Acute myeloid leukemia (AML) the most common acute leukemia in adults is characterized by various cytogenetic and molecular abnormalities. However, the genetic etiology of the disease is not yet fully understood. MicroRNAs (miRNAs) are small single- stranded noncoding RNAs that are negative regulators of gene expression. miRNAs influence processes of proliferation, differentiation and apoptosis. Deregulation of miRNAs expression can contribute to human disease. Circulating miRNAs are emerging biomarkers in many diseases and cancers such as breast cancer, colorectal cancer and lung cancer. However, defining a plasma miRNA signature in AML that could serve as a biomarker for diagnosis has been conducted only once. We studied miRNA expression in plasma of 8 AML patients in first detection of the disease and repeatedly after achieving remission using TaqMan miRNA microarray for 750 human miRNA. The plasma expression level of 25 miRNA was down-regulated whilst that of 20 miRNA was up-regulated in the AML group at diagnosis when compared to healthy controls. The plasma expression level of 21 miRNA was down-regulated whilst that of 13 miRNA was up-regulated in the AML group in remission compared to healthy controls. Keywords acute myeloid leukemia (AML), biomarker, microRNA (miRNA), plasma, TaqMan Low...

Le gène hybride BCR-ABL1, responsable de la leucémie myéloïde chronique (LMC), code une protéine à activité tyrosine kinase constitutive. Lors d’une étude transcriptomique menée au laboratoire sur des patients résistants secondaires à l’imatinib, les deux gènes codant les protéines des rétrotransposons LINE-1 ont été trouvés sous exprimés d’environ 20 fois lorsque les patients rechutent. Le rôle des transposons n’a jamais été clairement défini, ils assurent certainement une fonction importante puisqu’ils sont conservés au cours de l’évolution et présents chez tous les organismes. Le but de ce travail a été d’étudier l’implication de LINE-1 dans la LMC. La sous-expression de LINE-1 est-elle une conséquence de la présence de BCR-ABL1 ou une cause de son apparition ? Différents groupes ont montré que les rétrotransposons LINE-1 possédent la capacité de réparation des cassures double-brin de l’ADN. Nous avons fait l’hypothèse qu’une diminution de l’expression des gènes codés par les rétrotransposons LINE-1 entraînerait l’instabilité génétique observée dans la LMC. Une étude réalisée chez des patients atteints de LMC et des sujets contrôles a montré une correlation inverse entre l’expression de LINE-1 et celle de l’oncogène BCR-ABL1. Parallèlement, une étude sur des lignées cellulaires leucémiques humaines BCR-ABL positives et négatives a été réalisée. Nous avons recherché le lien qui existe entre l’expression de LINE 1, de BCR-ABL1 et la réparation des cassures double-brin de l’ADN. Nous avons montré d’une part qu’une inhibition de l’expression de BCR-ABL1 induit une augmentation de l’expression des transposons LINE-1 D’autre part, une diminution de l’expression de LINE-1 entraîne une apparition du transcrit BCR-ABL1 dans les cellules BCR-ABL negatives. / BCR-ABL1 fusion gene, responsible of the chronic myeloid leukemia (CML) encodes a constitutively activated tyrosine kinase protein. Expression of both LINE-1 retrotransposon ORFs were found decreased at the time of imatinib resistance in a comparative transcriptional study focused on secondary resistant patients. The role of retrotransposons is unclear. They are conserved through evolution. This project focuses on the involvement of LINE-1 in CML. Is LINE-1 under expression a result of BCR-ABL1 expression or is it at the origin of BCR ABL1? Different groups have shown that LINE-1 retrotransposons were able to repair DNA double strands breaks. We suggest that LINE-1 under expression could be responsible of genetic instability observed in CML. We show in a study on CML patients and healthy subjects that LINE-1 expression is inverse correlated to BCR-ABL1 expression. Moreover, study on BCR-ABL+ and BCR-ABL- human leukemic cell lines was carried on. First, we show that decrease of BCR-ABL1 expression induces increase of LINE-1 expression. Then that decrease of LINE-1 expression generates BCR-ABL1 transcript in BCR-ABL negatives cell lines.

