Dysregulated angiogenesis in B-chronic lymphocytic leukemia: Morphologic, immunohistochemical, and flow cytometric evidence

Background

The extent of enhanced bone marrow angiogenesis in chronic lymphocytic leukemia (CLL) and relationship to proangiogenic factors and prognostic indicators is largely unexplored.

Methods

To further investigate the role of angiogenesis in CLL by evaluating the topography and extent of angiogenesis in a group of CLL bone marrow biopsies, to study the expression of pro and antiangiogenic vascular factors in CLL cells to more precisely document the cell types producing these factors, and to evaluate the role, if any, of localized hypoxia in upregulation of angiogenesis in CLL We used immunohistochemistry (IHC) (n = 21 pts) with antibodies to CD3 and CD20, proangiogenic (VEGF, HIF-1a) and antiangiogenic (TSP-1) factors, and VEGF receptors -1 and -2 to examine pattern/extent of CLL marrow involvement, microvessel density (MVD), and angiogenic characteristics; flow cytometry (FC) was performed on 21 additional cases for VEGF and TSP-1.

Results

CLL patients had higher MVD (23.8 vs 14.6, p~0.0002) compared to controls (n = 10). MVD was highest at the periphery of focal infiltrates, was not enhanced in proliferation centers, and was increased irrespective of the presence or absence of cytogenetic/immunophenotypic markers of aggressivity. By IHC, CLL cells were VEGF(+), HIF-1a (+), TSP-1(-), VEGFR-1(+), and VEGFR-2(+). By FC, CLL cells were 1.4–2.0-fold brighter for VEGF than T cells and were TSP-1(-).

Conclusion

CLL demonstrates enhanced angiogenesis, with increased MVD, upregulated VEGF and downregulated TSP-1. Upregulation of HIF-1a in all CLL cases suggests localized tissue hypoxia as an important stimulant of microvessel proliferation. The presence of VEGF receptors on CLL cells implies an autocrine effect for VEGF. Differences in MVD did not correlate with traditional genetic/immunophenotypic markers of aggressiveness.     

Heavy meromyosin binding to microfilaments involved in cell and morphogenetic movements

Certain microfilaments found in migratory single cells and in morphogenetically-active epithelial cells are shown to bind heavy meromyosin prepared from skeletal muscle. This ‘actin-like’ feature of the filaments is compatible with the hypothesis that such filaments are components of contractile systems in these cells.     

The use of proteolytic enzymes to improve immunoglobulin staining by the PAP technique

Synopsis Proteolytic enzymes, protease and trypsin have recently been introduced to reduce the inconsistency hitherto encountered in the unlabelled antibody-enzyme method using PAP. This study investigated factors determining the optimum conditions for use of such enzymes in order to establish which one is most suitable. Trypsin was the most effective enzyme; however, its activity decreased over 3 h, a feature paralleled immunocytochemically. Method and duration of fixation appears to influence the required time of exposure to trypsin in order that consistent immunostaining may be produced. Treatment of sections with trypsin prior to the use of the unlabelled antibody-enzyme method using PAP renders the technique reliable, provided the enzyme is used in a carefully controlled manner.     

Rapid Removal of Acid from Glycol Methacrylate for Improved Histological Embedding

A method for the rapid and complete removal of methacrylic acid from commercial samples of glycol methacrylate is presented. It entails conversion of the acid to an insoluble N-acylurea by treatment with an equivalent amount of N, N'-dicyclohexylcarbodiimide. Sections of tissue embedded in polymer prepared from the purified monomer can be stained with basic dyes without simultaneously staining the polymer.     

Reactivity of carboxyl groups in modified proteins

The reactivities of carboxyl groups to carbodiimides in non-reduced, S-carboxymethyl, and S-cyanoethyl proteins have been compared. When disulphide bonds are split, a decrease in reactivity was found, relatively minor in the S-carboxymethyl derivative and almost complete loss of reactivities in the S-cyanoethyl derivative.     

HLA-Associated Clinical Progression Correlates with Epitope Reversion Rates in Early Human Immunodeficiency Virus Infection

