Nature:靶向攻击p53和c-MYC可选择性清除白血病干细胞

正在一项新的研究中,来自英国格拉斯哥大学、曼彻斯特大学和澳大利亚墨尔本大学的一个跨学科研究团队揭示出慢性粒细胞白血病(chronicmyeloidleukaemia,CML)的阿喀琉斯之踵(即致命弱点),并且发现在小鼠体内成功地靶向攻击这种弱点和根除这种疾病的药物。相关研究结果发表在Nature期刊上。该团队在6年多的时间里一直在开展这项研究。这项研究分析了慢性粒细胞白血病干细胞(CML干细胞,是一种肿瘤干细胞)和正常的造血干细胞,发现两种蛋白是CML干细胞存活的关键。研究人员     

慢性粒细胞性白血病急变的分子机制

慢性粒细胞性白血病(chronic myelogenous leukemia,CML)是源于造血干细胞伴有t(9;22)(q34;q11)染色体易位的恶性骨髓增生性疾病,其急变期与急性白血病相似,具有较强致死性。本文对CML急变分子机制有关的最新研究成果进行了综述,旨在深入理解CML急变的分子机制,并试图发现新的研究思路。     

miRNA与伊马替尼耐药相关性的研究进展

伊马替尼(imatinib, IM)是BCR-ABL1、KIT和PDGFR等多种酪氨酸激酶的抑制剂。90%～95%的慢性粒细胞白血病(CML)含有BCR-ABL融合基因,85%～90%的胃肠道间质瘤(GIST)存在KIT或PDGFRA突变,目前IM主要作为靶向药应用于CML和GIST,它的问世是CML和GIST治疗的重大突破。然而,约30%的CML由于耐药或不耐受而停止使用,约50%的GIST在治疗后的两年内出现了耐药,因此,了解IM耐药机制对于解决IM耐药问题至关重要。miRNA (microRNA, small RNA)是一类长约22 nt的非编码RNA,可通过与特定mRNA结合或调节特定mRNA的翻译过程来调控基因的表达。许多药物耐药与miRNA的异常表达有关,miRNA与IM耐药是近年来的研究热点,改变miRNA的表达模式可以有效抑制耐药和应对治疗。该文综述了miRNA表达与IM耐药的关系及其作用机制,为解决IM耐药问题提供了新的思路。     

慢性粒细胞白血病小鼠动物模型建立的研究进展*

慢性粒细胞白血病(chronic myeloid leukemia,CML)是造血干细胞(hematopoietic stem cells,HSC)恶性克隆性增殖引起的一种血液系统疾病。动物模型是研究CML发病机制及药物靶向治疗的重要载体和工具。研究表明,CML小鼠模型可以通过逆转录病毒介导、转基因和白血病细胞移植的方法建立。三种方法建立的CML小鼠模型均可用于CML发病机制及药物疗效评估研究。实验动物模型进一步通过血常规、血涂片和骨髓涂片、免疫学、分子生物学及病理学等检测手段,判断模型是否建立成功。本文就近年来CML小鼠模型的建立、鉴定及研究应用进展进行综述。     

首个酪氨酸激酶抑制剂药物Gleevec

G1eevec^TM(原名STI571)是第一个被美国食品与药物管理局(FDA)批准上市的酪氨酸激酶抑制剂,能选择性地抑制慢性髓样白血病(CML)患者的Bcr-Abl蛋白酪氨酸激酶活性,对治疗CML取得了很好的疗效。Gleevec治疗CML的实验研究和临床试验都显示出令人满意的结果,分子作用和耐药机制的研究也有了新的认识和发现。该药物的开发成功,带动了酪氨酸激酶抑制剂的研究热潮,成为本世纪抗肿瘤研究的重点。     

自噬在慢性粒细胞白血病中的研究进展

自噬(autophagy)是真核细胞内一种保守的自降解系统,是细胞在营养或生长因子缺乏、低氧、微生物感染、内质网应激等有害刺激的作用下,为了维持细胞的代谢平衡、细胞内环境的稳定以及促进细胞生存作出的适应性反应。自噬与慢性粒细胞白血病(chronic myeloid leukemia,CML)的发生、耐药、复发密切相关,在CML中具有促进细胞存活和诱导细胞死亡的双重效应。因此,明确不同干预条件下自噬对CML细胞的不同作用,寻找特异性的自噬调控通路,联合应用自噬诱导剂或自噬抑制剂,将有助于CML患者的治疗。该文就自噬在CML中的研究进展作一综述。     

