A leucemia mieloide crônica (LMC) é uma expansão clonal da célula tronco hematopoética, traduzindo-se por hiperplasia mieloide, leucocitose, neutrofilia, basofilia e esplenomegalia. O cromossomo Filadélfia é característico da doença, sendo produto da translocação t(9:22)(q34;q11), resultando na fusão dos genes ABL e BCR. Esta fusão gera um gene híbrido que codifica uma proteína com elevada atividade tirosinoquinase e tem um papel central na patogenia da LMC. O mesilato de imatinibe (MI) é um derivado da fenilaminopirimidina que inibe a proteína tirosinoquinase BCR-ABL1 in vitro e in vivo. O MI interage com transportadores de membrana de influxo, como o organic carion solute carrier 22 ,member 1 (SLC22A1,hOCT1); e de efluxo, como ATP binding cassette B1 (ABCB1, MDR1, P-gp). Os polimorfismos ABCB1 c.1236C>T, C.3435C>T e c.2677G>T/A têm sido associados com a alteração da função da P-gp. Este estudo teve por objetivo investigar a relação da expressão do RNAm de ABCB1 e SLC22A1 com marcadores de resposta ao tratamento com MI e avaliar a atividade funcional da P-gp em células mononucleares de pacientes com diferentes haplótipos para os polimorfismos ABCB1 c.1236C>T, c.3435C>T e c.2677G>T/A. Foram incluídos 118 pacientes com LMC para o estudo da expressão do RNAm de SLC22A1 e ABCB1 e para o estudo da atividade da P-gp foram selecionados 28 pacientes de acordo com os haplótipos dos polimorfismos ABCB1 c.1236C>T, c.3435C>T e c.2677G>T/A. Para o estudo da expressão do RNAm de SLC22A1 e ABCB1 foram constituídos dois grupos: Grupo 1 com 70 pacientes com resposta citogenética completa com a dose padrão de MI (400 mg/dia de MI) em até 18 meses e, Grupo 2 com 48 pacientes sem resposta citogenética completa com a dose inicial de 400 mg/dia de MI ou que perderam esta resposta ao longo do tratamento. Para o estudo da atividade funcional da P-gp, dos 118 pacientes incluídos, foram selecionados 10 pacientes que apresentaram o haplótipo 1236CC/3435CC/2677GG, 10 pacientes que apresentaram o haplótipo 1236CT/3435CT/2677GT e 8 pacientes que apresentaram o haplótipo 1236TT/3435TT/2677TT. A resposta ao tratamento foi avaliada segundo os critérios da European LeukemiaNet. Amostras de sangue foram obtidas para: quantificação de BCR-ABL1, extração do RNAm total, análise citogenética de banda G, dosagem da concentração plasmática de MI e análise da atividade e expressão da P-gp. A análise da expressão dos genes ABCB1 e SLC22A1 foi feita por PCR em tempo real, a análise da atividade e expressão da P-gp foram feitas por citometria de fluxo e a dosagem da concentração plasmática de MI foi realizada por eletroforese capilar. Resultados: A expressão de ABCB1 e SLC22A1 foi analisada nos 118 pacientes incluídos e foi similar entre os grupos de resposta. A elevada expressão do gene SLC22A1 foi associada àqueles pacientes que alcançaram a resposta molecular maior (RMM) no grupo respondedor (P=0,009). Não houve associação entre a expressão de ABCB1 e a resposta ao MI. Nenhum dos genes foi associado à resposta molecular completa (RMC). No estudo da atividade da P-gp foi observada uma maior atividade nos pacientes que apresentavam o haplótipo 1236CC/3435CC/2677GG quando comparado àqueles que possuíam o haplótipo com alelo mutado. Não houve diferença na expressão do RNAm dos genes SLC22A1 e ABCB1, expressão da P-gp e concentração plasmástica de MI entre os grupos de haplótipos. Os pacientes que não alcançaram a RMM apresentaram uma maior taxa de efluxo mediado pela P-gp quando comparado aos indivíduos que alcançaram esta resposta (64,7% vs. 45,7%; P=0,001). Os indivíduos que alcançaram a RMM e RMC apresentaram maior mediana de expressão do gene SLC22A1. Os pacientes sem RMM apresentaram menor concentração plasmática de MI quando comparados aos que alcançaram esta resposta (0,51 µg/mL vs. 1,42 µg/mL; P=0,001). Não foi observada associação entre a concentração plasmática de MI e a RMC. Em conclusão os pacientes respondedores a dose padrão de 400mg/dia de MI e que alcançaram a RMM apresentam maior expressão de RNAm de SLC22A1 e os portadores