54例慢性淋巴细胞白血病的临床回顾性分析

目的：本研究旨在探讨慢性淋巴细胞白血病（CLL）的实验室检查特点及特征性临床表现。方法：利用血细胞分析仪、流式细胞术、骨髓形态分析及R显带技术等对我院2002年4月．2012年4月收治的54例慢性淋巴细胞白血病患者的相关临床资料如血细胞计数、骨髓形态、染色体及免疫表型等进行检测并对结果进行回顾性分析。结果：CLL多发于老年患者,男性多见,中位年龄65岁（45．82岁）。大部分患者初诊时可出现典型的临床表现,37例（68％）患者初诊时淋巴结大,49例（91％）初诊时白细胞≥10×109、L,淋巴细胞绝对值≥5×109／L。13例（24％）初诊时肝脾或者脾大,17例（31％）初诊时乏力、消瘦。34（63％）例患者可见典型的CLL免疫表型,CD5、CDl9．CD23、CD20的阳性率分别为90％、87％、72％、67％。32例患者染色体检测结果表明：13q-2例,17p．2例,11q-1例,＋12有1例,6q-1例,t（14,16）1例。2例患者发生了自身免疫性溶血性贫血（AIHA）。1例患者发生了Richter转化,肿大淋巴结活检显示部分区域为弥漫性大B细胞淋巴瘤,其高表达CD20、CDl9、CD22。结论：慢性淋巴细胞白血病具有其典型的临床表现、免疫表型及遗传学改变,并且对诊断及治疗有重要意义。     

54 例慢性淋巴细胞白血病的临床回顾性分析*

摘要目的：本研究旨在探讨慢性淋巴细胞白血病(CLL)的实验室检查特点及特征性临床表现。方法：利用血细胞分析仪、流式细 胞术、骨髓形态分析及R显带技术等对我院2002 年4 月-2012 年4 月收治的54 例慢性淋巴细胞白血病患者的相关临床资料如 血细胞计数、骨髓形态、染色体及免疫表型等进行检测并对结果进行回顾性分析。结果：CLL多发于老年患者,男性多见,中位年 龄65 岁（45-82 岁）。大部分患者初诊时可出现典型的临床表现,37 例（68%）患者初诊时淋巴结大,49 例（91%）初诊时白细胞≥ 10× 109/L,淋巴细胞绝对值≥ 5× 109/L。13 例（24%）初诊时肝脾或者脾大,17 例（31%）初诊时乏力、消瘦。34（63%）例患者可见典 型的CLL免疫表型,CD5、CD19. CD23、CD20 的阳性率分别为90%、87%、72%、67%。32 例患者染色体检测结果表明：13q-2 例, 17p-2 例,11q-1 例,+12 有1 例,6q-1 例,t(14,16)1 例。2 例患者发生了自身免疫性溶血性贫血（AIHA）。1例患者发生了Richter转 化,肿大淋巴结活检显示部分区域为弥漫性大B细胞淋巴瘤,其高表达CD20、CD19、CD22。结论：慢性淋巴细胞白血病具有其典 型的临床表现、免疫表型及遗传学改变,并且对诊断及治疗有重要意义。     

Genitope公司开始CLL的个性化治疗

美国Genitope公司2006年2月开始了慢性淋巴细胞性白血病（CLL）的个性化治疗“MyVax”法的临床试验。“MyVax”法是基于患者自身肿瘤特异的基因构型量身定制式的免疫疗法，具有使免疫系统活化的作用。[第一段]     

荧光原位杂交技术在慢性淋巴细胞白血病遗传学异常检测中的应用

目的:分析在荧光原位杂交技术慢性淋巴细胞白血病遗传学异常检测中的应用,并分析相关指标在评价患者预后中的应用。方法:对我院收治的45例初诊CLL患者采用荧光原位杂交技术进行特异性探针D13S25(13q14.3)、RB1(13q14)、p53(17p13)、ATM(11q22.3)、以及CSP12(12号染色体3体)染色体标本检测,分析CLL患者遗传学异常的发生率。采用实时定量PCR检测miR-15a和miR-16-1与CLL患者遗传学异常的相关性。结果:45例CLL初诊患者中,荧光原位检测发现CLL遗传学异常37例,CLL遗传学异常率82.22%。其中d(13q14.3)遗传异常13例,d(13q14)遗传异常7例,d(11q22-23)遗传异常6例,d(17p13)遗传异常5例,12号染色体三体异常6例,遗传学异常多呈异质性。实时定量PCR检测发现miR-15a和miR-16-1与d(13q14)遗传异常显著相关。结论:荧光原位杂交技术是一种检测CLL遗传学异常的快速、灵敏方法,可以提高CLL遗传异常检出率。miR-15a和miR-16-1可以预测d(13q14)遗传异常CLL患者预后。     