As células-tronco mesenquimais (MSCs) da medula óssea compreendem uma população de células multipotentes com propriedades imunorreguladoras e capacidade de secreção de fatores de crescimento, desempenhando um papel fundamental na regulação da hematopoiese. À luz dessas propriedades, alguns estudos fornecem uma análise das relações estabelecidas entre células-tronco hematopoiéticas normais (HSCs) e MSCs quando expostas à cocultura. Jing et al. (Haematologica, 2010) demonstram neste tipo de arranjos de cocultura a geração de três populações distintas de células: células não aderentes (Fração A), células aderidas à superfície de MSCs (Fração B) e células abaixo das MSCs (Fração C). Além disso, dados recentes apontam para a associação da progressão da doença com a evidência de transferência de mitocôndrias funcionais (mt) e espécies reativas de oxigênio (ROS) das MSCs para as células leucêmicas. É teorizado como um mecanismo de MSCs, a fim de reduzir as espécies reativas de oxigênio (ROS). No entanto, os desempenhos diferenciais nesses processos de transferência entre MSCs normais e leucêmicas em sistemas de cocultura em cada uma dessas populações de células distintas não foram estabelecidos. As células leucêmicas (CD45+) têm um aumento de quase três vezes na proliferação em todas as três populações após a cocultura com MSCs leucêmicas, mas não após a cocultura com MSCs saudáveis. As células CD45+ da fração A têm uma baixa taxa de proliferação em cocultura com MSCs normais comparadas com as células leucêmicas. Em 5d, as MSCs leucêmicas (CD73+) aumentam 20 vezes a coloração de mitotracker em comparação com 3d, implicando que os blastos AML estimulam MSCs a produzir mais mt, embora os MSCs normais apresentem os mesmos níveis de mitotracker em 3 / 5d. Além disso, os níveis de mtROS diminuem em 10 vezes em 5d em comparação com 3d em leucemia, mas não em MSCs normais, sugerindo uma recuperação mediada por mt em MSCs leucêmicas após a cocultura. Finalmente, o ROS total diminui 2 vezes nas células CD45+ após cocultura com MSCs leucêmicas por 5d, mas não em contrapartida normal. Em essência, esses achados sugerem diferentes mecanismos de doação mitocondrial de MSCs para blastos LMA. Além disso, o estudo fornece um passo importante nacompreensão da natureza complexa do metabolismo do tumor, não apenas na célula maligna, mas também dentro do microambiente que a suporta. / Bone marrow mesenchymal stromal cells (MSCs) comprise a population of multipotent cells with immunoregulatory properties and the capability of secreting growth factors, playing a key role in the regulation of hematopoiesis. In light of these properties, some studies provide analysis of the relations established between normal hematopoietic stem-cells (HSCs) and MSCs when exposed to coculture. Jing et al. (Haematologica, 2010) demonstrate in these kind of coculture arrangements the generation of three distinct cells populations: non-adherent cells (supernatant), phasebright cells (adhered to the surface of MSCs) and phase-dim cells (beneath the MSCs). Furthermore, recent data pointed to the association of disease progression in AML with the evidence of functional mitochondria (mt), and reactive oxygen species (ROS) transference from MSCs to the blasts cells. It is theorized as a mechanism of MSCs in order to reduce the reactive oxygen species (ROS). Nevertheless, the differential performances in these transference process among normal and leukemic-MSCs in coculture systems in each of those distinct cells populations were not established. AML cells (CD45+) have an increase of almost 2.5-fold in proliferation in all of 03 populations after coculture with leukemic-MSCs but not after coculture with a normalMSCs. The CD45+ cells in phase-bright/dim have a low proliferation rate in coculture with normal-MSCs compared with the leukemic cells. In 5d, the leukemic-MSCs (CD73+) increase 20-fold the mitotracker staining compared with 3d, implying that AML blasts stimulate MSCs to produce more mt, albeit the normal-MSCs present the same mitotracker levels in 3/5d. Additionally, the mtROS levels decrease by 10-fold in 5d compared with 3d in leukemic, but not in normal-MSCs, suggesting mt mediated recover in leukemic-MSCs after coculture. Finally, total ROS decrease 2-fold in CD45+ cells after coculture with leukemic-MSCs for 5d, but not in normal counterpart. In essence, these findings suggest different mechanisms of mitochondrial donation from MSCs to AML blats. Moreover, the study provides an important step in the understanding of the complex nature of tumor metabolism, not only in the malignant cell, but also within the microenvironment which supports it.

Malgré une amélioration de la prise en charge thérapeutique au cours des dernières années, les leucémies aiguës myéloïdes (LAM) pédiatriques sont des hémopathies graves, avec des taux de rechute pouvant atteindre 30% et des taux de survie inférieurs à 75%. Une meilleure description des anomalies moléculaires chez les enfants atteints de LAM est nécessaire pour affiner le pronostic de ces patients. En utilisant le séquençage haut débit ciblé sur 36 gènes et la technique de LD (ligation-dependent) RT-PCR, ce travail décrit le profil moléculaire ainsi que sa signification pronostique chez 385 enfants atteints de LAM de novo inclus dans l’essai clinique prospectif ELAM02. 76 % des patients présentent au moins une mutation parmi les gènes étudiés. Les mutations les plus fréquentes concernent les gènes contrôlant les voies de signalisation des tyrosine kinases (61 %), suivis par les facteurs de transcription (16 %), les suppresseurs de tumeurs (14 %), les modificateurs de la chromatine (9 %), la méthylation de l'ADN (8 %), la cohésine (5 %) et le spliceosome (3 %). De plus, un transcrit de fusion est détecté dans près de la moitié des cas. Au final, les réarrangements impliquant le CBF, les mutations de NPM1 et double-mutations de CEBPA (CEBPA-dm) représentent 37% de la cohorte et définissent un sous-groupe moléculaire au pronostic favorable (survie globale à 3 ans: 92,1%) alors que les fusions impliquant NUP98, les mutations WT1, RUNX1 et PHF6 (15% de la cohorte) constituent un sous-groupe moléculaire au pronostic péjoratif (survie globale à 3 ans: 46,1%). Les réarrangements de KMT2A (21 % de la cohorte) sont associés à un risque intermédiaire. Malgré quelques similitudes, le profil moléculaire et sa signification pronostique diffèrent entre les LAM de l’enfant et de l’adulte. Ces résultats contribuent à affiner la stratification du risque pronostique des LAM pédiatriques et ainsi améliorer leur prise en charge thérapeutique. Cette classification moléculaire reste à valider dans d’autres cohortes pédiatriques indépendantes. / Despite major treatment improvements over the past decades, pediatric acute myeloid leukemia (AML) is still a life-threatening malignancy with relapse rates up to 30% and survival rates below 75%. A better description of the pattern of molecular aberrations in childhood AML is needed to refine prognostication in such patients. We report here the comprehensive molecular landscape using both high-throughput sequencing focused on 36 genes and ligation-dependent RT-PCR in 385 children with de novo AML enrolled in the prospective ELAM02 trial and we evaluated their prognostic significance. 76% of patients had at least one mutation among the genes we screened. The most common class of mutations involved genes that control kinase signaling (61%) followed by transcription factors (16%), tumor suppressors (14%), chromatin modifiers (9%), DNA methylation controllers (8%), cohesin genes (5%) and spliceosome (3%). Moreover, a recurrent transcript fusion was detected in about a half of pediatric patients. Overall, CBF rearrangements, NPM1 and double CEBPA mutations represented 37% of the cohort and defined a favorable molecular subgroup (3-years overall survival: 92.1%) while NUP98 fusions, WT1, RUNX1 and PHF6 mutations (15% of the cohort) segregated into a poor molecular subgroup (3-years overall survival: 46.1%). KMT2A-rearrangements (21% of the cohort) were associated with an intermediate risk. Despite some overlaps, the spectrum of molecular aberrations and their prognostic significance differ between childhood and adult AML. These data have important implications to contribute in refining risk stratification of pediatric AML and show the need for further validations in independent pediatric cohorts.

