Bone Marrow Chimerism Research Articles

The predictive value of T-cell chimerism for disease relapse after allogeneic hematopoietic stem cell transplantation.

Chimerism is closely correlated with disease relapse after allogeneic hematopoietic stem cell transplantation (allo-HSCT). However, chimerism rate is dynamic changes, and the sensitivity of different chimerism requires further research. To investigate the predictive value of distinct chimerism for relapse, we measured bone marrow (BM), peripheral blood (PB), and T-cell (isolated from BM) chimerism in 178 patients after allo-HSCT. Receiver operating characteristic (ROC) curve showed that T-cell chimerism was more suitable to predict relapse after allo-HSCT compared with PB and BM chimerism. The cutoff value of T-cell chimerism for predicting relapse was 99.45%. Leukemia and myelodysplastic syndrome (MDS) relapse patients' T-cell chimerism was a gradual decline from 2 months to 9 months after allo-HSCT. Higher risk of relapse and death within 1 year after allo-HSCT. The T-cell chimerism rates in remission and relapse patients were 99.43% and 94.28% at 3 months after allo-HSCT (P = 0.009), 99.31% and 95.27% at 6 months after allo-HSCT (P = 0.013), and 99.26% and 91.32% at 9 months after allo-HSCT (P = 0.024), respectively. There was a significant difference (P = 0.036) for T-cell chimerism between early relapse (relapse within 9 months after allo-HSCT) and late relapse (relapse after 9 months after allo-HSCT) at 2 months after allo-HSCT. Every 1% increase in T-cell chimerism, the hazard ratio for disease relapse was 0.967 (95% CI: 0.948-0.987, P<0.001). We recommend constant monitoring T-cell chimerism at 2, 3, 6, and 9 months after allo-HSCT to predict relapse.

Alloengraftment without significant toxicity or GVHD in CD45 antibody-drug conjugate–conditioned Fanconi anemia mice

AbstractFanconi anemia (FA) is an inherited DNA repair disorder characterized by bone marrow (BM) failure, developmental abnormalities, myelodysplasia, leukemia, and solid tumor predisposition. Allogeneic hematopoietic stem cell transplantation (allo-HSCT), a mainstay treatment, is limited by conditioning regimen–related toxicity and graft-versus-host disease (GVHD). Antibody-drug conjugates (ADCs) targeting hematopoietic stem cells (HSCs) can open marrow niches permitting donor stem cell alloengraftment. Here, we report that single dose anti-mouse CD45–targeted ADC (CD45-ADC) facilitated stable, multilineage chimerism in 3 distinct FA mouse models representing 90% of FA complementation groups. CD45-ADC profoundly depleted host stem cell enriched Lineage−Sca1+cKit+ cells within 48 hours. Fanca−/− recipients of minor-mismatched BM and single dose CD45-ADC had peripheral blood (PB) mean donor chimerism >90%; donor HSCs alloengraftment was verified in secondary recipients. In Fancc−/− and Fancg−/− recipients of fully allogeneic grafts, PB mean donor chimerism was 60% to 80% and 70% to 80%, respectively. The mean percent donor chimerism in BM and spleen mirrored PB results. CD45-ADC–conditioned mice did not have clinical toxicity. A transient <2.5-fold increase in hepatocellular enzymes and mild-to-moderate histopathological changes were seen. Under GVHD allo-HSCT conditions, wild-type and Fanca−/− recipients of CD45-ADC had markedly reduced GVHD lethality compared with lethal irradiation. Moreover, single dose anti–human CD45-ADC given to rhesus macaque nonhuman primates on days −6 or −10 was at least as myeloablative as lethal irradiation. These data suggest that CD45-ADC can potently promote donor alloengraftment and hematopoiesis without significant toxicity or severe GVHD, as seen with lethal irradiation, providing strong support for clinical trial considerations in highly vulnerable patients with FA.

Risk factors and survival analysis of human leukocyte antigen loss in relapsed acute myeloid leukaemia/myelodysplastic syndrome patients after allogeneic haematopoietic stem cell transplantation.

To investigate the clinical characteristics and risk factors of specific human leukocyte antigen loss (HLA loss) in relapsed acute myeloid leukaemia (AML)/myelodysplastic syndrome (MDS) patients after allogeneic haematopoietic stem cell transplantation (allo-HSCT), and compare the responses of patients with HLA loss relapse with those without HLA loss (non-HLA loss) to different treatment regimens. Clinical data of traceable patients with AML/MDS after myeloablative allo-HSCT in our centre between January 2010 and June 2021, who experienced disease relapse after the transplantation, were collected. The patients were divided into the HLA loss relapse group and the non-HLA loss relapsed group based on HLA loss gene test findings by next-generation sequencing. The patients' median overall survival (OS) after the relapse were compared, and univariate and multivariate analyses were performed using the Kaplan-Meier survival curve and Cox proportional hazard model to explore the responses to different treatments after relapse. A total of 2359 patients were selected. Retrospective HLA gene loss gene detection was performed for the deoxyribonucleic acid in 179 relapsed patients, including 47 patients in the HLA loss group (27.2%), 126 patients in the non-HLA loss group (72.8%) and 6 patients were excluded due to a lack of confirmed results. There was no significant statistical difference in the baseline characteristics of patients between the two groups, but as to transplantation-related characteristics, the donor-recipient relationship and HLA mismatched loci were statistically different between the two groups (both p < 0.001). Multivariate Cox analysis showed that more HLA mismatched loci ≥3 (HR = 3.66; 95% CI: 1.61-8.31; p = 0.002), time (≤6 months) from HSCT to relapse (HR = 7.92; 95% CI: 3.35-18.74; p < 0.001) and donor chimerism (CD3) in bone marrow at relapse (HR = 1.02; 95% CI: 1.00-1.03; p = 0.036) were independent factors affecting HLA loss relapse. The ratio of negative conversion of FLT3-ITD or CEBPA mutation was significantly lower in patients with post-transplantation HLA loss relapse than in the non-HLA loss group (0.0% vs. 45.5%, p = 0.003; 0.0% vs. 80.0%, p = 0.035), with none of the patients with FLT3-ITD or CEBPA mutation turned negative in the HLA loss group. The number of gene mutations turned negative when relapse in the non-HLA loss group was remarkably higher than that in the HLA loss group (p = 0.001). Using donor lymphocyte infusion (DLI) could not prolong OS for the HLA loss group (p = 0.42). Nevertheless, second transplantation had a significant positive impact on OS in the HLA loss group (p = 0.017), although only five patients in the HLA loss group underwent second transplantation. However, patients in the non-HLA loss group using DLI had a relatively longer OS time than those without DLI (p = 0.017). Second transplantation could also prolong OS in the non-HLA loss group, but the effect was not as significant as in the HLA loss group (p = 0.053). In summary, HLA loss detection is essential for patients with recurrence after transplantation, especially for those with more HLA mismatched loci and non-sibling donor. Furthermore, the detection of HLA loss has a guiding role in choosing subsequent therapy when relapsed, as secondary transplantation is more suitable than DLI for those with HLA loss.

Risk factors for graft-versus-host-disease after donor lymphocyte infusion following T-cell depleted allogeneic stem cell transplantation.

