Variation in Mesenchymal KITL/SCF and IGF1 Expression at Middle Age Underlies Steady-State Hematopoietic Stem Cell Aging

Intrinsic molecular programs and extrinsic factors including pro-inflammatory molecules are understood to regulate hematopoietic aging. This is based on foundational studies using genetic perturbation to evaluate causality. However, individual organisms exhibit natural variation in hematopoietic aging phenotypes and the molecular basis of this heterogeneity is poorly understood. Here, we generated individual single cell transcriptomic profiles of hematopoietic and non-hematopoietic cell types in five young adult and nine middle-aged C57BL/6J female mice, providing a web-accessible transcriptomic resource for the field. Among all assessed cell types, hematopoietic stem cells (HSCs) exhibited the greatest phenotypic variation in expansion among individual middle-aged mice. We computationally pooled samples to define modules representing the molecular signatures of middle-aged HSCs and interrogated which extrinsic regulatory cell types and factors would predict variance in these signatures between individual middle-aged mice. Decline in signaling mediated by ADIPOQ, KITL and IGF1 from mesenchymal stromal cells (MSCs) was predicted to have the greatest transcriptional impact on middle-aged HSCs, as opposed to signaling mediated by endothelial cells or mature hematopoietic cell types. In individual middle-aged mice, lower expression of Kitl and Igf1 in MSCs highly correlated with reduced lymphoid lineage commitment of HSCs and increased signatures of differentiation-inactive HSCs. These signatures were independent of expression of aging-associated pro-inflammatory cytokines including IL1, IL6, TNF and RANTES. In sum, we find that Kitl and Igf1 expression are co-regulated and variable between individual mice at middle age and expression of these factors is predictive of HSC activation and lymphoid commitment independently of inflammation.

Mesenchymal Stromal Cell Senescence Induced by Dnmt3a -Mutant Hematopoietic Cells is a Targetable Mechanism Driving Clonal Hematopoiesis and Initiation of Hematologic Malignancy

Clonal hematopoiesis (CH) can predispose to blood cancers due to enhanced fitness of mutant hematopoietic stem and progenitor cells (HSPCs), but the mechanisms driving this progression are not understood. We hypothesized that malignant progression is related to microenvironment-remodelling properties of CH-mutant HSPCs. Single-cell transcriptomic profiling of the bone marrow microenvironment in Dnmt3a R878H/+ mice revealed signatures of cellular senescence in mesenchymal stromal cells (MSCs). Dnmt3a R878H/+ HSPCs caused MSCs to upregulate the senescence markers SA-β-gal, BCL-2, BCL-xL, Cdkn1a (p21) and Cdkn2a (p16), ex vivo and in vivo . This effect was cell contact-independent and can be replicated by IL-6 or TNFα, which are produced by Dnmt3a R878H/+ HSPCs. Depletion of senescent MSCs in vivo reduced the fitness of Dnmt3a R878H/+ hematopoietic cells and the progression of CH to myeloid neoplasms using a sequentially inducible Dnmt3a ; Npm1 -mutant model. Thus, Dnmt3a -mutant HSPCs reprogram their microenvironment via senescence induction, creating a self-reinforcing niche favoring fitness and malignant progression.

Statement of Significance

Mesenchymal stromal cell senescence induced by Dnmt3a -mutant hematopoietic stem and progenitor cells drives clonal hematopoiesis and initiation of hematologic malignancy.

Hematopoietic stem cell aging and leukemia transformation

With aging, hematopoietic stem cells (HSCs) have an impaired ability to regenerate, differentiate, and produce an entire repertoire of mature blood and immune cells. Owing to dysfunctional hematopoiesis, the incidence of hematologic malignancies increases among elderly individuals. Here, we provide an update on HSC-intrinsic and -extrinsic factors and processes that were recently discovered to contribute to the functional decline of HSCs during aging. In addition, we discuss the targets and timing of intervention approaches to maintain HSC function during aging and the extent to which these same targets may prevent or delay transformation to hematologic malignancies.

