I have been interested in the molecular mechanisms of Haematopoietic malignant diseases such as leukaemia and lymphoma, especially those involving oncogenic tyrosine kinases. About 30 of the 90 tyrosine kinases in the human genome have been implicated in cancer (Blume-Jensen P, 2001). The oncogenic tyrosine kinases (OTKs), such as Bcr-Abl (product of chromosomal translocations of two genes bcr and abl) in Chronic Myelogenous Leukaemia, and Erythroblastic leukaemia viral oncogene homolog 2(Erb-B2) in mammary and other cancers, mediate their transforming effects via a diverse array of signalling pathways involved in DNA damage, cell survival and cell cycle regulation (Deutsch E, 2001; Skorski T, 2002; Kumar R, 1996). My work has been centred around the analysis of a mouse cancer model that is driven by an oncogenic tyrosine kinase – p56 Lck-F505 expressed on CD45 knock- out background (Baker M, 2000). The investigation of this mouse model has revealed that oncogenic inhibition of deamidation of the Bcl-xL survival protein plays a critical role in protecting thymocytes from DNA-damage induced apoptosis. Cells that would normally be eliminated due to accumulating DNA damage are instead preserved with an increasing load of double-stranded breaks, leading to genomic instability, chromosomal abnormalities and transformation. This work was published in Cancer Cell (An oncogenic tyrosine kinase inhibits DNA repair and DNA-damage-induced BclxL deamidation in T cell transformation. Zhao R, 2004). Following that I have tried to elucidate the different roles of the two deamidated species of Bcl-xL in apoptosis, and also the molecular mechanisms of DNA damage- induced Bcl-xL deamidation in order to understand the inhibition of Bcl-xL deamidation by oncogenic tyrosine kinases. Recently I have shown that Bcl-xL deamidation, whereby two critical Asn residues are converted to iso-Asp, cripples the ability of the protein to sequester pro-apoptotic BH3-only proteins such as Bim and p53- upregulated modulator of apoptosis (PUMA), thereby explaining its loss of pro-survival functionality. In vivo, DNA damage causes intracellular alkalinisation that is both necessary and sufficient to deamidate Bcl-xL, promoting apoptosis: no enzyme is necessary for this process. In pre-tumourigenic thymocytes alkalinisation is blocked, so preserving Bcl-xL in its pro-survival mode. Furthermore murine tumours are protected from genotoxic attack by native Bcl-xL, but enforced alkalinisation and consequent Bcl-xL deamidation promotes apoptosis. This part of work was published in Plos Biology (DNA damage-induced Bcl-xL deamidation is mediated by NHE-1 antiport regulated intracellular pH. Zhao R, 2007). Through collaboration with Prof AR Green’s research group at the Department of Haematology of the University of Cambridge, I have also analysed the Bcl-xL deamidation pathway in human myeloproliferative disorders, e.g. Polycythemia vera(PV) and Chronic Myelogenous Leukaemia (CML). We found that the oncogenic tyrosine kinases involved in these disorders, i.e. Jak2V617F and Bcr-Abl also inhibit the Bcl-xL deamidation pathway in DNA damage responses. These findings shed light on potential therapeutic application of the Bcl-xL deamidation pathway in human malignancies. This piece of work was recently published in the New England Journal of Medicine (Inhibition of the Bcl-xL deamidation pathway in myeloproliferative disorders. Zhao R, 2008). Overall the cited work has led to several important new insights into the molecular mechanisms involved in oncogenesis: first, that Bcl-xL deamidation is important in the cascade of events leading from DNA damage to apoptosis; second, that oncogenic tyrosine kinases inhibit these events in both the murine and human context; third, that up-regulation of the NHE-1 antiport and consequent intracellular alkalinisation are critical events in this DNA damage-induced cascade leading to apoptosis. In the process I have demonstrated the first in vivo mechanism for the deamidation of an internal protein Asn. Essentially, a completely new and unexpected signalling pathway has been uncovered that seems to pertain to all murine and human haematopoietic cell lineages that have been investigated so far.

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 4 uppsatser.

