TET2 as a tumor suppressor and therapeutic target in T-cell acute lymphoblastic leukemia

Abstract

Pediatric T-cell acute lymphoblastic leukemia (T-ALL) is an aggressive malignancy resulting from overproduction of immature T-cells in the thymus and is typified by widespread alterations in DNA methylation. As survival rates for relapsed T-ALL remain dismal (10 to 25%), development of targeted therapies to prevent relapse is key to improving prognosis. Whereas mutations in the DNA demethylating enzyme TET2 are frequent in adult T-cell malignancies, <i>TET2</i> mutations in T-ALL are rare. Here, we analyzed RNA-sequencing data of 321 primary T-ALLs, 20 T-ALL cell lines, and 25 normal human tissues, revealing that <i>TET2</i> is transcriptionally repressed or silenced in 71% and 17% of T-ALL, respectively. Furthermore, we show that <i>TET2</i> silencing is often associated with hypermethylation of the <i>TET2</i> promoter in primary T-ALL. Importantly, treatment with the DNA demethylating agent, 5-azacytidine (5-aza), was significantly more toxic to <i>TET2</i>-silenced T-ALL cells and resulted in stable re-expression of the <i>TET2</i> gene. Additionally, 5-aza led to up-regulation of methylated genes and human endogenous retroviruses (HERVs), which was further enhanced by the addition of physiological levels of vitamin C, a potent enhancer of TET activity. Together, our results clearly identify 5-aza as a potential targeted therapy for <i>TET2</i>-silenced T-ALL.