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难治性/复发性急性髓系白血病化疗失败的机制:阿糖胞苷耐药和线粒体代谢的作用

Mechanisms of chemotherapy failure in refractory/relapsed acute myeloid leukemia: the role of cytarabine resistance and mitochondrial metabolism.

作者信息

Yeon Chae Soo, Jang Se-Young, Kim Jinhui, Hwang Sehyun, Malani Disha, Kallioniemi Olli, Yun Seung Gyu, Kim Jong-Seo, Kim Hugh I

机构信息

Department of Chemistry, Korea University, Seoul, Republic of Korea.

Center for Proteogenome Research, Korea University, Seoul, Republic of Korea.

出版信息

Cell Death Dis. 2025 Apr 23;16(1):331. doi: 10.1038/s41419-025-07653-6.

Abstract

Acute myeloid leukemia (AML) is an aggressive hematological malignancy. Patients with wild-type FLT3 relapsed or refractory (R/R) AML face significant therapeutic challenges due to the persistent lack of effective treatments. A comprehensive understanding of the mechanisms underlying chemotherapy resistance is needed to the development of effective treatment strategies. Therefore, we investigated the molecular mechanisms underlying cytarabine (Ara-C) resistance and daunorubicin (DNR) tolerance in Ara-C-resistant RHI-1 cells derived from the wild-type FLT3 AML cell line SHI-1. Quantitative analysis of intracellular drug concentrations, proteomics, and phosphoproteomics showed that DNR resistance in Ara-C-resistant RHI-1 cells is driven by metabolic remodeling toward mitochondrial metabolism, upregulation of DNA repair pathways, and enhanced reactive oxygen species (ROS) detoxification rather than reduced drug uptake. Moreover, targeting these compensatory mechanisms, particularly the OXPHOS complex I proteins, significantly improved the efficacy of both Ara-C and DNR. Conclusively, these findings highlight mitochondrial metabolism and DNA repair as critical factors in chemotherapy resistance and offer valuable insights into potential therapeutic targets for enhancing treatment outcomes in patients with wild-type FLT3 R/R AML.

摘要

急性髓系白血病(AML)是一种侵袭性血液系统恶性肿瘤。野生型FLT3复发或难治性(R/R)AML患者由于持续缺乏有效治疗方法,面临着重大的治疗挑战。为了制定有效的治疗策略,需要全面了解化疗耐药的潜在机制。因此,我们研究了源自野生型FLT3 AML细胞系SHI-1的阿糖胞苷(Ara-C)耐药RHI-1细胞中阿糖胞苷耐药和柔红霉素(DNR)耐受的分子机制。细胞内药物浓度、蛋白质组学和磷酸化蛋白质组学的定量分析表明,Ara-C耐药RHI-1细胞中的DNR耐药是由向线粒体代谢的代谢重塑、DNA修复途径的上调以及活性氧(ROS)解毒增强驱动的,而不是药物摄取减少。此外,靶向这些代偿机制,特别是氧化磷酸化复合体I蛋白,显著提高了Ara-C和DNR的疗效。总之,这些发现突出了线粒体代谢和DNA修复是化疗耐药的关键因素,并为增强野生型FLT3 R/R AML患者治疗效果的潜在治疗靶点提供了有价值的见解。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d1de/12019594/4292917c1e31/41419_2025_7653_Fig1_HTML.jpg

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