Monitoring treatment efficacy is a large area of cancer research as it can increase the effectiveness of therapy regimens. Diffusion weighted Magnetic Resonance imaging (DWI), allows assessment of tissue microstructure without exogenous contrast agents. In this thesis, two different DWI techniques were used to acquire data from acute myeloid leukemia cells undergoing apoptosis, and data was fitted to an analytical model of re- stricted diffusion. Results indicated a decrease in average restriction size from 6.4 to 2.7μm, and an increase in the restricted diffusion coefficient from 0.17 to 0.82μm^2/ms in untreated versus treated cells. The free diffusion coefficient was constant indicating changes in restrictions, rather than any intrinsic changes in the intra-cellular or extra- cellular fluid. This combination of techniques has the potential for use in preclinical and clinical settings as it demonstrates that apoptotic changes may be measured consistently.

Monitoring treatment efficacy is a large area of cancer research as it can increase the effectiveness of therapy regimens. Diffusion weighted Magnetic Resonance imaging (DWI), allows assessment of tissue microstructure without exogenous contrast agents. In this thesis, two different DWI techniques were used to acquire data from acute myeloid leukemia cells undergoing apoptosis, and data was fitted to an analytical model of re- stricted diffusion. Results indicated a decrease in average restriction size from 6.4 to 2.7μm, and an increase in the restricted diffusion coefficient from 0.17 to 0.82μm^2/ms in untreated versus treated cells. The free diffusion coefficient was constant indicating changes in restrictions, rather than any intrinsic changes in the intra-cellular or extra- cellular fluid. This combination of techniques has the potential for use in preclinical and clinical settings as it demonstrates that apoptotic changes may be measured consistently.

Acute myeloid leukemia (AML) is a life-threatening malignant disorder with dismal prognosis. AML is characterized by frequent genetic changes involving tyrosine kinases, normally acting as important mediators in many basic cellular processes. Due to the overexpression and frequent mutations of the FMS-like receptor tyrosine kinase 3 (FLT3) in AML, this tyrosine kinase receptor has become one of the most sought after targets in AML drug development. In this thesis, we have used a combination of high-throughput screens, direct target interaction assays and sequential cellular screens, including primary patient samples, as an approach to discover new targeted therapies. Gefitinib, a previously known inhibitor of epidermal growth factor receptor and the two novel tyrosine kinase inhibitors AKN-032 and AKN-028, have been identified as compounds with cytotoxic activity in AML. AKN-028 is a potent inhibitor of FLT3 with an IC50 value of 6 nM in an enzyme assay, but also displaying in vitro activity in a variety of primary AML samples, irrespective of FLT3 mutation status or quantitative FLT3 expression. AKN-028 shows a sequence dependent in vitro synergy when combined with standard cytotoxic agents cytarabine or daunorubicin, with better efficacy when cells are exposed to standard chemotherapy simultaneously or for 24 hours prior to adding AKN-028. Antagonism is observed when cells are pre-treated with AKN-028, possibly explained by the cell cycle arrest induced by the compound. In vivo cytotoxic activity and good oral bioavailability have made AKN-028 a candidate drug for clinical studies and the compound is presently investigated in an international two-part multicenter phase I/II study. Results from microarray studies performed to further elucidate the mechanism of action of AKN-028, revealed significantly altered gene expression induced by AKN-028 in both AML cell lines and in primary AML cells, with an enrichment of the Myc pathway among the downregulated genes. Furthermore, tyrosine kinase activity profiling shows a dose-dependent kinase inhibition by AKN-028 in all AML samples tested. Interestingly, cells with a high overall kinase activity were more sensitive to AKN-028. Provided conformation in a larger set of samples, kinase activity profiling may give useful information in individualizing treatment of patients with AML.