Les néoplasmes myéloprolifératifs (NMPs) classiques BCR-ABL négatifs regroupent la Polyglobulie de Vaquez, la Thrombocytémie Essentielle et la Myélofibrose Primaire. Ce sont des pathologies malignes clonales entraînées par la signalisation constitutive de la voie JAK2/STAT en raison de mutations somatiques acquises qui affectent trois gènes, JAK2, CALR et MPL. Il s’agit des mutations “motrices” de la maladie responsable du syndrome myéloprolifératif et du phénotype. Cependant CALR n’est pas une molécule de signalisation mais une chaperonne du réticulum endoplasmique. En utilisant des lignées dépendantes de facteurs de croissance soit murines (Ba/F3) soit humaines (UT-7), des cellules primaires de patients et des modèles murins nous avons montré que les mutants CALRdel52 et CALRins5 avaient acquis de nouvelles propriétés qui en font des molécules de signalisation en induisant: - une indépendance aux facteurs de croissance uniquement lorsque MPL, le récepteur de la thrombopoïétine est exprimé ; - une phosphorylation constitutive de JAK2, des STAT1, 3 et 5 et une activation faible des voies PI3K/AKT et ERK1/2, suggérant une activation de MPL/JAK2 par les mutants CALR différente de celle induite par JAK2V617F. De manière intéressante un mutant de la CALR ayant une délétion entière de l’exon 9 n’est pas transformant, suggérant que l’activité oncogénique est liée à la présence de la nouvelle séquence C-terminale. L’activation de JAK2 uniquement par MPL en présence des mutants CALR pourrait expliquer le phénotype mégacaryocytaire/plaquettaire de ces NMPs. Cette activation de MPL au contraire de celle exercée par JAK2V617F a lieu non seulement à la membrane mais aussi dans le cytoplasme.Les modèles murins ont montré que les mutants CALR étaient responsables de la maladie et que celle-ci était dépendante de MPL, validant les résultats obtenus sur les lignées.Nous avons également montré que contrairement à JAK2V617F, les mutants de la CALR induisent chez l’homme une dominance clonale très tôt au niveau du compartiment des cellules souches. L’ensemble de ces résultats contribue à une meilleure compréhension du rôle des mutations CALR dans les NMPs. La démonstration que les molécules mutées sont présentes à la surface cellulaire ouvre la voie à des immunothérapies ciblant le nouveau peptide C-terminal. / Classical BCR-ABL negative myeloproliferative neoplasms (MPNs) include three disorders: Polycythemia Vera, Essential Thrombocythemia and Primary Myelofibrosis. They are clonal malignant diseases driven by the constitutive JAK2/STAT signaling pathway due to acquired somatic mutations affecting three genes: JAK2, CALR and MPL. These are the "driver" mutations of the disease responsible of the myeloproliferation and of the disease phenotype. However, CALR is not a signaling molecule, but a chaperonne of the endoplasmic reticulum. Using murine (Ba/F3) and human (UT-7) cell lines dependent on growth factors and primary patient cells and mouse model, we have shown that the CALRdel52 and CALRins5 mutants have acquired new signaling properties and induce:- growth factor independence only when MPL, the thrombopoietin receptor, is expressed;- constitutive phosphorylation of JAK2, of STAT1, 3 and 5 and a low activation of the PI3K/AKT and ERK1/2 pathways, suggesting an activation of MPL/JAK2 by a different manner than JAK2V617F. Interestingly, a CALR mutant deleted for the entire exon 9 has not transformation properties suggesting that the oncogenic activity is related to the presence of the new C-terminal sequence. This JAK2 activation only by MPL in presence of CALR mutants could explain the megakaryocytic/platelet phenotype of these MPNs.The use of a mouse modeling using retroviral vectors and bone marrow transplantation has shown that CALRdel52 and ins5 were really the drivers of the disease and that in vivo the thrombocytosis was dependent of MPL validating the results obtained in vitro.In addition, we have shown that in human, CALR mutants induce a clonal dominance early in the stem cell compartment in ET. This is in sharp contrast with JAK2V617F in ET. Overall, these results contribute to a better comprehension of the role of CALR mutations in MPNs. Furthermore, the demonstration that the CALR mutants are expressed at the cell surface open the way to the development of new immunotherapy targetting the new C-terminus peptide.

