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Mpakou V, Spathis A, Bouchla A, Tsakiraki Z, Kontsioti F, Papageorgiou S, Bazani E, Gkontopoulos K, Thomopoulos T, Glezou I, Galanopoulos A, Symeonidis A, Diamantopoulos PT, Viniou NA, Kontandreopoulou CN, Zafeiropoulou K, Kotsianidis I, Lamprianidou E, Foukas P, Mpamias A, Pappa V. Upregulated hypoxia inducible factor 1α signaling pathway in high risk myelodysplastic syndrome and acute myeloid leukemia patients is associated with better response to 5-azacytidine-data from the Hellenic myelodysplastic syndrome study group. Hematol Oncol 2021; 39:231-242. [PMID: 33332639 DOI: 10.1002/hon.2834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/09/2020] [Accepted: 12/15/2020] [Indexed: 11/07/2022]
Abstract
5-azacytidine (5-AZA) is considered the standard of care for patients with high-risk myelodysplastic syndromes (MDS) and patients with acute myeloid leukemia (AML) not candidate for intensive chemotherapy. However, even after an initial favorable response, almost all patients relapse, with the exact mechanisms underlying primary or secondary 5-AZA resistance remaining largely unknown. Several reports have previously demonstrated the significance of hypoxia in the regulation of both physiological and malignant hematopoiesis. In MDS, high hypoxia inducible factor 1α (Hif-1α) expression has been correlated with poor overall survival and disease progression, while its involvement in the disease's pathogenesis was recently reported. We herein investigated the possible association of the Hif-1α signaling pathway with response to 5-AZA therapy in MDS/AML patients. Our data demonstrated that 5-AZA-responders present with higher Hif-1α mRNA and protein expression compared to 5-AZA-non-responders/stable disease patients, before the initiation of therapy, while, interestingly, no significant differences in Hif-1α mRNA expression at the 6-month follow-up were observed. Moreover, we found that 5-AZA-responders exhibited elevated mRNA levels of the Hif-1α downstream targets lactate dehydrogenase a (LDHa) and BCL2 interacting protein 3 like (BNIP3L), a further indication of an overactivated Hif-1a signaling pathway in these patients. Kaplan-Meier survival analysis revealed a significant correlation between high Hif-1α mRNA expression and better survival rates, while logistic regression analysis showed that Hif-1α mRNA expression is an independent predictor of response to 5-AZA therapy. From the clinical point of view, apart from proposing Hif-1α mRNA expression as a significant predictive factor for response to 5-AZA, our data offer new perspectives on MDS combinational therapies, suggesting a potential synergistic activity of 5-AZA and Hif-1α inducers, such as propyl hydroxylases inhibitors (PHDi).
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Affiliation(s)
- Vassiliki Mpakou
- Second Department of Internal Medicine and Research Institute, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Aris Spathis
- Second Department of Pathology, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Anthi Bouchla
- Second Department of Internal Medicine and Research Institute, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Zoi Tsakiraki
- Second Department of Pathology, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Frieda Kontsioti
- Second Department of Internal Medicine and Research Institute, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Sotirios Papageorgiou
- Second Department of Internal Medicine and Research Institute, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Efthymia Bazani
- Second Department of Internal Medicine and Research Institute, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Konstantinos Gkontopoulos
- Second Department of Internal Medicine and Research Institute, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Thomas Thomopoulos
- Second Department of Internal Medicine and Research Institute, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Irene Glezou
- Second Department of Internal Medicine and Research Institute, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Athanasios Galanopoulos
- Department of Clinical Hematology, G. Gennimatas District General Hospital, Athens, Greece.,The Hellenic MDS Study Group, Hellenic Society of Haematology, Athens, Greece
| | - Argiris Symeonidis
- The Hellenic MDS Study Group, Hellenic Society of Haematology, Athens, Greece.,Hematology Division, Dept of Int. Medicine, University of Patras Medical School, Patras, Greece
| | - Panagiotis T Diamantopoulos
- First Department of Internal Medicine, Hematology Unit, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Nora-Athina Viniou
- The Hellenic MDS Study Group, Hellenic Society of Haematology, Athens, Greece.,First Department of Internal Medicine, Hematology Unit, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Christina-Nefeli Kontandreopoulou
- First Department of Internal Medicine, Hematology Unit, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Kalliopi Zafeiropoulou
- Hematology Division, Dept of Int. Medicine, University of Patras Medical School, Patras, Greece
| | - Ioannis Kotsianidis
- The Hellenic MDS Study Group, Hellenic Society of Haematology, Athens, Greece.,Department of Hematology, Democritus University of Thrace, Medical School, Alexandroupolis, Greece
| | - Eleftheria Lamprianidou
- Department of Hematology, Democritus University of Thrace, Medical School, Alexandroupolis, Greece
| | - Periklis Foukas
- Second Department of Pathology, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Aristoteles Mpamias
- Second Department of Internal Medicine and Research Institute, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Vasiliki Pappa
- Second Department of Internal Medicine and Research Institute, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece.,The Hellenic MDS Study Group, Hellenic Society of Haematology, Athens, Greece
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