1 2781 136 EZH2 IN MYELOID MALIGNANCIES. OUR UNDERSTANDING OF THE SIGNIFICANCE OF EPIGENETIC DYSREGULATION IN THE PATHOGENESIS OF MYELOID MALIGNANCIES HAS GREATLY ADVANCED IN THE PAST DECADE. ENHANCER OF ZESTE HOMOLOG 2 (EZH2) IS THE CATALYTIC CORE COMPONENT OF THE POLYCOMB REPRESSIVE COMPLEX 2 (PRC2), WHICH IS RESPONSIBLE FOR GENE SILENCING THROUGH TRIMETHYLATION OF H3K27. EZH2 DYSREGULATION IS HIGHLY TUMORIGENIC AND HAS BEEN OBSERVED IN VARIOUS CANCERS, WITH EZH2 ACTING AS AN ONCOGENE OR A TUMOR-SUPPRESSOR DEPENDING ON CELLULAR CONTEXT. WHILE LOSS-OF-FUNCTION MUTATIONS OF EZH2 FREQUENTLY AFFECT PATIENTS WITH MYELODYSPLASTIC/MYELOPROLIFERATIVE NEOPLASMS, MYELODYSPLASTIC SYNDROME AND MYELOFIBROSIS, CASES OF CHRONIC MYELOID LEUKEMIA (CML) SEEM TO BE LARGELY CHARACTERIZED BY EZH2 OVEREXPRESSION. A VARIETY OF OTHER FACTORS FREQUENTLY ABERRANT IN MYELOID LEUKEMIA CAN AFFECT PRC2 FUNCTION AND DISEASE PATHOGENESIS, INCLUDING ADDITIONAL SEX COMBS LIKE 1 (ASXL1) AND SPLICING GENE MUTATIONS. AS THE GENETIC BACKGROUND OF MYELOID MALIGNANCIES IS LARGELY HETEROGENEOUS, IT IS NOT SURPRISING THAT EZH2 MUTATIONS ACT IN CONJUNCTION WITH OTHER ABERRATIONS. SINCE EZH2 MUTATIONS ARE CONSIDERED TO BE EARLY EVENTS IN DISEASE PATHOGENESIS, THEY ARE OF THERAPEUTIC INTEREST TO RESEARCHERS, THOUGH TARGETING OF EZH2 LOSS-OF-FUNCTION DOES PRESENT UNIQUE CHALLENGES. PRELIMINARY RESEARCH INDICATES THAT COMBINED TYROSINE KINASE INHIBITOR (TKI) AND EZH2 INHIBITOR THERAPY MAY PROVIDE A STRATEGY TO ELIMINATE THE RESIDUAL DISEASE BURDEN IN CML TO ALLOW PATIENTS TO REMAIN IN TREATMENT-FREE REMISSION. 2020 2 4769 35 NUCLEAR MORPHOMETRY, NUCLEOMICS AND PROSTATE CANCER PROGRESSION. PROSTATE CANCER (PCA) RESULTS FROM A MULTISTEP PROCESS. THIS PROCESS INCLUDES INITIATION, WHICH OCCURS THROUGH VARIOUS AGING EVENTS AND MULTIPLE INSULTS (SUCH AS CHRONIC INFECTION, INFLAMMATION AND GENETIC INSTABILITY THROUGH REACTIVE OXYGEN SPECIES CAUSING DNA DOUBLE-STRAND BREAKS), FOLLOWED BY A MULTISTEP PROCESS OF PROGRESSION. THESE STEPS INCLUDE SEVERAL GENETIC AND EPIGENETIC ALTERATIONS, AS WELL AS ALTERATIONS TO THE CHROMATIN STRUCTURE, WHICH OCCUR IN RESPONSE TO THE CARCINOGENIC STRESS-RELATED EVENTS THAT SUSTAIN PROLIFERATIVE SIGNALING. EVENTS SUCH AS EVADING GROWTH SUPPRESSORS, RESISTING CELL DEATH, ENABLING REPLICATIVE IMMORTALITY, INDUCING ANGIOGENESIS, AND ACTIVATING INVASION AND METASTASIS ARE READILY OBSERVED. IN ADDITION, IN CONJUNCTION WITH THESE CRITICAL DRIVERS OF CARCINOGENESIS, OTHER FACTORS RELATED TO THE ETIOPATHOGENESIS OF PCA, INVOLVING ENERGY METABOLISM AND EVASION OF THE IMMUNE SURVEILLANCE SYSTEM, APPEAR TO BE INVOLVED. IN ADDITION, WHEN CANCER SPREAD AND METASTASIS OCCUR, THE 'TUMOR MICROENVIRONMENT' IN THE BONE OF PCA PATIENTS MAY PROVIDE A WAY TO SUSTAIN DORMANCY OR SENESCENCE AND EVENTUALLY ESTABLISH A 'SEED AND SOIL' SITE WHERE PCA PROLIFERATION AND GROWTH MAY OCCUR OVER TIME. WHEN PCA IS INITIATED AND PROGRESSION ENSUES, SIGNIFICANT ALTERATIONS IN NUCLEAR SIZE, SHAPE AND HETEROCHROMATIN (DNA TRANSCRIPTION) ORGANIZATION ARE FOUND, AND KEY NUCLEAR TRANSCRIPTIONAL AND STRUCTURAL PROTEINS, AS WELL AS MULTIPLE NUCLEAR BODIES CAN LEAD TO PRECANCEROUS AND MALIGNANT CHANGES. THESE SERIES OF CELLULAR AND TISSUE-RELATED MALIGNANCY-ASSOCIATED EVENTS CAN BE QUANTIFIED TO ASSESS DISEASE PROGRESSION AND MANAGEMENT. 2012 3 5971 38 TET PROTEINS AND 5-METHYLCYTOSINE OXIDATION IN HEMATOLOGICAL CANCERS. DNA METHYLATION HAS PIVOTAL REGULATORY ROLES IN MAMMALIAN DEVELOPMENT, RETROTRANSPOSON SILENCING, GENOMIC IMPRINTING, AND X-CHROMOSOME INACTIVATION. CANCER CELLS DISPLAY HIGHLY DYSREGULATED DNA METHYLATION PROFILES CHARACTERIZED BY GLOBAL HYPOMETHYLATION IN CONJUNCTION WITH HYPERMETHYLATION OF PROMOTER CPG ISLANDS THAT PRESUMABLY LEAD TO GENOME INSTABILITY AND ABERRANT EXPRESSION OF TUMOR SUPPRESSOR GENES OR ONCOGENES. THE RECENT DISCOVERY OF TEN-ELEVEN-TRANSLOCATION (TET) FAMILY DIOXYGENASES THAT OXIDIZE 5MC TO 5-HYDROXYMETHYLCYTOSINE (5HMC), 