Cross-talk between chronic lymphocytic leukemia (CLL) tumor B cells and mesenchymal stromal cells (MSCs): implications for neoplastic cell survival

Leukemic cells from Chronic Lymphocytic Leukemia (CLL) patients interact with stromal cells of the surrounding microenvironment. Mesenchymal Stromal Cells (MSCs) represent the main population in CLL marrow stroma, which may play a key role for disease support and progression. In this study we evaluated whether MSCs influence in vitro CLL cell survival. MSCs were isolated from the bone marrow of 46 CLL patients and were characterized by flow cytometry analysis. Following co-culture of MSCs and leukemic B cells, we demonstrated that MSCs were able to improve leukemic B cell viability, this latter being differently dependent from the signals coming from MSCs. In addition, we found that the co-culture of MSCs with leukemic B cells induced an increased production of IL-8, CCL4, CCL11, and CXCL10 chemokines.As far as drug resistance is concerned, MSCs counteract the cytotoxic effect of Fludarabine/Cyclophosphamide administration in vivo, whereas they do not protect CLL cells from the apoptosis induced by the kinase inhibitors Bafetinib and Ibrutinib. The evidence that leukemic clones are conditioned by environmental stimuli suggest new putative targets for therapy in CLL patients

HS1, a Lyn Kinase Substrate, Is Abnormally Expressed in B-Chronic Lymphocytic Leukemia and Correlates with Response to Fludarabine-Based Regimen

In B-Chronic Lymphocytic Leukemia (B-CLL) kinase Lyn is overexpressed, active, abnormally distributed, and part of a cytosolic complex involving hematopoietic lineage cell-specific protein 1 (HS1). These aberrant properties of Lyn could partially explain leukemic cells’ defective apoptosis, directly or through its substrates, for example, HS1 that has been associated to apoptosis in different cell types. To verify the hypothesis of HS1 involvement in Lyn-mediated leukemic cell survival, we investigated HS1 protein in 71 untreated B-CLL patients and 26 healthy controls. We found HS1 overexpressed in leukemic as compared to normal B lymphocytes (1.38±0.54 vs 0.86±0.29, p<0.01), and when HS1 levels were correlated to clinical parameters we found a higher expression of HS1 in poor-prognosis patients. Moreover, HS1 levels significantly decreased in ex vivo leukemic cells of patients responding to a fludarabine-containing regimen. We also observed that HS1 is partially localized in the nucleus of neoplastic B cells. All these data add new information on HS1 study, hypothesizing a pivotal role of HS1 in Lyn-mediated modulation of leukemic cells’ survival and focusing, one more time, the attention on the BCR-Lyn axis as a putative target for new therapeutic strategies in this disorder

Le cellule mesenchimali staminali nella patogenesi della leucemia linfatica cronica di tipo B

