© F e r r a t a S t o r t i F o u n d a t i o n(ROS) production or reduced antioxidant capacity. A principle antioxidant pathway is regulated by the redox sensitive transcription factor, NF-E2 p45-related factor-2 (NRF2/NFE2L2). In unstressed cells, low levels of NRF2 are maintained through interaction with Kelch-like ECHassociated protein 1 (KEAP1), an adapter for the E3 ubiquitin ligase Cullin 3 (CUL3) that directs NRF2 for proteasomal degradation. 13 Modification of redox and electrophile sensitive cysteine residues inhibits the substrate adaptor activity of KEAP1 allowing NRF2 accumulation. The interaction of KEAP1 with NRF2 is further modulated by phosphorylation of NRF2 at serine 40 by protein kinase C (PKC).14 Within the nucleus, NRF2 forms heterodimers with v-maf musculoaponeurotic fibrosarcoma oncogene homolog (MAF) proteins (MAF-F, G and K) and binds to antioxidant response elements (AREs) in the promoters of target genes such as those required for glutathione synthesis and its own promoter. 15 This activity is regulated by the transcriptional repressor BTB and CNC homology 1 transcription factor (BACH1) which competes for the MAF binding partners and for binding to gene promoters. 16 In addition, genetic models suggest that binding of Nrf-2 and its activity are regulated by the ATM substrate, Brca1.
17The most compelling evidence for the role of ATM in redox homeostasis comes from studies of the human radiosensitivity syndrome, Ataxia Telangiectasia (A-T), where both ATM alleles are inactivated. Cells from these patients display increased oxidative stress as a consequence of elevated levels of ROS, increased oxidized/reduced glutathione (GSSG/GSH) ratio, diminished capacity to scavenge ROS and mitochondrial dysfunction. 12,18 Furthermore, ATM is directly activated by oxidative stress 19 and can exert antioxidant activity through regulation of the pentose-phosphate pathway. 20 Recent evidence suggests that ATM might regulate oxidative stress through NRF2. Namely, Nrf2 target gene expression was decreased in Atm-/-murine osteoblasts and this was rescued by the ectopic expression of PKC delta (PKCδ). 21 In this study, we tested the hypothesis that ATM-null CLLs have an intrinsic defect in their antioxidant defenses that might be exploited to induce synthetic lethality of tumor cells by escalating oxidative stress. We show that compared to ATM-wild type (wt) CLL, ATM-null CLL tumors exhibited defective NRF2-dependent antioxidant transcriptional responses, decreased antioxidant capacity, elevated mitochondrial ROS, and increased sensitivity to pro-oxidants both in vitro and in vivo. Furthermore, we demonstrate that pro-oxidant treatment bypassed the need for a functional DRR and induced cell death via a p53-and caspase-independent mechanism involving apoptosis inducing factor (AIF).
Methods
Patients' samples and cell linesChronic lymphocytic leukemia samples were obtained from Birmingham and Bournemouth Hospitals (Online Supplementary Table S1). These were comprised of 3 CLLs with monoallelic ATM...