5-FORMYLCYTOSINE (5FC), AND 5-CARBOXYLCYTOSINE (5CAC) IN DNA HAS LED TO PROFOUND PROGRESS IN UNDERSTANDING THE MECHANISM UNDERLYING DNA DEMETHYLATION. AMONG THE THREE TET GENES, TET2 RECURRENTLY UNDERGOES INACTIVATING MUTATIONS IN A WIDE RANGE OF MYELOID AND LYMPHOID MALIGNANCIES. TET2 FUNCTIONS AS A BONA FIDE TUMOR SUPPRESSOR PARTICULARLY IN THE PATHOGENESIS OF MYELOID MALIGNANCIES RESEMBLING CHRONIC MYELOMONOCYTIC LEUKEMIA (CMML) AND MYELODYSPLASTIC SYNDROMES (MDS) IN HUMAN. HERE WE REVIEW DIVERSE FUNCTIONS OF TET PROTEINS AND THE NOVEL EPIGENETIC MARKS THAT THEY GENERATE IN DNA METHYLATION/DEMETHYLATION DYNAMICS AND NORMAL AND MALIGNANT HEMATOPOIETIC DIFFERENTIATION. THE IMPACT OF TET2 INACTIVATION IN HEMATOPOIESIS AND VARIOUS MECHANISMS MODULATING THE EXPRESSION OR ACTIVITY OF TET PROTEINS ARE ALSO DISCUSSED. FURTHERMORE, WE ALSO PRESENT EVIDENCE THAT TET2 AND TET3 COLLABORATE TO SUPPRESS ABERRANT HEMATOPOIESIS AND HEMATOPOIETIC TRANSFORMATION. A DETAILED UNDERSTANDING OF THE NORMAL AND PATHOLOGICAL FUNCTIONS OF TET PROTEINS MAY PROVIDE NEW AVENUES TO DEVELOP NOVEL EPIGENETIC THERAPIES FOR TREATING HEMATOLOGICAL MALIGNANCIES. 2015 4 453 32 APPLICATIONS OF CRISPR SYSTEMS IN RESPIRATORY HEALTH: ENTERING A NEW 'RED PEN' ERA IN GENOME EDITING. RESPIRATORY DISEASES, SUCH AS INFLUENZA INFECTION, ACUTE TRACHEAL BRONCHITIS, PNEUMONIA, TUBERCULOSIS, CHRONIC OBSTRUCTIVE PULMONARY DISEASE, ASTHMA, LUNG CANCER AND NASOPHARYNGEAL CARCINOMA, CONTINUE TO SIGNIFICANTLY IMPACT HUMAN HEALTH. DISEASES OF THE LUNG AND RESPIRATORY TRACT ARE INFLUENCED BY ENVIRONMENTAL CONDITIONS AND SOCIO-ECONOMIC FACTORS; HOWEVER, MANY OF THESE SERIOUS RESPIRATORY DISORDERS ARE ALSO ROOTED IN GENETIC OR EPIGENETIC CAUSES. CLUSTERED REGULARLY INTERSPACED PALINDROMIC REPEATS (CRISPR) AND CRISPR-ASSOCIATED (CAS) PROTEINS, ISOLATED FROM THE IMMUNE SYSTEM OF PROKARYOTES, PROVIDE A TOOL TO MANIPULATE GENE SEQUENCES AND GENE EXPRESSION WITH SIGNIFICANT IMPLICATIONS FOR RESPIRATORY RESEARCH. CRISPR/CAS SYSTEMS ALLOW PRECLINICAL MODELLING OF CAUSAL FACTORS INVOLVED IN MANY RESPIRATORY DISEASES, PROVIDING NEW INSIGHTS INTO THEIR UNDERLYING MECHANISMS. CRISPR CAN ALSO BE USED TO SCREEN FOR GENES INVOLVED IN RESPIRATORY PROCESSES, DEVELOPMENT AND PATHOLOGY, IDENTIFYING NOVEL DISEASE DRIVERS OR DRUG TARGETS. FINALLY, CRISPR/CAS SYSTEMS CAN POTENTIALLY CORRECT GENETIC MUTATIONS AND EDIT EPIGENETIC MARKS THAT CONTRIBUTE TO RESPIRATORY DISORDERS, PROVIDING A FORM OF PERSONALIZED MEDICINE THAT COULD BE USED IN CONJUNCTION WITH OTHER TECHNOLOGIES SUCH AS STEM CELL REPROGRAMMING AND TRANSPLANTATION. CRISPR GENE EDITING IS A YOUNG FIELD OF RESEARCH, AND CONCERNS REGARDING ITS SPECIFICITY, AS WELL AS THE NEED FOR EFFICIENT AND SAFE DELIVERY METHODS, NEED TO BE ADDRESSED FURTHER. HOWEVER, CRISPR/CAS SYSTEMS REPRESENT A SIGNIFICANT STEP FORWARD FOR RESEARCH AND THERAPY IN RESPIRATORY HEALTH, AND IT IS LIKELY WE WILL SEE THE BREAKTHROUGHS GENERATED FROM THIS TECHNOLOGY CONTINUE. 2019 5 535 37 ASXL1 MUTATION CORRECTION BY CRISPR/CAS9 RESTORES GENE FUNCTION IN LEUKEMIA CELLS AND INCREASES SURVIVAL IN MOUSE XENOGRAFTS. RECURRENT SOMATIC MUTATIONS OF THE EPIGENETIC MODIFIER AND TUMOR SUPPRESSOR ASXL1 ARE COMMON IN MYELOID MALIGNANCIES, INCLUDING CHRONIC MYELOID LEUKEMIA (CML), AND ARE ASSOCIATED WITH POOR CLINICAL OUTCOME. CRISPR/CAS9 HAS RECENTLY EMERGED AS A POWERFUL AND VERSATILE GENOME EDITING TOOL FOR GENOME ENGINEERING IN VARIOUS SPECIES. WE HAVE USED THE CRISPR/CAS9 SYSTEM TO CORRECT THE ASXL1 HOMOZYGOUS NONSENSE MUTATION PRESENT IN THE CML CELL LINE KBM5, WHICH LACKS ASXL1 PROTEIN EXPRESSION. CRISPR/CAS9-MEDIATED ASXL1 HOMOZYGOUS CORRECTION RESULTED IN PROTEIN RE-EXPRESSION WITH RESTORED NORMAL FUNCTION, INCLUDING DOWN-REGULATION OF POLYCOMB REPRESSIVE COMPLEX 2 TARGET GENES. SIGNIFICANTLY REDUCED CELL GROWTH AND INCREASED MYELOID DIFFERENTIATION WERE OBSERVED IN ASXL1 MUTATION-CORRECTED CELLS, PROVIDING NEW INSIGHTS INTO THE ROLE OF ASXL1 IN HUMAN MYELOID CELL DIFFERENTIATION. MICE XENOGRAFTED WITH MUTATION-CORRECTED KBM5 CELLS SHOWED SIGNIFICANTLY LONGER SURVIVAL THAN UNCORRECTED XENOGRAFTS. THESE RESULTS SHOW THAT THE SOLE CORRECTION OF A DRIVER MUTATION IN LEUKEMIA CELLS INCREASES SURVIVAL IN VIVO IN MICE. THIS STUDY PROVIDES PROOF-OF-CONCEPT FOR DRIVER GENE MUTATION CORRECTION VIA CRISPR/CAS9 TECHNOLOGY IN HUMAN LEUKEMIA CELLS AND PRESENTS A STRATEGY TO ILLUMINATE THE IMPACT OF ONCOGENIC MUTATIONS ON CELLULAR FUNCTION AND SURVIVAL. 