Coupling of growth and differentiation in normal myeloid precursors and the breakdown of this coupling in leukemia

Practical Procedures for Improving Detection of Circulating miRNAs in Cardiovascular Diseases

Hemolysis has been known to affect the measurement of circulating biomarkers. In this study, clinically applicable procedures for microRNA (miRNA) detection in serum samples of acute myocardial infarction patients were established. The 89 samples from patients admitted to the coronary care unit were collected. These samples obtained from heparin-treated and untreated patients were subjected to heparinase digestion prior to miRNA measurements by multiplex RT-qPCR. The good reproducibility of miRNA detection after heparinase digestion (average R2 = 0.97) indicated that this method can be used routinely for samples regardless of heparin medication. Additionally, the degree of hemolysis in these samples was highly related to the hemoglobin absorbance at 414 nm. Based on the hemoglobin absorbance, five hemolysis-associated miRNAs were identified in our data normalized with respect to both the spike-in control and the RNA amount in a given sample. Using these calibration procedures, miRNAs can be accurately quantified and identified for clinical samples. Graphical Abstract The practical procedures for miRNA detection in serum samples from the coronary care unit were established, and five hemolysis-associated miRNAs were accurately clarified through serial normalization.

The molecular regulators of macrophage and granulocyte development. Role of MGI-2/IL-6

The development of a cell culture system for the in vitro cloning and clonal differentiation of normal hematopoietic cells made it possible to identify the proteins that regulate growth and differentiation of different hematopoietic cell lineages and the change in normal controls that produce leukemia. A model system with myeloid cells has identified different myeloid cell colony-inducing proteins, which we called MGI-1 (= CSF, including IL-3). There is another protein that we first described in 1976 and called MGI-2 in 1980 that induces differentiation of myeloid cells to macrophages or granulocytes without inducing the clonal growth of myeloid cells. The four CSF proteins and IL-1 induce the production of MGI-2 in myeloid cells and MGI-2 induces the production of GM-CSF. This shows the participation of MGI-2 in the network of interactions with different myeloid regulatory proteins. Using a monoclonal antibody to MGI-2, amino acid sequencing, and recombinant protein, we have shown in collaboration with the Genetics Institute that the major form of MGI-2 (MGI-2A) is IL-6. This shows that IL-6 is a myeloid cell differentiation inducing protein. The results also suggest new clinical potentials for MGI-2/IL-6.

Regulation of leukaemic cells by interleukin 6 and leukaemia inhibitory factor

Interleukin 6 (IL-6) and leukaemia inhibitory factor (LIF) can have pleiotropic effects on different cell types. M1 myeloid leukaemic cells respond to IL-6 with activation of a terminal differentiation programme which includes activation of genes for certain haemopoietic regulatory proteins (IL-6, IL-1 alpha, IL-1 beta, granulocyte-macrophage colony-stimulating factor [GM-CSF], M-CSF, tumour necrosis factor and transforming growth factor [TGF] beta 1) and for receptors for some of these proteins, thus establishing a network of positive and negative regulatory cytokines. IL-6 and some other cytokines also induce during differentiation sustained levels of transcription factors that can regulate and maintain gene expression in the differentiation programme. M1 leukaemic cells induced to differentiate with IL-6 undergo programmed cell death (apoptosis) on withdrawal of IL-6, and can be rescued from apoptosis by IL-6, IL-3, M-CSF, G-CSF or IL-1, but not by GM-CSF. These differentiating leukaemic cells can also be rescued from apoptosis by the tumour promoter TPA (12-O-tetradecanoylphorbol-13-acetate) but not by the non-tumour-promoting isomer 4-alpha-TPA, and rescue from apoptosis can be achieved by different pathways. Apoptosis can also be induced in undifferentiated M1 leukaemic cells by expression of the wild-type form of the tumour suppressor p53 protein and IL-6 can rescue the cells from this wild-type p53-mediated apoptosis. There are clones of M1 cells that differentiate with IL-6 but not with LIF and another M1 clone that differentiates with either IL-6 or LIF. Differentiation induced by IL-6 or LIF is inhibited by TGF-beta 1. The pleiotropic effects of LIF, like those of IL-6, are presumably also in a network of interacting regulatory proteins.

Cytokine control of developmental programs in normal hematopoiesis and leukemia

The establishment of a system for in vitro clonal development of hematopoietic cells made it possible to discover the cytokines that regulate hematopoiesis. These cytokines include colony stimulating factors and others, which interact in a network, and there is a cytokine cascade which couples growth and differentiation. A network allows considerable flexibility and a ready amplification of response to a particular stimulus. A network may also be necessary to stabilize the whole system. Cells called hematopoietic stem cells (HSC) can repopulate all hematopoietic lineages in lethally irradiated hosts, and under appropriate conditions give rise to neuronal, muscle, and epithelial cells. Granulocyte colony stimulating factor induces migration of both HSC and in vitro colony forming cells from the bone marrow to peripheral blood. Granulocyte colony stimulating factor is also used clinically to repair irradiation and chemotherapy associated suppression of normal hematopoiesis in cancer patients, and to stimulate normal granulocyte development in patients with infantile congenital agranulocytosis. It is suggested that there may also be appropriate conditions under which in vitro colony forming cells have a wider differentiation potential similar to that shown by HSC. An essential part of the developmental program is cytokine suppression of apoptosis by changing the balance in expression of apoptosis inducing and suppressing genes. Decreasing the level of cytokines that suppress therapeutic induction of apoptosis in malignant cells can improve cancer therapy. Cytokines and some other compounds can reprogram abnormal developmental programs in leukemia, so that the leukemic cells differentiate to mature non dividing cells, and this can also be used for therapy. There is considerable plasticity in the developmental programs of normal and malignant cells.

