Philadelphia positive (Ph+) Acute Lymphoblastic Leukaemia (ALL) is characterised by the presence of the BCR-ABL fusion gene, which encodes a protein tyrosine kinase with aberrant activity. Imatinib, a chemical Bcr-Abl inhibitor, is rarely effective in Ph+ ALL patients as a single agent. In this study, insight into molecular and signalling changes occurring in Ph+ ALL during Imatinib therapy were investigated using cDNA microarrays. An optimal microarray assay was established to examine the gene expression changes in leukaemic cells from Ph+ ALL patients treated with Imatinib. Over 500 genes with ≥1.5-fold up- or down-regulation were identified. Based on gene ontology and novelty to Bcr-Abl signalling, six genes were selected and expression changes in five of these genes (PKCε, PINK1, SPRY2, ATF4 and PECAM1) confirmed by real time RT-PCR in Imatinib treated primary Ph+ ALL cells or the SUP-B15 cell line. The functional role of Protein Kinase C epsilon (PKCε) in response to Imatinib was further investigated using the Ph+ lymphoid and myeloid cell lines, SUP-B15 and K562. Detection of Imatinib-induced apoptosis by annexin V and PI staining demonstrated that SUP-B15 cells were less sensitive to Imatinib compared to K562 cells. PKCε mRNA was 50-fold higher in Ph+ ALL cells than Ph+ myeloid cells. In SUP-B15 cells, Imatinib upregulated PKCε mRNA but the protein was reduced by proteolytic cleavage. Inhibition of caspases showed that this cleaved product was not required for Imatinib induced-apoptosis. The treatment of SUP-B15 and primary Ph+ ALL cells with TAT-εV1-2 peptide, a specific inhibitor of PKCε, increased Imatinib-induced apoptosis. While the forced overexpression of PKCε in K562 cells reduced Imatinib-induced apoptosis. This increased expression of PKCε was associated with the increase of survival and anti-apoptotic proteins, Akt and Bcl-2. In summary, Gene expression profiling of Ph+ ALL cells during Imatinib therapy identified PKCε as an Imatinib responsive gene. A novel role of PKCε in Ph+ ALL response to imatinib is proposed. Experimental data presented in this thesis indicate that PKCε mediates pro-survival/anti-apoptosis signals in Ph+ ALL thereby reducing Imatinib-induced death. Thus, targeting PKCε during Imatinib therapy may be beneficial for the future treatment of Ph+ ALL.

Les leucémies aiguës (LA) sont un groupe hétérogène d'hémopathies malignes dues à latransformation oncogénique clonale des cellules souches hématopoïétiques (CSH). On distingue les LA myéloblastiques etlymphoblastiques (LAL). Les LAL sont classées selon le type de précurseur lymphoïde atteint, leur degré de maturité et leurs anomalies cytogénétiques.Le traitement permettant d'obtenir 80 à 90 % de rémission complète (RC) comporte une chimiothérapie d'induction, une consolidation et une intensification(intensification retardée ou allogreffe de CSH selon la situation pronostique). Néanmoins la survie globale à long terme n'est que de 40 à 50 %, du fait de la survenue de rechutes et de la toxicité des traitements. Différents groupes pronostiques basés sur la cytogénétique et la biologie moléculaire se dégagent,pouvant bénéficier de thérapeutiques adaptées. Dans les LAL à chromosome philadelphie (LAL à Ph),antérieurement de mauvais pronostic, les inhibiteurs de tyrosine kinase (ITK) permettent d'obtenir 80% de RCavec cependant un taux de rechute non négligeable. Nous avons démontré qu'une intensification thérapeutique par autogreffe chez des patients avec une maladie résiduelle indétectable permettait une survie à long terme prolongée avec une toxicité moindre que celle de l'allogreffe. En montrant l'implication de l'autotaxine dans les mécanismes de résistance aux ITK dans les LAL à Ph, nous ouvrons la voie à l'utilisation potentielle de nouvelles thérapeutiques. Dans les LAL T, groupe considéré de bon pronostic, un tiers des patients rechute. Nous avons démontré que l'absence de mutation de Notch et/ou FBXW7 ou la présence de mutations de RAS ou PTEN était de mauvais pronostic identifiant un sous-groupe de LAL T dont le traitement devait être renforcé. Nos travaux ont ainsi contribué à l'identification des groupes pronostiques dans les LAL et à l'adaptation des traitements afin d'améliorer les chances de survie. / Acute leukemias are a heterogeneous groups of malignant hematological diseases due to the clonaloncogenic transformation of hematopoietic stem cells(HSTs). We distinguish acute myeloblastic leukaemiafrom acute lymphoblastic leukemia (ALL). ALLs are classified according to the type of lymphoid precursoraffected, its degree of maturity, and with associated cytogenetic abnormalities.Treatment incorporating induction therapy,consolidation, and intensification – delayedintensification or allogeneic stem cell transplantation(SCT) according to prognostic factors – enable 80 to 90% of complete remission (CR). Nevertheless, long-termoverall survival is only 40 to 50% because of relapseand treatment-related toxicity. Different prognosticgroups based on cytogenetic abnormalities andmolecular biology are emerging and patients from eachprognostic group can benefit from adapted therapies.In chromosome Philadelphia-positive ALL (Ph+ ALL) which used to be of particular bad prognosis, tyrosinekinase inhibitors (TKIs) enables 80% of CR but with ahigh-relapse risk. We demonstrated that high-dosetherapy followed by autologous SCT enables prolongedlong-term survival with less drug-related toxicity ascompared to allogeneic SCT in patients with undetectable minimal residual disease. By showing the implication of autotaxine in the resistance to TKIs inPh+ LAL, we enable the use of novel therapeutics inclinical practice.T-cell ALL is considered of poor prognosis as one thirdof patients relapse. In this group of patients we showedthat the absence of a Notch and/or a FBXW7 mutation or the presence of mutations in RAS or PTEN identified a subgroup of patients in whom the treatmentmust be intensified. Our research has contributed to the identification of prognostic groups in ALL and to theadjustment of treatment according to potential survival.