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RhoH est une petite protéine G de la famille Rho constitutivement activée. Cette protéine, exclusivement exprimée dans les cellules hématopoïétiques, intervient dans le développement du système immunitaire. Elle régule la croissance des cellules souches et des progéniteurs hématopoïétiques, la différenciation des lymphocytes T et la signalisation des récepteurs TCR, BCR et FcεRI présents respectivement à la surface des cellules T, B et des mastocytes. La dérégulation de l’expression du gène RHOH est un facteur de progression tumorale dans certaines leucémies. En effet, l’augmentation de son expression dans la Leucémie Lymphoïde Chronique (LLC) et sa répression dans la leucémie à tricholeucocytes (HCL) sont des évènements impliqués dans la progression de ces maladies. La LLC et l’HCL sont deux pathologies affectant des lymphocytes B matures mais, pour cette dernière, les cellules présentent un état de différenciation plus avancé. RhoH module donc différemment les processus de prolifération, de migration et de survie cellulaires selon le stade de maturation des cellules, suggérant que son expression soit finement régulée dans les cellules hématopoïétiques. Au laboratoire, notre équipe a mis en évidence la répression de RHOH dans l’HCL, responsable de la progression de cette maladie. Cette expression anormale est le résultat d’une diminution des transcrits RHOH initiés en amont de l’exon 4. Le même phénomène a également été observé dans la leucémie T de l’adulte (ATL). L’HCL et l’ATL sont deux maladies caractérisées par une prolifération anormale de cellules matures activées de type B (HCL) ou de type T (ATL). Nous avons donc projeté de comprendre les mécanismes moléculaires intervenant dans la régulation physiologique du gène RHOH au cours de l’activation lymphocytaire B et T ; puis de mettre en évidence les évènements responsables de la répression de RHOH dans l’HCL et l’ATL. Notre objectif serait d’y restaurer l’expression de RHOH et ainsi d’essayer de contrecarrer le phénotype leucémique, ceci dans le but de proposer de potentielles nouvelles cibles thérapeutiques dans ces deux leucémies, dont les traitements sont soit inefficaces (ATL), soit satisfaisants mais associés à des taux de rechutes assez élevés (HCL). Notre projet s’est tout d’abord orienté sur l’étude de la régulation normale du gène RHOH dans les cellules B et T. Nos résultats ont permis de montrer que l’expression du gène RHOH est principalement due à l’activité du promoteur P3 dans les lymphocytes B et T normaux et dans des lignées cellulaires lymphoïdes. Dans les lignées lymphoïdes B, le promoteur P3 a été caractérisé et correspond à la séquence -236/+67, en regard du site d’initiation de la transcription. Nous avons observé une augmentation de son activité suite à l’activation de ces cellules par un analogue du diacylglycérol (DAG), suggérant que des facteurs de transcription comme AP1, complexe formé des membres des familles Jun et Fos, sont impliqués dans la régulation du gène RHOH dans des lignées cellulaires lymphoïdes B. Nos résultats ont également permis de mettre en évidence : d’une part, la fixation de JunD sur le promoteur P3, par immunoprécipitation de la chromatine et son rôle de régulateur négatif dans la transcription de RHOH ; d’autre part, l’importance des membres de la famille Fos dans l’expression de ce gène, dans la lignée lymphoïde B Raji. Dans les lymphocytes T, l’activation des cellules par des anticorps anti-CD3 et anti-CD28 a permis d’observer une variation biphasique de l’expression des transcrits RHOH initiés en amont de l’exon 4, au niveau du promoteur P3 : tout d’abord, une forte augmentation du taux des ARN messagers, reproduite par l’utilisation d’un ionophore pour le calcium, suivie d’une répression, mimée par l’analogue du DAG. / The hematopoietic GTPase RhoH is an atypical family member of the Rho GTPases as it is constitutively active and not regulated through the classical cycling between GTP- and GDP-bound state. A number of studies investigated the role of RhoH in hematopoietic cells. RhoH is