Stimuler le système immunitaire est un enjeu majeur dans le traitement des leucémies aigües. Nous avons centré notre étude sur la leucémie aigüe myéloïde (LAM) et la leucémie à cellules dendritiques plasmacytoïdes (LAPDC). Dans une première partie, nous avons étudié les médicaments immunomodulateurs (IMiDs) utilisés dans le traitement du myélome multiple et des syndromes myélodysplasiques à délétion 5q. Les IMiDs présentent des propriétés anti-angiogéniques, anti-prolifératives, pro-apoptotiques, et immunomodulatrices en particulier sur les cellules NK (Natural Killer). Nous avons évalué les effets anti-leucémiques des IMiDs (lenalidomide et pomalidomide) dans le but d’améliorer l’activité cytotoxique des NK dans la LAM. Nous avons mis en évidence une altération de la survie des blastes de LAM par les IMiDs in vitro, et dans un modèle in vivo de greffe dans les souris immunodéficientes NOD/SCID/IL2rg-/- (NSG). Nous avons également montré une sensibilisation par les IMiDs des blastes de LAM à la lyse par les NK allogéniques, indépendamment de la cible moléculaire connue, le cereblon. Le traitement des blastes de LAM par IMiDs stimule les fonctions NK. Enfin, nous avons décrit des modifications phénotypiques induites par les IMiDs sur les récepteurs NK, et une diminution d’expression de HLA-classe I sur les cellules de LAM. Ces résultats encouragent la poursuite du développement des IMiDs dans la LAM, en particulier les associations stimulant les fonctions NK. Dans une seconde partie, nous avons développé un modèle murin de LAPDC dans la souris NSG. Cet outil préclinique est indispensable dans l’élaboration de stratégies d’immunothérapie dans les leucémies aigües. / Boosting the Immune System is a major challenge in the treatment of acute leukemias. We focused our study on acute myeloid leukemia (AML) and plasmacytoid dendritic cell leukemia (BPDCN). In the first part, we studied immunomodulatory drugs (IMiDs) that are currently used in the treatment of patients with myeloma and myelodysplastic syndrome with 5q deletion. IMiDs exhibit anti-angiogenesis, anti-proliferative, pro-apoptotic, and immunomodulatory properties especially on NK cells and T lymphocytes. We investigated the anti-leukemic effects of two IMiDs (lenalidomide and pomalidomide) in order to improve NK cell cytotoxic activity in AML. We have shown that IMiDs impaired survival of AML blasts in vitro, and in vivo in NOD/SCID/IL2rg-/- (NSG) murine model. In addition, IMiDs treatment sensitized AML blasts to allogeneic NK cell mediated lysis, independently of Cereblon, the known molecular target of IMiDs. IMiDs treatment of AML blasts enhanced NK cell functions such as degranulation and cytokine production. Finally, we have described phenotypic changes induced by IMiDs on NK receptors, and a down-regulation of HLA-class I on AML blasts. These results encourage continuing investigation for the use of IMiDs in AML, especially in combination with immunotherapies based on NK cells. In a second part, we have developed a murine model of plasmacytoid dendritic cell leukemia (BPDCN) in NSG mice. Murine model of leukemia are essential preclinical tools in the development of new immunotherapies in acute leukemias.

