Diss. (sammanfattning) Uppsala : Univ., 2001. / Härtill 4 uppsatser.

KIT receptor (CD117) is a receptor tyrosine kinase crucial for homeostasis of mast cells (MCs) in tissues and recruitment to sites of inflammation and tumors in response to its ligand Stem cell factor (SCF). Gain of function mutations in KIT (e.g. D816V) are frequently observed in systemic mastocytosis and other cancer types. Src Homology 2 domain containing phosphatase-2 (SHP2 or PTPN11) is a protein tyrosine phosphatase that promotes cell proliferation, survival and motility in multiple pathways and cell types. To study SHP2 function in MCs, we generated novel MC-specific Shp2 knock-out (KO) mice (MC-shp2 KO). These mice had reduced numbers of MCs in skin and peritoneum, and defective contact hypersensitivity responses compared to control mice, consistent with SHP2 promoting MC homeostasis. Using an inducible SHP2 KO bone marrow-derived MC (BMMC) culture model, we found that SHP2 KO cells were prone to apoptosis and had no MC repopulating activity in vivo. Mechanistically, SHP2 enhanced ERK activation and downregulation of pro-apoptotic protein Bim. SHP2 KO BMMCs also had defects in chemotaxis towards SCF, due to impaired activation of a Lyn/Vav/Rac pathway in SHP2 KO BMMCs. This correlated with defects in cell spreading, and F-actin polymerization in response to SCF. Treatment of BMMCs with a SHP2 inhibitor (II-B08) also led to reduced chemotaxis, consistent with SHP2 phosphatase activity being required for KIT-induced chemotaxis. Lastly, we tested whether SHP2 regulates oncogenic KIT signaling using a P815 mouse mastocytoma model. Stable silencing of SHP2 in P815 cells led to reduced cell growth and survival in vitro, and less aggressive systemic mastocytosis development in syngeneic mice. Overall, these studies identify SHP2 as a key node in SCF/KIT and oncogenic KIT pathways, and as a potential therapeutic target in several human diseases. / Thesis (Ph.D, Biochemistry) -- Queen's University, 2013-06-25 12:03:57.818

Systemic mastocytosis refers to a heterogeneous group of clinical disorders characterized by excessive mast cell accumulation in one or multiple organs. Mastocytosis is now considered as a separate disease category in the 2016 WHO classification of myeloid neoplasm and acute leukemia. It is no longer considered as a subgroup of meyloproliferate neoplasms. The clinical presentation of mastocytosis is heterogeneous ranging from skin-limited disease (cutaneous mastocytosis) to a more aggressive form with extra cutaneous presentation (systemic mastocytosis) with or without skin involvement. We are presenting a case of systemic mastocytosis that aroused in a patient who carried diagnosis of CMML for almost 2 years. The worsening B symptoms along with worsening splenomegaly were the driving factor for further investigations including Bone Marrow biopsy which revealed the diagnosis. A 74 year old Caucasian male with past oncology history of Chronic myelomoncytic leukemia diagnosed after persistant monocytosis on complete blood count . Patient presented with gradual onset of low grade fever , weight loss and night sweating , CT abdomen showed hepatosplenomegaly. core biopsy of the liver showed portal and lobular infiltrate consistent with involvement by mastocytes and extra medullary hematopoiesis. The infiltrate was positive for CD117, CD33, CD68, myeloperoxidase and CD163. Patient had bone marrow biopsy which showed increased CD117 positive cells consistent with involvement by systemic mastocytosis. The core biopsy showed multifocal nodules of spindle cells with fibrosis which was morphologically consistent with abnormal mast cells. Immunohistochemistry for CD117 was strongly positive in the spindle cell nodules and scattered polygonal cell nodules. KIT D816V mutation was detected. Patient met criteria for diagnosis of systemic mastocytosis with presence of previous diagnosis of CMML and classified as Systemic mastocytosis with an associated hematologic neoplasm (SM-AHN). Due to patient multiple comorbiditeis , he was not a candidate for Allo HCT. In an attempt to control his disease , patient was started on dose reduced Dacogen, but his functional status continued to delined and eventually dacogen was discontinued and patient was placed on best supportive car Conclusion Systemic mastocytosis is a rare entity with heterogeneous clinical presentation, highly variable disease course and consequently survival rates.Though recent advances in understanding genetic and molecular basis of disease, bone marrow transplantation remains the only treatment with possible curative potential in patients with advanced form of mastocytosis though carrying substantial mortality risk .Further understanding of Kit mutation might be able to offer a highly effective medication with durable response in a fashion similar to the success story of gleevac with CML treatment .