慢性粒细胞白血病细胞选择性培养和净化

近年来,随着体外净化方法的不断发展和完善,以及家庭的日益小型化,使得自体骨髓移植在治疗急性白血病方面越来越受到重视。但对慢性粒细胞性白血病(CML)至今仍未找到理想的净化骨髓的方法,从而使自体骨髓移植在CML中的应用受到很大的限制。 CML是起源于多能干细胞的肿瘤性疾病,疾病的发生、发展、转归、细胞生物学及分子生物学变化     

应用基因芯片筛选伊马替尼和尼洛替尼处理K562 细胞表达差异基因

目的:探讨两种酪氨酸激酶抑制剂(TKIs)处理K562细胞的基因表达谱变化,为认识慢性粒细胞白血病(CML)的发病机制、耐药机制提供新的思路,同时也为治疗寻找潜在重要靶标分子。方法:利用GEO数据库下载慢性粒细胞细胞系(K562)基因表达芯片数据,通过差异基因的筛选,趋势分析、GO分析,信号通路分析,最后获得的重要差异表达核心基因,并建立相互作用网络。结果:获得显著表达差异基因1000,通过趋势分析、功能富集分析及信号通路分析提示主要涉及到代谢途径、细胞凋亡、癌症的途径、细胞周期、p53信号通路。相互作用网络分析及同表达相互作用网络分析,得到重要的核心节点基因:AK2、ADSL、PKLR、PKM、SHMT2、ATIC、LDHA、ENO1、CTH、GOT1;YARS、CYP3A5、CTH、GYPA、ALAS2、MTHFD2、BLVRB、GUK1、CTSH、LMO2。结论:利用生物信息学的方法,分析慢性粒细胞白血病细胞基因芯片得到参与不同TKIs处理K562细胞的重要的细胞功能及信号通路主要涉及代谢通路及增殖凋亡信号途径,并且寻找到核心节点基因,为认识K562的耐药机制及治疗靶点提供新的思路。     

针对bcr／abl的锤头状核酶的骨髓净化作用

为了探讨锤头状核酶对原代慢性粒细胞白血病 (chronicmyelogenousleukemia ,CML)细胞的作用及其在体外骨髓净化的效果 ,应用逆转录病毒介导的基因转移法将针对bcr abl融合基因的核酶转染原代CML和正常人骨髓单个核细胞 ,通过造血祖细胞集落培养、流式细胞术、免疫细胞化学法检测核酶对原代CML细胞的作用 ;进一步将此核酶转染CML缓解模型 ,通过白血病细胞集落培养、巢式RT PCR检测其在体外骨髓净化的效果。结果表明 ,原代CML细胞生长增殖和p2 10的表达显著受抑 ,但正常造血祖细胞受影响较小 ;核酶完全抑制模拟缓解骨髓中残留K5 6 2细胞的增殖及bcr ablmRNA表达 ,但并不影响ablmRNA表达 ,因此有望用于CML的体外骨髓净化。     

聚焦慢性粒细胞白血病

随着靶向治疗时代的到来,慢性粒细胞白血病 （CML）已经从不治之症转变为基本可控的慢性病。患者生存率有了显著提高,当然在疗效、耐受性及耐药性方面仍有提升的空间。长期以来,酪氨酸激酶抑制剂格列卫（Gleevec）一直被认为是合理药物设计的典范,但更有效的二代药物已经开始作为一线药物获得认可。然而,由于缺乏完整的生存期数据,这些二代药物和格列卫相比所具有的优势还有待于进一步去发现。由于患者需要长时间治疗,毒性和成本的可控性更可能成为选择治疗药物的重要推动因素。治疗慢性粒细胞白血病的产品线首先侧重于解决耐药性问题,尤其是在一线药物治疗失败而三线药物又无法满足需求的情况下。如果患者使用酪氨酸激酶抑制剂有效,那么最终的问题是患者是否可以通过这些药物治愈。     

Molecular and cellular bases of chronic myeloid leukemia

Chronic myeloid leukemia (CML) is a myeloproliferative disease characterized by the overproduction of granulocytes, which leads to high white blood cell counts and splenomegaly in patients. Based on clinical symptoms and laboratory findings, CML is classified into three clinical phases, often starting with a chronic phase, progressing to an accelerated phase and ultimately ending in a terminal phase called blast crisis. Blast crisis phase of CML is clinically similar to an acute leukemia; in particular, B-cell acute lymphoblastic leukemia (B-ALL) is a severe form of acute leukemia in blast crisis, and there is no effective therapy for it yet. CML is induced by the BCR-ABL oncogene, whose gene product is a BCR-ABL tyrosine kinase. Currently, inhibition of BCR-ABL kinase activity by its kinase inhibitor such as imatinib mesylate (Gleevec) is a major therapeutic strategy for CML. However, the inability of BCR-ABL kinase inhibitors to completely kill leukemia stem cells (LSCs) indicates that these kinase inhibitors are unlikely to cure CML. In addition, drug resistance due to the development of BCR-ABL mutations occurs before and during treatment of CML with kinase inhibitors. A critical issue to resolve this problem is to fully understand the biology of LSCs, and to identify key genes that play significant roles in survival and self-renewal of LSCs. In this review, we will focus on LSCs in CML by summarizing and discussing available experimental results, including the original studies from our own laboratory.     

