Loss of Tet2 affects proliferation and drug sensitivity through altered dynamics of cell-state transitions

Summary A persistent puzzle in cancer biology is how mutations, which neither alter canonical growth signaling pathways nor directly interfere with drug mechanism, can still recur and persist in tumors. One notable example is the loss-of-function mutation of the DNA demethylase Tet2 in acute myeloid leukemias (AMLs) that frequently persists from diagnosis through remission and relapse (Rothenberg-Thurley et al. , 2018; Corces-Zimmerman et al. , 2014; Nibourel et al. , 2010), but whose fitness advantage in the setting of anti-leukemic chemotherapy is unclear. Here we use paired isogenic human AML cell lines to show that Tet2 loss-of-function alters the dynamics of transitions between differentiated and stem-like states. Mathematical modeling and experimental validation reveal that these altered cell-state dynamics can benefit the cell population by slowing population decay during drug treatment and lowering the number of survivor cells needed to re-establish the initial population. These studies shed light on the functional and phenotypic effects of a Tet2 loss-of-function in AML, illustrate how a single gene mutation can alter a cells’ phenotypic plasticity, and open up new avenues in the development of strategies to combat AML relapse.