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Spred1 deficit promotes treatment resistance and transformation of chronic phase CML


Spred1 is highly expressed in normal hematopoietic stem cells (HSCs). Lack of Spred1 function has been associated with aberrant hematopoiesis and acute leukemias. In chronic myelogenous leukemia (CML), Spred1 is reduced in patients with accelerated phase (AP) or blast crisis (BC) CML, thereby suggesting that deficit of this protein may contribute to disease transformation. In fact, Spred1 knockout (KO) in SCLtTA/BCR-ABL CML mice either globally, or restricted to hematopoietic cells (i.e., HSCs) or to endothelial cells (ECs), led to transformation of chronic phase (CP) CML into AP/BC CML. Upon BCR-ABL induction, all three Spred1 KO CML models showed AP/BC features. However, compared with global Spred1 KO, the AP/BC phenotypes of HSC-Spred1 KO and EC-Spred1 KO CML models were attenuated, suggesting a concurrent contribution of Spred1 deficit in multiple compartments of the leukemic bone marrow niche to the CML transformation. Spred1 KO, regardless if occurred in HSCs or in ECs, increased miR-126 in LSKs (LinSca-1+c-Kit+), a population enriched in leukemic stem cells (LSCs), resulting in expansion of LSCs, likely through hyperactivation of the MAPK/ERK pathway that augmented Bcl-2 expression and stability. This ultimately led to enhancement of Bcl-2-dependent oxidative phosphorylation that supported homeostasis, survival and activity of LSCs and drove AP/BC transformation.

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Fig. 1: Downregulation of Spred1 was observed in BM and CD34+ cells from patients with BC CML and associated with an increased “stemness” phenotype.
Fig. 2: Spred1 deficit promotes CML transformation.
Fig. 3: BM or LSK cells from Spred1 KO CML mice recapitulated AP/BC phenotype in recipient mice.
Fig. 4: Spred1 insufficiency in HSCs caused an attenuated CML transformation phenotype.
Fig. 5: SPRED1 KO in ECs increases arterioles in the BM niche.
Fig. 6: Spred1 loss in the BM vascular niche independently contributes to CML transformation.
Fig. 7: Spred1 loss in the BM vascular niche independently contributes to CML transformation.
Fig. 8: Spred1 depletion promotes TKI resistance in CML.

Availability of data and materials

RNA sequencing data produced in our laboratory and analysed in this study are available at the Gene Expression Omnibus (GEO) repository of the National Center for Biotechnology Information (GSE181589). Supplementary Information including Supplementary Fig. 112 and Supplementary Table 1 are provided with the online version of this paper. All other datasets generated during this study are available from the corresponding author on reasonable request.


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This work was supported in part by National Cancer Institute grants: CA248475 (GM/BZ), CA205247 (YHK/GM), CA201184 (GM), CA25004467 (RCR/YHK/GM), the Gehr Family Foundation (GM), the George Hoag Family Foundation (GM), International Program for Ph.D. Candidates (Sun Yat-Sen University, China), JSPS KAKENHI (S) JP17H06175 and AMED-CREST JP 20gm1110009 (AY). We are grateful to Marjorie Robbins for editing the manuscript. We acknowledge the support of the Animal Resources Center, Analytical Cytometry, Pathology (Hematopoietic Tissue Biorepository), Light Microscopy, and DNA/RNA Cores at City of Hope Comprehensive Cancer Center supported by the National Cancer Institute of the National Institutes of Health under award number P30CA33572. We are grateful to COH Comprehensive Cancer Center, the patients, and their physicians for providing primary patient material for this study.

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Authors and Affiliations



JQ designed and conducted experiments, analyzed data, wrote the manuscript; CL, DZ and L.X.T.N designed and conducted experiments and analyzed data; FC, SS, DHH, FP, IRR and YE conducted experiments; LG provided patient samples; AY provided Spred1 KO and Spred1flox/flox mice and reviewed the manuscript; AS, HA, PK, and DP reviewed data and the manuscript; MC and AH reviewed data and the manuscript and provided administrative support; BZ and GM designed experiments, analyzed data, wrote manuscript and provided administrative support.

Corresponding authors

Correspondence to Anjia Han, Bin (Amber) Zhang or Guido Marcucci.

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The authors declare no competing interests.


Patient sample acquisition was approved by the Institutional Review Boards (IRB) at the COHNMC, in accordance with an assurance filed with and approved by the Department of Health and Human Services and met all requirements of the Declaration of Helsinki. CML patients were consented on the IRB #18067 protocol.

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Qiao, J., Liang, C., Zhao, D. et al. Spred1 deficit promotes treatment resistance and transformation of chronic phase CML. Leukemia 36, 492–506 (2022).

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