“…CD44 belongs to a family of transmembrane glycoproteins whose primary function is to bind hyaluronic acid (HA), laminins, collagens, matrix metalloproteinases (MMPs), osteopontin, etc., 12 and this receptor has previously been implicated in cell migration, proliferation, differentiation, survival, and bone marrow homing of hematopoietic stem/progenitor cells as well as in the homing of LSCs to intra-and extra-medullary niches and in resistance to chemotherapy. 12 We observed that the leukemic precursors with a higher expression of CD44 (the group of cells we called "definitive leukemic cells") also exhibit a parallel upregulation of genes whose products interact directly (COL4A5, LAMB2) 9,10 or indirectly (MMP2, COL18A1) 12 with CD44 and downregulation of MMP9 (which directly interacts with CD44 but whose levels correlate inversely with patient prognosis), 13 suggesting that the establishment of a "CD44-ECM network", rather than the expression of CD44 alone, is a crucial step in the progression of leukemic cells towards an aggressive phenotype. This also seems to be supported by the observation that, in two independent cohorts, patients with an ECM profile similar to that of the definitive leukemic cells showed significantly shorter survival (overall and endpoint), independently from well-known karyotypical or molecular drivers of AML.…”