MLL-AFX is a fusion gene created by t(X;11) chromosomal translocations in a subset of acute leukemias of either myeloid or lymphoid derivation. It codes for a chimeric protein consisting of MLL fused to AFX, a forkhead transcription factor that normally regulates genes involved in apoptosis and cell cycle progression. We demonstrate here that forced expression of MLL-AFX enhances the self-renewal of hematopoietic progenitors in vitro and induces acute myeloid leukemias after long latencies in syngeneic recipient mice. MLL-AFX interacts with the transcriptional coactivator CBP, which is also a fusion partner for MLL in human leukemias. A potent minimal transactivation domain (CR3) at the C terminus of AFX mediates interactions with the KIX domain of CBP and is necessary for transformation of myeloid progenitors by MLL-AFX. However, CR3 alone is not sufficient, suggesting that simple acquisition of a transactivation domain per se does not activate the oncogenic potential of MLL. Rather, two conserved transcriptional effector domains (CR2 and CR3) of AFX are required for full oncogenicity of MLL-AFX and also endow it with the potential to competitively interfere with transcription and apoptosis mediated by wild-type forkhead proteins. Furthermore, a dominant-negative mutant of AFX containing CR2 and CR3 enhances the growth of myeloid progenitors in vitro, although considerably less effectively than does MLL-AFX. Taken together, these data suggest that recruitment of transcriptional cofactors utilized by forkhead proteins is a critical requirement for oncogenic action of MLL-AFX, which may impact both MLL-and forkhead-dependent transcriptional pathways.Rearrangements of the mixed lineage leukemia (MLL) gene (also known as HRX, ALL-1, and Htrx) result from chromosomal translocations in a subset of acute leukemias with lymphoid, myeloid, or biphenotypic features (16,25,56). MLL codes for a 431-kDa protein that is a structural and functional homolog of Drosophila trithorax, a positive regulator of Hox genes during embryonic development (24,26,48,61,62). Remarkably, MLL undergoes fusion with more than 30 different partner proteins as a result of chromosomal translocations, to yield chimeric proteins containing amino-terminal portions of MLL fused in-frame to a carboxy-terminal partner. MLL fusion partners are highly diverse but appear to comprise two general categories of proteins, either nuclear factors with putative roles in transcriptional regulation or cytoplasmic proteins that may be involved in signal transduction (14). The wide array and diverse functions of MLL fusion partners have suggested several possible mechanisms for the oncogenic activation of MLL, including positive and negative gain-of-function, as well as forced oligomerization (17,21).Knockin mouse models (11) and retroviral transduction or transplantation assays (36) support a gain-of-function mechanism for a subset of MLL fusion proteins in leukemogenesis. For several nuclear partners, this appears to be the consequence of transcriptional effector d...