Unter Verwendung eines mathematischen Hämatopoese-Modells werden verschiedene Fragen adressiert, die im Zusammenhang mit einer möglichen Optimierung der gegenwärtigen Therapie chronischer myeloischer Leukämie (CML) stehen. Es handelt sich um ein agentenbasiertes Modell, das heißt, jede Zelle wird als einzelnes Objekt repräsentiert und gemäß festgelegter Regeln im Computer simuliert. Es werden proliferative von ruhenden Stammzellen unterschieden, wobei sich der Proliferationszustand reversibel ändern kann. Das Modell basiert auf der Annahme, dass sich normale und maligne Stammzellen in einem Wettbewerb um gemeinsame Ressourcen befinden, wobei der CML-Klon einen kompetitiven Vorteil besitzt. Es ist ungeklärt, ob Tyrosinkinaseinhibitoren wie Imatinib (IM) in der Lage sind, die Erkrankung zu heilen. Es gibt Evidenz, dass residuale leukämische Stammzellen im Knochenmark persistieren, welche in einem Ruhezustand (G0-Phase des Zellzyklus) von IM nicht eradiziert werden können. Proliferativ aktive Zellen sind der IM-Wirkung hingegen ausgesetzt. Das Modell sagt voraus, unter welchen Bedingungen eine Kombinationsstrategie von IM mit stammzellaktivierenden Substanzen Synergieeffekte hervorbringen könnte. Ein verwandtes Problem ist die Frage, in welchen Fällen nach Reduktion der Tumorlast auf ein mittels hochsensitiver Messmethoden undetektierbares Niveau ein Therapieabbruch gerechtfertigt ist. Basierend auf dem dynamischen Modell wird in dieser Arbeit ein Prädiktor vorgeschlagen, der vorhersagt, ob ein Patient nach Abbruch der Therapie einen molekularen Rückfall zu erwarten hat. Zusätzlich wird approximativ ein modellunabhängiger Prädiktor angegeben, der die Vorhersage nur auf Basis klinisch messbarer Größen gestattet.

Aberrant subcellular localization of mutant transmembrane receptors is increasingly acknowledged as a possible mechanism for an altered signaling quality leading to transformation. There is evidence that mutated receptor tyrosine kinases of subclass III, for example the platelet-derived growth factor receptor (PDGFR) and KIT-protein, are aberrantly localized in human cancers. In order to further analyze this phenomenon, we investigated the localization of FLT3, a subclass III receptor tyrosine kinase frequently mutated in leukemia. By immunofluorescence staining and confocal laser scanning microscopy we found that in retrovirally transduced COS7 cells, wild type FLT3 receptor protein is localized primarily at the cell surface. In contrast, a mutant FLT3 receptor protein with an internal tandem duplication (ITD) accumulates in a perinuclear region and is not detectable at the plasma membrane. Surprisingly, and in contrast to previously published data, intracellular FLT3-ITD accumulation could neither be detected in the endoplasmic reticulum (ER) nor in the Golgi apparatus. Furthermore, transient overexpression per se leads to accumulation of wild type FLT3 receptor protein in the ER in addition to surface localization, probably due to inefficient intracellular transport by the overloaded sorting machinery of the secretory pathway. Based on our data and the immature glycosylation pattern of FLT3-ITD, we speculate that the mutant protein resides most probably in an unidentified compartment of the secretory pathway between the ER and the Golgi apparatus. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Accurate localization of breakpoints and deleted regions on chromosome 7 in bone marrow cells of patients is an essential step in identifying genes involved in tumor transformation of a cell. In case of hematological malignancies usually oncogenes and tumor suppressor genes are activated or deleted by a change in the arrangement of genetic material. Aberration of chromosome 7, total or partial loss of chromosome, especially long arms 7q, are among the recurrent cytogenetic abnormalities in patients with myeloid diseases such as myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML). Aberrations of chromosome 7 are an important prognostic marker occurring in 8-10% de novo MDS and AML and in 40-50% treated MDS / AML. For a detailed analysis of chromosome 7 breakpoints and aberrations, samples of 51 adult patients diagnosed with AML / MDS were examined using conventional and molecular cytogenomic methods. In our testing group we demonstrated a separate 7q deletion in one patient (2%) and an isolated monosomy of chromosome 7 in six patients (12%). Aberration of chromosome 7 detected in combination with another change was found in 17 cases (33%) and 27 patients (53%) had complex karyotype changes including chromosome 7. The most frequent breakpoint was 7q22. In 26 patients we proved a deletion...

