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




AuthorsSchimmer, 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 year2026

Journal: Blood

Volume147

Issue15

First page 1663

Last page1679

ISSN0006-4971

eISSN1528-0020

DOIhttps://doi.org/10.1182/blood.2025030230

Publication's open availability at the time of reportingOpen 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 addresshttps://research.utu.fi/converis/portal/detail/Publication/522975808

Self-archived copy's licenceCC BY NC ND

Self-archived copy's versionPublisher`s PDF


Abstract

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.).


Last updated on 30/04/2026 02:23:07 PM