Background: Chronic myeloproliferative disorders (CMPD) seem to be associated with an increased risk for pulmonary hypertension (PH). Case Report: A patient with history of chronic idiopathic myelofibrosis (CIMF) presented with progressive dyspnea (New York Heart Association class III). Until this time he had not received specific treatment for CIMF. Echocardiography and rightheart catheterization confirmed PH. Further diagnostic procedures excluded a specific cause of PH. Therefore, primary PH was assumed. 2 years later he presented again with progressive dyspnea due to a progress of PH. A few days later the patient died from acute posterior myocardial infarction. Pathologic examination of the lung showed an obstruction of the small vessels by conglomerates of megakaryocytes. Discussion: We conclude that PH developed secondarily due to CMPD. PH should be suspected in patients with CMPD and should influence the decision for treatment of CMPD. / Hintergrund: Chronische myeloproliferative Erkrankungen (CMPD) scheinen mit einem erhöhten Risiko für pulmonale Hypertonie (PH) assoziiert zu sein. Kasuistik: Ein Patient mit chronisch idiopathischer Myelofibrose (CIMF) wurde aufgrund einer progressiven Belastungsdyspnoe (New York Heart Association Stadium III) überwiesen. Bis zu diesem Zeitpunkt erhielt er keine spezifische Behandlung seiner CIMF. Echokardiographie und Rechtsherzkatheter ergaben das Vorliegen einer PH. Eine spezifische Ursache der PH konnte zunächst ausgeschlossen werden. Somit wurde das Vorliegen einer primären PH vermutet. 2 Jahre später wurde der Patient mit erneut verschlechterter Belastungsdyspnoe vorgestellt, wobei ein Progress der PH feststellbar war. Einige Tage später verstarb der Patient an einem Hinterwandinfarkt. Die Autopsie des Lungengewebes zeigte einen Verschluss der kleinen Lungengefäße durch Konglomerate von Megakaryozyten. Diskussion: Die Entwicklung der PH ist bei diesem Patienten als Folge der CMPD einzuschätzen. Das Vorliegen einer PH bei Patienten mit CMPD sollte die Entscheidung zu spezifischen therapeutischen Maßnahmen hinsichtlich der CMPD beeinflussen. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Das Ziel der vorliegenden Arbeit war die Quantifizierung JAK2 p.V617F mutierter Allele zur Verlaufskontrolle von Patienten mit JAK2 p.V617F positiven MPN nach allogener Stammzelltransplantation (SCT). Dabei sollte insbesondere untersucht werden, ob sich frühzeitig nach SCT ein höheres Rezidivrisiko der MPN vorhersagen lässt und zu welchen Zeitpunkten molekulare Untersuchungen nach SCT sinnvoll sind. Wir analysierten retrospektiv den Krankheitsverlauf von 30 Patienten. Dafür verwendeten wir die ARMS-QPCR und WTB-AS QPCR als zwei allel-spezifische Amplifikationsmethoden und untersuchten 142 Proben der ersten Kohorte (n=14) und 32 Proben einer zweiten Kohorte (n=16) im direkten Vergleich. Aus unseren Ergebnissen konnten folgende Rückschlüsse gezogen werden: 1. Die beiden allel-spezifischen Amplifikationsmethoden ARMS-QPCR und WTB-AS QPCR zur Quantifizierung der JAK2 p.V617F Mutation sind vergleichbar. 2. Als Ausgangsmaterial sind antikoaguliertes Vollblut oder auch Beckenkammbiopsien gleichermaßen geeignet. 3. Der Nachweis von > 1% JAK2 p.V617F Allele 28 Tage nach allogener SCT ist assoziiert mit einem signifikant höheren Rezidivrisiko einer JAK2 positiven MPN und einem schlechteren Gesamtüberleben.

