ALBERT

Description: A functional BCR is essential for survival of normal B-cells, in response to cognate antigen or tonic, antigen-independent stimuli. Cross-linking of BCR by antigen triggers key phosphorylation events in the early signalosome. Mammalian wild type BRAF, a member of the RAF cytosolic kinase family (A-RAF, B-RAF, C-RAF) is critical to BCR function, mediating RAS-RAF-MEK-ERK or mitogen-activated protein kinase (MAPK) pathway signal transduction, via phosphorylation of ERK1/2. The MAPK pathway is a central conduit for survival and proliferation. Importantly, use of inducible deletion models have shown that wild type BRAF is the predominant kinase that transduces BCR signals to activate ERK1/2, with C-RAF playing an accessory role and A-RAF displaying a x20-30 fold lower basal activity in ERK1/2 stimulation. Tonic BCR survival signals in normal B-cells are also transduced via phosphorylation of ERK1/2, but do not require antigen stimuli. Whether the BCR plays a comparable role in sustaining survival in malignant B-cells is less well characterized and remains a central question in understanding the origins and progression of mature B-cell neoplasms. Hairy cell leukaemia (HCL) is a rare B cell leukaemia with characteristic hair-like cytoplasmic projections on tumor cells, displaying distinctive activation markers. A striking feature of monoclonal HCL tumors is expression of multiple variant immunoglobulin heavy chain (sIgH) isotypes as components of the BCR on individual tumor cells, defining the major subset of disease (mult-HCL). Most mult-HCL tumors exhibit IGV somatic hypermutation with a low level of on-going mutations and AID expressed, implicating initial contact with antigen via the BCR. The functional relevance of the BCR to transformation and survival however has as yet not been mapped in HCL. Seminal exome sequencing data in typical HCL identified mutant BRAF V(600)E as almost universal in this tumor. Consistent with mutant BRAFV(600)E, levels of phosphorylated ERK (p-ERK) are raised in hairy cells. As there is an essential requirement for wild type BRAF in transducing BCR signals, the question arises how mutant BRAF may affect BCR function in HCL, given requirements for dimerization of wild type BRAF for ERK1/2 activation, and whether ERK1/2 activation can be enhanced by functional BCR signals for downstream effector signals in HCL. To examine this, we evaluated BCR signalling in mult-HCL (n=10), in cases uniformly displaying mutated BRAF and IGHV genes. Two apparent functional sets were delineated by IgD co-expression. In sIgD+ mult-HCL, IgD mediated persistent Ca2+ flux, which was also evident via 〉1 sIgH isotype, linked to increased ERK1/2 activation and BCR endocytosis (4/4 cases). In sIgD-vemult-HCL however (6/6 cases), BCR-mediated signals activating ERK1/2 for downstream effects were restricted to a single sIgH isotype, with sIgM notably dysfunctional and remaining immobilised on the cell surface. These observations reveal a clear discordance between expression and function of individual isotypes in mult-HCL. In dual sIgL expressing mult-HCL (3/3 cases), only a single sIgL was fully functional. We next examined effects of anti-BCR stimuli on mult-HCL tumor cell survival ex-vivo. Significantly, all functional non-IgD isotypes increased ERK1/2 phosphorylation but triggered apoptosis of tumor cells, in both sets (4/4 cases) to establish a consistent outcome in these replicate cases. IgD stimuli, in marked contrast retained tumor viability with no evidence for pre-apoptotic effects (2 cases; 1 mult-HCL and 1 sIgD only-HCL). Despite mutant BRAF, BCR signals amplify ERK1/2 phosphorylation, but isotype dictates functional downstream outcomes. In mult-HCL lacking IgD, a role for antigen in stimulating the BCR for tumor persistence appears unlikely. It remains feasible that mutant BRAF in these cases retains tonic signals through activated ERK1/2 for survival, but this remains speculative at present. Surface IgD emerges with potential to transduce BCR signals for tumor survival and persistence in-vivo, but given its enigmatic role even in normal B-cells, its relevance to HCL progression is unclear. These observations raise the possibility that mutant BRAF may be a mechanism to bypass any antigen-dependent BCR signalling constraints in mult-HCL. Disclosures: No relevant conflicts of interest to declare.

Description: An unusual group of human B-cell tumors with cellular features of chronic lymphocytic leukemia or lymphoplasmacytoid leukemia, together with high levels of a monoclonal IgG serum protein, has been investigated. Analysis of tumor-derived VH genes of neoplastic B lymphocytes was used to determine the clonal relationship between the IgM expressed or secreted by the tumor cells and the IgG serum paraprotein. In all five cases, VH gene sequences showed transcripts of IgM and IgG of common clonal origin. Sequences were derived from VH3 (4 of 5) and VH1 (1 of 5) families and were all highly somatically mutated with strong evidence for antigen selection. There was no intraclonal variation detectable in either IgM or IgG sequences. In 3 of 5 cases, in which monoclonal IgM and IgG were found in serum, the VH genes combined to Cμ or Cγ showed identical mutational patterns. However, in 2 of 5 cases, in which IgM was confined to cell expression with only monoclonal IgG in serum, sequences of the VH transcripts of IgM and IgG showed many shared mutations but also numerous differences. In these cases, the level of mutation was similar in IgM and IgG and both appeared to be antigen selected. In summary, the final neoplastic event in this group of tumors has apparently occurred at the point of isotype switch from IgM to IgG, leading to dual isotype synthesis. In the group that secreted both isotypes, the mutation pattern was identical, indicating either synthesis by a single cell, or silencing of mutational activity before switching. In the group that did not secrete IgM, cells of each isotype were distinct and reflected a divergent mutational history.