Panhematopoietic RNA barcoding enables kinetic measurements of nucleate and anucleate lineages and the activation of myeloid clones following acute platelet depletion

BACKGROUND

Platelets and erythrocytes constitute over 95% of all hematopoietic stem cell output. However, the clonal dynamics of HSC contribution to these lineages remains largely unexplored.

RESULTS

We use lentiviral genetic labeling of mouse hematopoietic stem cells to quantify output from all lineages, nucleate, and anucleate, simultaneously linking these with stem and progenitor cell transcriptomic phenotypes using single-cell RNA-sequencing. We observe dynamic shifts of clonal behaviors through time in same-animal peripheral blood and demonstrate that acute platelet depletion shifts the output of multipotent hematopoietic stem cells to the exclusive production of platelets. Additionally, we observe the emergence of new myeloid-biased clones, which support short- and long-term production of blood cells.

CONCLUSIONS

Our approach enables kinetic studies of multi-lineage output in the peripheral blood and transcriptional heterogeneity of individual hematopoietic stem cells. Our results give a unique insight into hematopoietic stem cell reactivation upon platelet depletion and of clonal dynamics in both steady state and under stress.

Plasma cell-derived mtDAMPs activate the macrophage STING pathway, promoting myeloma progression

Mitochondrial damage-associated molecular patterns (mtDAMPs) include proteins, lipids, metabolites, and DNA and have various context-specific immunoregulatory functions. Cell-free mitochondrial DNA (mtDNA) is recognized via pattern recognition receptors and is a potent activator of the innate immune system. Cell-free mtDNA is elevated in the circulation of trauma patients and patients with cancer; however, the functional consequences of elevated mtDNA are largely undefined. Multiple myeloma (MM) relies upon cellular interactions within the bone marrow (BM) microenvironment for survival and progression. Here, using in vivo models, we describe the role of MM cell-derived mtDAMPs in the protumoral BM microenvironment and the mechanism and functional consequence of mtDAMPs in myeloma disease progression. Initially, we identified elevated levels of mtDNA in the peripheral blood serum of patients with MM compared with those of healthy controls. Using the MM1S cells engrafted into nonobese diabetic severe combined immunodeficient gamma mice, we established that elevated mtDNA was derived from MM cells. We further show that BM macrophages sense and respond to mtDAMPs through the stimulator of interferon genes (STING) pathway, and inhibition of this pathway reduces MM tumor burden in the KaLwRij-5TGM1 mouse model. Moreover, we found that MM-derived mtDAMPs induced upregulation of chemokine signatures in BM macrophages, and inhibition of this signature resulted in egress of MM cells from the BM. Here, we demonstrate that malignant plasma cells release mtDNA, a form of mtDAMPs, into the myeloma BM microenvironment, which in turn activates macrophages via STING signaling. We establish the functional role of these mtDAMP-activated macrophages in promoting disease progression and retaining MM cells in the protumoral BM microenvironment.

HSC-derived fatty acid oxidation in steady-state and stressed hematopoiesis

Metabolism impacts all cellular functions and plays a fundamental role in physiology. Metabolic regulation of hematopoiesis is dynamically regulated under steady-state and stress conditions. It is clear that hematopoietic stem cells (HSCs) impose different energy demands and flexibility during maintenance compared with stressed conditions. However, the cellular and molecular mechanisms underlying metabolic regulation in HSCs remain poorly understood. In this review, we focus on defining the role of fatty acid oxidation (FAO) in HSCs. We first review the existing literature describing FAO in HSCs under steady-state hematopoiesis. Next, we describe the models used to examine HSCs under stress conditions, and, finally, we describe how infection causes a shift toward FAO in HSCs and the impact of using this pathway on emergency hematopoiesis.

