Recentemente, a expressão gênica dos receptores TLR foi encontrada em diversos tipos de células tumorais. A sua participação na biologia do câncer é controversa já que foram descritas ações pró e anti-tumorais após a ativação de sua sinalização. Na Leucemia Mielóide Crônica (LMC) nada se tem demonstrado. BCR-ABL é uma oncoproteína quimérica cujo sítio tirosina quinasa constitutivamente ativado promove inúmeras vias de sinalizações que desencadeia a transformação celular. Este trabalho se inicia com a hipótese de existir uma relação entre o oncogene BCR-ABL e a expressão dos receptores TLRs. Nós verificamos em células murinas TonB210.1 com expressão de BCR-ABL induzível por doxiciclina que Tlr1 e Tlr2 tem sua expressão gênica relativa aumentada na presença da oncoproteína. A regulação positiva de Tlr1 é dependente da ação tirosina quinasa de BCR-ABL. Também mostramos que as vias p38 e JNK estão reprimindo a expressão de Tlr1 induzida por BCR-ABL enquanto que a via ERK é utilizada pelo BCR-ABL para promovê-la. Por outro lado, observamos que a ligação de TLR1/TLR2 com seu agonista sintético Pam3CSK4 em células TonB210.1 BCR-ABL positivas induz um aumento da produção de IL-6 e leva ao aumento da resistência a morte quando induzida pelas drogas Ara-C e VP16. Em conclusão, estes resultados indicam que BCR-ABL esta regulando a expressão gênica de alguns TLRs. Por tanto esses dados contribuem para a compreensão sobre o comportamento de células tumorais BCR-ABL positivas em um contexto de infecção e por conseqüência, dão margem ao estudo de novos alvos de fator de risco para a LMC. / Recently, the gene expression of TLR receptors have been described in several kinds of tumour cells. Its participation in cancer biology is controversial because roles were already been described in pro and anti-tumoral activities after their signaling activation. In Chronic Myeloid Leukemia (CML) there are no published data. BCR-ABL is a quimeric protein and its tyrosine-kinase site is activated constitutively. Thus, many signaling pathways are activated and several cell processes are altered thereby resulting in cellular transformation. This work has started with the hypothesis that a putative relationship between the oncogene BCR-ABL and the expression of TLR receptors could exists. We verified in murine cells TonB210.1 BCR-ABL expression inducible by doxycicline that Tlr1 and Tlr2 have their relative gene expression up-regulated in the presence of the oncoprotein. Therefore the Tlr1 regulation is dependent of BCR-ABL tyrosine kinase action. Using MAPK inhibitors we showed that p38 and JNK pathways are suppressing the TLR1 induction by BCR-ABL while ERK pathway is used by the oncoprotein for promote it. On the other hand, we observed in TonB210.1 BCR-ABL positive cells that the binding of TLR1/TLR2 heterodimer to their synthetic agonist Pam3CSK4 induced an increased production of IL-6 and when these cells were induced by Ara-C and VP-16 drugs the apoptosis resistance increased. In conclusion, these results indicate that the oncoprotein regulates the gene expression of some TLRs. Therefore, this fact gives us data about the behavior of BCR-ABL positive tumor cells in the context of infection and in consequence the study of new risk factor targets for CML.

