Cited by 1,443Acute Myeloid Leukemia ResearchHematopoietic Stem Cell TransplantationRetinoids in leukemia and cellular processes

Identification of pre-leukaemic haematopoietic stem cells in acute leukaemia

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Shlush, Liran I., Zandi, Sasan, Mitchell, Amanda, Chen, Weihsu Claire, Brandwein, Joseph M., Gupta, Vikas, Kennedy, James A., Schimmer, Aaron D. +18 more·2014·Nature

Abstract

In acute myeloid leukaemia (AML), the cell of origin, nature and biological consequences of initiating lesions, and order of subsequent mutations remain poorly understood, as AML is typically diagnosed without observation of a pre-leukaemic phase. Here, highly purified haematopoietic stem cells (HSCs), progenitor and mature cell fractions from the blood of AML patients were found to contain recurrent DNMT3A mutations (DNMT3A(mut)) at high allele frequency, but without coincident NPM1 mutations (NPM1c) present in AML blasts. DNMT3A(mut)-bearing HSCs showed a multilineage repopulation advantage over non-mutated HSCs in xenografts, establishing their identity as pre-leukaemic HSCs. Pre-leukaemic HSCs were found in remission samples, indicating that they survive chemotherapy. Therefore DNMT3A(mut) arises early in AML evolution, probably in HSCs, leading to a clonally expanded pool of pre-leukaemic HSCs from which AML evolves. Our findings provide a paradigm for the detection and treatment of pre-leukaemic clones before the acquisition of additional genetic lesions engenders greater therapeutic resistance.

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Crossref · 10.1038/nature13038

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  • Preleukemic stem cell populations are the cellular origin of leukemia-initiating cells in human AML, and their functional importance and clinical significance have been confirmed in patients.

    “Recent studies in patients with AML have confirmed the functional importance and clinical significance of preleukemic stem cell populations as the cellular origin of leukemia-initiating cells in human disease27, 48.”

    From Minimal PU.1 reduction induces a preleukemic state and promotes development of acute myeloid leukemia (2015) · cites this paper as [48]

    The Discussion identifies pre-leukemic HSCs as ancestral to the dominant AML clone and reports a functional repopulation advantage; the Introduction says they persist after chemotherapy. But the Discussion treats their role in relapse as a possibility requiring future study, so their clinical significance is not confirmed to the extent the citing sentence suggests. The paper also does not directly establish that these cells give rise to leukemia-initiating cells. Page numbers are unavailable in our copy. (LLM, conf=0.85)

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  • DNMT3A functions as an initiating mutation in acute myeloid leukemia and myelodysplastic syndromes.

    “DNMT3A is also recurrently mutated in blood diseases such as acute myeloid leukemia (AML; ref. 9) and myelodysplastic syndromes (MDS; ref. 10) where it functions as an initiating mutation (11).”

    From <i>Txnip</i> Enhances Fitness of <i>Dnmt3a</i> -Mutant Hematopoietic Stem Cells via <i>p21</i> (2022) · cites this paper as [11]

    The Discussion (page unavailable) describes DNMT3A as an initiating mutation in the AML cases studied. The paper does not establish that DNMT3A functions as an initiating mutation in MDS, so that extension is unsupported. (LLM, conf=0.88)

    Experimental — accuracy not yet measured
  • DNA sequencing of HSCs from AML patients in remission revealed that stem cells with only a single driver mutation were often present, suggesting that pre-malignant clonal hematopoiesis was a generalizable finding in AML.

    “In later studies, DNA sequencing of HSCs from AML patients in remission revealed that stem cells with only a single driver mutation were often present, suggesting that pre-malignant clonal hematopoiesis was a generalizable finding in AML 23–25.”

    From Clonal hematopoiesis in human aging and disease (2019) · cites this paper as [24]

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Authors
Shlush, L. I., Zandi, S., Mitchell, A., Chen, W. C., Brandwein, J. M., Gupta, V., Kennedy, J. A., Schimmer, A. D., Schuh, A. C., Yee, K. W., McLeod, J. L., Doedens, M., Medeiros, J. J. F., Marke, R., Kim, H. J., Lee, K., McPherson, J. D., Hudson, T. J., Pan-Leukemia Gene Panel Consortium, T. H., Brown, A. M. K., Yousif, F., Trinh, Q. M., Stein, L. D., Minden, M. D., Wang, J. C. Y., & Dick, J. E.
Affiliations
  • University Health Network (CA)
  • Chonnam National University (KR)
  • Ontario Institute for Cancer Research (CA)
Corresponding author
Dick, John E.
Venue
Nature
Published
2014-02-12
Volume
506
Issue
7488
Pages
328-333
ISSN
  • 0028-0836 (ISSN-L)
  • 1476-4687
OpenAlex
W2076031927
Cited by
1,443
References
53
Citations by year
2026: 50 · 2025: 48 · 2024: 75 · 2023: 95 · 2022: 94 · 2021: 110 · 2020: 136 · 2019: 131 · 2018: 139 · 2017: 160 · 2016: 153 · 2015: 159 · 2014: 88 · 2013: 1 · 2012: 2
FWCI
132.63
Type
journal article
Language
en
Open access
Locations
  • Nature (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
  • Radboud Repository (Radboud University) (submittedVersion)
Funders
  • Hospital for Sick Children
  • Canadian Institutes of Health Research (105367_1)
  • National Cancer Institute (R21CA152613)
Topics
  • Health Sciences › Medicine › Hematology › Acute Myeloid Leukemia Research
  • Health Sciences › Medicine › Hematology › Hematopoietic Stem Cell Transplantation
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Retinoids in leukemia and cellular processes
Keywords
acute myeloid leukemia, DNMT3A mutation, NPM1 mutation, clonal evolution, treatment resistance, relapse, clonal expansion, chemotherapy remission, tumor heterogeneity, xenografts, mutation order, hematopoiesis
MeSH terms
DNA Methyltransferase 3A, Nucleophosmin, Animals, Cell Differentiation, Cell Division, Clone Cells, DNA (Cytosine-5-)-Methyltransferases, Female, Hematopoiesis, Hematopoietic Stem Cells, Humans, Isocitrate Dehydrogenase, Mutation, Neoplasm Transplantation, Nuclear Proteins, Remission Induction, T-Lymphocytes, Neoplastic Stem Cells, Leukemia, Myeloid, Acute, Mice, SCID, Mice, Inbred NOD, Drug Resistance, Neoplasm, Cell Lineage, Mice, Heterografts

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