L'utilisation des ressources en fer et les variations du potentiel redox sont des processus impliqués dans la prolifération et la différenciation cellulaire. Ils participent à l'hématopoïèse normale et leur dérégulation peut être associée à des conditions pathologiques. Les hémopathies, telles que la leucémie aiguë myéloïde (LAM), témoignent du lien entre disponibilité en fer, signalisation redox et leucémogenèse. La déplétion en fer induit un arrêt de la prolifération suivi de la mort cellulaire, et pour des cellules primaires leucémiques (blastes) de patients LAM, elle peut conduire à un réengagement de la différenciation vers la lignée monocytaire. Cependant, les besoins en fer des clones leucémiques restent mal définis. Dans les cellules animales, le cœur du réseau de régulation du fer est organisé à travers le système régulateur IRE-IRP. Les Iron Regulatory Proteins (IRP), agissent sur la traduction de nombreuses protéines impliquées dans la gestion du fer par interaction avec les Iron Responsive Elements (IRE) localisés sur les régions non codantes des ARN messager (ARNm) régulés. A partir de lignées cellulaires leucémiques (KG1, K562), de blastes de patients LAM et de progéniteurs CD34+ contrôles issus de sang de cordon et de moelle osseuse de donneurs sains, le statut du système de gestion cellulaire du fer a été caractérisé pour les premières étapes de l'hématopoïèse normale et pathologique. A travers la manipulation des apports cellulaires en fer, notamment par l'utilisation de chélateurs à usage thérapeutique, la réponse du système homéostatique a été suivie. Nos données soulignent les faibles besoins en fer des progéniteurs hématopoïétiques, et d'autres cellules, pour proliférer. Dans les lignées cellulaires le régulateur IRP est en excès par rapport à ses cibles IRE, ce qui pourrait être une caractéristique générale du contrôle de la traduction pour des ARNm spécifiques par fixation de régulateurs translationnels. La régulation semble exclusivement le fait d' IRP1, puisqu' IRP2 n'a pas été détecté dans les progéniteurs hématopoïétiques, qu'ils soit pathologiques ou non. De subtiles différences ont été identifiées dans les quantités des composants du réseau gérant le fer dans les cellules leucémiques en comparaison des cellules saines témoins, ainsi que des capacités différentes à croître dans un milieu minimal comportant des concentrations en fer précisément définies. Les informations obtenues à travers ce travail pourraient bénéficier à l'élaboration de protocoles thérapeutiques, incluant notamment la manipulation du fer, dans les LAM ou d'autres pathologies. / Use of iron resources and variations of the redox balance are processes involved in cell proliferation and differentiation. They participate to normal hematopoiesis and their disturbance may be associated with pathological conditions. Hematological neoplasms, such as acute myeloid leukemia (AML), provide clinical evidence of the link between iron availability, redox signaling, and malignancy. Stringent iron depletion induces arrest of proliferation followed by cell death, and deprived primary leukemic cells of AML patients (blasts) have been previously shown to engage into the monocytic lineage. Yet, the iron needs of leukemic clones are unknown. The core network of cellular iron regulation in mammals is organized around the IRE-IRP system. The Iron Regulatory Proteins (IRP) act on the translation of many proteins involved in iron management by interacting with Iron Responsive Elements (IRE) located on the untranslated regions of messenger RNA (mRNA) coding these proteins. Using leukemic cell lines (KG1, K562), blasts of AML patients and CD34+ progenitors isolated from cord blood or the bone marrow of healthy donors, the status of the iron management system was established in the first stages of normal and pathological hematopoiesis. The response of the homeostatic system upon manipulation of iron provision, including with clinically implemented chelators, has been monitored. Our data emphasize the weak iron requirements of hematopoietic progenitors, and other cells, to proliferate. In cell lines the IRP regulator is in excess of its IRE targets, which may be a general feature of translational control for specific mRNA. The regulation seems exclusively mediated by IRP1, as the IRP2 regulator has not been detected in normal or malignant hematopoietic progenitors. Subtle differences have been found in the iron handling system of leukemic cells as compared to normal cells, together with different abilities to grow on a minimal medium containing precisely defined iron concentrations. The design of improved therapeutic regimens including iron manipulation, in AML and other pathologies, may benefit from considering the information obtained in this work.