Unmodified donor lymphocyte infusions (DLI) after allogeneic stem cell transplantation (alloSCT) can boost the beneficial Graft-versus-Leukemia (GvL) effect but may also induce severe Graft-versus-Host-Disease (GvHD). To improve the balance between GvL and GvHD, it is crucial to identify factors that influence the alloreactivity of DLI. We investigated the effects of the presence of patient-derived antigen-presenting cells at time of DLI as estimated by the bone marrow (BM) chimerism status, lymphopenia as measured by the absolute lymphocyte count (ALC) at time of DLI, and the presence of a viral infection (de novo or reactivation) close to DLI on the risk of GvHD after DLI. The cohort consisted of patients with acute leukemia or myelodysplastic syndrome who prophylactically or pre-emptively received DLI as standard care after alemtuzumab-based alloSCT. In patients at high risk for relapse, DLI was administered at 3 months after alloSCT (n=88) with a dose of 0.3x106 or 0.15x106 T cells/kg in case of a related or unrelated donor, respectively. All other patients (n=76) received 3x106 or 1.5x106 T cells/kg, respectively, at 6 months after alloSCT. For both DLIs, patients with reduced-intensity conditioning and an unrelated donor had the highest risk of GvHD. For DLI given at three months, viral infection within 1 week before and 2 weeks after DLI was an additional significant risk factor (hazard ratio (HR) 3.66 compared to no viral infection) for GvHD. At six months after alloSCT, viral infections were rare and not associated with GvHD. In contrast, mixed BM chimerism (HR 3.63 for ≥5% mixed chimerism compared to full donor) was an important risk factor for GvHD after DLI given at six months after alloSCT. ALC of <1000x106/l showed a trend for association with GvHD after this DLI (HR 2.05 compared to ≥1000x106/l, 95% confidence interval 0.94-4.45). Furthermore, the data suggested that the presence of a viral infection close to the DLI at three months or ≥5% mixed chimerism at time of the DLI at six months correlated with the severity of GvHD, thereby increasing their negative impact on the current GvHD-relapse-free survival. These data demonstrate that the risk factors for GvHD after DLI depend on the setting of the DLI.

NLRP3 Deficiency in Nonimmune Cells Averts Obesity-Induced Fatty Liver Disease

Obesity predisposes to metabolic dysfunction-associated fatty liver disease (MAFLD), cardiovascular disease, and type 2 diabetes. Accumulating evidence suggests a complex role of NLR family pyrin domain containing 3 (NLRP3) inflammasome function in multiple manifestations of the metabolic syndrome, with contradictory results. Its broad expression and pleiotropic functions during obesity led us to investigate the contribution of its expression in nonimmune versus immune cells to the development of obesity and MAFLD. Bone marrow chimerism was used to target NLRP3 deficiency to immune (ImmuneΔNlrp3) versus nonimmune (NonimmuneΔNlrp3) cells. Irradiated WT mice reconstituted with WT bone marrow served as controls. Mice were fed a 60% high-fat diet for 16 weeks. NonimmuneΔNlrp3 mice gained less weight and displayed reduced liver and epididymal white adipose tissue (epiWAT) mass. They also exhibited reduced adipocyte hypertrophy and increased epiWAT adipogenesis and lipolysis. Notable was the diminished hepatic steatosis in NonimmuneΔNlrp3 livers, which persisted even following equilibration of their body weight to that of the control. This was accompanied by a decline in liver triglycerides and in expression of transcriptional modules involved with lipid uptake, storage, and de novo lipogenesis. Thermogenic pathways in brown adipose tissue were comparable to control mice, but an elevation was observed in the genes encoding for lipid transporters and fatty acid oxidation. In contrast, deletion of NLRP3 in the immune cell compartment had limited effects on obesity and hepatic steatosis. Collectively, our results outline a prominent role for NLRP3 in nonimmune cells in facilitating MAFLD during constant energy surplus.

Randomized Trial of Prophylactic Donor Lymphocyte Infusion with Positively Selected CD4+ T Cells after HLA-Identical Allogeneic Stem Cell Transplantation

Introduction Allogeneic stem cell transplantation (alloSCT) can cure patients with hematological malignancies by T-cell mediated alloreactivity against patient hematopoiesis, the graft-versus-leukemia (GvL) effect. GvL can coincide with graft-versus-host disease (GvHD) when donor T cells target non-hematopoietic tissues. Increase of donor chimerism in bone marrow (BM) or peripheral blood (PB) after alloSCT indicates GvL response. After T-cell depleted alloSCT, donor lymphocyte infusion (DLI) can restore GvL. Dose and timing of DLI influence the degree of alloreactivity. Low dose of unmodified DLI as low as 0.3x10 6 T cells/kg 3 months after alloSCT appeared not to cause GvHD. (Zouwen et al. Ann Hematol, 2023) We hypothesized that infusion of a higher dose of purified CD4+ donor T cells would not cause GvHD, while inducing GvL by selective targeting of the MHC class II positive hematopoietic cells. Method A randomized controlled phase 2 trial was conducted in patients with hematological malignancies after HLA-identical sibling alloSCT with alemtuzumab added to the graft. Patients without GvHD or relapse were randomized at 2.5 months for prophylactic DLI with 1.0x10 6/kg CD4+ T cells (CD4+ DLI) 3 months after alloSCT or conventional care without DLI (CC). Both groups were eligible for prophylactic unmodified DLI at 6 months. Cumulative incidence (CI) of GvHD requiring immunosuppressive treatment 3 months after randomization was the primary endpoint. Changes in the trajectory of chimerism in BM and subsets in PB (CD4+ T cells, CD8+ T cells, NK cells, B cells and monocytes) were compared by means of mixed effects beta regression as secondary endpoints. Results 66 patients were included (table 1). CI of GvHD did not differ between groups (CD4+DLI: 6.1% vs CC: 9.1%, Gray's test p&amp;gt;0.9). Relapse was comparable (CD4+DLI: 15% vs CC: 12%), although heterogeneity of diseases prevented a formal comparison. In the CD4+ DLI group, BM chimerism was full donor (FD, &amp;gt;95% donor) at baseline in 23/33 patients, while 10/33 had mixed chimerism (MC, ≤95%). In the CC group, 23/33 were FD and 10/33 MC. Some patients with MC at baseline converted to FD in both groups (CD4+ DLI: 1/10 vs CC: 1/10). Changes in BM chimerism did not differ between CD4+ DLI and CC (p = 0.9). Chimerism of B cells, NK cells and monocytes in PB resembled bone marrow chimerism with most patients being FD at baseline. Changes in chimerism did not differ between CD4+ DLI and CC (p = 1.0, 0.5 and 0.9 for B cells, NK cells and monocytes respectively). In the CD4+ DLI group, 25/30 evaluable patients were MC in the CD4+ T-cell subset in PB at baseline. 3 month after randomization 7/25 had converted to FD, 17/25 remained MC and 1/25 was unevaluable. Of the 17 patient who remained MC, CD4+ donor chimerism increased (absolute increase &amp;gt;5%) in 13, decreased (&amp;gt;5%) in 2 and was stable in 2. In the CC group, 26/32 were MC in CD4+ T cells at baseline, of which 6 converted to FD, 18 remained MC and 2 were unevaluable. Of the 18 patients remaining MC, CD4+ chimerism increased in 5, decreased in 9 and remained stable in 4. The CD4+ donor chimerism increased significantly after CD4+ DLI compared to CC (p = 0.01) (Figure 1). In the CD4+ DLI group, 23/29 evaluable patients were MC in the CD8 subset at baseline. 7/23 converted to FD, 15/23 remained MC and 1 was unevaluable. Of these 15 MC patients at 3 months, 9 had increasing, 5 stable and 1 decreasing donor chimerism after 3 months. In CC, 22/31 were MC at baseline. 4/22 converted to FD at 3 months and 17/22 remained in MC. Of the 17 MC patients, 6 had increasing, 3 decreasing and 8 stable chimerism. The CD8+ donor chimerism increased significantly in the CD4+ DLI group compared to CC (p = 0.03). Conclusion CD4+ selected DLI at a dose of 1x10 6 CD4+/kg 3 months after HLA identical T-cell depleted alloSCT did not cause GvHD. Chimerism in BM leukocytes, B cells, NK cells or monocytes did not indicate GvL mediated by CD4+ DLI, possibly because most patients were already FD at baseline. CD4+ and CD8+ T-cell donor chimerism increased significantly after CD4+ DLI, suggesting a GVL-effect - earlier demonstrated in vitro for 4 selected patients. (Van Balen et al. Front Immunol, 2018) However, most patients did not convert to FD in the T-cell compartment, suggesting the GvL-effect of CD4+ DLI was limited. We considered this GvL-effect insufficient to prevent relapse and stress the importance of CD8+ donor T cells as main drivers of alloreactivity after DLI following HLA-identical alloSCT.

