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Single-cell transcriptomic profiling identifies developmental haematopoietic program enrichment in KMT2A-rearranged infant acute lymphoblastic leukaemia
Uppsala University, Science for Life Laboratory, SciLifeLab. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Cancer precision medicine. (Helena Jernberg Wiklund)ORCID iD: 0000-0001-6941-5843
Uppsala University, Disciplinary Domain of Science and Technology, Biology, Department of Cell and Molecular Biology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Cancer precision medicine. Uppsala University, Science for Life Laboratory, SciLifeLab.ORCID iD: 0009-0005-0913-9492
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Infant acute lymphoblastic leukaemia (iALL) (age < 1 year) is a rare haematological disease, corresponding to less than 5% of all childhood ALL. Translocations in the KMT2A gene (KMT2A/MLL) are found in about 75% of iALL patients. Notably, the KMT2A rearrangement (KMT2A-r) has previously been strongly correlated with a poor prognosis and disease relapse in iALL. However, the molecular mechanisms by which KMT2A-r drives disease progression and confers treatment resistance remain poorly understood. Here, we employed scRNA-seq to investigate the transcriptional landscapes of KMT2A-r and germline KMT2A (KMT2A-g) iALL. We demonstrated that KMT2A-r is dominated by a highly proliferative and transcriptionally immature cell population characterized by aberrant expression of early hematopoietic programs. In contrast, KMT2A-g iALL exhibited a more differentiated B-cell–like phenotype with increased transcriptional heterogeneity. Our data suggest that both disease subtypes have distinct transcriptional programs that might underpin KMT2A-r leukemogenesis and potentially drive new therapeutic strategies. 

National Category
Medical Genetics and Genomics
Identifiers
URN: urn:nbn:se:uu:diva-583020OAI: oai:DiVA.org:uu-583020DiVA, id: diva2:2048204
Available from: 2026-03-24 Created: 2026-03-24 Last updated: 2026-03-27
In thesis
1. Epigenetic signatures pave the way to precision medicine in haematological malignancies
Open this publication in new window or tab >>Epigenetic signatures pave the way to precision medicine in haematological malignancies
2026 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Haematological malignancies remain clinically challenging due to the incomplete understanding of the molecular mechanisms that drive disease progression and therapeutic resistance. Multiple myeloma (MM) is a heterogeneous malignancy characterised by the clonal expansion of malignant plasma cells within the bone marrow. Although recurrent genetic alterations contribute to disease development, genetic lesions alone are insufficient to establish malignancy. Instead, epigenetic reprogramming plays a central role in shaping the transcriptional landscape that sustains tumour growth and survival. 

In paper I we explored the impact of combined G9a and DNMTs inhibition in MM. Dual targeting exerted synergistic anti-tumour effects, reprogramming gene expression toward tumour suppression and increased apoptosis. Moreover, in vivo combination treatment significantly reduced tumour burden compared with single agents. Together, these results uncovered a cooperative epigenetic axis driving MM progression and highlight novel therapeutic vulnerability. In paper II we investigated whether overexpressed lncRNAs cooperate with PRC2 to mediate gene silencing in MM. By integrating RIP-seq and RNA-seq analyses, we identified PVT1 as a key lncRNA interacting with EZH2. Genome-wide analyses revealed that PVT1 guides PRC2 silenced tumour suppressor and pro-apoptotic genes. Disruption of either EZH2 or PVT1 restored transcription of tumour suppressor genes, defining a PVT1-PRC2 regulatory axis that contributes to MM pathogenesis.  In paper III we further explored lncRNA-mediated PRC2 recruitment by characterizing the role of PCAT1 in MM. We demonstrated a direct interaction between PCAT1 and PRC2 and showed that PCAT1 overexpression correlates with poor overall survival and advanced disease stage. Integrative transcriptomic analyses revealed that the PCAT1-PRC2 axis regulates gene programs linked to MM pathogenesis and identified SLC44A2 and PIK3CD as novel candidate tumour suppressor targets, supporting a broader role for lncRNAs-driven epigenetic remodelling. 

Infant acute lymphoblastic leukaemia (iALL) is an aggressive haematological malignancy that arises in children below one year of age and is characterised by extremely poor clinical outcome. In Paper IV, we used scRNA-seq to characterise disease heterogeneity in iALL. We found that KMT2A status defined distinct transcriptional states within shared cellular compartments. KMT2A-rearranged iALL was enriched for immature, highly proliferative, and immune-evasive programs. In contrast, KMT2A-germline cases showed more differentiated lymphoid states and increased immune activation. These differences reflect transcriptional reprogramming rather than distinct cell types. Together, this highlights subtype-specific biology with potential therapeutic implications.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2026. p. 71
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 2258
Keywords
multiple myeloma, infant acute lymphoblastic leukaemia, G9a, DNMTs, PVT1, PCAT1
National Category
Medical and Health Sciences Basic Cancer Research Medical Epigenetics and Epigenomics Medical Genetics and Genomics
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-583279 (URN)978-91-513-2798-3 (ISBN)
Public defence
2026-05-22, Rudbecksalen, Rudbecklaboratoriet, Dag Hammarskjölds Väg 20, Uppsala, 09:15 (English)
Opponent
Supervisors
Available from: 2026-04-29 Created: 2026-03-27 Last updated: 2026-04-29

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Garrido-Zabala, BertaTziola, Stefania IlianaHarila, ArjaÖberg, FredrikKomorowski, JanJernberg Wiklund, HelenaKalushkova, Antonia

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Garrido-Zabala, BertaTziola, Stefania IlianaHarila, ArjaÖberg, FredrikKomorowski, JanJernberg Wiklund, HelenaKalushkova, Antonia
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Science for Life Laboratory, SciLifeLabCancer precision medicineDepartment of Cell and Molecular BiologyDepartment of Immunology, Genetics and PathologyPediatric oncological and neurological researchComputational Biology and BioinformaticsSwedish Collegium for Advanced Study (SCAS)
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