Les protéines de choc thermiques (HSP) sont des chaperons moléculaires qui stabilisent le pliage et la conformation de protéines normales et oncogéniques, prévenant la formation d'agrégats protéiques. Elles sont impliquées dans la régulation de l'apoptose, de la survie cellulaire et dans la cancérogénèse. HSP90 est la protéine chaperone majeure de stabilisation d'oncogènes impliqués dans les hémopathies malignes. L'objectif de notre travail était de déterminer l'implication de HSP90 dans différents types d'hémopathies malignes, les Leucémies Aiguës Myéloïdes (LAM), les Syndromes Myélodysplasiques (SMD) et les Leucémies Aiguës Lymphoblastiques (LAL), et de tester son inhibition par un inhibiteur spécifique, la tanespimycine (17- AAG). Dans les LAM, nous avons évalué l'implication des différentes isoformes de la protéine dans la résistance aux chimiothérapies et aux inhibiteurs de HSP90. Ce travail met en évidence la valeur péjorative de l'expression de HSP90 dans les différents sous types d'hémopathies, corrélant avec un risque de rechute élevé ou d'évolution vers des formes plus agressives. L'utilisation de la tanespimycine a permis de déclencher l'apoptose dans les cellules immatures impliquées dans ces pathologies. HSP90 constitue donc une protéine majeure de la cellule leucémique, et son ciblage offre des perspectives intéressantes dans le traitement des hémopathies malignes / Heat shock proteins (HSP) are molecular chaperones that stabilize the folding and conformation of normal and oncogenic proteins, preventing the formation of protein aggregates. They are involved in the regulation of apoptosis, cell survival and carcinogenesis. HSP90 is the major chaperone implicated in stabilization of oncogenes involved in hematologic malignancies. The aim of our study was to determine the involvement of HSP90 in various types of malignancies, Acute Myeloid Leukemia (AML), Myelodysplastic Syndromes (MDS) and Acute Lymphoblastic Leukemia (ALL) and to test its inhibition by a specific inhibitor, the tanespimycine (17-AAG). In acute myeloid leukemia, we evaluated the involvement of different isoforms of the protein in resistance to chemotherapy and inhibitors of HSP90. This work highlights the pejorative value of HSP90 expression in different subtypes of malignancies, correlated with a high risk of relapse or progression to more aggressive forms. Use of tanespimycine has triggered apoptosis in immature cells involved in these diseases. HSP90 is therefore a major protein of the leukemic cell and its targeting offers interesting perspectives in the treatment of hematologic malignancies

A leucemia mielóide aguda ainda apresenta altos índices de mortalidade em adultos, exceção feita à leucemia promielocítica. A otimização dos protocolos de tratamento tem sido muito discutida há 3 décadas, com resultados ainda insatisfatórios. Fatores prognósticos como idade, cariótipo e tolerância à consolidação com altas doses de citarabina guardam relação com a melhor sobrevida. Com o objetivo de avaliar diferentes protocolos de tratamento e validar estes e outros fatores prognósticos, conduzimos um estudo retrospectivo no Hospital das Clínicas da Universidade de São Paulo, analisando prontuários médicos e os eventos relacionados à leucemia mielóide aguda, de 1978 a 2007. Analisamos 400 pacientes tratados curativamente e achamos que idade abaixo de 60 anos (27% vs 7%), cariótipo favorável (53% vs 28% vs 5%) e administração de doses totais de citarabina, principalmente se acima da mediana de 45,45 gramas (68% vs 44% vs 21%) tem impacto positivo na sobrevida global em 5 anos, sendo o uso de altas doses de citarabina um fator independente. A positividade para mieloproxidase, classificação FAB e protocolo de tratamento não mostraram associação estatisticamente significante para melhores índices de sobrevida. Pudemos concluir que, se os protocolos de indução não apresentam diferenças estatísticas, a consolidação intensiva com altas doses de citarabina em pacientes abaixo de 60 anos tem impacto independente na sobrevida global, com resultados ainda melhores quando a dose total é maior ou igual a 45,45 gramas. O cariótipo também foi validado em nossa população / Acute