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Collinson RJ, Wilson L, Boey D, Ng ZY, Mirzai B, Chuah HS, Howman R, Grove CS, Malherbe JAJ, Leahy MF, Linden MD, Fuller KA, Erber WN, Guo BB. Transcription factor 3 is dysregulated in megakaryocytes in myelofibrosis. Platelets 2024; 35:2304173. [PMID: 38303515 DOI: 10.1080/09537104.2024.2304173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/02/2024] [Indexed: 02/03/2024]
Abstract
Transcription factor 3 (TCF3) is a DNA transcription factor that modulates megakaryocyte development. Although abnormal TCF3 expression has been identified in a range of hematological malignancies, to date, it has not been investigated in myelofibrosis (MF). MF is a Philadelphia-negative myeloproliferative neoplasm (MPN) that can arise de novo or progress from essential thrombocythemia [ET] and polycythemia vera [PV] and where dysfunctional megakaryocytes have a role in driving the fibrotic progression. We aimed to examine whether TCF3 is dysregulated in megakaryocytes in MPN, and specifically in MF. We first assessed TCF3 protein expression in megakaryocytes using an immunohistochemical approach analyses and showed that TCF3 was reduced in MF compared with ET and PV. Further, the TCF3-negative megakaryocytes were primarily located near trabecular bone and had the typical "MF-like" morphology as described by the WHO. Genomic analysis of isolated megakaryocytes showed three mutations, all predicted to result in a loss of function, in patients with MF; none were seen in megakaryocytes isolated from ET or PV marrow samples. We then progressed to transcriptomic sequencing of platelets which showed loss of TCF3 in MF. These proteomic, genomic and transcriptomic analyses appear to indicate that TCF3 is downregulated in megakaryocytes in MF. This infers aberrations in megakaryopoiesis occur in this progressive phase of MPN. Further exploration of this pathway could provide insights into TCF3 and the evolution of fibrosis and potentially lead to new preventative therapeutic targets.
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Affiliation(s)
- Ryan J Collinson
- School of Biomedical Sciences, The University of Western Australia, Crawley, WA, Australia
| | - Lynne Wilson
- School of Biomedical Sciences, The University of Western Australia, Crawley, WA, Australia
| | - Darren Boey
- School of Biomedical Sciences, The University of Western Australia, Crawley, WA, Australia
| | - Zi Yun Ng
- School of Biomedical Sciences, The University of Western Australia, Crawley, WA, Australia
- Department of Haematology, Royal Perth Hospital, Perth, WA, Australia
| | - Bob Mirzai
- PathWest Laboratory Medicine, Nedlands, WA, Australia
| | - Hun S Chuah
- Department of Haematology, Royal Perth Hospital, Perth, WA, Australia
- PathWest Laboratory Medicine, Nedlands, WA, Australia
- Department of Haematology, Rockingham General Hospital, Rockingham, WA, Australia
| | - Rebecca Howman
- Department of Haematology, Sir Charles Gairdner Hospital Nedlands Australia
| | - Carolyn S Grove
- School of Biomedical Sciences, The University of Western Australia, Crawley, WA, Australia
- Department of Haematology, Royal Perth Hospital, Perth, WA, Australia
- Department of Haematology, Sir Charles Gairdner Hospital Nedlands Australia
| | | | - Michael F Leahy
- Department of Haematology, Royal Perth Hospital, Perth, WA, Australia
- PathWest Laboratory Medicine, Nedlands, WA, Australia
| | - Matthew D Linden
- School of Biomedical Sciences, The University of Western Australia, Crawley, WA, Australia
| | - Kathryn A Fuller
- School of Biomedical Sciences, The University of Western Australia, Crawley, WA, Australia
| | - Wendy N Erber
- School of Biomedical Sciences, The University of Western Australia, Crawley, WA, Australia
- PathWest Laboratory Medicine, Nedlands, WA, Australia
| | - Belinda B Guo
- School of Biomedical Sciences, The University of Western Australia, Crawley, WA, Australia
