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Updated: May 6, 2026

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Published on: June 6, 2025
Recurrent mutations, including NPM1c, activate a BRD4-dependent core transcriptional program in acute myeloid
M A Dawson1, E J Gudgin2, S J Horton3
11] Department of Haematology, Cambridge Institute for Medical Research and Addenbrookes Hospital, University of Cambridge, Cambridge, UK [2] Wellcome Trust-Medical Research Council Cambridge Stem Cell Institute, Cambridge, UK [3] Gurdon Institute and Department of Pathology, University of Cambridge, Cambridge UK.
Bromodomain and extra-terminal (BET) inhibitors show promise for treating acute myeloid leukemia (AML). Targeting a core transcriptional program, particularly in NPM1-mutated AML, offers a potential therapeutic strategy.
Area of Science:
- Oncology
- Epigenetics
- Molecular Biology
Background:
- Bromodomain and extra-terminal (BET) epigenetic readers are emerging therapeutic targets in acute myeloid leukemia (AML).
- BET inhibitors, such as I-BET151, may offer clinical utility against diverse AML subtypes.
Purpose of the Study:
- To validate the efficacy of BET inhibition in AML.
- To identify a core transcriptional program associated with AML sensitivity to BET inhibitors.
- To investigate the role of Nucleophosmin (NPM1) mutations in AML pathogenesis and response to BET inhibition.
Main Methods:
- Treatment of various AML subtypes with the BET inhibitor I-BET151.
- Analysis of a common, HOX gene-independent core transcriptional program.
- Investigation of super-enhancer-associated genes.
- Focus on NPM1-mutated AML and its interaction with BRD4.
- Evaluation of I-BET151 in murine models and primary patient samples.
Main Results:
- I-BET151 demonstrated efficacy across diverse AML subtypes.
- A core transcriptional program, enriched for super-enhancer genes, was downregulated in AML and linked to I-BET sensitivity.
- This program could classify AML patients into distinct subgroups, indicating biomarker potential.
- NPM1 mutations relieve BRD4 inhibition, upregulating the core program in AML.
- I-BET therapy and NPM1 nuclear restoration abrogated this program.
Conclusions:
- BET inhibitors, like I-BET151, are effective against various AML subtypes.
- A core transcriptional program regulated by super-enhancers is a key target for AML therapy.
- NPM1 mutations play a critical role in AML development by affecting BRD4 activity.
- BET inhibitors represent a promising therapeutic strategy for clinical trials in AML, particularly for NPM1-mutated cases.
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