A leucemia mielóide aguda (LMA) acomete pacientes de todas as faixas etárias com freqüência aumentada em idosos. Nosso estado não apresenta registros sistemáticos da patologia, justificando-se desta forma o levantamento através dos centros de diagnóstico e tratamento, os quais concentram a maioria dos casos. Foram incluídos todos os pacientes com diagnóstico de LMA “de novo” levantados a partir dos registros dos centros de diagnóstico e tratamento da patologia no estado no período entre 1996 e 2000. Foram computados no período 532 pacientes (taxa estimada de 1,04 casos / 100.000 habitantes / ano). A idade média ao diagnóstico foi 41,0 anos e 46,6 % dos casos eram do sexo masculino. Houve distribuição semelhante nas 7 mesorregiões geográficas do estado. Em relação ao número de casos por faixa etária, observou-se uma taxa estimada em 0,5 – 1 caso / 100.000 habitantes até a faixa etária dos 45 anos, atingindo 3,5 casos / 100.000 habitantes na faixa etária igual ou superior a 70 anos. A sobrevida média considerando todos os casos foi de 17%, aumentando para 25% considerando a população abaixo de 60 anos e alcançando 40% na população entre 10 e 20 anos. Tais dados evidenciam uma distribuição semelhante por região, estimativa de incidência na faixa infantil semelhante a países desenvolvidos e bastante menor na população idosa. A mortalidade geral foi semelhante àquela relatada na literatura. / Acute myeloid leukemia (AML) affects patients in all age groups, but it is more frequent among elderly people. The state of Rio Grande do Sul does not have systematic data on AML; thus these data have to be collected from hospitals or centers where the disease is diagnosed and treated. Patients with de novo acute myeloid leukemia were included based on the information retrieved from hospital registries between 1996 and 2000. At the time, 532 patients had been registered (estimated rate of 1.04 cases per 100,000 inhabitants / year). Mean age at diagnosis was 41.0 years, and 46.6% of the patients were male. Cases were similarly distributed across the seven meso-regions of Rio Grande do Sul. There was an estimated incidence of 0.5 to 1 case per 100,000 inhabitants up to the age of 45 years, and of 3.5 cases per 100,000 inhabitants for individuals aged 70 years and older. The mean five-year survival rate was 17% for all cases, 25% for patients under the age of 60 years, and 40% for those aged between 10 and 20 years. There was a similar distribution of AML cases per region, an incidence rate in the pediatric population similar to that of developed countries, and a much lower incidence among elderly patients. Overall mortality was comparable to that reported in the literature.

The 21st Century has seen a rise in incidence of complex diseases such as cancer and in the quest to develop essential new therapeutic options, the study of drug-cell interactions can yield powerful information. Acute myeloid leukaemia (AML) is an aggressive cancer that causes life-threatening deficits of functional blood cells in humans for which current treatment options are highly toxic and often poorly tolerated. A combination of two existing drugs, bezafibrate and medroxyprogesterone acetate in a drug redeployment situation has shown promise in vitro and in vivo and further investigations are crucial to elucidate the mode of action of this treatment. This project investigated the mechanistic action of BaP at a cellular level. Orthogonal spectroscopic and mass spectrometric platforms were employed to probe the biochemical composition of two AML cell lines, HL60 and K562 in the presence and absence of this combined drug treatment. Analysis was performed on single living cells, dehydrated cells, fixed cells and cell extracts to give a large and detailed data set. A consideration of the main spectral differences obtained by Synchrotron-FTIR and ATR-FTIR in conjunction with multivariate statistical analysis revealed a significant change to the cellular lipid composition with drug treatment; furthermore, this response was not caused by cell apoptosis. In particular, the ratio of CH2:CH3 was observed to increase with BaP treatment and this was determined to be a significant change in both cell lines (p <0.05). An overall increase in lipid unsaturation suggests that BaP targets cellular lipid biosynthesis. Raman microspectroscopy added a further dimension to the spectroscopic study by providing spatial information of lipid distribution which suggested that BaP-induced saturation change is uniform across a single cell. UHPLC-MS was employed for global metabolomics analysis of AML cell extracts and revealed a number of biochemical pathways that were indicated as targets of BaP therapy in both cell lines. Univariate and multivariate analysis determined statistically significant metabolites for which putative identifications were made. Pyrimidine metabolism was the most significant pathway identified for changes consistent in both HL60 and K562 cell lines. The complementarity of ToF-SIMS and UHPLC-MS provided large coverage of the lipidome of AML cells through untargeted and targeted approaches. For data derived by both techniques, a general increase in polyunsaturated species for BaP treated cell extracts was observed which correlated well with findings from spectroscopic investigations. Adopting a multi-disciplinary approach to cell analysis can afford a powerful insight into understanding drug mode of action at a cellular level and novel information regarding BaP mechanistic action in AML cell lines was revealed. This analytical approach could be extended to the future study of drug-cell interactions for other oncological systems.