Le système de communication SCF/KIT est impliqué dans le développement et l’homéostasie de plusieurs lignages cellulaires. Des dysfonctionnements de la voie sont à l’origine de pathologies affectant ces compartiments. En particulier, des mutations gain-de-fonction, qui entraînent l’activation constitutive du récepteur à activité tyrosine kinase KIT, sont responsables de néoplasies chez l’homme.L’objectif des travaux réalisés durant cette thèse était d’étudier certaines spécificités de la signalisation de formes oncogéniques de KIT, ceci dans le modèle du mastocyte transformé par l’oncogène KIT-D816V. Cette étude a été menée au niveau proximal sur le récepteur lui-même ainsi qu’au niveau distal sur la voie STAT ,une des voies de signalisation spécifiquement activée de manière constitutive par le récepteur mutant.Au niveau proximal, nous avons pu montrer que le motif dityrosine Y568-Y570situé dans le domaine juxtamembranaire de hKIT est une plateforme majeure de recrutement des effecteurs de la signalisation intracellulaire avec au moins 15partenaires différents recrutées. Par ailleurs l’étude de modèles cellulaires dans des analyses liées aux fonctions physiologiques du récepteur réalisés in vitro et in vivo ont révélé que le site est impliqué dans la régulation négative du signal transformant issu de l’oncogène KIT-D816.Au niveau distal, nous avons analysé les mécanismes de phosphorylation des protéines STAT1, -3 et -5 ainsi que l’importance fonctionnelle de leur activation dans la transformation dépendante de KIT-D816. Nous avons ainsi étudié la contribution de différentes kinases dans les phosphorylations activatrices des STATs sur tyrosine et serine. Nos résultats suggèrent que seul STAT5 a une activité transcriptionnelle dans nos modèles suggérant une implication potentielle non canonique des STAT1et -3 dans la transformation dépendante de KIT-D816.L’ensemble de nos travaux contribue à une meilleure compréhension des mécanismes de l’oncogenèse dépendante de KIT-D816, un point critique dans le développement raisonné de thérapeutiques anticancéreuses ciblées. / The receptor tyrosine kinase KIT and its ligand, the stem cell factor (SCF), are implicated both in the development and the homeostasis of multiple cell lineages. Dysfunctions in the KIT/SCF pathway are involved in several pathologies affecting these compartments. In particular, gain-of-function mutations that lead to constitutive activation of the receptor KIT are found in human neoplasia.The purpose of this thesis project was to investigate some differences between normal and oncogenic signalling of KIT receptor using mast cells transformed by the KIT-D816 oncogene as a model. This question was analysed at aproximal level on the oncogenic receptor itself and at a more distal level on the STAT signal transduction pathway, which is specifically and constitutively activated by theKIT-D816 mutant.At the proximal level, we show that the juxtamembrane dityrosine motif Y568-Y570 of KIT is the major platform of recruitment of intracellular signalling partnerswith more than 15 interactors found in mast cells. Furthermore, the analysis ofcellular models in both in vitro and in vivo assays related to KIT physiological functions has revealed the negative role of the motif in KIT-D816-mediated cell transformation. At the distal level, we have analysed the mechanisms of phosphorylation ofSTAT1, -3 and -5 proteins and the functional relevance of their activation in KITD816-mediated transformation. We describe the contribution of different kinases inthe phosphorylation of STATs on both serine and tyrosine residues. Our results suggest that only STAT5 is transcriptionaly active whereas STAT1 and STAT3 are not, suggesting a non conventional implication of their activation in celltransformation. Our work contributes to a better understanding of the mechanisms of KITD816-mediated oncogenesis and could be used to improve the rational developmentof new targeted cancer therapies

