1. Introduction
Mitochondria are double-membrane organelles considered the power supply of the cells. Alterations in mitochondrial functions not only impinge cell homeostasis, bioenergetics, and redox balance but also drive cell fate [
1]. Cancer cells reprogram the mitochondrial metabolic pathways to support the increased bioenergetics and biosynthetic demands required to overcome the cellular stress arising from microenvironmental cues (e.g., nutrient depletion, hypoxia) or anti-cancer treatments [
2].
Leucine zipper/EF hand-containing transmembrane-1 (LETM1) is one of the inner mitochondrial membrane proteins required to maintain the tubular shape of mitochondria, mitochondrial cristae, and for the assembly of respiratory chain supercomplexes [
3,
4]. LETM1 is ubiquitously expressed and modulates mitochondrial homeostasis, mediates calcium and potassium/proton antiport, increases the glycolytic ATP supply, and initiates mitochondrial translation [
5,
6,
7]. LETM1 also regulates cell fate by affecting autophagy and apoptosis via BECLIN-1/BCL-2 complex regulation. Remarkably, loss of
LETM1 results in AMPK-mediated activation of autophagy [
8].
Autophagy is a lysosome-driven catabolic process that has been proven to play a dual role in cancer [
9,
10]. On one side, it can contribute to carcinogenesis by sustaining the metabolic demands of cancer stem cells or by protecting tumor cells from harsh conditions and DNA damage [
11,
12]. On the other hand, hyper-induction of autophagy (and mitophagy) may lead to autophagic cell death, a death pathway alternative to apoptosis that could be exploited for overcoming chemoresistance [
13].
Accumulating evidence shows that the dysregulation of LETM1 may lead to carcinogenesis and progression of malignant tumors through dysfunctional mitochondrial Ca
2+ handling and metabolic alterations [
14,
15,
16]. In this regard, LETM1 upregulation has been reported in multiple human solid tumors, like breast, prostate, and lung cancers compared with their normal tissue counterparts [
15,
17,
18,
19]. So far, the prognostic role of LETM1 has been described in different solid cancers, while the prognostic role and its mechanistic involvement in hematologic malignancies remain unexplored.
Here, we interrogated two different datasets from the TCGA database to address the translational relevance of LETM1 in diffuse large B cell lymphoma (DLBCL) and acute myeloid leukemia (AML). From the in-silico analysis, we found that overexpression of LETM1 correlates with poor prognosis. Searching for the most relevant biological processes correlated with LETM1 expression, we noticed a positive correlation with genes regulating cell cycle, glucose transport, cell growth, and survival pathways, and a negative correlation with genes involved in apoptosis and autophagy-lysosome pathways. To be noted, LETM1 downregulation causes the over-induction of BECLIN-1-dependent mitophagy, which in turn ultimately results in reduction of oncogenic signaling pathways and invasive features and confers a better clinical outcome to DLBCL and AML patients, suggesting that targeting LETM1 expression could be a valuable therapeutic strategy to cure these malignancies.
3. Discussion
Mitochondrion is an essential organelle responsible for several cellular functions, including cell growth, division, energy production, cellular metabolism, calcium and redox homeostasis, and apoptosis [
1]. Mitochondrial dysfunctions have been associated with various human diseases including cancers, as cancer cells rely on mitochondrial bioenergetics for metabolic reprogramming during initiation, progression, and acquisition of resistance toward anti-cancer therapy [
21,
22,
23]. Damaged and superfluous mitochondria need to be timely removed through the selective autophagic process known as mitophagy [
24,
25].
Autophagy is an intracellular lysosomal-dependent catabolic process for macromolecular and organelle degradation that plays a pivotal role in hematopoietic stem cells’ homeostasis, and it is found often dysregulated in blood tumors [
12,
26]. Autophagy acts as a crossroad between cancer cell survival and cell death pathways by supporting either chemoresistance or onco-suppressive functions [
27]. We have recently demonstrated that BECLIN-1-dependent autophagy negatively correlates with BCL-2 expression and predicts favorable clinical outcomes with improved therapeutic efficacy in DLBCL patients [
28].
Remarkably, LETM1, a protein essential for mitochondria homeostasis, has been reported as an inhibitor of the BECLIN-1-Vps34 autophagic initiation complex; indeed, knockdown of
LETM1 favors BECLIN-1/BCL-2 complex dissociation through phosphorylation of AMPK, thereby promoting autophagy and apoptosis in hepatocellular carcinoma cells [
8].
In the present work, we investigated the functional role of LETM1 and its prognostic value in hematological malignancies. We found that in DLBCL and AML patients, high expression of LETM1 correlates with shorter overall survival compared to that of low LETM1 expressors. Unfortunately, this analysis has one limitation related to the small number of TCGA DLBCL patients (N = 48), which allowed us only to describe the trends, without reaching statistical significance. In the future, we aim to extend our bioinformatic analysis to other databases with a larger number of cases.