2015 6 390 42 AN INTEGRATIVE MODEL OF PATHWAY CONVERGENCE IN GENETICALLY HETEROGENEOUS BLAST CRISIS CHRONIC MYELOID LEUKEMIA. TARGETED THERAPIES AGAINST THE BCR-ABL1 KINASE HAVE REVOLUTIONIZED TREATMENT OF CHRONIC PHASE (CP) CHRONIC MYELOID LEUKEMIA (CML). IN CONTRAST, MANAGEMENT OF BLAST CRISIS (BC) CML REMAINS CHALLENGING BECAUSE BC CELLS ACQUIRE COMPLEX MOLECULAR ALTERATIONS THAT CONFER STEMNESS FEATURES TO PROGENITOR POPULATIONS AND RESISTANCE TO BCR-ABL1 TYROSINE KINASE INHIBITORS. COMPREHENSIVE MODELS OF BC TRANSFORMATION HAVE PROVED ELUSIVE BECAUSE OF THE RARITY AND GENETIC HETEROGENEITY OF BC, BUT ARE IMPORTANT FOR DEVELOPING BIOMARKERS PREDICTING BC PROGRESSION AND EFFECTIVE THERAPIES. TO BETTER UNDERSTAND BC, WE PERFORMED AN INTEGRATED MULTIOMICS ANALYSIS OF 74 CP AND BC SAMPLES USING WHOLE-GENOME AND EXOME SEQUENCING, TRANSCRIPTOME AND METHYLOME PROFILING, AND CHROMATIN IMMUNOPRECIPITATION FOLLOWED BY HIGH-THROUGHPUT SEQUENCING. EMPLOYING PATHWAY-BASED ANALYSIS, WE FOUND THE BC GENOME WAS SIGNIFICANTLY ENRICHED FOR MUTATIONS AFFECTING COMPONENTS OF THE POLYCOMB REPRESSIVE COMPLEX (PRC) PATHWAY. WHILE TRANSCRIPTOMICALLY, BC PROGENITORS WERE ENRICHED AND DEPLETED FOR PRC1- AND PRC2-RELATED GENE SETS RESPECTIVELY. BY INTEGRATING OUR DATA SETS, WE DETERMINED THAT BC PROGENITORS UNDERGO PRC-DRIVEN EPIGENETIC REPROGRAMMING TOWARD A CONVERGENT TRANSCRIPTOMIC STATE. SPECIFICALLY, PRC2 DIRECTS BC DNA HYPERMETHYLATION, WHICH IN TURN SILENCES KEY GENES INVOLVED IN MYELOID DIFFERENTIATION AND TUMOR SUPPRESSOR FUNCTION VIA SO-CALLED EPIGENETIC SWITCHING, WHEREAS PRC1 REPRESSES AN OVERLAPPING AND DISTINCT SET OF GENES, INCLUDING NOVEL BC TUMOR SUPPRESSORS. ON THE BASIS OF THESE OBSERVATIONS, WE DEVELOPED AN INTEGRATED MODEL OF BC THAT FACILITATED THE IDENTIFICATION OF COMBINATORIAL THERAPIES CAPABLE OF REVERSING BC REPROGRAMMING (DECITABINE+PRC1 INHIBITORS), NOVEL PRC-SILENCED TUMOR SUPPRESSOR GENES (NR4A2), AND GENE EXPRESSION SIGNATURES PREDICTIVE OF DISEASE PROGRESSION AND DRUG RESISTANCE IN CP. 2020 7 4839 38 ONCOGENIC ROLE AND TARGET PROPERTIES OF THE LYSINE-SPECIFIC DEMETHYLASE KDM1A IN CHRONIC LYMPHOCYTIC LEUKEMIA. IN CHRONIC LYMPHOCYTIC LEUKEMIA (CLL), EPIGENETIC ALTERATIONS ARE CONSIDERED TO CENTRALLY SHAPE THE TRANSCRIPTIONAL SIGNATURES THAT DRIVE DISEASE EVOLUTION AND UNDERLIE ITS BIOLOGICAL AND CLINICAL SUBSETS. CHARACTERIZATIONS OF EPIGENETIC REGULATORS, PARTICULARLY HISTONE-MODIFYING ENZYMES, ARE VERY RUDIMENTARY IN CLL. IN EFFORTS TO ESTABLISH EFFECTORS OF THE CLL-ASSOCIATED ONCOGENE T-CELL LEUKEMIA 1A (TCL1A), WE IDENTIFIED HERE THE LYSINE-SPECIFIC HISTONE DEMETHYLASE KDM1A TO INTERACT WITH THE TCL1A PROTEIN IN B CELLS IN CONJUNCTION WITH AN INCREASED CATALYTIC ACTIVITY OF KDM1A. WE DEMONSTRATE THAT KDM1A IS UPREGULATED IN MALIGNANT B CELLS. ELEVATED KDM1A AND ASSOCIATED GENE EXPRESSION SIGNATURES CORRELATED WITH AGGRESSIVE DISEASE FEATURES AND ADVERSE CLINICAL OUTCOMES IN A LARGE PROSPECTIVE CLL TRIAL COHORT. GENETIC KDM1A KNOCKDOWN IN EMU-TCL1A MICE REDUCED LEUKEMIC BURDEN AND PROLONGED ANIMAL SURVIVAL, ACCOMPANIED BY UPREGULATED P53 AND PROAPOPTOTIC PATHWAYS. GENETIC KDM1A DEPLETION ALSO AFFECTED MILIEU COMPONENTS (T, STROMAL, AND MONOCYTIC CELLS), RESULTING IN SIGNIFICANT REDUCTIONS IN THEIR CAPACITY TO SUPPORT CLL-CELL SURVIVAL AND PROLIFERATION. INTEGRATED ANALYSES OF DIFFERENTIAL GLOBAL TRANSCRIPTOMES (RNA SEQUENCING) AND H3K4ME3 MARKS (CHROMATIN IMMUNOPRECIPITATION SEQUENCING) IN EMU-TCL1A VS