Downregulation of the Wnt inhibitor CXXC5 predicts a better prognosis in acute myeloid leukemia

Kuhnl, A., Valk, P. J. M., Sanders, M. A., Ivey, A., Hills, Robert Kerrin ORCID: https://orcid.org/0000-0003-0166-0062, Mills, K. I., Gale, R. E., Kaiser, M. F., Dillon, R., Joannides, M., Gilkes, Amanda F., Haferlach, T., Schnittger, S., Duprez, E., Linch, D. C., Delwel, R., Lowenberg, B., Baldus, C. D., Solomon, E., Burnett, Alan K. and Grimwade, D. 2015. Downregulation of the Wnt inhibitor CXXC5 predicts a better prognosis in acute myeloid leukemia. Blood 125 (19) , pp. 2985-2994. 10.1182/blood-2014-12-613703

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Abstract

The gene CXXC5 on 5q31 is frequently deleted in acute myeloid leukemia (AML) with del(5q), suggesting that inactivation of CXXC5 might play a role in leukemogenesis. Here, we investigated the functional and prognostic implications of CXXC5 expression in AML. CXXC5 mRNA was downregulated in AML with MLL rearrangements, t(8;21) and GATA2 mutations. As a mechanism of CXXC5 inactivation, we found evidence for epigenetic silencing by promoter methylation. Patients with CXXC5 expression below the median level had a lower relapse rate (45% vs 59%; P = .007) and a better overall survival (OS, 46% vs 28%; P < .001) and event-free survival (EFS, 36% vs 21%; P < .001) at 5 years, independent of cytogenetic risk groups and known molecular risk factors. In gene-expression profiling, lower CXXC5 expression was associated with upregulation of cell-cycling genes and codownregulation of genes implicated in leukemogenesis (WT1, GATA2, MLL, DNMT3B, RUNX1). Functional analyses demonstrated CXXC5 to inhibit leukemic cell proliferation and Wnt signaling and to affect the p53-dependent DNA damage response. In conclusion, our data suggest a tumor suppressor function of CXXC5 in AML. Inactivation of CXXC5 is associated with different leukemic pathways and defines an AML subgroup with better outcome.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine
Subjects:	R Medicine > R Medicine (General)
Publisher:	American Society of Hematology
ISSN:	0006-4971
Date of Acceptance:	11 March 2015
Last Modified:	31 Oct 2022 10:23
URI:	https://orca.cardiff.ac.uk/id/eprint/84636

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