Die myeloische Entwicklung wird durch die Familie der Transkriptionsfaktoren CCAAT/Enhancer-Binding-Protein (C/EBP) reguliert. Eine aberrante Expression oder Funktion von C/EBPs stört die normale myeloische Differenzierung und wird bei vielen Arten hämatopoetischer Malignome beobachtet. Mutationen von CEBPA führen zu einem veränderten Expressionsanteil der verkürzten Isoform C/EBPa p30 und werden bei etwa 15% der AML-Patienten (akute myeloische Leukämie) nachgewiesen. Obwohl die verkürzte Isoform C/EBPα p30 als Onkogen identifiziert wurde da sie die Proliferation myeloischer Vorläufer fördert, behält sie dennoch eine Differenzierungsfunktion. Unser Interesse gilt der Frage, wie diese beiden Funktionen von C/EBPα p30 reguliert werden. Die C/EBP-Familie gehört der Gruppe intrinsisch ungeordneter Proteine an, die zudem viele posttranslationale Modifikationen (PTMs) aufweisen. PTMs auf C/EBPα verändern seine biologische Funktionsweise stark. Frühere Forschungsarbeiten haben drei Argininreste am N-Terminus von C/EBPα p30 identifiziert, die aufgrund des Methylierungsstatus differentiell mit anderen Proteinen interagieren. In dieser Arbeit untersuchen wir den Einfluss der C/EBPα p30 Arginin-Methylierung auf seine pro-leukämische Aktivität sowie dessen Fähigkeit zur Neuausrichtung der hämatopoietischen Differenzierungslinie. Mit Hilfe von Aminosäuresubstitutionen fanden wir heraus, dass C/EBPα p30 Mutanten der Methylierungsmimesis oder Ladungsabschaffung die myeloische Differenzierung verstärkt, während Ladungserhalt-Mutanten die Erneuerung und Proliferation hämatopoetischer Stamm-/Vorläuferzellen unterstützt. Transkriptionelles Profiling von Zellen, die mutierte C/EBPα -p30-Varianten exprimieren, deutet auf potenzielle Ziele der methyliertem bzw. unmethyliertem C/EBPα p30 hin. Die Ergebnisse legen nahe, dass der Arginin-Methylierungsstatus das Leukämie- und Differenzierungs-Potenzial von C/EBPα p30 verändert und somit ein neues Ziel der Leukämietherapie darstellen könnten. / Myeloid development is regulated by the family of transcription factors CCAAT/enhancer-binding-protein (C/EBP). Aberrant expression or functioning of C/EBPs disturbs normal myeloid differentiation and is found in many types of hematopoietic malignancies. Mutations of CEBPA lead to imbalanced expression of the truncated isoform C/EBPα p30 and are found in approximately 15% of AML (acute myeloid leukemia) patients. Yet, how C/EBPα participates in leukemic progression remains to be discovered. More specifically, the truncated isoform C/EBPα p30, although being identified as an oncogenic isoform that promotes proliferation of myeloid progenitors, still retains differentiation function. The question of how both functions of C/EBPα p30 are regulated, is of our interest. C/EBP family also represents a group of intrinsically disordered proteins, which contain many post-translational modifications (PTMs). PTMs on C/EBPα greatly alter its functioning. Previous works have identified three arginine residues at the N-terminus of C/EBPα p30 that interact differently with others protein dependent on their methylation status. We hypothesize, that methylation of these arginine residues plays important roles in the biology of C/EBPα p30. In this study, we used a lymphoid-to-myeloid transdifferentiation (LMT) system to investigate the influence of arginine-methylation on C/EBPα-induced lineage switch and its pro-leukemic activity. Using amino acid substitution, we found that C/EBPα p30 mutants that resemble arginine-methylated p30 enhanced myeloid differentiation, while the charge-retention mutant, resembling arginine-unmethylated p30, supported renewability and proliferation of hematopoietic progenitors. Transcriptional profiling of cells expressing C/EBPα p30 variants suggested potential targets of either methylated or unmethylated p30. The results implied that arginine methylations alter C/EBPα p30’s leukemic potential and might comprise novel targets of leukemia therapy.