Les leucémies, syndromes myéloprolifératifs et myelodysplasiques sont la première cause de cancer chez l’enfant de moins de 15 ans. Les facteurs de transcription STAT5 ont un rôle indispensable dans la genèse et le maintien des leucémies. L’inhibition de STAT5 contribuerait à diminuer la survie, l’auto-renouvellement et la quiescence des cellules leucémiques ainsi que leur résistance potentielle aux agents anti-cancéreux. Suite à un précédent criblage de notre chimiothèque, un dérivé comprenant un noyau 4,4-diméthyl-1,2,3,4-tétrahydroquinoléine lié à un indole par une chaine éthoxy, a été identifié comme inhibiteur de la phosphorylation de STAT5. Dans ce contexte, nous avons optimisé la synthèse du bicycle et réalisé une étude de pharmacomodulation donnant ainsi 31 nouveaux inhibiteurs potentiels. Un des composés obtenus réduit la viabilité de lignées modèles de leucémie myéloïde chronique et aigüe avec des CE50 de 3 à 9 µM. Ce « lead » inhibe sélectivement la phosphorylation de STAT5. / Leukemias, myeloproliferative and myelodysplastic syndromes are the leading cause of cancer in children under 15 years. STAT5 transcription factors have a key role in the genesis and maintenance of leukemia. The inhibition of STAT5 could decrease survival, self-renewal and quiescence of leukemic cells and their potential resistance to anti-cancer agents. After a previous screening of our chemical library, a derivative comprising a 4,4-dimethyl-1,2,3,4-tetrahydroquinoline core linked to an indole by an ethoxy chain, was identified as an inhibitor of STAT5 phosphorylation. In this context, we have optimized the synthesis of the biheterocyclic scaffold and carried out pharmacomodulation studies yielding 31 new potential inhibitors. One of these new compounds reduced viability of chronic and acute myeloid leukemia cell lines with EC50 from 3 to 9 µM. This new lead selectively inhibits STAT5 phosphorylation.

A leucemia mielóide crônica (LMC) é uma doença mieloproliferativa resultante da expansão clonal da célula hematopoética precursora. Sua fisiopatologia está associada ao cromossomo (cr) Philadelphia (Ph) originado da t(9;22) e ao oncogene bcr-abl1 que codifica a proteína Bcr-Abl1 com constitutiva atividade de tirosinoquinase (TK). A expressão de Bcr-Abl determina a leucemogênese por meio da alteração da adesão das células progenitoras leucêmicas ao estroma medular e resistência à apoptose. Os inibidores de TK, o mesilato de imatinibe, dasatinibe e nilotinibe são utilizados no tratamento da LMC, entretanto, casos de resistência têm sido relacionados à presença de mutações em Bcr-Abl1, duplicação do cr Ph e superexpressão do gene bcr-abl1. A resistência ou refratariedade de alguns pacientes ao tratamento com inibidores de TK impulsiona a realização de estudos para melhor conhecimento da fisiopatologia da LMC e descrição de novos alvos terapêuticos. Nesse contexto, o presente estudo investigou a participação de microRNAs na modulação da expressão de genes que regulam a apoptose. O objetivo geral deste trabalho foi investigar o efeito de bcr-abl1 e da atividade tirosinoquinase de Bcr-abl na expressão desses miRNAs em linhagens celulares e pacientes com LMC. O RNA das linhagens celulares, de pacientes e controles foram obtidos por meio da extração com Trizol® e o cDNA sintetizado com o kit High Capacity cDNA reverse transcription. A expressão dos microRNAs e dos genes alvoss foi quantificada por PCR em tempo real utilizando o kit SYBR Green PCR Master Mix® e TaqMan Universal PCR Master Mix®. A inibição de Bcr-Abl1 na linhagem HL-60.Bcr-Abl1 tratada com o mesilato de imatinibe aumentou a expressão de miR-let-7d, miR-15a, miR-130a e miR-145 e diminuiu os níveis de miR-21. O tratamento com dasatinibe aumentou a expressão de miR-let-7e, miR-15a, miR-16, miR-21, miR-30e, miR-130a e miR-142-3p. O nilotinibe aumentou a expressão de miR-let-7e, miR-15a, miR-16, miR-130a e miR-145 e, diminuiu os níveis de miRlet- 7d e miR-21. Os resultados obtidos da análise entre