The human Philadelphia chromosome (Ph) arises from a translocation between chromosomes 9 and 22 [t(9;22)(q34;q11)]. The resulting chimeric BCR-ABLoncogene encodes a constitutively activated, oncogenic tyrosine kinase that induces chronic myeloid leukemia (CML) and B-cell acute lymphoblastic leukemia (B-ALL). The BCR-ABL tyrosine kinase inhibitor (TKI), imatinib mesylate, induces a complete hematologic and cytogenetic response in the majority of CML patients, but is unable to completely eradicate BCR-ABL–expressing leukemic cells, suggesting that leukemia stem cells are not eliminated. Over time, patients frequently become drug resistant and develop progressive disease despite continued treatment. Two major reasons cause the imatinib resistance. The first one is the BCR-ABL kinase domain mutations which inhibit the interaction of BCR-ABL kinase domain with imatinib; the second one is the residual leukemia stem cells (LSCs) in the patients who are administrated with imatinib. To overcome these two major obstacles in CML treatment, new strategies need further investigation. As detailed in Chapter II, we evaluated the therapeutic effect of Hsp90 inhibition by using a novel water-soluble Hsp90 inhibitor, IPI-504, in our BCR-ABL retroviral transplantation mouse model. We found that BCR-ABL mutants relied more on the HSP90 function than WT BCR-ABL in CML. More interestingly, inhibition of HSP90 in CML leukemia stem cells with IPI-504 significantly decreases the survival and proliferation of CML leukemia stem cells in vitro and in vivo. Consistent with these findings, IPI-504 treatment achieved significant prolonged survival of CML and B-ALL mice. IPI-504 represents a novel therapeutic approach whereby inhibition of Hsp90 in CML patients and Ph+ ALL may significantly advance efforts to develop a cure for these diseases. The rationale underlying the use of IPI-504 for kinase inhibitor–resistant CML has implications for other cancers that display oncogene addiction to kinases that are Hsp90 client proteins. Although we proved that inhibition of Hsp90 could restrain LSCs in vitro and in vivo, it is still unclear how to define specific targets in LSCs and eradicate LSCs. In Chapter III, we took advantage of our CML mouse model and compared the global gene expression signature between normal HSCs and LSCs to identify the downregulation of Pten in CML LSCs. CML develops faster when Pten is deleted in Ptenfl/fl mice. On the other hand, Pten overexpression significantly delays the CML development and impairs leukemia stem cell function. mTOR is a major downstream of Pten-Akt pathway and it is always activated or overepxressed when Pten is mutated or deleted in human cancers. In our study, we found that inhibition of mTOR by rapamycin inhibited proliferation and induced apoptosis of LSCs. Notably, our study also confirmed a recent clinical report that Pten has been downregulated in human CML patient LSCs. In summary, our results proved the tumor suppressor role of Pten in CML mouse model. Although the mechanisms of Pten in leukemia stem cells still need further study, Pten and its downstream, such as Akt and mTOR, should be more attractive in LSCs study.

Longitudinal monitoring of BCR-ABL transcript levels in peripheral blood of CML patients treated with tyrosine kinase inhibitors (TKI) revealed a typical biphasic response. Although second generation TKIs like dasatinib proved more efficient in achieving molecular remission compared to first generation TKI imatinib, it is unclear how individual responses differ between the drugs and whether mechanisms of drug action can be deduced from the dynamic data. We use time courses from the DASISION trial to address statistical differences in the dynamic response between first line imatinib vs. dasatinib treatment cohorts and we analyze differences between the cohorts by fitting an established mathematical model of functional CML treatment to individual time courses. On average, dasatinib-treated patients show a steeper initial response, while the long-term response only marginally differed between the treatments. Supplementing each patient time course with a corresponding confidence region, we illustrate the consequences of the uncertainty estimate for the underlying mechanisms of CML remission. Our model suggests that the observed BCR-ABL dynamics may result from different, underlying stem cell dynamics. These results illustrate that the perception and description of CML treatment response as a dynamic process on the level of individual patients is a prerequisite for reliable patient-specific response predictions and treatment optimizations.

Inhibiting BCR-ABL kinase activity with tyrosine kinase inhibitors (TKIs) has been the frontline therapy for CML. Resistance to TKIs frequently occurs, but the mechanisms remain elusive. First, to uncover survival pathways involved in TKI resistance in CML, I conducted a genome-wide RNAi screen in human CML cells to identify genes governing cellular sensitivity to the first generation TKI called IM (Gleevec). I identified genes converging on and activating the MEK/ERK pathway through transcriptional up-regulation of PRKCH. Combining IM with a MEK inhibitor synergistically kills TKI-resistant CML cells and CML stem cells. Next, I performed single cell RNA-seq to compare expression profiles of CML stem cells and hematopoietic stem cells isolated from the same patient. Among the genes that are preferentially expressed in CML stem cells is PIM2, which encodes a pro-survival serine-threonine kinase that phosphorylates and inhibits the pro-apoptotic protein BAD. Inhibiting PIM2 function sensitizes CML stem cells to IM-induced apoptosis and prevents disease relapse in a CML mouse model. Last, I devised a CRISPR-Cas9 based strategy to perform insertional mutagenesis at a defined genomic location in murine hematopoietic Ba/F3 cells. As proof of principle, we showed its capability to perform unbiased, saturated point mutagenesis in a 9 amino acid region of BCR-ABL encompassing the socalled “gatekeeper” residue, an important determinant of TKI binding. We found that the ranking order of mutations from the screen correlated well with their prevalence in IM-resistant CML patients. Overall, my findings reveal novel resistance mechanisms in CML and provide alternative therapeutic strategies.

