ALBERT

Description: Key Points Targeted deletion of the gene for macrophage migration inhibitory factor (MIF) delays development of chronic lymphocytic leukemia and prolongs survival in mice. MIF recruits leukemia-associated macrophages to spleen or liver.

Description: Neonatal thrombocytopenia occurs in about 1% of all newborns. Inherited forms like 11q- or Jacobsen syndrome are rare. However, they may remain undetected with karyotyping because the deleted regions in 11q often involve small subtelomeric regions. Here we report on the detection of deletions in 11q in two newborns with normal routine karyotypes who were shown to carry subtelomeric deletions in 11q by means of fluorescence in situ hybridization (FISH) using a subtelomeric 11q probe (Abbott, Diagnostics, Wiesbaden, Germany). Both children showed thrombocytopenia (18.000/μl and 26.000/μl, respectively) and dysmegakaryopoiesis (absence of normal megakaryocytes and presence of micromegakaryocytes) associated with facial dysmorphism, cardiac defects and psychomotoric retardation. In the second case, the mother and the grandmother also showed mild thrombocytopenia. In both patients, FISH analyses on peripheral blood and bone marrow showed the loss of the telomere-associated region of 11q distal of the MLL gene. In the first patient, the deletion of 11q resulted from an unbalanced complex rearrangement with duplication of 11p. As the source of this chromosomal aberration, a paternal pericentric inversion of chromosome 11 was identified. The partial monosomy 11q and the partial trisomy 11p in the first patient were confirmed by comparative genomic hybridization (CGH) analysis. Array/matrix CGH assisted in determining the breakpoints at 11p15.1 and 11q24.1. No structural aberrations of 11q were found in the mother of the second patient, but further investigations are under way. These findings give further evidence that small subtelomeric deletions of 11q and probably mutations of genes located therein cause thrombocytopenia. Since it can be very difficult to detect these deletions by karyotyping, FISH using a subtelomeric 11q probe seems to be an extremely useful new diagnostic tool. This new method should be applied in children with congenital thrombocytopenia, in particular if they have additional complex dysmorphic features.

Description: Loss of neurofibromin or interferon consensus sequence binding protein (Icsbp) leads to a myeloproliferative disorder. Transcription of NF1 is directly controlled by ICSBP. It has been postulated that loss of NF1 expression resulting from loss of transcriptional activation by ICSBP contributes to human hematologic malignancies. To investigate the functional cooperation of these 2 proteins, we have established Icsbp-deficient mice with Nf1 haploinsufficiency. We here demonstrate that loss of Icsbp and Nf1 haploinsufficiency synergize to induce a forced myeloproliferation in Icsbp-deficient mice because of an expansion of a mature myeloid progenitor cell. Furthermore, Nf1 haploinsufficiency and loss of Icsbp contribute synergistically to progression of the myeloproliferative disorder toward transplantable leukemias. Leukemias are characterized by distinct phenotypes, which correlate with progressive genetic abnormalities. Loss of Nf1 heterozygosity is not mandatory for disease progression, but its occurrence with other genetic abnormalities indicates progressive genetic alterations in a defined subset of leukemias. These data show that loss of the 2 tumor suppressor genes Nf1 and Icsbp synergize in the induction of leukemias.

Description: As recent case reports have suggested that proto-oncogene activation by replication-deficient retroviral vectors may trigger leukemia in mice and men, there is an urgent need for models allowing predictive investigations into the pathomechanisms of this complication. Previously, we have shown that dose-escalated replication-defective retrovirus vectors (such as HaMDR1 or SF91dsRedpre) may trigger combinatorial leukemia-initiating events in single cells, with a probability that allows prospective studies in simple mouse models (C57Bl/6). Meanwhile, we have performed molecular analyses for 5 different leukemias, harboring 6 to 12 vector insertions according to Southern blot. 34 insertions recovered from these clones by LM-PCR and LAM-PCR showed that 4 leukemias had combinatorial hits in at least one established proto-oncogene (class 1 genes: Hivep1, Mllt3, Fli1, HoxA7, Brd2, Evi1, Csfr3, Bcl11a, Ski) with at least one hit in other signaling genes (class 2 genes). One leukemia for which 2 insertions remain to be identified showed at least 3 class 2 hits, so far without a class 1 event. All leukemias presented with hits in genes involved in cytoplasmic signal cascades along with genes contributing to nuclear regulatory networks. Some of these leukemias had a normal karyotype. A comparison with 62 insertion sites from healthy control animals (determined in peripheral blood DNA harvested 7 months after transplantation) revealed a significant enrichment of class 1 hits in leukemias (14-fold over expected and 3-fold over control). Healthy animals still showed 6 hits (~10%) in class 1 genes, obviously not being sufficient for leukemia induction. Three of these occurred upstream of Evi1, one upstream of Nfic, one upstream of Pdclg2, and one in Bcl11a. Interestingly, upstream vector insertion was preferred in class 1 gene hits. Overall, insertions recovered from both normal and leukemic samples revealed an overrepresentation of hits within (or upstream of) known or predicted genes (89 and 90%, respectively). In line with the data of a related murine marking study (Kustikova, Fehse et al., ASH 2004), our study strongly suggests that single hits in class 1 or class 2 genes are not sufficient to induce leukemia in mice. However, certain combinations of such events in single cells may well be leukemogenic with a given latency. Our findings establish a powerful approach for both oncogene discovery and safety validation in gene therapy.