However, previous studies reported in literature state that
LETM1 expression is significantly higher in the patients presenting lymph node metastasis, high tumor grading, and advanced clinical stage in multiple human solid cancers, including breast, head and neck squamous cell carcinoma, colorectal, esophageal, lung, ovarian, and gastric tumors [
15,
17,
19,
29,
30,
31,
32,
33]. Additionally, overexpression of
LETM1 was found to positively correlate with the expression of stemness-associated markers, epithelial to mesenchymal transition factors, and cell cycle regulatory genes, thereby supporting its pro-tumorigenic role [
18].
In vitro studies reported that LETM1 overexpression promotes gastric cancer cell proliferation, migration, and invasion via initiating the PI3K/AKT pathway [
33] and Wnt/β-catenin signaling pathway in bladder cancer and renal cell carcinoma, respectively [
34,
35].
Consistently, our transcriptomic analysis performed on DLBCL and AML patients’ cohorts revealed that LETM1 expression is positively associated with genes regulating the pro-survival pathways, such as mitochondrial calcium transport, glucose transport, stem cell maintenance, mTOR and Wnt signaling, mitotic G2/M phase transition, and cell proliferation. On the other side, LETM1 negatively correlates with genes associated with mitophagy, autophagosome formation, lysosomal proteolysis, endocytosis, and apoptosis.
We hypothesized that patients bearing a tumor with low
LETM1 expression display an upregulation of BECLIN-1-dependent autophagy (particularly, mitophagy), which in turn may confer a favorable prognosis for DLBCL and AML patients. Our
in-silico analysis shows that both DLBCL and AML low
LETM1 expressors display active autophagy/mitophagy as indicated by high levels of
BECN1,
MAP1LC3B,
PINK1 and
BNIP3L. Remarkably, these patients exhibit a better prognosis, which could be related to sensitization of cancer cells to therapy via BECLIN1-dependent autophagy/mitophagy upregulation. Consistently,
in vitro findings demonstrated that silencing LETM1 induces autophagy in colorectal cancer cells by triggering ROS-mediated AMPK/mTOR signaling, thus blocking tumor progression [
36]. Moreover, it has been shown that knockdown of
LETM1 results in a dramatic decrease in ATP levels, which ultimately changes the ADP or AMP/ATP ratio, and activates AMPK, which in turn promotes autophagy activation [
8,
14]. Taken together, these observations support the view that targeting LETM1 may increase the efficacy of anti-cancer therapies. However, so far these perspectives have not been translated yet into novel approaches for improving the treatment of hematological malignancies.
In conclusion, this is the first study showing that high expression of LETM1 correlates with poor overall survival in DLBCL and AML patients. Our data indicate that autophagy/mitophagy induction improves the clinical outcome of oncohematological patients, suggesting that LETM1/autophagy axis modulation may represent a crucial target in overcoming therapy resistance. These findings may pave the way for considering LETM1 as a potentially valuable biomarker for implementing personalized treatment of hematological malignancies.
Figure 1.
High expression of LETM1 is associated with poor prognosis in DLBCL and AML patients. A, C) Box-plots showing the distribution of LETM1 expression based on expression levels in DLBCL and AML patients (high vs. low), respectively. B, D) Overall survival status for DLBCL and AML patients, respectively, based on LETM1 expression levels (high vs. low).
Figure 1.
High expression of LETM1 is associated with poor prognosis in DLBCL and AML patients. A, C) Box-plots showing the distribution of LETM1 expression based on expression levels in DLBCL and AML patients (high vs. low), respectively. B, D) Overall survival status for DLBCL and AML patients, respectively, based on LETM1 expression levels (high vs. low).
Figure 2.
LETM1 positively correlates with genes regulating cell cycle and cell proliferation and negatively correlates with genes belonging to autophagy and apoptotic cell death in DLBCL and AML patients. Biological processes associated with LETM1-positively and negatively correlated genes in DLBCL (A, B) and AML (C, D), respectively.
Figure 2.
LETM1 positively correlates with genes regulating cell cycle and cell proliferation and negatively correlates with genes belonging to autophagy and apoptotic cell death in DLBCL and AML patients. Biological processes associated with LETM1-positively and negatively correlated genes in DLBCL (A, B) and AML (C, D), respectively.
Figure 3.
Oncoprint reporting copy number variations and expression profile. Oncoprint showing the genetic alterations (upper part) and mRNA expression levels (A) DLBCL (TCGA, Firehose Legacy) and (B) AML patients’ datasets (TCGA, OHSU, Nature 2018). [Note: the majority of AML patients are lacking mRNA expression profiles; expression data are available only for 365 out of 622 patients].