dos haplótipos 1236CT/3435CT/2677GT e 1236TT/3435TT/2677TT exibem menor efluxo mediado pela P-gp apresentando maior frequência de RMM. / Chronic myeloid leukemia (CML) is a clonal expansion of hematopoietic stem cell, translating into myeloid hyperplasia, leukocytosis, neutrophilia, basophilia and splenomegaly. The Philadelphia chromosome is characteristic of the disease, being the product of the translocation t(9:22)( q34,q11), resulting in the fusion of the BCR and ABL genes. This fusion generates a hybrid gene that encodes a protein with elevated tyrosine kinase activity and plays a central role in the pathogenesis of CML. Imatinib mesylate (IM) is a derivative of fenilaminopirimidine that inhibits BCR-ABL1 fusion protein tyrosine kinase in vitro and in vivo. IM interacts with uptake membrane transporters, such as cation organic solute carrier 22, member 1 (SLC22A1, hOCT1) and efflux as ATP binding cassette B1 (ABCB1, MDR1,P-gp). ABCB1 polymorphisms c.1236C>T,c.3435C>T and c.2677G>T/A have been associated with altered function of P-gp. This study aimed to investigate the relationship between mRNA expression of ABCB1 and SLC22A1 with markers of response to treatment with IM and evaluate the functional activity of P-gp in mononuclear cells of patients with different haplotypes for ABCB1 c.1236C>T, c.3435C>T and c.2677G>T/A polymorphisms. This study included 118 patients with CML to study the mRNA expression of SLC22A1 and ABCB1 and to study the P-gp activity, 28 patients were selected according to the haplotypes of ABCB1 c.1236C>T, c.3435C>T and c.2677G>T/A polymorphisms. To study the mRNA expression of SLC22A1 and ABCB1, two groups were constituted: Group 1 with 70 patients with a complete cytogenetic response with standard-dose IM (400 mg/day) in 18 months, and group 2 with 48 patients without complete cytogenetic response with the initial dose of IM (400 mg/day) or have lost this response during treatment. To study the P-gp functional activity, 10 patients with haplotype 1236CC/3435CC/2677GG, 10 patients with haplotype 1236CT/3435CT/2677GT and 8 patients with haplotype 1236TT/3435TT/2677TT were enrolled. Treatment response was assessed according to European LeukemiaNet criteria. Blood samples were obtained for: quantification of BCR-ABL1, mRNA extraction, G band cytogenetic analysis, measurement of IM plasma levels and P-gp activity and expression. The ABCB1 and SLC22A1 gene expression analysis was made by real-time PCR, analysis of P-gp activity and protein expression were performed by flow cytometry and determination of plasma Levels of IM was performed by capillary electrophoresis. Results: Expression of ABCB1 and SLC22A1 were analyzed in 118 patients included and was similar between the response groups. Higher expression of the SLC22A1 gene was associated with those patients who achieved a major molecular response (MMR) in the responder group (P=0.009). There was no association between ABCB1 expression and IM response. None of the studied genes was associated with complete molecular response (CMR). In the study of P-gp activity we observed greater activity mediated by P-gp in patients with 1236CC/3435CC/2677GG haplotype when compared to those with the mutated allele. There was no difference in mRNA expression of SLC22A1 and ABCB1 genes, P-gp expression and IM plasma levels between haplotypes groups. Patients who did not achieve MMR showed a higher rate of efflux mediated by P-gp compared to individuals who did achieve this response (64.7% vs. 45.7%, P=0.001). Individuals who achieved MMR and CMR had higher median of SLC22A1 expression. Patients without MMR had lower IM plasma levels compared with those who achieved this response (0.51 µg/mL vs. 1.42 µg/mL, P=0.001). No association was observed between IM plasma levels and CMR. In conclusion patients responders to standard dose of IM (400 mg/day) and who achieved MMR have higher SLC22A1 mRNA expression and the carriers of 1236CT/3435CT/2677GT 1236TT/3435TT/2677TT haplotypes exhibit lower efflux mediated by P-gp with higher frequency of MMR.