Background: Chronic myeloproliferative disorders (CMPD) seem to be associated with an increased risk for pulmonary hypertension (PH). Case Report: A patient with history of chronic idiopathic myelofibrosis (CIMF) presented with progressive dyspnea (New York Heart Association class III). Until this time he had not received specific treatment for CIMF. Echocardiography and rightheart catheterization confirmed PH. Further diagnostic procedures excluded a specific cause of PH. Therefore, primary PH was assumed. 2 years later he presented again with progressive dyspnea due to a progress of PH. A few days later the patient died from acute posterior myocardial infarction. Pathologic examination of the lung showed an obstruction of the small vessels by conglomerates of megakaryocytes. Discussion: We conclude that PH developed secondarily due to CMPD. PH should be suspected in patients with CMPD and should influence the decision for treatment of CMPD. / Hintergrund: Chronische myeloproliferative Erkrankungen (CMPD) scheinen mit einem erhöhten Risiko für pulmonale Hypertonie (PH) assoziiert zu sein. Kasuistik: Ein Patient mit chronisch idiopathischer Myelofibrose (CIMF) wurde aufgrund einer progressiven Belastungsdyspnoe (New York Heart Association Stadium III) überwiesen. Bis zu diesem Zeitpunkt erhielt er keine spezifische Behandlung seiner CIMF. Echokardiographie und Rechtsherzkatheter ergaben das Vorliegen einer PH. Eine spezifische Ursache der PH konnte zunächst ausgeschlossen werden. Somit wurde das Vorliegen einer primären PH vermutet. 2 Jahre später wurde der Patient mit erneut verschlechterter Belastungsdyspnoe vorgestellt, wobei ein Progress der PH feststellbar war. Einige Tage später verstarb der Patient an einem Hinterwandinfarkt. Die Autopsie des Lungengewebes zeigte einen Verschluss der kleinen Lungengefäße durch Konglomerate von Megakaryozyten. Diskussion: Die Entwicklung der PH ist bei diesem Patienten als Folge der CMPD einzuschätzen. Das Vorliegen einer PH bei Patienten mit CMPD sollte die Entscheidung zu spezifischen therapeutischen Maßnahmen hinsichtlich der CMPD beeinflussen. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

CBL proteins are E3 ubiquitin ligases and adaptor proteins. The mammalian homologs – CBL, CBL-B and CBL-3 show broad tissue expression; accordingly, the CBL proteins play roles in multiple cell types. We have investigated the function of the CBL-B protein in hematopoietic cells and fibroblasts. The causative agent of chronic myeloid leukemia (CML) is BCR-ABL. This oncogenic fusion down-modulates CBL-B protein levels, suggesting that CBL-B regulates either the development or progression of CML. To assess the involvement of CBL-B in CML, bone marrow transduction and transplantation (BMT) studies were performed. Recipients of BCR-ABL-infected CBL-B(-/-) cells succumbed to a CML-like myeloproliferative disease with a longer latency than the wild-type recipients. Peripheral blood white blood cell numbers were reduced, as were splenic weights. Yet despite the reduced leukemic burden, granulocyte numbers were amplified throughout the animals. As well, CBLB(-/-) bone marrow (BM) cells possessed defective BM homing capabilities. From these results we concluded that CBL-B negatively regulates granulopoiesis and that prolonged latency in our CBL-B(-/-) BMT animals was a function of perturbed homing.To develop an in vitro model to study CBL-B function we established mouse embryonic fibroblasts (MEFs) deficient in CBL-B expression. Transduction of the wild-type and CBL-B-deficient MEFs with BCR-ABL did not confer transformation; nevertheless, the role of CBL-B in fibroblasts was evaluated. The CBL-B(-/-) MEFs showed enhanced chemotactic migration toward serum in both Transwell migration and time-lapse video microscopy studies. The biochemical response to serum was extensively evaluated leading to the development of a model. We predict that CBL-B deficiency either: (a) augments GRB2-associated binding protein 2 (GAB2) phosphorylation leading to enhanced extracellular signal-regulated kinase (ERK) and protein kinase B (PKB / Akt) signaling, or (b) alleviates negative control of Vav3 resulting in stimulation of Rho effectors. In either case, our results reveal a negative regulatory role for CBL-B in fibroblast migration. The two studies detailed herein expand our knowledge of CBL-B function. They strongly suggest that CBL-B can modulate granulocyte proliferation and point toward a role for CBL-B in the motility of numerous cell types.