<p>Hyperspectral imaging is widely used for obtaining optical information of light absorbers (e.g. biochemical composition) in a variety of specimens or tissues in a label-free manner. Acquiring and processing spectral data using hyperspectral imaging usually requires advanced instrumentation such as spectrometers, spectrographs or tunable color filters, which are not easily adaptable in developing instrumentation for field-based applications. Also, use of only RGB information from conventional cameras is not sufficient to obtain a reliable correlation with the actual content of the analyte of interest. We propose a new concept of ‘virtual hyperspectral imaging’ to reconstruct the full reflectance spectra from RGB image data. This allows us to use only RGB image data to determine detailed spatial distributions of analytes of interest. More importantly, it simplifies instrumentation without requiring bulky and expensive hardware. Using a data-driven approach, we apply multivariate regression to reconstruct hyperspectral reflectance image data from RGB images obtained using a conventional camera or a smartphone. </p> <p> </p> <p>In developing a reliable reconstruction matrix, it is critical to obtain a training data set of the specimen of study under the same optical geometry since the spectral reflectance and absorbance is sensitive to the detection and illumination parameters. We designed an image-guided hyperspectral system that can acquire both hyperspectral reflectance and RGB data sets under the same imaging configuration to minimize any discrepancies in the hyperspectral reflectance data acquired using different optical sensing geometries. In our technology development, a telecentric lens that is commonly used in machine vision systems but rarely in bioimaging, serves as a key component for reducing unwanted scattering in biological tissue due to its highly anisotropic scattering properties, by acting as a back-directional gating component to suppress diffuse light. We evaluate our spectrometer-less reflectance imaging method using RGB-based hyperspectral reconstruction algorithm for integration into a smartphone application for non-invasive hemoglobin analysis for anemia risk assessment in communities with limited access to central laboratory tests.</p>

The CBFbeta-SMMHC fusion protein is expressed in acute myeloid leukemia (AML) samples with the chromosome inversion inv(16)(p13;q22). This fusion protein binds the transcription factor RUNX with higher affinity than its physiological partner CBFbeta and disrupts the core binding factor (CBF) activity in hematopoietic stem and progenitor cells. Studies in the Castilla laboratory have shown that CBFbeta-SMMHC expression blocks differentiation of hematopoietic progenitors, creating a pre-leukemic progenitor that progresses to AML in cooperation with other mutations. However, the combined function of cumulative cooperating mutations in the pre-leukemic progenitor cells that enhance their expansion to induce leukemia is not known. The standard treatment for inv(16) AML is based on the use of non-selective cytotoxic chemotherapy, resulting in a good initial response, but with limited long-term survival. Therefore, there is a need for developing targeted therapies with improved efficacy in leukemic cells and minimal toxicity for normal cells. Here, we used conditional Nras+/LSL-G12D; Cbfb+/56M; Mx1Cre knock-in mice to show that allelic expression of oncogenic N-RasG12D expanded the multi-potential progenitor (MPP) compartment by 8 fold. Allelic expression of Cbfbeta-SMMHC increased the MPPs and short-term hematopoietic stem cells (ST-HSCs) by 2 to 4 fold both alone and in combination with N-RasG12D expression. In addition, allelic expression of oncogenic N-RasG12D and Cbfbeta-SMMHC increases survival of pre-leukemic stem and progenitor cells. Differential analysis of bone marrow cells determined that Cbfb+/MYH11 and Nras+/G12D; vii Cbfb+/MYH11 cells included increased number of blasts, myeloblasts and promyelocytes and a reduction in immature granulocytes, suggesting that expression of N-RasG12D cannot bypass Cbfbeta-SMMHC driven differentiation block. N-RasG12D and Cbfbeta-SMMHC synergized in leukemia, in which Nras+/G12D; Cbfb+/MYH11 mice have a shorter median latency than Cbfb+/MYH11 mice. In addition, the synergy in leukemogenesis was cell autonomous. Notably, leukemic cells expressing N-RasG12D and Cbfbeta-SMMHC showed higher (over 100 fold) leukemia-initiating cell activity in vivo than leukemic cells expressing Cbfbeta-SMMHC (L-IC activity of 1/4,000 and 1/528,334, respectively). Short term culture and biochemical assays revealed that pre-leukemic and leukemic cells expressing N-RasG12D and Cbfbeta-SMMHC have reduced levels of pro-apoptotic protein Bim compared to control. The Nras+/G12D; CbfbMYH11 pre-leukemic and leukemic cells were sensitive to pharmacologic inhibition of MEK/ERK signaling pathway with increasing apoptosis and Bim protein levels but not sensitive to PI3K inhibitors. In addition, knock-down of Bcl2l11 (Bim) expression in Cbfbeta-SMMHC pre-leukemic progenitors decreased their apoptosis levels. In collaboration with Dr. John Bushweller’s and other research laboratories, we recently developed a CBFbeta-SMMHC inhibitor named AI-10-49, which specifically binds to CBFbeta-SMMHC, prevents its binding to RUNX proteins and restores CBF function. Biochemical analysis in human leukemic cells showed that AI-10-49 has significant specificity in reducing the viability of leukemic cells expressing CBFbeta-SMMHC (IC50= 0.83μM), and negligible toxicity in normal cells. Likewise, mouse Nras+/G12D; viii Cbfb+/MYH11 leukemic cells were sensitive to AI-10-49 (IC50= 0.93μM). By using the NrasLSL-G12D; Cbfb56M mouse model, we also show that AI-10-49 significantly prolongs the survival of mice bearing the leukemic cells. Preliminary mechanistic analysis of AI-10-49 activity has shown that AI-10-49 increased BCL2L11 transcript levels in a dose and time dependent manner in murine and human leukemic cells, suggesting that the viability through BIM-mediated apoptosis may be targeted by both oncogenic signals. My thesis study demonstrates that Cbfbeta-SMMHC and N-RasG12D promote the survival of pre-leukemic myeloid progenitors primed for leukemia by activation of the MEK/ERK/Bim axis, and define NrasLSL-G12D; Cbfb56M mice as a valuable genetic model for the study of inv(16) AML targeted therapies. For instance, the novel CBFbeta-SMMHC inhibitor AI-10-49 shows a significant efficacy in this mouse model. This small molecule will serve as a promising first generation drug for targeted therapy of inv(16) leukemia and also a very useful tool to understand mechanisms of leukemogenesis driving by CBFbeta-SMMHC.

