Lymphocytes from patients with B-chronic lymphocytic leukemia (B-CLL) express large numbers of P2X7 receptors for extracellular adenosine triphosphate (ATP). Activation of P2X7 receptors induces multiple downstream effects, of which the best documented is the opening of an ionic channel that is selective for divalent cations. Another effect of ATP is to induce the shedding of L-selectin (CD62L), a molecule which is involved in the adhesive interactions of lymphocytes on endothelial cells. High levels of soluble L-selectin and CD23 are found in the serum of patients with B-CLL, although the mechanisms involved in their production are poorly characterized. Because extracellular ATP causes shedding of L-selectin, we studied the effect of ATP on shedding of CD23, an adhesion molecule expressed on the surface of B-CLL lymphocytes. ATP induced the shedding of CD23 at an initial rate of 12% of that for L-selectin, while the EC50 of ATP (35 uM) and BzATP (10 uM) was identical for shedding of both molecules. Inactivation of the P2X7 receptor by pre-incubation with OxATP, an irreversible inhibitor of P2X7 purinoceptor, abolished ATP-induced shedding of both molecules. Moreover, KN-62, the most potent inhibitor for the P2X7 receptor inhibited ATP-induced shedding of both CD23 and L-selectin with the same IC50 (12 nM). Ro 31-9790, a membrane permeant zinc chelator which inhibits the phorbol-ester stimulated shedding of L-selectin also inhibited shedding of CD23 from B-CLL lymphocytes, but the IC50 was different for the two shed molecules (25 versus 1 ug/ml respectively). Although L-selectin was completely shed by incubation of cells with phorbol-ester no CD23 was lost under these conditions. Also, Ca2+ inhibits ATP-induced CD23 shedding but not L-selectin shedding. Since soluble CD23 and L-selectin are found in the serum of normal subjects and B-CLL patients, the expression of these two adhesion molecules on lymphocytes before and after transendothelial migration was studied in an in vitro model of this process. In normal and B-CLL subjects, 71�b5% of L-selectin from both T and B cells and 90% of CD23 from B cells was lost following transmigration, while the expression of a range of other adhesion molecules such as VLA-4, ICAM-1, LFA-1 and CD44 was unchanged. Lymphocytes incubated with OxATP retained their capacity for transendothelial migration and showed the same loss of L-selectin as control leukaemic lymphocytes. Ro 31-9790, which can protect ATP-induced both L-selectin and CD23 shedding, had no effect on inhibiting L-selectin and CD23 lost during transmigration. These data show the presence of a second pathway for the downregulation of L-selectin and CD23 from the lymphocyte surface. Data in vivo from 'knock-out' mice show that L-selectin is essential for the emigration of lymphocytes through high endothelial venules into lymph nodes. The migration of normal and B-CLL lymphocytes across confluent human umbilical vein endothelial monolayers was studied in an in vitro model of this process. Lymphocytes treated with ATP or BzATP showed 56�b25% or 67�b16% loss of L-selectin on the surface and 36�b24% or 64�b19% decrease of transmigration, respectively, while OxATP, which does not alter the L-selectin level, had no effect on lymphocyte transmigration. Further experiments examined this correlation between L-selectin expression and lymphocyte transendothelial migration in this model system. A quantitative assay for cell surface L-selectin showed that expression of L-selectin was lower on B-CLL lymphocytes (8,880�b5,700 molecules/cell) than on normal lymphocytes (29,500�b7,500 molecules/cell, p less than 0.001). Also the rate of transmigration of B-CLL lymphocytes (1.5�b0.9 migrated cells/HUVEC) was lower than normal peripheral lymphocytes (2.4�b0.9 migrated cells/HUVEC, p=0.04). Incubation of lymphocytes in complete medium for 24 hrs increased the expression of L-selectin on B-CLL lymphocytes by 1.5 to 2 fold while the normal lymphocyte L-selectin remained at the initial level. This upregulation of B-CLL L-selectin correlated with a 2 fold increased rate of transendothelial migration. A correlation was found between L-selectin expression on lymphocytes and their ability for transendothelial migration (r^2=0.6). This study shows that the adhesion molecules L-selectin and CD23 can be lost from lymphocytes by two different physiological pathways. One is by P2X7 receptor activation by extracellular ATP while the second is activated by transendothelial migration of these cells. A second finding is that B-CLL lymphocytes have lower level of L-selectin expression and an impaired ability for transendothelial migration compared with normal peripheral blood lymphocytes. Do these results explain the high serum levels of soluble L-selectin and CD23 observed in B-CLL? Although B-CLL lymphocytes do not recirculate as rapidly as normal peripheral blood lymphocytes, the greatly increased number of leukaemic cells in B-CLL ensures that much more soluble L-selectin and CD23 is generated during the recirculation of these cells through the body.