As neoplasias mieloproliferativas (NMP) são doenças hematológicas caracterizadas pela proliferação aumentada e acúmulo de células mieloides maduras de uma ou mais séries hematopoéticas: granulocítica, eritrocítica, megacariocítica ou mastocítica. Os pacientes com NMP podem apresentar mutações como a JAK2V617F, MPL e CALR, cujas descrições foram fundamentais para o início da elucidação da fisiopatologia das NMP. As células neoplásicas das NMP apresentam resistência à apoptose e proliferação celular exacerbada. Sabe-se ainda que essas doenças são consideradas oncoinflamatórias e pré-leucêmicas. Apesar de todos esses conhecimentos sobre os mecanismos moleculares e celulares envolvidos na patogênese das NMP, não há até a presente data tratamentos eficazes que curam ou alteram a história natural de progressão dessas desordens para LMA. Pelo exposto, foi aqui investigada a potencial participação dos membros da via de sinalização Hippo na fisiopatologia das NMP BCR-ABL1 negativas mais frequentes, a policitemia vera (PV), trombocitemia essencial (TE) e mielofibrose primária (MF). A via de sinalização Hippo foi descrita como supressora de tumor e é uma das responsáveis pela regulação da proliferação, diferenciação e morte celular. Foi analisada, ainda nesse estudo, a correlação dos níveis de expressão dos genes da via Hippo com o perfil de citocinas plasmáticas dos pacientes com PV, TE e MF, a associação com o \"status mutacional\" e com a expressão dos genes que regulam a apoptose celular pela via intrínseca. Os principais achados nos pacientes com PV foram a diminuição da expressão dos genes supressores de tumor LATS2, MST1 e MST2 acompanhada pela presença de elevada concentração de citocinas pró-inflamatórias e fenótipo de resistência a apoptose. Na TE, os dados relevantes foram a detecção da diminuição da expressão dos genes supressores de tumor LATS1, LATS2 MST1 e SAV1, e o observação da relação entre alta expressão dos genes SAV1 e MOB1B e a mutação da CALR. Em MF destaca-se a redução da expressão dos genes SAV1 e TAZ da via de sinalização Hippo e do gene AURKB do ciclo celular. Em conclusão, os dados indicam que a diminuição da expressão dos genes supressores de tumor da via Hippo contribui para a fisiopatologia e para o fenótipo de resistência das células neoplásicas à apoptose das NMP. / Myeloproliferative neoplasms (MPN) are hematological disorders characterized by increased proliferation of mature myeloids cells of one or more hematopoietic series: granulocytic, erythrocytic, megakaryocytic or mastocytic. Patients with MPN may present mutations such as JAK2V617F, MPL and CALR, which were essential descriptions for the beginning of pathophysiological elucidation of MPN. The NMP neoplastic cells show resistance to apoptosis and exacerbated cell proliferation. It is known that these entities are considered also oncoinflamatory and pre-leukaemic. Despite all this knowledge about the molecular and cellular mechanisms involved in the pathogenesis of MPN, there are no effective treatments that cure or alter the natural history of progression of these disorders to AML. For the above, a participatory potential of the Hippo signaling pathway members in the pathophysiology of the most frequent negative BCR-ABL1 MPN, the polycythemia vera (PV), essential thrombocythemia (ET) and primary myelofibrosis (PMF) were investigated. The Hippo signaling pathway has been described as tumor suppressor and is responsible for the regulation of proliferation, differentiation and cell death. The correlation analysis of the expression levels of the Hippo pathway genes with the plasma cytokine profile of patients with PV, ET and PMF, the association with the mutational status and the expression of the genes that regulate intrinsic cellular apoptosis were performed. The main findings in patients with PV were decreased expression of the tumor suppressor genes LATS2, MST1 and MST2 accompanied by the presence of high concentration of proinflammatory cytokines and phenotype of resistance to apoptosis. In ET, relevant data were the detection of decreased expression of the tumor suppressor genes LATS1, LATS2 MST1 and SAV1, and the observation of the relationship between high expression of the SAV1 and MOB1B genes and the mutation of the CALR. In PMF, stands out the reduction of the SAV1 and TAZ gene expression of the Hippo signaling pathway and the AURKB gene of the cell cycle. In conclusion, the data indicate that decreased expression of the tumor suppressor genes of the Hippo pathway contributes to the pathophysiology and neoplastic cell resistance phenotype to the apoptosis of MPN.