All-trans-retinoic acid effects the growth, differentiation and apoptosis of normal human myeloid progenitors derived from purified CD34+ bone marrow cells

We have previously shown that all-trans retinoic acid (ATRA) increases the number of CFU-GM colonies grown from unseparated human bone marrow cells with crude sources of colony stimulating factors. In this study, we further characterized the effect of ATRA on the growth of CFU-GM stimulated by individual cytokines from multiple samples of CD34+ enriched or purified human bone marrow cells. The number of IL-3- or GM-CSF-induced CFU-GM with 3 x 10(-7) M ATRA was 3.25+/-1.13, and 2.17+/-0.8-fold greater respectively, compared to controls without ATRA, while G-CSF had no effect and the ratio of colony-induced with or without ATRA was 1.06+/-0.17 (P = 0.00012). No colonies grew with ATRA + IL-6 or ATRA without a cytokine. Maximum enhancing effect on IL-3-induced CFU-GM occurred when ATRA was added on day 2, gradually diminished when delaying ATRA, and in cultures of day 9 or older adding ATRA had no effect. In 14 days liquid cultures of purified CD34+ cells with IL-3, ATRA increased the number of myeloid differentiated cells to 91-95%, compared to 37-70% with IL-3 alone. In addition, the number of apoptotic cells using the annexin V method increased after 14 days from 5.1% with IL-3 to 17.1% with IL-3 + ATRA and by the TUNEL in situ method from 10-26% to 60-95%, respectively. This study demonstrates that ATRA consistently enhances the growth of myeloid progenitors from CD34+ cells. This effect is dependent on the stimulating cytokine, suggesting the myeloid cells responding to ATRA are the less mature CFU-GMs that are targets of IL-3 and GM-CSF and not the G-CSF-responding mature progenitors. The growth stimulation by ATRA and IL-3 is also associated with granulocyte differentiation and increased apoptosis. These studies further suggest a potential role of pharmacological doses of ATRA on the development of normal human hematopoietic cells.

Induction of leukemia cell differentiation and apoptosis by recombinant P48, a modulin derived from Mycoplasma fermentans

P48 is a 48-kDa monocytic differentiation/activation factor which was originally identified in the conditioned medium of the Reh and other leukemia cell lines and has recently been shown to be a Mycoplasma fermentans gene product. Previously, conditioned medium P48 has been shown to induce differentiation of HL-60 (human promyelocytic leukemia) cells. Recently our laboratory isolated cDNA clones for P48 from Reh cells and genomic clones from Mycoplasma fermentans and expressed the recombinant protein as a maltose binding protein (MBP) fusion protein in E. coli. In this report we present the initial characterization of this recombinant P48 fusion protein (rP48-MBP). We show that rP48-MBP induces differentiation of HL-60, U937 (human histiocytic lymphoma), and M1 (mouse myeloid leukemia) cell lines. Interestingly, rP48-MBP also induces apoptosis of U937 and HL-60 cells as assessed by terminal transferase (TUNEL) assays. This is the first report of induction of apoptosis by a Mycoplasma gene product. P48 is a Mycoplasma-derived immunomodulatory molecule which has differentiation and apoptosis-inducing activities and may be important in the pathophysiology of Mycoplasma infections. The recombinant protein may be useful in studying the mechanisms of differentiation, cytokine production, and apoptosis in malignant and nonmalignant hematopoietic cells.

The molecular control of hematopoiesis: from clonal development in culture to therapy in the clinic

The establishment of a cell culture system for the clonal development of hematopoietic cells has made it possible to discover the proteins that regulate cell viability, growth and differentiation of different hematopoietic cell lineages and the molecular basis of normal and abnormal cell development in blood-forming tissues. These regulators include cytokines now called colony stimulating factors and interleukins. Different cytokines can induce cell viability, multiplication and differentiation, and hematopoiesis is controlled by a network of interactions between these cytokines. This network includes positive regulators such as colony stimulating factors and interleukins and negative regulators such as transforming growth factor beta and tumor necrosis factor. Gene cloning has shown that there is a family of different genes for these cytokines. The functioning of the network requires an appropriate balance between positive and negative regulators and the selective regulation of programmed cell death (apoptosis). There are different ways of inducing or inhibiting programmed cell death, and differences in the regulation of this program can result in tumor promotion or tumor suppression. The cytokine network which has arisen during evolution allows considerable flexibility, depending on which part of the network is activated and the ready amplification of response to a particular stimulus. A network may also be necessary to stabilize the whole system. Cytokines that regulate hematopoiesis can induce the expression of genes for transcription factors can thus ensure the autoregulation and transregulation of cytokine genes that occur in the network.(ABSTRACT TRUNCATED AT 250 WORDS)