Lymphocytes from patients with B-chronic lymphocytic leukemia (B-CLL) express large numbers of P2X7 receptors for extracellular adenosine triphosphate (ATP). Activation of P2X7 receptors induces multiple downstream effects, of which the best documented is the opening of an ionic channel that is selective for divalent cations. Another effect of ATP is to induce the shedding of L-selectin (CD62L), a molecule which is involved in the adhesive interactions of lymphocytes on endothelial cells. High levels of soluble L-selectin and CD23 are found in the serum of patients with B-CLL, although the mechanisms involved in their production are poorly characterized. Because extracellular ATP causes shedding of L-selectin, we studied the effect of ATP on shedding of CD23, an adhesion molecule expressed on the surface of B-CLL lymphocytes. ATP induced the shedding of CD23 at an initial rate of 12% of that for L-selectin, while the EC50 of ATP (35 uM) and BzATP (10 uM) was identical for shedding of both molecules. Inactivation of the P2X7 receptor by pre-incubation with OxATP, an irreversible inhibitor of P2X7 purinoceptor, abolished ATP-induced shedding of both molecules. Moreover, KN-62, the most potent inhibitor for the P2X7 receptor inhibited ATP-induced shedding of both CD23 and L-selectin with the same IC50 (12 nM). Ro 31-9790, a membrane permeant zinc chelator which inhibits the phorbol-ester stimulated shedding of L-selectin also inhibited shedding of CD23 from B-CLL lymphocytes, but the IC50 was different for the two shed molecules (25 versus 1 ug/ml respectively). Although L-selectin was completely shed by incubation of cells with phorbol-ester no CD23 was lost under these conditions. Also, Ca2+ inhibits ATP-induced CD23 shedding but not L-selectin shedding. Since soluble CD23 and L-selectin are found in the serum of normal subjects and B-CLL patients, the expression of these two adhesion molecules on lymphocytes before and after transendothelial migration was studied in an in vitro model of this process. In normal and B-CLL subjects, 71�b5% of L-selectin from both T and B cells and 90% of CD23 from B cells was lost following transmigration, while the expression of a range of other adhesion molecules such as VLA-4, ICAM-1, LFA-1 and CD44 was unchanged. Lymphocytes incubated with OxATP retained their capacity for transendothelial migration and showed the same loss of L-selectin as control leukaemic lymphocytes. Ro 31-9790, which can protect ATP-induced both L-selectin and CD23 shedding, had no effect on inhibiting L-selectin and CD23 lost during transmigration. These data show the presence of a second pathway for the downregulation of L-selectin and CD23 from the lymphocyte surface. Data in vivo from 'knock-out' mice show that L-selectin is essential for the emigration of lymphocytes through high endothelial venules into lymph nodes. The migration of normal and B-CLL lymphocytes across confluent human umbilical vein endothelial monolayers was studied in an in vitro model of this process. Lymphocytes treated with ATP or BzATP showed 56�b25% or 67�b16% loss of L-selectin on the surface and 36�b24% or 64�b19% decrease of transmigration, respectively, while OxATP, which does not alter the L-selectin level, had no effect on lymphocyte transmigration. Further experiments examined this correlation between L-selectin expression and lymphocyte transendothelial migration in this model system. A quantitative assay for cell surface L-selectin showed that expression of L-selectin was lower on B-CLL lymphocytes (8,880�b5,700 molecules/cell) than on normal lymphocytes (29,500�b7,500 molecules/cell, p less than 0.001). Also the rate of transmigration of B-CLL lymphocytes (1.5�b0.9 migrated cells/HUVEC) was lower than normal peripheral lymphocytes (2.4�b0.9 migrated cells/HUVEC, p=0.04). Incubation of lymphocytes in complete medium for 24 hrs increased the expression of L-selectin on B-CLL lymphocytes by 1.5 to 2 fold while the normal lymphocyte L-selectin remained at the initial level. This upregulation of B-CLL L-selectin correlated with a 2 fold increased rate of transendothelial migration. A correlation was found between L-selectin expression on lymphocytes and their ability for transendothelial migration (r^2=0.6). This study shows that the adhesion molecules L-selectin and CD23 can be lost from lymphocytes by two different physiological pathways. One is by P2X7 receptor activation by extracellular ATP while the second is activated by transendothelial migration of these cells. A second finding is that B-CLL lymphocytes have lower level of L-selectin expression and an impaired ability for transendothelial migration compared with normal peripheral blood lymphocytes. Do these results explain the high serum levels of soluble L-selectin and CD23 observed in B-CLL? Although B-CLL lymphocytes do not recirculate as rapidly as normal peripheral blood lymphocytes, the greatly increased number of leukaemic cells in B-CLL ensures that much more soluble L-selectin and CD23 is generated during the recirculation of these cells through the body.