associated with regulation of proliferation of hematopoietic stem and progenitors. This protein exhibits essential functions in thymocyte development and TCR, BCR, FcεRI signaling in T, B and mast cells, respectively. Recently, a report provided evidence implicating RhoH overexpression in the initiation and progression of Chronic Lymphocytic Leukemia (CLL); on the other hand, RhoH underexpression has been implicated in the progression of Hairy Cell Leukemia (HCL). Most data indicate that RhoH is an important regulatory molecule with antagonistic functions in proliferation, adhesion or migration in hematopoietic cells and therefore must be accurately regulated. Previous experiments from our laboratory reported that HCL is characterized by abnormal underexpression of RhoH, corresponding to a decreased level of RHOH mRNA initiated upstream of exon 4. Reconstitution of RhoH expression reduced proliferation, adhesion and migration that is central in HCL pathogenesis. Transcriptional repression of this gene was also observed in another leukemia, Adult T cell Leukemia (ATL). Aimed at identifying new therapeutic targets to combat HCL and ATL, we wanted to examine molecular mechanisms implicated in RhoH underexpression in both diseases. HCL and ATL are chronic lymphoproliferative disorders characterized by proliferation of mature cells with memory B cell or T-helper cell phenotype, respectively. In the first part of our work, we wanted to investigate molecular mechanisms mediating normal RhoH expression in activated B and T cells, as well as induced pathways; in the second part, we tempted to identify transcription factors implicated in RhoH repression in HCL and ATL. Firstly, our work has focused onto physiological expression of RHOH gene in B and T cells. We showed that RHOH gene expression observed in these cells was mostly due to transcriptional activity of P3 promoter, upstream of RHOH exon 4. The promoter was isolated spanning nucleotides -236/+67 relative to the transcription start site, in B cells. B cells stimulation by PMA (Phorbol-12-Myristate-13-Acétate) induced an increase of P3 promoter activity. PMA is a DiacylGlycerol (DAG) analogous. This result suggested that transcription factors related to DAG pathway stimulation, like AP1 (Activator Protein 1), could be responsible for RHOH expression in B cells. We could show that the Jun family member JunD is able to bind to endogenous P3 promoter and can act as a repressor of RHOH expression in a B cell line, Raji. Other Jun family members seemed not to be implicated in this regulation. We also reported that Fos family members are important in RHOH expression. Our results suggest that the transcription factor AP1 could regulate this process in B cells. T cell activation by antibodies directed against CD3 and CD28 induced biphasic kinetics of expression of RHOH mRNA initiated upstream of exon 4. We observed a high increase of RHOH transcript level, mimicked by use of ionomycin, followed by an important decrease, mimicked by use of PMA. RHOH P3 promoter was isolated in a T cell line, Jurkat, then we investigated putative binding sites for transcription factors, which could be implicated in this biphasic event in T cells. Our preliminary results have shown that some potential binding sites for transcription factors related to calcium pathway and inducing RHOH expression are present between nucleotides -236 and -201; also sites for transcription factors induced by DAG pathway and repressing this gene are present between nucleotides -583 and -380.