Human immunodeficiency virus type 1 (HIV-1) can evade immunity shortly after transmission to a new host but the clinical significance of this early viral adaptation in HIV infection is not clear. We present an analysis of sequence variation from a longitudinal cohort study of HIV adaptation in 189 acute seroconverters followed for up to 3 years. We measured the rates of variation within well-defined epitopes to determine associations with the HLA-linked hazard of disease progression. We found early reversion across both the gag and pol genes, with a 10-fold faster rate of escape in gag (2.2 versus 0.27 forward mutations/1,000 amino acid sites). For most epitopes (23/34), variation in the HLA-matched and HLA-unmatched controls was similar. For a minority of epitopes (8/34, and generally associated with HLA class I alleles that confer clinical benefit), new variants appeared early and consistently over the first 3 years of infection. Reversion occurred early at a rate which was HLA-dependent and correlated with the HLA class 1-associated relative hazard of disease progression and death (P = 0.0008), reinforcing the association between strong cytotoxic T-lymphocyte responses, viral fitness, and disease status. These data provide a comprehensive overview of viral adaptation in the first 3 years of infection. Our findings of HLA-dependent reversion suggest that costs are borne by some escape variants which may benefit the host, a finding contrary to a simple immune evasion paradigm. These epitopes, which are both strongly and frequently recognized, and for which escape involves a high cost to the virus, have the potential to optimize vaccine design.The dynamics of viral replication in acute and early human immunodeficiency virus (HIV) infection are not well understood as longitudinal data from large cohorts of seroconverters are hard to assemble. Recent studies have shown that new HIV infections may be the result of a single transmitted variant, that new env gene mutations can be detected within a few weeks (25), and that early immune escape can be detected at sites across the HIV genome (9). These data add to a body of work showing that cytotoxic T cells act early, contributing to the early reduction in viremia (8, 30).Whether early cytotoxic T-lymphocyte (CTL) immune responses influence longer-term clinical outcome is not clear. Antigen-specific CTLs capable of producing gamma interferon and other cytokines are detectable at all stages of HIV infection (1, 3, 24, 41). Much weight is placed on the macaque/simian immunodeficiency virus model in which nearly total peripheral blood CD8⁺ T-cell elimination using monoclonal antibodies results in rising viremia (42). The role of other forms of host immunity (e.g., neutralizing antibodies, natural killer cells, and macrophages) has, to some extent, been pursued with less intensity in light of persuasive evidence that CTLs can control retrovirus infection (46). The extent to which the simian model mirrors HIV infection has been questioned (5) and, despite exhaustive cellular assays of T-cell function—from gamma interferon enzyme-linked immunospot assays(1, 27, 38) to polyfunctional cytokine matrices (2, 6)—no CTL function correlates robustly with HIV plasma viral load or viral dynamics. Moreover, analyses of evolutionary data suggest that CTLs are inefficient at killing HIV-infected cells (4).However, statistical analysis of data from large cross-sectional studies link HLA class I alleles with specific genome-wide HIV polymorphisms, suggestive of a pervasive selection pressure enacted by CTLs (7, 10, 18, 36, 40). It is clear that associations between some HLA class I alleles and particular amino acid polymorphisms are robust although it is disputed whether immune escape influences disease progression. The viral fitness costs resulting from immune escape may even contribute to better clinical outcomes associated with the possession of HLA class I alleles such as B*27, B*57, and B*58 (18).Evolutionary studies of HIV require longitudinal data from large cohorts of patients sampled since seroconversion to detect adaptation in new hosts as it accrues. HIV is one of the few pathogens where it is possible to do this within individuals because of the high viral turnover and rapid intrahost evolution. Here, we investigate a cohort of 189 acute seroconverters—the largest cohort reported to date—followed for up to 3 years to study the rates of viral mutation in individual epitopes within internal HIV proteins and to determine the association between HLA class I alleles and rates of immune escape and reversion.     

Integrated Genomic Analysis Implicates Haploinsufficiency of Multiple Chromosome 5q31.2 Genes in De Novo Myelodysplastic Syndromes Pathogenesis

Deletions spanning chromosome 5q31.2 are among the most common recurring cytogenetic abnormalities detectable in myelodysplastic syndromes (MDS). Prior genomic studies have suggested that haploinsufficiency of multiple 5q31.2 genes may contribute to MDS pathogenesis. However, this hypothesis has never been formally tested. Therefore, we designed this study to systematically and comprehensively evaluate all 28 chromosome 5q31.2 genes and directly test whether haploinsufficiency of a single 5q31.2 gene may result from a heterozygous nucleotide mutation or microdeletion. We selected paired tumor (bone marrow) and germline (skin) DNA samples from 46 de novo MDS patients (37 without a cytogenetic 5q31.2 deletion) and performed total exonic gene resequencing (479 amplicons) and array comparative genomic hybridization (CGH). We found no somatic nucleotide changes in the 46 MDS samples, and no cytogenetically silent 5q31.2 deletions in 20/20 samples analyzed by array CGH. Twelve novel single nucleotide polymorphisms were discovered. The mRNA levels of 7 genes in the commonly deleted interval were reduced by 50% in CD34+ cells from del(5q) MDS samples, and no gene showed complete loss of expression. Taken together, these data show that small deletions and/or point mutations in individual 5q31.2 genes are not common events in MDS, and implicate haploinsufficiency of multiple genes as the relevant genetic consequence of this common deletion.     

Passive sexual transmission of human immunodeficiency virus type 1 variants and adaptation in new hosts

Human immunodeficiency virus type 1 (HIV-1) genetic diversity is a major obstacle for the design of a successful vaccine. Certain viral polymorphisms encode human leukocyte antigen (HLA)-associated immune escape, potentially overcoming limited vaccine protection. Although transmission of immune escape variants has been reported, the overall extent to which this phenomenon occurs in populations and the degree to which it contributes to HIV-1 viral evolution are unknown. Selection on the HIV-1 env gene at transmission favors neutralization-sensitive variants, but it is not known to what degree selection acts on the internal HIV-1 proteins to restrict or enhance the transmission of immune escape variants. Studies have suggested that HLA class I may determine susceptibility to HIV-1 infection, but a definitive role for HLA at transmission remains unproven. Comparing populations of acute seroconverters and chronically infected patients, we found no evidence of selection acting to restrict transmission of HIV-1 variants. We found that statistical associations previously reported in chronic infection between viral polymorphisms and HLA class I alleles are not present in acute infection, suggesting that the majority of viral polymorphisms in these patients are the result of transmission rather than de novo adaptation. Using four episodes of HIV-1 transmission in which the donors and recipients were both sampled very close to the time of infection we found that, despite a transmission bottleneck, genetic variants of HIV-1 infection are transmitted in a frequency-dependent manner. As HIV-1 infections are seeded by unique donor-adapted viral variants, each episode is a highly individual antigenic challenge. Host-specific, idiosyncratic HIV-1 antigenic diversity will seriously tax the efficacy of immunization based on consensus sequences.