Doenças Mieloproliferativas Crônicas são desordens hematológicas malignas caracterizadas pela alteração na célula-tronco hematopoética e independência ou hipersensibilidade dos progenitores hematopoéticos a citocinas. Em 2008 a OMS renomeou esse grupo como Neoplasias Mieloproliferativas (NMPs), no qual estão inclusas as entidades nosológicas Policitemia Vera (PV), Trombocitemia Essencial (TE) e Mielofibrose Primária (MFP), doenças alvo desse estudo. Apesar dos avanços no diagnóstico das NMPs e nos mecanismos envolvidos com a fisiopatologia dessas doenças, sua patogênese permanece desconhecida. Alterações na maquinaria apoptótica parecem estar envolvidas em na fisiopatologia das NMP e por isso a compreensão dos mecanismos de regulação da apoptose e a interferência das galectinas-1 e 3 nesse processo, em pacientes com NMPs, é relevante para a busca de novos alvos terapêuticos. Neste contexto, os objetivos deste trabalho foram: avaliar em leucócitos de sangue periférico e células tronco hematopoéticas CD34+ de medula óssea dos pacientes com PV, TE e MFP os níveis de expressão das LGALS1 e LGALS3 e a concentração de galectina-3 plasmática. Foram determinadas as correlações dos níveis de expressão de LGALS1 e LGALS3 e da concentração da galectina-3 plasmática com os níveis de expressão do RNAm das moléculas reguladoras da apoptose e com os dados clínico-laboratoriais dos pacientes como a concentração de hemoglobina, percentagem de hematócrito, porcentagem de alelos mutados JAK2V617F, contagem de leucócitos e esplenomegalia. A expressão de LGALS1 estava diminuída em células CD34+ em PV e MFP e em leucócitos de sangue periférico de pacientes com MFP. Os pacientes de TE apresentaram aumento na expressão de LGALS3 em leucócitos de sangue periférico e alta concentração de galectina-3 no plasma. Houve correlação entre os níveis de expressão de LGALS1 e a porcentagem de alelos mutados e a contagem de leucócitos, em pacientes com PV. Foi detectada a correlação entre os níveis de expressão de LGALS3 a porcentagem de alelos mutados e o tamanho do baço, em pacientes com MFP. Com relação aos genes reguladores da apoptose, foram observadas correlações entre os níveis de expressão de LGALS1 e BCL-2 em células CD34+ de pacientes PV e entre LGALS3 e A1, MCL-1, BAX e C-FLIP em leucócitos de de pacientes com TE. Os resultados obtidos indicam que as NPM apresentam expressão diferencial de LGALS1 e LGALS3 e sugerem a associação entre a expressão de galectinas e o status da mutação JAK2V617F, principalmente em pacientes com MFP / Chronic myeloproliferative diseases are haematological malignant disorders characterized by the presence of an altered haematopoietic stem cell and independence or hypersensibility of their hematopoietic progenitors to cytokines. In 2008, WHO renamed this group of diseases as Myeloproliferative Neoplasms (MPN) in which is included Polycythemia Vera (PV), Essential Thrombocythemia (ET) and Primary Myelofibrosis (PMF). There have been advances concerning the knowledge about the mechanisms involved in MPN pathophysiology, however their pathogenesis remains unknow. Deregulation in apoptotic machinery seems to be involved in MPN pathophysiology. Fully understanding of apoptotic machinery and the influence of galectin-1 and 3 in this process in NMP patients might unveil novel targets for manipulation. The aims of the present study were to evaluate in leukocytes and CD34+ hematopoietic stem cells from PV, ET and PMF patients the LGALS1 and LGALS3 expression levels, the Galectin-3 plasma levels and to correlate LGALS1 and LGALS3 expression levels with galectin-3 plasma levels, apoptosis-related genes expression, JAK2 mutation status and clinic-laboratorial parameters. PV and PMF patients showed decreased expression levels of LGALS1 in CD34+ cells and also decreased LGALS1 expression levels in PMF leukocytes. ET patients presented an increased expression level of galectin-3 in leukocytes and plasma. We detected the correlations between LGALS3 gene expression with JAK2 allele burden and with leukocytes number in PV patients. We also observed in PMF patients the correlation between LGALS3 expression levels with JAK2 allele burden and spleen size. We also detected the correlation between LGALS1 expression levels BCL-2 gene expression in PV CD34+ HSC cells and between LGALS3 expression and A1, MCL-1, BAX and C-FLIP gene expression in TE leukocytes. Taken together, the results suggest the LGALS1and LGALS3 differential expression in NMP and the relation between JAK2V617F status with galectins expression, especially in PMF patients.

