A1 Refereed original research article in a scientific journal
Bone marrow failure, somatic rescue by p53 inactivation, and enhanced leukemogenesis in germ line ERCC6L2 disease
Authors: Schimmer, Roman R.; Klemm, Nancy; Fullin, Jonas; Topçu, Ebru; Treacy, Milena; Zielińska, Karolina A.; Doerdelmann, Cyril; Devesa-Serrano, Daphne; Lock, Melissa; Caiado, Francisco; Koch, Christian; Dietliker, Nadja; Schwotzer, Rahel; Bühler, Marco; Myllymäki, Mikko; Kurppa, Kari J.; Manz, Markus G.; Lopes, Massimo; Boettcher, Steffen
Publication year: 2026
Journal: Blood
Volume: 147
Issue: 15
First page : 1663
Last page: 1679
ISSN: 0006-4971
eISSN: 1528-0020
DOI: https://doi.org/10.1182/blood.2025030230
Publication's open availability at the time of reporting: Open Access
Publication channel's open availability : Partially Open Access publication channel
Web address : https://doi.org/10.1182/blood.2025030230
Self-archived copy’s web address: https://research.utu.fi/converis/portal/detail/Publication/522975808
Self-archived copy's licence: CC BY NC ND
Self-archived copy's version: Publisher`s PDF
Recessively inherited loss-of-function mutations in excision repair cross-complementing 6–like 2 (ERCC6L2) cause a bone marrow failure (BMF) syndrome characterized by moderate cytopenias, frequent somatic TP53 mutations, and a propensity to develop myeloid malignancies. The pathophysiology and molecular mechanisms underlying the BMF syndrome as well as its association with TP53-mutant clonal hematopoiesis and myeloid malignancies have remained poorly understood. Using novel preclinical in vitro and in vivo model systems, we demonstrate that Ercc6l2 maintains the competitive fitness of hematopoietic stem and progenitor cells (HSPCs) by mitigating replication stress. Sustained replication stress and DNA damage in Ercc6l2-deficient HSPCs cause p53 pathway activation followed by cell cycle arrest and apoptosis. Moreover, Ercc6l2 deficiency results in decreased expression of master hematopoietic regulators Runx1 and Gata1 in HSPCs. Altogether, loss of Ercc6l2 leads to reduced HSPC numbers, bone marrow hypocellularity, and cytopenias. Notably, somatic Trp53 mutations restore cellular fitness of Ercc6l2-deficient HSPCs by abrogating p53 pathway activation and restoring Runx1 and Gata1 expression, thereby correcting the BMF phenotype. However, p53 loss fails to normalize replication stress, allowing for the accumulation of DNA damage over time, which increases the likelihood for leukemic transformation. Our data uncover the pathogenesis of ERCC6L2 disease and provide a prototypic example of clonal compensation in BMF syndromes, in which somatic mutations in leukemia-associated genes, in this case TP53, transiently improve blood cell production at, however, the expense of increasing leukemogenic potential.
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Funding information in the publication:
This work was supported by research grants from the KRAK Physician Scientist Fellowship and the Jacques and Gloria Gossweiler Foundation (R.R.S.); the Sigrid Juselius Foundation, Research Council of Finland, and Finnish Medical Foundation (M.M.); the Swiss National Science Foundation (320030_219676/1; M.G.M.); and the Swiss National Science Foundation (310030_197562/1) and the Helmut Horten Foundation (S.B.).