myeloid leukemia in adults is still a highly fatal disease, except for acute promyelocitic leukemia. The optimization of treatment protocols has been debated for three decades, without satisfactory results. Prognostic factors like age, kariotype and consolidation with cytarabine in high dosis seem to correlact with a better overall survival. We conducted a retrospective study in the General Hospital of University of Sao Paulo analyzing medical records and acute myeloid leukemia outcomes to compare different treatment protocols used through 1978 to 2007. We also intended to validate international prognostic factors as the ones cited in our population. We analyzed 400 patients treated with curative intention and found better overall survival in 5 years regarding age less than 60 years (27% vs 7%), favorable karyotipe (53% vs 28% vs 5%) and high dosis cytarabine in consolidation, meanly if total dose was at least the median of 45,45 g (68% vs 44% vs 21%). Consolidation with high dosis cytarabine was an independent predictor of better overall survival. No estatistical differences were seen regarding myeloperoxidase positivity, induction protocol and FAB classification. We concluded that, if the induction protocols seem to be no different in results, consolidation with high dosis cytarabine for patients under 60 years has impact in overall survival, being even better when the total dosis is at least 45,45 g. Karyotipe has also been validated in our study population

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Despite technological advances, the prognosis and survival of acute myeloid leukemia (AML) adult patients remain low, compared with other hematologic malignancies. Some antigens detected by immunophenotyping may soon play a significant role in the pathophysiologic, prognostic, and overall survival (OS) rate of AML patients. Therefore, we conducted a systematic review and meta-analysis of PubMed, Scopus, Science Direct, Web of Science, and the Cochrane Library (using PRISMA guidelines). We analyzed 11 studies and 13 antigens, detected through the immunophenotyping of 639 patients. From them, 12 exhibited a negative impact with AML prognosis. The meta-analysis demonstrated a high expression of AML markers, which have been associated with a decrease in survival over 10 months (RR 2.55; IC 95%; 1.49-4.37) and over 20 months (RR 2.46; IC 95%; 1.75-3.45). Knowing that the expression of immunophenotypic markers, which are not used on a routine basis, might be able to influence disease behavior, looks promising. Since they have been associated with a poor prognosis as well as a decrease in survival. This may allow for different chemotherapeutical protocols, including future studies for new therapeutic targets. / Apesar dos avanços tecnológicos, o prognóstico e a sobrevida dos pacientes adultos com leucemia mieloide aguda (LMA) permanecem baixos quando comparados com outras neoplasias hematológicas. Alguns antígenos identificados pela técnica de imunofenotipagem por citometria de fluxo podem desempenhar um papel significativo na compreensão da fisiopatologia, no prognóstico e na sobrevida global dos pacientes com LMA. Sendo assim, foi realizada uma revisão sistemática e metanálise nas bases de dados PubMed, Scopus, Science Direct, Web of Science e Cochrane Library (utilizando as diretrizes do PRISMA). Em onze estudos realizados em um total de 639 pacientes, foram detectados treze antígenos, analisados pela metodologia de imunofenotipagem por citometria de fluxo. Destes marcadores, doze exibiram um impacto negativo no prognóstico da LMA. A metanálise demonstrou que a alta expressão dos marcadores de LMA tem sido associada a uma diminuição nas taxas de sobrevida em 10 meses (RR 2,55; IC 95%; 1,49-4,37) e 20 meses (RR 2,46; IC 95%; 1,75- 3.45). O conhecimento de que a expressão de novos marcadores imunofenotípicos pode ser capaz de influenciar o comportamento da doença, parece ser uma informação promissora, pois demonstra influência no prognóstico e diminuição da sobrevida dos pacientes com LMA. Isto pode servir de base para a investigação de diferentes protocolos quimioterápicos, incluindo o estudo prospectivo de novos alvos terapêuticos.