Die Verwendung von nukleinsäuretemplatgesteuerten Reaktionen stellt einen innovativen Ansatz zur Therapie von Krankheiten dar, deren Ursprung in einer genetischen Veränderung von Zellen liegt. Im Rahmen der hier vorliegenden Arbeit erfolgte eine Weiterentwicklung der RNA-templatgesteuerten Acyltransferreaktion nach Seitz et al. hinsichtlich des Aufbaus von aromatischen Amidbindungen, wie sie in vielen niedermolekularen Wirkstoffen vorkommen. Als Modellverbindungen dienten die Bcr-Abl-Tyrosinkinaseinhibitoren Nilotinib, Ponatinib und GZD824, die durch zentrale Benzanilidmotive charakterisiert sind und zur Therapie der chronischen myeloischen Leukämie eingesetzt werden. Das konzipierte Reaktionssystem beruht auf dem Mechanismus der nativen chemischen Ligation, weswegen die Bcr-Abl-Inhibitoren durch die Einführung einer Thiolgruppe modifiziert werden mussten. Es wurde gezeigt, dass diese Modifikation in den meisten Fällen nur zu einer geringen Beeinträchtigung der biologischen Aktivität führt. Der RNA-templatgesteuerte Aufbau der Benzanilidstrukturen konnte sowohl mit PNA- als auch mit DNA-verknüpften Inhibitorfragmenten basierend auf Ponatinib und GZD824 erzielt werden. In Gegenwart eines komplementären RNA-Templats erfolgte die benachbarte Hybridisierung der reaktiven Konjugate, infolgedessen ein Benzoyltransfer von einem thioestermodifizierten Donor auf ein ortho-Mercaptoanilinderivat als Akzeptor stattfand. Mit PNA/PNA-Reaktionssystemen wurde auch in Abwesenheit des RNA-Templats eine signifikante Produktbildung beobachtet, was auf hydrophobe Wechselwirkungen der Konjugate zurückgeführt wurde. Unter Verwendung von DNA/DNA- bzw. PNA/DNA-Konjugatpaaren blieb die templatunabhängige Produktbildung hingegen ausreichend gering. Die entsprechenden Reaktionssysteme wurden hinsichtlich der erzielten Produktausbeuten optimiert, wobei sowohl die Linkerlänge bzw. -struktur der reaktiven Konjugate als auch die Templatarchitektur variiert wurde. / The use of nucleic acid-templated reactions represents an innovative approach to the therapy of diseases that originate in genetic alterations of cells. In this work, the RNA-templated acyl transfer reaction invented by Seitz et al. was extended towards the formation of aromatic amide bonds which occur in a variety of small molecule drugs. The Bcr-Abl tyrosine kinase inhibitors nilotinib, ponatinib, and GZD824 were used as model compounds, as they are characterized by central benzanilide motifs and find application in the treatment of chronic myeloid leukemia. The designed reaction system is based on the mechanism of native chemical ligation which required the modification of the Bcr-Abl inhibitors by introducing a thiol group. It was shown that thiolation affected the biological activity only moderately. The RNA-templated formation of the benzanilide structures was achieved with both PNA- and DNA-linked inhibitor fragments of ponatinib and GZD824. The presence of a complementary RNA template enabled adjacent binding of the reactive conjugates, triggering a rapid benzoyl transfer from a thioester-linked donor to an ortho-mercaptoaniline derivative as an acceptor. With PNA/PNA reaction systems, significant product formation was observed in absence of the RNA template, which was attributed to hydrophobic interactions between the conjugates. However, the template-independent product formation remained low when DNA/DNA or PNA/DNA conjugate pairs were used. The product yields of the corresponding reaction systems were optimized by varying the linker length and structure of the conjugates as well as the template architecture.

