Abstract
Acute myeloid leukemias (AMLs) are a heterogeneous group of diseases that are sustained by relatively rare leukemia-initiating cells (LICs) that exhibit diverse genetic and phenotypic properties. AML heterogeneity presents a major challenge to development of targeted therapies, and effective treatment will require targeting of common molecular drivers of AML maintenance. The orphan nuclear receptors NR4A1 and NR4A3 are potent tumor suppressors of AML. They are silenced in all human AML LICs, irrespective of patient cytogenetics, and their deletion in mice leads to postnatal AML development. In the current report, we address the tumor-suppressive mechanisms and therapeutic potential of NR4As for AML intervention. We show that rescue of either NR4A1 or NR4A3 inhibits the leukemogenicity of AML cells in vivo and reprograms a subset of gene signatures that distinguish primary human LICs from normal hematopoietic stem cells (HSCs), irrespective of subtype. Central to NR4A reprogramming is the acute suppression of an LIC submodule that includes the transcriptional repression of MYC. Additionally, we show that upregulation of MYC is an acute preleukemic consequence of NR4A deletion and that MYC suppression functionally contributes to NR4A antileukemic effects. Collectively, these results identify NR4As as novel targets for AML therapeutic intervention and reveal molecular targets of NR4A tumor suppression, including the suppression of MYC.