A leucemia mielóide aguda (LMA) acomete pacientes de todas as faixas etárias com freqüência aumentada em idosos. Nosso estado não apresenta registros sistemáticos da patologia, justificando-se desta forma o levantamento através dos centros de diagnóstico e tratamento, os quais concentram a maioria dos casos. Foram incluídos todos os pacientes com diagnóstico de LMA “de novo” levantados a partir dos registros dos centros de diagnóstico e tratamento da patologia no estado no período entre 1996 e 2000. Foram computados no período 532 pacientes (taxa estimada de 1,04 casos / 100.000 habitantes / ano). A idade média ao diagnóstico foi 41,0 anos e 46,6 % dos casos eram do sexo masculino. Houve distribuição semelhante nas 7 mesorregiões geográficas do estado. Em relação ao número de casos por faixa etária, observou-se uma taxa estimada em 0,5 – 1 caso / 100.000 habitantes até a faixa etária dos 45 anos, atingindo 3,5 casos / 100.000 habitantes na faixa etária igual ou superior a 70 anos. A sobrevida média considerando todos os casos foi de 17%, aumentando para 25% considerando a população abaixo de 60 anos e alcançando 40% na população entre 10 e 20 anos. Tais dados evidenciam uma distribuição semelhante por região, estimativa de incidência na faixa infantil semelhante a países desenvolvidos e bastante menor na população idosa. A mortalidade geral foi semelhante àquela relatada na literatura. / Acute myeloid leukemia (AML) affects patients in all age groups, but it is more frequent among elderly people. The state of Rio Grande do Sul does not have systematic data on AML; thus these data have to be collected from hospitals or centers where the disease is diagnosed and treated. Patients with de novo acute myeloid leukemia were included based on the information retrieved from hospital registries between 1996 and 2000. At the time, 532 patients had been registered (estimated rate of 1.04 cases per 100,000 inhabitants / year). Mean age at diagnosis was 41.0 years, and 46.6% of the patients were male. Cases were similarly distributed across the seven meso-regions of Rio Grande do Sul. There was an estimated incidence of 0.5 to 1 case per 100,000 inhabitants up to the age of 45 years, and of 3.5 cases per 100,000 inhabitants for individuals aged 70 years and older. The mean five-year survival rate was 17% for all cases, 25% for patients under the age of 60 years, and 40% for those aged between 10 and 20 years. There was a similar distribution of AML cases per region, an incidence rate in the pediatric population similar to that of developed countries, and a much lower incidence among elderly patients. Overall mortality was comparable to that reported in the literature.

abstract: Acute Myeloid Leukemia (AML) is a disease that occurs when genomic changes alter expression of key genes in myeloid blood cells. These changes cause them to resume an undifferentiated state, proliferate, and maintain growth throughout the body. AML is commonly treated with chemotherapy, but recent efforts to reduce therapy toxicity have focused on drugs that specifically target and inhibit protein products of the cancer’s aberrantly expressed genes. This method has proved difficult for some proteins because of structural challenges or mutations that confer resistance to therapy. One potential method of targeted therapy that circumvents these issues is the use of small molecules that stabilize DNA secondary structures called G-quadruplexes. G-quadruplexes are present in the promoter region of many potential oncogenes and have regulatory roles in their transcription. This study analyzes the therapeutic potential of the compound GQC-05 in AML. This compound was shown in vitro to bind and stabilize the regulatory G-quadruplex in the MYC oncogene, which is commonly misregulated in AML. Through qPCR and western blot analysis, a GQC-05 mediated downregulation of MYC mRNA and protein was observed in AML cell lines with high MYC expression. In addition, GQC-05 is able to reduce cell viability through induction of apoptosis in sensitive AML cell lines. Concurrent treatment of AML cell lines with GQC-05 and the MYC inhibitor (+)JQ1 showed an antagonistic effect, indicating potential competition in the silencing of MYC. However, GQC-05 is not able to reduce MYC expression significantly enough to induce apoptosis in less sensitive AML cell lines. This resistance may be due to the cells’ lack of dependence on other potential GQC-05 targets that may help upregulate MYC or stabilize its protein product. Three such genes identified by RNA-seq analysis of GQC-05 treated cells are NOTCH1, PIM1, and RHOU. These results indicate that the use of small molecules to target the MYC promoter G-quadruplex is a viable potential therapy for AML. They also support a novel mechanism for targeting other potentially key genetic drivers in AML and lay the groundwork for advances in treatment of other cancers driven by G-quadruplex regulated oncogenes. / Dissertation/Thesis / Masters Thesis Molecular and Cellular Biology 2017