Die B-CLL ist eine niedrigmaligne Erkrankung, die im höheren Lebensalter auftritt und für die es weiterhin keine dauerhaft kurative Therapie gibt. Die Erforschung der genetischen Grundlagen dieser Krankheit könnte Erkenntnisse über die Funktionsmechanismen und neue Diagnose- und Therapieansätze erbringen. Ziel dieser Arbeit war es, eine Genbank von CLL-Patienten bzw. gesunden Spendern zu erstellen, um Gene, die für die Entstehung der Erkrankung mitverantwortlich sein könnten, zu identifizieren. Die subtraktive suppressive Hybridisierung (SSH) wurde als Methode eingesetzt, um cDNA-Mischungen zu generieren, in denen differentielle Gene angereichert wurden. In dieser Arbeit wurden drei differentielle Gene identifiziert. Eines dieser Gene kodiert den Oberflächenmarker CD5, der bei CLL-Erkrankten stärker exprimiert wurde. Da CD5 ein für die B-CLL relativ spezifischer Marker ist, bestätigte dieses Ergebnis die Qualität der Genbank. Mit Hilfe der SSH wurde ein Verlust der Expression der cDNA für den Oberflächenmarker CD20 bei CLL-Erkrankten nachgewiesen. CD20 ist möglicherweise ein Kalziumkanal und wird als Ziel des anti-CD20-Antikörpers Rituximab verwendet. Der Verlust von CD20 im Verlauf der Erkrankung konnte in dieser Arbeit angedeutet werden. Weiterhin wurde eine verringerte Expression von cDNA für IkappaBa (Mad-3) bei CLL-Patienten entdeckt. Der Transkriptionsfaktor IkBa spielt im zellulären Ablauf der Apoptose eine wichtige Rolle. Phosphoryliertes IkBa inhibiert die Wirkung von NF-kB. Eine Reduktion von IkBa-cDNA könnte ebenfalls die Funktion von NF-kB beeinflussen. Dieses Ergebnis könnte auch für zukünftige immuntherapeutische Ansätze von Bedeutung sein. Weiterhin sind die nachgewiesenen Gene interessant für die Technik des "DNA-Microarrays". Diese schnelle Methode ermöglicht kostengünstige Diagnosen und könnte daher eine zukunftsweisende Alternative zu herkömmlichen Ansätzen bieten. In der vorliegenden Arbeit konnten differentielle Transkripte auf mRNA-Ebene bei B-CLL-Erkrankten und gesunden Kontrollen festgestellt und untersucht werden. Die Ergebnisse geben neue Einsichten über Onkogene und Tumorsurpressorgene in der B-CLL und eröffnen zukünftige immuntherapeutische Ansätze. / The B-CLL is a malignancy that appears in the higher age and for which it gives further no durably curative therapy. The investigation of the genetic bases of this illness could furnish understandings of the function mechanisms and new diagnosis and therapy extensions. It was the goal of this work of generating a gene bank of CLL-patients and healthy donors, in order to identify genes, that could be responsible for the origin of the disease. The subtractive suppressive hybridisation (SSH) was inserted as a method in order to generate cDNA-mixtures, in which differential genes were enriched. In this work, three differential genes were identified. One of these genes codes for CD5 that in CLL-patients was stronger expressed. Because CD5 is a marker relatively specific for the B-CLL, this result confirmed the quality of the gene bank. By means of the SSH, a loss of the Expression of the cDNA was proved for CD20 in CLL-patients. Possibly CD20 is a calcium canal and is used as a goal of the anti-CD20-antibody Rituximab. The loss of CD20 in the progress of the disease could be indicated in this work. Further a diminished expression was discovered by cDNA for IkBa (Mad-3) in CLL-patients. The transcription factor IkBa plays an important role in the cellular system of apoptosis. Phosphorylated IkBa is inhibiting the effect of NF-kB. A reduction of IkBa-cDNA could influence also the function of NF-kB. This result could be interesting for future immune therapeutic extension. Further the proved genes are interesting for the technology of the "DNA-Microarrays". This fast method enables favorable diagnoses and could offer therefore a leading-edge alternative to conventional extensions. In the existing work, differential transcripts could be assessed on mRNA-levels in B-CLL-patients and healthy donors. The results give new insights over oncogenes and tumor surpressing genes in the B-CLL and open future immune therapeutic extensions.