As neoplasias mieloproliferativas (NMPs) negativas para o rearranjo t(9;22)/BCRABL1, incluindo Policitemia Vera (PV), Trombocitemia Essencial (TE) e Mielofibrose Primária (MFP), são doenças hematopoéticas clonais e estão frequentemente associadas à mutação JAK2V617F. Apesar dos avanços no conhecimento da fisiopatologia após a descoberta da mutação JAK2V617F e do desenvolvimento de inibidores da JAK2, o tratamento permanece não curativo. Sabe-se que as célulastronco mais primitivas nas NMPs são responsáveis pela iniciação da doença e que a expansão dos precursores mieloeritróides contribui para o fenótipo clínico. Dados recentes obtidos com ensaios in vitro mostram que as proteínas da família BCL2, reguladoras da apoptose mitocondrial, desempenham um papel relevante na patogênese das NMPs. Acreditamos que a expressão anômala de BCL2 nas células progenitoras hematopoéticas (CPH) das NMPs pode contribuir para a patogênese desse grupo de doenças. Avaliamos a expressão gênica, por meio de PCR em Tempo Real, da família BCL2 (genes antiapoptóticos BCL-xL e BCL2 e o pró-apoptótico BIM) nas diferentes subpopulações de progenitores hematopoéticos murinos (de um modelo condicional knockin de expressão heterozigótica condicional da Jak2V617F) e de pacientes portadores de NMPs bem como sua contribuição para o fenótipo da doença e resposta ao inibidores da JAK2 (com a droga ruxolitinibe) e/ou inibição da família BCL2 (com o inibidor de BCL2 obatoclax). Não encontramos diferença de expressão basal dos genes BCL2, BCL-xL e BIM nas células CD34+ bem como nas subpopulações de células CD34+38-/+ de pacientes com NMPs, independente da presença da mutação JAK2V617F, em relação às células CD34+ e subpopulações CD34+38-/+ dos controles (p>0.05). Nas células CD34+ de pacientes com TE encontramos aumento de expressão de BCL2 em relação às células CD34+ pacientes com MFP (p=0.03). No modelo transgênico de camundongos Jak2 wt/VF (que apresentam uma NMP semelhante à PV) e Jak2 wt/wt (controles), comparamos a expressão diferencial dos genes da família Bcl2 em precursores hematopoéticos imaturos (LSKs) e progenitores mieloides mais maduros (MPs). A expressão do BclxL em MPs de camundongos wt/VF foi maior em relação à subpopulação de células LSKs e em relação as duas subpopulações de células dos controles (p=0.0011). Não houve diferença significativa de expressão do Bcl2 nas subpopulações de células LSKs e MPs de animais wt/VF e wt/wt (p=0.12). Observou-se menor expressão de Bim em LSKs em relação às células MPs dos animais mutados (p=0.026), diferença essa não observada entre os controles Jak2 wt/wt. O tratamento isolado com inibidor de JAK2 ou de BCL2 resultou em aumento de expressão do Bim nas CPH (LSKs e MPs) de camungongos Jak2 wt/VF em relação aos animais Jak2 wt/wt. Este aumento da expressão de Bim foi ainda mais evidente após o tratamento das células com a combinação das duas drogas quando comparadas às células não tratadas ou tratadas com um dos dois inibidores, sendo maior em animais doentes do que em animais controles (p<0.0001). A análise do efeito do tratamento com os inibidores de JAK2 e BCL2 na indução de apoptose por meio de citometria de fluxo (marcação com anexina/7-AAD) revelou que as células LSKs foram mais resistentes à apoptose tardia do que as células MPs independentemente da mutação da JAK2 (p<0.05). O tratamento com obatoclax resultou em indução de apoptose diferentemente do que foi observado com o tratamento com ruxolitinibe (p=0.594) nas células MPs de animais Jak2 wt/VF. Ademais, o tratamento combinado com ruxolitinibe e obatoclax resultou no aumento da apoptose nas células MPs dos animais com fenótipo de PV (Jak2 wt/VF) em relação aos animais Jak2 wt/wt (p=0.05). Em conclusão, demonstramos que a resistência à apoptose nas NMPs ocorre desde as CPH iniciadoras da doença. Nossos resultados sugerem que a modulação da apoptose mitocondrial pode ser uma nova estratégia terapêutica para pacientes com NMP