IKDM1AKD;EMU-TCL1A MICE (CONFIRMED IN HUMAN CLL) IMPLICATE KDM1A AS AN ONCOGENIC TRANSCRIPTIONAL REPRESSOR IN CLL WHICH ALTERS HISTONE METHYLATION PATTERNS WITH PRONOUNCED EFFECTS ON DEFINED CELL DEATH AND MOTILITY PATHWAYS. FINALLY, PHARMACOLOGIC KDM1A INHIBITION ALTERED H3K4/9 TARGET METHYLATION AND REVEALED MARKED ANTI-B-CELL LEUKEMIC SYNERGISMS. OVERALL, WE ESTABLISHED THE PATHOGENIC ROLE AND EFFECTOR NETWORKS OF KDM1A IN CLL VIA TUMOR-CELL INTRINSIC MECHANISMS AND ITS IMPACTS IN CELLS OF THE MICROENVIRONMENT. OUR DATA ALSO PROVIDE RATIONALES TO FURTHER INVESTIGATE THERAPEUTIC KDM1A TARGETING IN CLL. 2023 8 1283 27 DECIPHERING THE EPIGENETIC CODE OF T LYMPHOCYTES. THE MULTIPLE LINEAGES AND DIFFERENTIATION STATES THAT CONSTITUTE THE T-CELL COMPARTMENT ALL DERIVE FROM A COMMON THYMIC PRECURSOR. THESE DISTINCT TRANSCRIPTIONAL STATES ARE MAINTAINED BOTH IN TIME AND AFTER MULTIPLE ROUNDS OF CELL DIVISION BY THE CONCERTED ACTIONS OF A SMALL SET OF LINEAGE-DEFINING TRANSCRIPTION FACTORS THAT ACT IN CONJUNCTION WITH A SUITE OF CHROMATIN-MODIFYING ENZYMES TO ACTIVATE, REPRESS, AND FINE-TUNE GENE EXPRESSION. THESE CHROMATIN MODIFICATIONS COLLECTIVELY PROVIDE AN EPIGENETIC CODE THAT ALLOWS THE STABLE AND HERITABLE MAINTENANCE OF THE T-CELL PHENOTYPE. RECENTLY, IT HAS BECOME APPARENT THAT THE EPIGENETIC CODE REPRESENTS A THERAPEUTIC TARGET FOR A VARIETY OF IMMUNE CELL DISORDERS, INCLUDING LYMPHOMA AND ACUTE AND CHRONIC INFLAMMATORY DISEASES. HERE, WE REVIEW THE RECENT ADVANCES IN EPIGENETIC REGULATION OF GENE EXPRESSION, PARTICULARLY AS IT RELATES TO THE T-CELL DIFFERENTIATION AND FUNCTION. 2014 9 4565 28 MYELOID MALIGNANCIES: MUTATIONS, MODELS AND MANAGEMENT. MYELOID MALIGNANT DISEASES COMPRISE CHRONIC (INCLUDING MYELODYSPLASTIC SYNDROMES, MYELOPROLIFERATIVE NEOPLASMS AND CHRONIC MYELOMONOCYTIC LEUKEMIA) AND ACUTE (ACUTE MYELOID LEUKEMIA) STAGES. THEY ARE CLONAL DISEASES ARISING IN HEMATOPOIETIC STEM OR PROGENITOR CELLS. MUTATIONS RESPONSIBLE FOR THESE DISEASES OCCUR IN SEVERAL GENES WHOSE ENCODED PROTEINS BELONG PRINCIPALLY TO FIVE CLASSES: SIGNALING PATHWAYS PROTEINS (E.G. CBL, FLT3, JAK2, RAS), TRANSCRIPTION FACTORS (E.G. CEBPA, ETV6, RUNX1), EPIGENETIC REGULATORS (E.G. ASXL1, DNMT3A, EZH2, IDH1, IDH2, SUZ12, TET2, UTX), TUMOR SUPPRESSORS (E.G. TP53), AND COMPONENTS OF THE SPLICEOSOME (E.G. SF3B1, SRSF2). LARGE-SCALE SEQUENCING EFFORTS WILL SOON LEAD TO THE ESTABLISHMENT OF A COMPREHENSIVE REPERTOIRE OF THESE MUTATIONS, ALLOWING FOR A BETTER DEFINITION AND CLASSIFICATION OF MYELOID MALIGNANCIES, THE IDENTIFICATION OF NEW PROGNOSTIC MARKERS AND THERAPEUTIC TARGETS, AND THE DEVELOPMENT OF NOVEL THERAPIES. GIVEN THE IMPORTANCE OF EPIGENETIC DEREGULATION IN MYELOID DISEASES, THE USE OF DRUGS TARGETING EPIGENETIC REGULATORS APPEARS AS A MOST PROMISING THERAPEUTIC APPROACH. 2012 10 4124 41 MECHANISMS OF DISEASE PROGRESSION AND RESISTANCE TO TYROSINE KINASE INHIBITOR THERAPY IN CHRONIC MYELOID LEUKEMIA: AN UPDATE. CHRONIC MYELOID LEUKEMIA (CML) IS CHARACTERIZED BY THE PRESENCE OF THE BCR-ABL1 FUSION GENE, WHICH ENCODES A CONSTITUTIVE ACTIVE TYROSINE KINASE CONSIDERED TO BE THE PATHOGENIC DRIVER CAPABLE OF INITIATING AND MAINTAINING THE DISEASE. DESPITE THE REMARKABLE EFFICACY OF TYROSINE KINASE INHIBITORS (TKIS) TARGETING BCR-ABL1, SOME PATIENTS MAY NOT RESPOND (PRIMARY RESISTANCE) OR MAY RELAPSE AFTER AN INITIAL RESPONSE (SECONDARY RESISTANCE). IN A SMALL PROPORTION OF CASES, DEVELOPMENT OF RESISTANCE IS ACCOMPANIED OR SHORTLY FOLLOWED BY PROGRESSION FROM CHRONIC TO BLASTIC PHASE (BP), CHARACTERIZED BY A DISMAL PROGNOSIS. EVOLUTION FROM CP INTO BP IS A MULTIFACTORIAL AND PROBABLY MULTISTEP PHENOMENON. INCREASE IN BCR-ABL1 TRANSCRIPT LEVELS IS THOUGHT TO PROMOTE THE ONSET OF SECONDARY CHROMOSOMAL OR GENETIC DEFECTS, INDUCE DIFFERENTIATION ARREST, PERTURB RNA TRANSCRIPTION, EDITING AND TRANSLATION THAT TOGETHER WITH EPIGENETIC AND METABOLIC CHANGES MAY ULTIMATELY LEAD TO THE EXPANSION OF HIGHLY PROLIFERATING, DIFFERENTIATION-ARRESTED MALIGNANT CELLS. A MULTITUDE OF STUDIES OVER THE PAST TWO DECADES HAVE INVESTIGATED THE MECHANISMS UNDERLYING THE CLOSELY INTERTWINED PHENOMENA OF DRUG RESISTANCE AND DISEASE PROGRESSION. HERE, WE PROVIDE AN UPDATE ON WHAT IS CURRENTLY KNOWN ON THE MECHANISMS UNDERLYING PROGRESSION AND PRESENT THE LATEST ACQUISITIONS ON BCR-ABL1-INDEPENDENT RESISTANCE AND LEUKEMIA STEM CELL PERSISTENCE. 