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At diagnosis and during treatment, dyslipidemia and the bone marrow adipose microenvironment are commonly observed in pediatric leukemia. However, the intricate connection between these factors and disease progression remains largely unexplored. We found that abnormal triglyceride accumulation increased the risk of death. Further investigation into the adipogenic potential of BM\u2010MSCs revealed a correlation between higher adipogenicity and elevated serum TG levels, which subsequently led to the rapid proliferation of leukemia cells and heightened the risk of post\u2010relapse mortality. Through RNA sequencing, Gremlin1 (GREM1) was identified as an important factor affecting adipogenicity. Silencing of <jats:italic>GREM1<\/jats:italic> in BM\u2010MSCs induced adipogenic differentiation, partly through the BMP\/SMAD signaling pathway. In an in vitro co\u2010culture model, shGREM1\u2010MSCs promoted B\u2010ALL cell proliferation and induced drug resistance to dexamethasone, while increasing sensitivity to L\u2010asparaginase. Furthermore, GREM1\u2010deficient BM\u2010MSCs promoted B\u2010ALL disease progression in xenograft models. This study provides new insights into overcoming drug resistance, relapse, and death by elucidating the novel mechanism by which GREM1 deficiency induces adipogenic differentiation of BM\u2010MSCs and promotes B\u2010ALL disease progression.<\/jats:p>","DOI":"10.1002\/ijc.35418","type":"journal-article","created":{"date-parts":[[2025,4,26]],"date-time":"2025-04-26T05:43:24Z","timestamp":1745646204000},"page":"559-572","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["<scp>GREM1<\/scp> deficiency induced bone marrow adipose niche promotes B\u2010cell acute lymphoblastic leukemia disease progression"],"prefix":"10.1002","volume":"157","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3290-3330","authenticated-orcid":false,"given":"Lili","family":"Song","sequence":"first","affiliation":[{"name":"Department of Clinical Nutrition, Shanghai Children's Medical Center Shanghai Jiao Tong University School of Medicine  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