os de pacientes com LMC em diferentes fases da doença mostraram elevados níveis de miR-15a, miR-130b e miR-145 em pacientes na fase crônica versus controles e baixos níveis de miR-16, miR-26a e miR-146a. Pacientes em fases avançadas versus controles apresentaram baixa expressão de miR-let-7d, miR-16, miR-142-3p, miR-145 e miR-146a. Baixos níveis de miR-let-7d, miR-15a, miR-16, miR-29c, miR-142-3p, miR-145 e miR-146a foram observados nas fases avançadas da LMC em relação a fase crônica. Os genes anti-apoptóticos a1, bcl-2, c-flip, ciap-1 e ciap-2 estavam mais elevados na fase crônica do que nos controles. A expressão do gene c-flip estava diminuída e dos genes a1, ciap-1 e mcl-1 aumentada nas fases avançadas em relação aos controles e a fase crônica. Pacientes com LMC resistentes ao MI apresentaram menores níveis de miR-26a, miR-29c, miR-130b, miR-146a e dos genes anti-apoptóticos ciap-1 e mcl-1. Os dados obtidos sugerem que a TK Bcr-Abl modula a expressão de microRNAs que possuem como alvos genes que regulam a apoptose celular / Chronic myeloid leukemia (CML) is a myeloproliferative disease resulting from clonal expasion of hematopoietic precursor cells. Its physiopathology is associated to Philadelphia (Ph) chromosome (cr) originated from the t(9;22) and bcr-abl1 oncogene that encodes the Bcr-Abl protein with constitutive tyrosine kinase activity (TK). The Bcr-Abl1 expression determines leukemogenesis by altering the leukemic progenitor cells´ adhesion by bone marrow stroma and apoptosis resistance. TK inhibitors imatinib mesylate, dasatinib and nilotinib are used to treat CML, however, cases of resistance have been linked to mutation in Bcr-Abl1, duplication of the cr Ph and overexpression of the bcr-abl1. The resistance or refractoriness of some patients to treatment with TK inhibitors drives the studies to better understand the CML physiopathology and description of new therapeutic targets. In this context, this study investigated the participation of microRNAs in modulating expression of the genes that regulate apoptosis. The aim of this study was to investigate the effect of Bcr- Abl1 and its kinase activity in the expression of miRNAs in cell lines and CML patients. The RNA from cell lines, patients and controls were obtained by extraction with Trizol® and cDNA was synthesized with the kit High Capacity cDNA reverse transcription. The expression of miRNAs and target genes was quantified by real time PCR using SYBR Green PCR Master Mix® kit and TaqMan Universal PCR Master Mix®. The Bcr-Abl1 inhibition in the cell line HL-60.Bcr-Abl1 treated with imatinib mesylate increased the expression of miR-let- 7d, miR-15a, miR-130a and miR-145 and decreased miR-21 levels. Treatment with dasatinib increased the expression of miR-let-7e, miR-15a, miR-16, miR-21, miR-30e, miR-130a and miR- 142-3p. Nilotinib increased the expression of miR-let-7e, miR-15a, miR-16, miR-130a and miR- 145 and, decreased miR-let-7d and miR-21 levels. The results of the analysis among patients with CML in different stages of disease showed high levels of miR-15a, miR-130b and miR-145 in chronic phase versus controls and low levels of miR-16, miR-26a and miR-146a. Patients in advanced phases versus controls showed low expression of miR-let-7d, miR-16, miR-142-3p, miR-145 and miR-146a. Low levels of miR-let-7d, miR-15a, miR-16, miR-29c, miR-142-3p, miR-145 and miR-146a were observed in CML advanced phases when compared with chronic phase. The antiapoptotic genes a1, bcl-2, c-flip, ciap-1 and ciap-2 were higher in chronic phase than in controls. The c-flip expression was decreased and a1, ciap-1 and mcl-1 expression was increased in advanced phases when compared to controls and chronic phase. CML patients resistant to imatinib mesylate presented low levels of miR-26a, miR-29c, miR-130b, miR-146a and ciap-1 and mcl-1 antiapoptotic genes. The data obtained suggest that Bcr-Abl1 TK modulates the miRNA expression which has target genes involved in the apoptosis´ regulation.

