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.

Thesis (Ph. D.)--University of Alabama at Birmingham, 2007. / Title from first page of PDF file (viewed Feb. 18, 2009). Includes bibliographical references.

No description available.

La contribution des Cellules Souches/Stromales Mésenchymateuses (CSM) dans le développement des Leucémies Aiguës Myéloblastiques (LAM) n’est pas encore clairement établie. L'objectif de ce travail a été de rechercher de potentielles modifications phénotypiques et fonctionnelles au sein des CSM médullaires de patients atteints de LAM de novo au diagnostic. Nous montrons que ces cellules présentent un défaut prolifératif accompagné d’une augmentation de l’apoptose et d’un déficit d’expression de certains facteurs de la niche (Ang-1, SCF, TPO et VCAM-1). De façon intéressante, ce défaut prolifératif est indépendamment associé à une évolution péjorative de la maladie. Néanmoins, ces anomalies des CSM de LAM ne semblent pas affecter leur capacité de soutien de l’hématopoïèse physiologique ou leucémique in vitro. En effet, comme les CSM normales, elles protègent les cellules leucémiques de l’apoptose, induisent leur quiescence (principalement par contact direct) et ainsi diminuent la proportion des cassures double-brin d’ADN. Ces données suggèrent que les modifications des CSM de LAM, probablement une des conséquences délétères de la prolifération tumorale, n'auraient pas un rôle spécifique dans le développement du processus leucémique. / The contribution of Mesenchymal Stem/Stromal Cells (MSCs) to the development of Acute Myeloid Leukemias (AMLs) remains poorly understood. In the present study, we investigated potential functional and phenotypic modifications of Bone Marrow (BM)-derived MSCs from patients with AML de novo at diagnosis. We showed that BM-derived MSCs from most of AML patients display proliferative defect, had increased apoptosis levels and demonstrated defective expression of several niche-related factors (Ang-1, SCF, TPO and VCAM-1). Interestingly, this proliferative defect was independently associated with disease progression. Nevertheless, these abnormalities in AML MSCs did not affect their in vitro capacity to support physiological but also leukemic hematopoiesis. Indeed, as normal MSCs do, they protect blast cells from apoptosis, induce their quiescence (mainly by direct contact), and decreased yields of DNA double-strand breaks. Consequently, in AML de novo these stromal cell alterations, probably a consequence of the deleterious effect of the tumor cell growth on BM MSCs, do not appear to have a specific role in the development of the leukemic process.

Dans le monde, 350 000 leucémies sont diagnostiquées chaque année. La rechute reste un problème majeur des leucémies aiguës myéloïdes (LAM) et le métabolisme oxydatif pourrait jouer un rôle essentiel dans la réponse au traitement. Un faible niveau des espèces réactives de l’oxygène (ROS) est associé à des propriétés des cellules souches leucémiques et la quiescence alors qu’un niveau plus élevé caractérise les leucoblastes proliférants. L’homéostasie des ROS repose sur un équilibre entre les systèmes oxydants et antioxydants. Les antioxydants sont bien documentés dans les LAM alors que les connaissances sur l’activité oxydante sont encore limitées. Dans ce travail nous avons choisi d’étudier les sept complexes NADPH oxydases (NOX) dans 25 lignées issues de LAM humaines et des LAM primaires. L’analyse des ARNm et des protéines montre des profils d’expression variables entre les lignées avec une expression plus forte des sous-unités du complexe NOX2 dans les lignées correspondant à des stades de différenciation myéloïde plus avancés. L’activité enzymatique des NOX est cependant équivalente entre les lignées. Deux inhibiteurs, DPI et VAS3947, ont été utilisés pour connaître la contribution des NOX à la production des ROS cellulaires. Alors qu’ils ont inhibé l’activité, ils ont aussi généré un stress oxydatif majeur conduisant à une diminution de la prolifération cellulaire et une forte apoptose, le DPI en augmentant les ROS mitochondriaux et VAS3047 les ROS cytoplasmiques. Afin de connaitre les sous-unités impliquées et de mieux comprendre les mécanismes, les sous-unités NOX2 et p22phox ont été inhibée par ARN interférence. Celle-ci n’ont pas affecté la prolifération mais ont montré des effets compensatoires. Nos data montrent qu’inhiber les NOX pourrait s’avérer