B-cell Chronic Lymphocytic Leukemia (B-CLL) is the most common leukemia in adults and is characterized by the accumulation of mature clonal CD5+ B lymphocytes in peripheral blood, bone marrow and lymphoid tissues. The defect in programmed cell death favours the disease progression through a prolonged survival of malignant cells and the induction of the drug-resistance. The defective apoptosis of B-CLL cells is not only due to intrisic defects of the leukemic clone, but also to extrinsic factors that influence its behavior in the tissue microenvironment. Since the accumulation of monoclonal B cells is also supported by their interaction with surrounding cells, we focused our attention on mesenchymal stem cells (MSCs) in order to evaluate their role in survival and localization of neoplastic clone. MSCs can be isolated, expanded with high efficiency and induced to differentiate into multiple mesenchymal lineages under appropriated colture conditions. In addition, they show crucial immunoregulatory properties suppressing several T-, B- and NK-cell functions and affecting dendritic cell activities. In the present study MSCs isolated from the bone marrow of 47 B-CLL patients were expanded ex vivo and characterized through fluocytometric analysis and differentiation coltures (adipocytes and osteocytes). While MSCs from B-CLL patients exhibited normal phenotype and differentiation capacities, when co-coltured with neoplastic B cells they exherted an anti-apoptotic effect reducing lymphocyte apoptosis. After 7 days of colture in presence of CLL-MSC, we observed a relevant extended survival of leukemic cells, but not of normal B lymphocytes. The same effect was observed on B-CLL cells isolated from 3 patients treated with pro-apoptotic compounds, suggesting an involvement of MSCs in drug-resistance. Finally, chemotaxis tests showed the ability of MSCs to produce molecules promoting migration and localization of neoplastic B cells in bone marrow. Taken together, these findings suggest that MSCs derived from patients with B-CLL, despite an apparent normal phenotype and normal differentiation ability, provide survival signals to neoplastic cells extending their lifespan and producing chemotattic factors favouring their accumulation in the bone marrow.La leucemia linfatica cronica di tipo B (LLC-B) è la forma più comune di leucemia nell’adulto ed è caratterizzata dall'accumulo clonale di piccoli linfociti B CD5+ nel sangue periferico, nel midollo osseo e negli organi linfatici, dovuto sia ad un aumento della proliferazione che ad un difetto dei meccanismi di morte cellulare programmata. La resistenza all’apoptosi in questi linfociti favorisce la progressione della malattia attraverso un’aumentata sopravvivenza del clone neoplastico e l’induzione della resistenza ai farmaci citostatici. Tali alterazioni sono imputabili sia a fattori intrinseci che a fattori estrinseci derivanti dal microambiente. Poiché l’aumentata sopravvivenza ed il progressivo accumulo del clone linfocitario risultano selettivamente favoriti dall'interazione con cellule accessorie non tumorali presenti nel microambiente in cui esso risiede, in questa tesi abbiamo focalizzato l’attenzione sulle cellule mesenchimali staminali (MSC), allo scopo di valutare il loro ruolo nella sopravvivenza e nella compartimentalizzazione del clone B leucemico. Le MSC costituiscono una frazione esigua (inferiore allo 0,01%) della popolazione di cellule midollari, sono cellule staminali multipotenti in grado di differenziare in diversi tessuti di origine mesenchimale; sono inoltre dotate di proprietà immunomodulatorie verso linfociti B, T, Natural Killer e cellule dendritiche. In questa tesi le MSC sono state isolate dal sangue midollare di 47 pazienti affetti da LLC-B e sono state caratterizzate fenotipicamente e funzionalmente mediante analisi citofluorimetrica (positività per CD73, CD90 e CD105, negatività per CD31, CD34 e CD45) e colture differenziative (adipociti ed osteociti) confrontandole con MSC di donatori sani. Successivamente si sono allestite co-colture di linfociti B di pazienti affetti da LLC e MSC allo scopo di valutare l’effetto delle MSC sul clone neoplastico di LLC. Le MSC ottenute dai pazienti non hanno presentato alterazioni dal punto di vista fenotipico né funzionale rispetto alle MSC di donatori sani, tuttavia esse hanno sviluppato interazioni capaci di favorire la sopravvivenza del clone leucemico. Gli esperimenti di co-coltura hanno dimostrato infatti che le MSC esercitano un effetto anti-apoptotico sui linfociti B neoplastici, documentato da un aumento significativo della sopravvivenza delle cellule B di LLC dopo 7 giorni di coltura, effetto verificatosi anche con MSC di donatori sani e invece molto meno marcato nei linfociti B normali. Tale attività anti-apoptotica si è osservata, seppur di minore intensità, anche nei linfociti B di pazienti sottoposti a trattamento chemioterapico in vivo con Fludabarina e Ciclofosfamide, suggerendo che le MSC possano essere implicate anche nei meccanismi di chemio resistenza del clone di LLC. Infine l’analisi della migrazione cellulare dei linfociti B patologici in presenza di terreno condizionato derivante dalle colture di MSC ha dimostrato la capacità delle MSC di produrre stimoli chemiotattici in grado di richiamare in sede midollare il clone maligno, ma non i linfociti B normali. I dati riportati suggeriscono che le MSC nei pazienti affetti da LLC-B, sebbene non mostrino alterazioni dal punto di vista fenotipico e funzionale, svolgono un ruolo attivo nel favorire la sopravvivenza e la compartimentalizzazione delle cellule B neoplastiche a livello midollare

Intrinsic and extrinsic mechanisms contribute to maintain the JAK/STAT pathway aberrantly activated in T-type large granular lymphocyte leukemia

The JAK/STAT pathway is altered in T-cell large granular lymphocytic leukemia. In all patients, leukemic LGLs display upregulation of phosphorylated STAT3 (P-STAT3) that activates expression of many antiapoptotic genes. To investigate the mechanisms maintaining STAT3 aberrantly phosphorylated using transcriptional protein and functional assays, we analyzed interleukin (IL)-6 and suppressor of cytokine signaling-3 (SOCS3), 2 key factors of the JAK/STAT pathway that induce and inhibit STAT3 activation, respectively. We showed that IL-6 was highly expressed and released by the patients' peripheral blood LGL-depleted population, accounting for a trans-signaling process. By neutralizing IL-6 or its specific receptor with specific antibodies, a significant reduction of P-STAT3 levels and, consequently, LGL survival was demonstrated. In addition, we found that SOCS3 was down-modulated in LGL and unresponsive to IL-6 stimulation. By treating neoplastic LGLs with a demethylating agent, IL-6-mediated SOCS3 expression was restored with consequent P-STAT3 and myeloid cell leukemia-1 down-modulation. Methylation in the SOCS3 promoter was not detectable, suggesting that an epigenetic inhibition mechanism occurs at a different site. Our data indicate that loss of the inhibitor SOCS3 cooperates with IL-6 to maintain JAK/STAT pathway activation, thus contributing to leukemic LGL survival, and suggest a role of demethylating agents in the treatment of this disorder

Craniosynostosis, hydrocephalus, Chiari I malformation and radioulnar synostosis: Probably a new syndrome

We report on clinical and molecular findings of two brothers that both presented with sagittal craniosynostosis, hydrocephalus, Chiari I malformation, blepharophimosis, small low-set ears, hypoplastic philtrum, radioulnar synostosis, kidney malformation, and hypogenitalism. Their father presented mild brachydactyly. Conventional cytogenetic and array CGH screening did not show any chromosomal gains or losses. Furthermore, molecular genetic screening of genes involved in different craniosynostosis syndromes, namely FGFR1, FGFR2, FGFR3, TWIST, RECQL4, and POR genes failed to detect any mutations in genomic DNA. The unique range of clinical manifestations in these two patients and the negative findings of the molecular genetic screening suggest the hypothesis of a previously unrecognized syndrome