Ng, Ka Yan. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 118-131). / Abstracts in English and Chinese. / Thesis Abstract --- p.i / 論文摘要 --- p.vi / Acknowledgements --- p.x / Abbreviations --- p.xii / Thesis Content --- p.xv / List of Figures --- p.xix / List of Tables --- p.xxi / Chapter Chapter 1 --- Introduction --- p.1 / Chapter 1.1 --- Haematopoiesis --- p.1 / Chapter 1.2 --- Leukemia --- p.2 / Chapter 1.3 --- Childhood B-cell precursor acute lymphoblastic leukemia (BCP-ALL) --- p.3 / Chapter 1.3.1 --- Epidemiology --- p.4 / Chapter 1.3.2 --- Causes and risk factors --- p.4 / Chapter 1.3.3 --- Clinical features --- p.6 / Chapter 1.3.4 --- Morphology --- p.6 / Chapter 1.4 --- Classification of BCP-ALL --- p.7 / Chapter 1.4.1 --- Immunophenotyping --- p.7 / Chapter 1.4.2 --- Cytogenetics and molecular genetics --- p.9 / Chapter 1.5 --- Prognostic factors --- p.13 / Chapter 1.6 --- Current treatments of BCP-ALL --- p.15 / Chapter Chapter 2 --- Literature Review --- p.18 / Chapter 2.1 --- Cytogenetics abnormalities in BCP-ALL --- p.18 / Chapter 2.1.1 --- Chromosomal translocation --- p.18 / Chapter 2.1.2 --- Aneuploidy --- p.21 / Chapter 2.2 --- Epigenetic aberrations --- p.21 / Chapter 2.2.1 --- DNA methylation --- p.22 / Chapter 2.2.2 --- Mechanism of DNA Methylation in Transcription Repression --- p.23 / Chapter 2.3 --- DNA Methylation in Normal Haematopoiesis --- p.25 / Chapter 2.4 --- DNA Methylation in Haematological Malignancies --- p.26 / Chapter 2.4.1 --- DNA methylation in ALL --- p.26 / Chapter 2.4.2 --- DNA methylation in BCP-ALL --- p.29 / Chapter 2.5 --- Angiogenesis in pathogenesis of acute leukemias --- p.30 / Chapter 2.6 --- Thrombospondin-1 (TSP-1) --- p.32 / Chapter 2.6.1 --- Structure of TSP-1 --- p.33 / Chapter 2.6.2 --- The role of TSP-1 in tumorigenesis --- p.34 / Chapter 2.6.3 --- TSP-1 mediates the activation of TGFβ --- p.36 / Chapter 2.6.4 --- TSP-1 mediates TGFβ-induced Apoptosis --- p.37 / Chapter 2.6.5 --- Association of TGFβ with normal haematopoiesis and haematological malignancies progression --- p.40 / Chapter 2.6.6 --- TSP-1 Induced Apoptosis via its Receptor CD36 --- p.42 / Chapter 2.6.7 --- THBS1 promoter hypermethylation and its association with tumorigenesis --- p.43 / Chapter 2.6.8 --- Effect of THBS1 aberrant methylation on TGFp --- p.45 / Chapter Chapter 3 --- Rationale of Study --- p.47 / Chapter Chapter 4 --- Materials and Methods --- p.52 / Chapter 4.1 --- Patient sample --- p.52 / Chapter 4.2 --- Cell lines --- p.52 / Chapter 4.3 --- Mononuclear cells isolation --- p.53 / Chapter 4.4 --- THBS1 promoter hypermethylation analysis --- p.54 / Chapter 4.4.1 --- DNA extraction from mononuclear cells and cell lines --- p.54 / Chapter 4.4.2 --- Bisulfite conversion --- p.55 / Chapter 4.4.3 --- Methylation specific PCR (MSP) --- p.55 / Chapter 4.5 --- Quantification of THBS1 mRNA expression --- p.57 / Chapter 4.5.1 --- RNA extraction --- p.57 / Chapter 4.5.2 --- Reverse transcription PCR --- p.58 / Chapter 4.5.3 --- Real-time RT-PCR --- p.58 / Chapter 4.6 --- Determination of plasma TSP-1 level --- p.59 / Chapter 4.7 --- TSP-1 treatment --- p.60 / Chapter 4.8 --- Flow cytometry analysis --- p.60 / Chapter 4.8.1 --- Annexin-V analysis --- p.60 / Chapter 4.8.2 --- Cell fixation --- p.61 / Chapter 4.8.3 --- Analysis of Caspase-3 activation --- p.62 / Chapter 4.8.4 --- "Analysis of TGFβ downstream pathway activation: Phosphorylation of Smad2/3, JNK and p38" --- p.62 / Chapter 4.9 --- Determination ofTGF-β expression --- p.63 / Chapter 4.10 --- Statistical analysis methods --- p.64 / Chapter Chapter 5 --- Results / Chapter 5.1 --- THBS1 methylation statuses in BCP-ALL patients and cell lines --- p.66 / Chapter 5.2 --- Correlation of THBS1 methylation statuses and clinico- pathological features in BCP-ALL patients --- p.68 / Chapter 5.3 --- Association of THBS1 methylation and THBS1 mRNA expression --- p.69 / Chapter 5.4 --- Effect of TSP-1 treatment on apoptosis level of BCP-ALL cells --- p.72 / Chapter 5.4.1 --- Annexin-V assay --- p.72 / Chapter 5.4.2 --- Caspase-3 activation assay --- p.75 / Chapter 5.5 --- THBS1 methylation and activation of secreted TGFβ --- p.78 / Chapter 5.6 --- Effect of TSP-1 treatment on activation of TGFβ --- p.80 / Chapter 5.7 --- The involvement ofTGFβ activation in TSP-1 induced apoptosis in BCP-ALL --- p.82 / Chapter 5.8 --- The association of TGFβ signaling pathway activities with THBS1 methylation --- p.86 / Chapter Chapter 6 --- Discussion --- p.91 / Chapter 6.1 --- THBS-1 promoter hypermethylation in BCP-ALL cell lines and patients: Correlation with expression and clinico-pathological profile --- p.93 / Chapter 6.1.1 --- THBS1 promoter hypermethylation