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Blood, 15 June 2008, Vol. 111, No. 12, pp. 5672-5682.
Prepublished online as a Blood First Edition Paper on April 3, 2008April 10, 2008; DOI 10.1182/blood-2007-09-108175.


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Submitted September 4, 2007
Accepted February 23, 2008

Leukemogenic mechanisms and targets of a NUP98/HHEX fusion in acute myeloid leukemia (AML)

Dragana Jankovic, Paolo Gorello, Ting Liu, Sabine Ehret, Roberta La Starza, Cecile Desjobert, Florent Baty, Martin Brutsche, Padma-Sheela Jayaraman, Alessandra Santoro, Cristina Mecucci, and Juerg Schwaller*

Department of Research, University Hospital Basel, Basel, Switzerland
Hematology and Bone marrow transplantation Unit, University of Perugia, Perugia, Italy
Department of Biochemistry, University of Bristol, Bristol, United Kingdom
Department for Internal Medicine, University Hospital Basel, Basel, Switzerland
Division of Immunity and Infection, University of Birmingham, Birmingham, United Kingdom
Divisione di Ematologia, Ospedale V. Cervello, Palermo, Italy

* Corresponding author; email: j.schwaller{at}unibas.ch.

We have studied a patient with acute myeloid leukemia (AML) and t(10;11)(q23;p15) as the sole cytogenetic abnormality. Molecular analysis revealed a translocation involving nucleoporin 98 (NUP98) fused to the DNA binding domain of the hematopoietically expressed homeobox gene (HHEX). Expression of NUP98/HHEX in murine bone marrow cells leads to aberrant self-renewal and a block in normal differentiation which depends on the integrity of the NUP98 GFLG repeats and the HHEX homeodomain. Transplantation of bone marrow cells expressing NUP98/HHEX leads to transplantable acute leukemia characterized by extensive infiltration of leukemic blasts expressing myeloid markers (Gr1+) as well as markers of the B-cell lineage (B220+). A latency period of 9 months and its oligoclonal character suggest that NUP98/HHEX is necessary but not sufficient for disease induction. Expression of EGFP-NUP98/HHEX fusions showed a highly similar nuclear localization pattern as for other NUP98/homeodomain fusions, such as NUP98/HOXA9. Comparative gene expression profiling in primary bone marrow cells provided evidence for the presence of common targets in cells expressing NUP98/HOXA9 or NUP98/HHEX. Some of these genes (Hoxa5, Hoxa9, Flt3) are deregulated in NUP98/HHEX induced murine leukemia as well as in human blasts carrying this fusion and might represent bona fide therapeutic targets.


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