A leucemia mielóide aguda (LMA) acomete pacientes de todas as faixas etárias com freqüência aumentada em idosos. Nosso estado não apresenta registros sistemáticos da patologia, justificando-se desta forma o levantamento através dos centros de diagnóstico e tratamento, os quais concentram a maioria dos casos. Foram incluídos todos os pacientes com diagnóstico de LMA “de novo” levantados a partir dos registros dos centros de diagnóstico e tratamento da patologia no estado no período entre 1996 e 2000. Foram computados no período 532 pacientes (taxa estimada de 1,04 casos / 100.000 habitantes / ano). A idade média ao diagnóstico foi 41,0 anos e 46,6 % dos casos eram do sexo masculino. Houve distribuição semelhante nas 7 mesorregiões geográficas do estado. Em relação ao número de casos por faixa etária, observou-se uma taxa estimada em 0,5 – 1 caso / 100.000 habitantes até a faixa etária dos 45 anos, atingindo 3,5 casos / 100.000 habitantes na faixa etária igual ou superior a 70 anos. A sobrevida média considerando todos os casos foi de 17%, aumentando para 25% considerando a população abaixo de 60 anos e alcançando 40% na população entre 10 e 20 anos. Tais dados evidenciam uma distribuição semelhante por região, estimativa de incidência na faixa infantil semelhante a países desenvolvidos e bastante menor na população idosa. A mortalidade geral foi semelhante àquela relatada na literatura. / Acute myeloid leukemia (AML) affects patients in all age groups, but it is more frequent among elderly people. The state of Rio Grande do Sul does not have systematic data on AML; thus these data have to be collected from hospitals or centers where the disease is diagnosed and treated. Patients with de novo acute myeloid leukemia were included based on the information retrieved from hospital registries between 1996 and 2000. At the time, 532 patients had been registered (estimated rate of 1.04 cases per 100,000 inhabitants / year). Mean age at diagnosis was 41.0 years, and 46.6% of the patients were male. Cases were similarly distributed across the seven meso-regions of Rio Grande do Sul. There was an estimated incidence of 0.5 to 1 case per 100,000 inhabitants up to the age of 45 years, and of 3.5 cases per 100,000 inhabitants for individuals aged 70 years and older. The mean five-year survival rate was 17% for all cases, 25% for patients under the age of 60 years, and 40% for those aged between 10 and 20 years. There was a similar distribution of AML cases per region, an incidence rate in the pediatric population similar to that of developed countries, and a much lower incidence among elderly patients. Overall mortality was comparable to that reported in the literature.

Orientador: Fabíola Traina / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T22:39:22Z (GMT). No. of bitstreams: 1 Scopim-Ribeiro_Renata_M.pdf: 3643524 bytes, checksum: fec865c6ccea452efda050e40c6f1aa1 (MD5) Previous issue date: 2014 / Resumo: As neoplasias mieloides compreendem um grupo heterogêneo de doenças hematológicas que se originam de um precursor mieloide comum, em diferentes fases de diferenciação. As alterações celulares que levam ao desenvolvimento de neoplasias podem ocorrer através de mecanismos epigenéticos ou de alterações genéticas. DNMT3A codifica metiltransferases que adicionam grupamentos metil a resíduos de citosina do DNA e TET2 promove a hidroxilação da citosina metilada, o que os caracteriza como elementos importantes no controle epigenético. DNMT3A e TET2 encontram-se frequentemente mutados em neoplasias mieloides, mas o impacto prognóstico destas mutações ainda é controverso. A consequência funcional da mutação de DNMT3A em neoplasias mieloides ainda não foi definida, mas o silenciamento da proteína em células progenitoras murinas favorece a autorrenovação e compromete a diferenciação celular. A mutação de TET2 tem como consequência a perda