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Published on: February 21, 2018
Hyperactivation of the RAS signaling pathway in myelodysplastic syndrome with AML1/RUNX1 point mutations
1Department of Hematology/Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.
Abstract:
AML1/RUNX1 mutations have been reported frequently in myelodysplastic syndrome (MDS) patients, especially those diagnosed with refractory anemia with excess blast (RAEB), RAEB in transformation (RAEBt), or AML following MDS (these categories are defined as MDS/AML). Although AML1 mutations are suspected to play a pivotal role in the development of MDS/AML, acquisition of additional genetic alterations is also necessary. We analyzed gene alterations in MDS/AML patients with AML1 mutations, comparing them to alterations in those without an AML1 mutation. AML1 mutations were significantly associated with -7/7q-, whereas MDS/AML patients without AML1 mutations showed a high frequency of -5/5q- and a complex karyotype. Patients with AML1 mutations showed more mutations of their FLT3, N-RAS, PTPN11, and NF1 genes, resulting in a significantly higher mutation frequency for receptor tyrosine kinase (RTK)-RAS signaling pathways in AML1-mutated MDS/AML patients compared to AML1-wild-type MDS/AML patients (38% versus 6.3%, P < 0.0001). Conversely, p53 mutations were detected only in patients without AML1 mutations. Furthermore, blast cells of the AML1-mutated patients expressing surface c-KIT, and SHP-2 mutants contributed to prolonged and enhanced extracellular signal-regulated kinase activation following stem cell factor stimulation. Our results suggest that MDS/AML arising from AML1/RUNX1 mutations has a significant association with -7/7q- alteration, and frequently involves RTK-RAS signaling pathway activation.
Insights
Mutations in AML1/RUNX1 are linked to specific genetic changes like -7/7q- and increased receptor tyrosine kinase-RAS pathway activation in myelodysplastic syndrome/acute myeloid leukemia (MDS/AML). These findings clarify distinct molecular pathways in MDS/AML development.
Area of Science:
- Hematology
- Oncology
- Molecular Biology
Background:
- Mutations in AML1/RUNX1 are frequently observed in myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) developing from MDS (MDS/AML).
- While AML1 mutations are implicated in MDS/AML pathogenesis, additional genetic alterations are crucial for disease development.
Purpose of the Study:
- To investigate and compare gene alterations in MDS/AML patients with and without AML1 mutations.
- To identify specific genetic alterations and signaling pathway involvement associated with AML1 mutations in MDS/AML.
Main Methods:
- Comparative analysis of gene alterations in MDS/AML patients stratified by the presence or absence of AML1 mutations.
- Assessment of chromosomal abnormalities, including -7/7q- and -5/5q-.
- Mutation analysis of key genes in signaling pathways, including FLT3, N-RAS, PTPN11, NF1, and p53.
- Evaluation of surface marker expression (c-KIT) and downstream signaling (ERK activation) in relation to specific mutations.
Main Results:
- AML1 mutations were significantly associated with the chromosomal alteration -7/7q-.
- MDS/AML patients without AML1 mutations frequently exhibited -5/5q- and complex karyotypes.
- A higher frequency of mutations in FLT3, N-RAS, PTPN11, and NF1 genes was observed in AML1-mutated patients, leading to increased activation of receptor tyrosine kinase (RTK)-RAS signaling pathways (38% vs. 6.3%).
- p53 mutations were exclusively found in patients without AML1 mutations.
- AML1-mutated cells expressed c-KIT and demonstrated enhanced ERK activation upon stem cell factor stimulation.
Conclusions:
- MDS/AML associated with AML1/RUNX1 mutations shows a distinct genetic profile, characterized by -7/7q- and frequent activation of the RTK-RAS signaling pathway.
- These findings highlight distinct molecular mechanisms underlying MDS/AML based on AML1 mutation status.
- Understanding these differences can inform targeted therapeutic strategies for MDS/AML patients.
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