Septin11 and Septin 8 Play Critical and Overlapping Roles Murine Stem Cell Function

Septins are highly conserved GTP binding proteins which regulate a variety of cellular functions including cytokinesis, polarity, cell cycle, vesicle trafficking, and exocytosis and are now considered the fourth component of the cytoskeleton. Septins are implicated in T and B cell lymphomas; and acute myeloid leukemias, where they frequently act as fusion partners with the Mixed-Lineage Leukemia (MLL) gene. Previous data in our laboratory led to the discovery of a small molecular inhibitor, DW0254, which inhibits RAS function and its downstream target RhoGTPase, Rac, including the hematopoietic-specific Rac2 GTPase, also implicated in MLL leukemias. The inhibitor leads to apoptosis of leukemia cell lines. Using biophysical methods, we discovered that DW0254 binds both the RAS chaperone, PDE6D, and Septin11, which is a member of the Septin6 family (Sara CN, et al., Blood Cancer 2022). Although Septins have been reported to be involved in function of the RhoGTPase Cdc42 and hematopoietic stem progenitor cell (HSPC) polarity, the role of Septin11 in hematopoiesis has not been reported. Septin11 is a member of the Septin6 family of proteins which consists of Septin6, 8, 10, 11 and 14 with significant homology between family members. Previous data in yeast has hypothesized functional overlap within each family of Septin proteins. To better understand the functional role of Septin11, we created lentivirus vectors tagged with a GFP reporter that contained shmiRs against Septin11. Culture of Septin11 knockdown (Septin11 KD) murine HSPC in IMDM (10ng/ml IL-3, 25ng/ml of SCF, TPO, Flt-3 and IL-6) resulted in an average of 13-fold decrease in cell counts compared to controls (p=0.02) and a decrease in total clonogenic activity (Figure 1) with defects seen in both myeloid (GM) and erythroid (BFU-E) colonies. Reduced clonogenic numbers were accompanied by a significant increase in early apoptotic cells suggesting that Septin11 is important in regulating apoptosis in HSPC. To determine the potential role of Septin11 in more primitive hematopoietic cells, we utilized competitive repopulation assays. Transduced BoyJ HSPC (GFP+ Septin11 KD and BFP+ control, mixed 1:1) were injected into lethally irradiated C57Bl/6 mice. We observed a reduction in multilineage chimerism in the peripheral blood, bone marrow, spleen and thymus in primary transplant recipients after knockdown of Septin11 (Table 1). To better define function in specific hematopoietic populations of HSPC, we performed knockdown in FACS-sorted purified cells. Engraftment studies demonstrated a significant reduction in bone marrow chimerism in primary transplant recipients after knockdown of Septin11 most clearly in LT-HSC and ST-HSC (Table 1) with no statistically significant change in MPP. Therefore, to better study the hematopoietic stem cell compartment, we performed secondary transplants utilizing the cells obtained from primary competitive repopulation assays. We observed an unexpected recovery in engraftment in secondary transplant recipients that was accompanied by an increase in the mRNA expression of Septin8. Since Septin8 and Septin11 are closely related we hypothesized that induction of Septin8 was subserving key functions of Septin11. To test this hypothesis, we created a lentivirus vector that expressed both a shmiR against Septin11 and the Septin8 cDNA. Concurrent overexpression of Septin8 with Septin11 knockdown HSPC caused a significant increase in the total number of colonies compared to controls (Figure 1). These data indicate an important role of Septin11 in murine hematopoiesis and a potential redundant role for Septin8.

Haploidentical Hematopoietic Cell Transplantation Combined with an Unrelated Cord Blood Unit for Adult Acute Myeloid Leukemia Results in Improved Survival Compared to Haploidentical Hematopoietic Cell Transplantation: Results of a Multicenter, Randomized, Phase III Trial