de função do gene e participa da transformação neoplásica das células mieloides, favorecendo a proliferação da série mielomonocítica. Entretanto, a expressão de TET2 e DNMT3A nestas doenças ainda é pouco elucidada. Assim, os objetivos deste estudo foram (1) investigar a expressão de TET2 e DNMT3A em células hematopoéticas de indivíduos normais e pacientes com síndrome mielodisplásica (SMD) e leucemia mieloide aguda (LMA), (2) correlacionar a expressão de TET2 e DNMT3A com o fenótipo clínico e sobrevida de pacientes com SMD; (3) investigar a expressão de TET2 e DNMT3A durante a diferenciação celular hematopoética e (4) avaliar o efeito do silenciamento de DNMT3A no fenótipo de linhagens celulares leucêmicas. No presente estudo, verificamos redução na expressão de TET2 em células provenientes de pacientes com SMD e LMA quando comparada à expressão em controles normais (p<.001), e redução em SMD alto risco quando comparada à SMD baixo risco (p=.02). Os resultados em amostras sequenciais de cinco pacientes com SMD indicaram redução da expressão de TET2 no momento da progressão da doença. A análise univariada evidenciou que fatores clínicos tiveram impacto tanto na sobrevida livre de evento como sobrevida global, incluindo a classificação de risco pela OMS 2008 (alto vs. baixo, p<.0001), IPSS (int-2/alto vs. baixo/int-1, p<.0001), hemoglobina (<10 vs. ? 10, p<.05), contagem de leucócitos (< 3 vs. ? 3 x109/L, p<.05), contagem absoluta de neutrófilos (< 1.5 vs. ? 1.5, p<.05) e porcentagem de blastos na medula óssea (? 5 vs. <5 ou ? 10 vs. <10, p<.0004). Além disso, a baixa expressão de TET2 teve impacto negativo na sobrevida livre de evento (HR: 6.51 [2.42-17.49], p=.0002) e na sobrevida global (HR: 7.25 [2.77-18.99], p<.0001). A análise multivariada indicou que a baixa expressão de TET2 (p <.0001), IPSS alto/intermediate-2 (p <.0001), e hemoglobina <10 g/dL (P<.03) são fatores prognósticos para menor sobrevida livre de evento e sobrevida global. Durante a diferenciação eritroide de células CD34+ de indivíduos normais e pacientes com SMD, observamos um aumento significativo da expressão de TET2 (p=. 03). Na avaliação da diferenciação celular de linhagens leucêmicas, observamos aumento significativo na expressão de TET2 durante as diferenciações granulocítica (p=.04) e megacariocítica (p=.03); e um aumento não significativo durante a diferenciação eritrocítica. A expressão de DNMT3A foi semelhante entre pacientes com LMA, SMD e controles normais, e não teve impacto significativo na sobrevida dos pacientes com SMD. A expressão de DNMT3A não foi modulada durante a diferenciação eritroide de células CD34+ de indivíduos normais e pacientes com SMD. Nos modelos de diferenciação celular de linhagens leucêmicas, observamos aumento significativo da expressão de DNMT3A durante a diferenciação granulocítica, mas não durante a diferenciação eritrocítica e megacariocítica. A redução na expressão de DNMT3A não resultou em alteração significativa na apoptose, na proliferação e no ciclo celular em linhagens leucêmicas HL60 e U937. A expressão gênica e proteica de PTEN não foi modulada em células leucêmicas submetidas à inibição de DNMT3A. Os achados aqui descritos sugerem que, similarmente à presença de mutação no TET2, a baixa expressão de TET2 pode participar do processo de transformação celular em SMD de alto risco e LMA; estudos clínicos deveriam considerar a investigação da expressão gênica de TET2 em conjunto com a pesquisa de mutação TET2 na definição de prognóstico. Os resultados de expressão e função de DNMT3A sugerem que a mutação, e não a expressão, deva ser o principal mecanismo pelo qual o DNMT3A participa da transformação neoplásica e que a função de DNMT3A pode depender da linhagem celular estudada / Abstract: Myeloid neoplasms comprise a heterogeneous group of hematologic malignancies that originate from a common myeloid precursor at different stages of differentiation. Cellular changes that lead to development of malignancies may occur through epigenetic mechanisms or genetic alterations. DNMT3A encodes methyltransferases that add methyl groups to cytosine residues in DNA, TET2 promotes hydroxylation of methylated cytosine, and both proteins are important elements in epigenetic control. TET2 and DNMT3A are recurrently mutated in myeloid malignancies, but the prognostic consequence of TET2 and DNMT3A mutation is still controversial. The functional consequences of DNMT3A mutation has not been