[ES] La leucemia mieloide aguda (LMA) se trata de un grupo heterogéneo de desórdenes hematológicos producidos por alteraciones genéticas en las células precursoras mieloides. Las mutaciones en la enzima Isocitrato deshidrogenasa 2 (IDH2) son unas de estas alteraciones. Las mutaciones más frecuentes en esta proteína afectan a las posiciones R140 y R172, provocando una ganancia de función con la producción del oncometabolito D-2-hidroxiglutarato (2-HG). A pesar de que ambas inducen la producción de 2-HG, la mutación R172 produce mayor cantidad de oncometabolito, presenta menos concurrencias con otras alteraciones genéticas y se asocia a una peor respuesta a la quimioterapia y un mayor riesgo de recaída. Los modelos de investigación han permitido conocer el papel de las mutaciones genéticas en el desarrollo de la enfermedad. A pesar de ello, es necesario desarrollar nuevos modelos que expresen de forma endógena estas mutaciones para estudiar en profundidad las vías moleculares afectadas. Por todo ello, en esta Tesis se han desarrollado nuevas estrategias de edición génica mediante el sistema CRISPR/Cas9 con el objetivo de desarrollar nuevos modelos in vitro e in vivo de mutaciones implicadas en LMA. Debido a la baja eficiencia de transfección de los plásmidos CRISPR en las líneas celulares leucémicas, el método más empleado para introducir los elementos CRISPR han sido principalmente vectores lentivirales. Para evitar los inconvenientes de este tipo de vectores, en esta Tesis se ha desarrollado una estrategia alternativa para la introducción de la nucleasa Cas9 y los guías CRISPR. El gen codificante de la Cas9 se introdujo en el genoma de células NB4 mediante transducción con lentivirus, generando una línea celular con expresión constitutiva de la nucleasa. Por otro lado, se desarrolló un sistema sencillo de producción de los guías CRISPR mediante PCR con los elementos esenciales para su expresión y la expresión del reportero GFP de forma opcional. Con el objetivo de optimizar la técnica y probar su eficiencia en distintas dianas se modificaron dos genes implicados en LMA. Estos fueron el gen IDH2, en el cuál se buscó introducir la mutación R172, y el gen MYBL2. Finalmente, las eficiencias de edición obtenidas se compararon con el uso de complejos de ribonucleoproteínas CRISPR, muy utilizados por su alta eficiencia. Mientras que los complejos de ribonucleoproteínas presentaron una mayor eficiencia de corte, la eficiencia de edición de la mutación R172 fue similar en ambas estrategias. Mediante secuenciación masiva se confirmó y caracterizó esta edición y se comprobó que la maquinaria de edición no había producido cortes inespecíficos en regiones similares del genoma. Por tanto, la nueva metodología desarrollada permitió editar de forma precisa líneas celulares leucémicas con eficiencias similares a otras técnicas CRISPR más extendidas y sin producir efectos inespecíficos no deseados. Por otro lado, gracias a la gran conservación evolutiva del gen IDH2, los residuos R140 y R172 se encuentran conservados en la proteína idh-2 de Caenorhabditis elegans. Se empleó la estrategia co-CRISPR para desarrollar y seleccionar cepas mutantes con las mutaciones ortólogas a R140 y R172, y una cepa con ambas mutaciones. A pesar de la conservación, no se observó el aumento del oncometabolito 2-HG esperado en las cepas mutantes en comparación con la cepa salvaje control N2. Un estudio exhaustivo de las vías implicadas nos serviría para desarrollar modelos de investigación con las alteraciones moleculares observadas en los pacientes. Para concluir, la estrategia desarrollada de introducción de elementos CRISPR en líneas celulares, junto a los modelos producidos en C. elegans, permitirán en futuros estudios investigar en detalle los efectos moleculares de mutaciones detectadas en pacientes de LMA, su implicación en el desarrollo y pronóstico de la LMA y comprender su papel en la estratificación de los pacientes. / [CA] La leucèmia mieloide aguda (LMA) es tracta d'un grup heterogeni de desordres hematològics produïts per alteracions genètiques en les cèl·lules precursores mieloides. Les mutacions en l'enzim Isocitrato deshidrogenasa 2 (IDH2) son d'aquestes alteracions. Les mutacions més freqüents en aquesta proteïna afecten a les posicions R1240 i R172, produint un guany de funció amb la producció de l'oncometabolit D-2-hidroxiglutarat (2-HG). A pesar que ambdues indueixen la producció de 2-HG, la mutació R172 produeix mes quantitat de oncometabolit, presenta menys co ocurrències con altres alteracions genètiques i