Les leucémies aiguës myéloïdes (LAM) sont des hémopathies malignes caractérisées par une accumulation dans la moelle et le sang de progéniteurs hématopoïétiques bloqués dans un stade différenciation. La mutation FLT3-ITD, qui entraîne une activation constitutive du récepteur à activité tyrosine kinase FLT3, est retrouvée dans 20-25% des LAM et est associée à un mauvais pronostique. De nombreux inhibiteurs de FLT3 ont été développés et certains sont testés en clinique mais des études mettent en évidence l'apparition de résistance. Une meilleure compréhension des mécanismes oncogéniques de FLT3-ITD est donc nécessaire afin d'améliorer le traitement des LAM. Mes travaux de thèse ont été centrés sur l'analyse du processus autophagique qui correspond à l'un des mécanismes de résistance décrits dans les cellules cancéreuses en réponse aux traitements. Au cours de cette étude, nous avons constaté que l'expression de FLT3-ITD augmente l'autophagie basale des cellules de LAM, et que l'inhibition du récepteur réduit cette autophagie dans des échantillons primaires de LAM et dans des lignées cellulaires. Nous avons pu montrer que l'autophagie est requise pour la prolifération et la survie in vitro et in vivo des cellules de LAM et que sont ciblage permet de surmonté la résistance aux inhibiteurs de FLT3. De plus, nous avons identifié la protéine ATF4 comme un acteur essentiel au processus d'autophagie en aval de FLT3-ITD. Ces résultats suggèrent que le ciblage de l'autophagie ou d'ATF4 chez les patients exprimant les mutations de FLT3 peut représenter une stratégie thérapeutique prometteuse et innovatrice dans les LAM. / Acute myeloid leukemias (AMLs) are a family of hematological malignancies characterized by an accumulation in the marrow and blood of hematopoietic progenitors blocked in their differentiation process. The FLT3-ITD mutation is found in 20-25% of AMLs and is associated with a poor prognosis. Different FLT3 inhibitors have been developed and some of them are clinically tested but resistance to treatment has been observed in many patients. A better understanding of AML biology is necessary in order to improve the treatment of AMLs. My thesis project focused on the analysis of the autophagic process, which is one of the mechanisms described in the resistance of cancer cells. In this study, we found that the FLT3-ITD expression increases basal autophagy in AML cells, and that the receptor inhibition reduced this autophagy in primary patient samples and cell lines. We show that autophagy is required for proliferation and survival in vitro and in vivo of leukemic cells lines and inhibition of autophagy overcomes resistance to FLT3 inhibitors. In addition, we identified the ATF4 protein as a key actor of the autophagy process induced by the FLT3-ITD mutation. These results suggest that targeting autophagy or ATF4 may represent a promising and innovative therapeutic strategy for FLT3 mutated AMLs.

A Leucemia Mieloide Aguda (LMA) é uma neoplasia originada a partir da expansão clonal de blastos da linhagem mieloide em medula óssea, sangue periférico e outros tecidos. Entre as mutações mais frequentemente detectadas nas LMAs, se encontra a mutação do tipo duplicação interna em tandem (FLT3-ITD) que é detectada em aproximadamente 25% dos pacientes adultos. Esta mutação no receptor de tirosina quinase FLT3 é uma inserção de 3 a 400 pares de base na região juxtamembrana do receptor, a qual é responsável pelo controle da atividade enzimática dos domínios tirosina quinase. Quando esta mutação se encontra presente, a região juxtamembrana perde a capacidade de controlar a ativação dos domínios tirosina quinase e o receptor fica constitutivamente ativo conferindo uma vantagem proliferativa ao clone leucêmico. Esta mutação é considerada de mal prognóstico e já foram desenvolvidos inibidores de tirosina quinase específicos para o receptor FLT3 (FLT3 TKI). Porém, os resultados dos primeiros ensaios clínicos não apresentaram a efetividade esperada e continua a busca de novas combinações de drogas que contribuam a aumentar a efetividade destes inibidores. É por isso que este trabalho teve por objetivo testar a combinação de FLT3 TKIs com o ácido trans-retinoico (ATRA) já aplicado no tratamento da Leucemia Promielocítica Aguda (LPA) com PML-RARA. A combinação de FLT3 TKIs com ATRA induziu a morte celular programada de forma precoce tanto na linhagem de LMA MV4-11 como na MOLM-13. Esta morte celular observada foi inibida com pré- tratamento com inibidor de caspases QVD. O tratamento combinado in vivo em camundongos Nod Scid Gamma (NSG) transplantados com células MOLM-13, aumentou a sobrevida dos animais e diminuiu a percentagem de células CD45 humanas em medula óssea, baço e sangue periférico. No seu conjunto, nossos dados sugerem que o ATRA aumenta o efeito citotóxico dos FLT3-TKIs. Este achado poderá ser relevante para o tratamento de pacientes com LMA portadores de mutaçãoes ITD no gene FLT3 / Acute Myeloid Leukemia (LMA) is hematological disease that arises from the clonal expansion of a myeloid blast in bone marrow, peripheral blood and other tissues. Among LMAs mutations most frequently detected, 25% of adult patients carry the FLT3-ITD mutation. This mutation is a pair base insertion of 3 to 400 in the juxtamembrane domain of the receptor and leads to the constitutive activation of the kinase domains. It gives the leukemic clone a proliferative advantage and it is associated with a bag prognosis. FLT3 tyrosine kinase inhibitors (FLT3 TKI) were already developed in order to improved patients\' treatment. However, results from the first clinical trials were not as promising as expected. Therefore, there is still room for testing new drug combinations that could improve FLT3 TKIs efficacy. The main objective of this work was to test FLT3 TKIs in combination with all-trans retinoic acid (ATRA) already used in Acute Promyelocytic Leukemia (APL) with PMLRARA treatment. The combination of FLT3-TKIs and ATRA induced early programmed cell death in both the MV4-11 and MOLM-13 LMA lines. This early cell death was inhibited with QVD caspase inhibitor pre-treatment. In vivo combined treatment in Nod Scid Gamma (NSG) mice transplanted with MOLM-13 cells, increased animals survival and decreased the percentage of human CD45 cells in bone marrow, spleen and peripheral blood. Taken together, our data suggest that ATRA increases the cytotoxic effect of FLT3- TKIs. This finding may be relevant for the treatment of patients with AML with ITD mutations in the FLT3 gene