En hématologie, du fait de leur évolution favorable, les tumeurs spontanément regressives comme lesmodèles myéloïde de la mastocytose, et lymphoïde de la papulose lymphomatoïde sont peu étudiés. Lamastocytose est une hémopathie myéloproliférative clonale dont les lésions cutanées peuvent régresserspontanément chez l’enfant alors que la maladie est chronique chez l’adulte. Les mutations chezl’enfant sont en partie différentes de celles retrouvées chez l’adulte. Nous avons montré in vivo dansles mastocytoses pédiatriques une expression diminuée de la télomérase, associée à des télomèrescourts. In vitro, grâce à deux modèles cellulaires comportant différents mutants de KIT de « typepédiatriques » ou de « type adulte », nous avons montré une augmentation de la longueur destélomères dans le mutant adulte, associée à une moindre sénescence comparées aux mutantspédiatriques sans pour autant mettre en évidence de différence dans l’expression et l’activité de latélomérase. Ces observations permettent en partie d’expliquer la régression des formes pédiatriques.La papulose lymphomatoïde est une lymphoprolifération cutanée T CD30+ dont les lésions régressentspontanément sans traitement. Cependant 10 à 20% des cas sont associés à un lymphome. Nous avonsétudié la physiopathologie d’expression du PDGFRβ dans les cellules tumorales via l’activation deNotch1. L’étude des télomères et de la télomérase in vivo et in vitro est préliminaire, et montrenotamment des télomères courts dans les cellules tumorales. En conclusion, nous montrons d’une partque la longueur des télomères dans les mastocytoses et la papulose lymphomatoïde est corrélée àl’évolution de la maladie, d’autre part, nous identifions un type de mutation potentiellement agressivedans les mastocytoses. Nous recommandons le génotypage systématique de cette pathologie dans lebut d’un suivi clinique attentif lorsque les lésions sont persistantes ou évolutives. / Childhood mastocytosis and lymphomatoid papulosis are mostly spontaneously regressive diseases.Mastocytosis is a clonal myeloproliferative disease; whereas cutaneous forms may regressspontaneously especially in childhood, the disease is chronic among adults. KIT mutations aredifferent between children and adults. We showed in vivo that children with mastocytosis displaydecreased telomerase expression with shorter telomere length. In vitro, using infected cells withdifferent KIT mutants, "paediatric" or "adult " one, we found longer telomere among adult mutant withdecreased senescence compared to paediatric mutant, without significant differences of telomeraseexpression and activity. These observations could explain the regression in paediatric mastocytosis.Lymphomatoid papulosis is a primary cutaneous CD30+ T-cell lymphoproliferative disorder.Cutaneous lesions are spontaneously regressive but association with a T-cell lymphoma is observed in10 to 20% of cases. We studied PDGFRβ expression to explain proliferative phase and telomerebiology to understand the regressive phase of the disease. Our result showed that PDGFRβ expressionin CD30+ cells was associated to short telomeres. In conclusion, we showed for the first time thattelomere length in mastocytosis and lymphomatoid papulosis seemed to be correlated with diseaseoutcome; on the other hand, we identify a mutation potentially aggressive. Taken together, werecommend to systematically look for KIT mutation among each patient with mastocytosis in order tocarefully monitor them when the cutaneous lesions are persistent and/or progressive.

