Caractérisée par la présence de la mutation JAK2 V617F, la polyglobulie primitive voit son développement contenu par des saignées mais est associée à une incidence plus élevée de cancers. Une exploration globale de l'immunité des patients a été réalisée par la quantification des sous populations lymphocytaires de l'immunité innée et adaptative. Ceci a permis la mise en évidence d'une diminution des lymphocytes B et d'une augmentation des cellules NK. Les cellules NK sont réputées pour leurs propriétés antitumorales mais elles ne sont pourtant pas capables d'éradiquer la PV, posant la question de leurs capacités fonctionnelles. Si les cellules NK des patients présentent une activité cytotoxique basale inférieure aux témoins, elles ne présentent pas d'anomalies de l'expression de leurs récepteurs, de la production de molécules cytolytiques ou de prolifération. Par contre, les cellules NK d'un patient ayant développé une érythroleucémie ou des cellules NK de sujets âgés par rapport à des témoins plus jeunes présentent des anomalies d'expression des récepteurs. L'augmentation des cellules NK pourrait être liée à la mutation JAK2 V617F. Si cette mutation est présente dans les lymphocytes de tous les patients, il existe des arguments pour sa présence dans les cellules NK de certains patients. Enfin, une analyse transcriptomique a permis de définir un profil d'expression propre aux cellules NK des patients. / Characterized by the presence of the JAK2 V617F mutation, polycythemia vera's development is content by phlebotomy but is associated with a higher incidence of cancer. A global exploration of the immunity of patients was performed by quantification of lymphocyte subpopulations of innate and adaptive immunity. This allowed the detection of a decrease in B cells and an increase in NK cells. NK cells are known for their antitumor properties but they are not yet able to eradicate PV, raising the question of their functional abilities. If NK cells of patients have a lower basal cytotoxic activity than healthy donors, they do not show abnormal expression of their receptors, the production of cytolytic molecules or proliferation. On the contrary, NK cells from a patient who developed erythroleukemia or NK cells from elderly healthy donors compared with younger healthy donors exhibit abnormalities of receptors expression. The increase in NK cells could be related to the JAK2 V617F mutation. If the mutation is present in cells of all patients, there are arguments for its presence in the NK cells of some patients. Finally, transcriptome analysis has identified an expression profile specific to NK cells of patients.

The Mevalonate Pathway: A Potential Therapeutic Target for JAK2-driven Myeloproliferative Neoplasms Lori Nicole Griner Abstract Myeloproliferative neoplasms (MPNs) are diseases of hematopoietic stem cell origin and are characterized by uncontrolled growth of cells of the myeloid compartment. The Philadelphia chromosome negative classical MPNs, including polycythemia vera, essential thrombocythemia, and myelofibrosis, are diseases of dysregulated JAK2 signaling. In fact, the majority of MPN patients have activating mutations in JAK2 (e.g JAK2-V617F), a tyrosine kinase that contributes to the growth and survival of myeloid cells. While MPNs were first described over sixty years ago, a significant need remains to develop therapeutic strategies for them. Inhibitors of JAK2 are currently being developed, and one inhibitor, ruxolitinib, was recently approved for certain MPN patients. Ruxolitinib has made profound impacts on improving splenomegaly and constitutional symptoms in MPN patients, but it and other JAK2 inhibitors have not significantly reduced the JAK2 mutant allele burden, and thus such inhibitors have not induced remission in these patients. The current consensus in the MPN field supports JAK inhibition for the treatment of patients, but a further understanding of MPNs and JAK2 signaling, as well as improved JAK2 inhibitors, may be necessary for treating MPN patients. The work described in this dissertation has uncovered novel requirements for JAK2-V617F-driven signaling and transformation. We demonstrate that JAK2-V617F co-localizes with lipid rafts, cholesterol-rich microdomains within the plasma membrane that function to serve as platforms for signaling complex formation. Signaling complex formation is a necessary component for dysregulated signaling induced by JAK2-V617F. We provide evidence that cholesterol altering-lipid raft disrupting agents attenuate JAK2-V617F-driven signaling. We also show that cholesterol-lowering statins are effective at downregulating JAK2 signaling and inducing apoptosis in JAK2-V617F-driven cell lines. Importantly, we show that statins, inhibitors of the mevalonate pathway, inhibit the growth of primary MPN cells, while the same statin doses have no effect on healthy controls. Impressively, we demonstrate that statins cooperate with multiple JAK inhibitors, including ruxolitinib, to inhibit cell growth and induce apoptosis of JAK2-V617F-driven cells. This report establishes statin-mediated inhibition of the mevalonate pathway as a potential approach to improve MPN therapeutics. We propose future studies with statins and JAK2 inhibitors in the treatment of MPNs.

