31The inv(16) acute myeloid leukemia associated CBFβ-MYH11 fusion is proposed to block 32 normal myeloid differentiation, but whether this subtype of leukemia cells is poised for a 33 unique cell lineage remains unclear. Here, we surveyed the functional consequences of CBFβ-34 MYH11 in primary inv(16) patient blasts, upon expression during hematopoietic 35 differentiation in vitro and upon knockdown in cell lines by multi-omics profiling. Our results 36 reveal that primary inv(16) AML cells share common transcriptomic signatures and 37 epigenetic determiners with megakaryocytes and erythrocytes. Using in vitro differentiation 38 systems, we reveal that CBFβ-MYH11 knockdown interferes with normal megakaryocyte 39 maturation. Two pivotal regulators, GATA2 and KLF1, are identified to complementally 40 occupy RUNX1 binding sites upon fusion protein knockdown, and overexpression of GATA2 41 partly restores megakaryocyte directed differentiation suppressed by CBFβ-MYH11. 42Together, our findings suggest that in inv (16) leukemia, the CBFβ-MYH11 fusion inhibits 43 primed megakaryopoiesis by attenuating expression of GATA2/KLF1 and interfering with a 44 balanced transcriptional program involving these two factors. 45 46 Expression of CBFβ-MYH11 is able to disrupt normal myeloid differentiation, predispose for 62 AML initiation, and cause full leukemia transformation upon the acquisition of additional 63 genetic changes 7, 8 . A recent study revealed that CBFβ-MYH11 maintains inv(16) leukemia 64 by obstructing RUNX1-mediated repression of MYC expression, which is featured by the 65 replacement of SWI/SNF for PRC1 at MYC distal enhancers 9 . However, at which 66 differentiation stage CBFβ-MYH11 blocks myeloid differentiation is still unclear. Mutational 67 analysis of FACS-purified hematopoietic stem cells (HSC) as compared to leukemia cells 68 confirmed the presence of CBFβ-MYH11 in HSCs, suggesting that the fusion event is 69 involved in setting up a preleukemic cell state 10 . Further pursuing which differentiation 70 pathway exactly is targeted by the oncoprotein would be needed. 71 GATA2 expression is essential for inv(16) AML development. 92 93 Materials and methods 94 4 95