A leucemia mieloide crônica (LMC) é uma expansão clonal da célula progenitora hematopoiética, traduzindo-se por hiperplasia mielóide, 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 produz uma proteína com elevada atividade tirosinoquinase que tem um papel central da patogenia da LMC. O mesilato de imatinibe (MI) é um derivado da fenilaminopirimidina que inibe a proteína-tirosina quinase ABL in vitro e in vivo. O MI interage com transportadores de membrana de efluxo, como o ATP binding cassette B1 (ABCB1). Polimorfismos no gene ABCB1 têm sido associados com alteração na sua funcionalidade e podem estar envolvidos na resposta ao tratamento farmacológico. Este estudo tem por objetivo investigar a relação dos polimorfismos C1236T, C3435T e G2677T/A no gene ABCB1 com marcadores de resposta ao tratamento com MI, em indivíduos com LMC, e determinar os fatores de predisposição de resposta ao MI. Foram incluídos 118 pacientes portadores de LMC. Foram constituídos dois grupos: Grupo 1 com 70 pacientes com resposta citogenética completa com a dose padrão de MI (400 mg/dia de MI) por 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 . Amostras de sangue foram obtidas para: quantificação de BCR-ABL1, extração de DNA genômico e análise citogenética de banda G. As análises dos polimorfismos foram realizadas por PCR-RFLP. A resposta ao tratamento foi avaliada segundo os critérios da European LeukemiaNet. A distribuição da frequência dos genótipos dos polimorfismos C1236T, C3435T e G2677T/A foi similar nos dois gêneros e entre brancos e não brancos. Não houve influência dos polimorfismos estudados no risco de desenvolvimento da LMC e na resposta ao MI. O haplótipo ABCB1 1236CT/2677GT/3435CT (para os polimorfismos C1236T/G2677T/C3435T no gene ABCB1) foi encontrado em 51,7% dos pacientes com resposta molecular maior (P=0,010). Houve tendência a maior frequência de pacientes portadores de genótipos 1236 CT e TT no grupo de respondedores (86,7%) quando foi analisada a resposta molecular completa (p=0,069). O mesmo aconteceu no grupo de não respondedores quando foi considerado o polimorfismo C1236T. Houve tendência a maior frequência de resposta molecular completa em portadores de genótipo 2677 GT+TT+TA nos dois grupos (respondedores P=0,074 e não respondedores P=0,076). Em conclusão, os genótipos e haplótipos para os polimorfismos ABCB1 C1236T, C3435T e G2677T/A estão associados com a resposta molecular em portadores de LMC respondedores ao tratamento com MI. / The chronic myeloid leukemia (CML) is a clonal expansion of the hematopoietic progenitor cell, representing myeloid hyperplasia, leukocytosis, neutrophilia, basophilia and splenomegaly. The Philadelphia chromosome is peculiar on the disease, being the result of the translocation t(9; 22) (q34; q11), leading on the fusion of the ABL and BCR genes. This merger creates a hybrid gene that produces a protein with high activity of tyrosine kinase that is the main pathogenesis of CML. The Imatinib mesylate (IM) is a fenilaminopirimidine derivative which inhibits the ABL protein-tyrosine kinase in vitro and in vivo. The MI interacts with membrane efflux transporters, such as ATP binding cassette B1 (ABCB1). Polymorphisms in the ABCB1 gene have been associated with changes in its functionality and may be involved on the response to drug treatment. This study aims to investigate the relationship of C1236T, C3435T and G2677T / A polymorphisms in ABCB1 gene with response markers for MI treatment in individuals with CML, and to determine the predisposing factors of response to MI. 118 patients with CML were included and divided in two groups. Group 1: 70 patients with complete cytogenetic response and a standard dose of IM (400 mg / day IM) for up to 18 months. Group 2: 48 patients without a complete cytogenetic response and initial dose of 400 mg / day IM or whith response lost throughout the treatment. Blood samples were obtained for: quantification of BCR-ABL1, genomic DNA extraction and band G cytogenetic analysis. The analysis of the polymorphisms were performed by PCR-RFLP. The treatment response was evaluated according to European LeukemiaNet criteria. The frequency distribution of genotypes of C1236T, C3435T and G2677T / A polymorphisms were similar in both sexes and between whites and nonwhites. The polymorphisms studied had no influence on the CML development or MI response. The haplotype ABCB1 1236CT/2677GT/3435CT (for C1236T/G2677T/C3435T polymorphisms in the ABCB1) was found in 51.7% patients with major molecular response (P = 0.010). There was a tendency for higher frequency of patients with 1236 CT and TT genotypes in the responders group (86.7%) when the molecular response was analyzed (p = 0.069). The same happened in the nonresponders group when the C1236T polymorphism was considered. There was a tendency for a higher frequency of complete molecular response in patients with 2677 GT + TT + TA genotype in both groups (responders P = 0.074 and nonresponders P = 0.076). In conclusion, genotypes and haplotypes for ABCB1 C1236T, C3435T and G2677T / A polymorphisms are associated with molecular response in patients with CML that respond to MI treatment.