Faculty of Science School of Molecular Medicine and Haematology Masters Dissertation / Studies on the development of drug resistance in several cancer types, including acute myeloid leukaemia (AML), have implicated the PI3-kinase pathway. This pathway phosphorylates Akt resulting in the activation of proteins involved in cell survival. The aim of this study is to determine the role that Akt plays in urvival and the relationship between Akt, IKK and IkB in HL-60 cells. This study demonstrated that etoposide caused apoptosis in HL-60 cells, which was slightly increased when the PI3-kinase pathway was inhibited by LY294002. Stimulation with PDGF resulted in cell proliferation and increased Akt, IKK and IkB phosphorylation. Although pre-treatment with LY294002 decreased the amount of Phospho-Akt, phosphorylation of IKK and IkB still occurred. Therefore additional pathways must be involved in IkB regulation in HL-60 cells. Akt mRNA transcription was decreased when the cells were pretreated with LY294002 and either PDGF or etoposide. In conclusion, the PI3-kinase pathway plays a minor role in the survival of HL-60 cells and Akt substrates other than IKK are mediating this survival.

Myeloid leukemias include malignant diseases characterized by clonal expansion of the myeloid cell lineage. While in case of chronic myeloid leukemia (CML), the main cause of the disease has already been identified - t(9;22) and the aktivity of the fusion product of the translocation BCR-ABL, acute myeloid leukemia (AML) has been associated with plenty of different translocations and mutations. The aim of this work was to contribute to the improvement of monitoring of patients with myeloid leukemias via detailed study of the panleukemic marker Wilms tumor gene 1 (wt1) expression. Prognostic value of wt1 expression has been proved for AML patients, however, it has not yet been confirmed for CML patients. Expression of different wt1 variants (more then 36 protein products) is known very poorly in both, AML and CML as well as in normal hematopoiesis. Most of the study is focused on CML, only limited parts are dedicated to AML. In the first part of the work, we clearly proved prognostic value of total wt1 mRNA expression for CML patients. Statistical evaluations revealed critical wt1 values which enable to specify prognosis of patients responding non-optimally to imatinib. Bcr-abl looses much of its prognostic value in these patients. Further, we have designed and optimized PCRs for selected wt1...

De nombreuses études en oncoimmunologie portent sur l’échec immunitaire dans le contexte de progression tumorale, mais elles sont plus rares à porter sur un contexte de régression, lorsque le système immunitaire est efficace. De ce fait, bien souvent la littérature met en avant le rôle cytotoxique des lymphocytes T CD8+, ou bien leur anergie dans le contexte de progression tumorale, causée par des cellules myéloïdes telles que les MDSC ou les macrophages de phénotypes M2, considérés comme pro-tumoraux. J’ai pour ma part étudié la réponse immunitaire dans le cadre d’une régression tumorale. Des cellules TC1 transplantées en s.c. dans des souris C57BL6/J, donnent des tumeurs solides d’environ 6mm de diamètre 11 jours plus tard. A ce moment là (J0), les souris sont vaccinées à proximité de la tumeur (priming), par un vaccin contenant la sous-unité B non toxique de la Shiga toxine couplée au peptide E7 de l’HPV16 (exprimé par les TC1), combiné à de l’IFNα. Une semaine plus tard (J7), un « boost » est effectué. Après le boost, la croissance tumorale cesse puis la tumeur régresse. L’analyse cinétique par cytométrie révèle un infiltrat immunitaire important pendant, et précédant la régression tumorale. La nature de cette infiltrat varie avec le temps. A J5, un infiltrat myéloïde est observé, suivi d’un infiltrat lymphocytaire à partir de J8. Une déplétion des cellules T CD8+ inhibe la régression tumorale, alors que dans les souris CXCR3-/-, dans lesquelles les CD8+ ne sont pas déplétés mais leur recrutement est fortement affecté, une régréssion tumorale est possible malgré un infiltrat T CD8+ très faible. Cela laisse penser que d’autres acteurs que les LT cytotoxiques sont nécessaires à la régression tumorale, comme probablement les cellules myéloïdes qui infiltrent le tumeur avant les cellules T. L’analyse de cette population montre une activation des monocytes et macrophages (MHC II+), avec un pic d’activation autour de J9, au début de la régression. La capacité cytotoxique de ces cellules, mesurée in vitro par immunofluorescence est augmentée comparée à des myéloïdes isolées de tumeurs de souris en progression. De plus, l’ajout d’un anticorps anti-TNFα inhibe partiellement cette cytotoxicité. Cela montre qu’après vaccination, les monocytes/macrophages sont capables de tuer les cellules tumorales. Une déplétion partielle des macrophages au moment de la vaccination, à l’aide du PLX3397 (inhibiteur du CSF1R), réduit l'efficacité de la vaccination. Les cellules myéloïdes, lorsqu'elles sont présentes, contribuent fortement