Myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML) are diseases of abnormal hematopoietic differentiation with aberrant epigenetic alterations. Azacitidine (AZA) is a DNA methyltransferase inhibitor widely used to treat MDS and AML, yet the impact of AZA on the cell-surface proteome has not been defined. To identify potential therapeutic targets for use in combination with AZA in AML patients, we investigated the effects of AZA treatment on four AML cell lines representing different stages of differentiation. The effect of AZA treatment on these cell lines was characterized at three levels: the DNA methylome, the transcriptome, and the cell-surface proteome. Untreated AML cell lines showed substantial overlap at all three omics levels; however, while AZA treatment globally reduced DNA methylation in all cell lines, changes in the transcriptome and surface proteome were subtle and differed among the cell lines. Transcriptome analysis identified five commonly up-regulated coding genes upon AZA treatment in all four cell lines, TRPM4 being the only gene encoding a surface protein, and surface proteome analysis found no commonly regulated proteins. Gene set enrichment analysis of differentially regulated RNA and surface proteins showed a decrease in metabolic pathways and an increase in immune defense response pathways. As such, AZA treatment led to diverse effects at the individual gene and protein levels but converged to common responses at the pathway level. Given the heterogeneous responses in the four cell lines, we discuss potential therapeutic strategies for AML in combination with AZA.AML | azacitidine | target discovery | multiomics | surface proteomics M yelodysplastic syndromes (MDS) and acute myeloid leukemia (AML) are hematopoietic malignancies that are genetically and epigenetically diverse in nature. As myeloid lineage cells differentiate from their hematopoietic stem/progenitor cells, aberrant epigenetic changes can occur at any differentiation stage, driving cells into cancerous phenotypes (1). As such, AML is routinely classified according to hematopoietic lineages by cell morphology or by cytometry using sparse surface markers (2, 3). Among many epigenetic changes that occur in MDS and AML, the best-characterized change is the DNA methylation of cytosine bases in CpG islands (4). In fact, a hallmark of epigenetic changes in AML is the redistribution of methylated CpG dinucleotides with loss of methylation across intergenic regions, primarily transposable elements and repeats, and gain of aberrant methylation near the promoters of a number of genes, including well-known tumor suppressors such as p16INK4a (5). As such, it is believed that these diseases are more sensitive to hypomethylating agents such as DNA methyltransferase inhibitors (DMNTi) (6, 7). One such DMNTi, azacitidine (AZA), has been efficaciously used for over a decade to treat MDS and AML (8,9). At high doses, AZA induces rapid DNA damage and is cytotoxic; at lower doses, AZA induces DNA hypomethylation by covalent trappi...