DNMT3A mutations promote anthracycline resistance in acute myeloid leukemia via impaired nucleosome remodeling

Nat Med. 2016 Dec;22(12):1488-1495. doi: 10.1038/nm.4210. Epub 2016 Nov 14.


Although the majority of patients with acute myeloid leukemia (AML) initially respond to chemotherapy, many of them subsequently relapse, and the mechanistic basis for AML persistence following chemotherapy has not been determined. Recurrent somatic mutations in DNA methyltransferase 3A (DNMT3A), most frequently at arginine 882 (DNMT3AR882), have been observed in AML and in individuals with clonal hematopoiesis in the absence of leukemic transformation. Patients with DNMT3AR882 AML have an inferior outcome when treated with standard-dose daunorubicin-based induction chemotherapy, suggesting that DNMT3AR882 cells persist and drive relapse. We found that Dnmt3a mutations induced hematopoietic stem cell expansion, cooperated with mutations in the FMS-like tyrosine kinase 3 gene (Flt3ITD) and the nucleophosmin gene (Npm1c) to induce AML in vivo, and promoted resistance to anthracycline chemotherapy. In patients with AML, the presence of DNMT3AR882 mutations predicts minimal residual disease, underscoring their role in AML chemoresistance. DNMT3AR882 cells showed impaired nucleosome eviction and chromatin remodeling in response to anthracycline treatment, which resulted from attenuated recruitment of histone chaperone SPT-16 following anthracycline exposure. This defect led to an inability to sense and repair DNA torsional stress, which resulted in increased mutagenesis. Our findings identify a crucial role for DNMT3AR882 mutations in driving AML chemoresistance and highlight the importance of chromatin remodeling in response to cytotoxic chemotherapy.

MeSH terms

  • Animals
  • Anthracyclines / therapeutic use*
  • Antineoplastic Agents / therapeutic use
  • Cell Line, Tumor
  • Cell Proliferation / genetics
  • Cell Survival
  • Chromatin Assembly and Disassembly / genetics*
  • DNA (Cytosine-5-)-Methyltransferases / genetics*
  • DNA Methyltransferase 3A
  • Daunorubicin / therapeutic use
  • Drug Resistance, Neoplasm / genetics*
  • Hematopoietic Stem Cells
  • Humans
  • Immunoblotting
  • Immunoprecipitation
  • Leukemia, Myeloid, Acute / drug therapy
  • Leukemia, Myeloid, Acute / genetics*
  • Mass Spectrometry
  • Mice
  • Mutation
  • Nuclear Proteins / genetics
  • Nucleophosmin
  • Nucleosomes / metabolism
  • fms-Like Tyrosine Kinase 3 / genetics


  • Anthracyclines
  • Antineoplastic Agents
  • DNMT3A protein, human
  • Dnmt3a protein, mouse
  • NPM1 protein, human
  • Npm1 protein, mouse
  • Nuclear Proteins
  • Nucleosomes
  • Nucleophosmin
  • DNA (Cytosine-5-)-Methyltransferases
  • DNA Methyltransferase 3A
  • fms-Like Tyrosine Kinase 3
  • Daunorubicin