à la régression tumorale induit par le vaccin composite, et leur action implique probablement des interactions avec les LT CD8+. C'est ce que suggère l'observation de tumeurs vaccinées dans des souris IFNϒ-/-, dans lesquelles l'efficacité vaccinale est aussi inhibée. Cette thèse montre qu’après une stimulation appropriée, qui peut, comme ici, mimer une infection virale, les cellules myéloïdes peuvent participer activement à la régression tumorale. / Most oncoimmunology studies are performed in an immune failure context of progressing tumor. They rarely describe tumor regressions, when the immune response is efficient. As a result, the literature tends to highlight the cytotoxic role of CD8+ T cell or their anergy in the context of tumor progression, caused by myeloid cells such as the MDSC or M2 polarized macrophages, considered as protumoral. My PhD work has been focused on the immune response in a context of tumor regression. TC1 cells transplanted s.c. in C57 BL6 J mice, give rise to solid tumors of approximately 6 mm diameter 11 days later. At that time (day 0), mice are vaccinated peritumorally for a priming with a composite vaccine containing the subunit B of the Shiga toxin coupled to E7 peptide from HPV16 (present on TC1), combined with the IFNα. A week later (day 7), a boost is made. After the boost, tumor growth stops and the tumor regress. Kinetic cytometric analysis revealed a significant immune infiltrate during and prior to tumor regression. The nature of this infiltrate varies with time. On day 5, a myeloid infiltrate is observed, followed by a lymphocytic infiltrate which is conspicuous after day 8. Depletion of CD8+ T cells inhibits tumor regression, while in CXCR3- /- mice, in which the CD8+ are not depleted but their recruitment is severely affected, tumor regression is possible despite a very low CD8+ T cell infiltrate. This suggests that some effectors, other than cytotoxic T cells, are required for tumor regression, including probably myeloid cells that infiltrate the tumor before T cells. The analysis of this population shows an activation of monocytes and macrophages (MHC II+) with a peak of activation around day 9, early in the regression. The cytotoxic capacity of these cells was tested in vitro, by depositing F4/80+ cells from vaccinated tumors or not, on a TC1 cell monolayers in culture. Only myeloid cells from vaccinated tumors appear to kill tumor cells, and adding an anti-TNFα inhibits this cytotoxicity. This shows that after immunization, monocytes/macrophages are capable of killing tumor cells. A partial depletion of macrophages at the time of vaccination, after treatment with PLX3397 (CSF1R inhibitor), reduces the vaccine efficacy. Myeloid cells contribute significantly to the observed tumor regression, and their action involves interactions with CD8+ T cells. This hypothesis is consistent with the observation of tumors in vaccinated IFNϒ- /- mice, in which the vaccine efficacy is also inhibited. This thesis shows that after an appropriate stimulation, for instance, here, by mimicking a viral infection, myeloid cells can actively participate in tumor regression.

Les syndromes myélodysplasiques (SMD) peuvent être conçus comme des conditions pré-leucémiques dans lesquelles l’apoptose avorte les produits de différenciation de cellules souches mutées, potentiellement malignes. Néanmoins, peut-être à cause d’une inhibition progressive de l’apoptose, les SMD se transforment fréquemment en leucémies aiguës myéloïdes (LAM). Nos données indiquent que les SMD à faible risque se caractérisent par l’absence d’activation de NF-κB au sein des cellules portant des altérations cytogénétiques typiques. Par contre, dans les SMD à haut risque de transformation en LAM (ainsi que dans les LAM post-SMD), les cellules souches hématopoïétiques et leurs produits de différenciation montrent une translocation activatrice des sous-unités p50/p65 de NF-κB. L’utilisation d’antagonistes de IKK provoque une inhibition de NF-κB conduisant à une apoptose accélérée, ainsi l’activation de NF-κB serait responsable de la suppression progressive de l’apoptose et donc de la transformation maligne. Ce projet de thèse a consisté à comprendre les mécanismes impliqués dans la dérégulation de l’apoptose dans les SMD/LAM ; ainsi qu’à utiliser des technologies de criblage pour permettre une meilleure compréhension des voies de signalisation impliquées, et à adapter de nouveaux outils d’analyse. Au cours d’une première étude, nous avons montré que les inhibiteurs de méthyltransférase de l’ADN et les inhibiteurs d’histones déacétylases induisent efficacement l’apoptose dans la lignée cellulaire SMD/LAM P39, parallèlement à une inhibition de la translocation de NF-κB du cytoplasme au noyau. Dans une seconde étude, nous avons montré que l’inhibition pharmacologique du récepteur Flt3 induit une inhibition de la voie NF-κB, et pourrait être une cible thérapeutique pertinente. Dans une troisième étude, nous avons montré que l’auto-activation d’ATM chez les patients atteints de SMD/LAM joue un rôle dans l’activation constitutive de NF-κB suggérant qu’ATM serait également une bonne cible thérapeutique dont l’inhibition pourrait réduire le défaut d’apoptose des cellules SMD et LAM. Et enfin, grâce à l’optimisation d’une technique d’analyse d’images à haut débit, nous avons identifié deux composés capables d’induire la mort cellulaire des lignées cellulaires LAM in vitro : le zinc pyrithione et la ouabain. Leurs effets d’inhibition du signal de survie NF-κB, conduisant à une réduction de l’expression de protéines anti-apoptotiques, suggèrent que ces composés pharmaceutiques pourraient être utilisés comme des agents anti-leucémiques. Ce projet de thèse nous a permis de mettre en évidence le potentiel anti-leucémique de différents