Therapeutic options in acute myeloid leukemia (AML) have remained unchanged for nearly the past five decades, with cytarabine (AraC) and anthracyclines as the cornerstone for treating the disease. One of the challenges to the success of AML therapy is the resistance of leukemic stem cells to chemotherapy, leading to disease relapse1,2. Epigenetic regulation plays a vital role in cancer pathogenesis and drug resistance, and several epigenetic factors have emerged as promising therapeutic targets3,4,5. Epigenetic regulatory mechanisms affect proliferation and survival under continuous exposure to chemotherapeutic drugs. Studies in non-hematological malignancies have reported that a small fraction of cells that overcome the drug effect undergo various epigenetics modifications, resulting in those cells' survival6,7. However, the role of epigenetic factors in mediating acquired resistance to cytarabine in AML has not been explored.
High-throughput screening is an approach to drug discovery that has gained global importance over time and has become a standard method in different aspects to identify potential targets in cellular mechanisms, for pathway profiling, and at the molecular level8,9. The synthetic lethality concept involves the interaction between two genes where the perturbation of either gene alone is viable but of both genes simultaneously results in the loss of viability10. Exploiting synthetic lethality in cancer treatment could help identify and mechanistically characterize robust synthetic lethal genetic interactions11. We have adopted a combinatorial approach of high-throughput shRNA screening with synthetic lethality to identify the epigenetic factors responsible for acquired cytarabine resistance in AML.
Acute leukemias driven by chromosomal translocation of the mixed-lineage leukemia gene (MLL or KMT2A) are known to be associated with poor survival in patients. The resulting chimeric products of MLL gene rearrangements, i.e., MLL fusion proteins (MLL-FPs), can transform hematopoietic stem/progenitor cells (HSPCs) into leukemic blasts with the involvement of multiple epigenetic factors. These epigenetic regulators constitute a complicated network that dictates the maintenance of the leukemia program and, therefore, could form potential therapeutic targets. In this context, we used the MV4-11 cell line (harboring the MLL fusion gene MLL-AF4 with the FLT3-ITD mutation; termed as MV4-11 P) to develop the acquired cytarabine resistant cell line, termed as MV4-11 AraC R. The cell line was exposed to increasing doses of cytarabine with intermittent recovery from the drug treatment, known as a drug holiday. The half-maximal inhibitory concentration (IC50) was assessed by in vitro cytotoxicity assay.
We used the pooled epigenetic shRNA Library (see Table of Materials) driven by the hEF1a promoter with a pZIP lentiviral backbone. This library comprises shRNAs targeting 407 epigenetic factors. Each factor has 5-24 shRNAs, with a total of 5,485 shRNAs, including five non-targeting control shRNAs. The modified "UltrmiR" miR-30 scaffold has been optimized for efficient primary shRNA biogenesis and expression12,13.
The outline of this experiment is illustrated in Figure 1A. The current protocol focuses on RNAi screening using the epigenetic factor shRNA library in the MV4-11 AraC R cell line (Figure 1B), a suspension cell line. This protocol can be used to screen any targeted library in any drug-resistant cell line of one's choice. It should be noted that the transduction protocol will be different for adherent cells.