Eradication of leukemia stem cells (LSCs) is the ultimate goal of
treating acute myeloid leukemia (AML). We recently showed that the combined loss
of Runx1/Cbfb inhibited the development of MLL-AF9-induced AML.
However, c-Kit+/Gr-1− cells remained
viable in Runx1/Cbfb-deleted cells, indicating that suppressing
RUNX activity may not eradicate the most immature LSCs. In this study, we found
upregulation of several hemostasis-related genes, including the
thrombin-activatable receptor PAR-1 (protease-activated receptor-1), in
Runx1/Cbfb-deleted MLL-AF9 cells. Similar to the effect of
Runx1/Cbfb deletion, PAR-1 overexpression induced
CDKN1A/p21 expression and attenuated proliferation in MLL-AF9 cells. To our
surprise, PAR-1 deficiency also prevented leukemia development induced by a
small number of MLL-AF9 leukemia stem cells (LSCs) in vivo.
PAR-1 deficiency also reduced leukemogenicity of AML1-ETO-induced leukemia.
Re-expression of PAR-1 in PAR-1-deficient cells combined with a
limiting-dilution transplantation assay demonstrated the cell-dose-dependent
role of PAR-1 in MLL-AF9 leukemia: PAR-1 inhibited rapid leukemic proliferation
when there were a large number of LSCs, while a small number of LSCs required
PAR-1 for their efficient growth. Mechanistically, PAR-1 increased the adherence
properties of MLL-AF9 cells and promoted their engraftment to bone marrow. Taken
together, these data revealed a multifaceted role for PAR-1 in leukemogenesis,
and highlight this receptor as a potential target to eradicate primitive LSCs in
AML.