# Differential Gene Regulatory Network Analysis between Azacitidine-Sensitive and -Resistant Cell Lines

## TL;DR

This paper identifies gene networks linked to azacitidine resistance in leukemia, offering insights for precision medicine.

## Contribution

A new computational strategy for analyzing gene networks specific to drug resistance in cancer cell lines.

## Key findings

- Differentially regulated gene networks were identified between azacitidine-sensitive and -resistant cell lines.
- Metallothionein gene family and related pathways are linked to azacitidine resistance in AML.
- The method can uncover patient-specific molecular interplay for precision medicine in complex diseases.

## Abstract

Azacitidine, a DNA methylation inhibitor, is employed for the treatment of acute myeloid leukemia (AML). However, drug resistance remains a major challenge for effective azacitidine chemotherapy, though several studies have attempted to uncover the mechanisms of azacitidine resistance. With the aim to identify the mechanisms underlying acquired azacitidine resistance in cancer cell lines, we developed a computational strategy that can identify differentially regulated gene networks between drug-sensitive and -resistant cell lines by extending the existing method, differentially coexpressed gene sets (DiffCoEx). The technique specifically focuses on cell line-specific gene network analysis. We applied our method to gene networks specific to azacitidine sensitivity and identified differentially regulated gene networks between azacitidine-sensitive and -resistant cell lines. The molecular interplay between the metallothionein gene family, C19orf33, ELF3, GRB7, IL18, NRN1, and RBM47 were identified as differentially regulated gene network in drug resistant cell lines. The biological mechanisms associated with azacitidine and AML for the markers in the identified networks were verified through the literature. Our results suggest that controlling the identified genes (e.g., the metallothionein gene family) and “cellular response”-related pathways (“cellular response to zinc ion”, “cellular response to copper ion”, and “cellular response to cadmium ion”, where the enriched functional-related genes are MT2A, MT1F, MT1G, and MT1E) may provide crucial clues to address azacitidine resistance in patients with AML. We expect that our strategy will be a useful tool to uncover patient-specific molecular interplay that provides crucial clues for precision medicine in not only gastric cancer but also complex diseases.