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SHR Neuro Cancer Cardio Lipid Metab Microb

Moujalled, DM; Brown, FC; Chua, CC; Dengler, MA; Pomilio, G; Anstee, NS; Litalien, V; Thompson, E; Morley, T; MacRaild, S; Tiong, IS; Morris, R; Dun, K; Zordan, A; Shah, J; Banquet, S; Halilovic, E; Morris, E; Herold, MJ; Lessene, G; Adams, JM; Huang, DCS; Roberts, AW; Blombery, P; Wei, AH.
Acquired mutations in BAX confer resistance to BH3-mimetic therapy in acute myeloid leukemia.
Blood. 2023; 141(6):634-644 Doi: 10.1182/blood.2022016090
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Dengler Michael

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Randomized trials in acute myeloid leukemia (AML) have demonstrated improved survival by the BCL-2 inhibitor venetoclax combined with azacitidine in older patients, and clinical trials are actively exploring the role of venetoclax in combination with intensive chemotherapy in fitter patients with AML. As most patients still develop recurrent disease, improved understanding of relapse mechanisms is needed. We find that 17% of patients relapsing after venetoclax-based therapy for AML have acquired inactivating missense or frameshift/nonsense mutations in the apoptosis effector gene BAX. In contrast, such variants were rare after genotoxic chemotherapy. BAX variants arose within either leukemic or preleukemic compartments, with multiple mutations observed in some patients. In vitro, AML cells with mutated BAX were competitively selected during prolonged exposure to BCL-2 antagonists. In model systems, AML cells rendered deficient for BAX, but not its close relative BAK, displayed resistance to BCL-2 targeting, whereas sensitivity to conventional chemotherapy was variable. Acquired mutations in BAX during venetoclax-based therapy represent a novel mechanism of resistance to BH3-mimetics and a potential barrier to the long-term efficacy of drugs targeting BCL-2 in AML.
Find related publications in this database (using NLM MeSH Indexing)
Humans - administration & dosage
Aged - administration & dosage
bcl-2-Associated X Protein - genetics
Cell Line, Tumor - administration & dosage
Proto-Oncogene Proteins c-bcl-2 - genetics
Leukemia, Myeloid, Acute - drug therapy, genetics
Bridged Bicyclo Compounds, Heterocyclic - therapeutic use, pharmacology
Apoptosis - administration & dosage
Mutation - administration & dosage

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