New perspective in the treatment of chronic myeloid leukemia? gene silencing therapy

Chronic myeloid leukemia is an incurable white blood cell disease with slow progression which affects myeloid stem cells. In the course of chromosome 22 shortening a fusion oncogene arises whose product, a Bcr-Abl oncoprotein, is a continuously expressed tyrosine kinase protein. Beside the opportunity of chemotherapy, stem cell therapy and interferon-a therapy, the application of tyrosine kinase inhibitors also became widespread in the treatment of the disease. Patients bearing the T315I point mutation, however, show resistance against all tyrosine kinase inhibitors, which can be managed by dose escalation or the combination of therapies. The discovery of RNA interference or gene silencing put the therapeutic opportunity of CML in new light. The in vitro application of anti-bcr-abl siRNA showed promising results in the causal treatment of the disease, feasible for identification of new genes associated to the disease, but we do not have sufficient evidence for the safety and efficacy of this method in human therapy.     

Leukemia stem cells: the root of chronic myeloid leukemia

Chronic myeloid leukemia (CML) is a clonal myeloproliferative disorder characterized by a chromosome translocation that generates the Bcr-Abl oncogene encoding a constitutive kinase activity. Despite remarkable success in controlling CML at chronic phase by Bcr-Abl tyrosine kinase inhibitors (TKIs), a significant proportion of CML patients treated with TKIs develop drug resistance due to the inability of TKIs to kill leukemia stem cells (LSCs) that are responsible for initiation, drug resistance, and relapse of CML. Therefore, there is an urgent need for more potent and safer therapies against leukemia stem cells for curing CML. A number of LSCassociated targets and corresponding signaling pathways, including CaMKII-γ, a critical molecular switch for co-activating multiple LSC-associated signaling pathways, have been identified over the past decades and various small inhibitors targeting LSC are also under development. Increasing evidence shows that leukemia stem cells are the root of CML and targeting LSC may offer a curable treatment option for CML patients. This review summarizes the molecular biology of LSC and itsassociated targets, and the potential clinical application in chronic myeloid leukemia.     

Stem cell and kinase activity-independent pathway in resistance of leukaemia to BCR-ABL kinase inhibitors

BCR-ABL tyrosine kinase inhibitors, such as imatinib (Gleevec) are highly effective in treating human Philadelphia chromosome-positive (Ph+) chronic myeloid leukaemia (CML) in chronic phase but not in terminal acute phase; acquired drug resistance caused mainly by the development of BCR-ABL kinase domain mutations prevents cure of the leukaemia. In addition, imatinib is ineffective in treating Ph+ B-cell acute lymphoblastic leukaemia (B-ALL) and CML blast crisis, even in the absence of the kinase domain mutations. This type of drug resistance that is unrelated to BCR-ABL kinase domain mutations is caused by the insensitivity of leukaemic stem cells to kinase inhibitors such as imatinib and dasatinib, and by activation of a newly-identified signalling pathway involving SRC kinases that are independent of BCR-ABL kinase activity for activation. This SRC pathway is essential for leukaemic cells to survive imatinib treatment and for CML transition to lymphoid blast crisis. Apart from BCR-ABL and SRC kinases, stem cell pathways must also be targeted for curative therapy of Ph+ leukaemia.     

Establishment of a novel mesenchymal stem cell-based regimen for chronic myeloid leukemia differentiation therapy

