4 Combined treatment with chidamide and MI-3 disrupts DNA damage response. expressed in MOLM-13 cells treated with MI-3 vs. ITGA6 chidamide alone or Picaridin in combination. Physique S6. Treatment with chidamide results in increased acetylation of Picaridin histone H3 in both MLL-r and non-MLL-r AML cells. (DOCX 3896 kb) 13148_2019_723_MOESM1_ESM.docx (3.8M) GUID:?57F59A1C-9635-4558-9D15-DE1D6D337F6D Additional file 2: Table S1. List of all genes that were differentially expressed in cells exposed to MI-3, chidamide, or both, in which 635 overlapped genes shown in the Venn Diagram (Physique 3C) as well as 59 genes indicated by a square (Physique 3D) are highlighted in pink and yellow, respectively. (XLSX 1820 kb) 13148_2019_723_MOESM2_ESM.xlsx (1.8M) GUID:?D625CED2-C137-4A5F-BDA1-AA48E79A6804 Data Availability StatementThe RNAseq datasets of the present study are available on request from your corresponding author. Abstract While the aberrant translocation of the mixed-lineage leukemia (MLL) gene drives pathogenesis of acute myeloid leukemia (AML), it represents an independent predictor for poor prognosis of adult AML patients. Thus, small molecule inhibitors targeting menin-MLL fusion protein conversation have been emerging for the treatment of MLL-rearranged AML. As both inhibitors of histone deacetylase (HDAC) and menin-MLL conversation target the transcription-regulatory machinery involving Picaridin epigenetic regulation Picaridin of chromatin remodeling that governs the expression of genes involved in tumorigenesis, we hypothesized that these two classes of brokers might interact to kill MLL-rearranged (MLL-r) AML cells. Here, we report that this combination treatment with subtoxic doses of the HDAC inhibitor chidamide and the menin-MLL conversation inhibitor MI-3 displayed a highly synergistic anti-tumor activity against human MLL-r AML cells in vitro and in vivo, but not those without this genetic aberration. Mechanistically, co-exposure to chidamide and MI-3 led to strong apoptosis in MLL-r AML cells, in association with loss of mitochondrial membrane potential and a sharp increase in ROS generation. Combined treatment also disrupted DNA damage checkpoint at the level of CHK1 and CHK2 kinases, rather than their upstream kinases (ATR and ATM), as well as DNA repair likely via homologous recombination (HR), but not nonhomologous end joining (NHEJ). Genome-wide RNAseq revealed gene expression alterations involving several potential signaling pathways (e.g., cell cycle, DNA repair, MAPK, NF-B) that might account for or contribute to the mechanisms of action underlying anti-leukemia activity of chidamide and MI-3 as a single agent and particularly in combination in MLL-r AML. Collectively, these findings provide a preclinical basis for further clinical investigation of this novel targeted strategy combining HDAC and Menin-MLL conversation inhibitors to improve therapeutic outcomes in a subset of patients with poor-prognostic MLL-r leukemia. Electronic supplementary material The online version of this article (10.1186/s13148-019-0723-0) contains supplementary material, which is available to authorized users. 0.05, ** 0.01, and *** 0.001 for comparison with each single agent. c, d MOLM-13 (c) and MV4-11 (d) cells were treated as explained in Additional file 2: Supplemental Table 1, followed by the analysis of Picaridin cell viability as above, after which the CompuSyn analysis was performed to determine whether the conversation between these two brokers is usually synergistic (CI value 1.0) Co-exposure to chidamide and MI-3 induces apoptosis of MLL-rearrangement AML cells, in association with increased ROS generation and mitochondrial injury To validate the synergistic effect of the regimen combining chidamide and MI-3 on MLL-r AML cells, the colony formation assay was performed. As shown in Fig. ?Fig.2a,2a, whereas chidamide (2.6 M) and MI-3 (13.9 M) displayed moderate single-agent activity, a significant reduction in colony formation was observed in MOLM-13 cells after combined treatment, compared with these two brokers alone. Analogous results were obtained from MV4-11, another MLL-r AML cells (Additional file 1: Physique S3A). Moreover, circulation cytometry with Annexin V/PI staining was then performed to examine whether chidamide would interact with MI-3 to induce apoptosis in MLL-r cells. After exposing to chidamide and MI-3 alone or in combination for 48 h, the percentage of apoptotic (Annexin V-positive) cells was significantly increased in MOLM-13 (Fig. ?(Fig.2b)2b) and MV4-11 cells (Additional file 1: Physique S3B), compared to each single agent. As loss of mitochondrial membrane potential (MMP) plays a crucial role in the initiation of intrinsic mitochondrion-dependent apoptotic cascade , we next examined the effect of chidamide and MI-3 individually or in combination on MMP. Consistent with the results for apoptosis, combined treatment with chidamide and MI-3 also induced loss of MMP, reflected by impaired mitochondrial depolarization indicated by markedly decreased fluorescence intensity ratio between JC-1 aggregate and monomer (Fig. ?(Fig.2c2c and Additional file 1: Physique S3C). To unveil the potential mechanism underlying the synergistic conversation between these two brokers in the induction of apoptosis, circulation cytometry was carried out to monitor intracellular ROS levels. After co-treated with chidamide and MI-3 for 48 h, a significant.