s'associa a una pitjor resposta a la quimioteràpia i un major risc de recaiguda. Els models d'investigació han permés conéixer el paper de les mutacions genètiques en el desenvolupament de la malaltia. Malgrat això, és necessari desenvolupar nous models que expressen de manera endògena aquestes mutacions per a estudiar en profunditat les vies moleculars afectades. Per tot això, en aquesta Tesis s'han desenvolupat noves estratègies d'edició gènica mitjançant el sistema CRISPR/Cas9 amb l'objectiu de desenvolupar nous models in vitro i in vivo de les mutacions implicades en la LMA. Degut a la baixa eficiència de transfecció dels plasmids CRISPR en les línies cel·lulars leucèmiques, el mètode més emprat per a introduir els elements CRISPR han sigut principalment vectors lentivirals. Per a evitar els inconvenients d'aquesta mena de vectors, en aquesta Tesis s'ha desenvolupat una estratègia alternativa per a la introducció de la nucleasa Cas9 i els guies CRISPR. El gen codificant de la Cas9 es va introduir al genoma de cèl·lules NB4 mitjançant transducció amb lentivirus, generant una línia cel·lular amb expressió constitutiva de la nucleasa. D'altra banda, es va desenvolupar un sistema fàcil de producció dels guies CRISPR mitjançant PCR amb els elements essencials d'expressió i amb l'expressió del reporter GFP de manera opcional. Amb l'objectiu d'optimitzar la tècnica i provar la seua eficiència en diferents dianes es van modificar dos gens implicats en LMA. Aquests van ser el gen IDH2, en el qual es va buscar introduir la mutació R172, i el gen MYBL2. Finalment, les eficiències d'edició obtingudes amb la nova estratègia es van comparar amb l'ús de complexos ribonucleotproteïnes CRISPR, molt utilitzats per la seua alta eficiència. Mentre que els complexos de ribonucleoproteïnes van presentar una major eficiència de tall, l'eficiència d'edició de la mutació R172 va ser similar en les dues estratègies. Mitjançant seqüenciació massiva es va confirmar i caracteritzar aquesta edició i es va comprovar que la maquinària d'edició no havia produït talls inespecífics en regions similars del genoma. D'aquesta manera, la nova metodologia desenvolupada permet editar de manera precisa línies cel·lulars leucèmiques amb eficiències similars a altres tècniques CRISPR més esteses i sense produir efectes inespecífics no desitjats. D'altra banda, gràcies a la gran conservació evolutiva del gen IDH2, els residus R140 i R172 es troben conservats en la proteïna idh-2 de Caenorhabditis elegans. Es va utilitzar l'estratègia co-CRISPR per a desenvolupar i seleccionar ceps mutants amb les mutacions ortòlogues a R140 i R172, i un cep amb dues mutacions. Malgrat l'alta conservació, no es va observar l'augment del oncometabolit 2-HG esperat en els ceps mutants en comparació amb el cep salvatge control N2. Un estudi exhaustiu de les vies implicades ens serviria per a desenvolupar models d'investigació amb les alteracions moleculars observades en els pacients. Per a concloure, l'estratègia desenvolupada d'introducció d'elements CRISPR en línies cel·lulars, al costat dels models produïts en C. elegans permetran en estudis futurs investigar detalladament els efectes moleculars de mutacions detectades en pacients, la seua implicació en el desenvolupament i prognosi de la LMA i comprendre el seu paper en l'estratificació dels pacients. / [EN] Acute Myeloid Leukaemia (AML) is a heterogeneous group of haematological disorders caused by genetic alterations in myeloid precursors. Mutations in the Isocitrate dehydrogenase enzyme are among these alterations. The most frequent mutations in this protein affect R140 and R172 positions, leading to a gain of function with the production of the oncometabolite D-2-hydroxyglutarate (2-HG). Although both induce the 2-HG production, the R172 mutation generates greater amount of oncometabolite, has fewer co-occurrences with other genetic alterations and is associated with worse chemotherapy response and higher relapse risk. Research models have made possible to study the role of genetic mutations in disease development. Despite this progress, new models with endogenous expression of these mutations are needed to study in depth the molecular pathways involved. Therefore, in this Thesis we have developed new gene editing strategies using the CRISPR/Cas9 system with the aim of developing new in vitro and in vivo models of mutations involved in AML. Regarding in vitro model, due to the low transfection efficiency of CRISPR plasmids in leukemic cell lines, the most commonly method used for introducing CRISPR elements