A leucemia mielóide crônica (LMC) é uma doença mieloproliferativa, resultante da expansão clonal da célula-tronco hematopoética pluripotente. A fisiopatologia da LMC está associada a uma translocação entre os braços longos dos cromossomos 9 e 22, o que promove o aparecimento do neogene bcr-abl, cujo gene codifica uma proteína denominada Bcr-Abl. A oncoproteína Bcr-Abl possui atividade tirosina-quinase constitutiva que é a responsável pelo fenótipo maligno da célula, incluindo resistência à apoptose. O tratamento da LMC pode ser realizado com hidroxiuréia, IFN- associado à citarabina, inibidores de TK (mesilato de imatinibe e dasatinibe) e transplante de medula óssea. O tratamento de escolha para pacientes com LMC na fase crônica é o inibidor de tirosina-quinase mesilato de imatinibe e para os refratários utiliza-se o dasatinibe. Apesar do conhecimento acerca do mecanismo de ação dos inibidores de TK, pouco se sabe sobre seu efeito na maquinaria apoptótica. Sendo assim, no presente trabalho foi detectada a expressão dos genes e proteínas anti- (A1, Bcl-2, Bcl-Xl, Bcl-W, C-Flip, Ciap-1, Ciap-2 e Mcl-1) e pró-apoptóticos (Bad, Bak, Bax, Bcl-Xs, Bid, Bik, Bimel, Bmf, Bok, Fas, Fasl, Noxa e Puma) em células mononucleares de 32 indivíduos saudáveis e 26 pacientes com LMC antes e após 12 meses da terapia com mesilato de imatinibe e dasatinibe. Dentre os 26 pacientes avaliados, 13 eram do sexo feminino e 13 do sexo masculino, três eram negros, um amarelo e 22 brancos, com idade média de 48 anos (faixa etária de 25 a 77 anos). O grupo controle foi composto por 32 indivíduos, 16 do sexo feminino e 16 do sexo masculino, 26 eram brancos, quatro negros e dois amarelos, com idade média de 45 anos (idade de 23 a 77 anos). O isolamento das células mononucleares foi realizado pelo método de Ficoll-Hypaque, a determinação da expressão gênica por PCR em tempo real e a protéica por western-blot. Os resultados foram expressos em unidade relativa de expressão (U.R.E.), comparados entre os diferentes grupos (controle e pacientes pré- e pós-tratamento), associados à resposta aos medicamentos e correlacionados ao índice de prognóstico de SOKAL. Na comparação dos dados de expressão gênica entre pacientes e controles, verificou-se que os pacientes apresentaram maior expressão dos genes bcl-xL, c-flip, mcl-1 e fas e níveis reduzidos de bik. O mesilato de imatinibe modulou significativamente a transcrição dos genes bcl-xL, bok, mcl-1 e noxa, enquanto que o dasatinibe agiu sobre a expressão dos genes a1, bmf, c-flip, ciap-1, ciap-2 e mcl-1. Os pacientes refratários ao mesilato de imatinibe apresentaram níveis elevados de expressão de a1 e c-flip e reduzida expressão de bcl-2, ciap-2, bak, bax, bid e fasl em relação aos pacientes em remissão. A expressão protéica refletiu os dados da quantificação do RNAm dos genes. Os dados da presente investigação indicam que as células mononucleares dos pacientes com LMC apresentam desregulação do processo de apoptose celular. Essa alteração pode ser parcialmente associada ao fenótipo de resistência das células leucêmicas Bcr-Abl+ à apoptose e ausência de resposta aos inibidores de TK. Os dados revelam ainda que os inibidores de tirosina-quinase interferem na transcrição e tradução das moléculas envolvidas na regulação do processo de apoptose. / Chronic myeloid leukemia (CML) is a myeloproliferative disease resultant of a clonal expansion of pluripotent hematopoietic stem cells. The CML physiopathology is associated with a translocation between chromosomes 9 and 22 long arms, promoting the formation of a bcr-abl neogene, which codifies the Bcr-Abl protein. The Bcr-Abl oncoprotein presents tyrosine-kinase activity that is responsible for the malign phenotype which includes apoptosis resistance. CML treatment may be performed with hydroxyurea, IFN- plus cytarabine, tyrosine-kinase inhibitors (imatinib mesylate and dasatinib) and bone marrow transplantation. The standard treatment for CML patients in chronic phase is the tyrosine-kinase inhibitor imatinib mesylate (IM) and for IM-refractory patients dasatinibe is employed. Despite of the knowledge related to the mechanism of action of tyrosine-kinase inhibitors, little is known about its effects on the apoptosis machinery. In this work we characterized both the mRNA and protein patterns of expression of the anti- (A1, Bcl-2, Bcl-Xl, Bcl-W, C-Flip, Ciap-1, Ciap-2 e Mcl-1) and pro-apoptotic (Bad, Bak, Bax, Bcl-Xs, Bid, Bik, Bimel, Bmf, Bok, Fas, Fasl, Noxa e Puma) regulators in peripheral blood mononuclear cells (PBMC) from 32 healthy individual and 26 CML patients before and after 12 months of imatinib mesylate and dasatinibe therapy. Thirteen patients were female and thirteen were male, three were black, one was japanese and 22 were white, the mean age was 48 years (varying from 25 to 77 years). The control group was composed of 32 individuals, 16 were female and 16 were male, 26 were white, four black and two japanese, the mean age was 45 years (varying from 23 to 77 years). PBMC isolation was performed by Ficoll-Hypaque, gene expression was assessed by real time PCR and protein expression was carried out by western-blot methodology. Results were given by the relative expression, after comparison between the different groups (control and patients before and after treatment), associated with drug response and related to Sokal index. The comparison of gene expression profiles between patients and controls showed that CML patients present increased levels of bcl-xL, c-flip, mcl-1 and fas expression and reduced levels of bik gene expression. The imatinib mesylate significantly modulated the transcription of bcl-xL, bok, mcl-1 and noxa, whereas dasatinib affected the expression of a1, bmf, c-flip, ciap-1, ciap-2 and mcl-1. MI-refractory patients present higher levels of a1 and c-flip and lower levels of bcl-2, ciap-2, bak, bax, bid and fasl when compared to patients who achieved complete cytogenetic response. Overall, the patterns of protein expression agree with the profiles of mRNA expression. Taken together, the results described in this investigation indicate that PBMC from CML patients present deregulation in cell death pathways. These alterations could partly account for the apoptosis resistance phenotype observed in Bcr-Abl+ leukemic cells and for lack of response to tyrosine kinase inhibitors. Furthermore, our data also reveal that tyrosine kinase inhibitors interfere in the transcription and translation of molecules that regulate the apoptosis process.