miR-34家族——-肿瘤抑制蛋白p53高度相关microRNA

若干微小RNA(microRNA, miRNA)与肿瘤抑制蛋白p53高度相关, 其中miR-34家族最具代表性。一方面p53可通过对miR-34家族的调控实现对多个原癌基因如Bcl-2、c-myc以及细胞因子如cyclinE2、cyclinD1和c-Met的抑制, 进而发挥抑癌作用; 另一方面miR-34家族也可以通过抑制沉默信息调节子SIRTI来进一步增强p53的活性。p53与miR-34家族之间形成的正反馈调节网络对抑制肿瘤的发生发展及恶化均起着重要的作用。文章对p53高度相关的miR-34家族在肿瘤发生发展及治疗的最新进展作一论述。     

MEC-1移植法构建慢性淋巴细胞白血病小鼠模型

目的 制备并评估慢性淋巴细胞白血病小鼠模型，以期为慢性淋巴细胞白血病的治疗提供临床前模型。方法 通过文献查阅及实验确定环磷酰胺(cyclophosphamide, CTX)注射剂量以制备免疫抑制小鼠模型；通过腹腔注射、尾静脉注射将1×10⁷个MEC-1细胞连续3 d移植到小鼠体内，以制备慢性淋巴细胞白血病小鼠；应用流式细胞术、免疫组化等方法，检测慢性淋巴细胞白血病小鼠外周血白细胞、CD19⁺CD5⁺B淋巴细胞变化情况，并分析肝、脾、胸腺、肺、淋巴及骨髓中MEC-1细胞浸润情况。结果 确定CTX注射剂量为150 mg/kg注射4 d能够显著降低小鼠免疫系统功能；移植MEC-1细胞后小鼠表现慢性淋巴细胞白血病(chronic lymphocytic leukemia, CLL)特征，其白细胞及B淋巴细胞数量增多、骨髓细胞发生增殖。结论 CTX注射剂量为150 mg/kg连续注射4 d,可以使小鼠免疫功能显著下降；成功制备CLL小鼠模型。     

miR-181在免疫系统中的研究进展

介绍miR-181家族成员在免疫系统功能和作用的研究进展。miR-181是一个重要的免疫系统调控因子,涉及到B细胞、T细胞等免疫细胞的增殖分化,生物体免疫应答、免疫耐受以及炎症反应等生理过程的变化,同时miR-181与白血病,红斑狼疮等免疫系统疾病的发生和发展存在一定的关系。对miR-181家族成员在免疫系统中的功能与作用、存在问题以及未来的研究发展趋势做一综述,以期为免疫系统疾病提供新的治疗策略。     

微小RNA与胃癌的关系

微小RNA（microRNA、miRNA）与胃癌的发生发展可通过调控其靶基因参与的信号传导通路,影响胃癌的发生、侵袭和转移等过程,发挥着类似于癌基因或抑癌基因的作用。目前,已发现多种microR—NA与胃癌关系密切,包括通过调节周期蛋白依赖性蛋白激酶（Cdk）表达影响胃癌细胞增殖的miR-106b-93～25家族、miR-222—221家族和抑制高迁移率族蛋白A2（HMGA2）基因表达抑制胃癌细胞转移的miR-129和let-一7miRNA家族等。另有研究表明,miR-d21和miR-31检测阳性率显著高于血清CEA,可能成为新的胃癌肿瘤标志物。miR-15b和miR-16与胃癌多药耐药的关系也说明microRNA可能成为胃癌治疗新的靶点。     