Cooperative effect of 8-Cl-cAMP and rhGM-CSF on the differentiation of HL-60 human leukemia cells

In HL-60 leukemia cells the site-selective cAMP analog, 8-Cl-cAMP, at a dose of 5 microM produced growth inhibition with no signs of toxicity, whereas granulocyte-macrophage colony stimulating factor (GM-CSF) exerted an early transient increase of cell proliferation which was followed by differentiation toward monocytes. 8-Cl-cAMP in combination with GM-CSF blocked the growth stimulation due to GM-CSF and demonstrated a synergistic effect on the differentiation of HL-60 cells. The early proliferative effect of GM-CSF was correlated with an increased expression of type I regulatory subunit of cAMP-dependent protein kinase (RI alpha). Treatment with an RI alpha antisense oligodeoxynucleotide suppressed the GM-CSF-inducible cell proliferation and differentiation. Conversely, an RII beta antisense oligodeoxynucleotide, which suppresses the RII beta and causes a compensatory increase in RI alpha level, greatly enhanced the early proliferative input and the differentiation induced by GM-CSF. These results provide an insight into the mechanism of action of GM-CSF and the rationale for a combination differentiation therapy with 8-Cl-cAMP and GM-CSF.

Expression and function of interleukin-6 in epithelial cells

Epithelial cells both produce and are affected by interleukin-6 (IL-6). Experiments with an adenocarcinoma-derived cell line (HeLa) reveal that activation of the transfected human IL-6 promoter occurs largely through two partially overlapping second messenger (cAMP, phorbol ester)- and cytokine (IL-1, TNF, serum)-responsive enhancer elements (MRE 1, -173 to -151 and MRE II, -158 to -145). MRE I contains the typical GACGTCA cAMP and phorbol ester-responsive (CRE-TRE) motif, whereas MRE II defines a new CRE/TRE motif that contains an imperfect dyad repeat. The mechanism of dexamethasone-mediated repression of IL-6 gene expression in epithelial cells involves occlusion of the entire MRE enhancer region and of the core-promoter elements (TATA-box and RNA start site) by ligand-activated glucocorticoid receptor. Enhanced levels of IL-6 expression are observed in many solid tumors and in the hyperproliferative (and glucocorticoid-suppressible) lesions of psoriasis. In cell culture, IL-6 enhances, inhibits, or has no effect on the proliferation of epithelial cells depending upon the cell-type examined. IL-6 enhances proliferation of keratinocytes but inhibits that of breast carcinoma cell lines ZR-75-1 and T-47D. In these breast carcinoma cells, IL-6 elicits a major change in cell phenotype which is characterized by a fibroblastoid morphology, enhanced motility, increased cell-cell separation, and decreased adherens type junctions (desmosomes and focal adhesions). The new data identify IL-6 as a regulator of epithelial cell growth and of cell-cell association.

Hierarchical regulation of interleukin production: induction of interleukin 6 (IL-6) production from bone marrow cells and marrow stromal cells by interleukin 3 (IL-3)

IL-3 stimulated the production of IL-6 from a bone marrow-adherent cell population, macrophages and from hemopoietic supportive stromal cell lines. It also induced IL-6 production from a stem cell-enriched population of bone marrow cells which did not produce IL-6 without stimulation. In contrast, stimulation with IL-6 of all the cell populations studied in the present experiments did not induce IL-3 production. These results indicate a hierarchical network in the regulation of interleukin production, and existence of a positive feedback mechanism; IL-3 induces IL-6 production which in turn stimulates stem cells into cycle and induces stem cells to respond to IL-3.

Retinoic acid in mono- or combined differentiation therapy of myelodysplasia and acute promyelocytic leukemia

Myelodysplastic preleukemic syndromes (MDPS) and acute promyelocytic leukemia (APL) share a surprising in vivo sensitivity to the hormonally acting 13 cis or all trans retinoic acids (transRA). Here we show that transRA as a monotherapeutic agent induced a stable remission in APL at the third relapse. In MDPS, treatment with prednisone and 1 alpha,25-dihydroxyvitamin D3 (1 alpha,25D3) 13 cis RA induced a long-lasting hematological remission. Initially both patients had an impaired BM microenvironment which regenerated on retinoid therapy as judged by reappearance of the Hematon fraction in the BM aspirates. Our preclinical experiments using long-term liquid BM cultures (LTBMC) indicated that several individual patterns of growth and differentiation responses can be induced by combinations of transRA, 1 alpha,25D3 and hemopoietic growth factors (HGFs). The biological responses may vary from complete clonal extinction to a significant growth stimulation of the leukemic blast cell populations. These results further support the importance of preclinical studies in selecting "good" responders for, and excluding "poor" responders from protocols using differentiation therapy.

