Leukemic stem cells (LSCs) display several mechanisms that function to
maintain low levels of reactive oxygen species (ROS). LSCs reside in the hypoxic
bone marrow niche, limiting oxidative stress. Hypoxia-inducible factors (HIFs),
essential to the cellular response to hypoxia, are activated even in normoxia in
LSCs and niche factors such as thrombopoietin (TPO) and stem cell factor (SCF)
promote HIF stabilization. FOXO transcription factors also maintain low ROS
levels by regulating mitochondrial expression of superoxide dismutase (SOD2) and
glutamine synthetase. Glutamine, along with cysteine, is critical to the
production of glutathione, which scavenges free radicals and other ROS. FOXO TFs
are also required for autophagy and mitophagy, which mitigates oxidative stress
through removal of toxic proteins and damaged mitochondria. AMP kinase (AMPK),
which upregulates mitochondrial fission regulator FIS1 and therefore mitophagy,
is intrinsically activated in LSCs. The PML-PPARδ-FAO pathway,
upregulated in LSCs, also promotes mitophagy.