Made available in DSpace on 2015-07-22T20:50:04Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-06-30 / Objetivos: Descrever as alteracoes cromossomicas em policitemia vera (PV), trombocitemia essencial (TE) e mielofibrose primaria (MF). Verificar se a taxa de anormalidades cromossomicas e ampliada pela FISH nos casos com cariotipo normal e ausencia de metafases. Detectar a incidencia da mutacao JAK2 V617F em PV, TE e MF; de mutacoes no exon 12 do JAK2 em PV e de mutacoes MPL W515K/L em TE e MF. Correlacionar as alteracoes citogeneticas e moleculares encontradas com o grau de fibrose medular nos casos de MF; numero de leucocitos, plaquetas, hemoglobinas; e idade, ao diagnostico, em todos pacientes. Metodo: O estudo foi realizado em 20 casos de PV, 17 de TE e 21 de MF. O cariotipo por banda G foi realizado em amostras de medula ossea, semeadas em cultura de curta duracao (24h), sem mitogenos e processadas de forma habitual (Chauffaille, 2006). Parte da amostra (1mL) foi destinada a FISH, com sondas para as regioes: 20q12, 20q13.12, 13q14.3, 13qter (subtelomerica), 8p11.1-q11.1 (ƒ¿-satellite) e 9q12 (satellite III). A pesquisa das mutacoes JAK2V617F e MPL W515K/L foi realizada em DNA de sangue periferico, por PCR em tempo real, utilizando-se o kit JAK2 MutaScreenTM (Ipsogen). A pesquisa de mutacoes no exon 12 do JAK2 foi realizada por sequenciamento direto. Resultados: As alteracoes cromossomicas foram observadas em 11,8% das PV, 17,6% das MF e nenhuma das TE, nao havendo relacao entre dados clinicos avaliados e alteracoes cromossomicas. As anormalidades cromossomicas nao foram ampliadas pela FISH. JAK2 V617F foi observada em 90% das PV, 42,8% das MF e 47% das TE. Os pacientes com PV JAK2 V617F negativos apresentaram menores niveis de plaquetas em relacao aos PV V617F positivos (p<0,0001). MF V617F positivos apresentaram maiores graus de fibrose do que os V617F negativos (p=0,003). Nao foi detectada a presenca de mutacoes no exon 12 do JAK2 em pacientes com PV. MPL W515L foi observada em um caso de MF e em um de TE. Nao foi encontrada a mutacao MPL W515K nos pacientes com TE e MF. A paciente com TE MPL W515L positivo nao apresentou quadro clinico diferente dos demais pacientes com TE, enquanto que a paciente com MF MPL W515L positivo apresentou quadro clinico mais agressivo quando comparada aos demais pacientes com MF. O numero de alteracoes clonais nao mostrou diferenca quanto aos dados clinicos avaliados. Conclusoes: Os diferentes tipos de alteracoes clonais em neoplasias mieloproliferativas exaltam seus diferentes mecanismos fisiopatogenicos, auxiliando no diagnostico e compreensao da biologia destas doencas. Este estudo permitiu a caracterizacao citogenetica e molecular de PV, MF e TE. / Introcuction: Polycythemia vera (PV), essential thrombocythemia (ET) and myelofibrosis (MF) are clonal disorders of hematopoietic stem cell and clinical and biological aspects have in common that hinder their diagnosis, however, cytogenetic and molecular studies represent important tools to assist in this procedure. Therefore, the investigation of the presence of JAK2 V617F, mutations in exon 12 of JAK2, MPL W515K of MPLW515L and cytogenetic alterations per karyotype and FISH can provide a more detailed view for the diagnosis and prognosis of these diseases. In this study such cytogenetic and molecular changes were correlated with degree of fibrosis in cases of MF, the number of leukocytes, platelets, hemoglobin and age at diagnosis in PV, ET and MF Method: The karyotype by G-band was performed on samples of bone marrow, grown in culture for short duration (24h) without mitogens and processed as usual (Chauffaille, 2006). The sample (1 