Cooperative Inhibitory Effect of IDH1 Mutation and ASXL1 Mutation on Normal Myeloid Differentiation

Somatic mutations in the additional sex comb-like 1, ASXL1, have been described in various types of myeloid malignancies, including myelodysplastic syndromes, chronic myelomonocytic leukemia, and acute myeloid leukemia (AML). In addition, ASXL1 mutations are frequently found in healthy population, which predispose them to not only myeloid malignancies, but also cardiovascular diseases. This condition is known as clonal hematopoiesis with intermediate potential (CHIP), although the full etiology of this preleukemic condition is not elucidated. As for AML, patients with ASXL1 mutations are known to have very poor prognosis compared to non-mutated patients. Although previous studies demonstrated that mutant ASXL1 promoted myeloid leukemogenesis via both loss-of-function and gain-of-function manners, mechanisms how ASXL1 mutations induce myeloid transformation is not fully elucidated.

We analyzed publicly available datasets of AML patients, and found that isocitrate dehydrogenase 1 (IDH1) is co-mutated in 13% of AML with ASXL1. As the mechanism by which ASXL1 and IDH1 mutations cooperate to promote AML is not understood, we generated a model of AML with ASXL1 and IDH1 mutations using 32D-cl3 cells and discovered that mutant IDH1 could block myeloid differentiation only when mutant ASXL1 was present.

At first, in our experiments, we retrovirally overexpressed mutant (G646WfsX12) or normal form of ASXL1 in 32D-cl3, which is a commonly used IL-3 dependent cell-line of murine myeloid precursor cell. We found that Gr.1 expression levels were decreased in these cells compared to 32D-cl3 with mutant ASXL1 (11.1% vs 26.5%, respectively; p=0.014), and that the proportion of cells in which Gr1 expression was induced by treatment with G-CSF was significantly lower (29.1% vs 54.8%, respectively; p=0.003).

Next, we generated a tetracycline-inducible mutant (R132H) form of IDH1 lentiviral vector, and transfected them to these 32D-cl3 cells. We found that tetracycline-inducible mutant IDH1 inhibited G-CSF induced Gr.1 expression in the presence of mutant ASXL1 (7.1% with doxycycline vs 29.9% without doxycycline, respectively; p<0.01), while in the absence of mutant ASXL1, forced expression of mutant IDH1 could not block G-CSF induced Gr.1 expression (59.6% with doxycycline vs 59.2% without doxycycline, respectively; p=0.035). In accordance to these analyses of surface markers, we found that reduction of expression levels of CEBPβ induced by tetracycline-inducible ectopic expression of mutant IDH1 was only observed in 32D-cl3 cells with mutant ASXL1. Furthermore, we found that growth rate of 32D-cl3 cells with mutant ASXL1 and mutant IDH1 was significantly higher than those with mutant ASXL1 alone. These findings suggested that mutant IDH1 can exert its inhibitory effect of normal myeloid differentiation only when mutant ASXL1 is present. Herein, we hypothesized that mutant ASXL1 and mutant IDH1 had unknown cooperative mechanisms to suppress normal differentiation and promote leukemogenesis, and performed transcriptome analysis of the 32D-cl3 cells treated with G-CSF. Tendency toward decreased expression of genes associated with myeloid differentiation in the presence of IDH1 was only observed in cells with mutant ASXL1. Further, it was revealed that specifically dysregulated genes such as HDAC6 or KMT2A in leukemic stem cells were enriched in 32D-cl3 cells with mutant ASXL1, which suggested that mutant IDH1 could induce leukemogenesis only in the presence of ASXL1.

In our study, we found that the presence of IDH1 R132H mutation in 32D-cl3 cells had an inhibitory effect on normal myeloid differentiation only in the presence of ASXL1 mutation. Transcriptome analysis was performed to explore genes dysregulated by cooperation of mutant ASXL1 and mutant IDH1. We demonstrated that there might be cooperative mechanisms between ASXL1 and IDH1 to induce differentiation and promote leukemogenesis. Our study would not only provide a new role for IDH1 mutation in ASXL1 mutated AML, but also identify a new therapeutic target for ASXL1-mutatated AML.

Masamoto:Otsuka Pharmaceutical Co., Ltd: Honoraria; ONO PHARMACEUTICAL CO., LTD: Honoraria; Asahi Kasei Pharma: Honoraria; MSD K.K: Honoraria; Takeda Pharmaceutical Company Limited: Honoraria; Chugai Pharmaceutical Company: Honoraria; Kyowa Hakko Kirin Co., Ltd.: Honoraria, Research Funding; Nippon Shinyaku Co., Ltd: Honoraria; AbbVie GK: Honoraria; Janssen Pharmaceutical K.K: Honoraria; Bristol Myers Squibb: Honoraria; Sanofi: Honoraria; Yamasa Corporation: Honoraria; AstraZeneca: Honoraria; SymBio Pharmaceuticals: Honoraria. Kurokawa:Pfizer Japan Inc.: Research Funding, Speakers Bureau; Asahi Kasei Pharma Corporation.: Research Funding; Shionogi & Co., Ltd.: Research Funding; Otsuka Pharmaceutical Co., Ltd.: Speakers Bureau; AstraZeneca K.K.: Speakers Bureau; SymBio Pharmaceuticals Limited.: Speakers Bureau; Amgen Inc.: Speakers Bureau; Sanofi K.K.: Speakers Bureau; Janssen Pharmaceutical K.K.: Speakers Bureau; Otsuka Pharmaceutical Co., Ltd.: Research Funding; ONO PHARMACEUTICAL CO., LTD.: Research Funding, Speakers Bureau; Takeda Pharmaceutical Company Limited.: Research Funding, Speakers Bureau; Chugai Pharmaceutical Company: Research Funding, Speakers Bureau; Sumitomo Dainippon Pharma Co., Ltd.: Research Funding, Speakers Bureau; Kyowa Kirin Co., Ltd.: Research Funding, Speakers Bureau; Nippon Shinyaku Co., Ltd.: Research Funding, Speakers Bureau; Teijin Limited: Research Funding; Daiichi Sankyo Company .: Research Funding, Speakers Bureau; AbbVie GK: Research Funding; SANWA KAGAKU KENKYUSHO CO., LTD.: Consultancy, Speakers Bureau; Astellas Pharma Inc.、Eisai Co., Ltd.: Research Funding.