SEPT10 expression in chronic lymphocytic leukemia. Correlation with clinical and biological prognostic factors

Chronic lymphocytic leukemia (CLL) is characterized by a highly variable clinical course. Microarray studies allowed highlight genes differentially expressed in this pathology. In this study, we have evaluated the prognostic significance of SEPT10 expression in CLL patients. Results were correlated with immunoglobulin heavy-chain variable (IGHV) genes mutational status, genomic rearrangements and clinical parameters. SEPT10 mRNA levels were determined by quantitative real-time PCR in 70 newly diagnosed CLL patients consecutively referred to our Institution. A wide heterogeneity for SEPT10 expression was found. Gene upregulation was observed in 18.5% of cases. The univariate analysis showed a positive association between gen expression and platelet count (p < 0.0001) and a negative correlation with hemoglobin levels (p = 0.0094). Although no significant differences were observed, mean treatment free survival was shorter in patients with high expression (31 months) with respect to those with low mRNA levels (72 months). Cases with abnormal karyotypes had increased expression compared to those with normal karyotypes and no association between gene expression and FISH (fluorescence in situ hybridization) risk groups and IGHV mutational status was found. Cases using IGHV3-23 gene rearrangement had low SEPT10 expression. Our results showed an association between SEPT10 expression and features of adverse outcome but without independent prognostic value. The study of SEPT10 expression may be important for a better understanding of disease heterogeneity, adding further information to those provided by established prognostic factors.Fil: Travella, Ana Carolina. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; Argentina. Academia Nacional de Medicina de Buenos Aires; ArgentinaFil: Panero, Julieta. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; Argentina. Academia Nacional de Medicina de Buenos Aires; ArgentinaFil: Stanganelli, Carmen Graciela. Academia Nacional de Medicina de Buenos Aires. Instituto de Investigaciones Hematológicas "Mariano R. Castex"; ArgentinaFil: Bezares, Raimundo F.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Dr. Teodoro Álvarez"; ArgentinaFil: Slavutsky, Irma Rosa. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; Argentina. Academia Nacional de Medicina de Buenos Aires; Argentin

Dysregulation of H/ACA ribonucleoprotein components in chronic lymphocytic leukemia

Telomeres are protective repeats of TTAGGG sequences located at the end of human chromosomes. They are essential to maintain chromosomal integrity and genome stability. Telomerase is a ribonucleoprotein complex containing an internal RNA template (hTR) and a catalytic subunit (hTERT). The human hTR gene consists of three major domains; among them the H/ACA domain is essential for telomere biogenesis. H/ACA ribonucleoprotein (RNP) complex is composed of four evolutionary conserved proteins, including dyskerin (encoded by DKC1 gene), NOP10, NHP2 and GAR1. In this study, we have evaluated the expression profile of the H/ACA RNP complex genes: DKC1, NOP10, NHP2 and GAR1, as well as hTERT and hTR mRNA levels, in patients with chronic lymphocytic leukemia (CLL). Results were correlated with the number and type of genetic alteration detected by conventional cytogenetics and FISH (fluorescence in situ hybridization), IGHV (immunoglobulin heavy chain variable region) mutational status, telomere length (TL) and clinico pathological characteristics of patients. Our results showed significant decreased expression of GAR1, NOP10, DKC1 and hTR, as well as increased mRNA levels of hTERT in patients compared to controls (p=0.04). A positive correlation between the expression of GAR1-NHP2, GAR1-NOP10, and NOP10-NHP2 (p=0.0001), were observed. The analysis taking into account prognostic factors showed a significant increased expression of hTERT gene in unmutated-IGHV cases compared to mutated-CLL patients (p = 0.0185). The comparisons among FISH groups exhibited increased expression of DKC1 in cases with two or more alterations with respect to no abnormalities, trisomy 12 and del13q14, and of NHP2 and NOP10 compared to those with del13q14 (p = 0.03). The analysis according to TL showed a significant increased expression of hTERT (p = 0.0074) and DKC1 (p = 0.0036) in patients with short telomeres compared to those with long TL. No association between gene expression and clinical parameters was found. Our results suggest a role for these telomere associated genes in genomic instability and telomere dysfunction in CLL.Fil: Dos Santos, Patricia Carolina. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Panero, Julieta. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Stanganelli, Carmen Graciela. Academia Nacional de Medicina de Buenos Aires. Instituto de Investigaciones Hematológicas "Mariano R. Castex"; ArgentinaFil: Palau Nagore, Maria Virginia. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Stella, Flavia. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Bezares, Raimundo F.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Dr. Teodoro Álvarez"; ArgentinaFil: Slavutsky, Irma Rosa. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; Argentin