2019 11 1304 39 DEFECTS IN SPLICEOSOMAL MACHINERY: A NEW PATHWAY OF LEUKAEMOGENESIS. PROPER SPLICING OF PRE-MRNA IS REQUIRED FOR PROTEIN SYNTHESIS AND THEREFORE IS A FUNDAMENTAL CELLULAR FUNCTION. THE DISCOVERY OF A VARIETY OF SOMATIC SPLICEOSOMAL MUTATIONS IN HAEMATOLOGICAL MALIGNANCIES, INCLUDING MYELOID NEOPLASMS AND CHRONIC LYMPHOCYTIC LEUKAEMIA HAS POINTED TO A NEW LEUKAEMOGENIC PATHWAY INVOLVING SPLICEOSOMAL DYSFUNCTION. THEORETICALLY, SPLICEOSOMAL MUTATIONS CAN LEAD TO ACTIVATION OF INCORRECT SPLICE SITES, INTRON RETENTION OR ABERRANT ALTERNATIVE SPLICING OCCURRING IN PATTERNS GENERATED BY MUTATIONS OF INDIVIDUAL SPLICEOSOMAL PROTEINS. SUCH EVENTS CAN PRODUCE A DEFECTIVE BALANCE BETWEEN PROTEIN ISOFORMS LEADING TO FUNCTIONAL CONSEQUENCES INCLUDING DEFECTIVE REGULATION OF PROLIFERATION AND DIFFERENTIATION. THE OBSERVED PATTERN OF OCCURRENCE OF HIGHLY SPECIFIC MISSENSE MUTATIONS, COUPLED WITH THE LACK OF NONSENSE MUTATIONS AND DELETIONS, IMPLIES A GAIN-OF-FUNCTION OR BETTER GAIN-OF-DYSFUNCTION MECHANISM. INCORRECT SPLICING OF DOWNSTREAM GENES, SUCH AS TUMOUR SUPPRESSOR GENES, MAY RESULT IN HAPLOINSUFFICIENT EXPRESSION THROUGH NONSENSE-MEDIATED MRNA DECAY. THUS, SPLICEOSOMAL MUTATIONS MAY, DEPENDING ON THE PATTERN OF AFFECTED PROTEINS, LEAD TO SIMILAR FUNCTIONAL EFFECTS ON TUMOUR SUPPRESSOR GENES AS CHROMOSOMAL DELETIONS, EPIGENETIC SILENCING OR INACTIVATING/HYPOMORPHIC MUTATIONS. THE PROGNOSTIC VALUE OF THE MOST COMMON MUTATIONS AND THEIR PHENOTYPIC ASSOCIATION IN THE CLINICAL SETTING IS CURRENTLY UNDER INVESTIGATION. IT IS LIKELY THAT SPLICEOSOMAL MUTATIONS MAY INDICATE SENSITIVITY TO SPLICEOSOME INHIBITORS APPLIED IN THE FORM OF A SYNTHETIC LETHAL APPROACH. THIS REVIEW DISCUSSES THE MOST CURRENT ASPECTS OF SPLICEOSOMAL RESEARCH IN THE CONTEXT OF HAEMATOLOGICAL MALIGNANCIES. 2012 12 109 45 A REVIEW ON THE THERAPEUTIC ROLE OF TKIS IN CASE OF CML IN COMBINATION WITH EPIGENETIC DRUGS. CHRONIC MYELOID LEUKEMIA IS A MALIGNANCY OF BONE MARROW THAT AFFECTS WHITE BLOOD CELLS. THERE IS STRONG EVIDENCE THAT DISEASE PROGRESSION, TREATMENT RESPONSES, AND OVERALL CLINICAL OUTCOMES OF CML PATIENTS ARE INFLUENCED BY THE ACCUMULATION OF OTHER GENETIC AND EPIGENETIC ABNORMALITIES, RATHER THAN ONLY THE BCR/ABL1 ONCOPROTEIN. BOTH GENETIC AND EPIGENETIC FACTORS INFLUENCE THE EFFICACY OF CML TREATMENT STRATEGIES. TARGETED MEDICINES KNOWN AS TYROSINE-KINASE INHIBITORS HAVE DRAMATICALLY IMPROVED LONG-TERM SURVIVAL RATES IN CML PATIENTS DURING THE PREVIOUS 2 DECADES. WHEN COMPARED TO EARLIER CHEMOTHERAPY TREATMENTS, THESE DRUGS HAVE REVOLUTIONIZED CML TREATMENT AND ALLOWED MOST PEOPLE TO LIVE LONGER LIVES. ALTHOUGH EPIGENETIC INHIBITORS' ACTIVITY IS DISRUPTED IN MANY CANCERS, INCLUDING CML, BUT WHEN COMBINED WITH TKI, THEY MAY OFFER POTENTIAL THERAPEUTIC STRATEGIES FOR THE TREATMENT OF CML CELLS. THE EPIGENETICS OF TYROSINE KINASE INHIBITORS AND RESISTANCE TO THEM IS BEING STUDIED, WITH A PARTICULAR FOCUS ON IMATINIB, WHICH IS USED TO TREAT CML. IN ADDITION, THE USE OF EPIGENETIC DRUGS IN CONJUNCTION WITH TKIS HAS BEEN DISCUSSED. RESISTANCE TO TKIS IS STILL A PROBLEM IN CURING THE DISEASE, NECESSITATING THE DEVELOPMENT OF NEW THERAPIES. THIS STUDY FOCUSED ON EPIGENETIC PATHWAYS INVOLVED IN CML PATHOGENESIS AND TUMOR CELL RESISTANCE TO TKIS, BOTH OF WHICH CONTRIBUTE TO LEUKEMIC CLONE BREAKOUT AND PROLIFERATION. 