Introduction Haploidentical hematopoietic cell transplantation (haplo-HCT) is a potent treatment to improve the prognosis of acute myeloid leukemia (AML), but relapse and graft-versus-host disease (GVHD) related to dysregulation of alloreactivity are still the main causes of death posttransplantation. Cord blood graft usually has a promising graft-versus-leukemia effect with a lower cumulative incidence of GVHD. To improve the transplantation strategy, haplo-cord HCT combining haploidentical and unrelated cord blood (UCB) grafts (haplo-cord HCT) has been attempted. Previous studies showed significant improvement in prognosis in B-cell acute lymphoblastic leukemia or refractory acute leukemia patients with haplo-cord HCT compared to haplo-HCT. However, outcomes of haplo-cord HCT for AML patients are not yet clear. This is the first multicentric randomized trial designed specifically for the efficacy and safety of haplo-cord HCT for AML. Methods This is a multicenter, randomized, open-label, phase III study conducted in 5 centers in China (NCT03719534). Patients aged 18-60 years, diagnosed with AML (except for acute promyelocytic leukemia) with measurable residual disease, had an available haploidentical donor and were suitable for allotransplantation were enrolled. Patients were randomized 1:1 to receive UCB and haploidentical grafts infusion after Bu/Cy-based regimen or haploidentical graft infusion only after Bu/Cy-based regimen. The UCB unit, which had at least 3/6 matched HLA loci to the recipient and more than 1×10 4 CD34 + cells/kg of recipient weight, was infused immediately after resuscitation and eight hours before the haploidentical graft infusion. The primary endpoint was 3-year overall survival (OS) and secondary endpoints included progression-free survival (PFS), cumulative incidence of relapse (CIR), and non-relapse mortality (NRM). Results From June 1, 2017, to June 30, 2021, 268 patients were enrolled (Table 1). With a median follow-up of 36.00 months, the 3-year OS was 80.5% (95% CI 73.7-87.9) in the haplo-cord HCT group and 67.8% (95% CI 60.0-76.5) in the haplo-HCT group, respectively (p=0.013, figure 1A). Haplo-cord HCT group showed favorable 3-year PFS and CIR than haplo-HCT group (PFS: 70.3%, 95% CI 62.6-78.8 vs. 57.6%, 95% CI 49.6-67.0, p=0.012; CIR: 12.1%, 95% CI 12.0-12.2 vs. 30.3%, 95% CI 30.1-30.4, p=0.024, figure 1B,C). The 3-year NRM was similar in the two groups (figure 1D). Within two years posttransplantation, the most common grade 3-4 adverse events (AEs) in the haplo-cord HCT and haplo-HCT groups were infections (33.8% and 29.1%), acute GVHD (20.3% and 12.7%) and chronic GVHD (12.0% and 16.4%). AEs leading to death occurred in 8.3% of haplo-cord HCT and 14.9% haplo HCT patients. Post- hoc analysis showed similar median levels of haploidentical chimerism in bone marrow (BM) between the two groups. However, UCB microchimerism was detected in the haplo-cord HCT patients by SNP-NGS in +1m posttransplantation (BM: 0.3%, IQR 0.04-1.6; peripheral blood: 0.06%, IQR 0.03-0.4) and its chimerism percentage decreased with time (figure 1E). Compared to haplo-HCT group, haplo-cord HCT group showed a faster cumulative incidence of neutrophil recovery (p=0.026, figure 1F) and a similar cumulative incidence of platelet recovery. Monitor of immune reconstitution showed a more rapidly increasing rate of T cells in the early period after transplantation in the haplo-cord HCT group (figure 1G). Improved recovery of Th2 (p=0.042), Th17 (p=0.047), Treg (p=0.045), and Tc2 (p=0.045) cells was observed in haplo-HCT group. Conclusions Coinfusion of a UCB unit in haplo-HCT can improve OS in AML patients without excessive AEs, and affect T-cell reconstitution pattern posttransplantation. Haplo-cord HCT could serve as a suitable therapeutic option for this patient population.

Non-Genotoxic Conditioning for Hematopoietic Stem Cell Transplant through Engineered Stem Cell Antibody Paired Evasion (ESCAPE)

While ex vivo gene editing of CD34 + hematopoietic stem and progenitor cells (HSPCs) offers potentially curative therapies for patients with serious diseases, such as sickle cell anemia, significant autologous hematopoietic stem cell (HSC) transplant-related challenges remain, notably the requirement of myeloablative conditioning using chemotherapeutic agents such as busulfan. To address this challenge, we have developed a non-genotoxic conditioning strategy with our Engineered Stem Cell Antibody Paired Evasion (ESCAPE) approach where we aim to engineer the epitope of the HSC surface protein CD117 (cKIT) using base editors, in such a way that the engineered protein retains the normal CD117 receptor function, but escapes recognition by a cognate monoclonal antibody that recognizes the wildtype CD117 protein. The ESCAPE-CD117 edit can be combined with a therapeutic target edit to generate a multiplex-edited engineered HSC (eHSC). We previously reported that through large parallel antibody and antigen screening efforts, we could identify mAb: edit pairs in which the engineered epitope evades mAb-mediated blocking of the WT CD117 receptor-ligand interaction while maintaining normal CD117 receptor biology and HSPC function and differentiation potential in vitro and in vivo. To further characterize binding properties of our lead CD117 variant to the natural ligand SCF, we determined the 3-dimensional structure of the receptor-ligand complex using cryo-EM. Structural overlay between engineered CD117:SCF and WT CD117: SCF complexes showed high similarity, with root mean square deviation (RMSD) of 0.848-Å, indicating that our epitope engineering did not affect the structure of CD117 nor its binding to its ligand. We have previously demonstrated in vivo proof-of-concept data supporting selection of engrafted multiplex-edited eHSCs after a single dose of mAb in non-competitive and competitive transplant settings in multiple rodent xenotransplantation models. We next sought to examine whether mAb conditioning could achieve long-term, multilineage hematopoietic reconstitution of multiplex-edited eHSCs and potentially therapeutic mixed chimerism levels. To this end, we humanized an immunocompromised mouse model with unedited mobilized peripheral blood (mPB) hCD34 + cells to achieve stable human bone marrow chimerism and then administered a single dose of mAb followed by a second transplant from the same donor of eHSCs harboring both ESCAPE and therapeutic edits targeting the HBG1/2 promoter. Animals receiving CD117 mAb demonstrated significant engraftment by cells harboring our ESCAPE multiplex edits as detected by NGS of bulk BM (~50% multiplex editing) and within the sorted marrow CD34 + cell population (~60% multiplex editing), while the isotype control treated animals only showed 2-5% multiplex editing within the said compartments. We also isolated CD15 + myeloid cells and GlyA + erythroid cells from the bone marrow of the mAb treated animals, which also harbored &amp;gt;50% multiplex editing as detected by NGS. Furthermore, we could detect what is believed to be therapeutically relevant levels of HbF induction (&amp;gt;30%) in human GlyA + sorted bone marrow cells, suggesting that we could achieve therapeutic benefit with a single dose of mAb as the conditioning agent. In conclusion, our structural data showed a high level of structural similarity between our engineered CD117 epitope and the WT protein. Our in vitro assays and in vivo rodent xenotransplantation models showed enrichment of engineered HSCs upon mAb treatment. Altogether, our data suggest the feasibility of achieving therapeutically relevant levels of mixed bone marrow chimerism with our non-genotoxic conditioning ESCAPE platform. This approach may remove the need for patients to undergo systemic genotoxic conditioning prior to transplant and further unlock the promise of base editing therapies for the treatment of patients suffering from serious hematologic diseases.

Blast Clearance after High Dose-Melphalan Conditioning for Allogeneic Stem Cell Transplantation in Relapsed and Refractory Acute Myeloid Leukemia