Figure 3.
Oncoprint reporting copy number variations and expression profile. Oncoprint showing the genetic alterations (upper part) and mRNA expression levels (A) DLBCL (TCGA, Firehose Legacy) and (B) AML patients’ datasets (TCGA, OHSU, Nature 2018). [Note: the majority of AML patients are lacking mRNA expression profiles; expression data are available only for 365 out of 622 patients].
Figure 4.
High LETM1 expression positively correlates with genes involved in cell proliferation and inversely correlates with genes involved in autophagy and mitophagy in DLBCL and AML patients. Scatter plots showing the negative correlation between LETM1 and BECN1 (a), MAP1LC3B (b), PINK1 (c), BNIP3L (d) in DLBCL (A) and AML (B) patients.
Figure 4.
High LETM1 expression positively correlates with genes involved in cell proliferation and inversely correlates with genes involved in autophagy and mitophagy in DLBCL and AML patients. Scatter plots showing the negative correlation between LETM1 and BECN1 (a), MAP1LC3B (b), PINK1 (c), BNIP3L (d) in DLBCL (A) and AML (B) patients.
Figure 5.
Comparison of differentially expressed genes in two groups of DLBCL patients stratified based on LETM1 expression. Patients were divided into high LETM1 (Group A) and low LETM1 (Group B) expression. Heatmaps showing the top 5 genes for each biological process related to oncogenic pathways and autophagy-lysosomal proteolysis.
Figure 5.
Comparison of differentially expressed genes in two groups of DLBCL patients stratified based on LETM1 expression. Patients were divided into high LETM1 (Group A) and low LETM1 (Group B) expression. Heatmaps showing the top 5 genes for each biological process related to oncogenic pathways and autophagy-lysosomal proteolysis.
Figure 6.
Comparison of differentially expressed genes in two groups of AML patients stratified based on LETM1 expression. Patients were divided into high LETM1 (Group A) and low LETM1 (Group B) expression. Heatmaps showing the top 5 genes for each biological process related to oncogenic pathways and autophagy-lysosomal proteolysis.
Figure 6.
Comparison of differentially expressed genes in two groups of AML patients stratified based on LETM1 expression. Patients were divided into high LETM1 (Group A) and low LETM1 (Group B) expression. Heatmaps showing the top 5 genes for each biological process related to oncogenic pathways and autophagy-lysosomal proteolysis.
Figure 7.
Low LETM1 expression along with BECN1, MAP1LC3B, PINK1 and BNIP3L upregulation associated with longer overall survival in DLBCL patients. Box-plots showing the distribution of BECN1 (A), MAP1LC3B (C), PINK1 (E), and BNIP3L (G) expressions based on LETM1 and the expression levels (H/L and L/H). Kaplan–Meier plots representing the overall survival status of DLBCL patients stratified on the basis of differential expression of LETM1 and BECN1 (B), MAP1LC3B (D), PINK1 (F), and BNIP3L (H) expression (H/L and L/H).
Figure 7.
Low LETM1 expression along with BECN1, MAP1LC3B, PINK1 and BNIP3L upregulation associated with longer overall survival in DLBCL patients. Box-plots showing the distribution of BECN1 (A), MAP1LC3B (C), PINK1 (E), and BNIP3L (G) expressions based on LETM1 and the expression levels (H/L and L/H). Kaplan–Meier plots representing the overall survival status of DLBCL patients stratified on the basis of differential expression of LETM1 and BECN1 (B), MAP1LC3B (D), PINK1 (F), and BNIP3L (H) expression (H/L and L/H).
Figure 8.
Low LETM1 mRNA expression with BECN1, MAP1LC3B, PINK1, and BNIP3L upregulation associated with longer overall survival in AML patients. Box-plots showing the distribution of BECN1 (A), MAP1LC3B (C), PINK1 (E), and BNIP3L (G) expressions based on LETM1 and the expression levels (H/L and L/H). Kaplan–Meier plots representing the overall survival status of AML patients stratified on the basis of differential expression of LETM1 and BECN1 (B), MAP1LC3B (D), PINK1 (F), and BNIP3L (H) expression (H/L and L/H).
Figure 8.
Low LETM1 mRNA expression with BECN1, MAP1LC3B, PINK1, and BNIP3L upregulation associated with longer overall survival in AML patients. Box-plots showing the distribution of BECN1 (A), MAP1LC3B (C), PINK1 (E), and BNIP3L (G) expressions based on LETM1 and the expression levels (H/L and L/H). Kaplan–Meier plots representing the overall survival status of AML patients stratified on the basis of differential expression of LETM1 and BECN1 (B), MAP1LC3B (D), PINK1 (F), and BNIP3L (H) expression (H/L and L/H).