In Vivo Imaging of Bone Marrow Long-Chain Fatty Acid Uptake

In vivo imaging enables the detection and visualization of many different processes occurring within the body. Fatty acid uptake is a fundamental cellular process which is essential for the use of free fatty acids (FFAs) as a fuel source for metabolism. Detection and visualization of in vivo FFA uptake in the bone marrow has been relatively unknown. Here, we describe the process of non-invasive bioluminescent imaging of in vivo FFA uptake within the bone marrow.

Distinct Tumor Necrosis Factor Alpha Receptors Dictate Stem Cell Fitness versus Lineage Output in Dnmt3a-Mutant Clonal Hematopoiesis

Clonal hematopoiesis resulting from the enhanced fitness of mutant hematopoietic stem cells (HSC) associates with both favorable and unfavorable health outcomes related to the types of mature mutant blood cells produced, but how this lineage output is regulated is unclear. Using a mouse model of a clonal hematopoiesis-associated mutation, DNMT3AR882/+ (Dnmt3aR878H/+), we found that aging-induced TNFα signaling promoted the selective advantage of mutant HSCs and stimulated the production of mutant B lymphoid cells. The genetic loss of the TNFα receptor TNFR1 ablated the selective advantage of mutant HSCs without altering their lineage output, whereas the loss of TNFR2 resulted in the overproduction of mutant myeloid cells without altering HSC fitness. These results nominate TNFR1 as a target to reduce clonal hematopoiesis and the risk of associated diseases and support a model in which clone size and mature blood lineage production can be independently controlled to modulate favorable and unfavorable clonal hematopoiesis outcomes.

SIGNIFICANCE

Through the identification and dissection of TNFα signaling as a key driver of murine Dnmt3a-mutant hematopoiesis, we report the discovery that clone size and production of specific mature blood cell types can be independently regulated. See related commentary by Niño and Pietras, p. 2724. This article is highlighted in the In This Issue feature, p. 2711.

PGC-1α induced mitochondrial biogenesis in stromal cells underpins mitochondrial transfer to melanoma

INTRODUCTION

Progress in the knowledge of metabolic interactions between cancer and its microenvironment is ongoing and may lead to novel therapeutic approaches. Until recently, melanoma was considered a glycolytic tumour due to mutations in mitochondrial-DNA, however, these malignant cells can regain OXPHOS capacity via the transfer of mitochondrial-DNA, a process that supports their proliferation in-vitro and in-vivo. Here we study how melanoma cells acquire mitochondria and how this process is facilitated from the tumour microenvironment.

METHODS

Primary melanoma cells, and MSCs derived from patients were obtained. Genes' expression and DNA quantification was analysed using Real-time PCR. MSC migration, melanoma proliferation and tumour volume, in a xenograft subcutaneous mouse model, were monitored through bioluminescent live animal imaging.

RESULTS

Human melanoma cells attract bone marrow-derived stromal cells (MSCs) to the primary tumour site where they stimulate mitochondrial biogenesis in the MSCs through upregulation of PGC1a. Mitochondria are transferred to the melanoma cells via direct contact with the MSCs. Moreover, inhibition of MSC-derived PGC1a was able to prevent mitochondrial transfer and improve NSG melanoma mouse tumour burden.

CONCLUSION

MSC mitochondrial biogenesis stimulated by melanoma cells is prerequisite for mitochondrial transfer and subsequent tumour growth, where targeting this pathway may provide an effective novel therapeutic approach in melanoma.

LC3-associated phagocytosis in bone marrow macrophages suppresses acute myeloid leukemia progression through STING activation