Chronic myeloid leukemia (CML) is characterized by the accumulation of malignant and immature white blood cells which spread to the peripheral blood and other tissues/organs. Despite the fact that current tyrosine kinase inhibitors (TKIs) are capable of achieving the complete remission by reducing the tumor burden, severe adverse effects often occur in CML patients treated with TKIs. The differentiation therapy exhibits therapeutic potential to improve cure rates in leukemia, as evidenced by the striking success of all-trans-retinoic acid in acute promyelocytic leukemia treatment. However, there is still a lack of efficient differentiation therapy strategy in CML. Here we showed that MPL, which encodes the thrombopoietin receptor driving the development of hematopoietic stem/progenitor cells, decreased along with the progression of CML. We first elucidated that MPL signaling blockade impeded the megakaryocytic differentiation and contributed to the progression of CML. While allogeneic human umbilical cord-derived mesenchymal stem cells (UC-MSCs) treatment efficiently promoted megakaryocytic lineage differentiation of CML cells through restoring the MPL expression and activating MPL signaling. UC-MSCs in combination with eltrombopag, a non-peptide MPL agonist, further activated JAK/STAT and MAPK signaling pathways through MPL and exerted a synergetic effect on enhancing CML cell differentiation. The established combinational treatment not only markedly reduced the CML burden but also significantly eliminated CML cells in a xenograft CML model. We provided a new molecular insight of thrombopoietin (TPO) and MPL signaling in MSCs-mediated megakaryocytic differentiation of CML cells. Furthermore, a novel anti-CML treatment regimen that uses the combination of UC-MSCs and eltrombopag shows therapeutic potential to overcome the differentiation blockade in CML.Subject terms: Chronic myeloid leukaemia, Mesenchymal stem cells     

Growth arrest of BCR-ABL positive cells with a sequence-specific polyamide-chlorambucil conjugate

Chronic myeloid leukemia (CML) is characterized by the presence of a constitutively active Abl kinase, which is the product of a chimeric BCR-ABL gene, caused by the genetic translocation known as the Philadelphia chromosome. Imatinib, a selective inhibitor of the Bcr-Abl tyrosine kinase, has significantly improved the clinical outcome of patients with CML. However, subsets of patients lose their response to treatment through the emergence of imatinib-resistant cells, and imatinib treatment is less durable for patients with late stage CML. Although alternative Bcr-Abl tyrosine kinase inhibitors have been developed to overcome drug resistance, a cocktail therapy of different kinase inhibitors and additional chemotherapeutics may be needed for complete remission of CML in some cases. Chlorambucil has been used for treatment of B cell chronic lymphocytic leukemia, non-Hodgkin's and Hodgkin's disease. Here we report that a DNA sequence-specific pyrrole-imidazole polyamide-chlorambucil conjugate, 1R-Chl, causes growth arrest of cells harboring both unmutated BCR-ABL and three imatinib resistant strains. 1R-Chl also displays selective toxicities against activated lymphocytes and a high dose tolerance in a murine model.     

Salarin C inhibits the maintenance of chronic myeloid leukemia progenitor cells

We previously showed that incubation of chronic myeloid leukemia (CML) cells in very low oxygen selects a cell subset where the oncogenetic BCR/Abl protein is suppressed and which is thereby refractory to tyrosine kinase inhibitors used for CML therapy. In this study, salarin C, an anticancer macrolide extracted from the Fascaplysinopsis sponge, was tested as for its activity on CML cells, especially after their incubation in atmosphere at 0.1% oxygen. Salarin C induced mitotic cycle arrest, apoptosis and DNA damage. Salarin C also concentration-dependently inhibited the maintenance of stem cell potential in cultures in low oxygen of either CML cell lines or primary cells. Surprisingly, the drug also concentration-dependently enforced the maintenance of BCR/Abl signaling in low oxygen, an effect which was paralleled by the rescue of sensitivity of stem cell potential to IM. These results suggest a potential use of salarin C for the suppression of CML cells refractory to tyrosine kinase inhibitors     

Targeted therapies and autophagy: new insights from chronic myeloid leukemia

Patients who develop chronic myeloid leukemia (CML) are currently treated with tyrosine kinase inhibitors (TKIs), which inhibit the function of the oncogene BCR/Abl. Most CML cells undergo apoptosis when BCR/Abl tyrosine kinase activity is suppressed by TKIs. Cells surviving drug treatment are either stem cells (CML in early phase) or cells with BCR/Abl-dependent or -independent mechanisms of drug resistance (CML in advanced phase). Since survival of these cells is thought to be responsible for disease recurrence, it is critical to find ways to fully eradicate CML stem cells. We have recently shown that when CML cells, including stem cells, are exposed to TKI they activate an autophagic program, which relies on intracellular calcium and is not inhibited by Bcl-2. Pharmacological or RNAi-mediated inhibition of autophagy potentiates the effect of TKI in inducing death of CML cells, including the stem cells. These data strongly suggest that inhibition of autophagy may improve the therapeutic effects of TKIs in the treatment of CML. In addition, they give credence to the idea that in cancer cells autophagy is part of a stereotypic response to stress and specifically to abrogation of their main oncogenic signal(s).