status in childhood BCP-ALL --- p.93 / Chapter 6.1.2 --- THBS1 methylation as prognostic markers --- p.94 / Chapter 6.1.3 --- "Association of THBS1 methylation status, mRNA expression and TSP-1 protein expression in childhood BCP-ALL" --- p.96 / Chapter 6.2 --- Study of the correlation of TSP-1 induced apoptosis with the THBS1 promoter methylation status --- p.99 / Chapter 6.3 --- Elucidation of the molecular mechanisms of TSP-1 induced apoptosis: study of the involvement of TGFβ activation --- p.103 / Chapter 6.3.1 --- Latent TGFβ activation by TSP-1 in BCP-ALL and association with THBS1 methylation status --- p.103 / Chapter 6.3.2 --- TSP-1 induced cell death through activation ofTGFβ --- p.105 / Chapter 6.3.3 --- TSP-1 induced apoptotic signals via TGFβ signaling pathway --- p.107 / Chapter 6.4 --- Limitation of study --- p.113 / Chapter 6.5 --- Future studies --- p.114 / Chapter 6.5.1 --- Continuation study in TSP-1 induced TGFβ-mediated pathways --- p.114 / Chapter 6.5.2 --- Microarray analysis --- p.115 / Chapter 6.6 --- TSP-1 in treatment of childhood BCP-ALL --- p.115 / Chapter Chapter 7 --- Conclusion --- p.117 / Reference --- p.118

CD20 est une cible thérapeutique validée pour l’immunothérapie des néoplasmes lymphoïdesdes cellules B, incluant la Leucémie Lymphoïde Chronique (LLC). Nous avons comparé les effets de rituximab et de GA101 (nouvel anticorps anti-CD20) contre les cellules LLC fraiches in vitro. Le marquage avec Annexine V a démontré une induction de l’apoptose après l’exposition au rituximab et GA101.Contrairement au rituximab, GA101 induisait une réduction du potentiel transmembranaire mitochondrial, uneffet qui peut être partiellement inhibé par la cyclosporine A et qui est partiellement caspase-dépendant. GA101induisait aussi la production des espèces d’oxygènes réactives. L’analyse du niveau d’expression des protéinespro- et anti-apoptotiques après exposition aux anticorps a démontré une forte hétérogénéité entre les échantillons.Bax subissait une activation de conformation et une translocation mitochondriale suite à l’exposition aux anticorps d’une manière caspase-indépendante. GA101, mais pas rituximab, induisait le clivage des caspase-8, -9et -3. En transfectant les cellules LLC avec un siRNA ciblant Bcl-xL utilisant la sonoporation, nous avons trouvéque la réduction du niveau d’expression de Bcl-xL est associée à une augmentation de la sensibilité aux anticorps. Nos résultats suggèrent que les voies de signalisation apoptotiques diffèrent entre rituximab et GA101avec une implication de la voie mitochondriale avec le GA101. L’inhibition de Bcl-xL peut constituer une façon pour sensibiliser les cellules LLC aux effets apoptotiques des anticorps anti-CD20. / CD20 is a validated target for the immunotherapy of B lymphoid neoplasms, including ChronicLymphocytic Leukemia (CLL). We compared the activities of rituximab and GA101 (novel anti-CD20 antibody)on fresh human CLL cells in vitro. AnnexinV staining demonstrated induction of apoptosis after exposure torituximab or GA101. Unlike rituximab, GA101 induced a reduction of the mitochondrial transmembranepotential, an effect which could be partially inhibited by cyclosporin A and which was partially caspasedependent.GA101 was also found to induce the production of Reactive Oxygen Species. Analysis of pro- andanti-apoptotic protein content after exposure to antibodies demonstrated a strong degree of heterogeneity between samples. Bax underwent conformational activation and mitochondrial translocation upon exposure toantibodies in a caspase-independent manner. GA101 but not rituximab induced cleavage of caspase-8, -9 and -3.By transfecting CLL cells with anti-Bcl-xL siRNA using a sonoporation method, we found that reduction of BclxLcontent was associated with increased sensitivity to these antibodies. Our results suggest that apoptoticsignalization pathways differ between rituximab and GA101 with a greater involvement of the mitochondrialpathway for GA101. Inhibition of Bcl-xL could constitute an approach to sensitize CLL cells to the apoptoticeffects of anti-CD20 antibodies.

