Susceptibility of pediatric acute lymphoblastic leukemia to STAT3 inhibition depends on p53 induction

Luca Gasparoli, Clemence Virely, Alexia Tsakaneli, Noelia Che, Darren Edwards, Jack Bartram, Michael Hubank, Deepali Pal, Olaf Heidenreich, Joost H. A. Martens, Jasper de Boer, Owen Williams*

*Corresponding author for this work

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Advances in the clinical management of pediatric B cell Acute Lymphoblastic Leukemia (B-ALL) have dramatically improved outcomes for this disease. However, relapsed and high-risk disease still contribute to significant numbers of treatment failures. Development of new, broad range therapies is urgently needed for these cases. We previously reported the susceptibility of ETV6-RUNX1+ pediatric B-ALL to inhibition of signal transducer and activator of transcription 3 (STAT3) activity. In the present study, we demonstrate that pharmacological or genetic inhibition of STAT3 results in p53 induction and that CRISPR-mediated TP53 knockout substantially reverses susceptibility to STAT3 inhibition. Furthermore, we demonstrate that sensitivity to STAT3 inhibition in patient-derived xenograft (PDX) B-ALL samples is not restricted to any particular disease subtype, but rather depends on TP53 status, the only resistant samples being TP53 mutant. Induction of p53 following STAT3 inhibition is not directly dependent on MDM2 but correlates with degradation of MDM4. As such, STAT3 inhibition exhibits synergistic in vitro and in vivo anti-leukemia activity when combined with MDM2 inhibition. Taken together with the relatively low frequency of TP53 mutations in this disease, these data support the future development of combined STAT3/MDM2 inhibition in the therapy of refractory and relapsed pediatric B-ALL.
Original languageEnglish
Pages (from-to)1069-1081
Number of pages13
Issue number4
Early online date5 Oct 2023
Publication statusPublished - 31 Mar 2024

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