Mon travail a été d'étudier le rôle de l'expression de FZD9, un récepteur Wnt, dans l'hématopoïèse normale et maligne. Frizzled 9 (FZD9) est un composant clé de la voie de signalisation Wnt, une voie connue pour jouer un rôle important dans l'hématopoïèse normale et maligne. La méthylation d'un site CpG proximal de site d'initiation de la transcription du gène FZD9 est un facteur de mauvais pronostic dans les LAMs et sa déméthylation est un facteur prédictif de réponse aux thérapies épigénétiques. Sa fonction dans l'hématopoïèse n'est cependant pas connue. Au cours de ma thèse, j'ai démontré que le promoteur du gène FZD9 est dans un état non-permissif dans les cellules leucémiques. L'induction de la différenciation des cellules leucémiques restaure l'état permissif du promoteur, le recrutement du facteur E2F et de l'histone H3 acétyle permettant l'expression de FZD9. L'expression de FZD9 expression est également retrouvée au cours de la différenciation myéloïde d'une lignée IPS Dans les cellules de la lignée THP1 différenciées en monocytes, FZD9 est retrouvé dans un complexe comprenant LRP5/6 et Wnt5a. L'incubation des cellules différenciées par Wnt5a, un ligand de FZD9, déclenche la diminution de l'expression de -caténine et sa localisation nucléaire ainsi que l'expression des gènes cibles de la voie Wnt canonique (c-myc, Cyclin Dl and CD44). Nous n'avons détecté aucune augmentation des taux intracellulaires de calcium. Ces travaux suggèrent que la méthylation du promoteur de FZD9 dans les LAMs pourrait participer à la leucémogénèse en maintenant la voie b-caténine active / My goal was to study the importance of the expression of the FZD9, a Wnt receptor, in both normal and malignant hematopoiesis. Frizzled 9 (FZD9) is a key component of the Wnt signaling pathway, a pathway which has been shown to play a role in both normal and malignant hematopoiesis. Methylation of the CpG proximal to the transcription start site of the FZD9 gene is recognized as a prognostic factor in AML and its demethylation is a predictive factor for response to epigenetic therapy. Its function in hematopoiesis is however not known. The results show that the FZD9 promoter is in a non-permissive state in leukemic cells. Induction of myeloid differentiation in human myeloid leukemic cell fines restores FZD9 promoter permissiveness with recruitment of E2F and acetylated histone H3 and upregulation of FZD9 mRNA expression. FZD9 expression was progressively increased through the stages of myeloid differentiation in an IPS cell line. In differentiated monocytic THP1 cells, FZD9 was found in the LRPS/6 Wnt receptor complex. Incubation of differentiated cells with Wnt5a, a ligand of FZD9, triggered the decreased expression of - catenin and its nuclear localisation and the canonical Wnt-target genes (c-myc, Cyclin D1 and CD44). We detected no increase in calcium intracellular levels and thus activation of classical non-canonical pathway was not noted upon WntSa incubation. The results of my PhD suggest that the reported methylation of FZD9 promoter in AML and HR-MDS patients may participate in leukemogenesis by the maintenance of an activated Wnt canonical pathway.

