Rara, short for retinoic acid receptor alpha, is a key gene involved in the retinoic acid signaling pathway. The protein it encodes binds to retinoic acid response elements (RARE) as a heterodimer with retinoid X receptor protein (RXRA), regulating the transcription of genes associated with cell differentiation, development, and homeostasis [3].

In acute promyelocytic leukemia (APL), the t(15;17)(q24;q21) translocation generates the PML-RARA fusion gene, which is the hallmark of APL [1,2,3,5]. This fusion protein deregulates transcriptional control, disrupting myeloid differentiation and self-renewal, and also disrupts PML nuclear bodies [2]. Different RARA fusion genes, such as STRN3-RARA, PLZF-RARa, and ZBTB16-RARA, have been identified, and patients with these fusions may have different responses to treatment and prognoses [4,6,7]. For example, ZBTB16-RARA-positive AML patients have a poor response to all-trans retinoic acid (ATRA) and arsenic trioxide and a high incidence of ARID1A mutations [7].

In conclusion, Rara plays a crucial role in normal cell differentiation and development through the retinoic acid signaling pathway. In the context of APL, its fusion with other genes significantly impacts disease development, treatment response, and prognosis. Understanding Rara's normal and aberrant functions, as revealed by studies on APL-associated fusion genes, provides insights into leukemogenesis and potential therapeutic strategies for APL and related diseases.