Description: Overexpression of wild-type MN1 is a negative prognostic factor in patients with acute myeloid leukemia (AML) with normal cytogenetics. We evaluated whether MN1 plays a functional role in leukemogenesis. We demonstrate using retroviral gene transfer and bone marrow (BM) transplantation that MN1 overexpression rapidly induces lethal AML in mice. Insertional mutagenesis and chromosomal instability were ruled out as secondary aberrations. MN1 increased resistance to all-trans retinoic acid (ATRA)–induced cell-cycle arrest and differentiation by more than 3000-fold in vitro. The differentiation block could be released by fusion of a transcriptional activator (VP16) to MN1 without affecting the ability to immortalize BM cells, suggesting that MN1 blocks differentiation by transcriptional repression. We then evaluated whether MN1 expression levels in patients with AML (excluding M3-AML) correlated with resistance to ATRA treatment in elderly patients uniformly treated within treatment protocol AMLHD98-B. Strikingly, patients with low MN1 expression who received ATRA had a significantly prolonged event-free (P = .008) and overall (P = .04) survival compared with patients with either low MN1 expression and no ATRA, or high MN1 expression with or without ATRA. MN1 is a unique oncogene in hematopoiesis that both promotes proliferation/self-renewal and blocks differentiation, and may become useful as a predictive marker in AML treatment.

Description: Various neurotrophins (NT) are expressed in the hematopoietic microenvironment to deliver their signals through TRK receptor tyrosine kinases. Although previous reports suggested a transforming potential of activated TRK signaling in hematopoiesis, the target cells and underlying mechanisms are largely unknown. In this study, we investigated in vivo leukemogenesis of ΔTrkA, a mutant of TRKA isolated from a patient with acute myeloid leukemia (AML). Retroviral expression of ΔTrkA in myeloid 32D cells induced AML at ~4 weeks after transplantation into syngeneic C3H/Hej mice (n=11). C57BL/6J mice (n=15) transplanted with ΔTrkA-transduced primary bone marrow cells developed myeloid and/or lymphoid leukemia with infiltration in multiple organs including bone marrow, spleen, liver, lung, and central nervous system. While activation of a tyrosine kinase generally is not sufficient to cause AML, surprisingly, 7 out of 15 C57BL/6J mice developed a polyclonal AML with a latency of 78 days. This suggests that ΔTrkA can also transform long-term repopulating cells with a lymphoid potential. Retroviral insertion site analyses and spectral karyotyping revealed that induction of ALL by ΔTrkA required additional genetic lesions: Leukemic cells showed retroviral insertions in proto-oncogenes Bcl11a and Bcl11b, among others. Characterization of signal transduction demonstrated that PI3K and mTOR-raptor were crucial components of the transforming pathway induced by ΔTrkA. Phospholipase D was an important contributing factor, whereas STAT and MAP kinase pathways were not involved. In summary, our findings reveal potent transforming properties of altered NT receptor signaling in leukemia induction, which are in many respects distinct from other oncogenic tyrosine kinases. We would suggest to further evaluate the role of NT receptor signaling in leukemia pathogenesis, prognosis and treatment.