Ibrutinib impairs the phagocytosis of rituximab-coated leukemic cells from chronic lymphocytic leukemia patients by human macrophages

We have read with great interest the recent article of Kohrt, H.E. et al1 showing that Ibrutinib prevented NK cell mediated cytotoxicity of antibody-coated CLL cells in vitro. They also found that the concurrent treatment with Ibrutinib and rituximab or trastuzumab reduces the therapeutic efficacy of both anti-CD20 antibodies in a mouse model, while the sequential treatment with Ibrutinib and rituximab restored its anti-lymphoma activity. Since macrophages are the most important effector cells in CD20-directed cytotoxicity in murine models2,3 and they probably play a key role in human anti-CD20 therapy4,5, we determined whether Ibrutinib interferes the capacity of human macrophages to mediate phagocytosis of rituximab-coated CLL cells. To address this issue, macrophages differentiated from healthy peripheral blood monocytes were treated with or without Ibrutinib for 30 minutes and then cultured for 1, 2 or 3 hours with CFSE-labeled CLL cells or rituximab-coated CFSE-labeled CLL cells. Then, cells were tripsinized and the proportion of macrophages that have taken up CFSE-labeled CLL cells (CFSE+ macrophages) were scored by flow cytometry and verified using confocal microscopy, as previously described6. As expected, we found that the cultures with rituximab-coated CLL cells showed the highest percentage of CFSE+ macrophages, which increase in a time dependent manner (open circles in Figure 1A). Ibrutinib was able to reduce these values in all the times evaluated (solid circles in Figure 1A). Low percentages of CFSE+ macrophages were obtained in cultures with uncoated CLL cells, which were not modified by Ibrutinib (open and solid squares in Figure 1A). In addition, we found that Ibrutinib diminishes the percentage of CFSE+ macrophages in the cultures with rituximab-coated cells in a dose dependent manner (Figure 1B), which was not associated to a decreased viability of the macrophages (not shown). Moreover, the inhibitory effect of Ibrutinib was not limited to rituximab since comparable results were obtained when campath-coated CFSE-labeled CLL cells were employed (Figure 1C). Similar results were found when macrophages from CLL patients were used: mean±SE of the % of CFSE+ macrophages: 26.8 ± 2.1 vs, 17.3 ± 2.7 vs 10.8 ± 0.7 for rituximab-coated CFSE-labeled CLL cells alone, with 0.5μM or 5μM of Ibrutinib (n= 6). Representative dot plots are shown in Figure 1D. The results obtained by flow cytometry analysis were validated by confocal microscopy quantifying the number of macrophages that engulfed at least one tumor target cell (Figure 1E). A representative experiment is shown in Figure 1F. In addition, by performing a binding assay at 4oC, we confirmed that Ibrutinib did not reduce the binding of rituximab-coated CFSE-labeled CLL cells to macrophages (Figure 1G). Interestingly, while the presence of Ibrutinib during the assay impairs the phagocytosis of rituximab-coated CLL cells, when Ibrutinib was washed out, macrophages recovered their phagocytic capacity in a time-dependent manner (Figure 1H). In conclusion we found that the presence of Ibrutinib impairs the phagocytosis of rituximab-opsonized CLL cells by human macrophages, which was restored when the inhibitor was removed from the cultures. Our results, and those obtained by Kohrt et al1 suggest that the sequential administration of Ibrutinib followed by rituximab, and not the concurrent treatment of the patients with these agents, might enhance their anti-tumor activity in vivo.Fil: Borge, Mercedes. Universidad de Buenos Aires. Facultad de Medicina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Almejún, María Belén. Universidad de Buenos Aires. Facultad de Medicina. Departamento de Microbiología. Cátedra de Microbiología, Parasitología e Inmunología; ArgentinaFil: Podaza, Enrique Arturo. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Colado, Ana. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Fernández Grecco, Horacio. Sanatorio Municipal Dr. Julio Méndez; ArgentinaFil: Cabrejo, María. Sanatorio Municipal Dr. Julio Méndez; ArgentinaFil: Bezares, Raimundo F.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos ; ArgentinaFil: Giordano, Mirta Nilda. Universidad de Buenos Aires. Facultad de Medicina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Gamberale, Romina. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; Argentina. Universidad de Buenos Aires. Facultad de Medicina; Argentin