A natureza heterogênea da Leucemia Mielóide Aguda (LMA) tornou-se um desafio para o sucesso da quimioterapia convencional com o agente Citarabina (Ara-C), especialmente em leucemias com prognóstico desfavorável, como aquelas portadoras do rearranjo MLL. Visto que as células de LMA-MLL são consideradas sensíveis ao Ara-C quando comparadas às leucemias que não apresentam o rearranjo, mas a recaída à doença é frequente, a presente tese propôs estudar a relação entre características biológicas relacionadas às bases da resistêmcia ao Ara-C em LMA-MLL. A abordagem proposta foi a seleção de subpopulações de linhagens celulares portadoras do rearranjo MLL submetidas ao tratamento em longo prazo com Ara-C, comparando-as com as linhagens não expostas à droga. As células foram caracterizadas quanto: 1) ao potencial proliferativo na presença ou ausência de Ara-C; 2) a distribuição das células no ciclo celular; 3) a distribuição de marcadores clássicos de superfície de células-tronco hematopoiéticas, CD34 e CD38; e 4) o perfil de expressão global dos RNAs transcritos. O tratamento em longo prazo selecionou células mais resistentes ao Ara-C que as células parentais. Além disso, quanto ao ciclo celular, as células selecionadas com Ara-C apresentaram apoptose reduzida (fase sub-G1), acúmulo na fase de síntese (fase S) e aumento da capacidade proliferativa após reexposição à droga (fase G2-M). Quanto à análise de marcadores de células-tronco hematopoiéticas, observou-se que após o tratamento em longo com Ara-C, uma das linhagens celulares apresentou distribuição bimodal do marcador CD38. Quando separadas por sorting em citometria de fluxo, observou-se que as subpopulações com níveis distintos de expressão de CD38, denominadas MV-4-11 CD38High e MV-4-11 CD38Low apresentaram resposta distinta ao tratamento com Ara-C. Quando avaliadas quanto ao perfil global de expressão gênica, constatou-se que MV-4-11 CD38High eram mais semelhantes às células parentais, e que MV-4-11 CD38Low formavam um grupo isolado, distinto das outras duas populações celulares. A análise de ontologia gênica (GO) evidenciou que entre as categorias mais representativas de processos biológicos estavam atividades associadas à capacidade proliferativa, ao desenvolvimento e a resposta a estímulos. As análises de agrupamentos hierárquicos mostraram que: 1) o cluster de genes do desenvolvimento HOXA estava mais expresso nas células MV-4-11 CD38Low do que em MV-4-11 CD38High, que apresentaram expressão mais elevada do cluster HOXB; 2) o gene HOX mais diferencialmente expresso foi HOXA13, associado na literatura com prognóstico desfavorável em outros tipos de câncer; 3) dos genes associados a resposta a estímulos, o único relacionado à via de metabolização do Ara-C diferencialmente expresso entre as linhagens foi NME1; 4) aqueles que participam das vias de reparo de pareamento incorreto, reparo por excisão de bases e por excisão de nucleotídeos encontraram-se mais expressos nas células MV-4-11 CD38High que em MV-4-11 CD38Low. Além disso, diversas quinases dependentes de ciclinas (CDKs) também estiveram diferencialmente expressas entre MV-4-11 CD38High e MV-4-11 CD38Low. Sugere-se por fim, que o modelo in vitro proposto neste estudo para simular a situação de resistência ao Ara-C em subpopulações de LMA-MLL, demonstrou que os mecanismos de resposta à Citarabina nesta doença, vão além de alterações na detoxificação e metabolização da droga, e parecem mais associados a vantagens proliferativas e do desenvolvimento das células leucêmicas. Estas vias devem ser exploradas como alvos potenciais na terapia combinada