Glycolytic-inflammatory crosstalk mediated by Glyco-PMF-Rux hub genes drives PMF progression and ruxolitinib resistance.

Abstract

Background: Primary myelofibrosis (PMF) is an aggressive myeloproliferative neoplasm characterized by bone marrow fibrosis, chronic inflammation, and high leukemic risk. Although ruxolitinib (Rux) is a first-line therapy, nearly half of patients develop resistance within three years. Glycolytic reprogramming contributes to inflammatory signaling and drug resistance, while the link between metabolic reprogramming and Rux resistance remains unclear.

Objective: This study aims to identify key genes involved in glycolytic-inflammatory crosstalk driving PMF progression and Rux resistance, with the goal of evaluating their potential as diagnostic and therapeutic targets.

Methods: We integrated multiple GEO datasets to identify differentially expressed genes (DEGs) related to PMF, Rux resistance, and glycolysis. A total of 75 overlapping DEGs were identified. Protein-protein interaction analysis and centrality measures revealed four key hub genes: STAT1, EGR1, FOXO1 and SMAD7. Their diagnostic and functional relevance was assessed using GO/KEGG enrichment, ROC analysis, single-cell RNA-seq and immune infiltration analysis.

Results: All four hub genes were significantly dysregulated and showed potential diagnostic value. Functional enrichment highlighted pathways of inflammation, apoptosis, and metabolic reprogramming. Single-cell analysis revealed their enrichment in hematopoietic stem/progenitor cells and correlation with resistance markers. STAT1/EGR1 were associated with pro-inflammatory immune cells, while FOXO1/SMAD7 were linked to immune evasion. Notably, STAT1 and EGR1 were significantly upregulated in ruxolitinib-resistant HEL cells. Functional assays demonstrated that STAT1 knockdown suppressed the proliferation of resistant cells, while EGR1 was further validated by its significant upregulation in PMF mouse models.

Conclusions: STAT1, EGR1, FOXO1, and SMAD7 are associated with glycolytic-inflammatory crosstalk underlying PMF progression and ruxolitinib resistance, with experimental validation supporting STAT1 and EGR1 as potential diagnostic and therapeutic targets.