2021 13 864 30 CHROMOSOMAL INSTABILITY IN ORAL SQUAMOUS CELL CARCINOMA. ORAL SQUAMOUS CELL CARCINOMA (OSCC) DEMONSTRATES AN INCREASING RATE DUE TO HIGH RISK HUMAN PAPILLOMA VIRUS (HR-HPV) PERSISTENT INFECTION, AND ALSO TO CHRONIC CIGARETTE AND ALCOHOL CONSUMPTION. GROSS CHROMOSOMAL ALTERATIONS (POLYSOMY, ANEUPLOIDY, INTRA-CHROMOSOME REARRANGEMENTS) AND SPECIFIC GENE ABERRATIONS SUCH AS AMPLIFICATIONS, DELETIONS, POINT MUTATIONS COMBINED OR NOT WITH EPIGENETIC ONES (PROMOTER METHYLATIONS AND MIRNA DEREGULATIONS) ARE RESPONSIBLE FOR THE PROGRESSIVE TRANSFORMATION OF NORMAL SQUAMOUS CELL EPITHELIA TO THE CORRESPONDING MALIGNANT. CHROMOSOMAL INSTABILITY (CI) -BASED ON STRUCTURAL OR NUMERICAL ABNORMALITIES- LEADS TO SPECIFIC ABNORMAL KARYOTYPES COMBINED OR NOT WITH FUNCTIONAL SUPPRESSOR GENE INACTIVATION AND ONCOGENE OVERACTIVATION IN SOLID MALIGNANCIES, INCLUDING OSCC. EXTENSIVE CYTOGENETIC ANALYSES HAVE SHOWN THAT GROSS ALTERATIONS (GAINS/LOSSES) IN CHROMOSOMES 3, 4, 7, 8, 9, 11, 14, 17, 18, 19 AND ALSO 20 FORM DIFFERENT CI PATTERNS IN OSCC, WHICH IN CONJUNCTION WITH AN AGGRESSIVE PHENOTYPE (PRESENCE OF LYMPH NODAL METASTASIS) NEGATIVELY AFFECT THE PROGNOSIS IN THE CORRESPONDING PATIENTS. IN THE MAJORITY OF OSCC CASES, LOSS OF CHROMOSOMAL BANDS ARE ALMOST EQUALLY DETECTED COMPARED WITH GAINS REGARDING THE CHROMOSOMES REFERRED ABOVE. IN THE CURRENT SPECIAL MOLECULAR PAPER WE EXPLORED THE ROLE OF CI IN THE PROGRESSION AND BIOLOGICAL BEHAVIOR OF OSCCS. 2018 14 913 26 CHRONIC FLT3-ITD SIGNALING IN ACUTE MYELOID LEUKEMIA IS CONNECTED TO A SPECIFIC CHROMATIN SIGNATURE. ACUTE MYELOID LEUKEMIA (AML) IS CHARACTERIZED BY RECURRENT MUTATIONS THAT AFFECT THE EPIGENETIC REGULATORY MACHINERY AND SIGNALING MOLECULES, LEADING TO A BLOCK IN HEMATOPOIETIC DIFFERENTIATION. CONSTITUTIVE SIGNALING FROM MUTATED GROWTH FACTOR RECEPTORS IS A MAJOR DRIVER OF LEUKEMIC GROWTH, BUT HOW ABERRANT SIGNALING AFFECTS THE EPIGENOME IN AML IS LESS UNDERSTOOD. FURTHERMORE, AML CELLS UNDERGO EXTENSIVE CLONAL EVOLUTION, AND THE MUTATIONS IN SIGNALING GENES ARE OFTEN SECONDARY EVENTS. TO ELUCIDATE HOW CHRONIC GROWTH FACTOR SIGNALING ALTERS THE TRANSCRIPTIONAL NETWORK IN AML, WE PERFORMED A SYSTEM-WIDE MULTI-OMICS STUDY OF PRIMARY CELLS FROM PATIENTS SUFFERING FROM AML WITH INTERNAL TANDEM DUPLICATIONS IN THE FLT3 TRANSMEMBRANE DOMAIN (FLT3-ITD). THIS STRATEGY REVEALED COOPERATION BETWEEN THE MAP KINASE (MAPK) INDUCIBLE TRANSCRIPTION FACTOR AP-1 AND RUNX1 AS A MAJOR DRIVER OF A COMMON, FLT3-ITD-SPECIFIC GENE EXPRESSION AND CHROMATIN SIGNATURE, DEMONSTRATING A MAJOR IMPACT OF MAPK SIGNALING PATHWAYS IN SHAPING THE EPIGENOME OF FLT3-ITD AML. 2015 15 5162 33 PRECISION MEDICINE DRIVEN BY CANCER SYSTEMS BIOLOGY. MOLECULAR INSIGHTS FROM GENOME AND SYSTEMS BIOLOGY ARE INFLUENCING HOW CANCER IS DIAGNOSED AND TREATED. WE CRITICALLY EVALUATE BIG DATA CHALLENGES IN PRECISION MEDICINE. THE MELANOMA RESEARCH COMMUNITY HAS IDENTIFIED DISTINCT SUBTYPES INVOLVING CHRONIC SUN-INDUCED DAMAGE AND THE MITOGEN-ACTIVATED PROTEIN KINASE DRIVER PATHWAY. IN ADDITION, DESPITE LOW MUTATION BURDEN, NON-GENOMIC MITOGEN-ACTIVATED PROTEIN KINASE MELANOMA DRIVERS ARE FOUND IN MEMBRANE RECEPTORS, METABOLISM, OR EPIGENETIC SIGNALING WITH THE ABILITY TO BYPASS CENTRAL MITOGEN-ACTIVATED PROTEIN KINASE MOLECULES AND ACTIVATING A SIMILAR PROGRAM OF MITOGENIC EFFECTORS. MUTATION HOTSPOTS, STRUCTURAL MODELING, UV SIGNATURE, AND GENOMIC AS WELL AS NON-GENOMIC MECHANISMS OF DISEASE INITIATION AND PROGRESSION ARE TAKEN INTO CONSIDERATION TO IDENTIFY RESISTANCE MUTATIONS AND NOVEL DRUG TARGETS. A COMPREHENSIVE PRECISION MEDICINE PROFILE OF A MALIGNANT MELANOMA PATIENT ILLUSTRATES FUTURE RATIONAL DRUG TARGETING STRATEGIES. NETWORK ANALYSIS EMPHASIZES AN IMPORTANT ROLE OF EPIGENETIC AND METABOLIC MASTER REGULATORS IN ONCOGENESIS. CO-OCCURRENCE OF DRIVER MUTATIONS IN SIGNALING, METABOLIC, AND EPIGENETIC FACTORS HIGHLIGHTS HOW CUMULATIVE ALTERATIONS OF OUR GENOMES AND EPIGENOMES PROGRESSIVELY LEAD TO UNCONTROLLED CELL PROLIFERATION. PRECISION INSIGHTS HAVE THE ABILITY TO IDENTIFY INDEPENDENT MOLECULAR PATHWAYS SUITABLE FOR DRUG TARGETING. SYNERGISTIC TREATMENT COMBINATIONS OF ORTHOGONAL MODALITIES INCLUDING IMMUNOTHERAPY, MITOGEN-ACTIVATED PROTEIN KINASE INHIBITORS, EPIGENETIC INHIBITORS, AND METABOLIC INHIBITORS HAVE THE POTENTIAL TO OVERCOME IMMUNE EVASION, SIDE EFFECTS, AND DRUG RESISTANCE. 