have been mainly lentiviral vectors. To avoid the disadvantages of this type of vectors, in this Thesis we have developed an alternative strategy for introducing Cas9 nuclease and CRISPR guides. The gene encoding the Cas9 was introduced into NB4 genome by lentiviral transduction producing a stable cell line that constitutively express the nuclease. On the other hand, a simple system for the production of CRISPR guides by PCR with essential elements of expression was developed and with GFP reporter expression optionally. In order to optimise the technique and test its efficiency in different targets, two genes involved in AML were modified. These were IDH2 gene, in which R172 mutation was introduced, and MYBL2 gene. Finally, editing efficiencies obtained with the new strategy were compared with CRISPR ribonucleoproteins methodology, widely used for its high efficiency. Whereas ribonucleoprotein complexes showed higher cut efficiencies, the efficiency of edition of R172 mutation efficiency was similar in both strategies. These results were validated and characterized by means of next generation sequencing, and no off-target effects were found. Therefore, the new developed methodology allows precise gene editing in leukemic cell lines with similar efficiencies with other popular CRISPR techniques and without off-target effects. On the other hand, thanks to the high evolutive conservation of IDH2 gene R140 and R172 residues are conserved in Caenorhabditis elegans idh-2 protein. The co-CRISPR strategy was used to produce and select mutant strains with ortholog mutations to R140, R172 and one strain with both mutations. Despite the high conservation, the expected increase in oncometabolite 2-HG concentration was not detected in mutant strains compared to the N2 wild type strain. A comprehensive study of the pathways involved would help us to develop a research model with molecular alterations noticed in patients. In conclusion, the new developed strategy for CRISPR elements introduction in cell lines, together with C. elegans models, will allow an in-depth research of molecular effect of mutations detected in patients, its implication in AML progression and prognosis and understand their role in patient stratification. / González Romero, E. (2022). Investigación de la Leucemia Mieloide Aguda mediante el desarrollo de modelos in vitro e in vivo [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/181891

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La 1-β-D-arabinofuranosylcytosine (ara-C) demeure l’agent anticancéreux principalement utilisé dans le traitement de la leucémie myéloblastique aiguë (LMA), malgré sa dégradation et son élimination rapide après une administration parentérale. Son encapsulation dans des vecteurs pharmaceutiques, majoritairement des liposomes, a permis de surmonter ces inconvénients. L’objectif général de ce projet de doctorat était de développer deux systèmes à libération prolongée, à base de phospholipides, de cholestérol et de poly(éthylène glycol) (PEG) afin d’encapsuler l’ara-C et ultimement, d’améliorer son efficacité dans le traitement de la LMA. Des Sphérulites® (vésicules multilamellaires d’un type particulier) ont d’abord été étudiées pour leur forte capacité d’encapsulation, due à leur mode de préparation. Par la suite, une formulation liposomale capable, d’une part de cibler spécifiquement les cellules leucémiques et, d’autre part, de promouvoir la libération intracellulaire de l’ara-C grâce à sa sensibilité au pH, a été mise au point. Les deux formulations se devaient d’avoir un faible diamètre, une stabilité en présence de fluides biologiques et des temps de circulation prolongés chez l’animal. Une préparation de Sphérulites®, composée de Phospholipon 90G, de Solutol HS15 et de cholestérol, a permis d’obtenir des vésicules de 300 nm de diamètre. Un dérivé lipidique de PEG a pu être fixé à leur surface, sans modifier la disposition concentrique des lamelles, ni changer leur stabilité. Les Sphérulites® PEGylées ont été chargées d’ara-C et injectées chez le rat par la voie intraveineuse. Elles ont démontré des temps de circulation significativement prolongés comparativement aux Sphérulites® sans PEG. Cependant, l’ara-C s’est retrouvée éliminée de la circulation sanguine très rapidement, révélant une libération précoce du principe actif à partir de ces vésicules. Les liposomes sensibles au pH (~150 nm) ont été obtenus suite à l’insertion d’un copolymère à base de dioctadécyle, de N-isopropylacrylamide (NIPAM) et d’acide méthacrylique. L’anticorps anti-CD33, soit