une stratégie thérapeutique en augmentant le stress oxydatif dans les cellules leucémiques. / 350,000 leukaemia are diagnosed each year worldwide. In acute myeloid leukaemia (AML), relapse remains a major problem and the oxidative metabolism might play a crucial role in the therapeutic response. Low level of reactive oxygen species (ROS) is associated with properties of leukemic stem cells and quiescence whereas higher level promotes leukoblasts proliferation. ROS homeostasis relies on a tightly regulated balance between the oxidant and antioxidant systems. Although the antioxidant system is extensively studied in AML, the oxidant system remains poorly documented. In this work we aimed to study the seven NADPH oxidases (NOX) complexes in 25 AML human cell lines and primary samples. NOX transcriptional and protein profiles are variable with a higher expression of NOX2 in cell lines belonging to mature differentiation stages. An equivalent level of enzymatic activity was observed across all the cell lines. To reveal the contribution of NOX to global ROS production in the cells, two NOX inhibitors, DPI and VAS3947, were then used. Although both inhibitors efficiently blocked NOX activity they unexpectedly triggered strong oxidative stress leading to reduced cell proliferation and strong apoptosis, DPI by increasing mitochondrial ROS while VAS3947 by increasing cytoplasmic ROS production. To highlight which of the subunits were involved and to understand the mechanisms, NOX2 and p22phox subunits were inhibited using shRNA strategy. These did not affect cell proliferation but revealed a compensation effect. Our data suggest that NOX inhibition might be potential therapeutic strategy by increasing oxidative stress in leukemic cells.

L'utilisation des ressources en fer et les variations du potentiel redox sont des processus impliqués dans la prolifération et la différenciation cellulaire. Ils participent à l'hématopoïèse normale et leur dérégulation peut être associée à des conditions pathologiques. Les hémopathies, telles que la leucémie aiguë myéloïde (LAM), témoignent du lien entre disponibilité en fer, signalisation redox et leucémogenèse. La déplétion en fer induit un arrêt de la prolifération suivi de la mort cellulaire, et pour des cellules primaires leucémiques (blastes) de patients LAM, elle peut conduire à un réengagement de la différenciation vers la lignée monocytaire. Cependant, les besoins en fer des clones leucémiques restent mal définis. Dans les cellules animales, le cœur du réseau de régulation du fer est organisé à travers le système régulateur IRE-IRP. Les Iron Regulatory Proteins (IRP), agissent sur la traduction de nombreuses protéines impliquées dans la gestion du fer par interaction avec les Iron Responsive Elements (IRE) localisés sur les régions non codantes des ARN messager (ARNm) régulés. A partir de lignées cellulaires leucémiques (KG1, K562), de blastes de patients LAM et de progéniteurs CD34+ contrôles issus de sang de cordon et de moelle osseuse de donneurs sains, le statut du système de gestion cellulaire du fer a été caractérisé pour les premières étapes de l'hématopoïèse normale et pathologique. A travers la manipulation des apports cellulaires en fer, notamment par l'utilisation de chélateurs à usage thérapeutique, la réponse du système homéostatique a été suivie. Nos données soulignent les faibles besoins en fer des progéniteurs hématopoïétiques, et d'autres cellules, pour proliférer. Dans les lignées cellulaires le régulateur IRP est en excès par rapport à ses cibles IRE, ce qui pourrait être une caractéristique générale du contrôle de la traduction pour des ARNm spécifiques par fixation de régulateurs translationnels. La régulation semble exclusivement le fait d' IRP1, puisqu' IRP2 n'a pas été détecté dans les progéniteurs hématopoïétiques, qu'ils soit pathologiques ou non. De subtiles différences ont été identifiées dans les quantités des composants du réseau gérant le fer dans les cellules leucémiques en comparaison des cellules saines témoins, ainsi que des capacités différentes à croître dans un milieu minimal comportant des concentrations en fer précisément définies. Les informations obtenues à travers ce travail pourraient bénéficier à l'élaboration de protocoles thérapeutiques, incluant notamment la manipulation du fer, dans les LAM ou d'autres pathologies. / Use of iron resources and variations of the redox balance are