2017 16 2660 27 EPITHERAPY AND IMMUNE CHECKPOINT BLOCKADE: USING EPIGENETIC REINVIGORATION OF EXHAUSTED AND DYSFUNCTIONAL T CELLS TO REIMBURSE IMMUNOTHERAPY RESPONSE. BACKGROUND: CANCER CELLS SUBVERT NATURAL IMMUNOSUPPRESSION BY UPREGULATING THE EXPRESSION OF CHECKPOINT PROTEINS AND THEIR LIGANDS. FOR EXAMPLE, TUMOR CELLS EXPRESSING PROGRAMMED DEATH-LIGAND 1 (PD-L1) INDUCE IMMUNE CELL TOLERANCE TO CANCERS, THEREBY FACILITATING TUMOR PROGRESSION. THE RECENT CLINICAL SUCCESS OF IMMUNOTHERAPY, PARTICULARLY CHECKPOINT BLOCKADE, REPRESENTS A SIGNIFICANT ADVANCE IN CANCER THERAPY. HOWEVER, MANY CANCERS DEVELOP RESISTANCE TO IMMUNOTHERAPIES, AND THE UNDERLYING MECHANISMS AND HOW THESE MIGHT BE EXPLOITED TO OVERCOME RESISTANCE STILL NEED TO BE DETERMINED. METHODS: T CELL DYSFUNCTION, IN PART CAUSED BY CHRONIC T CELL RECEPTOR STIMULATION, DIMINISHES THE CAPACITY FOR DURABLE RESPONSES TO CHECKPOINT BLOCKADE. FURTHERMORE, T CELL POPULATIONS ARE PHENOTYPICALLY AND FUNCTIONALLY HETEROGENEOUS, RESULTING IN VARYING RESPONSES TO CHECKPOINT BLOCKADE. RECENT MOLECULAR STUDIES OF T CELL HETEROGENEITY HAVE SHOWN THAT CHECKPOINT BLOCKADE ON ITS OWN DOES NOT ALTER THE EPIGENETIC LANDSCAPE OF T CELLS, DESPITE EPIGENETIC CHANGES GOVERNING T CELL PHENOTYPE. CONCLUSION: HERE WE ARGUE THAT EPIGENETIC MODIFIERS CAN BE USED TO PRIME AND SENSITIZE T CELLS TO IMMUNOTHERAPY. ADMINISTERING EPITHERAPY IN CONJUNCTION WITH CHECKPOINT BLOCKADE COULD DECREASE T CELL EXHAUSTION AND IMMUNOTHERAPY RESISTANCE IN MANY CANCER TYPES. 2020 17 4552 45 MUTATIONAL LANDSCAPE OF CHRONIC MYELOID LEUKEMIA: MORE THAN A SINGLE ONCOGENE LEUKEMIA. THE BCR-ABL1 FUSION GENE, WHICH CAUSES ABERRANT KINASE ACTIVITY AND UNCONTROLLED CELL PROLIFERATION, IS THE HALLMARK OF CHRONIC MYELOID LEUKEMIA (CML). THE DEVELOPMENT OF TYROSINE KINASE INHIBITORS (TKI) THAT TARGET THE BCR-ABL ONCOPROTEIN HAS LED TO DRAMATIC IMPROVEMENT IN CML MANAGEMENT. HOWEVER, SOME CHALLENGES REMAIN TO BE ADDRESSED IN THE TKI ERA, INCLUDING PATIENT STRATIFICATION AND THE SELECTION OF FRONTLINE TKIS AND CML PROGRESSION. ADDITIONALLY, WITH THE EMERGING GOAL OF TREATMENT-FREE REMISSION (TFR) IN CML MANAGEMENT, BIOMARKERS THAT PREDICT THE OUTCOMES OF STOPPING TKI REMAIN TO BE IDENTIFIED. NOTABLY, RECENT REPORTS HAVE REVEALED THE POWER OF GENOME SCREENING IN UNDERSTANDING THE ROLE OF GENOME ABERRATIONS OTHER THAN BCR-ABL1 IN CML PATHOGENESIS. THESE STUDIES HAVE DISCOVERED THE PRESENCE OF DISEASE-PHASE SPECIFIC MUTATIONS AND LINKED CERTAIN MUTATIONS TO INFERIOR RESPONSES TO TKI TREATMENT AND CML PROGRESSION. A PERSONALIZED APPROACH THAT INCORPORATES GENETIC DATA IN TAILORING TREATMENT STRATEGIES HAS BEEN SUCCESSFULLY IMPLEMENTED IN ACUTE LEUKEMIA, AND IT REPRESENTS A PROMISING APPROACH FOR THE MANAGEMENT OF HIGH-RISK CML PATIENTS. IN THIS ARTICLE, WE WILL REVIEW CURRENT KNOWLEDGE ABOUT THE MUTATIONAL PROFILE IN DIFFERENT PHASES OF CML AS WELL AS PATTERNS OF MUTATIONAL DYNAMICS IN PATIENTS HAVING DIFFERENT OUTCOMES. WE HIGHLIGHT THE EFFECTS OF SOMATIC MUTATIONS INVOLVING CERTAIN GENES (E.G. EPIGENETIC MODIFIERS) ON THE OUTCOMES OF TKI TREATMENT. WE ALSO DISCUSS THE POTENTIAL VALUE OF INCORPORATING GENETIC DATA IN TREATMENT DECISIONS AND THE ROUTINE CARE OF CML PATIENTS AS A FUTURE DIRECTION FOR OPTIMIZING CML MANAGEMENT. 