Le Dimethyl Ampal Thiolester (DIMATE) est un inhibiteur des aldéhydes déshydrogénases (ALDHs) de type 1 et 3. L’intérêt croissant au cours de ces dernières années pour ces enzymes intra cytoplasmiques que sont les ALDHs, s’explique par leurs utilisations comme marqueurs pour distinguer les cellules souches, saines ou cancéreuses, au sein de différents tissus, comme le tissu hématopoïétique. Le traitement des Leucémies Aiguës Myéloïdes demeure une problématique clinique majeure. En effet, malgré un taux de rémission complète moyen d’environ 70% avec les traitements conventionnels, la survie moyenne des patients porteurs d’une LAM n’excède pas les 50% à 5 ans. A ce titre, le DIMATE, semble être un médicament d’avenir. Le DIMATE présente une toxicité majeure sur plusieurs lignées leucémiques humaines et sur des cellules souches leucémiques issues de patients. De manière remarquable, le DIMATE à ces doses anti-leucémiques présente une innocuité quasi-totale sur les cellules souches hématopoïétiques saines. In vivo, chez la souris, le DIMATE permet d’éradiquer spécifiquement les cellules leucémiques humaines xénogreffées et présente en monothérapie une efficacité similaire à l’association Cytarabine + Daunorubicine qui constitue le standard thérapeutique actuel. Ces résultats encourageants vont servir de support conceptuel à la mise en place prochaine d’essais cliniques. / The Dimethyl Ampal Thiolester (DIMATE) is a type 1 and 3 Aldehydes Dehydrogenases (ALDHs) inhibitor as an innovating treatment for AML. Interest in ALDH is due to its activity as a marker for identification of stem cell in different tissues. The different species of ALDHs control the levels of the endogenous apoptogenic aldehydes. Cancer cells protect themselves from the apoptogenic effect of these aldehydes by the ALDHs that oxidize them to their non-apoptogenic carboxylic acids. The vast majority of patients with AML achieve complete remission (CR) after standard induction chemotherapy. However, the majority subsequently relapses and dies of the disease. Therefore, AML remains a clinical challenge and new therapies are urgently needed. For this, DIMATE appears as a promising drug. In vitro, DIMATE is a powerful ALDH inhibitor and has a major cytotoxic activity on human AML cell lines. Moreover, DIMATE is highly active against leukemic population enriched in LSCs, but, unlike conventional chemotherapy, DIMATE is not toxic for healthy hematopoietic stem cells which retained after treatment their self-renewing and multi-lineage differentiation capacity. In immunodeficient mice, xenografted with human leukemic cells, DIMATE eradicates specifically human AML cells and spares healthy mouse hematologic cells. Moreover, DIMATE showed the same efficiency than the association Daunorubicin + Cyrabine, which is considered as the gold standard for AML induction. Results from our work open new therapeutic perspectives in AML and provide a conceptual support for initiation of a phase I-II clinical trials, but also innovating cellular therapy.

A técnica de análise de sobrevivência tem sido muito utilizada por pesquisadores na área de saúde. Neste trabalho foi usada uma distribuição em análise de sobrevivência recentemente estudada, chamada distribuição exponencial generalizada. Esta distribuição foi estudada sob todos os aspectos: para dados completos e censurados, sob a presençaa de covariáveis e considerando sua extensão para um modelo multivariado derivado de uma função cópula. Para exemplificação desta nova distribuição, foram utilizados dados reais de câncer (leucemia mielóide aguda e câncer gástrico) que possuem a presença de censuras e covariáveis. Os dados referentes ao câncer gástrico tem a particularidade de apresentar dois tempos de sobrevida, um relativo ao tempo global de sobrevida e o outro relativo ao tempo de sobrevida livre do evento, que foi utilizado para a aplicação do modelo multivariado. Foi realizada uma comparação com outras distribuições já utilizadas em análise de sobrevivência, como a distribuiçãoo Weibull e a Gama. Para a análise bayesiana adotamos diferentes distribuições a priori para os parâmetros. Foi utilizado, nas aplicações, métodos de simulação de MCMC (Monte Carlo em Cadeias de Markov) e o software Winbugs. / Survival analysis methods has been extensively used by health researchers. In this work it was proposed the use a survival analysis model recently studied, denoted as generalized exponential distribution. This distribution was studied in all respects: for complete data and censored, in the presence of covariates and considering its extension to a multivariate model derived from a copula function. To exemplify the use of these models, it was considered real cancer lifetime data (acute myeloid leukemia and gastric cancer) in presence of censored data and covariates. The assumed cancer gastric lifetime data has two survival responses, one related to the total lifetime of the patient and another one related to the time free of the disease, that is, multivariate data associated to each patient. In these applications there was considered a comparative study with standard existing lifetime distributions, as Weibull and gamma distributions.For a Bayesian analysis we assumed different prior distributions for the parameters of the model. For the simulation of samples of the joint posterior distribution of interest, we used standard MCMC (Markov Chain Monte Carlo) methods and the software Winbugs.