Description: Abstract 671 Gene therapy with gammaretroviral and lentiviral vectors has shown its potential for the treatment of inherited hematopoietic disorders. However, the occurrence of severe adverse events, namely the induction of leukemias in clinical trails for the treatment of severe combined immunodeficiency (SCID)-X1, chronic granulomatous disease and Wiskott Aldrich Syndrome due to insertional activation of proto-oncogenes by the integrated vector raised safety concerns. Lentiviral vectors are assumed to be safer due to their integration bias to transcription units in comparison to gammaretroviral vectors that have an integration preference to promoter regions and CpG islands. However, the recent report on the development of clonal dominance in a clinical trial for b-thalassemia mediated by deregulated gene expression due to alternative splicing after lentiviral insertion into an intron of HMGA2 highlights potential risks of lentiviral gene therapy. Here we report a case of B-cell lymphoblastic leukemia in a murine bone marrow (BM) transplantation model 199 days post transplantation of cells transduced by a lentiviral vector expressing eGFP from the human glycoprotein-I-b-alpha (GPIba) promoter (-286 to +309 relative to the transcription start site). The mouse developed leukocytosis (179×103/μl white blood cells counts) and leukemic infiltrations were found in the BM, spleen, liver and lung. The leukemia was clonal as determined by Southern blot analysis, derived from the donor cells as determined by the CD45.1 chimerism marker and reinitiated disease in secondary animals (n=7). Leukemic cells had the morphology of lymphoid blasts/progenitors, stained positive for the markers B220, CD43, and partially CD19 and were negative for IgM. We therefore concluded that the cells were arrested and the PrePro-B to Pro-B cell stage. Two lentiviral integrations were identified in the leukemic clone of which one was mapped to intron 8 of the Early B-cell factor 1 (Ebf1) gene, a major regulator of B-cell development. The other insertion site was detected in the first intron of the Nance-Horan-Syndrome-gene that has no known function in hematopoiesis and we could not detect altered expression of this gene. No further genomic alterations were identified by spectral karyotyping and Array CGH analysis. Because the vector contained various splice sites in its backbone and the internal GPIba promoter, we next analyzed potential splice products and detected mRNAs formed from splice events between Ebf1 exons 8 and 9 to the integrated vector. Some of these could result in early termination of the mRNA which would generate a truncated Ebf1 protein containing only the DNA-binding domain. However, the overall contribution of this early stop mRNAs was low (5% of total Ebf1 message) and we could not detect a truncated Ebf1 protein by Western blot. Overexpression of the truncated Ebf1 protein in a B-cell differentiation assay on OP9 cells in vitro did not interfere with B-cell development. In contrast, we found the Ebf1 full length mRNA to be ∼4-fold downregulated and the EBf1 protein in leukemic cells to be reduced compared to stage matched BM B-cell progenitors (CD19+CD43+). Genome wide expression analysis of leukemic cells compared to B-cell progenitors revealed downregulation of Ebf1 target genes and definite signs of transdifferentiation to the myeloid lineage as it was described upon loss of Ebf1 or its downstream target Pax5 in other studies. In addition, Gene Set Enrichment and Gene Ontology analyses suggested upregulation of genes implicated in JAK-STAT signalling. Indeed, we observed strong upregulation of Flt3 and high levels of STAT5 activation, in line with recent reports of B-cell leukemia development in Ebf1+/− mice overexpressing constitutively active STAT5 (Heltemes-Harris et al., J. Exp. Med 2011). STAT5 activation is also found in a large subset of human B-ALL and the occurrence of mono- or bi-allelic EBF1 deletions in human B-ALL is known (Mullighan et al., Nature, 2007). As the lentiviral integration was an early event in the leukemia development in our experiments, haploinsufficiency of Ebf1 will have been most likely the leukemia initiating event. Taken together our results highlight the risk of intragenic lentiviral vector integration of vectors containing splice sites that can induce alternative splicing, which, as shown here, may lead to inactivation of haploinsufficient tumour suppressor genes. Disclosures: Off Label Use: CliniMACS for selection of CD34+ hematopoietic cells.

Description: Activation of the DNA damage response (DDR) was recently claimed to serve as a critical anti−cancer barrier in early human tumorigenesis (Bartkova−J et al., and Gorgoulis−VG et al., Nature, 2005). As a consequence, deregulation of the DDR machinery may be required for tumor manifestation. Myc activation is an oncogenic event frequently detected in malignant lymphomas. It is known that constitutive Myc expression provokes apoptosis via the ARF/p53 pathway as a cellular failsafe mechanism to counteract malignant transformation, but the potential role of Myc signaling to the DDR machinery, mediated via the Atm (ataxia telangiectasia mutated) kinase, as another putative tumor suppressive restraint remains still elusive. Utilizing a tamoxifen−regulatable Myc system as well as RNA interference in vitro, we found in cell−based models that acute induction of Myc, associated with an increased production of reactive oxygen species (ROS) and marks of DNA strand breaks, leads to p53 activation which is mainly mediated by Atm and its upstream regulator PP5. To further examine the role of Atm during Myc−driven tumorigenesis in vivo, we intercrossed Atm knockout mice to Eμ−myc transgenic mice that develop B−cell lymphomas. Lymphomas formed significantly faster in the absence of Atm, mostly due to a significant apoptotic defect in Atm−/− lymphomas compared to Atm+/+ derived (referred to as ‘control’) lymphomas. In accordance with our in vitro findings, we detected significantly elevated levels of ROS−induced oxidative DNA damage and γ−H2AX foci in Myc−driven lymphomas. Importantly, constitutive expression of Myc selected against components of the Atm−governed DDR in a subset of control lymphomas. Like Atm deficiency, these lesions predetermined a poor response in subsequent cytotoxicity assays in vitro and anticancer therapy in vivo, since DNA damaging treatments also produce apoptosis via PP5/Atm. The role for ROS as inducers of DNA damage during the execution of Myc−induced apoptosis was further substantiated by the finding that Eμ−myc transgenic mice continuously exposed to the ROS scavenger N−acetylcysteine (starting prenatally) developed lymphomas with significantly reduced levels of spontaneous apoptosis and with less marks of DNA damage (i.e. γ−H2AX foci), but a retained ability to respond to anticancer therapy in vitro and in vivo. Hence, Atm eliminates pre−neoplastic lesions by converting oncogenic signaling into apoptosis, while selection for an attenuated Atm response permits lymphoma formation, and, in turn, has profound implications for reduced efficacy of DNA damaging therapies.