Les membres de la famille Homeobox jouent un rôle critique dans le développement hématopoïétique normal. L'expression ectopique des gènes Homeobox provoque des désordres dans l'hématopoïèse et le développement de leucémies. L'oncogène TLX3 s'exprime de manière ectopique exclusivement dans les Leucémies Aiguës Lymphoblastiques T (LAL-T), avec un blocage des thymocytes à un stade de différentiation précoce cortical CD4+CD8+ DP. De nombreuses études ont investigué les mécanismes d'action des oncogènes TLX1/3, mais plusieurs questions restent en suspens. Durant ma thèse, j'ai étudié l'impact de l'expression ectopique de l'oncogène TLX3 sur le développement lymphocytaire T et les mécanismes de transformation leucémique associés. L'expression de TLX3 a provoqué le blocage des thymocytes à un stade DN2 avec une immortalisation des clones preleucémiques. Les souris transplantées avec les cellules TLX3 ont développé des tumeurs similaires aux LAL-T. Les analyses de ChIP-Seq et d'expression génique ont identifié un recrutement de TLX3 sur les enhancers spécifiques aux cellules T par le motif de fixation Ets/Runx1. Nos résultats suggèrent que la fixation de TLX3 sur les éléments cis-régulateurs peut contribuer à la transformation maligne des thymocytes en perturbant les réseaux transcriptionnels responsables de l'oncogenèse LAL-T. / It is now well established that members of the homeobox gene family play a critical role in normal hematopoietic cell development and that their unbalanced or ectopic expression can lead to characteristic perturbations in haemopoiesis and the onset of leukaemia. TLX3 expression in human haematologic malignancies is exclusive to T-ALL, where it is almost universally associated with transformation of early cortical CD4+CD8+ DP thymocytes. Multiple studies intensively investigated the mechanisms by which TLX1/3 oncogenes could promote complex tumor development, but many questions remain still unclear. During my thesis I investigated the impact of ectopic TLX3 expression on T cell development, and the initiating mechanisms of T-cell transformation leading to leukemia onset. Forced expression of TLX3 disrupted the thymic develoment at DN2-like stage giving rise to immortalized preleukemic clones. Following the transfer into immunodeficient mice TLX3 preleukemic cells initiated malignant cell transformation resulting into leukemia-like disease. Applying a combination of ChIP sequencing and gene expression profiling, we identified TLX3 recruitment onto T-cell specific enhancers via interaction with Ets1/Runx1 composite motif sites as preferential molecular events in the initial steps of TLX3-induced transformation. Thus our findings suggest that the genome-wide binding properties of TLX3 on cis-regulatory elements may contribute to its ability to promote thymocyte preleukaemic state via perturbation of transcriptional regulatory networks responsible for T-ALL oncogenesis.

[Truncated abstract] The treatment of childhood acute lymphoblastic leukaemia (ALL) is one of the great success stories of paediatric oncology, transforming a universally fatal disease into one where 75 to 90% of children are now cured. Although in the past survival for children with T-cell ALL (T-ALL) lagged behind that of children with pre-B ALL, the use of contemporary intensified treatment strategies has significantly diminished this difference, with many investigators reporting similar cure rates for both groups of patients. Despite these marked improvements, numerous challenges still face physicians treating children with T-ALL. Firstly, there have been no additional major improvements in outcome over the last decade, despite additional treatment intensification. Secondly, effective regimens remain elusive for treating children with relapsed T-ALL or patients with resistant disease. Finally, there is a need to identify patients currently potentially overtreated and thus unnecessarily subjected to acute and long term toxicities without benefit. A major challenge therefore, is the identification of novel reliable prognostic markers, in order to identify patients at high risk of relapse and conversely those least likely to relapse, to guide therapy appropriately. Children predicted with a high risk of relapse would be candidates for intensification of therapy and/or novel experimental agents. Conversely, patients predicted to be at low risk of relapse could be offered clinical trials using reduced intensity therapy, thereby minimising toxicity. '...' Crucially, the 3-gene predictor was validated in a completely independent cohort of T-ALL patients, also treated on CCG style therapy. Our 3-gene predictor appears to identify a high risk group of patients which require alternative therapeutic strategies in order to attain a cure. This study has also identified a potential novel agent for the treatment of T-ALL, which may be used as an anthracycline potentiator or anthracycline-sparing agent. We hypothesised that genes associated with a relapse signature provide promising targets for novel therapies. We tested the hypothesis that CFLAR, an inhibitor of the extrinsic apoptotic pathway and a member of the 3-gene predictor may be involved in the development of resistance to chemotherapy. To test our hypothesis we used a novel agent, 2-cyano-3, 12-dioxooleana-1,9 (11)-dien-28-oic acid (CDDO), previously shown to inhibit CFLAR protein, in two cell lines established in our laboratory from paediatric patients diagnosed with T-ALL. We found that CDDO displayed single agent activity at sub-micromolar concentrations in both cell lines tested. Importantly, minimally lethal doses of CDDO resulted in significant enhancement of doxorubicin mediated cytotoxicity in one of the cell lines assessed. The findings presented as part of this thesis have revealed the value of gene expression analysis of childhood T-ALL for identifying novel prognostic markers. This study has shown that expression profiles may provide better prognostic information than currently available clinical variables. Additionally, genes that constitute a relapse signature may provide rational targets for novel therapies, as demonstrated in this study, which assessed a potential novel agent for the treatment of T-ALL.

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