RUNX3是RUNX轉錄因子家族的其中一位成員。RUNX轉錄因子家族是負責調控細胞的增殖和分化。最近研究表明RUNX3可能在造血過程中扮演其中一個角色。可是，它在髓系細胞中的調節角色依然未明。此前，我們發現在核心結合因子急性骨髓性白血病中的融合蛋白RUNX1-ETO和CBFB-MYH11會抑制RUNX3基因表達，並且RUNX3表達水平對兒童急性骨髓性白血病的預後有顯著影響。本研究的目的是要調查RUNX3在成人急性骨髓性白血病的預後價值，並透過闡明RUNX3的轉錄調節去了解其在髓系細胞分化扮演的角色。 / 首先，我們透過實時定量聚合鏈反應去量化在174個成人急性骨髓性白血病的患者骨髓中的RUNX3表達，從而調查RUNX3表達與成人急性骨髓性白血病預後的關係。我們發現低RUNX3表達與較好預後的核型(P=0.045)，NPM1基因突變(P=0.014) 和較年青患者(P=0.084) 有關聯。在存活分析中，我們把有完整生存數據的非急性前骨髓性白血病病人分成高RUNX3表達和低RUNX3表達兩組。在成人急性骨髓性白血病中，高RUNX3表達和較差整體存活率(OS) (P=0.011)和無事件存活率(EFS) (P=0.003)有顯著的關聯，這和我們在兒童急性骨髓性白血病所觀察的一致。高RUNX3表達和較差存活率的關係在有野生型FLT3基因的病人中更為明顯(OS, P=0.004; EFS, P=0.001)。由於低RUNX3表達和較好預後核型有關聯，我們進一步只對擁有較差預後核型的病人作將存活分析，發現RUNX3表達仍是影響EFS的一個顯著因素(P=0.017)。在多元分析中，高RUNX3表達在所有病人(EFS, P=0.026, HR=2.433, 95%CI = 1.114-5.356)，野生v 型FLT3基因的病人(OS, P=0.016, HR=4.830, 95%CI = 1.335-17.481; EFS, P=0.007, HR=4.103, 95%CI = 1.480-11.372)和較差預後核型的病人(EFS, P=0.024,HR=2.339, 95%CI = 1.117-4.896) 中都是一個獨立的不利預後因素。 / 接著，我們研究RUNX3基因的表達調控。我們鑒定出一個最小啟動子區對於在髓系細胞的基因表達有關鍵作用。透過預測啟動子區和轉錄因子結合位點的分析，顯示這個活性區域含有PU.1，AP-1和Sp1轉錄因子結合位點。我們透過報告基因系統研究，染色質免疫沈澱技術及電泳遷移率改變分析去闡明PU.1，c-Jun及Sp1和相對的轉錄因子結合位點參與RUNX3基因的表達調控。我們進一步透過PU.1基因剔除去證實RUNX3是PU.1的直接下遊靶基因並發現PU.1與RUNX3表達在急性骨髓性白血病人中呈正相關性。 / 由於RUNX3基因表達受到PU.1, c-Jun及Sp1的控制，我們繼續研究RUNX3在髓系細胞分化的功用。我們透過實時定量聚合鏈反應及流式細胞儀檢測發現RUNX3過度表達誘導K562細胞株作單核細胞及粒細胞分化。RUNX3能激活髓系基因的啟動子。它在成熟髓系細胞的表達水平明顯比血幹細胞為高。根據以上結果，RUNX3也許在單核細胞及粒細胞分化中有一定功能。但是，有別於其他癌細胞，RUNNX3不能在髓系細胞誘導細胞凋亡和周期阻滯。 / 總括而言，RUNX3表達在成人急性骨髓性白血病中是一個獨立的預後因素。除此之外，本研究表明RUNX3受到PU.1，c-Jun及Sp1的表達調控並在單核細胞及粒細胞分化中有一定功能。 / RUNX3 is a member of Runt-related domain (RUNX) transcription factor family, which regulates cell proliferation and differentiation. Recent studies have suggested a role of RUNX3 in hematopoiesis. However, its regulatory function in myeloid cells remains unclear. Our group previously showed that RUNX3 expression was repressed by the fusion proteins RUNX1-ETO and CBFB-MYH11 in core-binding factor acute myeloid leukemia (CBF-AML) and had prognostic implication in childhood AML patients. The aim of this study is to investigate the prognostic value of RUNX3 in adult AML patients and its role in myeloid differentiation by elucidating its transcriptional control. / To investigate the relationship between RUNX3 expression and prognosis of adult AML, RUNX3 expression in the diagnostic bone marrow samples from 174 adult AML patients were quantified by real time quantitative PCR (RQ-PCR). Low RUNX3 expression was found to be associated with favorable cytogenetic group (P=0.045), NPM1 mutations (P=0.014) and younger age (P=0.084). For the survival analysis, 110 non-acute promyelocytic leukemia (non-APL) patients with complete survival data were dichotomized into high and low expression groups. Concordant with our previous observation in childhood AML, a significant association between high RUNX3 expression and poorer overall survival (OS) (P=0.011) and event-free survival (EFS) (P=0.003) was observed. The association between high RUNX3 expression and poorer survival was further strengthened in patients with wild-type FLT3 (P=0.004 and 0.001 for OS and EFS respectively). Since low RUNX3 expression was associated with favorable cytogenetics, the analysis was next restricted to patients with non-favorable cytogenetics and RUNX3 expression remained as a significant factor for EFS (P=0.017). In multivariate analysis, high RUNX3 expression was an independent adverse prognostic factor in the whole cohort (EFS, P=0.026, HR=2.433, 95%CI = 1.114-5.356), patients with wild-type FLT3 (OS, P=0.016, HR=4.830, 95%CI = 1.335-17.481; EFS, P=0.007, HR=4.103, 95%CI = 1.480-11.372) and patients with non-favorable genetics (EFS, P=0.024,HR=2.339, 95%CI = 1.117-4.896). / Next, the transcriptional regulation of RUNX3 in myeloid cells was investigated. A minimal promoter region was identified to be critical for myeloid-specific promoter activity. Sequence analysis of the fragment revealed potential