ERG ENHANCER-BASED REPORTER IDENTIFIES LEUKEMIA CELLS WITH ELEVATED LEUKEMOGENIC POTENTIAL DRIVEN BY ERG-USP9X FEED-FORWARD REGULATION

Acute leukemia is a rapidly progressing blood cancer with low survival rates. Unfavorable prognosis is attributed to the insufficiently characterized subpopulations of Leukemia Stem Cells (LSCs) that drive chemoresistance and leukemia relapse. Here we utilized a genetic reporter which enables stemness assessment to enrich and functionally characterize LSCs. We revealed heterogeneous activity of the ERG+85 enhancer based fluorescent reporter in human leukemias. Cells with high reporter activity (tagBFPHigh) exhibited elevated expression of stemness and chemo-resistance genes, demonstrated increased clonogenicity and resistance to chemo- and radio- therapy as compared to their tagBFPNeg counterparts. Moreover, tagBFPHigh enriched fraction was capable of regenerating the original cellular heterogeneity and demonstrated increased invasion ability. Most importantly, tagBFPHigh fraction was enriched for leukemia initiating cells in a xenograft assay. We also identified USP9X deubiquitinase enzyme as a novel ERG transcriptional target that sustains ERG+85 positive cells by controlling ERG ubiquitination. Therapeutic targeting of USP9X led to the preferential inhibition of the ERG-dependent leukemias. In summary, we have developed a new strategy to characterize LSCs and propose ERG targeting via USP9X inhibition as a potential anti-leukemia treatment.