processes involved in cell proliferation and differentiation. They participate to normal hematopoiesis and their disturbance may be associated with pathological conditions. Hematological neoplasms, such as acute myeloid leukemia (AML), provide clinical evidence of the link between iron availability, redox signaling, and malignancy. Stringent iron depletion induces arrest of proliferation followed by cell death, and deprived primary leukemic cells of AML patients (blasts) have been previously shown to engage into the monocytic lineage. Yet, the iron needs of leukemic clones are unknown. The core network of cellular iron regulation in mammals is organized around the IRE-IRP system. The Iron Regulatory Proteins (IRP) act on the translation of many proteins involved in iron management by interacting with Iron Responsive Elements (IRE) located on the untranslated regions of messenger RNA (mRNA) coding these proteins. Using leukemic cell lines (KG1, K562), blasts of AML patients and CD34+ progenitors isolated from cord blood or the bone marrow of healthy donors, the status of the iron management system was established in the first stages of normal and pathological hematopoiesis. The response of the homeostatic system upon manipulation of iron provision, including with clinically implemented chelators, has been monitored. Our data emphasize the weak iron requirements of hematopoietic progenitors, and other cells, to proliferate. In cell lines the IRP regulator is in excess of its IRE targets, which may be a general feature of translational control for specific mRNA. The regulation seems exclusively mediated by IRP1, as the IRP2 regulator has not been detected in normal or malignant hematopoietic progenitors. Subtle differences have been found in the iron handling system of leukemic cells as compared to normal cells, together with different abilities to grow on a minimal medium containing precisely defined iron concentrations. The design of improved therapeutic regimens including iron manipulation, in AML and other pathologies, may benefit from considering the information obtained in this work.

Les protéines de choc thermiques (HSP) sont des chaperons moléculaires qui stabilisent le pliage et la conformation de protéines normales et oncogéniques, prévenant la formation d'agrégats protéiques. Elles sont impliquées dans la régulation de l'apoptose, de la survie cellulaire et dans la cancérogénèse. HSP90 est la protéine chaperone majeure de stabilisation d'oncogènes impliqués dans les hémopathies malignes. L'objectif de notre travail était de déterminer l'implication de HSP90 dans différents types d'hémopathies malignes, les Leucémies Aiguës Myéloïdes (LAM), les Syndromes Myélodysplasiques (SMD) et les Leucémies Aiguës Lymphoblastiques (LAL), et de tester son inhibition par un inhibiteur spécifique, la tanespimycine (17- AAG). Dans les LAM, nous avons évalué l'implication des différentes isoformes de la protéine dans la résistance aux chimiothérapies et aux inhibiteurs de HSP90. Ce travail met en évidence la valeur péjorative de l'expression de HSP90 dans les différents sous types d'hémopathies, corrélant avec un risque de rechute élevé ou d'évolution vers des formes plus agressives. L'utilisation de la tanespimycine a permis de déclencher l'apoptose dans les cellules immatures impliquées dans ces pathologies. HSP90 constitue donc une protéine majeure de la cellule leucémique, et son ciblage offre des perspectives intéressantes dans le traitement des hémopathies malignes / Heat shock proteins (HSP) are molecular chaperones that stabilize the folding and conformation of normal and oncogenic proteins, preventing the formation of protein aggregates. They are involved in the regulation of apoptosis, cell survival and carcinogenesis. HSP90 is the major chaperone implicated in stabilization of oncogenes involved in hematologic malignancies. The aim of our study was to determine the involvement of HSP90 in various types of malignancies, Acute Myeloid Leukemia (AML), Myelodysplastic Syndromes (MDS) and Acute Lymphoblastic Leukemia (ALL) and to test its inhibition by a specific inhibitor, the tanespimycine (17-AAG). In acute myeloid leukemia, we evaluated the involvement of different isoforms of the protein in resistance to chemotherapy and inhibitors of HSP90. This work highlights the pejorative value of HSP90 expression in different subtypes of malignancies, correlated with a high risk of relapse or progression to more aggressive forms. Use of tanespimycine has triggered apoptosis in immature cells involved in these diseases. HSP90 is therefore a major protein of the leukemic cell and its targeting offers interesting perspectives in the treatment of hematologic malignancies