transcription factor binding sites for PU.1, AP-1 and Sp1.The involvement of these putative binding sites and corresponding transcription factors in transcriptional regulation of RUNX3 was demonstrated by promoter reporter assay, chromatin immunoprecipitation (ChIP) and electrophoretic mobility shift assay (EMSA).Furthermore, PU.1 knockdown in U937 cells confirmed RUNX3 was a direct downstream target of PU.1 and a positive correlation between PU.1 and RUNX3 expression was observed in AML patient samples. / As RUNX3 was shown to be transcriptionally regulated by PU.1, c-Jun and Sp1, a role of RUNX3 in myeloid differentiation was postulated. Overexpression of RUNX3 induced both monocytic and granulocytic markers in K562 myeloid cells as detected by flow cytometry and RQ-PCR. RUNX3 was also found to activate myeloid-specific gene promoters and its expression was significantly higher in mature myeloid cells than in hematopoietic stem cells. This suggested a role of RUNX3 in both monocytic and granulocytic differentiation. However, unlike in other solid tumors, RUNX3 did not induce apoptosis and cell cycle arrest in myeloid cells. / In conclusion, RUNX3 expression was an independent prognostic factor in adult AML. Furthermore, our findings showed that RUNX3 was transcriptionally regulated by the master myeloid regulator PU.1 along with c-Jun and Sp1 and implicated a role in monocytic and granulocytic differentiation. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Kwan, Tsz Ki. / Thesis (Ph.D.) Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 171-202). / Abstracts also in Chinese.

Les leucémies aiguës myéloïdes (LAM) du sujet âgé sont les plus fréquentes des leucémies aiguës. Bien que de physiopathologie hétérogène, elles partagent un pronostic défavorable. L’azacitidine est devenue un des traitements de référence pour les patients jugés inéligibles pour une chimiothérapie intensive mais les critères de sélection des patients entre ces deux approches sont controversés. L’identification de biomarqueur prédictif de réponse à l’azacitidine doit permettre de rationnaliser ce choix thérapeutique. Les facteurs pronostiques classiques d’une cohorte de 334 patients atteints de LAM manquent de précision pour guider la meilleure stratégie pour un patient donné. A partir du séquençage de 224 patients traités par azacitidine, nous montrons un impact défavorable des mutations de TP53 sur la survie globale, quel que soit leur caractérisation fonctionnelle. Le séquençage des exomes de 49 patients selon leur réponse à l’azacitidine (26 répondeurs et 23 non répondeurs), suivi du re-séquençage ciblé de 4 polymorphismes chez 175 patients a montré un impact positif du polymorphisme rs7622799 de MECOM sur la survie globale sous azacitidine. / Elderly patients with acute myeloid leukemias (AML) represent the most frequent acute leukemias. Although they differ in their pathophysiology, they all share an adverse prognosis. Azacitidine has become one of the reference low-intensity frontline therapy for patients deemed unfit for intensive chemotherapy. Patients selection between these 2 options remains controversial. Predictive biomarkers of response to azacitidine should allowed to rationalize this decision making. Classical prognosis factors of a cohort of 334 newly diagnosed AML lack of precision to determine the optimum strategy for any individual patient. By sequencing of a 224-patients series of azacitidine-treated AML patients, we demonstrate an adverse impact of TP53 mutation on overall survival, irrespective of the functional characterization of p53 mutants. Exome sequencing of 49 patients with extreme phenotype as defined by their response under azacitidine (26 responders versus 23 non-responders), followed by targeted sequencing of 4 common polymorphisms in a validation set of 175 patients, showed a positif impact of MECOM rs7622799 on overall survival.