The control of growth and differentiation in normal and leukemic blood cells

The establishment of a cell culture system for the clonal development of hematopoietic cells has made it possible to discover the proteins that control growth and differentiation of different hematopoietic cell lineages and the molecular basis of normal and abnormal cell development in blood-forming tissues. A model system with myeloid cells has shown that normal hematopoietic cells require different proteins to induce cell multiplication and cell differentiation, and that a cascade of interactions between proteins determines the correct balance between immature and mature cells in normal development. Gene cloning has shown that there is a family of different genes for these proteins. Normal protein regulators of hematopoiesis can control the abnormal growth of certain types of leukemic cells and suppress malignancy by inducing differentiation to mature nondividing cells. Genetic abnormalities that give rise to malignancy in these leukemic cells can be bypassed and their effects nullified by inducing differentiation, which stops cells from multiplying. These hematopoietic regulatory proteins are active in culture and in vivo and have been used clinically to correct defects in blood cell development. The results provide new approaches to therapy.

Indirect induction of differentiation of normal and leukemic myeloid cells by recombinant interleukin 1

Different clones of myeloid leukemic cells can be induced to differentiate to mature macrophages or granulocytes by different normal hematopoietic regulatory proteins. The present experiments with recombinant IL-1 alpha and recombinant IL-1 beta show that, (a) that there are clones of myeloid leukemic cells which can be induced to differentiate to mature cells by the myeloid cell differentiation-inducing protein MGI-2 and can also be induced to differentiate to mature macrophages and granulocytes by both types of IL-1; (b) this IL-1-induced differentiation is mediated by endogenous production of differentiation-inducing protein MGI-2; (c) IL-1 and MGI-2 induce production of GM-CSF in these leukemic cells; and (d) IL-1 also induces cell differentiation and production of MGI-2 and GM-CSF in normal myeloid precursor cells. The results indicate that IL-1 induces differentiation indirectly.

Site-selective cyclic AMP analogs as new biological tools in growth control, differentiation, and proto-oncogene regulation

The physiologic role of cyclic adenosine monophosphate (cAMP) in the growth control of a spectrum of human cancer lines, including leukemic lines, and v-rasH oncogene-transformed NIH/3T3 cells is demonstrated by the use of site-selective cAMP analogs. These cAMP analogs, which can select either of the two known cAMP binding sites of the cAMP receptor protein, induce potent growth inhibition, phenotypic change, and differentiation (leukemic cells) of cancer cells at micromolar concentrations with no sign of cytotoxicity. The growth inhibition parallels selective modulation of cAMP-dependent protein kinase isozymes, type I versus type II, and suppression of cellular proto-oncogene expression. Site-selective cAMP analogs thus provide new biological tools for investigating cell proliferation and differentiation and also for the improved management of human cancers.

Slowing down aging of cultured embryonal chick chondrocytes by maintenance under lowered oxygen tension

Cultured epiphyseal-chondrocytes from embryonic chick may serve as a useful in vitro model to study aging processes in cartilage. The accelerated aging process in cultured chondrocytes is completed within a month and is manifested by typical changes in both cellular and extracellular compartments. Under common maintenance conditions, cells show a gradual loss of replicative capacity, increase in the rate of proteoglycan synthesis and age-dependent changes in the structure and composition of proteoglycan. An environmental factor--reduced oxygen tension--was found to slow down aging processes and preserve the young features of chondrocytes for a longer duration in culture. Cultures maintained under lower oxygen tension had higher proliferation rate, smaller cell size, lower rate of proteoglycan synthesis, and lower content of keratan sulfate side chains in the proteoglycan. In addition higher concentrations of free cytosolic calcium [Ca2+]in as compared to control cultures, was found. It is suggested that the increased proliferation rate and the decrease in proteoglycan synthesis caused by low oxygen tension may be signalled by the higher [Ca2+]in in these cells.

Target-cell specificity of hematopoietic regulatory proteins for different clones of myeloid leukemic cells: two regulators secreted by Krebs carcinoma cells

The normal myeloid hematopoietic regulatory proteins include one class of proteins that induces viability and multiplication of normal myeloid precursor cells to form colonies (called MGI-1 = CSF or IL-3) and another class (called MGI-2 = DF) that induces differentiation of normal myeloid precursors without inducing cell multiplication. Different clones of myeloid leukemia cells can differ in their response to these regulatory proteins. The present experiments characterize proteins secreted by Krebs ascites carcinoma cells that induce differentiation of 2 different types of myeloid leukemic cell clones (clones II and 7-M12). The results indicate the following: (1) Krebs cells produce 2 distinct and separable proteins, each inducing differentiation in one of the leukemic clones. (2) One protein induced differentiation of clone-II myeloid leukemic cells and of normal myeloid precursor cells was free of any colony-inducing (MGI-1 = CSF or IL-3) activity, bound to double-stranded mammalian DNA, and was thus a differentiation-inducing protein MGI-2. This MGI-2 protein (MGI-2A) was purified to a single silver-stained band on an SDS polyacrylamide gel. (3) The other protein induced differentiation of clone 7-M12 myeloid leukemic cells, did not bind to double-stranded DNA and could not be separated from the myeloid growth-inducing protein MGI-1GM (GM-CSF) after 6 steps of purification including high-pressure liquid chromatography. The use of specific antisera confirmed that the protein which induced differentiation of clone 7-M12 leukemic cells was MGI-1 GM. The results show that Krebs ascites tumor cells produce 2 different myeloid hematopoietic regulatory proteins that differ in their target specificity for different clones of myeloid leukemic cells.