A leucemia mielóide aguda ainda apresenta altos índices de mortalidade em adultos, exceção feita à leucemia promielocítica. A otimização dos protocolos de tratamento tem sido muito discutida há 3 décadas, com resultados ainda insatisfatórios. Fatores prognósticos como idade, cariótipo e tolerância à consolidação com altas doses de citarabina guardam relação com a melhor sobrevida. Com o objetivo de avaliar diferentes protocolos de tratamento e validar estes e outros fatores prognósticos, conduzimos um estudo retrospectivo no Hospital das Clínicas da Universidade de São Paulo, analisando prontuários médicos e os eventos relacionados à leucemia mielóide aguda, de 1978 a 2007. Analisamos 400 pacientes tratados curativamente e achamos que idade abaixo de 60 anos (27% vs 7%), cariótipo favorável (53% vs 28% vs 5%) e administração de doses totais de citarabina, principalmente se acima da mediana de 45,45 gramas (68% vs 44% vs 21%) tem impacto positivo na sobrevida global em 5 anos, sendo o uso de altas doses de citarabina um fator independente. A positividade para mieloproxidase, classificação FAB e protocolo de tratamento não mostraram associação estatisticamente significante para melhores índices de sobrevida. Pudemos concluir que, se os protocolos de indução não apresentam diferenças estatísticas, a consolidação intensiva com altas doses de citarabina em pacientes abaixo de 60 anos tem impacto independente na sobrevida global, com resultados ainda melhores quando a dose total é maior ou igual a 45,45 gramas. O cariótipo também foi validado em nossa população / Acute myeloid leukemia in adults is still a highly fatal disease, except for acute promyelocitic leukemia. The optimization of treatment protocols has been debated for three decades, without satisfactory results. Prognostic factors like age, kariotype and consolidation with cytarabine in high dosis seem to correlact with a better overall survival. We conducted a retrospective study in the General Hospital of University of Sao Paulo analyzing medical records and acute myeloid leukemia outcomes to compare different treatment protocols used through 1978 to 2007. We also intended to validate international prognostic factors as the ones cited in our population. We analyzed 400 patients treated with curative intention and found better overall survival in 5 years regarding age less than 60 years (27% vs 7%), favorable karyotipe (53% vs 28% vs 5%) and high dosis cytarabine in consolidation, meanly if total dose was at least the median of 45,45 g (68% vs 44% vs 21%). Consolidation with high dosis cytarabine was an independent predictor of better overall survival. No estatistical differences were seen regarding myeloperoxidase positivity, induction protocol and FAB classification. We concluded that, if the induction protocols seem to be no different in results, consolidation with high dosis cytarabine for patients under 60 years has impact in overall survival, being even better when the total dosis is at least 45,45 g. Karyotipe has also been validated in our study population

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Despite technological advances, the prognosis and survival of acute myeloid leukemia (AML) adult patients remain low, compared with other hematologic malignancies. Some antigens detected by immunophenotyping may soon play a significant role in the pathophysiologic, prognostic, and overall survival (OS) rate of AML patients. Therefore, we conducted a systematic review and meta-analysis of PubMed, Scopus, Science Direct, Web of Science, and the Cochrane Library (using PRISMA guidelines). We analyzed 11 studies and 13 antigens, detected through the immunophenotyping of 639 patients. From them, 12 exhibited a negative impact with AML prognosis. The meta-analysis demonstrated a high expression of AML markers, which have been associated with a decrease in survival over 10 months (RR 2.55; IC 95%; 1.49-4.37) and over 20 months (RR 2.46; IC 95%; 1.75-3.45). Knowing that the expression of immunophenotypic markers, which are not used on a routine basis, might be able to influence disease behavior, looks