Chromosomal translocations involving the Mixed Lineage Leukemia (MLL) gene produce chimeric proteins that cause abnormal expression of a subset of HOX genes and leukemia development. Here, we show that MLL normally regulates expression of mir-196b, a hematopoietic microRNA located within the HoxA cluster , in a pattern similar to that of the surrounding 5 Hox genes, Hoxa9 and Hoxa10, during embryonic stem (ES) cell differentiation. Within the hematopoietic lineage, mir-196b is most abundant in short-term hematopoietic stem cells and is down-regulated in more differentiated hematopoietic cells. Leukemogenic MLL fusion proteins cause overexpression of mir-196b, while treatment of MLL-AF9 transformed bone marrow cells with mir-196-specific antagomir abrogates their replating potential in methylcellulose. This demonstrates that mir-196b function is necessary for MLL fusion-mediated im-mortalization. Furthermore, overexpres-sion of mir-196b was found specifically in patients with MLL associated leukemias as determined from analysis of 55 primary leukemia samples. Overexpression of mir-196b in bone marrow progenitor cells leads to increased proliferative capacity and survival, as well as a partial block in differentiation. Our results suggest a mechanism whereby increased expression of mir-196b by MLL fusion proteins significantly contributes to leukemia development. (Blood. 2009;113:3314-3322) Introduction The Mixed Lineage Leukemia (MLL) gene is commonly involved in chromosome translocations that cause leukemia. 1,2 MLL-associated leukemias can be myeloid, lymphoid or biphenotypic, depending on the partner gene to which MLL is fused. 3 There have been more than 60 different MLL fusion partners isolated to date and, in most cases, overexpression of a subset of HOX genes is a hallmark of the disease. 4 HOX genes are transcription factors that play an important role during development and hematopoiesis. 5,6 Humans have 13 paralogous groups of HOX genes clustered on 4 different chromosomes. Expression of HOX genes is spatially and temporally regulated with 3 genes expressed earlier and having a more anterior boundary of expression. 5 Similarly, expression of HOX genes is tightly regulated during hemato-poiesis. Genes located at the 3 end of the cluster are down-regulated as CD34 cells become lineage-specific progenitors while 5 genes, like HOXA10, are turned off only after cells progress to the more differentiated CD34 stage. 7 MLL regulates expression of some of the HOX genes at the chromatin level by binding to the promoters and recruiting various transcriptional regulators. 8-10 However, what happens at the molecular level in the presence of the leukemogenic fusion proteins to cause HOX overexpression is still poorly understood. Among 6800 genes analyzed by expression microarrays, overex-pression of HOXA9 was the most correlative marker of poor prognosis in acute myeloid leukemia patients. 11 Immortalization of bone marrow progenitors by the MLL fusion protein MLL-ENL is dependent on the presence of Hoxa9 and Hoxa7ge...