La septicémie et les troubles associés demeurent une cause majeure de mortalité dans les unités de soins intensifs. Des récents travaux ont mis en lumière un lien inattendu entre les mitochondries et les fonctions des cellules immunitaires. Des modifications des fonctions mitochondriales ont pu être observées dans les cellules sanguines périphériques lors de septicémies. Dans le cadre de ce travail de thèse, nous avons cherché à évaluer si la mitophagie pouvait avoir un impact sur les fonctions des phagocytes dans le contexte d’une infection bactérienne. La mitophagie est une autophagie dédiée aux mitochondries qui régit l'élimination des mitochondries dysfonctionnelles. Nous avons démontré ici in vivo et in vitro que les macrophages exposés aux bactéries à Gram négatif ou à leurs composants de la paroi cellulaire (Lipopolysaccharides, LPS) présentent une inhibition marquée de la mitophagie qui constitue un mécanisme de protection contre la septicémie. L'activation des macrophages avec une combinaison LPS/IFNγ entraîne une inhibition précoce de la mitophagie dépendante de PINK1 selon une voie dépendante de STAT1-Caspase 11. Cette inhibition de la mitophagie contribue à expliquer la reprogrammation métabolique observée dans les macrophages classiquement activés (macrophages M1) et conduit à une augmentation de la production de ROS mitochondriaux (mROS). En tant que molécules de signalisation, les mROS conduisent à l'activation des macrophages de manière dépendante de HIF-1α et NF-κB. En outre, ces molécules contribuent à la clairance bactérienne dans les phagocytes activés. Il est intéressant de noter que nous avons démontré in vitro et in vivo que la modulation pharmacologique de la mitophagie permet d'imiter ou de réprimer les effets du LPS sur la polarisation des macrophages, la libération des cytokines et l'activité bactéricide. Pour conclure, ce travail démontre que l'inhibition de la mitophagie est une caractéristique de l'activation LPS-dépendante des macrophages et un mécanisme de protection contre les bactéries à Gram négatif. Cette étude souligne également une relation inconnue entre la signalisation IFNγ, les caspases inflammatoires et la mitophagie. Enfin, nos travaux mettent en lumière l'impact des modulateurs pharmacologiques de la mitophagie sur la fonction des macrophages et ouvrent de nouvelles opportunités pour le développement de nouvelles stratégies thérapeutiques pour stimuler la défense de l'hôte. / Sepsis and related organ dysfunctions remain a leading cause of mortality in intensive care units. Increasing evidences have shed light on an unexpected link between mitochondria and immune cell functions. Alterations in mitochondrial functions have been reported in peripheral blood cells in sepsis. We hypothesize here that mitophagy might impact on phagocyte functions in the context of bacterial infection. Mitophagy is a mitochondria-dedicated autophagy that governs the elimination of dysfunctional mitochondria. We demonstrated here in vivo and in vitro that macrophages exposed to Gram-negative bacteria or their cell wall component LPS display a marked inhibition of mitophagy that constitutes a protective mechanism against sepsis. LPS/IFNγ-driven macrophage activation results in early inhibition of PINK1-dependent mitophagy through a STAT1-Caspase 4/11 pathway. This inhibition of mitophagy contributes to explain the metabolic reprogramming observed in classically activated macrophages and leads to a rise in mitochondrial ROS (mROS) production. As signaling molecules, mROS lead to macrophages activation in a HIF-1α- and NF-κB-dependent manner. Furthermore, these molecules contribute to bacterial clearance in activated phagocytes. Interestingly, we demonstrated in vitro and in vivo that pharmacological modulation of mitophagy allows either mimicking or repressing the effects of LPS on macrophages polarization, cytokine release and bactericidal activity. To conclude, this work demonstrates that inhibition of mitophagy is a feature of LPS-dependent macrophage activation and a protective mechanism against Gram-negative bacteria. This study also highlights an unknown relationship between IFNγ-signaling, inflammatory caspases and mitophagy. Finally, our work point out the impact of pharmacological modulators of mitophagy on macrophage function and open new opportunities for the development of novel strategies to boost host defense