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Collinson RJ, Boey D, Wilson L, Ng ZY, Mirzai B, Chuah H, Leahy MF, Howman R, Linden M, Fuller K, Erber WN, Guo BB. PlateletSeq: A novel method for discovery of blood-based biomarkers. Methods 2023; 219:139-149. [PMID: 37813292 DOI: 10.1016/j.ymeth.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 10/04/2023] [Accepted: 10/06/2023] [Indexed: 10/11/2023] Open
Abstract
Platelets are small circulating fragments of cells that play important roles in thrombosis, haemostasis, immune response, inflammation and cancer growth. Although anucleate, they contain a rich RNA repertoire which offers an opportunity to characterise changes in platelet gene expression in health and disease. Whilst this can be achieved with conventional RNA sequencing, a large input of high-quality RNA, and hence blood volume, is required (unless a pre-amplification step is added), along with specialist bioinformatic skills for data analysis and interpretation. We have developed a transcriptomics next-generation sequencing-based approach that overcomes these limitations. Termed PlateletSeq, this method requires very low levels of RNA input and does not require specialist bioinformatic analytical skills. Here we describe the methodology, from sample collection to processing and data analysis. Specifically, blood samples can be stored for up to 8 days at 4 °C prior to analysis. Platelets are isolated using multi-step centrifugation and a purity of ≤ 1 leucocyte per 0.26x106 platelets is optimal for gene expression analysis. We have applied PlateletSeq to normal adult blood samples and show there are no age-associated variations and only minor gender-associated differences. In contrast, platelets from patients with myeloproliferative neoplasms show differences in platelet transcript profiles from normal and between disease subtypes. This illustrates the potential applicability of PlateletSeq for biomarker discovery and studying platelet biology in patient samples. It also opens avenues for assessing platelet quality in other fields such as transfusion research.
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Affiliation(s)
- Ryan J Collinson
- School of Biomedical Sciences, The University of Western Australia, Crawley, W.A., Australia
| | - Darren Boey
- School of Biomedical Sciences, The University of Western Australia, Crawley, W.A., Australia
| | - Lynne Wilson
- School of Biomedical Sciences, The University of Western Australia, Crawley, W.A., Australia
| | - Zi Yun Ng
- School of Biomedical Sciences, The University of Western Australia, Crawley, W.A., Australia; Royal Perth Hospital, Department of Health Western Australia, Perth, W.A., Australia
| | - Bob Mirzai
- PathWest Laboratory Medicine, Nedlands, W.A., Australia
| | - Hun Chuah
- Royal Perth Hospital, Department of Health Western Australia, Perth, W.A., Australia; PathWest Laboratory Medicine, Nedlands, W.A., Australia; Rockingham General Hospital, Department of Health Western Australia, Rockingham, W.A., Australia
| | - Michael F Leahy
- Royal Perth Hospital, Department of Health Western Australia, Perth, W.A., Australia; PathWest Laboratory Medicine, Nedlands, W.A., Australia; Medical School, The University of Western Australia, Crawley, W.A., Australia
| | - Rebecca Howman
- Sir Charles Gairdner Hospital, Department of Health Western Australia, Nedlands, W.A., Australia
| | - Matthew Linden
- School of Biomedical Sciences, The University of Western Australia, Crawley, W.A., Australia
| | - Kathy Fuller
- School of Biomedical Sciences, The University of Western Australia, Crawley, W.A., Australia
| | - Wendy N Erber
- School of Biomedical Sciences, The University of Western Australia, Crawley, W.A., Australia; PathWest Laboratory Medicine, Nedlands, W.A., Australia
| | - Belinda B Guo
- School of Biomedical Sciences, The University of Western Australia, Crawley, W.A., Australia.