Les Leucémies Aiguës Myéloïdes (LAM) représentent un groupe hétérogène d’hémopathies malignes, caractérisées par une accumulation de progéniteurs myéloïdes indifférenciés. Cette accumulation proviendrait de l’existence de cellules souches leucémiques responsables de la résistance aux traitements et de la rechute de la maladie. Les Cellules Souches Leucémiques (CSL) se comportent comme les cellules souches embryonnaires, lesquelles expriment des marqueurs embryonnaires leur procurant des capacités de prolifération, d’autorenouvellement et d’absence de différenciation. Plusieurs études ont démontré le rôle des marqueurs embryonnaires (OCT4, NANOG, SOX2, SSEA1 et SSEA3) dans la cancérogénèse mais peu de données concernent les LAM. Dans le but d’identifier le rôle fonctionnel des marqueurs embryonnaires dans la LAM, une évaluation de leur expression dans les compartiments CD34+ de cellules souches hématopoïétiques et leucémiques a été réalisée. Leur sur-expression et leur implication dans les propriétés des cellules leucémiques (notamment OCT4), nous laisse penser que ces antigènes embryonnaires peuvent être utilisés comme marqueurs discriminants de la maladie résiduelle mais aussi comme cible thérapeutique potentielle. Cependant, les mécanismes de leucémogénèse par lesquels les antigènes embryonnaires seraient impliqués restent encore à être élucidés / Acute Myeloid Leukemias (AMLs) represent a heterogeneous group of malignant haemopathies, characterized by an accumulation of undifferentiated myeloid progenitors. This accumulation comes from the presence of Leukemic Stem Cells (LSCs) responsible for the resistance to treatment and relapse of the disease. LSCs behave as embryonic stem cells, which express embryonic markers giving them proliferation, self-renewal and lack of differentiation. Several studies have demonstrated the role of embryonic markers (OCT4, NANOG, SOX2, SSEA1 and SSEA3) in carcinogenesis, but there is few data in AML. In order to identify the functional role of the embryonic markers in AML, an evaluation of their expression in haematopoietic and leukemic stem cells CD34+ compartments was carried out. Their overexpression and involvement in the properties of leukemic cells (especially OCT4), suggest that these embryonic antigens can be used as discriminating markers of residual disease as well as a potential therapeutic target. However, the mechanisms of leukemogenesis by which embryonic antigens are involved remain to be elucidated

Yau Wai Lok. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2006. / Includes bibliographical references (leaves 195-205). / Abstracts in English and Chinese. / ACKNOWLEDGEMENTS --- p.i / ABBREVIATIONS --- p.ii / ABSTRACT --- p.vii / 撮要 --- p.x / PUBLICATIONS --- p.xii / TABLE OF CONTENTS --- p.xiii / Chapter CHAPTER 1: --- GENERAL INTRODUCTION / Chapter 1.1 --- Hematopoiesis & Leukemia --- p.1 / Chapter 1.1.1 --- An Overview on Hematopoiesis --- p.1 / Chapter 1.1.2 --- An Overview of Leukemia --- p.4 / Chapter 1.1.2.2 --- Classification and Epidemiology of Leukemia --- p.5 / Chapter 1.1.2.3 --- Conventional Approaches to Leukemia Therapy --- p.8 / Chapter 1.1.2.4 --- Novel Approaches to Leukemia Therapy --- p.9 / Chapter 1.1.2.4.1 --- Differentiation Therapy --- p.10 / Chapter 1.1.2.4.2 --- Induction of Apoptosis --- p.10 / Chapter 1.1.2.4.3 --- Natural Products as a Source of Anti-leukemia Drug --- p.11 / Chapter 1.2 --- Cytokinins --- p.12 / Chapter 1.2.1 --- Historical Development and Occurrence of Cytokinins --- p.12 / Chapter 1.2.2 --- Functions of Cytokinins and the Signal Transduction of Cytokinins in Plants --- p.13 / Chapter 1.2.3 --- Phytochemistry and Metabolism of Cytokinins --- p.15 / Chapter 1.2.3.1 --- Chemical Structures of Cytokinins --- p.15 / Chapter 1.2.3.2 --- Biosynthesis of Cytokinins in Plants --- p.19 / Chapter 1.2.3.3 --- Metabolisms of Cytokinins in Plants and Animals --- p.22 / Chapter 1.2.4 --- Biological and Pharmacological Activities of Cytokinins in Animals --- p.23 / Chapter 1.2.4.1 --- Anti-aging Effect --- p.24 / Chapter 1.2.4.2 --- Anti-thrombosis Effect and Inhibition of Blood Platelet Aggregation --- p.24 / Chapter 1.2.4.3 --- Anti-tumor Effect --- p.25 / Chapter 1.3 --- Aims and Scopes of This Investigation --- p.27 / Chapter CHAPTER 2: --- MATERIALS AND METHODS / Chapter 2.1 --- Materials --- p.29 / Chapter 2.1.1 --- Animals --- p.29 / Chapter 2.1.2 --- Cell Lines --- p.29 / Chapter 2.1.3 --- "Cell Culture Medium, Buffers