聚焦慢性淋巴细胞白血病治疗药物

过去的10 年，慢性淋巴细胞白血病（CLL）的治疗策略已发生变化，其疗法已有长足进展，即从仅可治标性缓解病痛发展到能致病情完全缓解、最大限度根除疾患和提高存活率。Rituxan（rituximab）的开发及其在免疫化疗中的应用使抗CLL 疗法发生了改变，该药已成为目前用于小于65 岁患者的黄金标准治疗药物。然而，基于Rituxan 的免疫化疗仍仅局限用于两类常见CLL 病例——老年患者和具并发症及高危患者的治疗。再者，在为期两年的一线和二线治疗中，约有25% 和50% 的CLL 患者会复发，且已有数年缓解的患者对后续治疗的疗效较差。因此，对于CLL 的治疗，仍远不能满足需求。早期研究发现，B 细胞受体（BCR）信号通路与CLL 的发生和发展以及治疗后的高反应率与病情持续缓解有关联。鉴于此，靶向BCR信号通路的小分子药物得以快速发展。Imbruvic（ibrutinib）是首个口服Bruton 酪氨酸激酶（BTK）抑制剂，近期经快速审批上市，用于治疗复发/ 顽固性恶性淋巴瘤，但其长期生存率数据目前尚不成熟。眼下，新疗法面临着多个挑战：其需提供更高的反应率，特别是对老年患者和具并发症及高危患者，且需克服当前疗法造成的耐药性。目前，唯一的CLL 根治疗法是同种异体造血干细胞移植（HSCT），但其并不适用于大多数CLL 患者。而目前CLL 的标准治疗方案是化学免疫疗法，适用于小于65 岁的患者，但老龄或高危患者的治疗选择是有限的。因此，最终的问题是针对CLL 的小分子疗法是否能达到根治目的，期望随着在鉴定与CLL 发病机制和预后相关的细胞遗传学及分子变化方面取得进展，能促进下一代靶向疗法的快速发展。新型靶向性小分子抑制剂，如Imbruvica 和idelablisib，已展现出对CLL 的显著治疗作用。综述CLL 治疗领域重大行业投资和研发的主要市场博弈者和交易亮点。     

急性白血病及其前期与患者（儿）父母关系的遗传学研究

在长期研究家族性白血病及其前期的基础上,应用相同的血液学和细胞遗传学指标及Ｓｏｕｔｈｅｒｎ印迹杂交技术,对２０例急性白血病及其前期患者（儿）父母或兄弟姐妹等一级亲属骨髓和外周血进行研究,发现散发性白血病及其前期同家族性白血病及其前期一样,与患者（儿）父母骨髓巨核系、红系或／和粒系异常增生相关。家族性白血病及其前期患者（儿）父母一方或双方还有家族性骨髓细胞染色体单体性即非随机丢失或外周血显示淋巴细胞叶酸敏感型染色体脆性部位的高表达;而散发性白血病及其前期患者（儿）父母多数骨髓细胞核型正常,但其外淋巴细胞则表现出多种类型的染色体异常。鉴于以往已证明家族性骨髓巨核系和红系异常增生及其相关的ｃｅｒｂＢ重排的可遗传性,以及骨髓病态造血与ｃｅｒｂＢ重排扩增的相关性,除了ｃｅｒｂＢ重排扩增以及ＶｅｒｂＢＰＣＲ检测结果可作为白血病前期基因诊断指标外,ｃｅｒｂＢ重排及其相关的骨髓异常增生看来还可用于婚前检查、产前诊断和遗传咨询服务等,以便对白血病进行预防。     

Interdependent regulation of p53 and miR-34a in chronic lymphocytic leukemia

Chronic lymphocytic leukemia (CLL) has an incidence 4/100 000 people in the western world and is one of the first cancers reported to be associated with deregulated miRNA expression. microRNAs are small non coding RNAs that are important regulators of protein expression through binding to their untranslated 3'-UTR region. The miR-34 family was demonstrated to be induced by the tumor suppressor p53 and to elicit p53-like responses like senescence, cell cycle arrest and apoptosis depending on the cell type. We have shown in a recent paper that miR-34a is severely increased in the TCL1-mouse model of CLL. This finding was reflected in human CLL. Moreover, it is demonstrated that its expression is dependent on the presence of the SNP309 in the intronic promoter of the MDM2 gene. In addition, low miR-34a expression was associated with shorter time to treatment (log-rank P = 0.003) in CLL. When reintroduced into CLL cells, miR-34a was able to induce apoptosis. Interestingly, this was dependent on an intact p53 pathway. Here, we present data showing that knockdown of p53 in HCT-116 cells severely reduces miR-34a induced apoptosis. In conclusion, miR-34a is proposed as a marker for the activity of the p53 pathway in CLL.     

microRNA-34b/c on chromosome 11q23 is aberrantly methylated in chronic lymphocytic leukemia

A commonly deleted region in chronic lymphocytic leukemia (CLL) is the 11q22–23 region, which encompasses the ATM gene. Evidence suggests that tumor suppressor genes other than ATM are likely to be involved in CLL with del(11q). A microRNA (miR) cluster including the miR-34b and miR-34c genes is located, among other genes, within the commonly deleted region (CDR) at 11q. Interestingly, these miRs are part of the TP53 network and have been shown to be epigenetically regulated. In this study, we investigated the expression and methylation status of these miRs in a well-characterized cohort of CLL, including cases with/without 11q-deletion. We show that the miR-34b/c promoter was aberrantly hypermethylated in a large proportion of CLL cases (48%, 25/52 cases). miR-34b/c expression correlated inversely to DNA methylation (P = 0.003), and presence of high H3K37me3 further suppressed expression regardless of methylation status. Furthermore, increased miR-34b/c methylation inversely correlated with the presence of 11q-deletion, indicating that methylation and del(11q) independently silence these miRs. Finally, 5-azacytidine and trichostatin A exposure synergistically increased the expression of miR-34b/c in CLL cells, and transfection of miR-34b or miR-34c into HG3 CLL cells significantly increased apoptosis. Altogether, our novel data suggest that miR-34b/c is a candidate tumor suppressor that is epigenetically silenced in CLL.     

