BH3 mimetics augment cytotoxic T cell killing of acute myeloid leukemia via mitochondrial apoptotic mechanism

Authors:
Saxena K, Ryu E, Hung SH, Singh S, Zhang Q, Zeng Z, Wang Z, Konopleva M, Yee C
In:
Source: Nature
Publication Date: (2025)
Issue: 11(1): 120
Research Area:
Cancer Research/Cell Biology
Immunotherapy / Hematology
Gene Expression
Basic Research
Molecular Biology
Regenerative medicine
Cells used in publication:
OCI-AML2
Species: human
Tissue Origin: blood
Platform:
4D-Nucleofector® 96-well Systems
Experiment

Generation of knockout cell lines

Gene knockout kits against BAX, BAK, and BID as well as Cas9 from Streptococcus pyogenes (SpCas9) were purchased from Synthego (Redwood City, CA). sgRNA sequences are detailed below. Lyophilized sgRNA was resuspended in TE (Tris-EDTA) buffer per the manufacturer’s instructions. OCI-AML2 cells were transfected per a ribonucleoprotein (RNP) strategy of SpCas9 combined with sgRNA against the gene of interest. For negative control cells, SpCas9 was paired with a non-targeting negative control sgRNA obtained from Synthego. RNP complexes were incubated for 15 min at 37 degrees Celsius prior to addition to OCI-AML2 cells. OCI-AML2 cells were washed once in PBS and then resuspended in nucleofection SF buffer obtained from Lonza (Basel, Switzerland) containing the RNP complex. The cell suspension was then immediately placed in a Lonza Amaxa 4D Nucleofector X Unit using a 96-well plate format, and nucleofection was performed using the FF-120 protocol. OCI-AML2 cells were placed back into A221 media and either underwent repeated rounds of nucleofection or were assessed for BAX/BAK or BID protein expression by western blot. In order to create near-complete knockouts in a bulk population of cells, we performed several rounds of RNP nucleofection because these mitochondrial proteins are intracellular, precluding cell sorting for live knockout (KO) cells. We noted that protein expression by western blot would return by 4–5 days post-RNP nucleofection, suggesting that wild-type cells remained, which could outgrow the knockout population, and thus experiments were performed within 4 days of the terminal nucleofection. The control sample underwent the equivalent number of Cas9/nucleofection treatments with a control scramble gRNA as detailed above.

Abstract

Adoptive cell therapy (ACT) can address an unmet clinical need for patients with relapsed/refractory acute myeloid leukemia (AML), but its effect is often modest in the setting of high tumor burden. In this study, we postulated that strategies to lower the AML apoptotic threshold will augment T cell killing of AML cells. BH3 mimetics, such as venetoclax, are a clinically approved class of compounds that predispose cells to intrinsic apoptosis by inhibiting anti-apoptotic mitochondrial proteins. We explored the antileukemic efficacy of BH3 mimetics combined with WT1-specific CD8+ T cells on AML cell lines and primary samples from patients with a diverse array of disease characteristics to evaluate if lowering the cellular apoptotic threshold via inhibition of anti-apoptotic mitochondrial proteins can increase leukemic cell sensitivity to T cell therapy. We found that the combination approach of BH3 mimetic and CD8+ T cells led to significantly increased killing of established AML lines as well as of adverse-risk primary AML leukemic blast cells. In contrast to the hypothesis that enhanced killing would be due to combined activation of the intrinsic and extrinsic apoptotic pathways, our data suggests that CTL-mediated killing of AML cells was accomplished primarily through activation of the intrinsic/mitochondrial apoptotic pathway. This highly effective combinatorial activity due to convergence on the mitochondrial apoptotic pathway was conserved across multiple AML cell lines and primary samples, suggesting that mitochondrial priming may represent a novel mechanism of optimizing adoptive cell therapy for AML patients.