and Other Reagents" --- p.32 / Chapter 2.1.4 --- Reagents and Buffers for Flow Cytometry --- p.37 / Chapter 2.1.5 --- Reagents for DNA Extraction --- p.41 / Chapter 2.1.6 --- Cellular DNA Fragmentation ELISA Kit --- p.42 / Chapter 2.1.7 --- Reagents for Total RNA Isolation --- p.44 / Chapter 2.1.8 --- Reagents and Buffers for Reverse Transcription-Polymerase Chain Reaction (RT-PCR) --- p.46 / Chapter 2.1.9 --- Reagents and Buffers for Gel Electrophoresis for Nucleic Acids --- p.50 / Chapter 2.1.10 --- Reagents for Measuring Caspase Activity --- p.51 / Chapter 2.2 --- Methods --- p.54 / Chapter 2.2.1 --- Culture of the Tumor Cell Lines --- p.54 / Chapter 2.2.2 --- "Isolation, Preparation and Culture of Murine Peritoneal Macrophages" --- p.55 / Chapter 2.2.3 --- Determination of Cell Proliferation by [ 3H]-TdR Incorporation Assay --- p.55 / Chapter 2.2.4 --- Cytotoxicity Measurement by LDH Release Assay --- p.56 / Chapter 2.2.5 --- Determination of Cell Viability --- p.57 / Chapter 2.2.6 --- Determination of Anti-leukemic Activity In Vivo --- p.58 / Chapter 2.2.7 --- Analysis of Cell Cycle Profile/DNA Content by Flow Cytometry --- p.59 / Chapter 2.2.8 --- Measurement of Apoptosis --- p.59 / Chapter 2.2.9 --- Assessment of differentiation-associated characteristics --- p.63 / Chapter 2.2.10 --- Gene Expression Study --- p.67 / Chapter 2.2.11 --- Measurement of Caspase Activity --- p.68 / Chapter 2.2.12 --- Statistical Analysis --- p.70 / Chapter CHAPTER 3: --- STUDIES ON THE ANTI-PROLIFERATIVE EFFECT OF CYTOKININS ON LEUKEMIA CELLS / Chapter 3.1 --- Introduction --- p.71 / Chapter 3.2 --- Results --- p.72 / Chapter 3.2.1 --- Effect of Various Cytokinins and Their Riboside Derivatives on the Proliferation of Murine Myelomonocytic Leukemia WEHI-3B JCS Cells In Vitro --- p.72 / Chapter 3.2.2 --- Cytotoxicity of Kinetin and Kinetin Riboside on the WEHI-3B JCS Cells In Vitro --- p.86 / Chapter 3.2.3 --- Effects of Kinetin and Kinetin Riboside on the Proliferation of Various Leukemia Cell Lines In Vitro --- p.90 / Chapter 3.2.4 --- Cytotoxicity of Kinetin and Kinetin Riboside on Non-tumor Cell Lines and Primary Myeloid Cells In Vitro --- p.103 / Chapter 3.2.5 --- Kinetic and Reversibility Studies of the Anti-proliferative Effect of Kinetin and Kinetin Riboside on the WEHI-3B JCS Cells In Vitro --- p.107 / Chapter 3.2.6 --- Effects of Kinetin and Kinetin Riboside on the Cell Cycle Profile of WEHI-3B JCS Cells In Vitro --- p.115 / Chapter 3.2.7 --- Expression of Cell Cycle Related Genes in Kinetin- and Kinetin Riboside-treated WEHI-3B JCS Cells In Vitro --- p.118 / Chapter 3.2.8 --- Effects of Kinetin and Kinetin Riboside on the In Vivo Tumorigenicity of WEHI-3B JCS Cells --- p.123 / Chapter 3.2.9 --- In Vivo Anti-tumor Effect of Kinetin and Kinetin Riboside on WEHI-3B JCS Cells --- p.126 / Chapter 3.3 --- Discussion --- p.129 / Chapter CHAPTER 4: --- STUDIES ON THE APOPTOSIS-INDUCING EFFECT OF CYTOKININS / Chapter 4.1 --- Introduction --- p.134 / Chapter 4.2 --- Results --- p.136 / Chapter 4.2.1 --- Induction of DNA Fragmentation of Cytokinins in the Murine Myeloid Leukemia WEHI-3B JCS Cells In Vitro --- p.136 / Chapter 4.2.2 --- Mitochondrial Membrane Potential of Kinetin- and Kinetin Riboside-treated WEHI-3B JCS Cells In Vitro --- p.144 / Chapter 4.2.3 --- Caspase Activities of Kinetin- and Kinetin Riboside-treated WEHI-3B JCS Cells In Vitro --- p.147 / Chapter 4.2.4 --- Induction of Reactive Oxygen Species in Kinetin- and Kinetin Riboside-treated WEHI-3B JCS Cells In Vitro --- p.154 / Chapter 4.2.5 --- Expression of Apoptosis Regulatory Genes in Kinetin- and Kinetin Riboside-treated WEHI-3B JCS Cells In Vitro --- p.157 / Chapter 4.3 --- Discussion --- p.163 / Chapter CHAPTER 5: --- STUDIES ON THE DIFFERENTIATION-INDUCING EFFECT OF CYTOKININS / Chapter 5.1 --- Introduction --- p.168 / Chapter 5.2 --- Results --- p.170 / Chapter 5.2.1 --- Morphology of Kinetin- and Kinetin Riboside-treated WEHI-3B JCS Cells --- p.170 / Chapter 5.2.2 --- Cell Size and Granularity of Kinetin- and Kinetin Riboside-treated WEHI-3B JCS Cells --- p.175 / Chapter 5.2.3 --- Changes in Surface Antigen Expression of Kinetin- and Kinetin Riboside-treated WEHI-3B JCS Cells --- p.178 / Chapter 5.2.4 --- Monocytic Serine Esterase Activity in Kinetin- and Kinetin Riboside-treated WEHI-3B JCS Cells --- p.185 / Chapter 5.3 --- Discussion --- p.188 / Chapter CHAPTER 6: --- CONCLUSIONS AND FUTURE PERSPECTIVES --- p.190 / REFERENCES --- p.195