agents impliqués dans les principales voies de signalisation de l’apoptose dérégulées dans les SMD/LAM, qui pourraient prochainement servir de cibles pour de nouveaux essais thérapeutiques. / Myelodysplastic syndrome (MDS) is a group of hematopoietic stem cell disorders that is characterized by an ineffective hematopoiesis (finaly leading to blood cytopenias) and by a high risk of progression to acute myeloid leukemia (AML). It can therefore be viewed as a preleukemic condition in which apoptosis aborts the differentiation products of potentially malignant mutated (stem) cells. The progression of MDS into AML is associated with progressive inhibition of apoptotsis (by e.g. the expression of antiapoptotic proteins) and a negative prognostic value, suggesting that loss of the apoptotic program could favor the MDS-to-AML transition. Therefore the present project aimed at understanding the mechanisms involved in the deregulation of apoptosis in MDS and AML and the characterization of their underlying signaling pathways by means of standard biochemical and high throughput screening approaches. Our previous work showed that inhibitors of DNA methyltransferases and histone deacetylases effectively induced apoptosis in AML cells in vivo which was associated with an inhibition of NF-κB-dependent transactivation of survival signals. We further found that the pharmacological inhibition of the Flt3 receptor in AML cells decreased NF-κB activation and might therefore constitute a relevant therapeutic target for the treatment of AML. In line with these findings we demonstrated that the constitutive activation of ATM in high-risk MDS and AML patients accounts for the activation of NF-κB suggesting ATM as yet another drugable target for antileukemic therapy. Finally we generated a high throughput image based screening platform, which enabled us to perform large scale drug screening approaches and to identify two compounds with antileukemic properties. Both agent, pyrithione zinc (PZ) and Ouabain (OUA) efficiently induced cell death in AML cells in vitro associated with the inhibition of NF-κB. PZ and OUA exerted significant anticancer effects in vivo, on human AML cells xenografts as well as ex vivo, on CD34+ (but not CD34-) malignant myeloblasts from AML patients. Summarizing this project allowed us to shed some light on the importance of NF-κB during MDS to AML progression and at the same time it helped to identify drugable targets and agents with potential anticancer properties for the treatment of leukemia.

Les syndromes myélodysplasiques (SMD) sont un ensemble d’hémopathies clonales de la cellule souche. Ils touchent les sujets âgés et se caractérisent par une hématopoïèse inefficace, une différenciation anormale et une transformation fréquente en leucémie aiguë myéloblastique (LAM). La prise en charge thérapeutique a considérablement évolué ces dix dernières années, principalement avec l’arrivée de la 5-azacytidine (Aza) dans les SMD de haut risque. Malheureusement, il existe fréquemment un échec ou une perte de réponse rapide au traitement responsable d’une survie médiane globale de seulement quelques mois. La compréhension des mécanismes d’action des agents hypométhylants, la mise en évidence des facteurs biologiques impliqués dans la résistance à l’Aza ou encore l’identification de nouvelles associations de molécules constitue donc un enjeu majeur. Plusieurs équipes, dont la nôtre, ont démontré que l’erlotinib (Erlo) (inhibiteur de l’activité kinase de l’EGFR (Epidermal Growth Factor Receptor)) possède des effets antinéoplasiques dans les SMD/LAM. Compte tenu de sa toxicité modérée, cet inhibiteur de tyrosine kinase est actuellement en essai clinique en France et aux États-Unis dans les SMD en échec d’Aza. Dans ce travail, nous avons tenté de comprendre les mécanismes d’action impliqués dans l’activité de l’Aza et de l’Erlo seuls ou en association. Nous avons observé que l’Aza et la décitabine (un autre agent hypométhylant) induisent la déphosphorylation et la translocation dans le noyau du facteur de transcription FOXO3A où il réactive l’expression de gènes cibles tels que les facteurs pro apoptotiques PUMA et BIM. Cet effet observé rapidement, suggère un effet « off target » non lié à une reprogrammation épigénétique. La phosphorylation constitutive de FOXO3A étant considérée comme un facteur de mauvais pronostic dans les LAM, cette observation soulève l’intérêt potentiel des agents hypométhylants dans cette pathologie. Nous avons également identifié deux nouvelles cibles de l’Erlo : les SRC-kinases et la voie mTOR/p70S6K dont l’inhibition par des inhibiteurs biochimiques induit un arrêt du cycle cellulaire en G0/G1 sans apoptose ni différenciation confirmant l’hypothèse d’une action « multikinase » de l’Erlo. Par ailleurs, nous avons mis en évidence une activité synergique sur l’apoptose de l’association Aza et Erlo sur des lignées cellulaires de SMD/LAM et sur des cellules de patients. Cet effet n’a pas été retrouvé avec la décitabine ni les autres inhibiteurs de tyrosine kinase testés. La potentialisation de l’apoptose semble liée à plusieurs mécanismes associant l’augmentation de la concentration intracellulaire d’Aza via l’inhibition des transporteurs ABC, un arrêt de la prolifération, une activation des voies apoptotiques caspases-dépendantes et indépendantes et une activation des dommages à l’ADN. En conclusion, ce travail a permis l’identification de nouvelles cibles de l’Erlo et de l’AZA et a révélé un effet synergique entre ces deux molécules. Ces résultats précliniques encourageants suggèrent que cette association pourrait apporter un potentiel bénéfice chez les patients atteints de SMD/LAM, notamment ceux devenus réfractaires à l’Aza. / Myelodysplasic syndromes (MDS) constitute a diverse group of