The bone marrow (BM) microenvironment regulates acute myeloid leukemia (AML) initiation, proliferation, and chemotherapy resistance. Following cancer cell death, a growing body of evidence suggests an important role for remaining apoptotic debris in regulating the immunologic response to and growth of solid tumors. Here, we investigated the role of macrophage LC3–associated phagocytosis (LAP) within the BM microenvironment of AML. Depletion of BM macrophages (BMMs) increased AML growth in vivo. We show that LAP is the predominate method of BMM phagocytosis of dead and dying cells in the AML microenvironment. Targeted inhibition of LAP led to the accumulation of apoptotic cells (ACs) and apoptotic bodies (ABs), resulting in accelerated leukemia growth. Mechanistically, LAP of AML-derived ABs by BMMs resulted in stimulator of IFN genes (STING) pathway activation. We found that AML-derived mitochondrial damage–associated molecular patterns were processed by BMMs via LAP. Moreover, depletion of mitochondrial DNA (mtDNA) in AML-derived ABs showed that it was this mtDNA that was responsible for the induction of STING signaling in BMMs. Phenotypically, we found that STING activation suppressed AML growth through a mechanism related to increased phagocytosis. In summary, we report that macrophage LAP of apoptotic debris in the AML BM microenvironment suppressed tumor growth.

Free fatty-acid transport via CD36 drives β-oxidation-mediated hematopoietic stem cell response to infection

Acute infection is known to induce rapid expansion of hematopoietic stem cells (HSCs), but the mechanisms supporting this expansion remain incomplete. Using mouse models, we show that inducible CD36 is required for free fatty acid uptake by HSCs during acute infection, allowing the metabolic transition from glycolysis towards β-oxidation. Mechanistically, high CD36 levels promote FFA uptake, which enables CPT1A to transport fatty acyl chains from the cytosol into the mitochondria. Without CD36-mediated FFA uptake, the HSCs are unable to enter the cell cycle, subsequently enhancing mortality in response to bacterial infection. These findings enhance our understanding of HSC metabolism in the bone marrow microenvironment, which supports the expansion of HSCs during pathogenic challenge.

Abstract 2799: Multiple myeloma derived mitochondrial DAMPs induce a pro-inflammatory signature in the bone marrow microenvironment to promote pro-tumoral expansion

Multiple myeloma (MM) is an incurable malignancy of antibody (Ig) secreting differentiated B cells (plasma cells) characterized by the accumulation and localization of tumor cells in the bone marrow microenvironment (BMM). Mitochondrial DNA (mtDNA) is a damage associated molecular pattern (DAMP), as the mitochondrial genome contains islands of unmethylated CpG nucleotide motifs that have been shown to activate and promote memory B cell proliferation and antibody secretion. Recent studies have indicated that mtDNA is elevated in the circulation of trauma and cancer patients. Here we investigate the functional purpose of elevated mtDNA within the BM microenvironment of MM.We hypothesize that multiple myeloma cells secrete mitochondrial DAMPs into the bone marrow microenvironment promoting a state of chronic inflammation that drives the progression and expansion of multiple myeloma. NSG immunocompromised mice engrafted with human MM1S myeloma cell line showed elevated levels of MM derived mtDNA in the serum, detected by real-time PCR. Next we engrafted C57BL/6 mice with murine 5TGM1 myeloma cell line to establish a syngeneic mouse model. Flow cytometry analysis of the haematopoietic stem and progenitor cell (HSPC) populations showed that 5TGM1 induced an inflammatory expansion of the stem cell niche To determine the role of mtDNA in HSPC expansion we treated C57BL/6 mice with multiple doses of CpG oligodeoxynucleotides to mimic mtDNA export by MM. Results showed similar expansion of haematopoietic stem and progenitor cell populations. To understand the effects of mtDAMPs on the inflammatory cells of the BMM, we show that bone marrow derived macrophages treated with mtDNA and CpG had increased expression of pro-inflammatory cytokines including IL-6. In vivo, isolated F4/80+ bone marrow macrophages from 5TGM1 and CpG treated mice also showed increased expression of pro-inflammatory cytokines. Finally, to understand the role of mtDAMPs in regulating HSPC expansion we used blocking antibodies to TLR9 (toll-like receptor 9 for mtDNA) and FPR1 (receptor for formylated mitochondrial proteins) in 5TGM1 engrafted animals. Blocking these receptors resulted in reduced myeloma tumor burden compared to control animals. Here we establish that MM releases mtDNA into the microenvironment and highlight the involvement of mtDAMPs in creating a pro-inflammatory BMM that aids in MM disease progression. This data suggests the potential for the targeting of TLR9 or FPR1 signaling pathways as a novel therapeutic approach for MM.

