Increased Expression Of Fgf2 Induces Cytokine Hypersensitivity In Leukemia Stem Cells With Translocations Involving The MLL Gene

Leukemias with chromosomal translocation or partial tandem duplications involving the MLL (mixed lineage leukemia) gene have exceptionally poor prognosis (referred to as 11q23-leukemias). At the molecular level, 11q23-leukemias are characterized by increased expression of a set of homeodomain transcription factors in CD34+ hematopoietic stem cells (HSC) and differentiating CD34- myeloid progenitor cells. This transcription factor set includes HoxB3, B4, A7-11 and Meis1. Although many elegant studies have identified the precise molecular mechanisms by which MLL-fusion proteins increase HOX gene transcription, less is known about the downstream effects of increased Hox expression and potential implications for leukemogenesis. In prior studies, we determined that the gene encoding fibroblast growth factor 2 (Fgf2 or basic Fgf) is a HoxA10 target gene, and production of Fgf2 is increased in HoxA10 overexpressing primary bone marrow cells. In the current studies, we determine that FGF2 is also activated by HoxA9; identifying the only common target gene for HoxA9 and HoxA10 where both proteins activate transcription. We also find Mll-Ell (an MLL-fusion protein) increases FGF2 transcription and Fgf2 expression in a HoxA9 and HoxA10 dependent manner. Importantly, autocrine production of Fgf2 by Mll-Ell expressing HSC and myeloid progenitor cells increases cytokine-induced proliferation and enhances cell survival. In additional studies, we determine that these effects of Fgf2 are mediated by phospho inositol 3 kinase (PI3K) dependent stabilization of beta catenin. We find that autocrine production of Fgf2 results in increased expression of key beta catenin target genes in Mll-Ell expressing cells, including c-myc, survivin and cyclinD1. Beta catenin target genes also include the genes encoding CDX4 and HOXA10. Additionally, Cdx4 activates transcription of the HOXA9 and HOXA10 genes, and HoxA10 activates the CDX4 gene. Therefore, increased Fgf2 also establishes a positive feedback loop that enhances transcriptional activation of HOXA9 and HOXA10 by MLL-fusion proteins. 11q23-AML is generally refractory, but the molecular mechanisms for this are unknown. Our studies suggest that increased Fgf2 expression in 11q23-AML contributes to cytokine hypersensitivity and sustained survival of leukemia stem cells. Targeting the effects of Fgf2 might increase chemotherapy sensitivity in this form of leukemia. Small molecule inhibitors of Fgf-receptors are available, but have not yet been tested in this form of AML. We suggest that this would be a rational therapeutic approach to this disease.