During hematopoiesis, multilineage progenitor cells and the precursors are committed to individual hematopoietic lineages. In normal myelopoiesis, the immature myeloid cells (IMCs) differentiate into macrophages, neutrophils or dendritic cells. However, under tumor burden, these IMCs differentiate into myeloid derived suppressor cells (MDSCs) result in an up-regulation of immune suppressive factors and pro-tumor effect. The development of normal or malignant is tightly controlled by endogenous signals such as transcription factors and epigenetic regulations. HDAC11 is the newest identified members of the histone deacetylase (HDAC) family. Previous study in our group had identified HDAC11 as a negative regulator of interleukin 10 (IL-10) production in antigen-presenting cells (APCs). However, the mechanisms of HDAC11 in regulating myeloid cells differentiation and function remained unclear. We have uncovered for the first time that in the absence of HDAC11, upon LPS stimulation, neutrophils isolated form mice displays an over-production of pro-inflammatory cytokines such as TNF-alpha and IL-6. Strikingly, these HDAC11KO neutrophils showed a significantly higher migratory and phagocytosis activity, resulting from an overexpression of the migratory receptor and cytokine CXCR/L2. We have performed Chromatin Immunoprecipitation (ChIP) analysis on the neutrophils and discovered that HDAC11 was recruited to the promoter regulatory region of these genes we have identified. This part of data will be discussed mainly in chapter 2. Not only does HDAC11 plays a crucial role in the neutrophil function, our group have also found out that lacking of HDAC11 result in an increased suppressive activity of the Myeloid-derived Suppressor Cells (MDSCs). The previous publication of our group had shown that the tumor bearing mice experienced a much more aggressive growth pattern in the HDAC11 KO mice compare with C57BL/6 wild type control. MDSCs isolated from mice lacking HDAC11 appeared to gain increased capability to suppress the function of antigen-specific CD8+ T cells in vitro. Followed by this initial study, in chapter 3, we observed an up-regulation of both expression and enzymatic activity of arginase 1 and Nos2, two enzymes that are crucial in regulating MDSCs suppressive function. The aberrant enzymatic activity of Arg1 and Nos2 in HDAC11KO MDSCs is possibly result from an over-expression of the lineage-specific transcription factor C/EBPβ, which is previously proved to be essential for the differentiation of functional MDSCs. Furthermore, our ChIP data confirmed that HDAC11 may play as an negative regulator of C/EBPβ. Recently, our lab had demonstrated that T cells lacking HDAC11 gained a hyperactive phenotype and anti-tumor effect, indicating that HDAC11 may play a dual role in the host immune system. We further performed an adoptive transfer therapy to C57BL/6 tumor bearing mice. Our data showed that the additional administration of HDAC11KO MDSCs could eliminate, at least partially, the anti-tumor effect by adoptive transfer of HDAC11KO T cells. Taken together, we have uncovered a previously unknown role for HDAC11 as a transcriptional regulator in the myeloid cells differentiation and function. Based on our data and previous work from our lab, we propose a dual role of HDAC11 played in the host immune system. In the absence of HDAC11, host defenders such as neutrophils and T cells are functionally more aggressive against intruders such as pathogen and cancer. However, the immune suppressors such as MDSCs became more suppressive. The contradictory role HDAC11 played in the immune system may provide some insights for the assessment of the pharmacological value of HDAC11 and contribute to the development of novel immunotherapeutic strategies.