Anomalías cromosómicas estructurales nuevas en leucemia linfocítica crónica. Su valor pronóstico

El análisis citogenético permite la detección de anomalías estructurales (AE) que pasan desapercibidas con la técnica de FISH (fluorescence in situ hybridization). En este trabajo se analizaron 34 pacientes con leucemia linfocítica crónica (LLC) portadores de anomalías estructurales (AE) clonales y un grupo control de 78 pacientes sin alteraciones. Se realizó estudio cromosómico por bandeo G complementado con FISH, y análisis molecular del estado mutacional de IGVH y de la expresión de los genes LPL y ADAM-29. Se detectaron 16 casos (47%) con AE nuevas. El cromosoma 8 fue el más implicado con 7 alteraciones, seguido por los pares 13 (6), 12 (5) y 15 (4). Se observó una similar distribución de AE entre los pacientes con IGVH mutado y no mutado. Los casos con AE mostraron una tendencia a mayor expresión de LPL y menor de ADAM-29. Se encontraron diferencias significativas en el recuento de blancos (p=0,019), plaquetas (p=0,002), LDH (p=0,029) y sobrevida libre de tratamiento (13 meses) en los pacientes con AE nuevas respecto de controles (69 meses) (p=0,087). Los resultados obtenidos confirman el pronóstico adverso de las AE en pacientes con LLC reforzando la importancia del análisis citogenético en esta patología.Fil: Travella, Ana Carolina. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Bezares, Raimundo F.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Dr. Teodoro Álvarez"; ArgentinaFil: Rodriguez, Andrea. Academia Nacional de Medicina de Buenos Aires; ArgentinaFil: Slavutsky, Irma Rosa. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; Argentin

Anomalías cromosómicas estructurales nuevas en leucemia linfocítica crónica. Su valor pronóstico

El análisis citogenético permite la detección de anomalías estructurales (AE) que pasan desapercibidas con la técnica de FISH (fluorescence in situ hybridization). En este trabajo se analizaron 34 pacientes con leucemia linfocítica crónica (LLC) portadores de anomalías estructurales (AE) clonales y un grupo control de 78 pacientes sin alteraciones. Se realizó estudio cromosómico por bandeo G complementado con FISH, y análisis molecular del estado mutacional de IGVH y de la expresión de los genes LPL y ADAM-29. Se detectaron 16 casos (47%) con AE nuevas. El cromosoma 8 fue el más implicado con 7 alteraciones, seguido por los pares 13 (6), 12 (5) y 15 (4). Se observó una similar distribución de AE entre los pacientes con IGVH mutado y no mutado. Los casos con AE mostraron una tendencia a mayor expresión de LPL y menor de ADAM-29. Se encontraron diferencias significativas en el recuento de blancos (p=0,019), plaquetas (p=0,002), LDH (p=0,029) y sobrevida libre de tratamiento (13 meses) en los pacientes con AE nuevas respecto de controles (69 meses) (p=0,087). Los resultados obtenidos confirman el pronóstico adverso de las AE en pacientes con LLC reforzando la importancia del análisis citogenético en esta patología.Fil: Travella, Ana Carolina. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Bezares, Raimundo F.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Dr. Teodoro Álvarez"; ArgentinaFil: Rodriguez, Andrea. Academia Nacional de Medicina de Buenos Aires; ArgentinaFil: Slavutsky, Irma Rosa. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; Argentin

Neutrophils from chronic lymphocytic leukemia patients exhibit an increased capacity to release extracellular traps (NETs)

Chronic lymphocytic leukemia (CLL) is characterized by immune defects that contribute to a high rate of infections and autoimmune cytopenias. Neutrophils are the first line of innate immunity and respond to pathogens through multiple mechanisms, including the release of neutrophil extracellular traps (NETs). These web-like structures composed of DNA, histones, and granular proteins are also produced under sterile conditions and play important roles in thrombosis and autoimmune disorders. Here we show that neutrophils from CLL patients are more prone to release NETs compared to those from age-matched healthy donors (HD). Increased generation of NETs was not due to higher levels of elastase, myeloperoxidase, or reactive oxygen species production. Instead, we found that plasma from CLL patients was able to prime neutrophils from HD to generate higher amounts of NETs upon activation. Plasmatic IL-8 was involved in the priming effect since its depletion reduced plasma capacity to enhance NETs release. Finally, we found that culture with NETs delayed spontaneous apoptosis and increased the expression of activation markers on leukemic B cells. Our study provides new insights into the immune dysregulation in CLL and suggests that the chronic inflammatory environment typical of CLL probably underlies this inappropriate neutrophil priming.Fil: Podaza, Enrique Arturo. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Sabbione, Florencia. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Risnik, Denise Mariel. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Borge, Mercedes. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Almejún, María Belén. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Fisiología, Biología Molecular y Celular; ArgentinaFil: Colado, Ana. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Fernández Grecco, Horacio. Servicio de Hematología, Sanatorio Municipal Dr. Julio Méndez; ArgentinaFil: Cabrejo, María del Rosario. Servicio de Hematología, Sanatorio Municipal Dr. Julio Méndez; ArgentinaFil: Bezares, Raimundo F.. Servicio de Hematología, Hospital Municipal Dr. Teodoro Alvarez; ArgentinaFil: Trevani, Analía Silvina. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; Argentina; ArgentinaFil: Gamberale, Romina. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Giordano, Mirta Nilda. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; Argentin

