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JAK2V617F promotes replication fork stalling with disease-restricted impairment of the intra-S checkpoint response

Significance Cancers arise through a succession of enabling genetic lesions, but the consequences of many driver mutations remain unclear, especially in the earliest stages of tumor formation. The myeloproliferative neoplasms (MPNs) encompass a group of chronic hematologic disorders that can collectively provide a window into these early stages of leukemia evolution. This study reveals a role for the JAK2V617F mutation, the most frequent genetic abnormality in MPN patients, in impairing replication fork progression during cell division of MPN patient-derived tumor cells. Moreover, analysis of different MPN disease subtypes reveals unexpected differences in DNA repair activity in response to JAK2V617F-induced perturbations in replication dynamics. These findings have potential implications for tumor clonal evolution and individualized cancer therapy. Cancers result from the accumulation of genetic lesions, but the cellular consequences of driver mutations remain unclear, especially during the earliest stages of malignancy. The V617F mutation in the JAK2 non-receptor tyrosine kinase (JAK2V617F) is present as an early somatic event in most patients with myeloproliferative neoplasms (MPNs), and the study of these chronic myeloid malignancies provides an experimentally tractable approach to understanding early tumorigenesis. Introduction of exogenous JAK2V617F impairs replication fork progression and is associated with activation of the intra-S checkpoint, with both effects mediated by phosphatidylinositide 3-kinase (PI3K) signaling. Analysis of clonally derived JAK2V617F-positive erythroblasts from MPN patients also demonstrated impaired replication fork progression accompanied by increased levels of replication protein A (RPA)-containing foci. However, the associated intra-S checkpoint response was impaired in erythroblasts from polycythemia vera (PV) patients, but not in those from essential thrombocythemia (ET) patients. Moreover, inhibition of p53 in PV erythroblasts resulted in more gamma-H2Ax (γ-H2Ax)–marked double-stranded breaks compared with in like-treated ET erythroblasts, suggesting the defective intra-S checkpoint function seen in PV increases DNA damage in the context of attenuated p53 signaling. These results demonstrate oncogene-induced impairment of replication fork progression in primary cells from MPN patients, reveal unexpected disease-restricted differences in activation of the intra-S checkpoint, and have potential implications for the clonal evolution of malignancies.