"December 2001." Includes bibliographical references (leaves 178-225) Focuses on the ex vivo growth of human haemopoietic progenitor cells with the objective of defining culture conditions for generating myeloid post-progenitor cells for therapy

<p>All-trans retinoic acid (ATRA), a biologically active metabolite of vitamin A, is a powerful inducer of terminal differentiation and growth arrest of several myeloid cell lines <i>in vitro</i>. Although the efficacy of ATRA as an anti-cancer drug has been demonstrated by the successful treatment of acute promyelocytic leukemia (APL), knowledge concerning the molecular mechanisms directing ATRA-induced differentiation and cell cycle arrest of myeloid cells is lacking. Our results show, for the first time, that the complex regulation of cell cycle proteins and myeloid-specific transcription factors induced by ATRA relies on functional Stat1. We found that Stat1 is activated by both tyrosine-701 and serine-727 phosphorylation upon ATRA-induced differentiation of the human monoblastic cell line U-937. Expression of phosphorylation deficient mutants of Stat1 (Stat1Y701F or Stat1S727A) inhibited both ATRA-induced differentiation and cell cycle arrest of U-937 cells, pointing to a requirement of active Stat1 in these processes. </p><p>Detailed analysis of the molecular mechanism of ATRA-induced cell cycle arrest and differentiation showed that the onset of cell cycle arrest was associated with a decrease in c-Myc and cyclin E levels and upregulation of p27^Kip1 and p21^WAF1/CIP1. This was followed by a rapid fall in cyclin A and B and a coordinate dephosphorylation of the retinoblastoma protein (pRb). The inhibition of ATRA-induced cell-cycle arrest by constitutive expression of Stat1Y701F or Stat1S727A was associated with impaired regulation of these cyclins and p27^Kip1, positioning Stat1 activation upstream of these events. To further understand the process of ATRA-induced differentiation, the regulation of myeloid-specific transcription factors was investigated during ATRA-treatment. Notably, ATRA-induced upregulation of Stat2, ICSBP and C/EBP-ε was selectively impaired in sublines expressing Stat1Y701F or Stat1S727A, suggesting an important function of these factors downstream Stat1. Taken together, the work in this thesis clearly demonstrates that Stat1 plays a key role in ATRA-induced terminal differentiation of myeloid cells, through regulation of cell cycle proteins and myeloid-specific transcription factors. </p>

All-trans retinoic acid (ATRA), a biologically active metabolite of vitamin A, is a powerful inducer of terminal differentiation and growth arrest of several myeloid cell lines in vitro. Although the efficacy of ATRA as an anti-cancer drug has been demonstrated by the successful treatment of acute promyelocytic leukemia (APL), knowledge concerning the molecular mechanisms directing ATRA-induced differentiation and cell cycle arrest of myeloid cells is lacking. Our results show, for the first time, that the complex regulation of cell cycle proteins and myeloid-specific transcription factors induced by ATRA relies on functional Stat1. We found that Stat1 is activated by both tyrosine-701 and serine-727 phosphorylation upon ATRA-induced differentiation of the human monoblastic cell line U-937. Expression of phosphorylation deficient mutants of Stat1 (Stat1Y701F or Stat1S727A) inhibited both ATRA-induced differentiation and cell cycle arrest of U-937 cells, pointing to a requirement of active Stat1 in these processes. Detailed analysis of the molecular mechanism of ATRA-induced cell cycle arrest and differentiation showed that the onset of cell cycle arrest was associated with a decrease in c-Myc and cyclin E levels and upregulation of p27Kip1 and p21WAF1/CIP1. This was followed by a rapid fall in cyclin A and B and a coordinate dephosphorylation of the retinoblastoma protein (pRb). The inhibition of ATRA-induced cell-cycle arrest by constitutive expression of Stat1Y701F or Stat1S727A was associated with impaired regulation of these cyclins and p27Kip1, positioning Stat1 activation upstream of these events. To further understand the process of ATRA-induced differentiation, the regulation of myeloid-specific transcription factors was investigated during ATRA-treatment. Notably, ATRA-induced upregulation of Stat2, ICSBP and C/EBP-ε was selectively impaired in sublines expressing Stat1Y701F or Stat1S727A, suggesting an important function of these factors downstream Stat1. Taken together, the work in this thesis clearly demonstrates that Stat1 plays a key role in ATRA-induced terminal differentiation of myeloid cells, through regulation of cell cycle proteins and myeloid-specific transcription factors.