Im Rahmen dieser Dissertation wurde retrospektiv die Minimale Resterkrankung von Patienten mit akuter myeloischer Leukämie und Myelodysplastischen Syndrom nach allogener Stammzelltransplantation mit minimaler Konditionierung untersucht. Hierfür wurden vier unterschiedliche Methoden zur Detektion der Minimalen Resterkrankung analysiert. Nach Etablierung einer quantitativen Real-Time PCR für das Wilms Tumor Gen 1 (WT1) im peripheren Blut wurden diese Ergebnisse mit bereits routinemäßig erhobenen Daten des Chimärismus im Gesamtknochenmark und in CD34+ Zellen sowie der Fluoreszenz-in-situ-Hybridisierung (FISH) krankheitsspezifischer chromosomaler Aberrationen von insgesamt 88 Patienten verglichen und statistisch ausgewertet. Es konnte gezeigt werden, dass die Genexpressionanalysen des WT1 sowie die Chimärismusanalysen ein Rezidiv im Gegensatz zu den FISH Analysen vier Wochen im Voraus detektieren können. In Reiceiver Operating Curve Analysen wurden eine WT1 Expression von > 24 WT1/10.000 ABL1 Kopien und der Abfall des CD34+ Spenderchimärismus von ≥ 5% als diagnostisch stärkste Methoden identifiziert. In uni- und multivariaten Analysen von insgesamt 20 Parametern wurden die beiden Methoden als unabhängige Variablen für ein frühes Rezidiv, progressionsfreies Überleben und Gesamtüberleben bestätigt. Kombiniert man beide Methoden, so kann bei jeweiligem negativen Testergebnis ein Rezidiv innerhalb der nächsten vier Wochen nahezu ausgeschlossen werden.

Η θεραπεία της Οξείας Μυελογενούς Λευχαιμίας (ΟΜΛ) είναι συχνά ανεπιτυχής λόγω ανάπτυξης κυτταρικής αντίστασης στα αντιλευχαιμικά φάρμακα. Εκτός από την έκφραση Ρ-γλυκοπρωτείνης στα λευχαιμικά κύτταρα, άλλοι κυτταρικοί παράγοντες μπορούν επίσης να συμβάλλουν στην χημειοαντίσταση. Η c- Jun N-terminal Kinase (JNK) είναι μία πρωτεινική κινάση που ενεργοποιείται όταν τα κύτταρα εκτεθούν σε χημειοθεραπευτικά φάρμακα (ΧΜΘ). Πρόσφατες μελέτες σε συμπαγείς όγκους συσχετίζουν την χημειοαντίσταση με αδυναμία των καρκινικών κυττάρων να ενεργοποιήσουν τη JNK κατόπιν επίδρασης ΧΜΘ. Σκοπός της εργασίας είναι να διερευνήσει αν η χημειοαντίσταση στην ΟΜΛ οφείλεται σε ενδογενή αδυναμία των λευχαιμικών βλαστών να ενεργοποιήσουν τη JNK. Μεθοδολογία: Συγκρίναμε ευαίσθητες (U937) και ανθεκτικές (U937R) στις ανθρακυκλίνες κυτταρικές σειρές ΟΜΛ ως προς την δυνατότητα in vitro ενεργοποίησης της JNK κατόπιν επίδρασης ΧΜΘ (Western Blot). Επιπλέον, στις λευχαιμικές κυτταρικές σειρές ελέγξαμε απευθείας τη σημασία της JNK στην χημειοαντίσταση με πειράματα α) αποσιώπησης της JNK με JNK1–στοχεύον siRNA και β) ενεργοποίησης της JNK (διαμόλυνση με τον ΜΚΚ4/SEK1 άνωθεν ενεργοποιητή της JNK) Περαιτέρω, ελέγξαμε την in vitro δυνατότητα ενεργοποίησης της JNK σε 29 πρωτογενή μυελικά δείγματα ΟΜΛ κατόπιν βραχείας διάρκειας (30-60min) έκθεση στην daunorubicin (1μΜ) και συσχετίσαμε τα εργαστηριακά δεδομένα με κλινικά χαρακτηριστικά των ασθενών με ΟΜΛ. Αποτελέσματα: In vitro θεραπεία των U937 