Introduction: For patients (pts) with relapsed or refractory acute myeloid leukemia (r/r AML) allogeneic stem cell transplantation (ASCT) has become an established highly effective and potential curative treatment option. Even for pts with active disease, direct ASCT using sequential conditioning regimens has shown promising outcomes. In this retrospective study, we examined prognostic factors for long-term survival in r/r AML pts with active disease with special focus to the prognostic value of blast clearance during condition therapy. Patients and Methods: 186 r/r AML pts treated with sequential conditioning regimens at our center between 2014-2023 were included in our analysis. Patients underwent high-dose melphalan (100 - 140 mg/m 2, day -11 prior ASCT) followed by either fractionated total body irradiation with 8 Gy (TBI, n = 71) or non-TBI regimens (busulfan, n = 101, or treosulfan, n = 14) in combination with fludarabin (120 - 150 mg/m 2) from day -6 before ASCT. TBI-based conditioning was applied almost exclusively in patients aged &amp;lt; 60 years. Graft versus host-disease (GvHD) prophylaxis consisted of calcineurin inhibitors, mycophenolate and anti-T-lymphocyte globulin. In 180 out of 186 patients, blast clearance was assessed by cytologic and flow cytometric blast count via bone marrow (BM) aspirate in median 5 days after Melphalan and prior to continuation of the sequential conditioning therapy. Blast clearance was defined as cytologic BM blast count &amp;lt; 5% and &amp;lt; 0.1% BM cells with leukemia-associated immunophenotype in flow cytometry. Results: Median pts age was 67 years (range 45 - 76 years) in the non-TBI group and 51 years (range 19 - 71 years) in the TBI group, respectively. Median follow up of surviving patients was 46 months. As expected, comorbidities and disease-specific factors varied between these groups. HCTCI scores &amp;gt; 3 points were observed in 14% of TBI pts compared to 32% in non-TBI pts ( p .01) and 45% versus 54% harbored adverse risk genetics according to European Leukemia Net (ELN) 2017 classification ( p .41), respectively. In the non-TBI group, 38% of the pts had a secondary or therapy-related AML compared to 20% of pts in the TBI group ( p .03). HLA-mismatched (&amp;lt;10/10 matched) donor grafts were transplanted in 21% (TBI) vs. 20% (non-TBI) of the pts. 185 of 188 pts received GCS-F mobilized stem cell grafts; 3 pts received a bone marrow graft. Kaplan-Meier estimates for overall survival (OS) with and without blast clearance at 2 years were 69.6% (95% CI 60.1-80.6%) vs. 58% (95% CI 48.8-69.1%, p .33), for event free survival (EFS, event defined as death or overt relapse) 58.9% (95% CI 49-70.8%) vs. 46.1% (95% CI 36.7-58.1%, p .2), respectively. We included the re-occurrence / persistence of defined molecular and cytogenetic markers or decreasing CD34 + bone marrow chimerism (&amp;lt; 95%) after transplant as measures for impending relapse as a modified EFS. The EFS including impending relapse was 49.8% (95% CI 40-62%) vs. 36.4% (27.7-47.8%) after 2 years. A non-significant trend with reduced relapse risk for those patients who achieved blast clearance after Melphalan ( p .1, HR 0.73) was observed. Most patients with impending relapse showed similar survival as patients without evidence of relapse after ASCT. In multivariate cox regression, age, HCTCI scores &amp;gt; 3 points, adverse risk according to ELN 2017 definitions and donor mismatch &amp;lt; 10/10 resulted in adverse prognosis. Especially, patients with mismatched donors displayed highly significant inferior outcomes. Both leukemic burden prior to ASCT as well as blast clearance after melphalan showed no significant correlation with clinical outcome parameters. Conclusion: Sequential conditioning regimens followed by ASCT offer long-term survival for more than 50% of pts with active relapsed or refractory AML. Patients who did not achieve complete blast clearance during conditioning therapy showed a trend towards higher relapse risk after ASCT which did not result in inferior survival. This underscores the importance of close monitoring and early interventions such as accelerated immunosuppression tapering, preemptive donor lymphocyte infusions and targeted therapies in case of impending relapse after ASCT.

Efficacy of CLAE Chemotherapy Regimen Followed by Allogeneic Hematopoietic Stem Cell Transplantation in Patients with Relapsed/Refractory Acute Leukemia

To observe the efficacy and safety of CLAE intensive chemotherapy followed by allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with relapsed/refractory acute leukemia (R/R AL). CLAE regimen [cladribine 5 mg/(m2·d), d 1-5; cytarabine 1.5 g/(m2·d), d 1-5; etoposide 100 mg/(m2·d), d 3-5] followed by allo-HSCT was used to treat 3 R/R AL patients. The patients received CLAE chemotherapy in relapsed or refractory status and underwent bone marrow puncture to judge myelodysplastic state. After an interval of 3 to 5 days, followed by preconditioning regimen for allo-HSCT [fludarabine 30 mg/(m2·d), d -7 to d -3; busulfan 0.8 mg/kg q6h, d -6 to d -3 or d -5 to d -2. If the bone marrow hyperplasia was not active and the blasts were less than 10%, busulfan should be used for 3 days. If the bone marrow hyperplasia was active and the blasts were more than 10%, busulfan should be used for 4 days]. Cyclosporin A, mycophenolate mofetil and short-term methotrexate were used for graft-versus-host disease (GVHD) prevention. After transplantation, the status of minimal residual disease (MRD) and bone marrow chimerism were regularly monitored in all 3 patients, and demethylation drugs or dasatinib were used to prevent recurrence 3 months after transplantation. 2 patients with t(11;19) translocation and relapse/refractory acute myeloid leukemia recurred within 6 months after induction of remission, and received intensive chemotherapy with CLAE regimen followed by haploidentical allo-HSCT and unrelated donor allo-HSCT, respectively. The two patients both relapsed 6 months after transplantation, then achieved complete remission by donor lymphocyte infusion, interferon, interleukin-2 and other methods, and disease-free survival was 2 years after transplantation. The other patient was chronic myelogenous leukemia who developed acute lymphoblastic leukemia during oral administration of tyrosine kinase inhibitor, accompanied by T315I and E255K mutations in ABL1 kinase region and additional chromosomal abnormalities. After morphological remission by induction chemotherapy, central nervous system leukemia was complicated. Intensive chemotherapy with CLAE regimen followed by sibling allo-HSCT was performed in the positive state of MRD. The patient relapsed 3 months after transplantation, and achieved remission after chimeric antigen receptor T-cell (CAR-T) therapy, however, he died 5 months after transplantation because of severe cytokine release syndrome (CRS) and GVHD. CLAE regimen followed by allo-HSCT may be an effective salvage treatment option for R/R AL patients to prolong the overall survival.

Cytotoxic CNS-associated T cells drive axon degeneration by targeting perturbed oligodendrocytes in PLP1 mutant mice

Myelin defects lead to neurological dysfunction in various diseases and in normal aging. Chronic neuroinflammation often contributes to axon-myelin damage in these conditions and can be initiated and/or sustained by perturbed myelinating glia. We have previously shown that distinct PLP1 mutations result in neurodegeneration that is largely driven by adaptive immune cells. Here we characterize CD8+ CNS-associated Tcells in myelin mutants using single-cell transcriptomics and identify population heterogeneity and disease-associated changes. We demonstrate that early sphingosine-1-phosphate receptor modulation attenuates Tcell recruitment and neural damage, while later targeting of CNS-associated Tcell populations is inefficient. Applying bone marrow chimerism and utilizing random X chromosome inactivation, we provide evidence that axonal damage is driven by cytotoxic, antigen specific CD8+ T cells that target mutant myelinating oligodendrocytes. These findings offer insights into neural-immune interactions and are of translational relevance for neurological conditions associated with myelin defects and neuroinflammation.

Effect of lethal total body irradiation on bone marrow chimerism, acute graft-versus-host disease, and tumor engraftment in mouse models: impact of different radiation techniques using low- and high-energy X-rays.