ao Ara-C. / The heterogeneity of Acute Myeloid Leukemia (AML) became a challenge for the success of the conventional chemotherapy agent Cytarabine (Ara-C), especially in leukemias with poor prognosis, as those harboring MLL rearrangement. Since AML-MLL cells are considered sensitive to Ara-C when compared with leukemias that do not carry the rearrangement, but relapse is frequent, the present dissertation proposed to study the relationship between biological characteristics related to the basis of chemoresistance to Ara-C in AML-MLL. We proposed an approach based on the selection of subpopulations of cell lines bearing MLL rearrangement submitted to the long-term treatment with Ara-C, comparing them with the cell lines that were not previously exposed to the drug. The cells were characterized according to: 1) the proliferative potential in the presence and absence of Ara-C; 2) the distribution of the cells in the cell cycle; 3) distribution of hematopoietic stem cell classic surface markers, CD34 and CD38; and, 4) global expression profile of transcribed RNAs. The long-term treatment selected cells that are more resistant to Ara-C than the cells that were not previously treated (parental cells). Besides, according to cell cycle, the cells selected by Ara-C treatment present decreased apoptosis (sub-G1 phase), accumulation in the synthesis phase (S-phase) and increase in the proliferative capability after re-exposition to the drug (G2-M phase). Regarding the hematopoietic stem cell markers, we observed that after Ara-C long-term treatment, one of the cell lines exhibited a bimodal distribution of the CD38 marker. When sorted by flow cytometry, we observed that both subpopulations with distinct levels of CD38 expression, called MV-4-11 CD38High and MV-4-11 CD38Low also showed distinct response to Ara-C. When evaluated regarding to their global gene expression profiles, we verified that MV-4-11 CD38High were more closely related to the parental cells, and MV-4-11 CD38Low made up an isolated group, distinct of the other cell populations. Gene ontology (GO) analysis revealed that among the most representative categories of biological processes, activities associated with proliferative capability, development and response to stimuli were included. The hierarchical clustering analysis showed that: 1) the cluster HOXA of genes of development was more expressed in the MV-4-11 CD38Low than in the MV-4-11 CD38High cells, that presented increased expression of HOXB cluster; 2) the most differentially expressed HOX gene was HOXA13, which according to the literature is associated with poor prognosis in other types of cancer; 3) among the genes associated with response to stimuli, the only one related to Ara-C-metabolizing pathway that was differentially expressed between the cell lines was NME1; 4) those genes that take part in the mismatch repair, base excision repair and nucleotide excision repair pathways were more expressed in the MV-4-11 CD38High than in the MV-4-11 CD38Low cells. Additionally, several cyclin-dependent kinases (CDKs) were also differentially expressed between MV-4-11 CD38High and MV-4-11 CD38Low. Finally, we suggest that the in vitro model proposed in this study to mimic the situation of chemoresistance to Ara-C in subpopulations of AML-MLL, showed that the mechanisms of Ara-C response in this disease, go beyond changes in drug detoxification and metabolization, and seem more associated to proliferative and development advantages of the leukemic cells. These pathways should be explored as potential targets to Ara-C combination therapies.

