AML-108: Exogenous Mitochondrial Transfer and Endogenous Mitochondrial Fission Facilitate Resistance to OxPhos Inhibition in AML

Abstract

<h3>Context:</h3> Oxidative phosphorylation (OxPhos) inhibition induces mitochondrial trafficking from BM stromal cells to AML and is accompanied by mitochondrial fission and mitophagy. The mitochondrial coupling and crosstalk with BM stromal cells facilitate the development of resistance to OxPhos inhibition in AML cells. <h3>Objective:</h3> Acute myeloid leukemia (AML) cells are highly dependent on OxPhos for survival and continually adapt to fluctuations in nutrient and oxygen availability in the environment. We investigated how the BM microenvironment affects the response to OxPhos inhibition in AML by using a novel complex I OxPhos inhibitor, IACS-010759. <h3>Design:</h3> Primary AML cells from 26 patients, primary normal MSCs, and AML cell lines were utilized and treated with the OxPhos inhibitor IACS-0107598 and/or cytarabine. Cap analysis of gene expression transcriptome analyses for AML PDXs, primary samples, and AML cell lines has been performed. We performed an extracellular flux assay to measure the oxygen consumption rate. To visualize mitochondria, AML cell lines and MSCs were stably transfected with mitochondria-targeted PDHA1-GFP and -dsRed, respectively. Electron microscopy and immunoelectron microscopy analysis have been performed. <h3>Results:</h3> Cellular adhesion, growth, and apoptosis assays, along with measurements of mtDNA expression and mitochondrial reactive oxygen species generation, indicated that direct interactions with BM stromal cells triggered the compensatory activation of mitochondrial respiration and resistance to OxPhos inhibition in AML cells. Mechanistically, OxPhos inhibition induced (1) transfer of mesenchymal stem cell (MSC)-derived mitochondria to AML cells via tunneling nanotubes under direct-contact co-culture conditions and (2) mitochondrial fission with an increase in functional mitochondria and mitophagy in AML cells. Mitochondrial fission is known to enhance cell migration, and we observed mitochondrial transport to the leading edge of protrusions of migrating AML cells toward MSCs by electron microscopy analysis. We further demonstrated that cytarabine, a commonly used antileukemia agent, increased IACS-010759-triggered mitochondrial transfer from MSCs to AML cells. <h3>Conclusions:</h3> Our findings indicate an important role of exogenous mitochondrial trafficking from BM stromal cells to AML cells and of endogenous mitochondrial fission and mitophagy in the compensatory adaptation of leukemia cells to energetic stress in the BM microenvironment.