2021 18 4141 22 MECHANISMS OF POST-CRITICAL ILLNESS CARDIOVASCULAR DISEASE. PROLONGED CRITICAL CARE STAYS COMMONLY FOLLOW TRAUMA, SEVERE BURN INJURY, SEPSIS, ARDS, AND COMPLICATIONS OF MAJOR SURGERY. ALTHOUGH PATIENTS LEAVE CRITICAL CARE FOLLOWING HOMEOSTATIC RECOVERY, SIGNIFICANT ADDITIONAL DISEASES AFFECT THESE PATIENTS DURING AND BEYOND THE CONVALESCENT PHASE. NEW CARDIOVASCULAR AND RENAL DISEASE IS COMMONLY SEEN AND ROUGHLY ONE THIRD OF ALL DEATHS IN THE YEAR FOLLOWING DISCHARGE FROM CRITICAL CARE MAY COME FROM THIS CLUSTER OF DISEASES. DURING PROLONGED CRITICAL CARE STAYS, THE IMMUNOMETABOLIC, INFLAMMATORY AND NEUROHUMORAL RESPONSE TO SEVERE ILLNESS IN CONJUNCTION WITH RESUSCITATIVE TREATMENTS PRIMES THE IMMUNE SYSTEM AND PARENCHYMAL TISSUES TO DEVELOP A LONG-LIVED PRO-INFLAMMATORY AND IMMUNOSENESCENT STATE. THIS STATE IS PERPETUATED BY PERSISTENT TOLL-LIKE RECEPTOR SIGNALING, FREE RADICAL MEDIATED ISOLEVUGLANDIN PROTEIN ADDUCT FORMATION AND PRESENTATION BY ANTIGEN PRESENTING CELLS, ABNORMAL CIRCULATING HDL AND LDL ISOFORMS, REDOX AND METABOLITE MEDIATED EPIGENETIC REPROGRAMMING OF THE INNATE IMMUNE ARM (TRAINED IMMUNITY), AND THE DEVELOPMENT OF IMMUNOSENESCENCE THROUGH T-CELL EXHAUSTION/ANERGY THROUGH EPIGENETIC MODIFICATION OF THE T-CELL GENOME. UNDER THIS STATE, TISSUE REMODELING IN THE VASCULAR, CARDIAC, AND RENAL PARENCHYMAL BEDS OCCURS THROUGH THE ACTIVATION OF PRO-FIBROTIC CELLULAR SIGNALING PATHWAYS, CAUSING VASCULAR DYSFUNCTION AND ATHEROSCLEROSIS, ADVERSE CARDIAC REMODELING AND DYSFUNCTION, AND PROTEINURIA AND ACCELERATED CHRONIC KIDNEY DISEASE. 2022 19 2277 40 EPIGENETIC REGULATION BY ASXL1 IN MYELOID MALIGNANCIES. MYELOID MALIGNANCIES ARE CLONAL HEMATOPOIETIC DISORDERS THAT ARE COMPRISED OF A SPECTRUM OF GENETICALLY HETEROGENEOUS DISORDERS, INCLUDING MYELODYSPLASTIC SYNDROMES (MDS), MYELOPROLIFERATIVE NEOPLASMS (MPN), CHRONIC MYELOMONOCYTIC LEUKEMIA (CMML), AND ACUTE MYELOID LEUKEMIA (AML). MYELOID MALIGNANCIES ARE CHARACTERIZED BY EXCESSIVE PROLIFERATION, ABNORMAL SELF-RENEWAL, AND/OR DIFFERENTIATION DEFECTS OF HEMATOPOIETIC STEM CELLS (HSCS) AND MYELOID PROGENITOR CELLS HEMATOPOIETIC STEM/PROGENITOR CELLS (HSPCS). MYELOID MALIGNANCIES CAN BE CAUSED BY GENETIC AND EPIGENETIC ALTERATIONS THAT PROVOKE KEY CELLULAR FUNCTIONS, SUCH AS SELF-RENEWAL, PROLIFERATION, BIASED LINEAGE COMMITMENT, AND DIFFERENTIATION. ADVANCES IN NEXT-GENERATION SEQUENCING LED TO THE IDENTIFICATION OF MULTIPLE MUTATIONS IN MYELOID NEOPLASMS, AND MANY NEW GENE MUTATIONS WERE IDENTIFIED AS KEY FACTORS IN DRIVING THE PATHOGENESIS OF MYELOID MALIGNANCIES. THE POLYCOMB PROTEIN ASXL1 WAS IDENTIFIED TO BE FREQUENTLY MUTATED IN ALL FORMS OF MYELOID MALIGNANCIES, WITH MUTATIONAL FREQUENCIES OF 20%, 43%, 10%, AND 20% IN MDS, CMML, MPN, AND AML, RESPECTIVELY. SIGNIFICANTLY, ASXL1 MUTATIONS ARE ASSOCIATED WITH A POOR PROGNOSIS IN ALL FORMS OF MYELOID MALIGNANCIES. THE FACT THAT ASXL1 MUTATIONS ARE ASSOCIATED WITH POOR PROGNOSIS IN PATIENTS WITH CMML, MDS, AND AML, POINTS TO THE POSSIBILITY THAT ASXL1 MUTATION IS A KEY FACTOR IN THE DEVELOPMENT OF MYELOID MALIGNANCIES. THIS REVIEW SUMMARIZES THE RECENT ADVANCES IN UNDERSTANDING MYELOID MALIGNANCIES WITH A SPECIFIC FOCUS ON ASXL1 MUTATIONS. 2023 20 1082 43 CML - NOT ONLY BCR-ABL1 MATTERS. BCR-ABL1 IS IN THE CENTER OF CHRONIC MYELOID LEUKEMIA (CML) PATHOLOGY, DIAGNOSIS AND TREATMENT, AS CONFIRMED BY THE SUCCESS OF TYROSINE KINASE INHIBITOR (TKI) THERAPY. HOWEVER, ADDITIONAL MECHANISMS AND EVENTS, MANY OF WHICH FUNCTION INDEPENDENTLY OF BCR-ABL1, PLAY IMPORTANT ROLES, PARTICULARLY IN TERMS OF LEUKEMIC STEM CELL (LSC) PERSISTENCE, PRIMARY AND SECONDARY RESISTANCE, AND DISEASE PROGRESSION. PROMISING THERAPEUTIC APPROACHES AIM TO DISRUPT PATHWAYS WHICH MEDIATE LSC SURVIVAL DURING SUCCESSFUL TKI TREATMENT, IN THE HOPE OF IMPROVING LONG-TERM TREATMENT-FREE-REMISSION AND PERHAPS PROVIDE A FUNCTIONAL CURE FOR SOME PATIENTS. OVER THE YEARS THROUGH ADVANCES IN SEQUENCING TECHNOLOGY FREQUENT MOLECULAR ABERRATIONS IN ADDITION TO BCR-ABL1 HAVE BEEN IDENTIFIED NOT ONLY IN ADVANCED DISEASE BUT ALSO IN CHRONIC PHASE CML, OFTEN AFFECTING EPIGENETIC REGULATORS SUCH AS ASXL1, DNMT3A AND TET2. ANALYSES OF SERIAL SAMPLES HAVE REVEALED VARIOUS PATTERNS OF CLONAL EVOLUTION WITH SOME MUTATIONS PRECEDING THE BCR-ABL1 ACQUISITION. SUCH MUTATIONS CAN BE CONSIDERED TO BE IMPORTANT CO-FACTORS IN THE PATHOGENESIS OF CML AND COULD POTENTIALLY INFLUENCE THERAPEUTIC STRATEGIES IN THE FUTURE. 2020