Les kinases de la famille Pim sont impliquées dans de nombreux cancers hématologiques dont la leucémie aigüe myéloïde (LAM) et le myélome multiple. Contrairement à la plupart des autres protéines kinases dont l’activation nécessite la phosphorylation préalable du domaine catalytique, l’activité des Pim kinases est constitutive. Les mécanismes de régulation de l’expression de Pim2 ainsi que ses mécanismes d’action sont très peu connus. Une partie de mon projet a consisté en l’étude de l’expression et de la stabilité de Pim dans des cellules de LAM et de myélome. J’ai montré que l’expression de Pim2 est régulée au niveau transcriptionnel par STAT5. Les trois isoformes de Pim2 ont une demi-vie très courte. Leur rapide dégradation semble constitutive et indépendante des relais de signalisation intracellulaire. Elle implique la machinerie du protéasome mais ne semble pas nécessiter l’ubiquitination préalable de la protéine. Les formes de Pim2 qui s’accumulent dans les cellules sous l’action des inhibiteurs du protéasome sont constitutivement actives. Ces premières données m’ont conduit à envisager l’intérêt d’inhibiteurs de Pim dans le myélome multiple, où l’inhibition du protéasome comme traitement favorise l’accumulation de cette kinase oncogénique. La seconde partie de mon projet a consisté en l’identification de substrats et de partenaires potentiels de Pim2 dans les LAM. Pour cela, j’ai mis au point une méthode de marquage métabolique couplée à une analyse phosphoprotéomique quantitative globale, ainsi qu’une analyse de l’interactome de Pim2 après avoir produit un anticorps contre cette protéine. Les informations obtenues m’ont permis de montrer l’activation de la voie mTORC1 par Pim2 et d’identifier la Polo-Like Kinase (PLK1) comme un nouveau substrat et partenaire de Pim2. Mes résultats montrent une colocalisation de Pim2 et de PLK1 au cours des différentes phases de la mitose et en particulier au niveau du corps intermédiaire lors de la séparation des cellules filles. / The kinases of Pim family are implicated in many haematological cancers, whose Acute Myeloid Leukemia (AML) and multiple myeloma. Contrary of the most others proteins kinases which needs activation by the preliminary phosphorylation of catalytic domain, the activity of Pim kinases is constitutive. The regulation of Pim2 expression and its mechanisms of action are not well-known. One part of my project consisted in the study of the expression and stability of Pim2 in AML and myeloma cells. I have shown that the expression of Pim2 is regulated at transcriptional level by STAT5. The three isoforms of Pim2 have very short half-lives. Theirs fast degradations seem to be constitutive and independent of intracellular pathway. It involves the proteasome machinery but not seems to need the preliminary ubiquitination of the protein. Forms of Pim2 accumulated in the cells when the proteasome is inhibited are actives. These firsts data drove me to think about the interest of Pim inhibitor in multiple myeloma, where the using of proteasome inhibitor as treatment increase the accumulation of this oncogenic kinase. The second part of my project was to identify the potentials substrates and partners of Pim2 in AML. In this aim, I developed a method of metabolic labelling coupled with a global quantitative phosphoproteomic approach, as well as a specific antibody targeted against this protein to realize an interactome analysis of Pim2. The informations obtained allowed me to show the activation of mTORC1 pathway by Pim2 and to identify the Polo-Like Kinase (PLK1) as a new substrate and partner of Pim2. My results show that Pim2 and PLK1 are colocalized during the differents mitotic phases, particularly at the midbody level during the separation of cell.

Le cycle cellulaire est l'ensemble des étapes qui conduisent une cellule mère à se diviser en deux cellules filles. La protéine Checkpoint kinase 1 (Chk1) est importante pour sa progression. Nous avons d'une part cherché à savoir si Chk1 intervenait lors des mécanismes de production des plaquettes, car ces cellules permettant la coagulation du sang sont issues d'un cycle cellulaire particulier. Par ailleurs, nous avons étudié le rôle de Chk1 dans la Leucémie Aiguë Myéloïde (LAM), cancer des cellules sanguines. Les patients atteints de LAM sont traités par une chimiothérapie visant à endommager l'ADN afin d'entrainer la mort des cellules cancéreuses. Chk1 est garante du contrôle de la réparation des dommages de l'ADN, ce qui contrecarre l'effet de la chimiothérapie. Elle pourrait donc favoriser l'apparition de résistance. Son rôle dans les LAM étant peu connu, l'objectif de ce projet est donc de vérifier si Chk1 favorise la résistance des cellules leucémiques aux chimiothérapies. / The cell cycle is a series of events that takes place in a mother cell, leading to its division into two daughter cells. The protein Checkpoint kinase 1 (Chk1) is mandatory for its coordinated progression. In this PhD projet, we wondered on the one hand whether Chk1 could be involved in the platelets production process, because these componants of blood that enables coagulation are produced due to a particular cell cycle dedicated to this end. On the other hand, we studied the role of Chk1 in Acute Myeloid Leukemia (LAM) physiopathology. LAM is a cancer of blood cells, in which patients are treated with drugs that create DNA damages, causing the death of tumoral cells. The role of Chk1 in the drug response in LAM is not well studied, but, as it enables DNA repair, it may render theses medicines less efficient, leading to relapses to therapies. So the goal of this project is to check wether Chk1 favors the resistance of some LAM cells to chemotherapeutic treatments.

