A novel small molecule that kills a subset of MLL-rearranged leukemia cells by inducing mitochondrial dysfunction

Klaartje Somers, Victoria W. Wen, Shiloh M. C. Middlemiss, Brenna Osborne, Helen Forgham, MoonSun Jung, Mawar Karsa, Molly Clifton, Angelika Bongers, Jixuan Gao, Chelsea Mayoh, Newsha Raoufi-Rad, Eric P. Kusnadi, Kate M. Hannan, David A. Scott, Alan Kwek, Bing Liu, Claudia Flemming, Daria A. Chudakova, Ruby PandherTim W. Failes, James Lim, Andrea Angeli, Andrei L. Osterman, Toshihiko Imamura, Ursula R. Kees, Claudiu T. Supuran, Richard B. Pearson, Ross D. Hannan, Thomas P. Davis, Joshua McCarroll, Maria Kavallaris, Nigel Turner, Andrei V. Gudkov, Michelle Haber, Murray D. Norris, Michelle J. Henderson

Research output: Contribution to journalArticlepeer-review

17 Citations (Scopus)


Survival rates for pediatric patients suffering from mixed lineage leukemia (MLL)-rearranged leukemia remain below 50% and more targeted, less toxic therapies are urgently needed. A screening method optimized to discover cytotoxic compounds selective for MLL-rearranged leukemia identified CCI-006 as a novel inhibitor of MLL-rearranged and CALM-AF10 translocated leukemias that share common leukemogenic pathways. CCI-006 inhibited mitochondrial respiration and induced mitochondrial membrane depolarization and apoptosis in a subset (7/11, 64%) of MLL-rearranged leukemia cell lines within a few hours of treatment. The unresponsive MLL-rearranged leukemia cells did not undergo mitochondrial membrane depolarization or apoptosis despite a similar attenuation of mitochondrial respiration by the compound. In comparison to the sensitive cells, the unresponsive MLL-rearranged leukemia cells were characterized by a more glycolytic metabolic phenotype, exemplified by a more pronounced sensitivity to glycolysis inhibitors and elevated HIF1 alpha expression. Silencing of HIF1 alpha expression sensitized an intrinsically unresponsive MLL-rearranged leukemia cell to CCI-006, indicating that this pathway plays a role in determining sensitivity to the compound. In addition, unresponsive MLL-rearranged leukemia cells expressed increased levels of MEIS1, an important leukemogenic MLL target gene that plays a role in regulating metabolic phenotype through HIF1 alpha. MEIS1 expression was also variable in a pediatric MLL-rearranged ALL patient dataset, highlighting the existence of a previously undescribed metabolic variability in MLL-rearranged leukemia that may contribute to the heterogeneity of the disease. This study thus identified a novel small molecule that rapidly kills MLL-rearranged leukemia cells by targeting a metabolic vulnerability in a subset of low HIF1 alpha/low MEIS1-expressing MLL-rearranged leukemia cells.

Original languageEnglish
Pages (from-to)3824-3842
Number of pages19
Issue number20
Publication statusPublished - 16 May 2019


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