Made available in DSpace on 2016-04-12T12:32:35Z (GMT). No. of bitstreams: 2 596.pdf: 1353914 bytes, checksum: bee2473adf5a37f943c4f715f4043519 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2010 / Fundação Oswaldo Cruz. Centro de Pesquisas Aggeu Magalhães. Recife, PE, Brasil / A Leucemia Mielóide Crônica (LMC) é uma neoplasia mieloproliferativa crônica, cuja incidência é de 1,5 casos por 100.000 habitantes ao ano, com predomínio do gênero masculino. A predisposição hereditária parece não existir e o único fator bem caracterizado de risco é a exposição à radiação ionizante. O geoprocessamento é uma ferramenta informacional de auxílio aos profissionais e estudiosos da área da saúde capaz de mapear as doenças e permitir a análise de riscos sócio-ambientais. O objetivo deste estudo foi caracterizar a distribuição dos casos de LMC e de exposição a tóxicos industriais dos pacientes residentes no estado de Pernambuco com registro no Hospital Hemope nos últimos cinco anos. O estudo tipo série de casos incluiu todos os pacientes com diagnóstico de LMC, idade igual ou superior a 18 anos, de ambos os gêneros, atendidos no período de janeiro de 2004 a dezembro de 2009 e procedentes das diversas regiões de desenvolvimento do Estado. Para coleta e análise dos dados foram utilizados os registros dos prontuários de saúde e os aplicativos Excel 2003 e Terra View. No período do estudo foram diagnosticados 201 casos de LMC, com mediana de idade de 49 anos (extremos 18 a 93) e maior pico de incidência entre os 40 e 50 anos (24 por cento). Houve predomínio do sexo masculino (1,1:1) e de residentes de áreas urbanas (86 por cento). A incidência da LMC para as 12 regiões de desenvolvimento do Estado variou entre 0,5 e 3,8 casos por 100.000 habitantes/ano com média de 1,8 casos. As Regiões do Agreste Meridional e Sertão do Pajéu apresentaram maior incidência de casos de LMC, no entanto, não houve variação significante no número de casos ao longo dos anos e nem foram identificados determinantes sócio-ambientais relevantes associados. Apenas 10 por cento dos prontuários apresentaram registro sobre contato do pacientes com tóxicos industriais. A taxa de incidência da LMC encontrou-se dentro da frequência esperada, porém, com variações entre os municípios e as diferentes regiões de desenvolvimento do Estado. O estudo por geoprocessamento auxiliou na análise da distribuição espacial dos casos para uso dos dados como estudo de linha de base. A interface entre o profissional e o serviço de saúde pública é essencial para reconhecer e responder as preocupações com mudanças no perfil epidemiológico de doenças crônicas, frente aos novos cenários de desenvolvimento econômico

The presence of the translocation t(9;22)(q34;q11), leading to the BCR::ABL1 fusion transcript, is the hallmark of chronic myeloid leukemia (CML). Nevertheless, atypical presentation at diagnosis can be challenging. However, although most patients with CML are diagnosed with the e13a2 or e14a2 BCR:: ABL1 fusion transcripts, about 5% of them carry rare BCR::ABL1 fusion transcripts, such as e19a2, e8a2, e13a3, e14a3, e1a3, and e6a2. In particular, the e6a2 fusion transcript has been associated with clinically aggressive disease frequently presenting in accelerated or blast crisis phases. To date, there is limited evidence on the efficacy of front-line second-generation tyrosine kinase inhibitors for this genotype. Here, we report two patients, in whom the diagnosis of CML was challenging. The use of primers recognizing more distant exons from the common BCR::ABL1 breakpoint region correctly identified the atypical BCR::ABL1 e6a2 fusion transcript. Treatment with the second-generation tyrosine kinase inhibitor nilotinib was effective in our patient expressing the atypical e6a2 BCR::ABL1 fusion transcript.