Role of different normal hematopoietic regulatory proteins in the differentiation of myeloid leukemic cells

There are 4 different normal myeloid hematopoietic cell growth-inducing proteins MGI-1 (CSF or IL-3) that induce normal precursor cells to multiply and form clones containing only macrophages (MGI-1M = M-CSF = CSF-1), only granulocytes (MGI-1G = G-CSF), both granulocytes and macrophages (MGI-1GM = GM-CSF), or granulocytes, macrophages, eosinophils, mast cells, megakaryocytes and erythroid cells (interleukin-3) (IL-3). There is another type of normal myeloid regulatory protein (MGI-2) with no MGI-1 (CSF or IL-3) activity which can induce differentiation of normal myeloid precursors and certain clones of myeloid leukemic cells. The present results with MGI-2 and pure recombinant MGI-1G, MGI-1GM and IL-3 have shown that different clones of myeloid leukemic cells can be induced to differentiate by different hematopoietic regulatory proteins. One type of leukemic clone is induced to differentiate to mature cells only by MGI-2 and is partially differentiated by MGI-1G, a second type is differentiated only by MGI-1GM or IL-3, and other workers have found a third type that is differentiated only by MGI-1G. The presence of surface receptors does not necessarily make leukemic cells differentiation-competent for these hematopoietic regulatory proteins. All 4 types of MGI-1 (CSF or IL-3) induce endogenous synthesis of MGI-2 in normal myeloid precursor cells. It is suggested that, in addition to their potential therapeutic effect on the development of normal hematopoietic cells, MGI-2, MGI-1G, MGI-1GM and IL-3 all have the potential for differentiation-directed therapy of leukemia in leukemic cells that can be differentiated by one of these normal hematopoietic regulatory proteins.

The molecular control of blood cell development

The establishment of a cell culture system for the clonal development of blood cells has made it possible to identify the proteins that regulate the growth and differentiation of different blood cell lineages and to discover the molecular basis of normal and abnormal cell development in blood forming tissues. A model system with myeloid blood cells has shown that (i) normal blood cells require different proteins to induce cell multiplication (growth inducers) and cell differentiation (differentiation inducers), (ii) there is a hierarchy of growth inducers as cells become more restricted in their developmental program, and (iii) a cascade of interactions between proteins determines the correct balance between immature and mature cells in normal blood cell development. Gene cloning has shown that there is a family of different genes for these proteins. Normal protein regulators of blood cell development can control the abnormal growth of certain types of leukemic cells and suppress malignancy by inducing differentiation to mature nondividing cells. Chromosome abnormalities that give rise to malignancy in these leukemic cells can be bypassed and their effects nullified by inducing differentiation, which stops cells from multiplying. These blood cell regulatory proteins are active in culture and in the body, and they can be used clinically to correct defects in blood cell development.

Regulation of cell-surface receptors for hematopoietic differentiation-inducing protein MGI-2 on normal and leukemic myeloid cells

The normal myeloid hematopoietic regulatory proteins include 4 different growth-inducing proteins (IL-3, MGI-1GM = GM-CSF, MGI-1G = G-CSF, and MGI-1M = M-CSF = CSF-1). There is also another type of normal myeloid regulatory protein (MGI-2) with no MGI-1 (CSF or IL-3) activity, which can induce differentiation of normal myeloid precursors and certain clones of myeloid leukemic cells. Studies on the binding of MGI-2 to differentiation-competent (D+) and differentiation-defective (D-) clones of mouse myeloid leukemic cells and to normal cells indicate that: (1) D+ clones of myeloid leukemic cells had about 2,500 high-affinity surface receptors per cell, like mature normal myeloid cells, and the bound MGI-2 was rapidly internalized with its cell-surface receptors at 37 degrees C causing down-regulation of MGI-2 receptors in both the normal and leukemic cells; (2) in some D- clones, the number and internalization of MGI-2 receptors were similar to those of D+ clones whereas other D- clones had only 0-100 MGI-2 receptors per cell; (3) normal thymus and lymph-node lymphocytes and T lymphoma cells did not show detectable MGI-2 receptors; (4) there was an independent expression of receptors for MGI-2 and for the 4 myeloid growth-inducing proteins on different clones of myeloid leukemic cells; and (5) none of the 4 myeloid growth-inducing proteins IL-3, MGI-1GM, MGI-1G, or MGI-1M, inhibited binding of MGI-2 to its receptors. The cytotoxic proteins lymphotoxin and tumor necrosis factor did not induce differentiation of the mouse myeloid leukemic cells and also did not inhibit binding of MGI-2 to its receptors. These results show that the myeloid differentiation-inducing protein MGI-2 binds to cell-surface receptors that are different from the receptors for the 4 myeloid growth-inducing proteins and these cytotoxic proteins.