Effects of X‑ray energy levels used for myeloablative lethal total body irradiation (TBI) delivery prior to bone marrow transplantation (BMT) in preclinical mouse models were examined. In mouse models, single-fraction myeloablative TBI at alethal dose was delivered using two different X‑ray devices, either low (160 kV cabinet irradiator) or high energy (6MV linear accelerator), before semi-allogeneic hematopoietic stem-cell transplantation (HSCT) to ensure bone marrow (BM) chimerism, graft-versus-host disease (GVHD), and tumor engraftment. Recipient mice were clinically followed for 80days after bone marrow transplantation (BMT). Flow cytometry was performed to assess donor chimerism and tumor engraftment in recipient mice. Both X‑ray irradiation techniques delivered a10 Gy single fraction of TBI, presented alethal effect, and could allow near-complete early donor chimerism on day13. However, low-energy irradiation increased Tcells' alloreactivity compared to high-energy irradiation, leading to clinical consequences for GVHD and tumor engraftment outcomes. The alloreactive effect differences might be attributed to the distinction in inflammatory status of irradiated recipients at donor cell infusion (D0). Delaying donor cell administration (D1 after lethal TBI) attenuated Tcells' alloreactivity and clinical outcomes in GVHD mouse models. Different X‑ray irradiation modalities condition Tcell alloreactivity in experimental semi-allogeneic BMT. Low-energy X‑ray irradiator induces apost-TBI inflammatory burst and exacerbates alloreactive reactions. This technical and biological information should be considered in interpreting GVHD/ graft-versus-leukemia effect results in mice experimental models of BMT.

Human serum albumin promotes self-renewal and expansion of umbilical cord blood CD34+ hematopoietic stem/progenitor cells.

We investigated the effect of human serum albumin (HSA) on human umbilical cord blood (UCB) CD34+ hematopoietic stem/progenitor cells (HSPCs) cultured in vitro and transplanted in vivo. Human umbilical cord blood mononuclear cells were obtained by density gradient centrifugation. CD34+ cells were then sorted by CD34 conjugated magnetic microbeads. The sorted cells were cultured with or without HSA for 8 days in vitro. After 8 days, all cells were harvested for flow phenotyping and colony formation cell (CFC) experiments. The cells were injected into immunodeficient mice (NOD/Shi-scid/IL2Rγnull, NOG) via intravenous injections. From 4 weeks post-transplantation, flow cytometry was used to calculate human cell chimerism in the peripheral blood (PB) every 2 weeks. Flow phenotyping of human cell chimerism in bone marrow and spleen was calculated 16 weeks post-transplantation. Compared to the control group, CD34+ cells cultured with HSA increased significantly in vitro. The long-term engraftment of HSPCs and the hematopoietic multilineage reconstruction capacity were preserved by HSA. Normal engraftment of human cells could be maintained via HSA treatment could maintain normal engraftment of human cells in recipient PB. Here, we found that HSA was beneficial to maintaining CD34+ cell expansion and short-term colony formation in vitro and optimizing multilineage reconstitution in immunodeficient mice in vivo.

Characterization and Function of Cryopreserved Bone Marrow from Deceased Organ Donors: A Potential Viable Alternative Graft Source

Despite the readily available graft sources for allogeneic hematopoietic cell transplantation (alloHCT), a significant unmet need remains in the timely provision of suitable unrelated donor grafts. This shortage is related to the rarity of certain HLA alleles in the donor pool, nonclearance of donors owing to infectious disease or general health status, and prolonged graft procurement and processing times. An alternative hematopoietic progenitor cell (HPC) graft source obtained from the vertebral bodies (VBs) of deceased organ donors could alleviate many of the obstacles associated with using grafts from healthy living donors or umbilical cord blood (UCB). Deceased organ donor-derived bone marrow (BM) can be preemptively screened, cryogenically banked for on-demand use, and made available in adequate cell doses for HCT. We have developed a good manufacturing practice (GMP)-compliant process to recover and cryogenically bank VB-derived HPCs from deceased organ donor (OD) BM. Here we present results from an analysis of HPCs from BM obtained from 250 deceased donors to identify any substantial difference in composition or quality compared with HPCs from BM aspirated from the iliac crests of healthy living donors. BM from deceased donor VBs was processed in a central GMP facility and packaged for cryopreservation in 5% DMSO/2.5% human serum albumin. BM aspirated from living donor iliac crests was obtained and used for comparison. A portion of each specimen was analyzed before and after cryopreservation by flow cytometry and colony-forming unit potential. Bone marrow chimerism potential was assessed in irradiated immunocompromised NSG mice. Analysis of variance with Bonferroni correction for multiple comparisons was used to determine how cryopreservation affects BM cells and to evaluate indicators of successful engraftment of BM cells into irradiated murine models. The t test (with 95% confidence intervals [CIs]) was used to compare cells from deceased donors and living donors. A final dataset of complete clinical and matched laboratory data from 226 cryopreserved samples was used in linear regressions to predict outcomes of BM HPC processing. When compared before and after cryopreservation, OD-derived BM HPCs were found to be stable, with CD34+ cells maintaining high viability and function after thawing. The yield from a single donor is sufficient for transplantation of an average of 1.6 patients (range, 1.2 to 7.5). CD34+ cells from OD-derived HPCs from BM productively engrafted sublethally irradiated immunocompromised mouse BM (>44% and >67% chimerism at 8 and 16 weeks, respectively). Flow cytometry and secondary transplantation confirmed that OD HPCs from BM is composed of long-term engrafting CD34+CD38-CD45RA-CD90+CD49f+ HSCs. Linear regression identified no meaningful predictive associations between selected donor-related characteristics and OD BM HPC quality or yield. Collectively, these data demonstrate that cryopreserved BM HPCs from deceased organ donors is potent and functionally equivalent to living donor BM HPCs and is a viable on-demand graft source for clinical HCT. Prospective clinical trials will soon commence in collaboration with the Center for International Blood and Marrow Research to assess the feasibility, safety, and efficacy of Ossium HPCs from BM (ClinicalTrials.gov identifier NCT05068401).

Septin-6 Regulates Murine and Human Hematopoiesis, and Its Dysregulation Is Associated with Pediatric Myelodysplasia