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Greenwood M, Trahair T, Sutton R, Osborn M, Kwan J, Mapp S, Howman R, Anazodo A, Wylie B, D’Rozario J, Hertzberg M, Irving I, Yeung D, Coyle L, Jager A, Engeler D, Venn N, Frampton C, Wei AH, Bradstock K, Dalla-Pozza L. An MRD-stratified pediatric protocol is as deliverable in adolescents and young adults as in children with ALL. Blood Adv 2021; 5:5574-5583. [PMID: 34662896 PMCID: PMC8714725 DOI: 10.1182/bloodadvances.2021005576] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/21/2021] [Indexed: 11/20/2022] Open
Abstract
Pediatric regimens have improved outcomes in adolescent and young adult (AYA) acute lymphoblastic leukemia (ALL). However, results remain inferior to children with ALL. The Australasian Leukaemia and Lymphoma Group (ALLG) ALL06 study (anzctr.org.au/ACTRN12611000814976) was designed to assess whether a pediatric ALL regimen (Australian and New Zealand Children's Haematology and Oncology Group [ANZCHOG] Study 8) could be administered to patients aged 15 to 39 years in a comparable time frame to children as assessed by the proportion of patients completing induction/consolidation and commencing the next phase of therapy (protocol M or high-risk [HR] treatment) by day 94. Minimal residual disease (MRD) response stratified patients to HR treatment and transplantation. From 2012 to 2018, a total of 86 patients were enrolled; 82 were eligible. Median age was 22 years (range, 16-38 years). Induction/consolidation was equally deliverable in ALL06 as in Study 8. In ALL06, 41.5% (95% confidence interval [CI], 30.7-52.9) commenced protocol M or HR therapy by day 94 vs 39.3% in Study 8 (P = .77). Median time to protocol M/HR treatment was 96 days (interquartile range, 87.5-103 days) in ALL06 vs 98 days in Study 8 (P = .80). Induction mortality was 3.6%. With a median follow-up of 44 months (1-96 months), estimated 3-year disease-free survival was 72.8% (95% CI, 62.8-82.7), and estimated 3-year overall survival was 74.9% (95% CI, 65.3-84.5). End induction/consolidation MRD negativity rate was 58.6%. Body mass index ≥30 kg/m2 and day 79 MRD positivity were associated with poorer disease-free survival and overall survival. Pediatric therapy was safe and as deliverable in AYA patients as in children with ALL. Intolerance of pediatric ALL induction/consolidation is not a major contributor to inferior outcomes in AYA ALL.
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Affiliation(s)
- Matthew Greenwood
- Royal North Shore Hospital, St. Leonards, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Toby Trahair
- Children’s Cancer Institute, Lowy Cancer Research Centre, University of New South Wales, Randwick, NSW, Australia
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW, Australia
| | - Rosemary Sutton
- Children’s Cancer Institute, Lowy Cancer Research Centre, University of New South Wales, Randwick, NSW, Australia
- School of Women’s and Children’s Health, University of New South Wales Medicine, Randwick, NSW, Australia
| | | | - John Kwan
- Westmead Hospital, Westmead, NSW, Australia
| | - Sally Mapp
- Princess Alexandra Hospital, Brisbane, QLD, Australia
| | | | | | | | | | | | - Ian Irving
- The Townsville Hospital, Townsville, QLD, Australia
| | - David Yeung
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Luke Coyle
- Royal North Shore Hospital, St. Leonards, NSW, Australia
| | - Amanda Jager
- Australasian Leukaemia Lymphoma Group, Melbourne, VIC, Australia
| | - Dan Engeler
- Australasian Leukaemia Lymphoma Group, Melbourne, VIC, Australia
| | - Nicola Venn
- Children’s Cancer Institute, Lowy Cancer Research Centre, University of New South Wales, Randwick, NSW, Australia
| | - Chris Frampton
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Andrew H. Wei
- The Alfred Hospital and Monash University, Melbourne, VIC, Australia; and
| | - Kenneth Bradstock
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Westmead Hospital, Westmead, NSW, Australia
| | - Luciano Dalla-Pozza
- Cancer Centre for Children, The Children’s Hospital at Westmead, Westmead, NSW, Australia
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Guo BB, Linden MD, Fuller KA, Phillips M, Mirzai B, Wilson L, Chuah H, Liang J, Howman R, Grove CS, Malherbe JA, Leahy MF, Allcock RJ, Erber WN. Platelets in myeloproliferative neoplasms have a distinct transcript signature in the presence of marrow fibrosis. Br J Haematol 2019; 188:272-282. [PMID: 31426129 DOI: 10.1111/bjh.16152] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 04/08/2019] [Accepted: 06/20/2019] [Indexed: 01/10/2023]
Abstract
Marrow fibrosis is a significant complication of myeloproliferative neoplasms (MPN) that affects up to 20% of patients and is associated with a poor prognosis. The pathological processes that lead to fibrotic progression are not well understood, but megakaryocytes have been implicated in the process. The aim of this study was to determine whether platelets, derived from megakaryocytes, have transcriptomic alterations associated with fibrosis. Platelets from MPN patients with and without fibrosis and non-malignant control individuals were assessed using next generation sequencing. Results from the initial training cohort showed discrete changes in platelet transcripts in the presence of marrow fibrosis. We identified more than 1000 differentially expressed transcripts from which a putative 3-gene fibrotic platelet signature (CCND1, H2AX [previously termed H2AFX] and CEP55) could be identified. This fibrosis-associated signature was assessed blinded on platelets from an independent test MPN patient cohort. The 3-gene signature was able to discriminate between patients with and without marrow fibrosis with a positive predictive value of 71% (93% specificity, 71% sensitivity). This demonstrates that assessment of dysregulated transcripts in platelets may be a useful monitoring tool in MPN to identify progression to marrow fibrosis. Further, sequential monitoring could have clinical applications for early prediction of progression to fibrosis.