Das FMC7-Antigen, eine unbekannte B-Zell-Membranstruktur, dient als eines der immunphänotypischen Grundkriterien zur Diagnose der typischen B-CLL. Die unterschiedliche CD20-Expressionsintensität ist auch ein charakteristisches Merkmal bei der Subtypisierung der Lymphomentitäten. In der vorliegenden Arbeit wurde die Modulation des CD20- und des FMC7-Antigens während einer Therapie mit CD20-Antikörper (Rituximab) bei Patienten mit indolenten B-Zell-Lymphomen untersucht. Bei der durchflusszytometrischen Untersuchung quantitativer und qualitativer Charakteristika der monoklonalen B-Zell-Population bei CLL- (n=12) und Non-CLL-Patienten (n=10) unmittelbar nach der Antikörperinfusion und bis zur 8. Woche nach der Therapie wurden parallele Veränderungen von FMC7 und CD20 festgestellt. Die Anzahl und die Fluoreszenzintensitäten der für die beiden Antigene positiven Zellen korrelierten signifikant sowohl bei der malignen Zell-Population (Kurzzeitbeobachtung: n=89; r=0,9; p / The FMC7, although being an unknown structure of the B-cell membrane, represents one of the basic immunophenotypic criteria for the diagnosis of the typical B-CLL. A different CD20 expression is a characteristic sign for the sub-typing of lymphomas also. The underlying study investigated the qualitative and quantitative modulation of the CD20 and FMC7 antigens in patients with indolent B-cell lymphomas (CLL, n=12 and non-CLL, n=10) during the therapy with a CD20 antibody (rituximab). Concomitant changes of FMC7 and CD20 expression were found immediately after rituximab infusion and up to 8 weeks thereafter. A correlation was seen for the number of positive malignant cells and for the corresponding fluorescence intensity (short-time observation n=89; r=0.9; p

De nombreuses données expérimentales et cliniques ont montré l'importance des cellules Natural Killer (NK) dans l'immunosurveillance antitumorale. Les stratégies thérapeutiques basées sur les cellules NK pourraient donc être une alternative de choix dans le traitement de certains types de cancers. Nous avons focalisé notre étude sur deux types de cancer incurables malgré les récents progrès thérapeutiques : la leucémie lymphoïde chronique B (LLC-B) et le cancer de la prostate. Le but de notre étude est une meilleure compréhension des mécanismes mis en place par les cellules B leucémiques et les cellules tumorales prostatiques pour échapper à la réponse antitumorale des cellules NK. La connaissance de ces mécanismes d'échappement est un pré-requis indispensable à l'utilisation des cellules NK dans les thérapies antitumorales. Concernant la LLC-B, nos résultats suggèrent que les cellules NK de patients, fonctionnellement compétentes, ne peuvent pas initier une réaction immunitaire appropriée envers les cellules B leucémiques due au manque de reconnaissance de ces dernières. Concernant le cancer de la prostate, nos données préliminaires montrent que les cellules NK circulantes de patients sont également fonctionnellement compétentes, quelque soit le stade de la maladie, malgré la diminution significative de l'expression du récepteur NKp30. Ainsi, le degré d’immunogénicité des cellules B leucémiques et celui des cellules tumorales prostatiques devra être autant pris en compte que la fonctionnalité des cellules NK dans les stratégies visant à optimiser l'activité antitumorale de ces dernières. / Many experimental and clinical data have enlightened the importance of Natural Killer (NK) cells in tumor immunosurveillance. Therapeutic strategies based on NK cells could be an alternative in the treatment of certain cancers. We focused our study on two types of incurable cancers despite recent advances in treatment: B chronic lymphocytic leukemia (B-CLL) and prostate cancer. The aim of our study is a better understanding of the mechanisms set up by leukemic B cells and prostate cancer cells to escape from NK antitumor response. The knowledge of these escape mechanisms is an essential prerequisite to the use of NK cells in antitumor therapies. Regarding B-CLL, our results suggest that NK cells, although functionally competent, can not initiate an appropriate immune response against leukemic B cells due to a lack of recognition of the latter. Concerning the prostate cancer, our preliminary data show that circulating NK cells are functionally competent, whatever the stage of disease, despite the significant decrease in expression of the receptor NKp30. Thus, the degree of immunogenicity of leukemic B cells and of the prostate cancer cells must be taken into account as well as the functionality of NK cells in strategies aiming at improving NK antitumor activity.