Expression and function of cathelicidin hCAP18/LL-37 in chronic lymphocytic leukemia

Chronic lymphocytic leukemia (CLL) is characterized by the accumulation of clonal Bcellsin peripheral blood and lymphoid tissues 1. Circulating CLL cells are non-dividing Blymphocytes, but a significant fraction of the clone proliferates in lymphoid tissues wherethey receive a plethora of signals from the microenvironment that promote their survivaland expansion 2. Cathelicidins are a family of proteins with antibacterial functions mainlyexpressed by neutrophils, macrophages and epithelial cells 3. In humans, the only memberof this family, hCAP18, is encoded by the gene CAMP. The cleavage of hCAP18 generatesthe antimicrobial peptide LL-37, which has been recently implicated in the promotion oftumor growth, through direct stimulation of malignant cells, initiation of angiogenesis andrecruitment of immune cells 4. In this study, we investigated the role of hCAP18/LL-37 inCLL.Fil: Podaza, Enrique Arturo. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Palacios, Florencia. The Feinstein Institute for Medical Research. Karches Center for Oncology Research; Estados UnidosFil: Croci Russo, Diego Omar. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza. Instituto de Histología y Embriología de Mendoza Dr. Mario H. Burgos. Universidad Nacional de Cuyo. Facultad de Ciencias Médicas. Instituto de Histología y Embriología de Mendoza Dr. Mario H. Burgos; ArgentinaFil: Risnik, Denise Mariel. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Yan, Xiao J.. The Feinstein Institute for Medical Research. Karches Center for Oncology Research; Estados UnidosFil: Almejún, María Belén. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Colado, Ana. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Elías, Esteban Enrique. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Borge, Mercedes. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Morande, Pablo Elías. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Bezares, Raimundo F.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Dr. Teodoro Álvarez"; ArgentinaFil: Fernández Grecco, Horacio. Sanatorio Municipal Dr. Julio Méndez. Servicio de Hematología; ArgentinaFil: Rabinovich, Gabriel Adrián. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental. Fundación de Instituto de Biología y Medicina Experimental. Instituto de Biología y Medicina Experimental; ArgentinaFil: Gamberale, Romina. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Chiorazzi, Nicholas. The Feinstein Institute for Medical Research. Karches Center for Oncology Research; Estados UnidosFil: Giordano, Mirta Nilda. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; Argentin

Síndromes linfoproliferativos crónicos

El objetivo de la presente guía es confeccionar pautas de diagnóstico y tratamiento de los síndromes linfoproliferativos, teniendo en cuenta las recomendaciones de expertos así como las publicaciones internacionales relacionadas al tema, la disponibilidad de recursos locales y la experiencia de los especialistas convocados. La misma contempla: establecer pautas diagnósticas, clasificar y establecer factores pronósticos, unificar recomendaciones terapéuticas y contribuir a la toma de decisiones terapéuticas.Fil: Bezares, Raimundo F.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Dr. Teodoro Álvarez"; ArgentinaFil: Bistmas, Alicia. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; ArgentinaFil: Borge, Mercedes. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Cabrejo, María del Rosario. Sanatorio Méndez; ArgentinaFil: Custidiano, Rosario. Instituto Alexander Fleming.; ArgentinaFil: Dupont, Juan. Centro de Educaciones Médicas e Investigación Clínica "Norberto Quirno"; ArgentinaFil: Ferini, Gonzalo. Hospital Italiano; ArgentinaFil: Fernandez Grecco, Horacio. No especifíca;Fil: Gamberale, Romina. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Giordano, Mirta Nilda. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Kornblihtt, Laura Inés. Hospital de Clínicas, Uba; ArgentinaFil: Kruss, Mariana. Hospital Italiano; ArgentinaFil: Miroli, Augusto. Hospital Italiano; ArgentinaFil: Pavlovsky, Miguel A.. Fundación Para Combatir la Leucemia; ArgentinaFil: Riveros, Dardo Alberto. Centro de Educaciones Médicas e Investigación Clínica "Norberto Quirno"; ArgentinaFil: Rodríguez, Cecilia. Gobierno de la Provincia de Cordoba. Hospital de Clinicas.; ArgentinaFil: Slavutsky, Irma Rosa. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; Argentin

