A self-assembled leucine polymer sensitizes leukemic stem cells to chemotherapy by inhibiting autophagy in acute myeloid leukemia

Haematologica. 2022 Oct 1;107(10):2344-2355. doi: 10.3324/haematol.2021.280290.

Abstract

Chemotherapy is the primary treatment option for acute myeloid leukemia (AML), but leukemic stem cells (LSC) can survive chemotherapy for disease recurrence and refractory. Here, we found that AML cells obtained from relapsed patients had increased autophagy levels than de novo AML cells. Furthermore, doxorubicin (DOX) treatment stimulated autophagy in LSC by repressing the mTOR pathway, and pharmaceutical inhibition of autophagy rendered chemoresistant LSC sensitive to DOX treatment in MLL-AF9 induced murine AML. Moreover, we developed a self-assembled leucine polymer, which activated mTOR to inhibit autophagy in AML cells by releasing leucine. The leucine polymer loaded DOX (Leu-DOX) induced much less autophagy but more robust apoptosis in AML cells than the DOX treatment. Notably, the leucine polymer and Leu-DOX were specifically taken up by AML cells and LSC but not by normal hematopoietic cells and hematopoietic stem/progenitor cells in the bone marrow. Consequently, Leu-DOX efficiently reduced LSC and prolonged the survival of AML mice, with more limited myeloablation and tissue damage side effects than DOX treatment. Overall, we proposed that the newly developed Leu-DOX is an effective autophagy inhibitor and an ideal drug to efficiently eliminate LSC, thus serving as a revolutionary strategy to enhance the chemotherapy efficacy in AML.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Autophagy
  • Doxorubicin / pharmacology
  • Doxorubicin / therapeutic use
  • Leucine / pharmacology
  • Leukemia, Myeloid, Acute*
  • Mice
  • Neoplastic Stem Cells* / metabolism
  • Polymers / metabolism
  • Polymers / pharmacology
  • Polymers / therapeutic use
  • TOR Serine-Threonine Kinases / metabolism

Substances

  • Polymers
  • Doxorubicin
  • TOR Serine-Threonine Kinases
  • Leucine

Grants and funding

Funding: We would like to thank the National Key Research and Development Program of China (grant numbers: 2018YFA0107200, 2017YFA0103403), the Key Research and Development Program of Guangdong Province (grant number: 2019B020234002), NSFC (grant numbers: 82170112, 52173150, 81900101, 81970139), Guangdong Introducing Innovative and Entrepreneurial Research Teams (grant number: 2019ZT08Y485), Guangdong Natural Science Funds for Distinguished Young Scholar (grant number: 2021B1515020012), Sanming Project of Medicine in Shenzhen (grant number: SZSM201911004), and Advanced Medical Technology Center, The First Afliated Hospital, Zhongshan School of Medicine, Sun Yat-sen University for generous support.