complet soit son fragment Fab’, a été fixé à la surface des liposomes afin de cibler les cellules leucémiques. Les essais in vitro ont démontré la spécificité de la formulation pour différentes cellules leucémiques (CD33+), sa stabilité en présence de protéines plasmatiques et la libération intracellulaire d’un marqueur fluorescent et de l’ara-C. Enfin, des études menées chez la souris saine et immunodéprimée inoculée de cellules HL60 ont montré que la formulation exposant le fragment Fab’ possédait un profil pharmacocinétique et une biodistribution semblables à ceux des liposomes contrôles non-ciblés. L’encapsulation de l’ara-C a permis d’améliorer grandement ses temps de circulation après une administration intraveineuse. Cependant, bien que les immunoliposomes ont permis de prolonger la survie des souris leucémiques comparativement à l’ara-C libre, l’addition du polymère sensible au pH n’a pas permis d’apporter de réel avantage à la formulation lorsque administrée in vivo. Les résultats obtenus dans ce travail de thèse ont, dans un premier temps, mis en évidence que les Sphérulites® pourraient s’avérer utiles dans la vectorisation d’agents anticancéreux si leur capacité à retenir le principe actif in vivo était améliorée. Dans un second temps, les données présentées avec les immunoliposomes suggèrent qu’ils pourraient apporter un bénéfice notable dans le traitement de la LMA. / Despite its rapid degradation and fast elimination in vivo, 1-β-D-arabinofuranosylcytosine (ara-C) is the main anticancer agent used in the treatment of acute myeloid leukemia (AML). The encapsulation of this drug into nanocarriers such as liposomes has been shown to improve its stability, pharmacokinetic profile and, consequently, the treatment efficacy. The purpose of this doctoral work was to develop two nanocarriers employing phospholipids, cholesterol and poly(ethylene glycol) (PEG) to encapsulate ara-C, with the ultimate goal of developing more efficient treatments for AML. The first formulation relied on Spherulites®, which are multilamellar vesicles possessing high entrapment yields due to their fabrication method. In a second part, pH-sensitive immunoliposomes were optimized to target specifically the leukemia cells and promote the release of the loaded ara-C at the desired intracellular site. Both formulations required a small diameter, stability in the presence of biological fluids and long circulation time properties when injected intravenously. An optimized formulation of Spherulites® was developed. It was composed of Phospholipon 90G, Solutol HS15 and cholesterol. The vesicles (300 nm) were able to accommodate PEG-lipid derivatives at their surface without altering their concentric lamellar shape and their in vitro stability. The PEGylated Spherulites® were loaded with ara-C and injected intravenously into rats. The surface-modified vesicles exhibited longer circulation times compared to uncoated Spherulites®. However, most of the loaded-drug was cleared from the systemic circulation very rapidly, reflecting rapid leakage of ara-C from the vesicles. The pH-sensitive immunoliposomes (~150 nm) were obtained by including a terminally-alkylated copolymer made of dioctadecyl, N-isopropylacrylamide (NIPAM) and methacrylic acid in the liposome bilayer. The whole monoclonal antibody anti-CD33 or its Fab’ fragment were grafted on liposomes to target leukemic cells. In vitro assays revealed that this formulation was really specific for the various CD33+ leukemic cell lines, stable in presence of blood proteins, and able to promote the intracellular release of an encapsulated fluorescent probe as well as ara-C. In vivo studies in naïve Balb/c and immunodeprimed (SCID) mice inoculated with HL60 cells confirmed that the anti-CD33 Fab’ targeted formulation possessed pharmacokinetic and biodistribution profiles similar to those of the non-targeted liposomes. The encapsulation of ara-C in this formulation improved substantially its circulation time after intravenous injection. However, although ara-C-loaded immunoliposomes were able to prolong the survival of leukemic mice compared to the free drug, the addition of pH-sensitive polymer did not add any benefit to the formulation. Although these formulations require some optimization, the first part of this work pointed out that Spherulites® could be used to deliver anticancer agents provided that leakage is reduced in vivo. On the other hand, the data obtained with the targeted immunoliposomes suggest that these carriers could be beneficial in the treatment of AML.