microRNA-34b/c on chromosome 11q23 is aberrantly methylated in chronic lymphocytic leukemia

A commonly deleted region in chronic lymphocytic leukemia (CLL) is the 11q22–23 region, which encompasses the ATM gene. Evidence suggests that tumor suppressor genes other than ATM are likely to be involved in CLL with del(11q). A microRNA (miR) cluster including the miR-34b and miR-34c genes is located, among other genes, within the commonly deleted region (CDR) at 11q. Interestingly, these miRs are part of the TP53 network and have been shown to be epigenetically regulated. In this study, we investigated the expression and methylation status of these miRs in a well-characterized cohort of CLL, including cases with/without 11q-deletion. We show that the miR-34b/c promoter was aberrantly hypermethylated in a large proportion of CLL cases (48%, 25/52 cases). miR-34b/c expression correlated inversely to DNA methylation (P = 0.003), and presence of high H3K37me3 further suppressed expression regardless of methylation status. Furthermore, increased miR-34b/c methylation inversely correlated with the presence of 11q-deletion, indicating that methylation and del(11q) independently silence these miRs. Finally, 5-azacytidine and trichostatin A exposure synergistically increased the expression of miR-34b/c in CLL cells, and transfection of miR-34b or miR-34c into HG3 CLL cells significantly increased apoptosis. Altogether, our novel data suggest that miR-34b/c is a candidate tumor suppressor that is epigenetically silenced in CLL.     

MicroRNA expression profiling identifies activated B cell status in chronic lymphocytic leukemia cells

Chronic lymphocytic leukemia (CLL) is thought to be a disease of resting lymphocytes. However, recent data suggest that CLL cells may more closely resemble activated B cells. Using microRNA (miRNA) expression profiling of highly-enriched CLL cells from 38 patients and 9 untransformed B cells from normal donors before acute CpG activation and 5 matched B cells after acute CpG activation, we demonstrate an activated B cell status for CLL. Gene set enrichment analysis (GSEA) identified statistically-significant similarities in miRNA expression between activated B cells and CLL cells including upregulation of miR-34a, miR-155, and miR-342-3p and downregulation of miR-103, miR-181a and miR-181b. Additionally, decreased levels of two CLL signature miRNAs miR-29c and miR-223 are associated with ZAP70(+) and IgV(H) unmutated status and with shorter time to first therapy. These data indicate an activated B cell status for CLL cells and suggest that the direction of change of individual miRNAs may predict clinical course in CLL.     

Differential microRNA Profiles and Their Functional Implications in Different Immunogenetic Subsets of Chronic Lymphocytic Leukemia

Critical processes of B-cell physiology, including immune signaling through the B-cell receptor (BcR) and/or Toll-like receptors (TLRs), are targeted by microRNAs. With this in mind and also given the important role of BcR and TLR signaling and microRNAs in chronic lymphocytic leukemia (CLL), we investigated whether microRNAs could be implicated in shaping the behavior of CLL clones with distinct BcR and TLR molecular and functional profiles. To this end, we examined 79 CLL cases for the expression of 33 microRNAs, selected on the following criteria: (a) deregulated in CLL versus normal B-cells; (b) differentially expressed in CLL subgroups with distinct clinicobiological features; and, (c) if meeting (a) + (b), having predicted targets in the immune signaling pathways. Significant upregulation of miR-150, miR-29c, miR-143 and miR-223 and downregulation of miR-15a was found in mutated versus unmutated CLL, with miR-15a showing the highest fold difference. Comparison of two major subsets with distinct stereotyped BcRs and signaling signatures, namely subset 1 [IGHV1/5/7-IGKV1(D)-39, unmutated, bad prognosis] versus subset 4 [IGHV4-34/IGKV2-30, mutated, good prognosis] revealed differences in the expression of miR-150, miR-29b, miR-29c and miR-101, all down-regulated in subset 1. We were also able to link these distinct microRNA profiles with cellular phenotypes, importantly showing that, in subset 1, miR-101 downregulation is associated with overexpression of the enhancer of zeste homolog 2 (EZH2) protein, which has been associated with clinical aggressiveness in other B-cell lymphomas. In conclusion, specific miRNAs differentially expressed among CLL subgroups with distinct BcR and/or TLR signaling may modulate the biological and clinical behavior of the CLL clones.     

