The AML Therapeutic Landscape
Relapse remains one of the greatest challenges in treating Acute Myeloid Leukemia (AML). While targeted therapies have improved outcomes for some patients, high relapse rates and limited durable treatment options mean that many patients still face poor prognoses.
One pathway gaining attention is the Integrated Stress Response (ISR), a highly conserved protective signaling network that helps cells adapt to nutrient deprivation, oxidative stress, and other metabolic stressors. Many tumor types, including AML, depend heavily on this stress-response system to survive and proliferate.
Within this pathway, the kinase GCN2 (General Control Nonderepressible 2) serves as a key sensor of amino acid deprivation and metabolic stress, helping cancer cells survive under unfavorable conditions where lack of exogenous nutrients may disturb intracellular homeostatic balance. Disrupting this survival mechanism has emerged as a promising strategy to selectively target cancer cells and improve treatment outcomes. A recent study explored a novel and selective inhibitor of the stress-response kinase GCN2, APL-4098, as a potential therapeutic approach for AML1.
Ex Vivo Evaluation of APL-4098 in Patient-Derived AML Cells
Román-Trufero et al. first characterized the anti-leukemic activity of APL-4098 in ex vivo primary patient AML samples using Champions Oncology’s AML VitroScreen platform. A cohort of 30 patient-derived samples was treated with increasing concentrations of the compound and cell viability was measured using a luminescence-based viability readout to determine how effectively the drug inhibited leukemia cell growth. From these results, dose–response curves and IC50 values were generated to quantify drug potency across the cohort.
The results revealed strong inhibitory activity across the patient cohort with 70% of samples (21/30) showing a ≥50% reduction in cell viability, indicating high sensitivity to the GCN2 inhibitor. An additional 20% of samples demonstrated some sensitivity, with a 25–50% reduction in viability. Finally, 10% of the samples showed less than 25% decrease in viability and were categorized as insensitive (Figure 1).

Figure 1. APL-4098 cytotoxic activity ex vivo. (A) Effect of 500 nM APL-4098 on the viability of patient-derived AML samples after 72h treatment. Values for each specimen are expressed relative to each sample’s matched vehicle-treated control (normalized to 100%) and presented as mean ± SEM, n=3. (B) Selected APL-4098 dose-response curves of highly sensitive (green), sensitive (orange), and insensitive (red) patient-derived samples.
Notably, responses were observed across diverse genomic backgrounds, with no clear correlation between common AML mutations and sensitivity. Cells from pre-treated or relapsed patients also responded, suggesting that GCN2 inhibition may be effective even in difficult-to-treat AML.
This ex vivo screening step provided critical insight into which patient samples were most sensitive, laying the groundwork for subsequent in vivo evaluation in patient-derived xenograft (PDX) models.
In Vivo Evaluation of APL-4098 in AML Patient-Derived Xenografts
Following ex vivo screening, the anti-leukemic activity of APL-4098 was further assessed in Champions’ patient-derived xenograft (PDX) AML models. Human AML cells from a patient sample that showed ex vivo sensitivity to APL-4098 were implanted into immunodeficient NOG mice via tail vein injection, allowing leukemia to engraft in the bone marrow. Engraftment of human AML cells in the bone marrow was monitored in surrogate animals using flow cytometry, and once engraftment reached ~20% human CD45+ cells, mice were randomized into four treatment groups:
- Vehicle control (DMSO)
- APL-4098 alone (15 mg/kg once daily)
- Venetoclax alone (100 mg/kg once daily), as a standard-of-care comparator
- APL-4098 + venetoclax combination
Treatments were administered daily for 19 days, and leukemia burden was evaluated by analyzing multiple AML subpopulations, including blasts, progenitors, and leukemia stem cells (LSCs), using multicolor flow cytometry (Figure 2). This allowed researchers to evaluate both single-agent activity and potential synergy with venetoclax in a clinically relevant AML model.

Figure 2. Effect of APL-4098, Venetoclax and the combination of both in vivo in an AML PDX model. Bone marrow from AML-engrafted animals was assessed for (A) the percentage of viable human CD45+. (B) the number of viable blasts (CD34+/CD33+/-). (C) the number of viable AML progenitors (CD34+/CD38+) (D) the number of viable LCSs (CD34+/CD38-). In all graphs, data shown as mean ± SEM, statistical significance determined by one-way ANOVA. *p<0.05, **p<0.01, ***p<0.001, ****p<0.0001. DMSO, n=6; APL-4098, n=7; Venetoclax, n=8, APL-4098 + Venetoclax, n=7.
The results showed APL-4098 as a monotherapy had little to no effect on bulk leukemic burden, but preferentially targeted and reduced the LSC-enriched compartment, a niche generally considered primarily responsible for relapse initiation after bulk eradication of leukemic blasts2 Importantly, the combination of APL-4098 and Venetoclax, the standard of care BCL-2 inhibitor in AML patients, produced a pronounced synergistic response, achieving a 97% to 99% reduction across all leukemia subpopulations analysed. Mechanistic studies, including RNA sequencing and metabolic analyses, suggested that APL-4098 exerts its anti-leukemic activity by suppressing mitochondrial respiration, triggering the mitochondrial unfolded protein response, and inducing metabolic stress in AML cells.
Together, the researchers demonstrated APL-4098 effectively induces cytotoxicity both ex vivo and in vivo, with preferential effect against the LSC subpopulation, a key driver of patient relapse. While APL-4098 shows potential as a monotherapy agent in the preclinical setting, the potent synergistic interaction between APL-4098 and Venetoclax highlights a potential combination therapy for AML that merits further non-clinical and clinical exploration.
This study demonstrates the utility of Champions Oncology’s patient-derived platforms for preclinical and translational AML research, providing a framework to evaluate drug efficacy and explore new therapeutic strategies.
References
- Román-Trufero M, Whitlock G, Seydoux C, et al. A novel potent and selective GCN2 inhibitor, APL-4098, has anti-leukemic activity through dysregulation of mitochondrial function. Clin Cancer Res. 2026.
- Hansen Q, Bachas C, Smit L, Cloos J. Characteristics of leukemic stem cells in acute leukemia and potential targeted therapies for their specific eradication. Cancer Drug Resist. 2022.