ml) was intended to FISH with probes for the regions: 20q12, 20q13.12, 13q14.3, 13qter, 8p11.1-q11.1 and 9q12. The investigation of JAK2 V617F and MPL W515K/L mutations was performed on DNA from peripheral blood by real time PCR, using the kit MutaScreenTM JAK2 (IPSOGEN). The search for mutations in exon 12 of JAK2 was performed by direct sequencing. Results: Chromosomal abnormalities were observed in 11.8% of PV, 17.6% of MF and none of the ET, no relation between clinical data and assessed chromosomal alterations. Chromosomal abnormalities were not amplified by FISH. JAK2 V617F was observed in 90% of PV, 42.8% of MF and 47% of ET. Patients with JAK2 V617F negative PV showed lower levels of platelets in relation to V617F positive PV (p <0.0001). MF V617F negative and MPL W515L positive showed higher degrees of fibrosis than V617F negative (p =0.003). Was not detected the presence of mutations in exon 12 of JAK2 in PV patients. MPL W515L was observed in a case of MF and a TE. No MPL W515K mutation was found in patients with ET and MF. The ET patient MPL W515L positive showed no clinical different from other patients with ET, whereas the patient with MF MPL W515L showed positive clinical more aggressive when compared to other patients with MF. The number of clonal abnormalities showed no difference in the clinical data evaluated. Conclusions: Different types of clonal abnormalities in myeloproliferative neoplasms exalt their different pathophysiological mechanism, aiding in the diagnosis and understanding of the biology of these diseases. This study allowed the cytogenetics and molecular characterization of PV, MF and ET. / TEDE / BV UNIFESP: Teses e dissertações

Les néoplasies myéloprolifératives (NMP) sont des maladies hématologiques acquises de la cellule souche hématopoïétique. Une mutation activatrice de la protéine de signalisation JAK2, JAK2V617F, a été identifiée chez la moitié des patients atteints de NMP Philadelphie négatives. Il a été rapporté que les patients avec des NMP avaient une augmentation du risque thrombotique et de la densité microvasculaire dans la rate et la moelle osseuse, sans explication physiopathologique claire. Des travaux récents ont mis en évidence la présence de la mutation JAK2V617F non seulement dans les cellules sanguines mais également dans les cellules endothéliales (CE) de ces patients. Nous faisons l’hypothèse que la présence de JAK2V617F dans les CE pourrait modifier leurs propriétés expliquant l’augmentation de l’angiogenèse dans les NMP. Pour répondre à cette hypothèse, nous avons voulu étudier le phénotype angiogénique des cellules endothéliales portant la mutation JAK2V617F. In vitro, nous disposons des particules lentivirales permettant d’obtenir des CE JAK2V617F par transduction lentivirale. In vivo, nous disposons des souris transgéniques exprimant la mutation JAK2V617F de manière conditionnelle (JAK2V617F/WT) grâce à la stratégie Cre-lox. Pour répondre à notre hypothèse, il été nécessaire de travailler avec des modèles murins exprimant la mutation JAK2V617F spécifiquement dans les CE sans atteinte concomitante de la lignée hématopoïétique. Dans un premier temps, nous avons voulu caractériser deux modèles endothéliaux inductibles couramment utilisés, Cdh5(PAC)-CreERT2 et Pdgfb-iCreERT2, en termes d’efficacité et de spécificité de recombinaison dans les cellules endothéliales vis-à-vis du compartiment hématopoïétique. Nous avons démontré que les souris adultes Cdh5(PAC)-CreERT2 pouvaient être utilisées comme modèles endothéliaux spécifiques, avec toutefois la mise en garde que la recombinaison est très variable entre les souris. Nous avons constaté que les souris PDGFB-iCreERT2 