defined, but the protein silencing in murine progenitor cells promotes self-renewal and reduces cell differentiation. TET2 mutation results in loss of function and participates in the neoplastic transformation of myeloid cells, favoring the proliferation of granulomonocytic cells. However, the expression of TET2 and DNMT3A in these diseases has been rarely addressed. Then, the aims of this study were (1) to evaluate TET2 and DNMT3A gene expression in hematopoietic cells from healthy individuals and from patients with myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML); (2) to correlate TET2 and DNMT3A expression with clinical phenotype and outcomes of MDS patients; (3) to investigate TET2 and DNMT3A expression during hematopoietic cell differentiation; and (4) to evaluate the effect of DNMT3A silencing in the phenotype of leukemia cell lines. In this study, the expression of TET2 was decreased in cells from patients with MDS and AML compared to healthy donors (p<.001) and reduced high-risk MDS compared to low risk MDS (p=.02). The results in sequential samples from five patients with MDS indicate reduced expression of TET2 at the time of disease progression. By univariate analysis, clinical factors that significantly affected both event free survival (EFS) and overall survival (OS) included risk stratification by WHO 2008 (high vs. low, p<.0001), IPSS (int-2/high vs. low/int-1, p <.0001), hemoglobin (<10 vs. ? 10, p<.05), white blood cell counts (< 3 vs. ? 3 x109/L, p<.05), absolute neutrophil counts (< 1.5 vs. ? 1.5, p<.05) and bone marrow blast percentage (? 5 vs. <5 or ? 10 vs. <10, p<.0004). Furthermore, low TET2 expression negatively impacted both EFS (HR: 6.51 [2.42-17.49], p=.0002) and OS (HR: 7.25 [2.77-18.99], p<.0001). Multivariate analyses indicated that low TET2 expression (p <.0001), along with IPSS high/intermediate-2 risk group (p <.0001), and hemoglobin <10 g/dL (p<.03) were independently prognostic for worse EFS and OS. During erythroid differentiation of CD34+ cells from normal individuals and patients with low-risk MDS, we observed an increased expression of TET2 (p=.03). During cell differentiation of leukemic cell lines, we observed a significantly increase in the expression of TET2 during granulocytic and megakaryocytic differentiation (p=.04 and p=.03, respectively); there was also an increased expression during erythrocytic differentiation, but this was not statistically significant. The expression of DNMT3A was similar between patients with AML, MDS and healthy donors, and it did not impact survival outcomes in MDS patients. DNMT3A expression was not modulated during erythroid differentiation of CD34+ cells from normal individuals and patients with MDS. In leukemic cell lines models of differentiation, we observed a significantly increase in the DNMT3A expression during granulocytic differentiation, but not in erythrocytic and megakaryocytic differentiation. The DNMT3A silencing did not result in significant changes in apoptosis, proliferation and cell cycle in leukemic cell lines HL60 and U937. PTEN gene and protein expression was not modulated in leukemic cell lines submitted to inhibition of DNMT3A. The findings reported here suggest that, similarly to the presence of TET2 mutations, the low expression of TET2 can participate in the process of cell transformation in high risk MDS and AML. Clinical studies should consider the investigation of TET2 expression together with the studies of TET2 mutation to defining prognosis. Our results of expression and function suggest that DNMT3A mutation, instead of the expression, should be the main mechanism by which DNMT3A participates in neoplastic transformation and that DNMT3A function may vary according to the cell line studied / Mestrado / Clinica Medica / Mestra em Ciências