Chronic Lymphocytic Leukemia (CLL) is defined by the accumulation of clonally expanded CD5+ and CD19+ B lymphocytes in blood and secondary lymphoid organs with impaired apoptotic mechanisms. CLL represents one third of all leukemia cases with an average age of 72 years at diagnosis making it the most common adult leukemia. The Eµ-Tcl1 mouse serves as an excellent model to study the development of CLL as they progress to a CLL like disease by 9-14 months of age, due to overexpression of an oncogene, T cell Leukemia 1(Tcl1), specifically in B cells through the Ig VH promoter and Eµ enhancer (Bichi et al. PNAS. 2002). In an adoptive transfer model, intravenous or intraperitoneal injection of primary CD5+CD19+ CLL cells from the Eµ-Tcl1 CLL mouse into recipient syngeneic mice leads to the development of a CLL like disease within 3-8 weeks of transfer. We have characterized the growth of CLL cells in these mice by periodic submandibular bleeding, spleen ultrasonography and flow cytometry. We find that Eµ-Tcl1 CLL cells express more Prostate apoptosis response-4 protein (Par-4), a known pro-apoptotic tumor suppressor protein, than normal B-1 or B-2 cells in mice. Par-4 is silenced by promoter methylation in more than 30% of all cancers and has been shown to be secreted and to induce apoptosis selectively in various types of cancer cells but not in normal cells. We found that CLL cells have constitutively active B-cell receptor signaling (BCR) and that inhibition of BCR signaling with FDA approved drugs causes a decrease in Par-4 protein, mRNA levels, and an increase in apoptosis. In particular, activities of Src family kinases, spleen tyrosine kinase and Bruton’s tyrosine kinase are required for Par-4 expression in CLL cells, suggesting a novel regulation of Par-4 through BCR signaling in both Eµ-Tcl1 CLL cells and primary human CLL samples. Consistent with this, lenti-viral shRNA mediated knockdown of Lyn kinase leads to a decrease in Par-4 expression in MEC-1 cells, a human CLL derived cell line. Igα (CD79a) silencing in primary human CLL cells also results in down regulation of Par-4 expression. Additionally, we knocked down expression of Par-4 in MEC-1 cells which resulted in a decrease in cell growth that could be attributed to an increase in p21 expression and a reduction in the G1/S cell cycle transition. We have also observed this phenomenon by crossing mice deficient in Par-4 with the Eµ-Tcl1 mouse where lack of Par-4 delays CLL growth in the mouse significantly (time to euthanization due to poor body condition - Eµ-Tcl1: 8.9mo vs Par4-/-EµTcl1: 11.97 mo, p = 0.0472) and splenic B-CLL cells from these mice also have increased expression of p21. Since mice in this cohort are whole body knockout for Par-4, the difference in survival times between the Par-4 +ve and Par-4 –ve EµTcl1 mice could be due to the influence of Par-4 on CLL cells as well as the effect of Par-4 secreted by the CLL cells on the microenvironment. There could be other potential roles for Par-4 in the context of CLL which are under further investigation. We have also investigated the site of CLL growth in mouse models to determine that the spleen is the primary organ to accumulate the CLL tumor burden. We have found that splenectomy significantly delays the development of CLL in the primary Eμ-Tcl1 mouse model and prevents growth and development in the adoptive transfer model. Interestingly, splenectomy did not delay CLL development as significantly in animals deficient for Par-4 compared to C57BL/6 wild type mice. Par-4 appears to regulate a specific microenvironment required for CLL growth. Current studies are investigating the role of Par-4 in the microenvironment and the cell types that are critical for CLL growth within the splenic niche.