Citation Format: Aisha Jibril, Prakrit Kumar, Charlotte Hellmich, Jamie A. Moore, Jayna J. Mistry, Victoria Willimott, Kristian M. Bowles, Stuart A. Rushworth. Multiple myeloma derived mitochondrial DAMPs induce a pro-inflammatory signature in the bone marrow microenvironment to promote pro-tumoral expansion [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2799.

Abstract 2752: LC3-associated phagocytosis in bone marrow macrophages suppresses AML progression through TIM-4 mediated STING activation

Acute myeloid leukemia (AML) is a tumor dependent on its interactions within the bone marrow (BM) microenvironment. LC3-associated phagocytosis (LAP) maintains tissue homeostasis by regulating immune responses, including in tumor immunity. Here we investigate the function of LAP in the AML BM microenvironment.

We used two syngeneic leukemia models (HOXA9/Meis1 and MN1)to investigate the role of LAP on AML proliferation. AML cells were injected into LAP deficient (LAP-/-; ATG16E230-/-) and wild-type (WT) mice. LAP-/- mice had increased AML engraftment in the BM compared to WT mice, as well as reduced animal survival. Flow cytometry (Annexin+) of the BM microenvironment showed an increase in apoptosis in the BM compartment of mice engrafted with AML. This was further increased in LAP-/- mice with AML.

The number of BM macrophages (MØ) (CD45+, GR1-, F4/80+ CD115INT) did not differ between the WT and LAP-/- mice. Next, we quantified MØ numbers in the BM of WT and LAP-/- mice with AML. We found increased numbers of tumor associated CD206+ BM MØ in LAP-/- mice with AML compared to WT animals with AML. Gene expression analysis showed up-regulation of type I interferons (IFNs) relating to the STING pathway in the WT engrafted mice. Inhibition of the STING pathway reversed the LAP dependent AML suppression of inflammatory cytokines, suggesting LAP processing of apoptotic cells is important for STING activation.

AML has high mtDNA content compared to non-malignant cells, and as mtDNA can activate the STING pathway via cGAS we studied the effects of AML cells without mtDNA (AML ρ0) on STING pathway activation. Induction of apoptosis in AML ρ0 cells followed by co-culture with BM derived MØ (BMDM) for 24 hours did not activate the STING pathway in the MØ. In contrast, MØ co-culture with mitochondria containing apoptotic AML cells did activate the MØ STING pathway.

STING pathway activation via type I IFNs induces recruitment of cytotoxic T cells, but no increase in CD8+ T cell numbers or activation (Granzyme-B and IFN-γ) was observed in the BM between LAP-/- and WT animals engrafted with AML. Type I IFNs produced by MØ have been shown to act in an autocrine manner, we therefore investigated MØ phagocytic capacity in AML. Ex-vivo analysis showed enhanced phagocytosis and LAP processing of Zymosan fluorescent beads and LC3 association in MØ from AML engrafted mice compared to controls. Engulfment of apoptotic cells by MØ requires recognition of phosphatidylserine by surface TIM-4 which mediates LAP. We found TIM-4 inhibition increased AML proliferation in vivo. Finally, ex vivo analysis of TIM-4 inhibited MØ confirmed reduced LAP.

We report that BM MØ process apoptotic AML cells via LAP through TIM-4. Furthermore, AML apoptotic bodies containing mtDNA initiate MØ STING activation and inhibit AML proliferation.

Citation Format: Jamie Aaron Moore, Jayna J. Mistry, Charlotte Hellmich, Aisha Jibril, Tom Wileman, Angela Collins, Kristian M. Bowles, Stuart A. Rushworth. LC3-associated phagocytosis in bone marrow macrophages suppresses AML progression through TIM-4 mediated STING activation [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2752.

