IntroductionThe histone H3 lysine 4 (H3K4) methyltransferase mixed lineage leukemia (MLL) is necessary for the maintenance of HOX patterning and essential for normal hematopoiesis. Full-length MLL is a 3968 amino acid multi-domain protein, which is proteolytically cleaved into a 320 kDa N-terminal fragment (MLL N ) and a 180 kDa C-terminal fragment (MLL C ) that noncovalently associate to form a stable complex. 1 MLL N contains several DNA-binding domains including 3 AT-hooks and a CxxC domain, as well as a poorly understood PHD/Bromodomain (PHD/Bromo) region that contains 4 plant homeodomain fingers (PHD1-4), and a bromodomain between PHD3 and PHD4. MLL C contains a transactivation domain and a SET domain with intrinsic H3K4 methyltransferase activity ( Figure 1A). MLL positively regulates target gene expression through methylation of H3K4, an epigenetic mark closely associated with transcriptional activation. Genome-wide analysis has identified a large number of genes that are regulated by MLL, including homeobox (HOX) genes and their cofactors, such as MEIS1. 2 HOX genes are a group of transcription factors that specify segment identity and cell fate during development, and play essential roles during hematopoiesis. 3 MLL is responsible for maintaining expression of HOX and MEIS1 through H3K4 methylation in hematopoietic stem cells and progenitors, which is required for stem cell self-renewal and progenitor expansion. 2,4,5 Mll-null mice are defective in maintaining Hox gene expression resulting in embryonic lethality by E10.5, whereas reexpression of Hox genes in Mll-deficient progenitors rescues hematopoietic colony formation. 6,7 HOX expression decreases concurrent with hematopoietic differentiation. This is crucial for normal hematopoiesis, as constitutive activation of HOX genes is associated with leukemia and other malignancies. 3 In fact, HOXA9 was identified as the most highly correlated gene for poor prognosis in acute myeloid leukemia (AML). 8 Chromosomal translocations involving MLL are one of the most common genetic alterations in human leukemia, accounting for up to 80% of infant leukemia and approximately 5%-10% of adult leukemia overall. 9,10 Most of the leukemogenic MLL fusion proteins contain the N-terminus of MLL fused in frame to the C-terminus of a translocation partner, generally a transcription activator or a dimerizing protein, thus forming a chimeric protein with abnormal transactivation ability. 10 Both in vitro and in vivo studies have demonstrated that these MLL fusion proteins induce leukemogenesis mainly through constitutive activation of HOXA9 and MEIS1. [11][12][13] Notably, translocations of MLL invariably occur within the breakpoint cluster region (BCR), which leads to the deletion or disruption of the PHD/Bromo region. 14 Further, insertion of PHD/Bromo into MLL-AF9 and MLL-ENL fusion proteins abolishes their transformation ability, suggesting that this region may be important for the regulation of MLL. 15,16 Recent studies discovered that reciprocal MLL fusion proteins conta...