5-Azacytidine modulates CpG methylation levels of EZH2 and NOTCH1 in myelodysplastic syndromes

  • Anja L. Gawlitza
  • Johanna Speith
  • Jenny Rinke
  • Roman Sajzew
  • Elena K. Müller
  • Vivien Schäfer
  • Andreas Hochhaus
  • Thomas ErnstEmail author
Original Article – Clinical Oncology



Molecular mechanisms of response to hypomethylating agents in patients with myelodysplastic syndromes (MDS) and chronic myelomonocytic leukemia (CMML) still remain largely unknown. Therefore, the effects of 5-Azacytidine (Aza) on clonal architecture and DNA methylation were investigated in this study.


Using next-generation sequencing (NGS), 30 myeloid leukemia-associated genes were analyzed in 15 MDS/CMML patients with excellent response to Aza. Effects on methylation levels were analyzed by quantitative methylation analysis using pyrosequencing for the global methylation marker LINE-1 in patients and myeloid cell lines. Various myeloid cell lines and a healthy cohort were screened for methylation levels in 23 genes. Selected targets were verified on the MDS/CMML cohort.


The study presented here showed a stable variant allele frequency and stable global methylation levels in responding patients. A significant demethylation of EZH2 and NOTCH1 was revealed in patients with Aza response.


A response to Aza is not associated with eradication of malignant clones, but rather with a stabilization of the clonal architecture. We suggest changes in CpG methylation levels of EZH2 and NOTCH1 as potential targets of epigenetic response to Aza treatment which may also serve as useful biomarkers after clinical evaluation.


5-Azacytidine Azacitidine Myelodysplastic syndromes CpG methylation EZH2 NOTCH1 



This study was funded by the Interdisciplinary Center for Clinical Research (IZKF), Universitätsklinikum Jena, Germany.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

432_2019_3016_MOESM1_ESM.docx (291 kb)
Supplementary material 1 (DOCX 290 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Abteilung Hämatologie und Internistische Onkologie, Klinik für Innere Medizin IIUniversitätsklinikum JenaJenaGermany
  2. 2.Otto Schott Institute of Materials ResearchFriedrich Schiller UniversityJenaGermany

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