Patients with myelodysplasia or acute myeloid leukemia (AML) show decreased osteoblast numbers, and this is reproduced in mouse models of acute leukemia. Manipulating the osteoblast pool directly affects leukemia progression: osteoblast ablation increases leukemia burden, while maintenance of osteoblast numbers decreases it and prolongs survival. Here we show that the protective effect of osteoblasts against leukemia does not rely on a certain threshold of osteoblast numbers but rather requires a specific signaling pathway. Treatment of leukemic mice with parathyroid hormone, which increases osteoblast numbers, had no effect in leukemia progression. In contrast, maintaining the osteoblast pool in leukemic mice by decreasing the synthesis of gut-derived serotonin, reduced AML burden and prolonged survival. Using the human-AML MLL-AF9 model, we examined whether deletion of one of the main serotonin receptors expressed in osteoblasts affects leukemia progression. Global deletion of Htr1b in mice prevented leukemia. While removal of Htr1b in LepR+ positive mesenchymal stem cells had no effect in leukemia progression, its deletion in Col1a1-expressing osteoblast precursors significantly prevented lethality in the mutant mice. In order to dissect the crosstalk between leukemia-cells and osteoblasts, we co-cultured primary-human osteoblasts and AML cells. RNAseq analysis identified a signature of chemoattractants and pro-inflammatory cytokines secreted by osteoblasts upon exposure to AML cells, suggesting that the protective mechanism exerted by osteoblasts activates the anti-tumor immune response against leukemia. In summary, our data suggest that AML cells activate serotonin signaling in osteoblasts to promote their engraftment and expansion. Targeting this pathway may render the niche hostile to leukemia by enhancing the anti-tumor immune response elicited by osteoblasts.
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