The Wellcome Foundation lecture, 1986. The molecular regulators of normal and leukaemic blood cells

The development of a cell-culture system for the cloning and clonal differentiation of different types of blood cell has made it possible to identify: (i), the proteins that regulate growth and differentiation of different cell lineages in normal and leukaemic blood cells; (ii), the molecular basis of normal and abnormal control of cell development in blood-forming tissue; and (iii), how to suppress malignancy in leukaemic cells. By using myeloid blood cells as a model system, it has been shown that normal blood cells require different proteins to induce cell viability and multiplication (growth-inducers) and differentiation (differentiation-inducers), that there is a hierarchy of growth-inducers which act at various stages of cell development, and that a growth-inducer can switch on production of a differentiation-inducer. Gene cloning has established a multigene family for these proteins. Identification of these proteins and their interaction has shown how growth and differentiation are regulated in normal development and demonstrated the mechanisms that uncouple growth and differentiation so as to produce malignant cells. Normal cells require an external source of growth-inducing protein for cell viability and multiplication. Cells can become leukaemic by genetically changing this normal requirement for growth without blocking response to normal differentiation-inducers. The mature cells induced by adding these normal protein-inducers are then no longer malignant. Other genetic changes which inhibit differentiation by the normal blood-cell regulatory proteins can occur in the evolution of leukaemia. But even these leukaemic cells may still be induced to differentiate by other compounds that can induce differentiation by alternative pathways. The differentiation of leukaemic to mature cells, which stops the cells from multiplying, results in the suppression of malignancy by bypassing genetic changes that produce the malignant phenotype. The activity of blood-cell growth- and differentiation-inducing proteins has been shown in culture and in the body. They can, therefore, be clinically useful to correct defects in the development of normal and leukaemic blood cells.

Hemopoietic growth factors and oncogenes in myeloid leukemia development

Most primary myeloid leukemias are dependent for proliferative stimulation on the glycoprotein colony-stimulating factors. These agents are therefore mandatory co-factors in the development of myeloid leukemia. The CSFs also modify oncogene transcription, and in model leukemogenesis experiments GM-CSF has been shown to be a proto-oncogene. However, most evidence is against an autocrine hypothesis of myeloid leukemia based solely on CSF production by emerging leukemic cells. Because the CSFs also have differentiation commitment actions, they can induce differentiation in myeloid leukemic cells, and G-CSF in particular has an impressive capacity to suppress myeloid leukemic populations by this action. The antagonistic actions of the CSFs on myeloid leukemic cells make it difficult to predict whether they will prove to be useful agents in the management of myeloid leukemias.

Cell differentiation and malignancy

An understanding of the mechanism that controls growth and differentiation in normal cells would seem to be an essential requirement to elucidate the origin and reversibility of malignancy. For this approach I have mainly used normal and leukemic blood cells, and in most studies have used myeloid blood cells as a model system. Our development of systems for the in vitro cloning and clonal differentiation of normal blood cells made it possible to study the controls that regulate growth (multiplication) and differentiation of these normal cells and the changes in these controls in leukemia. Experiments with normal blood cell precursors have shown that normal cells require different proteins to induce growth and differentiation. We have also shown that in normal myeloid precursors, growth-inducing protein induces both growth and production of differentiation-inducing protein so this ensures the coupling between growth and differentiation that occurs in normal development. The origin of malignancy involves uncoupling of growth and differentiation. This can be produced by changes from inducible to constitutive expression of specific genes that result in asynchrony to the coordination required for the normal developmental program. Normal myeloid precursors require an external source of growth-inducing protein for growth, and we have identified different types of leukemic cells. Some no longer require and other constitutively produce their own growth-inducing protein. But addition of the normal differentiation-inducing protein to these malignant cells still induces their normal differentiation, and the mature cells are then no longer malignant. Genetic changes that produce blocks in the ability to be induced to differentiate by the normal inducer occur in the evolution of leukemia. But even these cells can be induced to differentiate by other compounds, including low doses of compounds now being used in cancer therapy, that induce the differentiation program by other pathways. This differentiation of leukemic cells has been obtained in vitro and in vivo, and our in vivo results indicate that this may be a useful approach to therapy. In some tumours, such as sarcomas, reversion from a malignant to a non-malignant phenotype can be a result of chromosome changes that suppress malignancy. But in myeloid leukemia, the stopping of growth in mature cells by induction of differentiation bypasses the genetic changes that produce the malignant phenotype. These conclusions can also be applied to other types of normal and malignant cells.