Orientadores: Irene Lorand-Metze, Fernando Ferreira Costa / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-18T22:11:55Z (GMT). No. of bitstreams: 1 Mello_MarianaRezendeBandeirade_D.pdf: 5178635 bytes, checksum: 8ac6a3134a752be699d5f1d5d6d8ba71 (MD5) Previous issue date: 2011 / Resumo: A classificação atual da OMS para LMA reconhece a importância da pesquisa de anormalidades genéticas para diagnóstico e manejo adequado do paciente. A textura da cromatina dos núcleos está relacionada com fenômenos epigenéticos como a metilação. Nosso estudo teve como objetivos estudar o status de metilação dos genes CDKN2B (p15), CDKN2A (p16), CDKN1C (p57), TP73 (p73), ESR1 (ER) e ABCB1 (MDR1), verificar a freqüência das mutações nos genes FLT3 e NPM1 e analisar parâmetros da morfometria e textura da cromatina. Verificamos também a associação entre o perfil imunofenotípico, textura nuclear e características moleculares. Além disso, analisamos a relação destas variáveis com a sobrevida global. Foram estudados 106 pacientes com LMA de novo (19 com LMA M3 e 87 com outros subtipos de LMA) diagnosticados no nosso Serviço. Nas LMAs M3 foi encontrado 15,8% de pacientes com FLT3-TKD e 10,5% FLT3-ITD. Os pacientes com LMA M3 foram mais jovens, apresentaram menor número de leucócitos e plaquetas. Tiveram também maior expressão de CD45 e MPO do que os outros subtipos de LMA. Os pacientes com LMA M3 tiveram melhor sobrevida que os outros subtipos. Dentre esses pacientes as LMA M3 FLT3-ITD+ apresentaram pior sobrevida. O desvio padrão do nível de cinza foi um fator independente de prognóstico. Em relação aos casos de LMA não M3 foi encontrado 23,3% dos pacientes com presença da mutação FLT3-ITD, 8,1% FLT3- TKD e 29,1% da mutação no gene NPM1. As mutações nos genes NPM1 e FLT3 foram mais frequente em pacientes com cariótipo normal. Dos pacientes com outros subtipos de LMA, 3,4% apresentaram metilação no gene ESR1, 26,4% no gene CDKN2B, 11,5% no gene CDKN2A, 1,1% no CDKN1C e 23,0% no gene TP73. Os pacientes que apresentaram o gene CDKN2B metilado tiveram menor dosagem de hemoglobina e expressão do CD13. Os pacientes com metilação no gene TP73 apresentaram menor contagem de leucócitos, expressão de CD45, CD13, CD33 e MPO. Os pacientes com LMA sem maturação apresentaram menor R245. Na análise de sobrevida dos pacientes com LMA, excluindo M3, os casos com NPM1+ FLT3-ITD- tiveram melhor sobrevida. O R245, a entropia e a mutação FLT3-ITD foram fatores independentes de prognóstico. A frequência das mutações e de metilação encontrada foram semelhantes a outros estudos. O R245 pode ser uma variável nova para avaliação da textura da cromatina / Abstract: The WHO classification for acute myeloid leukemia (AML) has emphacized the cytogenetic and molecular aspects for diagnosis and proper management of the patients. The nuclear chromatin texture is related to epigenetic phenomena such as methylation. In our study we examined the frequency of mutations in FLT3 and NPM1 genes, the methylation status of genes CDKN2B (p15), CDKN2A (p16), CDKN1C (p57), TP73 (p73), ESR1 (ER) and ABCB1 (MDR1) and analyzed features of nuclear morphometry and chromatin texture. We studied the association between the immunophenotypic profile, nuclear texture and molecular features. In addition, we analyzed the relationship between these variables and overall survival of the patients. We studied 106 patients with de novo AML: 19 with promyelocytic leukemia (APL) and 87 with other subtypes of AML diagnosed in our Service. Patients with APL were younger, had lower peripheral leukocyte counts and platelets. They also showed a higher expression of CD45 and MPO than other subtypes of AML. Among them, 15.8% presented FLT3-TKD and 10.5% showed FLT3- ITD. CDKN2B was methylated in 21.0%, CDKN2A in 21.0% and TP73 in 10.5% of the patients. Methylation in CDKN1C, ER and MDR1 were not found. Patients with APL had better survival than other subtypes. The standard deviation of gray level was an independent factor of prognosis. Among the other cases of AML, we found the FLT3-ITD mutation in 23.3%, the FLT3-TKD mutation in 8.1%, and 29.1% of the patients had mutation of the NPM1 gene. Mutations in NPM1 and FLT3 were more frequent in patients with a normal karyotype. Among these patients, 3.4% had methylation of the ESR1 gene, 26.4% in CDKN2B, 11.5% in CDKN2A, 1.1% in the CDKN1C and 23.0% in TP73. Patients with methylated CDKN2B showed lower hemoglobin levels and a lower expression of CD13. Patients with methylation in the TP73 gene had lower peripheral leukocyte counts and lower expression of CD45, CD13, CD33 and MPO. Patients with AML without maturation had lower R245. In the survival analysis of patients with AML, except APL, the cases with NPM1+ FLT3 ITD- had better survival. The R245, entropy and FLT3-ITD mutation were independent predictors of prognosis. The frequency of mutations and methylation found were similar with other studies. The R245 can be a new variable for evaluation of chromatin texture / Doutorado / Biologia Estrutural, Celular, Molecular e do Desenvolvimento / Doutor em Fisiopatologia Medica