La leucémie lymphoïde chronique (LLC) est caractérisée par une accumulation anormale de lymphocytes B matures. Les thérapies actuelles reposent sur l'utilisation d'inhibiteurs ciblant les kinases impliquées dans la voie du récepteur des cellules B (BCR), mais elles sont limitées par le niveau élevé de résistance à l’apoptose des cellules leucémiques. En effet, celles-ci échouent à éradiquer les cellules résistantes à l'apoptose, il est donc essentiel d'identifier d'autres voies de survie comme nouvelles cibles pour les thérapies anticancéreuses. La surexpression des récepteurs de surface couplés aux protéines G (RCPGs) entraîne une transformation cellulaire et joue ainsi un rôle essentiel dans les tumeurs malignes. Dans cette étude, nous montrons que le récepteur de la neurotensine de type 2 (NTSR2), un récepteur couplé aux protéines G, est un acteur essentiel dans les mécanismes de résistance à l'apoptose dans les cellules leucémiques. Le récepteur NTSR2 est surexprimé et constitutivement actif dans les cellules leucémiques, son activation dépend de son interaction avec le récepteur TrkB (Tropomyosin-related kinase B) et du recrutement des protéines Giα à la place de son interaction avec son ligand naturel, la neurotensine (NTS). L'interaction NTSR2-TrkB agit comme un oncogène conditionnel nécessitant le BDNF (Brain-Derived Neurotrophic Factor), le ligand de TrkB, qui est fortement exprimé dans les cellules B leucémiques, contrairement à son ligand naturel la NTS. L'interaction NTSR2-TrkB active les voies de signalisation de survie, y compris les voies de Src et Akt, ainsi que l'expression des protéines anti-apoptotiques Bcl-2 (B-cell lymphoma-2) et Bcl-xL (B-cell lymphoma-extra large). Néanmoins le récepteur TrkB seul ne protège pas les cellules B leucémiques d'une diminution drastique de la viabilité par apoptose lorsque NTSR2 est inactivé. L’ensemble de ces résultats suggèrent que l'interaction NTSR2-TrKB et l'activation soutenue des voies de signalisation dépendante de cette interaction constituent un mécanisme essentiel d’échappement à l'apoptose des cellules B leucémiques. Le ciblage du récepteur NTSR2 représente une stratégie prometteuse pour le traitement de cette pathologie. / Chronic lymphocytic leukemia (CLL) is characterized by the abnormal accumulation of mature B lymphocytes. Current therapies for CLL rely on using kinase inhibitors targeting B-cell receptor (BCR) pathways, but they are limited by the high level of apoptosis-resistant B-CLL cells, which results in a high frequency of patient relapse. Because current therapies fail to eradicate these apoptosis-resistant cells, it is essential to identify alternative survival pathways as novel targets for anticancer therapies. Overexpression of cell-surface G protein-coupled receptors (GPCRs) drives cell transformation, and thus plays a critical role in malignancies. In this study, we show that neurotensin receptor 2 (NTSR2), a G-protein-coupled receptor, is an essential driver of apoptosis resistance in B-CLL. NTSR2 was highly expressed and constitutively active in B-CLL cells, and its activation depended on its interaction with the tropomyosin-related kinase B receptor (TrkB) and the recruitment of Gi proteins, instead of its interaction with its natural ligand, neurotensin (NTS). The NTSR2-TrkB interaction acted as a conditional oncogenic driver requiring the TrkB ligand BDNF (Brain-Derived Neurotrophic Factor), which is highly expressed in B-CLL cells, unlike its natural ligand NTS. The NTSR2-TrkB interaction activates survival signaling pathways, including the Src and AKT kinase pathways, as well as expression of the anti-apoptotic proteins Bcl-2 (B-cell lymphoma-2) and Bcl-xL (B-cell lymphoma-extra large). TrkB failed to protect B-CLL cells from a drastic decrease in viability via typical apoptotic cell death when NTSR2 was down-regulated. Taken together, the results suggest that the NTSR2-TrKB interaction and the sustained activation of signaling pathways reliant on this interaction constitute an essential driving force for apoptosis evasion of B-CLL cells. Targeting NTSR2 could represent a promising strategy for treating B-CLL malignancy.