T-cell acute lymphocytic leukemia (T-ALL) affects approximately 1,500 people per year in the United States, many of them children. The overall survival rate of children with T-ALL is greater than 80%. However, patients in a newly identified subtype called early T-cell progenitor acute lymphocytic leukemia (ETP-ALL), have a survival rate of only 19%. We have used the Sleeping Beauty (SB) transposon/transposase system in mice to model the T-ALL subtypes and identify cancer-causing mutations in the diseases. We have also developed three strains of NOTCH1 transgenic mice. NOTCH1 is a gene that is mutated in over 60% of cases of T-ALL, and these NOTCH1 transgenic mice could be used to better understand the role NOTCH1 plays in T-cell transformation. In order to model T-ALL subtypes we crossed SB mice to Vav-iCre mice, Lck-Cre mice, and CD4-Cre mice. This causes activation of SB in hematopoietic stem cells (HSCs), double negative (DN) thymocytes, and double positive (DP) T-cells, respectively. The Vav/SB tumors were characterized by mutations in Notch1, Ikzf1, and Rasgrp1. The predominant mutations found in the Lck/SB and CD4/SB models were Stat5b, Myc, Gfi1, Whsc1, and Jak1. Microarray was performed on a subset of samples. It was found that the CD4/SB tumors had expression profiles very similar to human ETP-ALL samples, and the Vav/SB tumors had expression profiles very similar to typical T-ALL samples. This data indicates that the cell-of-origin for ETP-ALL may not be an early T-cell progenitor, but instead may be a double positive or single positive T-cell. It also indicates that the cell-of-origin for typical T-ALL may be a stem/progenitor cell of the T-lineage. In order to better study the oncogenic potential of mutant NOTCH1 in T- ALL, we produced three NOTCH1 transgenic mouse strains that mimic the most common NOTCH1 mutations found in human T-ALL patients. These mutations are found in two distinct regions of the gene, the heterodimerization (HD) domain and the PEST domain and can occur alone or in combination. The strains also contain a lox-stop-lox (LSL) cassette in the first exon of NOTCH1, making expression Cre-dependent. Preliminary results from NOTCH1-HD-PEST (NHDP) transgenic mice indicate that, when crossed to Lck-Cre mice, offspring do not develop T- cell lymphoma. However, when NHDP/Lck-Cre mice are crossed to SB mice, the mutant NOTCH1 transgene accelerates a SB-induced model of T-cell lymphoma.

Lymphocytes from normal subjects and patients with B-chronic lymphocytic leukemia (B-CLL) show functional responses to extracellular ATP characteristic of the P2X7 receptor. These responses include opening of a cation selective channel/pore which allows entry of the fluorescent dye, ethidium+ and activation of a membrane metalloprotease which sheds the adhesion molecule L-selectin. In this thesis, the surface expression of P2X7 receptors was measured in normal leucocytes, platelets and B-CLL lymphocytes and compared with their functional responses. Monocytes showed 4-5 fold greater expression of P2X7 than B-, T- and NK- lymphocytes, while P2X7 expression on neutrophils and platelets was weak. All cell types demonstrated abundant intracellular expression of this receptor. All 12 subjects with B-CLL expressed surface P2X7 at about the same level as for B-lymphocytes from normal subjects. P2X7 function, measured by ATP-induced uptake of ethidium, correlated closely with surface expression of this receptor in normal and B-CLL lymphocytes and monocytes. However, the ATP-induced uptake of ethidium into the malignant B-lymphocytes in 3 patients was low or absent. The lack of P2X7 function in these B-lymphocytes was confirmed by the failure of ATP to induce Ba2+ uptake into their lymphocytes. This lack of function of the P2X7 receptor resulted in a failure of ATP-induced shedding of L-selectin, an adhesion molecule which directs the recirculation of lymphocytes from blood into the lymph node. To study a possible genetic basis of non-functional P2X7 receptor, we sequenced DNA coding for the carboxyl terminal tail of P2X7. In 33 of 130 normal subjects a heterozygous nucleotide substitution (1513A--C) was found while 3 subject carried the homozygous substitution which codes for glutamic acid to alanine at amino acid position 496. Surface expression of P2X7 on lymphocytes was not affected by this 496Glu--Ala polymorphism demonstrated both by confocal microscopy and immunofluorescent staining. Monocytes and lymphocytes from the 496Glu--Ala homozygote subject expressed non-functional receptor while heterozygotes showed P2X7 function which was half that of wild type P2X7. Results of transfection experiments showed the mutant P2X7 receptor was