Medicine
Issue number6
Early online date22 Jun 2022
Publication statusPublished - Jun 2022
Externally publishedYes


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