malignant clonal disorders that typically occur in elderly people. MDS are characterized by ineffective hematopoiesis, refractory cytopenias, morphologic dysplasia and increased potential to transform into acute myeloid leukemia (AML). Treatment of MDS has progressed considerably in recent years with the emergence of new approval agents such as azacytidine (aza)(a hypomethylating agent (HMA)) in higher-risk MDS. However, there are still a significant proportion of patients who do not respond to therapy with aza. Therefore, understanding the mechanisms of action of HMAs, identifying predictive factors for aza resistance and combining HMAs with other active compounds in MDS represent a challenging area to improve MDS/AML treatment. Previous works showed that erlotinib (an inhibitor of the epidermal growth factor receptor (EGFR)) exhibits antineoplastic effects in MDS/AML. Due to its limited toxicity profile, this tyrosine kinase inhibitor is currently being evaluated after failure of aza in two clinical trials. In this project, we aimed at understanding the molecular mechanisms involved in the activity of aza and erlo alone or in combination. We observed that aza and decitabine (another HMA related to aza) induces dephosphorylation and translocation to nucleus of the transcriptional regulator FOXO3A promoting the upregulation of the pro-apoptotic factors PUMA and BIM. This effect could be an “off target” effect and could contribute the bebenfical role of HMA in AML as constitutive phosphorylation of FOXO3A has been shown to be an adverse prognostic factor. We discovered new target for erlo, Src-kinase kinases and mTOR that are implicated in the cell-cycle arrest but not in the induction of apoptosis or differentiation confirming the “multikinase” activity of erlo. We found that the combination of aza and erlo demonstrated synergistic induction of apoptosis in MDS/AML cell lines and in some patient cells. This effect was not observed with decitabine or other tyrosine kinase inhibitors frequently used in onco-hematology. We demonstrated that potentiation of cell death is associated with different mechanisms such as intracellular accumulation of aza (via inhibition of ABC transporters), cell cycle arrest with inhibition of leukemic cells growth, caspase-dependent and -independent induction of apoptosis and DNA damage level. In conclusion, this work identified new targets of aza and erlo and revealed a synergistic induction of apoptosis upon co-treatment suggesting that this drug combination might be promising for SMD/AML treatment SMD/AML, especially the resistant patients.

De nombreuses altérations épigénétiques ont été décrites dans les leucémies aiguës myéloïdes (LAM). Nous avons récemment mis en évidence un enrichissement anormal en la marque histone H3K27me3, située sur 70 kb du cluster HIST1 (6p22) dans 50% des échantillons de patients atteints d'une LAM avec un caryotype normal (CN). Nous étudions dans ce travail, les conséquences cliniques et moléculaires de cette marque. H3K27me3 HIST1high est associé à 1) une meilleure survie des patients en analyse multivariée 2) la sous-expression du mRNA de plusieurs gènes histones (HIST1H1D, HIST1H2BG et HIST1H2BH) 3) un enrichissement fonctionnel en gènes associés à la réponse immunitaire ou inflammatoire, en faveur d’un engagement dans la différenciation granulocytaire, surexprssion confirmée pour trois de ces gènes (CYBB, FCN1 et CLEC4A) par RT-qPCR dans les blastes de patients H3K27me3 HIST1high 4) une diminution de la quantité absolue de protéine histone linker H1d par spectormétrie de masse et par Western blot et 5) une meilleure sensibilité à la différenciation induite par l'acide rétinoïque dans la lignée OCI-AML3 avec un KD de H1d (augmentation de l’expression des marqueurs de différenciation CD11B et CD11C, présence de granules intra-cytoplasmiques et expression des gènes CYBB et ITGAM). En conclusion, le biomarqueur H3K27me3 HIST1high est associé à une meilleure survie dans les LAM-CN NPM1mut, un phénotype plus différencié des blastes et une sous-expression génique et protéique de certains histones incluant le sous-type histone linker H1d. H1d semble être important dans la différenciation des blastes de LAM NPM1mut et pourrait constituer une cible thérapeutique. / The epigenetic machinery is frequently altered in acute myeloid leukemia (AML). We previously described an abnormal histone H3K27me3 repressive enrichment covering 70 kb on the HIST1 cluster (6.p22). In the present work, we further studied the medical significance and the molecular impact of this new epigenetic biomarker. We observed that H3K27me3 HIST1high is associated with 1) a better patients' outcome in multivariate analysis, 2) a lower histone mRNA expression of several histone genes (HIST1H1D, HIST1H2BG and HIST1H2BH), 3) a mature granulocytic gene expression profile including immune or inflammatory responsive genes, (we confirmed the higher expression of three of these genes, CYBB, FCN1 and CLEC4A, using qPCR in the H3K27me3 HIST1high patients' samples), 4) a decrease in histone linker H1d absolute protein abundance by Mass spectrometry and by Western blot analyses and 5) a better retinoic acid sensitization of the H1d KD OCI-AML3 cell line (i.e. increase of CD11B and CD11C expression on cell surface, higher percentage of cytoplasmic granules and mRNA up-expression of two mature granulocytic genes, CYBB and ITGAM). To conclude, this study showed that epigenetic silencing of the HIST1 locus by the H3K27me3 mark is associated with a better outcome, but also a mature gene expression profile in the NPM1mut subgroup of patients. We suggested that H1d has an important role of histone linker expression in AML blast cell differentiation. This protein could constitute a new epigenetic target.