Student Number : 9708297R - MSc (Med) dissertation - School of Medicine - Faculty of Health Sciences / B chronic lymphocytic leukaemia (B-CLL) is a monoclonal haematopoietic disorder with expansion of small lymphocytes of B-cells. B-CLL cells accumulate in blood, bone marrow, lymph nodes and spleen, resulting in enlargement of these organs and decreased bone marrow function. B-CLL is the most common leukaemia, with an annual incidence of 1.8 to 3.0 per 100 000 population in the United States. It is characterised by the accumulation of long-lived monoclonal CD5+ B lymphocytes. In vivo normal B-lymphocytes derive growth factors through interactions with T-cells and monocytes. In culture however, survival and growth of activated B-cells depends on the availability of external factors such as interleukins. B-CLL cells populations are unable to survive in culture long enough to respond to the addition of growth factors. Such factors are important for the proliferation and survival of many cell types and in the absence of cytokines, these cells die as a result of apoptosis. Chronic lymphocytic leukaemia cells are influenced in vitro by a number of exogenously added cytokines that include IFN- α, IFN-γ, IL-2, IL-4, IL-10, IL-13, IL-15, TGF- β and TNF- α. The aim of this study was to investigate the effect of cytokines e.g., IFN, IL-2, IL-6, IL7 and IL-10 on the proliferation and survival of B-CLL cells and furthermore to compare the induction and reduction of spontaneous and induced apoptosis in vitro. Patients with B-CLL were recruited from three centres. Thirty blood samples were collected, separated using Ficoll Hypaque Gradient and purified by rosetting with AET treated SRBC. The proliferation and survival of B-CLL cells were studied in vitro in response to GM-CSF, IFN, IL-2, IL-6, IL7 and IL-10,. The survival and apoptosis of B-CLL cells in cultures with or without interleukins and other growth factors were studied under microscopic examinations and DNA agarose gel electrophoresis. It was observed in B-CLL cells cultures that IFN and IL-2 enhanced proliferation significantly. IL6, IL-7 and GM-CSF also enhanced proliferation of B-CLL cells but not to the greater extent than IL2 and IFN. IL-10 inhibited proliferation of B-CLL cells when compared to controls. In a long-term (5-day) culture, survival of B-CLL cells was greatly enhanced by IFN and followed by IL-2. Therefore it appeared that IFN and IL-2 are the two most potent growth factors tested in this study to promote B-CLL cells proliferation and survival. The combination of these mitogens did not further enhanced proliferation. IL-6 and GM-CSF enhanced proliferation and survival of B-CLL cells. IL-7 promoted proliferation but had no effect on survival of B-CLL cells in-vitro. IL-10 enhanced apoptosis and did not promote survival of B-CLL cells in-vitro. IFN and IL2 are survival and promoting growth factors for B-CLL cells in culture. In contrast, IL-10 has demonstrated to induce apoptotic cell death of B-CLL cells. In conclusion B-CLL cells proliferated equally well with IFN and IL-2. IL-6, IL-7 and GM-CSF had a much lower proliferation and survival effect with noticeable antiapototic activity when compared to IFN and IL-2. IL-7 was found not to promote survival of B-CLL cells and IL-10 enhanced cell death by apoptosis.

(EN) Chronic lymphocytic leukemia (B-CLL) represents a disease of mature-like B-cells. Due to failed apoptosis but also due to enhanced proliferative signals, the leukemic B-cells accumulate in the peripheral blood, bone marrow, lymph nodes and spleen. The clinical course of B-CLL is very heterogeneous; in some patients B-CLL progresses very rapidly into an aggressive form. Such patients need therapy sooner while in other patients with indolent B-CLL the onset of therapy takes years. Several standard prognostic and disease progression markers are used for disease staging and monitoring, however a reliable marker that will suggest when to start therapy is unknown. Expression of small, non-coding microRNAs is often deregulated and represent important prognostic markers in variety of cancers including leukemia. Hence in our study we concentrated to miR-155, an important molecule regulating differentiation of hematopoietic cells, inflammation process and antibody production. Its aberrant expression was described in Hodgkin`s as well as in non-Hodgkin`s lymphoma, including indolent lymphoproliferations like B- CLL. Our results confirmed elevated levels of both, primary miR-155 transcript and mature form of miR-155 in our B-CLL patient samples (N=239). The aberrant expression of miR-155 in B-CLL samples...