Hematooncological diseases are often accompanied by dietary restriction, especially in cytotoxic therapy. The main purpose of the work was to assess the effect of high-dose chemotherapy on the change of nutritional status in two groups of hematooncological patients. A total of 16 patients were enrolled. Changes of the body composition were evaluated using bioelectrical impedance analysis supplemented by monitoring of biochemical nutritional indicators. Observations showed that in both groups the majority lost weight. In the first group of eight patients with acute myeloid leukemia observed during three consecutive hospitalizations, the median of change of body weight was -3.7 kg (-4.3%). Loss of lean body mass with a median value of -4.8 kg (-7.2%) was detected at all patients. Body fat was reduced at half of the patients. In some cases, with length of observation, there was an increase in fat mass along with visceral fat. In the second group, which included eight patients (after autologous hematopoietic stem cell transplantation) at whom one hospitalization was evaluated, body weight was reduced at six patients. The medianof change of body weight was -2.1 kg (-2.3%). At five patients, the treatment representeda loss of active metabolic mass. The change of the weight of the lean body mass was shown...

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Indiana University-Purdue University Indianapolis (IUPUI) / Gain-of-function mutations in the KIT receptor tyrosine kinase have been associated with highly malignant human neoplasms. In particular, an acquired somatic mutation at codon 816 in the second catalytic domain of KIT involving an aspartic acid to valine substitution is found in patients with systemic mastocytosis (SM) and acute myeloid leukemia (AML). The presence of this mutation in SM and AML is associated with poor prognosis and overall survival. This mutation changes the conformation of the KIT receptor resulting in altered substrate recognition and constitutive tyrosine autophosphorylation leading to constitutive ligand independent growth. As there are currently no efficacious therapeutic agents against this mutation, this study sought to define novel therapeutic targets that contribute to aberrant signaling downstream from KITD816V that promote transformation of primary hematopoietic stem/progenitor cells in diseases such as AML and SM. This study shows that oncogenic KITD814V (murine homolog) induced myeloproliferative neoplasms (MPN) occurs in the absence of ligand stimulation, and that intracellular tyrosines are important for KITD814V-induced MPN. Among the seven intracellular tyrosines examined, tyrosine 719 alone has a unique role in regulating KITD814V-induced proliferation and survival. Residue tyrosine 719 is vital for activation of the regulatory subunit of phosphatidylinositol 3-kinase (PI3K), p85α, downstream from KITD814V. Downstream effectors of the PI3K signaling pathway, in of leukemic cells bearing KITD814V with an allosteric inhibitor of Pak or its genetic inactivation results in growth repression due to enhanced apoptosis. To assess the role of Rac GEFs in KITD814V induced transformation, EHop-016, an inhibitor of Rac, was used to specifically target Vav1, and found to be a potent inhibitor of human and murine leukemic cell growth. In vivo, the inhibition of Vav or Rac or Pak delayed the onset of MPN and rescued the associated pathology in mice. These studies provide insight on mechanisms and potential novel therapeutic targets for hematological malignancies harboring an oncogenic KIT mutation.

This work presents the results ofour research of cell-free nucleic acids (cfNA). The first part shows changes in methylation patterns of immune response genes promoters that are detectable in plasma during the hemodialysis sessions and also differences in methylation between patients and healthy subjects. Alterations include genes that play their role in the regulation of hematopoiesis and these changes are in close relation with the need of anemia therapy. In the other plasma cfNA study we detected miRNA signatures in patients with acute myeloid leukemia at diagnosis (6 highly abundant miRNAs found) and in remission achieved after standard chemotherapy (trend to n01malization, lower levels ofthese miRNAs). Another part of work presents data from the study of potential non-invasive biomarker of bladder cancer. The amounts of cfDNA in urine are higher in patients than in healthy subjects and there were found 5 down-regulated miRNAs. Simultaneously it was established set of 30 miRNAs that are constantly present in urine supematants independently on sex, age and healthy status of subjects. The last part presents analysis ofcell-free fetal DNA. We analyzed differences between a new quantification method - droplet digital PCR and real-time PCR which is used routinely nowadays. Slightly more precise was...