Le CD81 est une molécule de surface appartenant à la superfamille des tetraspanines. Son rôle pronostique a été précédemment étudié dans les pathologies lymphoïdes, dont le myélome multiple où son expression est associée à un pronostic péjoratif. A ce jour, ce marqueur n'a pas été étudié dans les leucémies aiguës myéloïdes (LAM). Nous avons étudié l'expression membranaire du CD81 sur les blastes de LAM au diagnostic, son association aux autres caractéristiques des LAM et sa potentielle influence sur la survie des patients sur une cohorte de 134 patients traités par chimiothérapie intensive.Le CD81 a été retrouvé chez 92 patients sur 134 (69%). Les patients exprimant ce marqueur avaient une leucocytose initiale plus élevée (p=0.02) et présentaient une cytogénétique intermédiaire ou défavorable (p<0.001). L'expression du CD81 avait un impact négatif sur la survie des patients (survie sans évènements (EFS), survie globale (OS), survie sans rechute (RFS)) en analyse uni- (p<0.001) et multivariées (p=0.003, 0.002 and <0.001 respectivement).De plus, le CD81 avait un impact négatif sur l'OS des patients avec une mutation de NPM1 (p=0.01) et chez les patients du groupe cytogénétique favorable (p=0.002) selon la classification ELN.Les anomalies du cycle cellulaire étant associées à la chimiorésistance, la croissance tumorale et l'agressivité de la pathologie, nous avons étudié l'expression du Ki67 sur les blastes de LAM au diagnostic. Ainsi, 10 prélèvements médullaires de patients avec une faible expression du CD81 par les blastes (moins de 20% de positivité) et 10 prélèvements avec une forte expression du marqueur ont été étudiés. Nous avons pu démontrer une expression significativement inférieure du Ki67 sur les blastes CD81 positifs par rapport aux blastes CD81 négatifs (p<0.001), suggérant ainsi un rôle potentiel du CD81 dans le contrôle du cycle cellulaire. De plus, nous nous sommes intéressés au rôle du CD81 dans la chimiorésistance et sur les différentes voies de signalisation cellulaire en étudiant le profil d'expression génique.En conclusion, le CD81 semble être un nouveau marqueur pronostique des LAM ainsi qu'une cible potentielle de traitement de ces pathologies. / CD81 is a cell surface protein which belongs to the tetraspanin family. While in multiple myeloma its expression on plasma cells is associated with worse prognosis, this has not yet been explored in acute myeloid leukemia (AML). We measured membrane expression of CD81 on AML cells at diagnosis, evaluated its association with AML characteristics and its influence on patient outcome after intensive chemotherapy in a cohort of 134 patients. CD81 was detected in 92/134 (69%) patients. Patients with AML expressing CD81 had elevated leukocyte count (p=0.02) and were more likely classified as intermediate or adverse-risk by cytogenetics (p<0.001). CD81 expression had a negative impact on survival (event-free [EFS], overall [OS] and relapse-free survival [RFS]) in univariate (p<0.001) and in multivariate analyses (p=0.003, 0.002 and <0.001, respectively). CD81 has a negative impact on OS in patients with NPM1 mutation (p=0.01) and in favorable risk patients by European Leukemia Net (ELN) classification (p=0.002).Since aberrations in cell cycle signaling can cause drug resistance, tumor growth and aggressiveness we measured Ki67 on primary blast cells from AML patients. We considered 10 bone marrow samples from AML patients with either weak CD81 expression (less than 20% of blast cells) or 10 bone marrow samples with strong CD81 expression on blasts. We found a significant lower ki67 expression on blast cells from CD81 positive patients compared with those from CD81 negative patients (p<0.001), indicating a potential role of CD81 in cell cycle control. Furthermore, we investigated the role of CD81 in chemotherapy resistance and investigated potentially implicated signaling pathways by gene expression profiling.In conclusion, the cell surface marker CD81 may be a new prognostic marker for diagnostic risk classification and a new potential therapeutic target for drug development in AML.