κυττάρων με ανθρακυκλίνες προκάλεσε ισχυρή και ταχεία ενεργοποίηση της JNK και απόπτωση. Αντίθετα, στα πολυανθεκτικά U937R κύτταρα δεν παρατηρήθηκε ενεργοποίηση της JNK, ακόμη και σε συνθήκες υψηλής ενδοκυττάριας συγκέντρωσης ανθρακυκλινών. Αποσιώπηση της JNK στα ευαίσθητα U937 κύτταρα τα έκανε ανθεκτικά στις ανθρακυκλίνες (JNK1-siRNA διαμολυσμένα U937 κύτταρα εμφάνισαν 50.4% και 61.3% ελαττωμένη daunorubicin- (DNR, 1μΜ 24hr) και doxorubicin- (DOX, 1.5μΜ 24hr) προκαλούμενη απόπτωση αντίστοιχα, συγκριτικά με U937 κύτταρα-μάρτυρες, P<0.001). Αντίστροφα, εκλεκτική ενεργοποίηση της ανενεργού JNK στα ανθεκτικά U937R κύτταρα τα έκανε 3.3 φορές πιο ευαίσθητα στη DNR και 3.1 φορά πιο ευαίσθητα στη DΟΧ, συγκριτικά με U937R κύτταρα-μάρτυρες. Επιπρόσθετα, παρατηρήσαμε ισχυρή συσχέτιση μεταξύ των in vitro φαρμακοδυναμικών αλλαγών των επιπέδων ενεργοποίησης της JNK στους λευχαιμικούς βλάστες και της ανταπόκρισης των ασθενών με ΟΜΛ στη χημειοθεραπευτική αγωγή (P=0.012). Η απουσία ενεργοποίησης της JNK στα βλαστικά κύτταρα συσχετίστηκε επίσης με αρνητικούς προγνωστικούς παράγοντες για την ΟΜΛ, όπως γηραιότερη ηλικία των ασθενών (P=0.046) και ΟΜΛ αναπτυσσόμενη επί εδάφους μυελοδυσπλασίας (P=0.017). Συνοψίζοντας, τα in vitro και in vivo αποτελέσματα μας προτείνουν την ενδογενή αποτυχία ενεργοποίησης της πρωτεινικής κινάσης JNK στους λευχαιμικούς βλάστες σαν έναν εναλλακτικό μηχανισμό χημειοαντίστασης στην ΟΜΛ. Η διελεύκανση των μηχανισμών εκείνων που επιφέρουν καταστολή της JNK στην χημειοανθεκτική ΟΜΛ μπορεί να ωφελήσει θεραπευτικά. / Chemotherapy resistance is a major challenge in acute myeloid leukemia (AML). Besides the P-glycoprotein efflux, additional cellular factors may contribute to drug-resistance in AML. c- Jun N-terminal Kinase (JNK) is activated after exposure of cells to chemotherapeutics. We asked whether chemoresistance in AML is attributed to intrinsic failure of the AML blasts to activate JNK. In vitro treatment of U937 AML cell line with anthracyclines induced a rapid and robust JNK phosphorylation and apoptosis. In contrast, the anthracyline-resistant derivative cell lines U937R and URD40 showed no JNK activation after exposure to anthracyclines, also at doses that resulted in high accumulation of the drug within the cells. RNA interference-based depletion of JNK1 in drug-sensitive U937 cells made them chemoresistant, whereas selective restoration of the inactive JNK pathway in the resistant U937R cells sensitized them to anthracyclines. Short-term in vitro exposure of primary AML cells (n=29) to daunorubicin showed a strong correlation between the in vitro pharmacodymanic changes of phospho-JNK levels and the response of patients to standard induction chemotherapy (P=0.012). We conclude that JNK activation failure confers another mechanism of anthracycline resistance in AML. Elucidating the ultimate mechanisms leading to JNK suppression in chemoresistant AML may be of major therapeutic value.

