Physiological cerebrospinal fluid like medium reveals autophagy dependency of leukaemia in the central nervous system

Abstract Nutrient availability is a critical environmental factor that influences the metabolism and adaptability of cancer cells, including acute lymphoblastic leukaemia (ALL) cells, prone to relapse in the central nervous system (CNS). Currently available cell culture media contain supraphysiological nutrient levels and do not represent the restricted metabolic environment of CNS-ALL which resides in the leptomeninges surrounded by cerebrospinal fluid (CSF). Therefore, we formulated a novel physiological CSF-like cell culture medium (CSFmax) that recapitulates the unique metabolite composition of the CSF. Through in vitro and in vivo metabolic and functional studies, we demonstrate that ALL cells cultured in CSFmax rewire their metabolism, closely mimicking the metabolic phenotype of CNS-ALL, including their metabolic activity and redox state. Utilising CSFmax, in comparison to conventional nutrient-rich culture media, we identified an essential role for autophagy in ALL adaptation to the CNS niche. This was evident by increased autophagic activity and selective sensitisation of ALL cells to pharmacological inhibition of autophagy and genetic knockout of Unc-51 Like Autophagy Activating Kinase 1 (ULK1) or autophagy related 7 (ATG7). Importantly, using a robust preclinical in vivo model, mice xenografted with ULK1 and ATG7 deficient ALL cells exhibited reduced CNS disease burden when compared to mice xenografted with control cells. Overall, our findings provide strong evidence that physiological CSFmax is superior to current in vitro culture systems in recapitulating the metabolic signature of CNS resident ALL cells. By exploiting this system, we revealed for the first time autophagy as a targetable therapeutic vulnerability in CNS-ALL. Key Points Culturing ALL cells in bespoke CSF-like medium (CSFmax) recapitulates the metabolic adaptation of ALL cells in the CNS niche Autophagy is critical for metabolic adaptation and survival of CNS resident ALL cells