La leucémie myéloïde aigüe (LMA) est la forme de leucémie la plus fréquente chez l’adulte au Canada. Bien que de nombreux réarrangements chromosomiques récurrents aient été identifiés chez les patients LMA, près de la moitié des cas présentent un caryotype normal (LMA-CN). L’étude de la LMA-CN in vitro est rendue difficile par le fait que la survie des cellules primaires de patients est défectueuse sur le long terme et que les lignées cellulaires leucémiques ont un caryotype hautement anormal. En 2009, Munker et son équipe ont établi une nouvelle lignée cellulaire, CG-SH, ayant la particularité d’avoir un caryotype normal. L’objectif principal de ce projet d’étude est de caractériser plus en détail ce nouveau modèle d’étude. Nous avons identifié l’ensemble des variants génétiques présents dans CG-SH grâce au séquençage du génome entier. Les variants susceptibles de participer à la leucémogénèse ont été isolés, tels que des insertions détectées dans EZH2 et GATA2, et de nombreux variants faux-sens détectés dans des gènes pertinents pour la LMA. Nous avons montré que les cellules CG-SH sont sensibles à l’effet prolifératif d’une combinaison de cytokines, qui agissent sur le comportement des cellules en modifiant l’expression des gènes associés à la régulation de la prolifération, de l’apoptose et de la différentiation. De plus, les cytokines diminuent le taux de nécrose des cellules en culture sur le court terme. La présente étude a permis d’approfondir notre connaissance sur les caractéristiques moléculaires de la lignée cellulaire CG-SH, un nouveau modèle d’étude in vitro de la LMA-CN. / Acute myeloid leukemia (AML) is the most frequent form of leukemia in the adult population in Canada. Although many recurrent chromosomal rearrangements have been identified in AML, almost half of all adult patients will present with a normal karyotype (NK-AML). The in vitro study of NK-AML is difficult because the long-term survival of primary patient samples is deficient and AML cell lines have a highly abnormal karyotype. In 2009, Munker and collegues established a new cell line, CG-SH, with the advantage of having a normal karyotype. The main goal of this research project is to further characterize this new model system. We identified all the genetic variants present in the CG-SH cells using whole genome sequencing. We also isolated the variants that are susceptible to participate to leukemogenesis, including the insertions detected in EZH2 and GATA2, and several missense mutations occurring in relevant genes for AML. We found that a combination of cytokines promotes the proliferation of CG-SH cells, and that cytokines act on the cells behavior through expression changes of the genes involved in the regulation of proliferation, apoptosis and differentiation. Moreover, cytokines trigger a decrease of the necrotic rate of CG-SH on the short-term. The current study allowed us to better appreciate molecular characteristics of the CG-SH cell line, a new model to study NK-AML in vitro.