Hematopoietic growth and differentiation factors and the reversibility of malignancy: cell differentiation and by-passing of genetic defects in leukemia

Our development of systems for the in vitro cloning and clonal differentiation of normal hematopoietic cells made it possible to identify: the factors that regulate growth and differentiation of these normal cells; the changes in the normal development program that result in leukemia, and how to reverse malignancy in leukemic cells. I have mainly used myeloid cells as a model system. Normal hematopoietic cells require different proteins to induce growth (growth factors) and differentiation (differentiation factors). There is a multigene family for these factors. Identification of these factors and their interaction has shown how growth and differentiation can be normally coupled. The development of leukemia involves the uncoupling of growth and differentiation. This can occur by changing the requirement for growth without blocking cell response to the normal inducers of differentiation. Addition of normal differentiation factors to these malignant cells still induces their normal differentiation, and the mature cells are then no longer malignant. Genetic changes which inhibit differentiation by normal differentiation factors can occur in the progression of leukemia, but even these leukemic cells may still be induced to differentiate by other compounds, including low doses of compounds now being used in cancer therapy, that can induce differentiation by alternative pathways. The differentiation of leukemic to mature cells results in the reversion of malignancy by by-passing genetic changes that produce the malignant phenotype. We have obtained this differentiation of leukemic cells in vitro and in vivo, and by-passing genetic defects by inducing differentiation can be a useful approach to therapy.

Independent regulation of myeloid cell growth and differentiation inducing proteins: in vivo regulation by compounds that induce inflammation

Regulation of the in vivo production of myeloid cell growth-inducing (MGI-1) and differentiation-inducing (MGI-2) proteins has been studied in mice injected with the inflammation-inducing compounds sodium caseinate, thioglycollate and bacterial lipopolysaccharide. The results indicate that these inflammation-inducing compounds can induce in vivo production of MGI-1 and MGI-2; that different inducing agents can cause a different body-distribution of MGI-1 and MGI-2; that there is an independent regulation of in vivo production and distribution of MGI-1 and MGI-2; and that there is a granulocyte growth-inducing protein (MGI-IG = G-CSF) that is not identical to the differentiation-inducing protein (MGI-2). Resident peritoneal macrophages produce MGI-1 and MGI-2 in vitro, but inflammatory macrophages show a reduced ability to spontaneously produce these proteins after in vivo injection of caseinate or thioglycollate. The results thus also indicate that macrophage activation can affect the ability of macrophages to produce the myeloid cell regulatory proteins MGI-1 and MGI-2.

Established leukemia cell lines: their role in the understanding and control of leukemia proliferation

For investigation of mechanisms of leukemogenesis and control of proliferation of leukemia cells, various preleukemic hematopoietic progenitor cell lines and leukemia cell lines have been established. The role of these established cell lines in understanding leukemogenesis and control of leukemia cell proliferation is described. The results of studies on biological characteristics of numerous human leukemia-lymphoma cell lines suggest that the heterogeneity in various markers of the cell lines reflects different patterns of normal hematopoietic cell differentiation. Then, recent studies on the control of proliferation of leukemia cells by induction of terminal differentiation with the use of established leukemia cell lines both in vitro and in vivo are described. Therapeutic significance of the results obtained with these leukemia cell lines is also discussed.

In vitro drug testing using hemopoietic cells: goals and limitations

In vitro drug sensitivity is one of many biologic variables which may predict in vivo drug response. Even if in vitro assays provide relevant data, for some tumors, variable levels of stem-cell origin, differentiation, tumor heterogeneity, or self renewal may be more important than cytotoxicity to proliferating cells. Although ANLL has been used here frequently as a model, it may not be the most appropriate tumor for study. Unlike many cancers, in ANLL, primary drug resistance is unusual, and in relapse, secondary drug resistance is usually incomplete. It has been suggested that in vitro drug sensitivity predicts remissions for patients who do not die of infection or remain aplastic during induction therapy. However, for the majority of patients, this argument acknowledges the overriding importance of biologic variables other than in vitro drug cytotoxicity. For rapidly growing tumors, such as Burkitt's lymphoma, rapid emergence of drug resistance related to disease burden may be the most important response determinant. Perhaps in other tumors, in vitro drug sensitivity will be an independent variable of overriding importance. To determine the role of in vitro drug testing, trials examining in vitro drug sensitivity must meet stringent criteria. The assays should use well-defined and reproducible cultures and drug exposures. The trials must be large enough, contain homogenously treated patients, and use carefully defined response and survival endpoints. Decision rules derived from such trials must be further tested by prospective evaluation. Investigators conducting these trials must be prepared to search for important in vitro results reflecting tumor biology and to analyze in vitro drug sensitivity as only one continuous variable determining in vivo responses. Such trials will be difficult to conduct and expensive. In the final analysis, in vitro assays may find their most important roles as preclinical drug screens and models for in vitro drug resistance. Further insights into molecular genetics of malignant transformation and drug resistance may make such assays obsolete, but for the present, they provide important insights into tumor variability and mechanisms of drug response.

