Targeting RUNX1 Germline Variants: Agents Under Investigation

Despite increased recognition of FPDMM and advancements in genetic technologies that have improved carrier identification and our understanding of RUNX1 function, the mechanisms driving hematologic malignancy (HM) development in this disorder remain incompletely understood. Currently, there are no FPDMM-specific therapeutic strategies, and clinical management is largely confined to surveillance and supportive measures. This review aims to summarise emerging therapeutic strategies across all stages of disease progression, from early preventive interventions to treatments post-malignant transformation.

Recent studies have explored multiple experimental strategies addressing distinct aspects of RUNX1-FPDMM pathobiology. These include CRISPR/Cas9-mediated correction of pathogenic germline RUNX1 variants, approaches that stabilize or enhance RUNX1 protein function by preventing its degradation or inhibition, and modulation of deregulated signaling pathways downstream of RUNX1 dysfunction. In addition, emerging therapies aim to target high-risk somatic variants that arise during disease progression. Interventions directed at hyperactivated inflammatory pathways, including JAK1/2 and mTOR, have also shown potential in mitigating the proinflammatory environment that contributes to hematologic malignancy development in FPDMM.

Therapeutic approaches for FPDMM are multi-modal with approaches including; correcting pathogenic RUNX1 gene variants, enhancing RUNX1 protein stability and protection, and modulating signaling pathways disrupted by its dysfunction to normalise the underlying hematological disturbances. Although several agents are in clinical studies, all approaches are at an early stage and there remains much work to be done to translate treatments for clinical benefit.