Aberrant subcellular localization of mutant transmembrane receptors is increasingly acknowledged as a possible mechanism for an altered signaling quality leading to transformation. There is evidence that mutated receptor tyrosine kinases of subclass III, for example the platelet-derived growth factor receptor (PDGFR) and KIT-protein, are aberrantly localized in human cancers. In order to further analyze this phenomenon, we investigated the localization of FLT3, a subclass III receptor tyrosine kinase frequently mutated in leukemia. By immunofluorescence staining and confocal laser scanning microscopy we found that in retrovirally transduced COS7 cells, wild type FLT3 receptor protein is localized primarily at the cell surface. In contrast, a mutant FLT3 receptor protein with an internal tandem duplication (ITD) accumulates in a perinuclear region and is not detectable at the plasma membrane. Surprisingly, and in contrast to previously published data, intracellular FLT3-ITD accumulation could neither be detected in the endoplasmic reticulum (ER) nor in the Golgi apparatus. Furthermore, transient overexpression per se leads to accumulation of wild type FLT3 receptor protein in the ER in addition to surface localization, probably due to inefficient intracellular transport by the overloaded sorting machinery of the secretory pathway. Based on our data and the immature glycosylation pattern of FLT3-ITD, we speculate that the mutant protein resides most probably in an unidentified compartment of the secretory pathway between the ER and the Golgi apparatus. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

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La contribution des Cellules Souches/Stromales Mésenchymateuses (CSM) dans le développement des Leucémies Aiguës Myéloblastiques (LAM) n’est pas encore clairement établie. L'objectif de ce travail a été de rechercher de potentielles modifications phénotypiques et fonctionnelles au sein des CSM médullaires de patients atteints de LAM de novo au diagnostic. Nous montrons que ces cellules présentent un défaut prolifératif accompagné d’une augmentation de l’apoptose et d’un déficit d’expression de certains facteurs de la niche (Ang-1, SCF, TPO et VCAM-1). De façon intéressante, ce défaut prolifératif est indépendamment associé à une évolution péjorative de la maladie. Néanmoins, ces anomalies des CSM de LAM ne semblent pas affecter leur capacité de soutien de l’hématopoïèse physiologique ou leucémique in vitro. En effet, comme les CSM normales, elles protègent les cellules leucémiques de l’apoptose, induisent leur quiescence (principalement par contact direct) et ainsi diminuent la proportion des cassures double-brin d’ADN. Ces données suggèrent que les modifications des CSM de LAM, probablement une des conséquences délétères de la prolifération tumorale, n'auraient pas un rôle spécifique dans le développement du processus leucémique. / The contribution of Mesenchymal Stem/Stromal Cells (MSCs) to the development of Acute Myeloid Leukemias (AMLs) remains poorly understood. In the present study, we investigated potential functional and phenotypic modifications of Bone Marrow (BM)-derived MSCs from patients with AML de novo at diagnosis. We showed that BM-derived MSCs from most of AML patients display proliferative defect, had increased apoptosis levels and demonstrated defective expression of several niche-related factors (Ang-1, SCF, TPO and VCAM-1). Interestingly, this proliferative defect was independently associated with disease progression. Nevertheless, these abnormalities in AML MSCs did not affect their in vitro capacity to support physiological but also leukemic hematopoiesis. Indeed, as normal MSCs do, they protect blast cells from apoptosis, induce their quiescence (mainly by direct contact), and decreased yields of DNA double-strand breaks. Consequently, in AML de novo these stromal cell alterations, probably a consequence of the deleterious effect of the tumor cell growth on BM MSCs, do not appear to have a specific role in the development of the leukemic process.