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University of Tennessee Health Science Center

The Heme-Regulated Inhibitor Pathway Modulates Susceptibility of Poor Prognosis B-Lineage Acute Leukemia to BH3-Mimetics

Abstract

dc:description.abstract

<p>Anti-apoptotic MCL1 is one of the most frequently amplified genes in human cancers and its elevated expression confers resistance to many therapeutics including the BH3-mimetic agents ABT-199 and ABT-263. The anti-malarial, dihydroartemisinin (DHA) translationally represses MCL-1 and synergizes with BH3-mimetics. To explore how DHA represses MCL-1, a genome-wide CRISPR screen identified that loss of genes in the heme synthesis pathway renders mouse BCR-ABL+ B-ALL cells resistant to DHA-induced death. Mechanistically, DHA disrupts the interaction between heme and the eIF2α kinase heme regulated inhibitor (HRI) triggering the integrated stress response. Genetic ablation of Eif2ak1, which encodes HRI, blocks MCL-1 repression in response to DHA treatment and represses the synergistic killing of DHA and BH3-mimetics compared to wild-type leukemia. Furthermore, BTdCPU, a small-molecule activator of HRI, similarly triggers MCL-1 repression and synergizes with BH3-mimetics in mouse and human leukemia including both Ph+ and Ph-like B-ALL. Lastly, combinatorial treatment of leukemia bearing mice with both BTdCPU and a BH3-mimetic extended survival and repressed MCL-1 in vivo. These findings reveal that the HRI-dependent cellular heme-sensing pathway can modulate apoptosis in leukemic cells by repressing MCL-1 and increasing their responsiveness to BH3-mimetics. This signaling pathway could represent a generalizable mechanism for repressing MCL-1 expression in malignant cells and sensitizing them to available therapeutics.</p>

Degree

thesis:*
Name thesis:degree_name
Doctor of Philosophy (PhD)
Level thesis:degree_level
Dissertation
Discipline thesis:degree_discipline
Biomedical Sciences
Year dc:date.available
2021

Author and committee

dc:creator, dc:contributor.*
Author dc:creator
  • Smith, Kaitlyn Hill
Contributors dc:contributor
  • Joseph T. Opferman, Ph.D

Subjects

dc:subject × 10

Identifiers

dc:identifier.*
Repository record dc:identifier
https://dc.uthsc.edu/dissertations/550
OAI identifier oai:identifier
oai:dc.uthsc.edu:dissertations-1547

Chain of custody

source
Harvested from
University of Tennessee Health Science Center
Base URL
dc.uthsc.edu/do/oai/
Last updated
2026-07-24
Source record
OAI-PMH GetRecord
citation

Smith, Kaitlyn Hill. The Heme-Regulated Inhibitor Pathway Modulates Susceptibility of Poor Prognosis B-Lineage Acute Leukemia to BH3-Mimetics. Dissertation thesis, 2021. https://dc.uthsc.edu/dissertations/550