Abstract 1048: Targeting BCL-2 and CD38 in models of acute myeloid leukemia reduces tumour burden

The prognosis for patients with acute myeloid leukemia (AML) remains poor with high mortality rates. It is often not possible to achieve complete remission with current therapy and relapse following treatment is common. New and more targeted treatment approaches are therefore needed to improve outcomes for patients. AML progression and treatment resistance has been associated with overexpression of BCL2. Venetoclax, a BH3 mimetic targeting BCL2, has been shown to effectively target AML cells and induce cell death. It has been approved for the treatment of AML but as with other AML treatments not all patients respond, and others develop treatment resistance. Research has therefore focussed on exploring combination therapies for Venetoclax. Our group has previously shown that mitochondrial transfer from mesenchymal stromal cells (MSC) to AML blasts promotes AML growth and is mediated by CD38. Daratumumab targets CD38 and inhibits this transfer, which results in impaired AML growth and improved animal survival. Here, we investigate the effect of inhibiting both CD38 with daratumumab and BCL2 with Venetoclax on the survival of AML. Primary AML blasts and MSC were isolated from patients' bone marrow in accordance with the Declaration of Helsinki. Flow cytometry was used to measure CD38 and BCL2 expression in AML blasts compared to normal CD34+ progenitor cells. BCL2 expression was significantly higher in AML blasts and CD38 expression was also increased. Cell viability was significantly reduced following treatment with Venetoclax alone, whilst Daratumumab alone or in combination with Venetoclax did not affect AML survival further. However, the action of daratumumab relies on the bone marrow microenvironment and AML blasts were therefore co-cultured with MSC and then treated with Venetoclax or daratumumab or in combination. After 24 hours cells were stained with Annexin V-FITC/PI and flow cytometry was used to assess levels of apoptosis. Combination treatment with Venetoclax and Daratumumab resulted in significantly more apoptosis in AML cells compared to AML cells treated with single agent. Finally, the effect of combination treatment with Venetoclax and Daratumumab was assessed in vivo using an NSG xenograft mouse model of AML. Mice were engrafted with MV411-luc or patient derived AML and then treated with vehicle control (PBS) or daratumumab alone (5mg/kg on day 7 and 14) or Venetoclax alone (100mg/kg/day) or both daratumumab and Venetoclax. Bioluminescence imaging was used to assess disease engraftment and progression before and after treatment. Combining treatment with Daratumumab and Venetoclax in vivo significantly reduced tumour burden and improved animal survival compared to control or single agent.

This data supports that combination treatment with Venetoclax and Daratumumab could have an important clinical application in the treatment of AML.

Citation Format: Charlotte Hellmich, Jayna J. Mistry, Amelia Lambert, Jamie A. Moore, Aisha Jibril, Angela Collins, Kristian M. Bowles, Stuart A. Rushworth. Targeting BCL-2 and CD38 in models of acute myeloid leukemia reduces tumour burden [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 1048.

Venetoclax and Daratumumab combination treatment demonstrates pre-clinical efficacy in mouse models of Acute Myeloid Leukemia

Acute myeloid leukemia (AML) remains an incurable malignancy despite recent advances in treatment. Recently a number of new therapies have emerged for the treatment of AML which target BCL-2 or the membrane receptor CD38. Here, we show that treatment with Venetoclax and Daratumumab combination resulted in a slower tumor progression and a reduced leukemia growth both in vitro and in vivo. These data provide evidence for clinical evaluation of Venetoclax and Daratumumab combination in the treatment of AML.