La mastocytose est une maladie hétérogène, caractérisée par une accumulation de mastocytes dans l’organisme. Les enfants et les adultes ont des mutations différentes de c-Kit. Dans un premier travail, nous avons montré que seules les formes adultes sont associées à la réactivation de la télomérase, alors que les formes pédiatriques ne sont pas. Cela semble être lié aux différences de mutations de c-Kit observées entre adultes et enfants et pourrait expliquer pourquoi seules les formes pédiatriques de mastocytose régressent spontanément et non les formes adultes. Ces résultats aident à mieux comprendre la physiopathologie de la mastocytose. Dans un second travail, nous a étudié le lien entre la longueur des télomères et les troubles psychologiques des adultes atteints de mastocytose. Nous avons montré que réactions émotionnelles négatives sont corrélées au raccourcissement de la longueur des télomères des leucocytes et que l’érosion télomérique est fortement prédite par les défauts de régulation des émotions. Nous émettons l'hypothèse qu’au cours des troubles neuropsychologiques, le mastocyte pourrait être impliqué dans le raccourcissement de la longueur des télomères en périphérie. / Mastocytosis is a heterogeneous disease characterized by an accumulation of mast cells. Children and adults hold different c-Kit mutations. In a first work, we showed that only adult forms are associated with reactivation of telomerase whereas pediatric forms are not. This seems to be linked to the differential c-Kit mutations observed between adults and children and could explain why only pediatric mastocytosis spontaneously regress in comparison with adult forms. These results help to better elucidate the pathophysiology of mastocytosis. In a second work, we studied the link between the telomere length and the psychological features of adults with mastocytosis and showed that negative emotionality correlated negatively to telomere length and that telomere shortening was strongly predicted by emotion regulation deficits. We hypothesize that in psychological disorders, mast cell may represent the link between brain and periphery and induce telomere shortening.

The aim of my thesis is the introduction of the systemic mastocytosis and discussion about results of allergen immunotherapy in patients with systemic mastocytosis and its preventive effects against recurrent anaphylactic reactions. Patients with systemic mastocytosis are more prone to severe systemic anaphylactic reactions after Hymenoptera stings than in the general insect venom allergic population patients without elevated basal tryptase. This severe reaction can result in the death of the patient, it is important to prevent it prophylactically. The medication of choice in insect venom allergic patients is hyposensibilization therapy - allergen immunotherapy, which uses venom allergens of causal Hymenoptera (honey bee, yellow jacket). The thesis aims to summarize the results obtained so far about the appropriateness of this treatment in patients with systemic mastocytosis, side-effects during VIT, optimal dosing schedule and duration of treatment in these patients.

This study was an autoethnography authored in the form of layered accounts. It was based on my journey toward a correct diagnosis with the rare, orphan disease known as mastocytosis. The purpose of the study was to utilize my experiences to investigate mastocytosis from the perspective of an individual diagnosed with the disease. Furthermore, I investigated what ways and how much adult education philosophies and principles (e.g., humanistic, behaviorist, and adults’ involvement in learning) may have been salient in my being correctly diagnosed to examine not only the disparities, but also the similarities in the way each physician I encountered approached the diagnostic process. The layered accounts—written in three distinct layers—revealed my perception of my journey toward a correct diagnosis as blind, discouraging, and isolating (layers one). Also noted in layer one are detailed descriptions of my bouts with chorea (extreme, uncontrollable spasms affecting the limbs), which was rarely discussed in the literature. The responses of those around me (layer two) ranged from shock, genuine concern, uncertainty, judgement, dismissal, disbelief, humor, anger, hurt, and positivity. Pertinent literature on mastocytosis was juxtaposed with my experiences divulged in the first layer and highlighted similarities in the approach to the diagnostic process taken by the physicians who treated me and multiple disparities between what the literature states my experience as someone diagnosed with mastocytosis versus my actual experiences (layer three). In addition to identifying the most salient adult education philosophies and principles in my journey to a correct diagnosis, this research identified parallels between the facilitator-learner relationship in adult education and the physician-patient relationship. The results implicate three principles and three philosophies salient to my correct diagnosis, along with one philosophy and one principle which were the most salient. An overarching theme of self-directedness emerged along with a multiple disparities between what the literature states my experience should have been versus what took place as I sought medical care.