promising. Since they have been associated with a poor prognosis as well as a decrease in survival. This may allow for different chemotherapeutical protocols, including future studies for new therapeutic targets. / Apesar dos avanços tecnológicos, o prognóstico e a sobrevida dos pacientes adultos com leucemia mieloide aguda (LMA) permanecem baixos quando comparados com outras neoplasias hematológicas. Alguns antígenos identificados pela técnica de imunofenotipagem por citometria de fluxo podem desempenhar um papel significativo na compreensão da fisiopatologia, no prognóstico e na sobrevida global dos pacientes com LMA. Sendo assim, foi realizada uma revisão sistemática e metanálise nas bases de dados PubMed, Scopus, Science Direct, Web of Science e Cochrane Library (utilizando as diretrizes do PRISMA). Em onze estudos realizados em um total de 639 pacientes, foram detectados treze antígenos, analisados pela metodologia de imunofenotipagem por citometria de fluxo. Destes marcadores, doze exibiram um impacto negativo no prognóstico da LMA. A metanálise demonstrou que a alta expressão dos marcadores de LMA tem sido associada a uma diminuição nas taxas de sobrevida em 10 meses (RR 2,55; IC 95%; 1,49-4,37) e 20 meses (RR 2,46; IC 95%; 1,75- 3.45). O conhecimento de que a expressão de novos marcadores imunofenotípicos pode ser capaz de influenciar o comportamento da doença, parece ser uma informação promissora, pois demonstra influência no prognóstico e diminuição da sobrevida dos pacientes com LMA. Isto pode servir de base para a investigação de diferentes protocolos quimioterápicos, incluindo o estudo prospectivo de novos alvos terapêuticos.

A natureza heterogênea da Leucemia Mielóide Aguda (LMA) tornou-se um desafio para o sucesso da quimioterapia convencional com o agente Citarabina (Ara-C), especialmente em leucemias com prognóstico desfavorável, como aquelas portadoras do rearranjo MLL. Visto que as células de LMA-MLL são consideradas sensíveis ao Ara-C quando comparadas às leucemias que não apresentam o rearranjo, mas a recaída à doença é frequente, a presente tese propôs estudar a relação entre características biológicas relacionadas às bases da resistêmcia ao Ara-C em LMA-MLL. A abordagem proposta foi a seleção de subpopulações de linhagens celulares portadoras do rearranjo MLL submetidas ao tratamento em longo prazo com Ara-C, comparando-as com as linhagens não expostas à droga. As células foram caracterizadas quanto: 1) ao potencial proliferativo na presença ou ausência de Ara-C; 2) a distribuição das células no ciclo celular; 3) a distribuição de marcadores clássicos de superfície de células-tronco hematopoiéticas, CD34 e CD38; e 4) o perfil de expressão global dos RNAs transcritos. O tratamento em longo prazo selecionou células mais resistentes ao Ara-C que as células parentais. Além disso, quanto ao ciclo celular, as células selecionadas com Ara-C apresentaram apoptose reduzida (fase sub-G1), acúmulo na fase de síntese (fase S) e aumento da capacidade proliferativa após reexposição à droga (fase G2-M). Quanto à análise de marcadores de células-tronco hematopoiéticas, observou-se que após o tratamento em longo com Ara-C, uma das linhagens celulares apresentou distribuição bimodal do marcador CD38. Quando separadas por sorting em citometria de fluxo, observou-se que as subpopulações com níveis distintos de expressão de CD38, denominadas MV-4-11 CD38High e MV-4-11 CD38Low apresentaram resposta distinta ao tratamento com Ara-C. Quando avaliadas quanto ao perfil global de expressão gênica, constatou-se que MV-4-11 CD38High eram mais semelhantes às células parentais, e que MV-4-11 CD38Low formavam um grupo isolado, distinto das outras duas populações celulares. A análise de ontologia gênica (GO) evidenciou que entre as categorias mais representativas de processos biológicos estavam atividades associadas à capacidade proliferativa, ao desenvolvimento e a resposta a estímulos. As análises de agrupamentos hierárquicos mostraram que: 1) o cluster de genes do desenvolvimento HOXA estava mais expresso nas células MV-4-11 CD38Low do que em MV-4-11 CD38High, que apresentaram expressão mais elevada do cluster HOXB; 2) o gene HOX mais diferencialmente expresso foi HOXA13, associado na literatura com prognóstico desfavorável em outros tipos de câncer; 3) dos genes associados a resposta a estímulos, o único relacionado à via de metabolização do Ara-C diferencialmente expresso