Venetoclax resistance induced by activated T cells can be counteracted by sphingosine kinase inhibitors in chronic lymphocytic leukemia

The treatment of chronic lymphocytic leukemia (CLL) patients with venetoclax-based regimens has demonstrated efficacy and a safety profile, but the emergence of resistant cells and disease progression is a current complication. Therapeutic target of sphingosine kinases (SPHK) 1 and 2 has opened new opportunities in the treatment combinations of cancer patients. We previously reported that the dual SPHK1/2 inhibitor, SKI-II enhanced the in vitro cell death triggered by fludarabine, bendamustine or ibrutinib and reduced the activation and proliferation of chronic lymphocytic leukemia (CLL) cells. Since we previously showed that autologous activated T cells from CLL patients favor the activation of CLL cells and the generation of venetoclax resistance due to the upregulation of BCL-XL and MCL-1, we here aim to determine whether SPHK inhibitors affect this process. To this aim we employed the dual SPHK1/2 inhibitor SKI-II and opaganib, a SPHK2 inhibitor that is being studied in clinical trials. We found that SPHK inhibitors reduce the activation of CLL cells and the generation of venetoclax resistance induced by activated T cells mainly due to a reduced upregulation of BCL-XL. We also found that SPHK2 expression was enhanced in CLL cells by activated T cells of the same patient and the presence of venetoclax selects resistant cells with high levels of SPHK2. Of note, SPHK inhibitors were able to re-sensitize already resistant CLL cells to a second venetoclax treatment. Our results highlight the therapeutic potential of SPHK inhibitors in combination with venetoclax as a promising treatment option for the patients

Tratamiento de la leucemia linfática crónica.La historia se repite.

Treatment in chronic lymphocytic leukemia (CLL) represents the paradigm of advances in the therapy for hematological malignancies. In the last 10 years, the increased knowledge on the mechanisms of tumor progression, crosstalk with the microenvironment, molecular biology and cytogenetic breakthroughs became the fundamental pieces of these advances.However, therapeutic strategies seem to follow the same pattern. Whereas early therapy used single drugs, they were gradually combined in duplets and triplets leading to successful results that had never been achieved and envisioning for the first time a future full of hope for this incurable disease.The development of ibrutinib has been probably the milestone that definitely highlighted the importance of signaling pathways in CLL progression and opens the investigation of novel target agents which constitute the current treatment of this disease. Today, we have a plethora of new drugs that, as in their early stages, went from being used as monotherapy to being tested in combinations with optimal results, even in high-risk patients. It shows us that history repeats itself.El tratamiento de la leucemia linfática crónica (LLC) representa el paradigma de los avances en la terapia de las neoplasias hematológicas. En los últimos 10 años el avance en el conocimiento de los mecanismos de progresión, relaciones con el microambiente tumoral, alteraciones en su biología molecular y hallazgos citogenéticos constituyeron las piezas fundamentales de estos progresos. Sin embargo, las estrategias terapéuticas parecen continuar con un mismo patrón. En sus comienzos la terapia en LLC utilizó monodrogas que paulatinamente condujeron a su combinación en dupletes y tripletes con los cuales se lograron resultados nunca obtenidos anteriormente, vislumbrando un futuro pleno de esperanzas en esta enfermedad incurable.Probablemente el desarrollo del ibrutinib fue el hito que marcó la importancia de las vías de señalización de las células leucémicas en la progresión de la enfermedad abriendo la investigación de nuevas drogas blanco que constituyen la base del tratamiento actual en LLC. Hoy disponemos de una pléyade de nuevos fármacos que, al igual que en sus primeras etapas, pasaron de ser utilizados como monoterapia a emplearse en combinaciones con resultados óptimos incluso en los pacientes de alto riesgo, lo cual nos demuestra que la historia vuelve a repetirse