38Inhibition of oxidative phosphorylation (OXPHOS) is a promising therapeutic strategy in Acute 39 Myeloid Leukemia (AML), but patients respond heterogeneously. Through chemically 40 interrogation of 200 sequenced specimens, we identified Mubritinib as a strong in vitro and in 41 vivo anti-leukemic compound, acting through ubiquinone-dependent inhibition of Electron 42 Transport Chain complex I (ETC1). ETC1 targeting showed selective toxicity against a subgroup 43 of chemotherapy-resistant leukemias exhibiting OXPHOS hyperactivity, high expression of 44 mitochondrial activity-related genes, and mutations affecting NPM1, FLT3 and DNMT3A.
45Altogether, our work thus identifies a novel ETC1 inhibitor with high clinical potential and reveals 46 the landscape of OXPHOS dependency in AML. 47 Keywords 48 Acute Myeloid Leukemia, Metabolism, Oxidative Phosphorylation, Mitochondrial Respiration, 49 Electron Transport Chain Complex I, NADH dehydrogenase inhibitor, Precision Medicine, 50 Therapeutic Target. 51 3 Main 52 Acute Myeloid Leukemia (AML) is a highly lethal disease, with a five-year overall survival rate of 53 only 27% 1,2 . Standard treatment for AML includes a combination of cytarabine (AraC) and 54 anthracycline as an induction regimen, followed by consolidation chemotherapy or 55 hematopoietic stem cell transplantation, depending on the patient's genetic risk class 3 . this study, we interrogated 200 genetically diverse primary AML patient specimens of the well-91 characterized Leucegene cohort (www.leucegene.ca) using an unbiased chemo-genomic 92 approach. Through this process, we identified a novel ubiquinone-dependent Electron Transport 93 Chain (ETC) complex I inhibitor and uncovered the genetic landscape of OXPHOS dependency 94 in this disease. 95 96 4 Results 97 Mubritinib targets a subset of poor outcome AMLs
98The Leucegene collection of sequenced AML specimens comprises 263 de novo non-M3