No description available.

Les mastocytoses systémiques (SM) constituent un groupe hétérogène de maladies rares, caractérisées par l’accumulation anormale de mastocytes malins dans la moelle osseuse et dans d’autres organes extra-cutanés. La majorité des patients avec SM ont une mutation activatrice du gène KIT, le plus souvent la mutation KIT D816V, retrouvée chez plus de 90% de tous les patients. Cette mutation induit l’activation constitutive du récepteur KIT en déclenchant de façon aberrante une cascade de voies de signalisation, dont la voie PI3K/AKT et JAK/STAT5, aboutissant à l’inhibition de l’apoptose et à l’augmentation de la prolifération et de la survie des mastocytes malins. Cependant, l’efficacité des inhibiteurs de tyrosines kinases (ITKs) sur cette mutation est limitée à cause de la résistance et/ou de toxicité liée à un manque de spécificité. Il est donc nécessaire de trouver de nouvelles approches thérapeutiques afin de contourner cette résistance au cours des SM KIT D816V+ avancées. Nous avons utilisé une approche consistant à cibler de façon combinée des molécules activées en aval de KIT D816V, comme AKT et STAT5, par des inhibiteurs pharmacologiques. Ceci nous a permis d’identifier une combinaison synergique entre un inhibiteur d’AKT (GSK690693) et un inhibiteur de STAT5 (BP-1-102). Ces composés sont capables d’inhiber la prolifération des cellules KIT D816V+ seuls ou en combinaison, mais à de très fortes concentrations, malheureusement non utilisables en thérapeutique. Néanmoins, ces premiers résultats ont permis de valider AKT et STAT5 comme cibles potentielles dans le traitement des SM avancées. La seconde approche employée a été de cibler directement le récepteur KIT D816V par des inhibiteurs pharmacologiques. A l’issu d’un criblage, nous avons identifié trois composés - BLU2317, BLU2718 et DCC-2618 - capables d’inhiber sélectivement la phosphorylation de KIT D816V. Ces composés inhibent la prolifération des cellules ROSAKIT D816V et HMC-1.2, et induisent l’apoptose des cellules de façon dose-dépendante. Bien que les effets de ces trois composés soient similaires, DCC-2618 agit à des concentrations plus faibles par rapport aux composés BLU2317 et BLU2718. Afin d’apprécier l’efficacité in vivo de DCC-2618, nous avons d’abord établi un nouveau modèle de SM basé sur l’injection intraveineuse des cellules ROSAKIT D816V-Gluc exprimant la Gaussia luciferase (Gluc) dans des souris NSG. La présence de la Gluc sécrétée par les cellules ROSAKIT D816V-Gluc facilite la mise en évidence de prise de greffe et permet un contrôle précis de la progression de la maladie. Ce modèle reproduit, au bout de 4 semaines, chez toutes les souris greffées, une SM avancée similaire à celle retrouvée chez l’homme, avec atteinte de la moelle osseuse, du sang, de la rate et du foie, tandis que la dégradation de l’état général des souris n’est observée qu’à partir de 12 semaines. Ce nouveau modèle offre suffisamment de temps pour explorer la cinétique de la progression de la maladie et surtout pour effectuer des études pharmacologiques précliniques. L’évaluation de l’effet de DCC-2618 in vivo a été réalisée sur ce modèle. Etonnamment, DCC-2618 n’a pas été capable d’inhiber la progression de la maladie chez les souris traitées, bien qu’atteignant des concentrations élevées dans la moelle osseuse et le plasma des souris traitées. Néanmoins, DCC-2618 s’est montré capable d’inhiber la phosphorylation de KIT dans les cellules issues de la moelle osseuse des souris traitées. En revanche, contrairement aux effets observés in vitro, DCC-2618 a induit une surexpression de phospho-ERK1/2 dans les cellules malignes des souris greffées. Ceci suggère qu’ERK1/2 joue un rôle important dans la résistance au composé DCC-2618 et éventuellement à d’autres ITKs, indépendamment du récepteur KIT. ERK1/2 pourrait donc être