A introdução do Mesilato de Imatinibe (MI) como primeiro inibidor específico de BCR-ABL1 na prática clínica revolucionou o tratamento da Leucemia Mieloide Crônica (LMC), tornando-se a terapia padrão para o tratamento desta doença. Porém, cerca de 30% dos pacientes com LMC não respondem à terapia com MI e um número substancial destes casos de resistência não tem causa conhecida. O MI interage com transportadores de membrana ABCG2 e SLCO1A2. Este estudo teve como objetivo investigar a relação da expressão gênica de ABCG2 e de SLCO1A2 com marcadores de resposta ao tratamento com MI, em indivíduos com LMC e avaliar a influência dos polimorfismos ABCG2 c.421C>A e ABCG2 c.-19-99G>A na resposta ao MI. Foram incluídos 118 pacientes com LMC os quais foram classificados em dois grupos: Grupo Respondedor, constituído por 70 pacientes com resposta citogenética completa com a dose padrão de MI (400 mg/dia) por até 18 meses e, Grupo não Respondedor constituído por 48 pacientes sem resposta citogenética completa à dose inicial de 400 mg/dia de MI ou que perderam esta resposta ao longo do tratamento e foram reescalonados para doses de 600 ou 800 mg/dia. A resposta ao tratamento foi avaliada segundo os critérios da European LeukemiaNet. Foram excluídos pacientes com alterações citogenéticas diferentes do cromossomo Ph e mutações no gene BCR-ABL1. Amostras de sangue periférico foram utilizadas para: extração do RNA total para quantificação dos transcritos BCR-ABL1 e expressão gênica de ABCG2 e SLCO1A2; extração de DNA e análise citogenética de banda G. A expressão do gene ABCG2 e SLCO1A2 e as análises dos polimorfismos foram feitas por PCR em tempo real. A expressão de ABCG2 foi maior no grupo de não respondedores ao MI (P=0,028). Este resultado foi influenciado pelos pacientes com resistência primária (N= 34 P=0,029), mas não pelos que apresentaram resistência secundária (N=14 P=0,249) quando comparado com respondedores (N=70). A elevada expressão do gene ABCG2 foi também associada àqueles pacientes que não tiveram resposta molecular maior (número de transcritos BCR-ABL1 ≤ 0,1%) (P=0,027) quando todos os pacientes foram analisados. O gene estudado não foi associado com a resposta molecular completa (número de transcritos BCR-ABL1 ≤ 0,032%). Com relação ao gene SLCO1A2 não foi possível determinar sua expressão devido à baixa concentração do RNA obtido. Os polimorfismos c.421C>A e c.-19-99G>A não foram associados com a expressão do gene ABCG2 e a resposta ao MI. A RMC (no grupo de respondedores) foi associada com o genótipo 421CC e houve tendência a maior frequencia de portadores do genótipo -19-99GG neste mesmo grupo. Portadores do genótipo -19-99AA apresentaram tendência ao risco de ter LMC. Os resultados deste estudo nos permitem concluir que a maior expressão de ABCG2 está associada com a resistência primária ao MI podendo então ser um mediador da resistência ao MI. Os polimorfismos do gene ABCG2 não influenciaram na expressão gênica de ABCG2, mas impactaram na RMC no grupo respondedor ao MI. / The introduction of imatinib mesylate (IM) as the first specific inhibitor of BCR-ABL1 in clinical practice has revolutionized the treatment of chronic myeloid leukemia (CML), becoming the standard therapy for this disease. However, about 20% of CML patients do not respond to therapy with IM and a substantial number of these cases of resistance have no known cause. The MI interacts with membrane transporters ABCG2 and SLCO1A2. The aim of this study was to investigate the relationship of ABCG2 and SLCO1A2 gene expression with markers of response to MI in individuals with CML and evaluate the influence of polymorphisms ABCG2 c.421C> A and c. ABCG2-19-99G> A in response to the MI. One hundred and eighteen patients in chronic phase of CML were studied and classified in two groups: Responder Group comprised 70 patients who had a complete cytogenetic response within 18 months of treatment. The non-responder group comprised 48 patients who did not have a complete cytogenetic response with the initial dose (400 mg/day) of IM or who relapsed during treatment and were submitted to higher doses of 600 or 800 mg/day. Criteria of failed response to treatment were established by European LeukemiaNet. Patients with cytogenetic patterns other than the Philadelphia chromosome and patients with mutations in the BCR-ABL1 gene were excluded from this study. Blood samples were obtained for: total RNA extraction for quantification of BCR-ABL1 and gene expression of ABCG2 and SLCO1A2; genomic DNA extraction and band G cytogenetic analysis. The gene expression and the analysis of the polymorphisms were performed by real time PCR. Expression of ABCG2 in non-responder group was higher than in responder group (P=0.028). This result was influenced by patients with primary resistance (n= 34 P=0.029) but not secondary resistance (n=14 P=0.249) when compared with responders (n=70). The higher expression of ABCG2 gene was also associated with those patients who had major molecular response (number of BCR-ABL1 . 0.1%) (P=0.027) when all patients were analyzed. The studied gene was not associated with the complete molecular response (number of BCR-ABL1 .0.0032). Regarding to the gene SLCO1A2 was not possible to determine its expression due to low concentration of RNA obtained. The c.421C>A e c.-19-99G>A were not associated neither with the ABCG2 gene expression and MI response. CMR in responders group was associated with the 421CC genotype ant there was a trend for higher frequency of carriers of genotype -19-99GG in the same group. Carriers of 19-99AA genotype tended to the risk of having CML. The results of this study allow us to conclude that the higher expression of ABCG2 is associated with primary resistance to IM and may be a mediator of resistance to IM. The ABCG2 polymorphisms did not influence the gene expression of ABCG2 but impacted in CMR of the responders to IM.

