HoxA9 transforms murine myeloid cells by a feedback loop driving expression of key oncogenes and cell cycle control genes.

Ectopic expression of the oncogenic transcription factor HoxA9 is a major cause of acute myeloid leukemia (AML). Here, we demonstrate that HoxA9 is a specific substrate of granule proteases. Protease knockout allowed the comprehensive determination of genome-wide HoxA9 binding sites by chromatin immunoprecipitation sequencing in primary murine cells and a human AML cell line. The kinetics of enhancer activity and transcription rates in response to alterations of an inducible HoxA9 were determined. This permitted identification of HoxA9-controlled enhancers and promoters, allocation to their respective transcription units, and discrimination against HoxA9-bound, but unresponsive, elements. HoxA9 triggered an elaborate positive-feedback loop that drove expression of the complete -A locus. In addition, it controlled key oncogenic transcription factors and and directly induced the cell cycle regulators and , as well as telomerase, drawing the essential blueprint for perturbation of proliferation by leukemogenic HoxA9 expression.