Abstract 2974: Targeting CD38 inhibits metabolic capacity of acute myeloid leukemia in the tumour microenvironment

Acute myeloid leukaemia (AML) causes 85,000 global deaths per year, which is estimated to double by 2040. AML has been shown to be highly dependent on the bone marrow (BM) microenvironment. Mesenchymal stromal cells (MSC) specifically, play an important pro-tumoral role. We previously demonstrated AML blasts rely on higher mitochondrial content and are more dependent on oxidative phosphorylation compared to non-malignant unstimulated CD34+ progenitor cells. To achieve this high metabolic demand, functional mitochondria are transferred from the MSC to the AML blasts. Mitochondrial transfer has also been demonstrated in myeloma in a pro-tumoral process regulated by CD38. Taken together, these data indicate that mitochondria are a biologically plausible and attractive drug target in the treatment of AML.We investigated the role mitochondrial transfer and the subsequent metabolic consequences of inhibiting CD38 using daratumumab on the AML BM microenvironment.Primary AML blasts and MSC were isolated from patient's BM. Mitochondrial transfer was assessed by coculture of AML and MSC in vitro using both qPCR DNA analysis and flow cytometry analysis. We used an NSG xenograft mouse model of AML, we transplanted OCI-AML3-luc, and treated the animals with either vehicle control (PBS) or daratumumab (5mg/kg) on day 9 and 16 followed by bioluminescence imaging. Post transplantation, AML mitochondrial transfer was assessed by murine mitochondrial DNA in human AML blasts by species specific PCR analysis. Post transplantation mitochondrial health and function was measured by TMRM and Seahorse analysis.Targeting CD38 using daratumumab inhibits the transfer of mitochondria from MSC to AML in vitro. In vivo, treatment with daratumumab significantly reduced tumor burden and improved survival compared to untreated controls. Additionally, we found two doses of daratumumab resulted in reduced mitochondrial potential, mitochondrial content and oxygen consumption rate in the AML cells sorted from the human xenograft mouse model. Finally, analysis of human AML cells sorted from NSG mouse BM showed reduced levels of mouse mitochondrial DNA in the human AML blasts from daratumumab treated mice compared to mice with AML treated with vehicle control.CD38 inhibition by daratumumab treatment inhibits mitochondrial transfer from MSC to AML blasts in the BM microenvironment. This results in a reduction in oxidative phosphorylation in AML blasts and subsequent reduced leukemia growth, which in turn results in improved NSG/AML animal survival. Whilst it is probable that daratumumab has a number of mechanisms of action, here we demonstrate inhibition of mitochondrial transfer is an addition to the list for this drug in AML. These data support the further clinical investigation of daratumumab based chemotherapeutic strategies as a therapeutic approach for the treatment AML.

Citation Format: Jayna J. Mistry, Jamie A. Moore, Christopher R. Marlein, Charlotte Hellmich, Genevra Pillinger, Federica Di Palma, Angela Collins, Kristian M. Bowles, Stuart A. Rushworth. Targeting CD38 inhibits metabolic capacity of acute myeloid leukemia in the tumour microenvironment [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 2974.

CD38-Driven Mitochondrial Trafficking Promotes Bioenergetic Plasticity in Multiple Myeloma

Metabolic adjustments are necessary for the initiation, proliferation, and spread of cancer cells. Although mitochondria have been shown to move to cancer cells from their microenvironment, the metabolic consequences of this phenomenon have yet to be fully elucidated. Here, we report that multiple myeloma cells use mitochondrial-based metabolism as well as glycolysis when located within the bone marrow microenvironment. The reliance of multiple myeloma cells on oxidative phosphorylation was caused by intercellular mitochondrial transfer to multiple myeloma cells from neighboring nonmalignant bone marrow stromal cells. This mitochondrial transfer occurred through tumor-derived tunneling nanotubes (TNT). Moreover, shRNA-mediated knockdown of CD38 inhibits mitochondrial transfer and TNT formation in vitro and blocks mitochondrial transfer and improves animal survival in vivo. This study describes a potential treatment strategy to inhibit mitochondrial transfer for clinical benefit and scientifically expands the understanding of the functional effects of mitochondrial transfer on tumor metabolism. SIGNIFICANCE: Multiple myeloma relies on both oxidative phosphorylation and glycolysis following acquisition of mitochondria from its bone marrow microenvironment.See related commentary by Boise and Shanmugam, p. 2102.