Fibrosis in the bone marrow is usually denominated myelofibrosis and may contribute to impaired hematopoiesis. Myelofibrosis is seen both in malignant and non-malignant diseases. The normal microenvironment in the bone marrow consists of a heterogenous population of hematopoietic and non-hematopoietic stromal cells, their extracellular products and hematopoietic cytokines. The stromal cells produce a complex array of molecules, among others collagens and glycosaminoglycans (GAGs) of which hyaluronan (HYA) is the most abundant. Marrow fibrosis results from an increased deposition of collagens, which are polypeptides. Staining for reticulin, mostly composed of collagen type III, is the common way of visualizing myelofibrosis. HYA, like the collagens, is widely distributed in connective tissues. Little is known about the distribution of HYA in bone marrow. The aims of this thesis have been to determine how HYA is distributed in normal and malignant bone marrow, compared to reticulin staining, and to follow patients with chronic myeloproliferative diseases (CMPD) during two years treatment with anagrelide considering development of cellularity and fibrosis. In bone marrow biopsies from healthy volunteers, the controls, HYA was found in a pattern that was concordant with the reticulin staining. Comparing patients with different malignant diseases with and without bone marrow involvemen, HYA staining was found to be significantly stronger in both groups compared to the controls. The HYA scores were also significantly higher in the bone marrow of patients with de novo acute myeloid leukemia (AML), compared to the controls. There was a correlation between HYA and reticulin in the patients with de novo AML, and in the patients with different malignant diseases with and without bone marrow involvement as in the controls. Increase of HYA, reticulin and cellularity in the bone marrow of patients with CMPD after two years of treatment with anagrelide indicated progression of fibrosis. Anagrelide is a valuable drug for reduction of platelets but seems unable to stop progression of fibrosis and hypercellularity. HYA is an interesting molecule with properties not only contributing to the structure of extracellular matrix but also to cell signaling and behaviour, although the understanding of the detailed mechanisms is still incomplete.

Chronic Myeloid Leukemia is a kind of blood cancer with around 1 incidence per 100 000 persons/year. After the development of an effective treatment, imatinib, in the late 1990:s, the survival percentage has increased drastically. The high survival has turned the attention to different kinds of treatment responses, which in turn are good prognostic factors to future health status. In this thesis, the focus is on whether or not the patient has achieved a so called major molecular response after 12 month, or not. More precisely, the aim is to find prognostic factors to the 12 month response. In order to find prognostic factors for this binary response variable, a multivariate logistic regression analysis is conducted, with the goal of finding a parsimonious logistic model that describes the data. The analysis is done from a merged dataset from three earlier studies. The prognostic factors in the final model are treatment, 3 month response, and enlarged spleen. However, the residual analysis indicates that the model is incomplete, implying that further research needs to be done.

Acute myeloid leukemia (AML) is a genetic disease whereby sequential genetic aberrations alter essential white blood cell development leading to differentiation arrest and hyperproliferation. Pertinent animal models serve as essential intermediaries between in vitro molecular studies and the use of new agents in clinical trials. We previously generated a transgenic zebrafish model expressing human NUP98-HOXA9 (NHA9), a fusion oncogene found in high-risk AML. This expression yields a pre-leukemic state in both embryos and adults. Using this model, we have identified the overexpression of dnmt1 and the Wnt/β-catenin pathway as downstream contributors to the myeloproliferative phenotype. Targeted dnmt1 morpholino knockdown and pharmacological inhibition with methyltransferase inhibitors rescues NHA9 embryos. Similarly, inhibition of β-catenin with COX inhibitors partially restores normal hematopoiesis. Interestingly, concurrent treatment with a histone deacetylase inhibitor and either a methyltransferase inhibitor or a COX inhibitor, synergistically inhibits the effects of NHA9 on embryonic hematopoiesis. Thus, we have identified potential pharmacological targets in NHA9-induced myeloid disease that may offer a highly efficient therapy with limited toxicity – addressing a major long-term goal of AML research.