Potential therapeutic role of antagomiR17 for the treatment of chronic lymphocytic leukemia

Recently it was reported that microRNA from the miR-17 ~ 92 family may have a key role in chronic lymphocytic leukemia (CLL). Here, we designed specific oligonucleotides to target endogenous miR-17 (antagomiR17). In-vitro administration of antagomiR17 effectively reduced miR-17 expression and the proliferation of CLL-like MEC-1 cells. When injected in-vivo in tumor generated by the MEC-1 cells in SCID mice, antagomiR17 dramatically reduced tumor growth and significantly increase survival. Altogether, our results provide the rationale for the use of antagomiR17 as a novel potential therapeutic tool in CLL and in other lymphoproliferative disorders where miR-17 has a driver role in tumor progression.     

Regulation of miR-34 Family in Neuronal Development

Differentiation of neural stem cells (NSC’s) to mature and functional neurons requires coordinated expression of mRNA, microRNAs (miRNAs) and regulatory proteins. Our earlier unbiased miRNA profiling studies have identified miR-200, miR-34 and miR-221/222 as maximally up-regulated miRNA families in differentiating PC12 cells and demonstrated the capability of miR-200 family in inducing neuronal differentiation (J. Neurochem, 2015, 133, 640–652). In present study, we have investigated role of miR-34 family in neuronal differentiation and identified P53 as mediator of nerve growth factor (NGF) induced miR-34a expression in differentiating PC12 cells. Our studies have shown that NGF induced miR-34a, arrests proliferating PC12 cells to G1 phase, which is pre-requisite for neuronal differentiation. Our studies have also shown that increased expression of miR-34a controls the P53 level in differentiated PC12 cells in feedback inhibition manner, which probably prevents differentiated cells from P53 induced apoptosis. Expression profiling of miR-34 family in different neuronal, non-neuronal and developing cells have identified differentiated and aged brain cells as richest source of miR-34, which also indicates that higher expression of miR-34 family helps in maintaining the mature neurons in non-proliferative stage. In conclusion, our studies have shown that miR-34 is brain enriched miRNA family, which up-regulates with neuronal maturation and brain ageing and co-operative regulation of P53 and miR-34a helps in neuronal differentiation by arresting cells in G1 phase.     

Epigenetic inactivation of the hsa-miR-203 in haematological malignancies

miR-203 is a tumour suppressor microRNA (miRNA). We studied the methylation of hsa-miR-203 in 150 samples including acute myeloid leukaemia (AML), acute lymphoblastic leukaemia (ALL), chronic myeloid leukaemia (CML), chronic lymphocytic leukaemia (CLL) and non-Hodgkin's lymphoma (NHL) by methylation-specific PCR, and miRNA expression by stem-loop RT-qPCR. hsa-miR-203 promoter was unmethylated in normal controls but homozygously methylated in two AML and four lymphoma cell lines, in which 5-Aza-2'-deoxycytidine treatment led to promoter demethylation and miR-203 re-expression. Restoration of miR-203 expression in lymphoma cells inhibited cellular proliferation and increased cell death, suggesting an inherent tumour suppressor activity. In primary samples, hsa-miR-203 methylation was absent in CML but detected in 5.0% ALL, 10.0% AML, 42.0% CLL and 38.8% of NHL (including six [60.0%] natural killer-cell, nine [40.9%] B-cell and four [23.5%] T cell NHL). Moreover, hsa-miR-203 methylation was associated with hypermethylation of hsa-miR-34a, -124a and -196b in NHL but not CLL. In CLL, hsa-miR-203 methylation was associated with a higher presenting Hb level (P = 0.033). The projected 10 year overall survival of the CLL patients was 58.2%, which was impacted by Rai stage and high-risk karyotypes but not hsa-miR-203 methylation. hsa-miR-203 was more frequently methylated in lymphoid than myeloid malignancies (P = 0.002). In conclusion, miR-203, a tumour suppressor gene, was hypermethylated in a tumour-specific manner with gene silencing. hsa-miR-203 was more frequently hypermethylated in lymphoid than myeloid malignancies. In NHL, hsa-miR-203 methylation was associated with concomitant methylation of other tumour suppressor miRNAs. The frequent hsa-miR-203 methylation in lymphoid malignancies suggested a pathogenetic role of hsa-miR-203 methylation.