AML Metabolism: A Dynamic Continuum of Functional Dependencies
- 1Interdisciplinary Department of Wellbeing, Health and Environmental Sustainability (BeSSA), Sapienza University of Rome, Complesso Santa Lucia—Via Delle Fontanelle snc, 02100 Rieti, Italy
- 2LIFE Institute for Research and Health Care—Santa Lucia IRCCS, Via del Fosso di Fiorano 64, 00143 Rome, Italy
- 3Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
Abstract
Metabolic reprogramming is increasingly recognized as a fundamental component of acute myeloid leukemia (AML) biology, but AML cannot be defined by a single metabolic phenotype. Leukemic cells occupy dynamic metabolic states shaped by differentiation, genetic background, the bone marrow microenvironment, and therapeutic pressure. In this Review, we propose that metabolic biomarkers should capture functional dependencies and metabolic plasticity rather than static metabolic states, with functional dependencies defined as the reliance of AML cells on a specific metabolic pathway or process for their survival, proliferation or maintenance, rather than a simple glycolytic-versus-oxidative dichotomy. Normal hematopoietic stem cells (HSCs), leukemic stem cells (LSCs), and bulk AML blasts display distinct metabolic programs. Quiescent HSCs maintain a low-energy state, whereas LSCs rely strongly on mitochondrial oxidative phosphorylation (OXPHOS), amino acid metabolism, mitochondrial quality control, and antioxidant defenses. AML blasts exhibit greater metabolic heterogeneity and can switch between glycolytic and oxidative pathways. Importantly, increased mitochondrial activity does not necessarily indicate an LSC phenotype, as therapy-resistant AML cells may acquire enhanced OXPHOS, fatty acid oxidation (FAO), and mitochondrial fitness as adaptive states. Acute promyelocytic leukemia (APL) provides a model of lineage-specific metabolic rewiring, with PML::RARA suppressing glycolysis while promoting FAO, TCA cycle activity, OXPHOS, and arginine-associated anaplerosis. We propose that metabolic biomarkers should identify functional dependencies and escape routes. Integrating metabolic profiling with multi-omics approaches may enable identification of AML subgroups with distinct vulnerabilities and guide rational combination therapies.
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BibTeX
@article{zardo2026metabolism,
title = {{AML Metabolism: A Dynamic Continuum of Functional Dependencies}},
author = {Giuseppe Zardo and Gloria Pasqualini and Gianfranco Catalano and Alessandra Zaza and Nelida Ines Noguera},
journal = {Cells},
year = {2026},
month = oct,
doi = {10.3390/cells15211955},
url = {https://www.mdpi.com/2073-4409/15/21/1955},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - AML Metabolism: A Dynamic Continuum of Functional Dependencies
AU - Giuseppe Zardo
AU - Gloria Pasqualini
AU - Gianfranco Catalano
AU - Alessandra Zaza
AU - Nelida Ines Noguera
PY - 2026
DA - 2026/10/27
JO - Cells
DO - 10.3390/cells15211955
UR - https://www.mdpi.com/2073-4409/15/21/1955
AB - Metabolic reprogramming is increasingly recognized as a fundamental component of acute myeloid leukemia (AML) biology, but AML cannot be defined by a single metabolic phenotype. Leukemic cells occupy dynamic metabolic states shaped by differentiation, genetic background, the bone marrow microenvironment, and therapeutic pressure. In this Review, we propose that metabolic biomarkers should capture functional dependencies and metabolic plasticity rather than static metabolic states, with functional dependencies defined as the reliance of AML cells on a specific metabolic pathway or process for their survival, proliferation or maintenance, rather than a simple glycolytic-versus-oxidative dichotomy. Normal hematopoietic stem cells (HSCs), leukemic stem cells (LSCs), and bulk AML blasts display distinct metabolic programs. Quiescent HSCs maintain a low-energy state, whereas LSCs rely strongly on mitochondrial oxidative phosphorylation (OXPHOS), amino acid metabolism, mitochondrial quality control, and antioxidant defenses. AML blasts exhibit greater metabolic heterogeneity and can switch between glycolytic and oxidative pathways. Importantly, increased mitochondrial activity does not necessarily indicate an LSC phenotype, as therapy-resistant AML cells may acquire enhanced OXPHOS, fatty acid oxidation (FAO), and mitochondrial fitness as adaptive states. Acute promyelocytic leukemia (APL) provides a model of lineage-specific metabolic rewiring, with PML::RARA suppressing glycolysis while promoting FAO, TCA cycle activity, OXPHOS, and arginine-associated anaplerosis. We propose that metabolic biomarkers should identify functional dependencies and escape routes. Integrating metabolic profiling with multi-omics approaches may enable identification of AML subgroups with distinct vulnerabilities and guide rational combination therapies.
SN - 2073-4409
ER -