non-functional when expressed at low receptor density but regained function at a high receptor density. This density-dependence of mutant P2X7 function was also seen on differentiation of fresh monocytes to macrophages with interferon-gamma which upregulated mutant P2X7 and partially restored its function. P2X7-mediated apoptosis of lymphocytes was impaired in homozygous mutant P2X7 compared with wild type. The data suggest that the glutamic acid at position 496 is required for optimal assembly of the P2X7 receptor. Apart from the 496Glu--Ala polymorphism, three other single nucleotide polymorphisms, 155His--Tyr, 348Ala--Thr and 568Ile--Asn were also found in the P2X7 receptor. The site directed mutant cDNA were generated for all 3 polymorphisms and transfected into HEK293 cells to study the impact of these polymorphisms on P2X7 function. Results suggested that Ile568 is important for P2X7 protein trafficking to cell surface. Further study of these two loss-of-function polymorphisms (496Glu--Ala and 568Ile--Asn) may help better understanding of the functional domains in the P2X7 receptor and its role in CLL, lymphoma and infectious diseases. Conclusions: 1.P2X7 receptor is expressed in human leukocytes, including lymphocytes, natural killer cells as well as monocytes, on both surface and intracellular locations. 2.Both the expression and function of P2X7 are highly variable between in human individuals. Non-functional P2X7 receptors are found in some subjects, including both normal subjects and CLL patients, and are often associated with defects in ATP-induced cytotoxicity and L-selectin shedding. 3.Two single nucleotide polymorphisms (SNPs), 496Glu--Ala and 568Ile--Asn, are found at low frequency in the human population and lead to the loss-of-function of P2X7. Both permeabllity function and the downstream effects mediated by P2X7 are affected by these two SNPs. The mechanisms for the loss-of-function differs between the two polymorphisms.

<p>Recent studies have shown that the somatic mutation status of the immunoglobulin (Ig) V_H genes can divide chronic lymphocytic leukemia (CLL) into two prognostic subsets, since cases with mutated V_H genes display superior survival compared to unmutated cases. Biased V_H gene usage has also been reported in CLL which may reflect antigen selection.</p><p>We performed V_H gene analysis in 265 CLL cases and confirmed the prognostic impact of the V_H mutation status. Preferential V_H gene usage was also demonstrated in both the mutated and unmutated subset. Interestingly, CLL cases rearranging one particular V_H gene, V_H3-21, displayed poor outcome despite that two-thirds showed mutated V_H genes. Many of the V_H3-21 cases expressed λ light chains, rearranged a V_λ2-14 gene, and had homologous complementarity determining region 3s (CDR3s), implying recognition of a common antigen epitope. We believe that the V_H3-21 subset comprises an additional CLL entity.</p><p>To further explore the B-cell receptors in CLL, we analyzed the V_H gene rearrangements and, specifically, the heavy chain CDR3 sequences in 346 CLL cases. We identified six new subgroups with similar HCDR3 features and restricted V_L gene usage as in the V_H3-21-using group. Our data indicate a limited number of antigen recognition sites in these subgroups and give further evidence for antigen selection in the development of CLL.</p><p>Different cutoffs have been suggested to distinguish mutated CLL in addition to the 2% cutoff. Using three levels of somatic mutations, i.e. <2%, 2-5% and >5%, we divided 323 CLLs into subsets with divergent survival. This division revealed a low-mutated subgroup (2-5%) with inferior outcome that would have been masked using the traditional 2% cutoff. </p><p>A 1513A/C polymorphism in the P2X₇ receptor gene was reported to be more frequent in CLL, but no difference in genotype frequencies was revealed in our 170 CLL cases and 200 controls. However, CLL cases with the 1513AC genotype showed superior survival than 1513AA cases and this was in particular confined to CLL with mutated V_H genes.</p><p> In summary, we could define new prognostic subgroups in CLL using Ig gene rearrangement analysis. This also allowed us to gain insights in the biology and potential role of antigen involvement in the pathogenesis of CLL.</p>