sont appropriées pour cibler les cellules endothéliales dans une large gamme d’organes à l'exception du foie, et devraient être utilisées dans les quatre premières semaines qui suivent l'induction, pour cibler un gène d’intérêt au niveau des cellules endothéliales, sans qu’il ait une atteinte concomitante dans la lignée hématopoïétique. Nous avons ensuite étudié les propriétés angiogéniques des cellules endothéliales JAK2V617F, in vitro en utilisant des HUVEC transduites avec un lentivirus permettant l’expression de JAK2V617F, et in vivo avec les souris Pdgfb-iCreERT2;JAK2V617F/WT. Nous avons démontré que les HUVEC JAK2V617F avaient un profil proangiogénique lié à une capacité proliférative élevée, résultant de l’activation de la voie JAK2/STAT3/PI3K. L’avantage hyperprolifératif que confère la mutation JAK2V617F aux cellules endothéliales a été confirmé in vivo avec le modèle de la vascularisation post-natale de la rétine, avec toutefois une diminution de la densité du réseau vasculaire due à une augmentation de la régression vasculaire au niveau de la rétine des souris Pdgfb-iCreERT2;JAK2V617F/WT. / Myeloproliferative neoplasms (MPNs) are acquired hematopoietic stem cell disorders. An activating mutation in the JAK2 signaling protein, JAK2V617F, was identified in half of the patients with Philadelphia chromosome-negative MPNs. It has been reported that patients with MPN had an increased risk of thrombosis but also an increased microvessel density in the spleen and bone marrow with no clear pathophysiological explanation. Several recent studies have demonstrated the presence of JAK2V617F mutation not only in blood cells but also in endothelial cells (EC) in MPN patients. We hypothesized that the presence of JAK2V617F in EC could change their properties leading to an increased angiogenesis process in MPNs. To address this question, our aim was to study the angiogenic phenotype of endothelial cells carrying the JAK2V617F mutation. For the in vitro experiments, we used lentiviral transduction of human JAK2V617F in EC. For the in vivo approach, we used transgenic mice (JAK2V617F/WT) that conditionally express JAK2V617F through Cre-lox strategy. To investigate our hypothesis, it was necessary to work with mice that express JAK2V617F specifically in EC without concomitant expression in hematopoietic cells. We first characterized two commonly-used inducible endothelial models, Cdh5(PAC)-CreERT2 and Pdgfb-iCreERT2, in terms of efficiency and specificity of recombination in endothelial cells. We showed that adult Cdh5(PAC)-CreERT2 mice can be used as specific endothelial model with however the wariness that recombination is highly variable among mice. We found that Pdgfb-iCreERT2 mice are appropriate to target endothelial cells in a wide range of organs except liver, and should be used within the four weeks after induction of Cre-mediated recombination to target a gene of interest in endothelial cells, without having a concomitant expression in hematopoietic lineage. We then studied the angiogenic properties of JAK2V617F endothelial cells, in vitro using JAK2V617F transduced HUVECs, and in vivo using Pdgfb-iCreERT2;JAK2V617F/WT mice. We observed that JAK2V617F HUVECs had a proangiogenic profile that was related to a highly proliferative potency, and that this phenotype results from a constitutive activation of JAK2/STAT3/PI3K pathway. The hyperproliferative advantage conferred by JAK2V617F to endothelial cells was confirmed in vivo using the postnatal vascularization model of the retina, with however a decrease in the density of the vascular network due to an increased vascular regression in Pdgfb-iCreERT2;JAK2V617F/WT mice’s retinas.