Background: Extramedullary manifestations (EM) are rare in acute myeloid leukemia (AML) and their impact on clinical outcomes is controversially discussed. - Methods: We retrospectively analyzed a large multi-center cohort of 1583 newly diagnosed AML patients, of whom 225 (14.21%) had EM. - Results: AML patients with EM presented with significantly higher counts of white blood cells (p < 0.0001), peripheral blood blasts (p < 0.0001), bone marrow blasts (p = 0.019), and LDH (p < 0.0001). Regarding molecular genetics, EM AML was associated with mutations of NPM1 (OR: 1.66, p < 0.001), FLT3-ITD (OR: 1.72, p < 0.001) and PTPN11 (OR: 2.46, p < 0.001). With regard to clinical outcomes, EM AML patients were less likely to achieve complete remissions (OR: 0.62, p = 0.004), and had a higher early death rate (OR: 2.23, p = 0.003). Multivariable analysis revealed EM as an independent risk factor for reduced overall survival (hazard ratio [HR]: 1.43, p < 0.001), however, for patients who received allogeneic hematopoietic cell transplantation (HCT) survival did not differ. For patients bearing EM AML, multivariable analysis unveiled mutated TP53 and IKZF1 as independent risk factors for reduced event-free (HR: 4.45, p < 0.001, and HR: 2.05, p = 0.044, respectively) and overall survival (HR: 2.48, p = 0.026, and HR: 2.63, p = 0.008, respectively). - Conclusion: Our analysis represents one of the largest cohorts of EM AML and establishes key molecular markers linked to EM, providing new evidence that EM is associated with adverse risk in AML and may warrant allogeneic HCT in eligible patients with EM.

The development and design of immune-based strategies have become an increasingly important topic during the last few years in acute myeloid leukemia (AML), based on successful immunotherapies in solid cancer. The spectrum ranges from antibody drug conjugates, immune checkpoint inhibitors blocking programmed cell death protein 1 (PD1), cytotoxic T lymphocyte antigen 4 (CTLA4) or T cell immunoglobulin and mucin domain containing-3 (TIM3), to T-cell based monoclonal and bispecific T-cell engager antibodies, chimeric antigen receptor-T-cell (CAR-T) approaches and leukemia vaccines. Currently, there are many substances in development and multiple phase I/II studies are ongoing. These trials will help us to deepen our understanding of the pathogenesis of AML and facilitate the best immunotherapeutic strategy in AML. We discuss here the mode of action of immune-based therapies and provide an overview of the available data.

Patients with acute promyelocytic leukemia (APL) often present with potentially lifethreatening hemorrhagic diathesis. The underlying pathomechanisms of APLassociated coagulopathy are complex. However, two pathways considered to be APLspecific had been identified: 1) annexin A2 (ANXA2)-associated hyperfibrinolysis and 2) podoplanin (PDPN)-mediated platelet activation and aggregation. In contrast, since disseminated intravascular coagulation (DIC) is far less frequent in patients with non- APL acute myeloid leukemia (AML), the pathophysiology of AML-associated hemorrhagic disorders is not well understood. Furthermore, the potential threat of coagulopathy in non- APL AML patients may be underestimated. Herein, we report a patient with non-APL AML presenting with severe coagulopathy with hyperfibrinolysis. Since his clinical course resembled a prototypical APL-associated hemorrhagic disorder, we hypothesized pathophysiological similarities. Performing multiparametric flow cytometry (MFC) and immunofluorescence imaging (IF) studies, we found the patient’s bone-marrow mononuclear cells (BM-MNC) to express ANXA2 - a biomarker previously thought to be APL-specific. In addition, whole-exome sequencing (WES) on sorted BM-MNC (leukemiaassociated immunophenotype (LAIP)1: ANXAlo, LAIP2: ANXAhi) demonstrated high intratumor heterogeneity. Since ANXA2 regulation is not well understood, further research to determine the coagulopathy-initiating events in AML and APL is indicated. Moreover, ANXA2 and PDPN MFC assessment as a tool to determine the risk of life-threatening DIC in AML and APL patients should be evaluated.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第23775号 / 医博第4821号 / 新制||医||1057(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 河本 宏, 教授 永井 純正, 教授 濵﨑 洋子 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM