Key Points• CN/AML patients have a high frequency of CSF3R and RUNX1 mutations. • CSF3R and RUNX1 mutations induce elevated proliferation of CD34 1 cells.Severe congenital neutropenia (CN) is a preleukemic bone marrow failure syndrome with a 20% risk of evolving into leukemia or myelodysplastic syndrome (MDS). Patterns of acquisition of leukemia-associated mutations were investigated using next-generation deep-sequencing in 31 CN patients who developed leukemia or MDS. Twenty (64.5%) of the 31 patients had mutations in RUNX1. A majority of patients with RUNX1 mutations (80.5%) also had acquired CSF3R mutations. In contrast to their high frequency in CN patients who developed leukemia or MDS, RUNX1 mutations were found in only 9 of 307 (2.9%) patients with de novo pediatric acute myeloid leukemia. A sequential analysis at stages prior to overt leukemia revealed RUNX1 mutations to be late events in leukemic transformation. Single-cell analyses in 2 patients showed that RUNX1 and CSF3R mutations were present in the same malignant clone. Functional studies demonstrated elevated granulocyte colony-stimulating factor (G-CSF)-induced proliferation with diminished myeloid differentiation of hematopoietic CD34 1 cells coexpressing mutated forms of RUNX1 and CSF3R. The high frequency of cooperating RUNX1 and CSF3R mutations in CN patients suggests a novel molecular pathway of leukemogenesis: mutations in the hematopoietic cytokine receptor (G-CSFR) in combination with the second mutations in the downstream hematopoietic transcription fator (RUNX1). The detection of both RUNX1 and CSF3R mutations could be used as a marker for identifying CN patients with a high risk of progressing to leukemia or MDS. (Blood. 2014;123(14):2229-2237

Key Points• RUNX1 inhibits erythroid differentiation by downregulation of the erythroid gene expression program.• RUNX1 can act as an activator and repressor during megakaryocytic differentiation and counteracts the activity of TAL1.The activity of antagonizing transcription factors represents a mechanistic paradigm of bidirectional lineage-fate control during hematopoiesis. At the megakaryocytic/erythroid bifurcation, the crossantagonism of krueppel-like factor 1 (KLF1) and friend leukemia integration 1 (FLI1) has such a decisive role. However, how this antagonism is resolved during lineage specification is poorly understood. We found that runt-related transcription factor 1 (RUNX1) inhibits erythroid differentiation of murine megakaryocytic/erythroid progenitors and primary human CD34 1 progenitor cells. We show that RUNX1 represses the erythroid gene expression program during megakaryocytic differentiation by epigenetic repression of the erythroid master regulator KLF1. RUNX1 binding to the KLF1 locus is increased during megakaryocytic differentiation and counterbalances the activating role of T-cell acute lymphocytic leukemia 1 (TAL1). We found that corepressor recruitment by RUNX1 contributes to a block of the KLF1-dependent erythroid gene expression program.Our data indicate that the repressive function of RUNX1 influences the balance between erythroid and megakaryocytic differentiation by shifting the balance between KLF1 and FLI1 in the direction of FLI1. Taken together, we show that RUNX1 is a key player within a network of transcription factors that represses the erythroid gene expression program. (Blood. 2015;125(23):3570-3579) IntroductionThe hematopoietic system is in a constant process of cell proliferation, differentiation, and cell death. Progenitor cells produced by hematopoietic stem cells undergo a hierarchical progression in which the selfrenewal capability is lost and a specific lineage determination is adopted. [1][2][3] In this process, genes important for stem cell functions are downregulated and the expression of genes important for differentiation and cell type-specific functions is upregulated. Transcription factors initiate and maintain cell-specific expression by binding to regulatory sequences of target genes and by recruitment of generegulative complexes with DNA-and histone-modifying activity. These epigenetic modifications reorganize the chromatin locally and genome-wide to sustain a cell type-specific gene expression pattern. [4][5][6] Antagonizing transcription factors play an important role in the establishment of cell type-specific gene expression programs during hematopoietic differentiation. 7 At the megakaryocytic/erythroid bifurcation, the crossantagonism of the transcription factors krueppel-like factor 1 (KLF1) and friend leukemia integration 1 (FLI1) plays such a decisive role. 8,9 However, the mechanism of how this antagonism is resolved is poorly understood. During differentiation of common megakaryocyte/erythroid progenitor cells (MEPs) 10 toward the megakaryoc...

Key Points• Runx1 is necessary for survival and development of B cell-specified progenitors and also the transition through the pre-B-cell stage.• Genomewide expression and Runx1 occupancy analyses identified critical target genes and collaborating transcription partners.The t(12;21) chromosomal translocation, targeting the gene encoding the RUNX1 transcription factor, is observed in 25% of pediatric acute lymphoblastic leukemia (ALL) and is an initiating event in the disease. To elucidate the mechanism by which RUNX1 disruption initiates leukemogenesis, we investigated its normal role in murine B-cell development. This study revealed 2 critical functions of Runx1: (1) to promote survival and development of progenitors specified to the B-cell lineage, a function that can be substituted by ectopic Bcl2 expression, and (2) to enable the developmental transition through the pre-B stage triggered by the pre-B-cell antigen receptor (pre-BCR). Gene expression analysis and genomewide Runx1 occupancy studies support the hypothesis that Runx1 reinforces the transcription factor network governing early B-cell survival and development and specifically regulates genes encoding members of the Lyn kinase subfamily (key integrators of interleukin-7 and pre-BCR signaling) and the stage-specific transcription factors SpiB and Aiolos (critical downstream effectors of pre-BCR signaling). Interrogation of expression databases of 257 ALL samples demonstrated the specific down-regulation of the SPIB and IKZF3 genes (the latter encoding AIOLOS) in t(12;21) ALL, providing novel insight into the mechanism by which the translocation blocks B-cell development and promotes leukemia. (Blood. 2013; 122(3):413-423)

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