by Chan Yick Bun. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1999. / Includes bibliographical references (leaves 145-165). / Abstracts in English and Chinese. / Acknowledgement --- p.II / Abstract --- p.IV / Contents --- p.VIII / Abbreviations --- p.XIV / List of Figures --- p.XVI / List of Tables --- p.XVII / Chapter Chapter One --- General introduction / Chapter 1.1 --- Leukemia: an overview --- p.1 / Chapter 1.1.1 --- Background --- p.1 / Chapter 1.1.2 --- Classification of leukemia --- p.1 / Chapter 1.1.3 --- Origin of leukemia --- p.3 / Chapter 1.1.4 --- Treatment of leukemia --- p.5 / Chapter 1.2 --- Introduction of leukemia cell re-differentiation --- p.8 / Chapter 1.2.1 --- Introduction --- p.8 / Chapter 1.2.2 --- Inducers of cell differentiation --- p.8 / Chapter 1.2.3 --- Genes involved in myeloid leukemia cell differentiation --- p.11 / Chapter 1.2.3.1 --- Transcription factors --- p.11 / Chapter 1.2.3.2 --- Signal transduction cascades --- p.16 / Chapter 1.2.3.3 --- Receptors --- p.18 / Chapter 1.2.3.4 --- Cytokines --- p.19 / Chapter 1.3 --- Tumor necrosis factor alpha induced WEHI 3B JCS cell differentiation --- p.21 / Chapter 1.3.1 --- Introduction --- p.21 / Chapter 1.3.2 --- Tumor necrosis factor alpha --- p.21 / Chapter 1.3.3 --- WEHI 3B JCS cells --- p.23 / Chapter 1.4 --- Aims of study --- p.25 / Chapter Chapter Two --- Isolation of differentially expressed genes during TNF-α induced WEHI 3B JCS cell differentiation / Chapter 2.1 --- Introduction --- p.26 / Chapter 2.1.1 --- Overview of differential genes screening methods --- p.26 / Chapter 2.1.2 --- Differential hybridization for analysis of gene expression profiles --- p.29 / Chapter 2.1.3 --- Factors affect differential hybridization --- p.33 / Chapter 2.2 --- Materials --- p.35 / Chapter 2.2.1 --- Cell line --- p.35 / Chapter 2.2.2 --- Mouse brain cDNA library --- p.35 / Chapter 2.2.3 --- E.coli strains --- p.35 / Chapter 2.2.3 --- Kits --- p.35 / Chapter 2.2.5 --- Chemicals --- p.35 / Chapter 2.2.6 --- Solutions and buffers --- p.36 / Chapter 2.2.7 --- Enzymes and reagents --- p.37 / Chapter 2.3 --- Methods --- p.38 / Chapter 2.3.1 --- Preparation of total RNA from TNF-a induced WEHI 3B JCS cells --- p.38 / Chapter 2.3.1.1 --- Preparation of cell lysates --- p.38 / Chapter 2.3.1.2 --- Extraction of total RNA --- p.38 / Chapter 2.3.2 --- Preparation of cDNA clones from cDNA library --- p.39 / Chapter 2.3.2.1 --- Rescue of phagemids from cDNA library --- p.39 / Chapter 2.3.2.2 --- Preparation of plasmids --- p.39 / Chapter 2.3.3 --- Primary differential hybridization --- p.40 / Chapter 2.3.3.1 --- Preparation of cDNA blots --- p.40 / Chapter 2.3.3.2 --- Preparation of cDNA probes --- p.40 / Chapter 2.3.3.3 --- Primary differential hybridization --- p.41 / Chapter 2.3.4 --- Subcloning of putative differential cDNA clones --- p.42 / Chapter 2.3.4.1 --- Preparation of DH5a competent cells --- p.42 / Chapter 2.3.4.2 --- Transformation of cDNA clones --- p.42 / Chapter 2.3.5 --- Secondary differential hybridization --- p.42 / Chapter 2.3.5.1 --- Preparation ofcDNA blots --- p.42 / Chapter 2.3.5.2 --- Secondary differential hybridization --- p.43 / Chapter 2.4 --- Results --- p.44 / Chapter 2.4.1 --- Analysis of total RNA prepared from TNF-α induced WEHI 3B JCS cells --- p.44 / Chapter 2.4.2 --- Spectrophotometric analysis of plasmid DNA --- p.46 / Chapter 2.4.3 --- Primary differential hybridization --- p.48 / Chapter 2.4.4 --- Secondary differential hybridization --- p.58 / Chapter 2.4.5 --- Comparison of two rounds of differential hybridization --- p.61 / Chapter 2.5 --- Discussions --- p.63 / Chapter 2.5.1 --- Study of gene expression profile by differential hybridization --- p.63 / Chapter 2.5.1.1 --- cDNA library --- p.63 / Chapter 2.5.1.2 --- Blots --- p.64 / Chapter 2.5.2 --- Two rounds of differential hybridization --- p.66 / Chapter 2.5.3 --- Comparison of two rounds of differential hybridization --- p.68 / Chapter Chapter Three --- Sequence analysis of putative differentially