Η παρούσα διδακτορική διατριβή έχει ως στόχο τη δημιουργία ενός αποδοτικού μοντέλου για το Λειτουργικό Συνδυασμό Βιο-Ιατρικών δεδομένων (BioMedical data integration). Ξεκινώντας από τη σχεδιαστική ανάλυση της ιατρικής γνώσης και των προβλημάτων που προκύπτουν από τον τρόπο παραγωγής των ιατρικών δεδομένων, προχωρεί στην επίλυση των επιμέρους θεμάτων Λειτουργικού Συνδυασμού εντός ενός συγκεκριμένου ιατρικού πεδίου και καταλήγει στον ολοκληρωμένο Λειτουργικό Συνδυασμό ιατρικών δεδομένων προερχόμενων από διαφορετικές πηγές και πεδία γνώσης. Συνεχίζει με τη σχεδίαση ενός μοντέλου βάσεων δεδομένων που ακολουθεί «οριζόντια» λογική και είναι αρκετά αποδοτικό ώστε να αποκρίνεται σε πολύπλοκα και ευρείας κλίμακας ερωτήματα σε πραγματικό χρόνο. Καταλήγει με την παρουσίαση μίας ολοκληρωμένης εφαρμογής η οποία εκμεταλλευόμενη τα πλεονεκτήματα του Λειτουργικού Συνδυασμού και της οριζόντιας δομής των δεδομένων είναι σε θέση να διαχειριστεί εξετάσεις προερχόμενες από κάθε κυτταρομετρητή ροής και συνδυάζοντάς αυτές με τις υπόλοιπες αιματολογικές κλινικοεργαστηριακές εξετάσεις να απαντά σε καθημερινά και σύνθετα ερευνητικά, ιατρικά ερωτήματα. Τα πρωτότυπα ερευνητικά αποτελέσματα που προέκυψαν στα πλαίσια της παρούσης εργασίας δημοσιεύτηκαν σε έγκυρα διεθνή περιοδικά και σε διεθνή και ελληνικά συνέδρια με κριτές. / Current dissertation focuses on the creation of an efficient model for Bio-medical data integration. Starting with an analytical approach of the medical knowledge and the problems that may occur cause of the way that medical data are produced, continues with the necessary solutions for single domain data integration and concludes with the proposal of a working framework for mass data integration, originating from multiple medical domains. The proposed integration model is based on the “horizontal” logic of a database design and it’s efficient enough to produce query results in real time, even for complex real-life medical questions. The proof of concept of the working framework and its goals for mass data integration is achieved through the presentation of a medical information system. The presented system, by taking advantage of the “horizontal” database design, is able to manage Flow Cytometry measurements, originating for any available hardware and by integrating the cytometric data with other types of hematological data is able to give answers to everyday and research medical questions. All original research results that produced within the scope of this dissertation were published in international research journals and medical conferences.

Η Β-χρόνια Λεμφογενής Λευχαιμία (Β-ΧΛΛ) αποτελεί τον πιο κοινό τύπο λευχαιμίας στο Δυτικό κόσμο. Η πρόγνωσή της θεωρείται ως ένα από τα πιο ενδιαφέροντα προβλήματα απόφασης στην κλινική έρευνα και πρακτική. Για διάφορους κλινικούς και εργαστηριακούς δείκτες είναι γνωστό ότι σχετίζονται με την εξέλιξη της νόσου. Για τις παραμέτρους, όμως, που εξάγονται με ανάλυση κυτταρομετρίας ροής, οι οποίες αποτελούν τον ακρογωνιαίο λίθο της διαδικασίας διάγνωσης της νόσου, το αν προσφέρουν επιπρόσθετη προγνωστική πληροφορία αποτελεί ανοιχτό πρόβλημα. Στη διατριβή αυτή προτείνουμε ένα σύστημα υποβοήθησης για τις αποφάσεις των ειδικών του πεδίου, το οποίο πραγματοποιεί πολυπαραμετρική πρόγνωση ασθενών με Β-ΧΛΛ, συνδυάζοντας τη χρήση ποικίλων ετερογενών προγνωστικών δεικτών (κλινικών, εργαστηριακών και κυτταρομετρίας ροής) που σχετίζονται με τη νόσο. Η διάγνωση της Β-ΧΛΛ βασίζεται κυρίως στη μελέτη του αντιγονικού φαινότυπου των κυττάρων των ασθενών, η οποία διενεργείται με κυτταρομετρία ροής. Αν και η διαδικασία που ακολουθείται κατά την ανάλυση αυτή είναι σαφώς ορισμένη, ο τρόπος με τον οποίο οι εργαστηριακοί υπεύθυνοι την πραγματοποιούν παραδοσιακά χαρακτηρίζεται από ανακρίβεια και υποκειμενικότητα. Καθώς η τεχνολογία της κυτταρομετρίας ροής εξελίσσεται ραγδαία, γίνεται όλο και πιο επιτακτική η ανάγκη για την ανάπτυξη αυτοματοποιημένων μεθόδων ανάλυσης των δεδομένων που παράγει. Σε αυτά τα πλαίσια, παρουσιάζουμε ένα χρήσιμο παράδειγμα αυτοματοποιημένης ανάλυσης κυτταρομετρικών δεδομένων, η οποία δεν απαιτεί την άμεση επίβλεψη των ειδικών, για τη διάγνωση ασθενών με Β-ΧΛΛ. Οι τιμές των χαρακτηριστικών