une nouvelle cible thérapeutique d’intérêt dans le traitement des SM résistantes aux ITKs / Systemic mastocytosis (SM) is a heterogeneous group of rare diseases characterized by abnormal accumulation of malignant mast cells (MCs) in the bone marrow (BM) and other extra-cutaneous organs. The majority of SM patients have an activating mutation in the KIT gene, usually the D816V point mutation, which is found in more than 90% of all patients. This mutation induces constitutive activation of the KIT receptor by triggering a cascade of signaling pathways, including the PI3K/AKT and the JAK/STAT5 pathways, resulting in the inhibition of apoptosis and increased survival and proliferation of malignant mast cells. However, the efficacy of the tyrosine kinase inhibitors (TKIs) on this mutation is limited due to resistance and/or toxicity associated with a lack of specificity. It is therefore critical to find new therapeutic approaches to overcome this resistance to TKIs, particularly for advanced KIT D816V+ SM. In the present thesis, we have used an approach consisting in targeting molecules activated downstream of KIT D816V, such as AKT and STAT5, using pharmacological inhibitors in combination. This allowed us to identify a synergistic combination of an AKT inhibitor (GSK690693) and an inhibitor of STAT5 (BP-1-102). These compounds are able to inhibit proliferation of KIT D816V+ cells, alone or in combination, but at very high concentrations, unfortunately not useful therapeutically. Nevertheless, these initial results have validated STAT5 and AKT as potential targets for the treatment of advanced SM. The second approach used was to target directly the KIT D816V receptor by pharmacological inhibitors. After a large screening, we identified three compounds - BLU2317, BLU2718 and DCC-2618 - which selectively inhibit the phosphorylation of KIT D816V. These compounds inhibit the proliferation of ROSAKIT D816V and HMC-1.2 cells, and induce apoptosis of these cells in a dose-dependent manner. Although the effects of these three compounds are similar, the DCC-2618 compound acts at lower concentrations relative to BLU2317 and BLU2718 compounds. In order to assess the in vivo efficacy of DCC-2618, we first established a new model of SM based on intravenous injection of cells expressing Gaussia luciferase (Gluc), ROSAKIT D816V-Gluc cells, in NSG mice. The presence of the secreted Gluc in ROSAKIT D816V-Gluc cells facilitates the detection of engraftment and allows precise monitoring of disease progression. This model reproduced within four weeks, in all grafted mice, an advanced SM similar to the one found in humans, with neoplastic MCs infiltration in BM, blood, spleen and liver, while the terminal deterioration of the clinical condition of the mice was observed after 12 weeks. Thus, this new in vivo model allows modulating the aggressiveness of the disease by varying the number of injected cells. It provides sufficient time to explore the kinetics of disease progression and especially to conduct preclinical pharmacological studies. We then evaluated the effect of DCC-2618 compound in vivo on this model. Surprisingly, DCC-2618 was not able to inhibit disease progression in treated mice, although it reached high concentrations in the BM and the plasma of treated mice. Nevertheless, we showed that the compound was able to inhibit the phosphorylation of the KIT receptor in cells derived from the BM of treated mice. In addition, contrasting to the effects observed in vitro, DCC-2618 induced an over-expression of phospho-ERK1/2 in the malignant cells of transplanted mice. This suggests that ERK1/2 may play a critical role in the resistance to DCC-2618, and possibly to other TKIs, independently of the KIT receptor. ERK1/2 could thus be a new interesting therapeutic target in the treatment of advanced SM resistant to TKIs