A Generalized Strategy to Kill Leukemic Cells by Targeting the Regulatory Systems Governing Mitochondrial Membrane Potential

Targeting mitochondria emerges as a promising anti-leukemia strategy, yet selective mitochondrial disruption remains challenging. Here, we identified elevated mitochondrial membrane potential (MMP) as a hallmark of leukemic transformation and chemotherapy-resistant cells, prompting screening for MMP-targeting agents. Alexidine, an MMP-depleting compound, demonstrated potent anti-leukemic activity with low toxicity. Mechanistically, Alexidine binds unsaturated cardiolipin to destabilize the inner membrane localization of mitochondrial ribosome, suppressing cardiolipin-dependent mitochondrial translation, a process validated as an independent prognostic marker in leukemia. Unlike chemotherapy, Alexidine eradicates baseline MMP and MMP heterogeneity within leukemic populations, a functional signature linked to stemness and chemoresistance. Intriguingly, this heterogeneity originates not from cardiolipin-mediated translation but from asparagine-driven mitochondrial protein synthesis, which leukemia cells selectively activate to bypass chemotherapy. Critically, pharmacological asparagine depletion synergistically enhances chemosensitivity by disrupting this resistance pathway. Our findings establish that MMP regulation through cardiolipin-maintained homeostasis and asparagine-fueled adaptation represents therapeutic vulnerabilities, advocating co-targeting strategies to overcome resistance.