expressed genes / Chapter 3.1 --- Introduction --- p.70 / Chapter 3.1.1 --- Basic structure of cDNA clones --- p.70 / Chapter 3.1.2 --- Strategies for DNA sequencing --- p.71 / Chapter 3.1.2.1 --- Primer walking --- p.71 / Chapter 3.1.2.2 --- Restriction digestion and subcloning --- p.71 / Chapter 3.1.2.3 --- Nested deletion sets --- p.72 / Chapter 3.1.2.4 --- Shotgun sequencing --- p.72 / Chapter 3.1.2.5 --- Other sequencing strategies --- p.73 / Chapter 3.1.3 --- Sequence alignment and database search --- p.74 / Chapter 3.1.3.1 --- Sequence database --- p.74 / Chapter 3.1.3.2 --- Sequence alignment --- p.74 / Chapter 3.1.3.3 --- BLAST algorithm --- p.75 / Chapter 3.2 --- Materials --- p.76 / Chapter 3.2.1 --- Kits --- p.76 / Chapter 3.2.2 --- Restriction enzymes --- p.76 / Chapter 3.2.3 --- Solutions and buffers --- p.76 / Chapter 3.2.4 --- Enzymes and reagents --- p.77 / Chapter 3.3 --- Methods --- p.78 / Chapter 3.3.1 --- Restriction digestion --- p.78 / Chapter 3.3.2 --- Subcloning --- p.79 / Chapter 3.3.2.1 --- Gel purification --- p.79 / Chapter 3.3.2.2 --- Ligation --- p.79 / Chapter 3.3.2.3 --- Transformation --- p.80 / Chapter 3.3.3 --- Shotgun sequencing --- p.80 / Chapter 3.3.4 --- Sequencing reaction --- p.81 / Chapter 3.3.4.1 --- Preparation of sequencing gel --- p.81 / Chapter 3.3.4.2 --- Sequencing reaction --- p.81 / Chapter 3.4 --- Results --- p.83 / Chapter 3.4.1 --- Restriction mapping of cDNA inserts --- p.83 / Chapter 3.4.2 --- Sequencing results --- p.85 / Chapter 3.4.3 --- Sequence analysis --- p.90 / Chapter 3.5 --- Discussions --- p.103 / Chapter 3.5.1 --- Sequencing strategies --- p.103 / Chapter 3.5.2 --- Sequence analysis --- p.104 / Chapter Chapter Four --- Characterization of the putative differentially expressed genes / Chapter 4.1 --- Introduction --- p.107 / Chapter 4.1.1 --- Midazolam induced WEHI 3B JCS cells differentiation --- p.107 / Chapter 4.1.2 --- Gene expression profiles in embryogenesis --- p.108 / Chapter 4.2 --- Materials --- p.110 / Chapter 4.2.1 --- Mouse embryo multiple tissue Northern (MTN´ёØ) blot --- p.110 / Chapter 4.2.2 --- Megaprime´ёØ DNA labelling system --- p.110 / Chapter 4.2.3 --- Chemicals --- p.110 / Chapter 4.2.3 --- Solutions and buffers --- p.111 / Chapter 4.3 --- Methods --- p.112 / Chapter 4.3.1 --- Preparation of Northern blots --- p.112 / Chapter 4.3.1.1 --- Preparation of total RNA from midazolam induced WEHI 3B JCS cells --- p.112 / Chapter 4.3.1.2 --- Preparation of Northern blots --- p.112 / Chapter 4.3.2 --- Preparation of DNA probes --- p.113 / Chapter 4.3.2.1 --- Preparation of DNA templates --- p.113 / Chapter 4.3.2.2 --- Preparation of 32P labelled probes --- p.114 / Chapter 4.3.3 --- Northern blot analysis --- p.115 / Chapter 4.3.3.1 --- Northern hybridization --- p.115 / Chapter 4.3.3.2 --- Stripping of Northern blot --- p.115 / Chapter 4.4 --- Results --- p.117 / Chapter 4.4.1 --- Analysis of midazolam induced JCS cells total RNA --- p.117 / Chapter 4.4.2 --- Preparation of DNA templates for probe syntheses --- p.119 / Chapter 4.4.3 --- Northern Hybridization --- p.121 / Chapter 4.4.4 --- Comparison of the results of differential hybridization and Northern hybridization --- p.126 / Chapter 4.5 --- Discussions --- p.127 / Chapter 4.5.1 --- Northern hybridization --- p.127 / Chapter 4.5.1.1 --- Gene expression patterns under TNF-α induction --- p.127 / Chapter 4.5.1.2 --- Normalization of Northern hybridization --- p.129 / Chapter 4.5.1.3 --- Gene expression patterns under midazolam induction --- p.130 / Chapter 4.5.1.4 --- Gene expression pattern during embryo development --- p.133 / Chapter Chapter Five --- General discussion / Chapter 5.1 --- Identification of differentially expressed genes in TNF-α induced WEHI 3B JCS diffentiation --- p.135 / Chapter 5.2 --- Differentially expressed genes and myeloid leukemia cell differentiation --- p.137 / Chapter 5.3 --- Differentially expressed genes and embryogenesis --- p.142 / Chapter 5.4 --- Further studies --- p.144 / References --- p.145