La vigueur de la réponse immunitaire générée par les cellules dendritiques (DC) a positionné ces cellules comme médiatrices centrales dans l’activation des lymphocytes T. La vulnérabilité des cellules cancéreuses de leucémie myéloïde chronique (LMC) à l’intervention immunitaire résulte apparemment de la capacité des cellules leucémiques de se différencier en DC. Ces DC ont alors la capacité de présenter des peptides provenant des cellules souches leucémiques aux lymphocytes T. Dans ce travail, nous démontrons que la plupart des patients atteints d’une LMC présentent un déficit important en DC au niveau du sang et de la moelle osseuse avant la greffe de cellules souches allogéniques. Les faibles niveaux de DC circulantes résultent en grande partie d’une perte de la diversité au niveau des cellules progénitrices CD34+ leucémiques au niveau de la moelle osseuse. Ces cellules progénitrices CD34+ présentent d’ailleurs une capacité réduite à se différencier en DC in vitro. Nous avons trouvé qu’un décompte faible de DC avant une greffe allogénique était associé à une diminution significative de la survie et une augmentation considérable du risque de développer une des complications mortelles. Puisque la reconstitution des DC suite à la greffe est absente, notre étude appuie aussi la thèse que ce sont les cellules DC pré greffe qui sont primordiales dans l'effet du greffon contre leucémie (GVL). Dans ce contexte, notre étude suggère que le compte des DC avant la greffe allogénique pourrait servir de marqueur pronostique pour identifier les patients LMC à risque de développer certaines complications suite à une greffe allogénique. / The intensity of the immune response that is generated by the dendritic cells (DCs) has established these cells as central mediators in the activation of T lymphocytes. The vulnerability of leukemic cells present in chronic myeloid leukemia is mostly attributable to the ability of the leukemic stems cell to differentiate themselves into potent DCs. The latter are then able to present peptides which come from endogenous origin and from leukemic stem cells to the T lymphocytes. In this thesis, we demonstrate that, before allogeneic stem cell transplant, the majority of patients afflicted by CML have a considerable lack of DCs in their peripheral blood as well as in their bone marrow. The low levels of circulating DCs result to a great extent from a loss of diversity in the CD34+ leukemic progenitor cells located in the bone marrow. Moreover, these CD34+ leukemic progenitor cells display a reduced capacity to differentiate themselves into DCs in vitro. Our findings show that having a low level of DCs prior to an allogeneic transplant is associated with a significant decline in survival rates as well as with increased risks of developing life threatening complications. Since the DCs’ reconstitution following an allogeneic bone marrow transplant is missing, our study supports the thesis that pre graft DCs are essential in the Graft versus leukemia effect (GVL).Therefore, our research suggests that tallying DC before proceeding with an allogeneic transplant could act as a prognostic marker to identify LMC patients who present risks of complications after an allogeneic transplant.

Introduction: Chronic myeloid leukaemia is a blood cancer which progresses from a chronic phase to an acute blast crisis if untreated. Disease progression and treatment resistance may be precipitated by the mutator action of BCR/ABL protein tyrosine kinase (PTK), but only few protein phosphosites involved in the DNA damage response have been investigated with respect to BCR/ABL action. Aim: The aim of this PhD project was to demonstrate that BCR/ABL PTK expression can affect the response to genotoxic stress signalling at the protein phosphorylation level. Methodology: Etoposide-induced DNA damage response has been studied in control and BCR/ABL PTK-expressing Ba/F3 cells using apoptosis and γH2AX assays. Quantitative phosphoproteomics was performed with iTRAQ peptide labelling to discover putative modulated phosphorylation sites. Absolute quantification (AQUA ) performed with selected reaction monitoring was used to validate discovery phosphoproteomics. The effect of genotoxic stress on the THO complex protein Thoc5/Fmip was studied using western blots. Results: The expression of BCR/ABL PTK induced γH2AX phosphorylation after etoposide exposure. This was associated with the modulation of H2AX tyrosine 142 phosphorylation, MDC1 (serines 595 and 1053) and Hemogen serine 380 phosphorylation among proteins regulated by both BCR/ABL PTK and etoposide. We identified that leukaemogenic PTKs mediate Thoc5/Fmip phosphorylation on tyrosine 225 via Src proto-oncogene and oxidative stress, while ATM and MEK1/2 may control its phosphorylation. Human CD34+ CD38- leukaemic stem cells showed pronounced level of THOC5/FMIP tyrosine phosphorylation. Expression of phosphomutant Thoc5/Fmip Y225F might reduce apoptosis mediated by etoposide and H2O2. Conclusion: BCR/ABL PTK can sustain, create, block and change the intensity of protein phosphorylation related to genotoxic stress. Modulation of H2AX, MDC1, Hemogen and Thoc5/Fmip post-translational modifications by BCR/ABL PTK might promote unfaithful DNA repair, genomic instability, anti-apoptotic signalling or abnormal cell differentiation, resulting in leukaemia progression.

Th.--Méd.--Nancy 1, 1984. N°: 161.