entre as linhagens foi NME1; 4) aqueles que participam das vias de reparo de pareamento incorreto, reparo por excisão de bases e por excisão de nucleotídeos encontraram-se mais expressos nas células MV-4-11 CD38High que em MV-4-11 CD38Low. Além disso, diversas quinases dependentes de ciclinas (CDKs) também estiveram diferencialmente expressas entre MV-4-11 CD38High e MV-4-11 CD38Low. Sugere-se por fim, que o modelo in vitro proposto neste estudo para simular a situação de resistência ao Ara-C em subpopulações de LMA-MLL, demonstrou que os mecanismos de resposta à Citarabina nesta doença, vão além de alterações na detoxificação e metabolização da droga, e parecem mais associados a vantagens proliferativas e do desenvolvimento das células leucêmicas. Estas vias devem ser exploradas como alvos potenciais na terapia combinada ao Ara-C. / The heterogeneity of Acute Myeloid Leukemia (AML) became a challenge for the success of the conventional chemotherapy agent Cytarabine (Ara-C), especially in leukemias with poor prognosis, as those harboring MLL rearrangement. Since AML-MLL cells are considered sensitive to Ara-C when compared with leukemias that do not carry the rearrangement, but relapse is frequent, the present dissertation proposed to study the relationship between biological characteristics related to the basis of chemoresistance to Ara-C in AML-MLL. We proposed an approach based on the selection of subpopulations of cell lines bearing MLL rearrangement submitted to the long-term treatment with Ara-C, comparing them with the cell lines that were not previously exposed to the drug. The cells were characterized according to: 1) the proliferative potential in the presence and absence of Ara-C; 2) the distribution of the cells in the cell cycle; 3) distribution of hematopoietic stem cell classic surface markers, CD34 and CD38; and, 4) global expression profile of transcribed RNAs. The long-term treatment selected cells that are more resistant to Ara-C than the cells that were not previously treated (parental cells). Besides, according to cell cycle, the cells selected by Ara-C treatment present decreased apoptosis (sub-G1 phase), accumulation in the synthesis phase (S-phase) and increase in the proliferative capability after re-exposition to the drug (G2-M phase). Regarding the hematopoietic stem cell markers, we observed that after Ara-C long-term treatment, one of the cell lines exhibited a bimodal distribution of the CD38 marker. When sorted by flow cytometry, we observed that both subpopulations with distinct levels of CD38 expression, called MV-4-11 CD38High and MV-4-11 CD38Low also showed distinct response to Ara-C. When evaluated regarding to their global gene expression profiles, we verified that MV-4-11 CD38High were more closely related to the parental cells, and MV-4-11 CD38Low made up an isolated group, distinct of the other cell populations. Gene ontology (GO) analysis revealed that among the most representative categories of biological processes, activities associated with proliferative capability, development and response to stimuli were included. The hierarchical clustering analysis showed that: 1) the cluster HOXA of genes of development was more expressed in the MV-4-11 CD38Low than in the MV-4-11 CD38High cells, that presented increased expression of HOXB cluster; 2) the most differentially expressed HOX gene was HOXA13, which according to the literature is associated with poor prognosis in other types of cancer; 3) among the genes associated with response to stimuli, the only one related to Ara-C-metabolizing pathway that was differentially expressed between the cell lines was NME1; 4) those genes that take part in the mismatch repair, base excision repair and nucleotide excision repair pathways were more expressed in the MV-4-11 CD38High than in the MV-4-11 CD38Low cells. Additionally, several cyclin-dependent kinases (CDKs) were also differentially expressed between MV-4-11 CD38High and MV-4-11 CD38Low. Finally, we suggest that the in vitro model proposed in this study to mimic the situation of chemoresistance to Ara-C in subpopulations of AML-MLL, showed that the mechanisms of Ara-C response in this disease, go beyond changes in drug detoxification and metabolization, and seem more associated to proliferative and development advantages of the leukemic cells. These pathways should be explored as potential targets to Ara-C combination therapies.