Description: An unusual group of human B-cell tumors with cellular features of chronic lymphocytic leukemia or lymphoplasmacytoid leukemia, together with high levels of a monoclonal IgG serum protein, has been investigated. Analysis of tumor-derived VH genes of neoplastic B lymphocytes was used to determine the clonal relationship between the IgM expressed or secreted by the tumor cells and the IgG serum paraprotein. In all five cases, VH gene sequences showed transcripts of IgM and IgG of common clonal origin. Sequences were derived from VH3 (4 of 5) and VH1 (1 of 5) families and were all highly somatically mutated with strong evidence for antigen selection. There was no intraclonal variation detectable in either IgM or IgG sequences. In 3 of 5 cases, in which monoclonal IgM and IgG were found in serum, the VH genes combined to Cμ or Cγ showed identical mutational patterns. However, in 2 of 5 cases, in which IgM was confined to cell expression with only monoclonal IgG in serum, sequences of the VH transcripts of IgM and IgG showed many shared mutations but also numerous differences. In these cases, the level of mutation was similar in IgM and IgG and both appeared to be antigen selected. In summary, the final neoplastic event in this group of tumors has apparently occurred at the point of isotype switch from IgM to IgG, leading to dual isotype synthesis. In the group that secreted both isotypes, the mutation pattern was identical, indicating either synthesis by a single cell, or silencing of mutational activity before switching. In the group that did not secrete IgM, cells of each isotype were distinct and reflected a divergent mutational history.

Description: The t(14;18) translocation is a hallmark of follicular lymphoma (FL) but has been reported to occur ~ in 20% of de novo (primary) diffuse large B-cell lymphomas (DLBCL). To determine the cell of origin in de novo t(14;18)+ DLBCL, both phenotype, defined by germinal center B cell-like (GCB) / non-GCB criteria, and Ig VH gene usage were determined in 9 previously untreated primary cases. Each of the cases was carefully reviewed and selected by the absence of any prior history of FL. Cases with additional translocations detected by conventional cytogenetic analysis involving BCL-6 (3q27) or c-MYC (8q24) were excluded. In the 9 selected cases, there was no evidence for follicular structures identifiable by morphology or by immunostaining for follicular dendritic cells (CNA42 and CD23), and all cases were classified as centroblastic. Immunohistochemical data revealed expression of BCL-2 and BCL-6 in 9/9 (100%) cases. Immunostaining for CD10, BCL-6 and MUM1 defined 8/9 cases (88%) as GCB and 1/9 as non-GCB. Of these, 4/9 cases (44%) co-expressed BCL-6 and MUM-1, indicating that the expression of the two proteins is not mutually exclusive. The proliferation index assessed by Ki-67 expression was 〉 50% in 7/9 cases. BCL-2, BCL-6, AID and c-MYC genes expression were further assessed by real time PCR assays in the 9 t(14;18) + DLBCL cases and compared with 14 cases of typical t(14;18)+ FL. No significant difference was observed in the mean levels of expression of BCL-2 (0.64, range 0.12 to 2.11), BCL-6 (1.03, range 0.05 to 4.08), c-MYC (1.96, range 0.77 to 6) or AID (0.76, range 0.03 to 3.22) between the two lymphoma cohorts. VH gene usage was identified in 9 t(14; 18) + DLBCL cases by RT-PCR assays using a mix of VH leader and JH primers, with the amplified DNA cloned for analysis. VH3 usage was common (3 VH3-23, 2 VH3-72, 2 VH3-48, 2 VH3-07, 1VH3-74). In 9/9 cases, VH genes were invariably somatically mutated, and all were potentially functional. The average mutational load was high and ranged from 8.4 to 24.4% deviation in homology to germline. Evidence for a low level of ongoing somatic mutation, observed as intraclonal heterogeneity, was apparent in 2/9 cases (7 to 10 clones analysed/case). Strikingly, somatic mutations yielded potential N-glycosylation sites identified as Asn-X-Ser/Thr motifs in 7/9 (78%) tumor-derived VH genes, a frequency significantly elevated above levels reported both in normal B cells (9%) and in randomly analysed DLBCL cases (44%), but directly comparable to the frequency of acquired glycosylation sites described in t(14;18) FL (79%). Of the acquired glycosylation motifs in t(14;18)+ DLBCL here, 6/7 (86%) were located in the CDR3 domain, suggestive of positive selection. No correlation was observed between VH mutational load and BCL-6, AID, c-MYC or BCL-2 gene expression. To conclude, the predominant GCB phenotype and, more importantly, generation of novel glycosylation sites in VH genes by somatic mutations provide compelling evidence for a common cell of origin linking evolution of de novo t(14;18)+ DLBCL and t (14;18)+ FL.