Advancements in prognostication have improved the subdivision of chronic lymphocytic leukaemia (CLL) into diverse prognostic subgroups. In CLL, IGHV unmutated and IGHV3-21 genes are associated with a poor-prognosis, conversely, IGHV mutated genes with a favourable outcome. The finding of multiple CLL subsets expressing ‘stereotyped’ B-cell receptors (BCRs) has suggested a role for antigen(s) in leukemogenesis. Patients belonging to certain stereotyped subsets share clinical and biological characteristics, yet limited knowledge exists regarding the genetic and epigenetic events that may influence their clinical behaviour. This thesis aimed to, further investigate Swedish IGHV3-21-utilising patients, screen for genetic and DNA-methylation events in CLL subgroups/subsets and study DNA methylation over time and within different CLL compartments. In paper I, IGHV gene sequencing of 337 CLL patients from a Swedish population-based cohort revealed a lower (6.5%) IGHV3-21 frequency relative to previous Swedish hospital-based studies (10.1-12.7%). Interestingly, this frequency remained higher compared to other Western CLL (2.6-4.1%) hospital-based cohorts. Furthermore, we confirmed the poor-outcome for IGHV3-21 patients to be independent of mutational and stereotypy status. In paper II, genomic events in stereotyped IGHV3-21-subset #2, IGHV4-34-subset #4 and subset #16 and their non-stereotyped counterparts were investigated via SNP arrays (n=101). Subset #2 and non-subset #2 carried a higher frequency of events compared to subset #4. A high frequency of del(11q) was evident in IGHV3-21 patients particularly subset #2 cases, which may partially explain their poor-prognosis. In contrast, the lower prevalence of aberrations and absence of poor-prognostic alterations may reflect the inherent low-proliferative disease seen in subset #4 cases. In papers III and IV, differential methylation profiles in IGHV mutated and IGHV unmutated patients were identified using DNA-methylation microarrays. CLL prognostic genes (CLLU1, LPL), tumor-suppressor genes (TSGs) (ABI3, WISP3) and genes belonging to TGF-ß and NF-kB/TNFR1 pathways were differentially methylated between the subgroups. Additionally, the re-expression of methylated TSGs by use of methyl and deacetyl inhibitors was demonstrated. Interestingly, analysis of patient-paired diagnostic/follow-up samples and patient-matched lymph node (LN) and peripheral blood (PB) cases revealed global DNA methylation to be relatively stable over time and remarkably similar within the different compartments. Altogether, this thesis provides insight into the aberrant genomic and DNA methylation events in divergent CLL subgroups. Moreover this thesis helps distinguish the extent to which DNA methylation changes with respect to time and microenvironment in CLL.

Recent studies have shown that the somatic mutation status of the immunoglobulin (Ig) VH genes can divide chronic lymphocytic leukemia (CLL) into two prognostic subsets, since cases with mutated VH genes display superior survival compared to unmutated cases. Biased VH gene usage has also been reported in CLL which may reflect antigen selection. We performed VH gene analysis in 265 CLL cases and confirmed the prognostic impact of the VH mutation status. Preferential VH gene usage was also demonstrated in both the mutated and unmutated subset. Interestingly, CLL cases rearranging one particular VH gene, VH3-21, displayed poor outcome despite that two-thirds showed mutated VH genes. Many of the VH3-21 cases expressed λ light chains, rearranged a Vλ2-14 gene, and had homologous complementarity determining region 3s (CDR3s), implying recognition of a common antigen epitope. We believe that the VH3-21 subset comprises an additional CLL entity. To further explore the B-cell receptors in CLL, we analyzed the VH gene rearrangements and, specifically, the heavy chain CDR3 sequences in 346 CLL cases. We identified six new subgroups with similar HCDR3 features and restricted VL gene usage as in the VH3-21-using group. Our data indicate a limited number of antigen recognition sites in these subgroups and give further evidence for antigen selection in the development of CLL. Different cutoffs have been suggested to distinguish mutated CLL in addition to the 2% cutoff. Using three levels of somatic mutations, i.e. &lt;2%, 2-5% and &gt;5%, we divided 323 CLLs into subsets with divergent survival. This division revealed a low-mutated subgroup (2-5%) with inferior outcome that would have been masked using the traditional 2% cutoff. A 1513A/C polymorphism in the P2X7 receptor gene was reported to be more frequent in CLL, but no difference in genotype frequencies was revealed in our 170 CLL cases and 200 controls. However, CLL cases with the 1513AC genotype showed superior survival than 1513AA cases and this was in particular confined to CLL with mutated VH genes. In summary, we could define new prognostic subgroups in CLL using Ig gene rearrangement analysis. This also allowed us to gain insights in the biology and potential role of antigen involvement in the pathogenesis of CLL.