Septin family proteins are key regulators of cytoskeletal organization and cytokinesis although little is known about their function in normal hematopoiesis. Septins are implicated in T and B cell lymphomas; and acute myeloid leukemias, where they frequently act as fusion partners with the Mixed-Lineage Leukemia (MLL) gene. Previously, we identified a non-syndromic newborn with severe neutropenia which progressed to myelodysplastic syndrome (MDS) (Renella et al. AJH, 2022). Next-generation sequencing revealed a novel X-linked germline mutation in the SEPTIN-6 gene associated with dysmyelopoiesis (SEPTIN6 c.1282T>C); and a second stop-gain somatic mutation hypothesized to rescue hematopoietic function, but the mechanism of MDS was not defined. Based on our initial publication, a second patient with neutropenia/MDS has since been identified in Seattle with a mutation in the same codon (SEPTIN6 c.1282T>A) suggesting an important new molecular mechanism for pediatric MDS. Both identified patients had a high degree of myeloid tetraploidy in the marrow and were refractory to G-CSF. To assess the pathobiology of the published patient's mutation, we replicated the germline T>C mutation using single base-pair gene editing in normal donor primary CD34+ cells. Editing rates were ~50-70%. Morphological studies demonstrated that SEPTIN-6 edited human CD34+ cells demonstrated enlarged, multi-nucleated and dysplastic nuclei. These findings were similar to the appearance of the patient's bone marrow myeloid precursor cells. These edited cells also demonstrated a decline in clonogenic activity notably with a selective reduction in granulocyte-macrophage (GM) colonies (Table 1). Both myeloid and erythroid colonies showed a reduction in colony size. These data directly confirm an important role for this mutated SEPTIN-6 in abnormal hematopoietic function. The septin-6 family of proteins consist of septin-6, 8, 10, 11 and 14 which may have overlapping functions in cells. Murine single cell mRNA expression data demonstrate that hematopoietic stem and progenitor cells (HSPC) express significant levels of Septin-6, Septin-11 and 8, with little to no expression of Septin-10 and 14. To better understand the functional role of Septin-6, we created lentivirus vectors tagged with a GFP reporter that contained shRNAs against Septin-6. Culture of Septin-6 knockdown (Septin-6 KD) murine HSPC in IMDM (10ng/ml IL-3, 25ng/ml of SCF, TPO, Flt-3 and IL-6) resulted in an average of 18-fold decrease in cell counts compared to controls (p=0.02). This was accompanied by an increase in cell cycle: S-phase: Septin-6 KD 55.7%; controls 42.5%, p=0.05 and a cumulative decrease in the G0/G1 and G2/M phase suggesting that Septin-6 is important in regulating cell cycle in HSPC. Controls were a non-targeting shRNA and an empty vector for all experiments described. Furthermore, knockdown of Septin-6 caused a decrease in total clonogenic activity with defects seen in both myeloid (GM) and erythroid (BFU-E) colonies (Table 1). Competitive repopulation assays, wherein transduced BoyJ HSPC (GFP+ Septin KD and BFP+ control were mixed 1:1) were injected into lethally irradiated C57Bl/6 mice, demonstrated a reduction in multilineage chimerism in the peripheral blood, bone marrow, spleen and thymus in primary and secondary transplant recipients after knockdown of Septin-6 (Table 2). To better define function in specific hematopoietic populations of HSPC, we performed knockdown in FACS-sorted purified cells. Engraftment studies demonstrated a significant reduction in bone marrow chimerism in primary transplant recipients after knockdown of Septin-6 most clearly in ST-HSC (Table 2) with a trend towards a decrease in LT-HSC and MPP. These data support a key role of Septin-6 in murine and human hematopoiesis via alterations in cell cycle and validate the pathogenic nature of a specific mutation in human SEPTIN-6. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Developing a Humanized Murine Model for Co-Transplantation of Acute Myeloid Leukemia

Humanized mouse models and primary disease xenografts have produced significant translational insight into the biology of the bone marrow (BM) niche and aided drug discovery in acute myeloid leukemia (AML). To enable the study of cell-cell interactions between hematopoietic stem and progenitor cells (HSPCs) and AML as an emerging source of drug resistance, we describe two complementary approaches to humanized AML xenotransplantation models. One strategy utilizes the sequential transplantation of humanized hCD34+ cells followed by human AML cells. Recipient NBSGW mice (NOD.Cg-Kit W-41J Tyr + Prkdcscid Il2rgtm1Wjl/ThomJ), known for high rates of medullary engraftment, were conditioned with 15mg/kg busulfan followed by injection with either granulocyte colony-stimulating (G-CSF)-mobilized or BM-derived human CD34+ HSPCs. Flow cytometric analysis of the BM following injection of hCD34+ cells revealed efficient BM engraftment by both G-CSF- and BM- derived hCD34+ cells, demonstrated by BM human chimerism (hCD45%) of 63.7±10.0% by 8-weeks post-injection. Further BM hCD45 subtype analyses revealed B-cell (hCD45+ hCD19+) dominant repopulation (78.3±4.48%), followed by myeloid cell (hCD45+ hCD33+) repopulation (18.12±4.19%). T-cell repopulation was predictably minimal (0.008±0.01%). At 9- and 15- weeks post hCD34+ cells injection, GFP-expressing MOLM-14 AML cells (MOLM-14-GFP; 1E5, 1E6, or 2E6 cells) were injected. Flow cytometric analyses of MOLM-14-GFP BM chimerism up to 21 days post-injection showed complete absence of MOLM-14-GFP cells in the BM with no significant changes in overall hCD45 chimerism and hCD45 subtype composition compared to a PBS-injected control. These observations are consistent with a potential role for residual healthy hematopoietic cells in suppressing AML engraftment in the BM, previously shown in congenic studies. To test this hypothesis, we developed a second humanized AML model designed to investigate immunotherapeutic approaches for AML, where AML blasts are engrafted first, then followed by a human immune cell challenge. FA-AML1 or Kasumi-1 AML cells were injected into NSG mice (NOD.Cg-Prkdcscid Il2rgtm1Wjl/SzJ) at 8 weeks of age. Injected mice were monitored for AML engraftment by HLA-DR expression in peripheral blood (PB). Engraftment occurred 6-12 weeks post-injection. After AML engraftment, we reconstituted a human immune system in the mice with a one-time injection of peripheral blood mononuclear cells (PBMCs), confirmed by flow cytometry for CD3+ T-cells (14.7±9.2%), CD33+ myeloid cells, and CD19+ B-cells. AML burden in the PB decreased 5-10% upon PBMC engraftment. In this model, a PB burden of <10% AML engraftment confers durable leukemic remission, whereas at >60% AML engraftment, leukemic cells persist in the periphery for over 100 days. Flow cytometric analysis demonstrated immune cell numbers peak in week 1 post-injection (30%), then decrease by week 4 to less than 1% in both the BM and PB, but persist at this low level for over 100 days. Altogether, these models confirm the ability of human hematopoietic cells to actively suppress leukemic engraftment in the BM microenvironment. More broadly, we demonstrate the development of two complementary humanized AML co-transplantation models that can attain dynamic ranges of human immune cell and AML cell engraftment to facilitate preclinical therapeutic development studies.