Synthesis by mouse peritoneal cells of G-CSF, the differentiation inducer for myeloid leukemia cells: stimulation by endotoxin, M-CSF and multi-CSF

Normal C57BL mouse peritoneal cells were able to synthesize material with the ability to induce differentiation in colonies of the mouse myelomonocytic leukemia cell line, WEHI-3B. The active factor was provisionally identified biochemically as the normal regulator, granulocyte colony-stimulating factor, G-CSF. Thioglycollate-induced peritoneal exudate cells had little or no capacity to synthesize such material. Production of active material was elevated 10-100-fold by exposure of peritoneal cells to endotoxin, detectable elevations being observed after the addition of as little as 0.8 ng/ml. Production of G-CSF was observed using adherent peritoneal macrophages, was a radioresistant process depending on protein synthesis and was not modified by the absence or addition of T-lymphocytes. Addition of unfractionated media containing M-CSF or Multi-CSF, partially purified M-CSF or fully purified Multi-CSF elevated the production of G-CSF by peritoneal cells from both C57BL mice and mice of the endotoxin-unresponsive strain C3H/HeJ, but an involvement of endotoxin in this process could not be excluded absolutely. The experiments provide further evidence that microorganisms and perhaps hemopoietic regulators play an important role in modulating the production of G-CSF and thus have the potentiality to influence the emergence and progressive proliferation of myeloid leukemia populations.

Heterogeneity of human colon carcinoma

In order to better understand colon cancer, a model system reflecting the heterogenous nature of this disease was developed and used in the development of new cytotoxic and non-cytotoxic therapeutic approaches. A large bank of colon carcinoma cell lines was established from primary human colon carcinomas and grouped based on their tumorigenicity in athymic mice, their growth rates in soft agarose and in tissue culture, and their secreted levels of carcinoembryonic antigen. These cell lines were later characterized based on cell surface proteins and antigens detected with antisera raised against a differentiated colon carcinoma cell line. Although these biochemical markers correlated with the biological classification of these cell lines, there was still extensive heterogeneity within each group in all properties examined. This colon carcinoma cell system was used to study natural vs. selected resistance to the anticancer drug mitomycin C (MMC). The differing IC50 values in vitro were reflected in the inhibition by MMC of xenograft growth in athymic mice. A new, more readily bioactivatable analogue of MMC was tried and shown to be more active in vitro and in vivo, suggesting that rapid efflux of the drug before activation may be important in examining causes of resistance to MMC. Another approach to the treatment of colon cancer is the use of non-cytotoxic agents such as growth factors and differentiation agents to restore normal growth to the malignant cells. We have isolated and characterized two types of polypeptides from colon carcinoma cells and conditioned medium from these cells. The first, transforming growth factors (TGF's) confer a transformed phenotype on non-transformed fibroblasts while the second, tumor inhibitory factors (TIF's), inhibits the anchorage independent growth of transformed cells. The fact that extracts of colon carcinoma cells contain both activities suggests that the heterogeneity of the cell lines could be due to different levels of TGF's and TIF's produced. The effectiveness of differentiation agents to restore normal growth control using a transformed mouse embryo cell line was examined. Treatment of these cells with differentiation agents restored normal growth control to these cells. An increased synthesis of TGF's resulted from these treatments. Therefore, differentiation agents may be useful in non-cytotoxic treatment. The use of this model system for human colon carcinoma will hopefully lead to more effective drugs for the treatment of colon cancer in man.

Control of in vivo differentiation of myeloid leukemic cells. III. Regulation by T lymphocytes and inflammation

Mouse and human (HL-60) MGI+D+ myeloid leukemic cells were induced to differentiate to mature cells in diffusion chambers implanted into the peritoneal cavity of normal mice when a xenogeneic source of serum was added to the diffusion chambers. Differentiation was inhibited in immune deficient mice including congenitally athymic nude and neonatally thymectomized mice, and mice treated with cyclophosphamide, hydrocortisone, or X-irradiation. There was no such inhibition of differentiation in mice with various genetic defects in their B lymphocytes, granulocytes, erythrocytes and natural killer cells. Differentiation in cyclophosphamide-treated mice was restored by a single intravenous injection of normal spleen cells highly enriched for T lymphocytes. Conditions permissive for differentiation were associated with a higher number of eosinophils in the peritoneum that conditions that inhibited differentiation. Intraperitoneal injections of inflammatory peritoneal exudate cells, peritoneal granulocytes, or the inflammation inducer sodium caseinate, restored the ability of defective mice to induce differentiation. Injections into defective mice of the normal mouse macrophage and granulocyte differentiation-inducing protein (MGI-2) restored differentiation of the mouse myeloid leukemic cells but not of the human myeloid leukemic cells. Differentiation of normal mouse bone marrow myeloid precursors to mature cells and of differentiation-defective (MGI-D-) mouse myeloid leukemic cells to intermediate stages of differentiation were not affected by the conditions that inhibited differentiation of the MGI+D+ myeloid leukemic cells. The results indicate: 1) that the intraperitoneal accumulation of inflammatory cells, including eosinophils, can induce differentiation of MGI+D+ leukemic cells in the peritoneal cavity; 2) that this response requires T lymphocytes and can be regulated by xenogeneic serum in the chamber; 3) that in vivo differentiation of normal and MGI+D+ myeloid leukemic cells can be regulated in different ways; and 4) that the in vivo differentiation of the mouse MGI+D+ leukemic cells, human MGI+D+ leukemic cells and mouse MGI-D- leukemic cells were induced by different compounds, so that differentiation of different types of leukemic cells may be differently regulated in vivo depending on which compounds induce differentiation.