Description: In multiple myeloma, sequence studies of VH genes used to encode clonal Ig in neoplastic plasma cells have shown a common pattern of extensive somatic hypermutation. A further consistent feature of these VH sequences is a complete lack of intraclonal variation. These findings indicate that the malignant cell arises at a mature, postfollicular stage of B-cell development. However, only a minority of cases have a distribution of somatic mutations in VH consistent with a prior role for antigen in selecting the B cell of origin. To complement these studies, and to take further the investigation of a role for antigen in the clonal history of myeloma, we have investigated tumor-derived VL sequences from bone marrows of 15 patients. All sequences (9Vκ and 6Vλ) were potentially functional and 5 of 15 had evidence for N-region additions. All had undergone extensive somatic hypermutation, and showed no intraclonal variation. In 4 of 15 cases, the distribution of mutations revealed a significant (P 〈 .05) clustering of replacement mutations in the CDR sequences, indicating a role for VL in selection by antigen. Comparison with the VH sequences used by the same tumor cells showed that, if significant clustering was present, it was in either VH or VL, but not both. Altogether, 10 of 15 V-regions showed evidence for antigen selection, suggesting that the B cell of origin has behaved as a normal germinal center B cell. Deductions concerning a role for antigen selection may require both VH and VL sequences for validation.

Description: Monoclonal gammopathy of undetermined significance (MGUS) can transform to multiple myeloma (MM). In myeloma, mutated VHgenes with sequence homogeneity reveal a postfollicular origin. Previously, some MGUS cases showed mutated VH genes with intraclonal variation, indicating an earlier stage of arrest. We investigated progression from 2 of 2 MGUS to MM, in which VH genes confirmed clonal evolution. In one MGUS case, intraclonal heterogeneity was evident, and transformation to myeloma occurred rapidly with apparent homogeneity in the emergent clone. However, residual MGUS-derived sequences were detectable at this time. Heterogeneity in MGUS does not associate with benign disease, but it indicates an origin from a tumorigenic cell, most likely surface immunoglobulin+, undergoing somatic mutation. The remaining case displayed intraclonal homogeneity at the MGUS stage, conceivably resulting from a self-cloning outgrowth from MGUS with heterogeneity. Transformation can occur at either MGUS stage, but it involves a single cell in which somatic mutation is then silent.

Description: IgM-secreting plasma cell tumors are rare variants of typical isotype-switched multiple myeloma with a similar disease outcome. To probe the origin and clonal history of these tumors, we have analyzed VH gene sequences in 6 cases. Potentially functional tumor-derived VH genes were all derived from VH3, with the V3-7 gene segment being used by 4 of 6. All were somatically mutated, with a mean deviation from germline sequence of 5.2% (range, 3.1% to 7.1%). The distribution of replacement mutations was consistent with antigen selection in 4 of 6 cases, and no intraclonal heterogeneity was observed. Clonally related switched isotype transcripts were sought in 4 cases, and Cγ transcripts with tumor-derived CDR3 sequence were identified in 2 of 4. These findings indicate that IgM-secreting myelomas are arrested at a postfollicular stage at which somatic mutation has been silenced. Isotype switch variants show the cell of origin to be at the IgM to IgG switch point. These features indicate that the final neoplastic event has occurred at a stage immediately before that of typical isotype-switched myeloma. One possibility is that IgM myeloma involves the previously identified precursor cell of typical myeloma.

Description: In multiple myeloma, sequence studies of VH genes used to encode clonal Ig in neoplastic plasma cells have shown a common pattern of extensive somatic hypermutation. A further consistent feature of these VH sequences is a complete lack of intraclonal variation. These findings indicate that the malignant cell arises at a mature, postfollicular stage of B-cell development. However, only a minority of cases have a distribution of somatic mutations in VH consistent with a prior role for antigen in selecting the B cell of origin. To complement these studies, and to take further the investigation of a role for antigen in the clonal history of myeloma, we have investigated tumor-derived VL sequences from bone marrows of 15 patients. All sequences (9Vκ and 6Vλ) were potentially functional and 5 of 15 had evidence for N-region additions. All had undergone extensive somatic hypermutation, and showed no intraclonal variation. In 4 of 15 cases, the distribution of mutations revealed a significant (P 〈 .05) clustering of replacement mutations in the CDR sequences, indicating a role for VL in selection by antigen. Comparison with the VH sequences used by the same tumor cells showed that, if significant clustering was present, it was in either VH or VL, but not both. Altogether, 10 of 15 V-regions showed evidence for antigen selection, suggesting that the B cell of origin has behaved as a normal germinal center B cell. Deductions concerning a role for antigen selection may require both VH and VL sequences for validation.