Mixed Bone Marrow Chimerism after Murine Stem Cell Transplantation Results in Distinct Platelet Subpopulations with Opposing Responsiveness

Mixed Bone Marrow Chimerism after Murine Stem Cell Transplantation Results in Distinct Platelet Subpopulations with Opposing Responsiveness

Investigation of Impact Induced By AML1-ETO on Self-Renewal and Differentiation of Hematopoietic Stem and Progenitor Cells in Pre-Leukemic Stage

AML1-ETO fusion gene is the most common cytogenetic subtype of AML, which occurs in approximately 15% of acute myeloid leukemia (AML) patients. More than 85% of patients could achieve complete remission after induction chemotherapy. However, it was less effective on the patients over the age of 60 who cannot tolerate standard chemotherapy. And nearly 30% of patients relapsed eventually with a dismal outcome. Therefore, identification of the initiating abnormal cells to inhibit the early occurrence induced by AML1-ETO is an urgent problem. In this study, an inducible conditional AML1-ETO knock-in murine model (Aml1Eto/+; Mx1-Cre) was successfully established, hereafter called AEKI. The stage of malignant transformation in hematopoietic stem and progenitor cells (HSPC) was identified. We found that the absolute number of LT-HSCs (1.43×106 vs 4.85×103, p<0.0001), ST-HSCs (7.90×106 vs 1.88×104, p<0.0001) and MPPs (6.07×105 vs 1.82×104, p=0.0358) in bone marrow (BM) increased significantly in AEKI group compared with that of control group, while CMPs (8.13×103 vs 1.83×105, p=0.0029), GMPs (8.48×103 vs 3.12×105, p=0.0026) and MEPs (1.25×104 vs 2.03×105, p=0.001) decreased. It suggested that the activation of AML1-ETO in vivo resulted in excessive accumulation of HSCs and differentiation blockage from HSCs to HPCs. However, AML1-ETO alone was insufficient to induce the onset of overt leukemia after 300-day observation of survival. Furthermore, the characteristics of AEKI HSPCs in the pre-leukemic stage were investigated. Colony forming assay (CFC) was performed to evaluate the stemness of HSCs in vitro. The equivalent of 2×103 LT-HSCs were isolated from BM of each group and plated for 14 days. AEKI LT-HSCs gave rise to dysplastic colonies and lost replating capability compared to that of control group (colony counts: 19.33 vs 30.17, p=0.016). Moreover, a progressive decrease in PB chimerism was observed in AEKI recipients via competitive transplantation assay in vivo (15.8% vs 62.5%, p<0.0001), for which BM cellularity exhibited a significant decrease (7.24×106 vs 4.81×107, p<0.0001). But it led to an notably expansion in HSC number (LT-HSC:1.18×105 v 8.59×103, p=0.0035) which had a same tendency as the phenotype of primary mice. Based on Ki67 and DAPI staining, proportion of HSCs in G1 phase increased (59.85% vs 38.63%, p=0.0007), while that in G0 (33.58% vs 44.2%, p=0.045) and S/G2/M (4.86% vs 13.41%, p=0.0002) phases decreased. These results implied that AML1-ETO induction could reduce the quiescence and self-renewal ability of HSCs obviously in comparison with normal HSCs. Bulk RNA sequencing was performed in LT-HSCs and GMPs sorted from both groups. Genesets related to cell proliferation, cell cycle regulation and Myc targets were enriched in LT-HSCs from control group. It was also found that genesets of tricarboxylic acid (TCA) cycle, glycolysis and fatty acid metabolism were enriched in LT-HSCs from control group. To validate it, Seahorse extracellular flux assay was performed to evaluate oxygen consumption rate (OCR) and extracellular acidification rate (ECAR) on HSPC population (c-kitenriched cells). We found that OCR and ECAR both decreased significantly in AEKI group that supported the results from RNA-seq. RNA-seq data also showed that fatty acid metabolic pathway was enriched in AEKI group during the process from LT-HSCs to GMPs, which suggested that AEKI HSPCs maintained abnormal function through excessive fatty acid supply while it was not necessary during normal hematopoiesis. To confirm the above speculation, the mice were fed with fat-free or normal food after the AML-ETO induction in vivo to evaluate the impact of fatty acid on hematopoiesis. Interestingly, BM chimerism increased on the fat-free group (31.56% vs 15.68%, p=0.013), with the absolute number of LT-HSCs (5.16×105 vs 1.80×106, p=0.068), ST-HSCs (1.28×106 vs 2.72×106, p=0.026) and MPPs (4.70×104 vs 2.53×105, p=0.013) reduced obviously compared with in a normal diet. It suggested the excessive accumulation of HSCs was partly recovered. In summary, our study suggested that AML1-ETO induction could cause HSCs to lose self-renewal potential and lead to differentiation disruption during the pre-leukemic stage of AML. Limiting exogenous lipid uptake was able to rescue the phenotype of differentiation disrupt of HSPCs partly and it could be a promising therapeutic strategy.

CD8 T Cells Mediate Host Death Following Lcmv Clone 13 Infection in Dgkα Deficiency

Diacylglycerol is a potent element of intracellular secondary signaling cascades whose production is enhanced by cell surface receptor agonism and function is regulated by enzymatic degradation by diacylglycerol kinases. In T cells, stringent regulation of the activity of this second messenger maintains an appropriate balance between effector function and anergy. In our study, we demonstrate that the DGKα is an indispensable regulator of T cell receptor-mediated activation of CD8 T cells in LCMV Clone 13 viral infection. In the absence of DGKα in mice, LCMV Clone 13 viral inoculation, a noncytopathic infection, resulted in a pathologic, proinflammatory state and host mortality. This was first observed in a systemic loss of function model, where significant mortality observed in DGKα-/- mice following LCMV Clone 13 when compared to wildtype (73% vs 6%, respectively, p < 0.0001). A similar trend towards increased post-infection mortality was observed in mice with CD8 T cell specific DGKα deficiency. The model was generated by chimeric bone marrow transplant of CD8-/- and DGKα-/- bone marrow, so that reconstituted marrow contained a DGKα deficiency specific to CD8 T cells. When compared to mice transplanted with DGKα sufficient bone marrow, increased mortality was observed in mice with CD8 T cell specific absence of DGKα (20% vs 80%, respectively, p=0.07). In contrast, when systemic DGKα-/- mice were treated with a CD8 depleting antibody prior to LCMV Clone 13 infection, none of the CD8 depleted mice suffered mortality, demonstrating DGKα-deficient CD8 T cells are necessary for the observed mortality. Next, an immunophenotype of the systemic knockout model during LCMV Clone 13 infection was established to determine the mechanism behind the increased mortality. This revealed a significant increase in the frequency of antigen (glycoprotein 33-41) specific CD8 T cells, and a significant decrease in serum viral load when compared to a similarly infected wildtype mouse. No appreciable differences in frequency of Treg or Th1 CD4 T cells were observed, but there was a discordant increase in Tfh CD4 T cells and a decrease in germinal center B cells. Myeloid subsets of macrophages, monocytes, and granulocytes were similar between infected DGKα-/- mice and wildtype controls. Following LCMV Clone 13 infection, transcriptomic analysis of RNA sequencing data gathered from sorted virus-specific, DGKα-deficient CD8 T cells revealed an enrichment of multiple cell cycling gene sets, and transcriptional upregulation of genes associated with glycolysis, effector function, and TCR signaling as compared to DGKα-sufficient, virus-specific CD8 T cells. These transcriptomic differences were confirmed phenotypically in vivo following competitive adoptive transfer of virus-specific, wildtype and DGKα-/- CD8 T cells into the same host. Following LCMV Clone 13 infection, a significant expansion of DGKα-/- virus-specific CD8 T cells occurred as compared to DGKα replete virus-specific CD8 T cells. Further, those deficient in DGKα displayed enhanced effector function, evidenced by significantly increased per-cell production of granzyme B and interferon gamma. In total, our data demonstrate that CD8 T cell expression of DGKα is necessary to prevent immunopathologic host death in the setting of LCMV Clone 13 infection. In its absence in CD8 T cells, a noncytopathic viral infection can propagate an overwhelming, mortal proinflammatory phenotype.