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How PML-RARa fusion proteins allow promyelocytes continued proliferation? 


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PML-RARa fusion proteins allow promyelocytes continued proliferation by stimulating transcription driven by HIF factors, which are critical regulators of adaptive responses to hypoxia and stem cell maintenance . Additionally, PML-RARa exploits a number of HIF-1a-regulated pro-leukemogenic functions, including cell migration, bone marrow neo-angiogenesis, and self-renewal of APL blasts . HIF-1a levels increase upon treatment of APL cells with all-trans retinoic acid (ATRA) . Inhibiting HIF-1a in APL mouse models delays leukemia progression and synergizes with ATRA to eliminate leukemia-initiating cells (LICs) . The PML-RARa fusion gene is the central leukemia-inducing lesion in APL and is directly targeted by ATRA and arsenic, both of which induce complete remissions . The blockage of ATRA signaling by PML-RARa is important for the pathogenesis of APL, considering the relevance of the ATRA signaling pathway for global hematopoiesis .

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PML-RARa fusion proteins stimulate transcription driven by HIF factors, which promote cell migration, angiogenesis, and self-renewal of APL blasts, allowing continued proliferation.
The paper does not provide information on how PML-RARa fusion proteins allow promyelocytes continued proliferation.

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