παραμέτρων που εξάγονται με εφαρμογή της προτεινόμενης μεθοδολογίας, ενσωματώνονται κατόπιν στο προαναφερθέν προγνωστικό σύστημα. Ανάγοντας το πρόβλημα της πρόγνωσης της Β-ΧΛΛ σε ένα στιγμιότυπο ταξινόμησης προτύπων, καθώς και προσομοιώνοντας κάθε ένα από τα βήματα της διαδικασίας της διάγνωσης της νόσου με ένα στιγμιότυπο συσταδοποίησης δεδομένων, αντιμετωπίσαμε τα δύο προβλήματα εφαρμόζοντας τεχνικές στατιστικής μάθησης. Εστιάσαμε σε μεθοδολογίες δικτύων πεποίθησης, χρησιμοποιώντας συγκεκριμένα το naïve-Bayes μοντέλο και για τις δύο περιπτώσεις, στην επιβλεπόμενη και στη μη επιβλεπόμενη εκδοχή του, αντίστοιχα. Τα χαρακτηριστικά και η φύση των δεδομένων (κυρίως των κυτταρομετρικών) που παράγονται από έναν παθολογικό υποκείμενο μηχανισμό, όπως αυτός της νόσου, δεν ευνοούν την απευθείας εφαρμογή του παραπάνω μοντέλου στο εκάστοτε στιγμιότυπο. Για το λόγο αυτό, συνδυάσαμε την εφαρμογή του naïve-Bayes μοντέλου με κατάλληλες ευρετικές αλγοριθμικές διαδικασίες, για την επίτευξη καλύτερων αποτελεσμάτων, με κριτήριο βέλτιστου όχι μόνο κάποιες συχνά χρησιμοποιούμενες μετρικές αποτίμησης αλγόριθμων, αλλά και τη γνώμη των αιματολόγων. Χάρη στην ιδιότητά τους να ενσωματώνουν την έμπειρη γνώση των ειδικών ως εκ των προτέρων πληροφορία αρχικοποίησης των μεθόδων μάθησής τους, οι Bayesian μεθοδολογίες κρίνονται ως οι πλέον κατάλληλες για την εφαρμογή τους σε τέτοιου τύπου προβλήματα. / B-Chronic Lymphocytic Leukemia (B-CLL) is known to be the most common type of leukemia in the Western world. Its prognosis remains one of the most interesting decision problems in clinical research and practice. Various clinical and laboratory factors are known to be associated with the evolution of the disease. However, for the parameters obtained by flow cytometry analysis, that are traditionally utilized as the cornerstone during the diagnosis procedure of the disease, whether they offer additional prognostic information is an open issue. In this dissertation, we propose a decision support system to the hematologists, that provides multiparametric B-CLL patients’ prognosis, combining the usage of diverse heterogeneous factors (clinical, laboratory and flow cytometry) associated with the disease. B-CLL diagnosis is primarily derived from the study of the antigenic phenotype of the patients’ blood cells, which is held with flow cytometry analysis. Despite the fact that the method of the analysis is well defined, the process traditionally followed by the laboratory experts is characterized by amounts of inexactness and subjectivity. As flow cytometry technology advances rapidly, the need for adequate automated (computer-assisted) analysis methodologies on the data it produces is accordingly increasing. In this context, we present a useful paradigm of automated analysis of flow cytometry data, that does not require the direct supervision of the expert, for B-CLL patients’ diagnosis. The values of the flow cytometry characteristic parameters extracted by applying the proposed methodology are afterward incorporated to the prognostic system for B-CLL mentioned above. By reducing the B-CLL prognosis problem to an instance of the pattern classification problem, as well as by simulating each step of the B-CLL diagnosis procedure with an instance of the data classification problem, we proceeded with applying statistical learning techniques. We focused on Bayesian network methodologies and utilized the naïve-Bayes model for both cases, in its supervised and unsupervised version, respectively. The characteristics of the data (especially of the flow cytometry ones) generated by a pathological underlying mechanism, like the disease’s one, did not encourage the direct use of the above model. Therefore, we combined the naïve-Bayes model with a set of suitable heuristic algorithmic procedures to obtain better results, not only with respect to some commonly used algorithmic optimality metrics, but also by considering the experts’ opinion. Due to their ability of incorporating the expert knowledge as a priori initial information to their learning methods, Bayesian methodologies are considered as the most appropriate ones to make use of in such types of applications.