em combinação aos inibidores de JAK2, na medida em que atua tanto nas CPH que iniciam a doença como nos MPs, responsáveis pelos sinais e sintomas de mieloproliferação. / Myeloproliferative Neoplasms (MPNs) negative for t(9;22)/BCR-ABL1 rearrangement, including Polycythemia Vera (PV), Essential Thrombocythemia (ET) and Primary Myelofibrosis (PMF), are clonal hematopoietic diseases and are often associated with the JAK2V617F mutation. Despite advances in the pathophysiology knowledge after the discovery of the JAK2V617F mutation and the development of JAK2 inhibitors, treatment remains non-curative. It is known that MPN primitive stem cells are essential for the initiation of the disease and that the expansion of the myeloeritroid precursors contributes to the clinical phenotype. Recent data, obtained with in vitro assays, showed that BCL2 family proteins, regulators of mitochondrial apoptosis, play a relevant role in the pathogenesis of MPNs. We believe that the anomalous expression of BCL2 in hematopoietic progenitor cells (HPCs) of MPNs may contribute to their pathogenesis. We evaluated BCL2 family (antiapoptotic genes BCL-xL and BCL2 and the pro-apoptotic BIM) gene expression by real-time PCR in different subpopulations of hematopoietic progenitors from a conditional Jak2V617F knockin murine model and from patients with MPNs as well as their contribution to the disease phenotype and response to JAK2 inhibitors (with ruxolitinib) and/or to the inhibition of the BCL2 family (with the BH3-mimetic obatoclax). We found no difference in the basal expression of the BCL2, BCL-xL and BIM in CD34+ cells as well as in subpopulations of CD34+ 38-/+ cells from patients with MPNs, regardless of the presence of the JAK2V617F mutation. In CD34+ cells obtained from patients with ET, we found an increase of BCL2 expression when compared to CD34+ cells with PMF (p=0.03). In the Jak2 wt/VF transgenic mice (that develop a MPN similar to PV) and Jak2 wt/wt controls, we compared the differential expression of Bcl2 family genes in immature hematopoietic precursors (LSKs) and more mature myeloid progenitors (MPs). Expression of Bcl-xL in MPs of wt/VF mice was greater when compared to LSKs and to the two progenitor subpopulations of control cells (p=0.0011). There was no significant difference in Bcl2 expression between the subpopulations of LSKs and MPs from wt/VF and wt/wt animals (p=0.12). Lower Bim expression in LSKs than in MPs was observed in samples from JAK2-mutated animals (p=0.026). Such difference was not observed between the Jak2 wt/wt subpopulations. Treatment with JAK2 or BCL2 inhibitors alone resulted in increased Bim expression in LSKs and MPs of the Jak2 wt/VF mice when compared to Jak2 wt/wt animals. This increase in Bim expression was even more evident when these cells were treated with the combination of the two drugs as compared to single treatment with one of the two inhibitors, being higher in mutaded than control animals (p<0.0001). The analysis of apoptosis by flow cytometry (annexin / 7-AAD labeling) revealed that LSK cells were more resistant to late apoptosis than MP cells regardless of the JAK2 mutation (p<0.05). Treatment with obatoclax resulted in greater apoptosis induction than it was observed with ruxolitinib treatment (p=0.594) on MP cells of Jak2 wt/VF animals. In addition, the combined treatment with ruxolitinib and obatoclax resulted in increased apoptosis in MP cells of animals with the PV phenotype (Jak2 wt/VF) as compared to the Jak2 wt/wt animals (p=0.05). In conclusion, we demonstrated that resistance to apoptosis in MPNs occurs at the level of the hematopoietic progenitors that initiate the disease. Our results suggest that modulation of mitochondrial apoptosis may be a new therapeutic strategy for MPN patients in combination with JAK2 inhibitors, as it acts on both the disease initiating and more mature progenitors, responsible for the clinical findings of myeloproliferation.