Les dernières avancées dans les traitements des hémopathies aboutissent à un meilleurs taux de rémission complète ainsi qu' à de meilleurs taux de survie après traitement. Cependant les risques de rechutes restent élevés. Notre projet s'inscrit dans la compréhension du rôle des cellules NK dans l'évolution de ce type de pathologies. Dans une première partie nous nous sommes intéressés à la polyglobulie de Vaquez. Cette pathologie présente une évolution lente et progressive, et elle est caractérisée par une mutation de JAK2 présente dans la lignée myéloïde chez plus de 95% des patients. Nous avons cherché à détecter la mutation dans les cellules NK de patients, puis, pour savoir si la mutation avait un effet sur les NK, nous avons exploré leurs fonctions in vitro. Nos résultats ont montré que, bien que la mutation soit présente dans les cellules NK, elle ne semble pas avoir d'impact sur les fonctions des cellules NK que nous avons pu tester. Nous en avons conclu que l'évolution de la polyglobulie de Vaquez en leucémie n'était peut-être pas due à une perte de fonction des NK mais plutôt à leur inhibition par l'environnement cellulaire.Dans une deuxième partie nous avons étudié la régulation des natural cytotoxicity receptors dans la leucémie aiguë myéloïde. D'apres des travaux antérieurs nous avons émis l'hypothèse que l'expression des trois NCR aurait une régulation commune s'effectuant au niveau de transcription de leurs gènes. Nos recherches bio-informatiques ainsi que notre expérimentation d'immunoprécipitation de la chromatine (Chip) montrent que le facteur de transcription ETS-1 semble être impliqué dans la régulation commune aux trois NCR. / The latest advances in blood disorders treatments lead to a better complete remission rate and a better survival rate after treatment. However, the risk of relapse remains high. Our project is included in the understanding of NK cells role in the development of these diseases.In a first part, we focused on polycythemia Vera for several reasons: the pathology has a slowly progressive disease, and it is characterized by the presence of JAK2 mutation for > 95% patients. We wanted to know if this mutation was found in NK cells from PV patients and what effects the mutation had on NK cells functions. Our results have shown that although the mutation was found in NK cells, it appears to have no impact on NK cells functions. We conclude that the evolution of PV to leukemia is not due to a loss of NK cell functions but to their inhibition by cellular environment.In a second part, we investigated the regulation of natural cytotoxicity receptors in acute myeloid leukemia because previous works have shown that NCR are weakly expressed in AML patients, that this down-regulation is acquired during evolution of AML and reversible after complete remission, ant that NCR weak expression is related to poor prognosis. We supposed that the expression of the three NCR has a common regulation at genes transcription level. Our bioinformatic researches and our experiment of chromatin immunoprecipitation show that ETS-1 transcription factor is a good candidate involved in the common regulation of the three NCR.

Human cells from acute myeloid leukemia (AML) patients are frequently transplanted into immune-compromised mouse strains to provide an in vivo environment for studies on the biology of the disease. Since frequencies of leukemia re-initiating cells are low and a unique cell surface phenotype that includes all tumor re-initiating activity remains unknown, the underlying mechanisms leading to limitations in the xenotransplantation assay need to be understood and overcome to obtain robust engraftment of AML-containing samples. We report here that in the NSG xenotransplantation assay, the large majority of mononucleated cells from patients with AML fail to establish a reproducible myeloid engraftment despite high donor chimerism. Instead, donor-derived cells mainly consist of polyclonal disease-unrelated expanded co-transplanted human T lymphocytes that induce xenogeneic graft versus host disease and mask the engraftment of human AML in mice. Engraftment of mainly myeloid cell types can be enforced by the prevention of T cell expansion through the depletion of lymphocytes from the graft prior transplantation.