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Affiliation(s)
- Belinda B Guo
- School of Biomedical Sciences, University of Western Australia, Crawley, WA, Australia
| | - Matthew D Linden
- School of Biomedical Sciences, University of Western Australia, Crawley, WA, Australia
| | - Kathryn A Fuller
- School of Biomedical Sciences, University of Western Australia, Crawley, WA, Australia.,PathWest Laboratory Medicine, Nedlands, WA, Australia
| | - Michael Phillips
- Centre for Medical Research, University of Western Australia, Crawley, WA, Australia
| | - Bob Mirzai
- School of Biomedical Sciences, University of Western Australia, Crawley, WA, Australia.,PathWest Laboratory Medicine, Nedlands, WA, Australia
| | - Lynne Wilson
- School of Biomedical Sciences, University of Western Australia, Crawley, WA, Australia.,PathWest Laboratory Medicine, Nedlands, WA, Australia
| | - Hun Chuah
- School of Biomedical Sciences, University of Western Australia, Crawley, WA, Australia.,Royal Perth Hospital, Department of Health Western Australia, Perth, WA, Australia
| | - James Liang
- School of Biomedical Sciences, University of Western Australia, Crawley, WA, Australia.,Sir Charles Gairdner Hospital, Department of Health Western Australia, Nedlands, WA, Australia
| | - Rebecca Howman
- Sir Charles Gairdner Hospital, Department of Health Western Australia, Nedlands, WA, Australia
| | - Carolyn S Grove
- School of Biomedical Sciences, University of Western Australia, Crawley, WA, Australia.,PathWest Laboratory Medicine, Nedlands, WA, Australia.,Sir Charles Gairdner Hospital, Department of Health Western Australia, Nedlands, WA, Australia
| | - Jacques A Malherbe
- School of Biomedical Sciences, University of Western Australia, Crawley, WA, Australia.,Medical School, University of Western Australia, Crawley, WA, Australia
| | - Michael F Leahy
- PathWest Laboratory Medicine, Nedlands, WA, Australia.,Royal Perth Hospital, Department of Health Western Australia, Perth, WA, Australia.,Medical School, University of Western Australia, Crawley, WA, Australia
| | - Richard J Allcock
- School of Biomedical Sciences, University of Western Australia, Crawley, WA, Australia.,PathWest Laboratory Medicine, Nedlands, WA, Australia
| | - Wendy N Erber
- School of Biomedical Sciences, University of Western Australia, Crawley, WA, Australia.,PathWest Laboratory Medicine, Nedlands, WA, Australia.,Medical School, University of Western Australia, Crawley, WA, Australia
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Guo BB, Liang J, Allcock RJN, Mirzai B, Augustson B, Howman R, Fuller KA, Erber WN. A mutation in PTPN11 may drive leukemic transformation in a case of essential thrombocythemia. Leuk Lymphoma 2017; 59:245-248. [PMID: 28587547 DOI: 10.1080/10428194.2017.1324162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Belinda B Guo
- a School of Biomedical Sciences, Faculty of Health and Medical Sciences , University of Western Australia , Crawley , WA , Australia
| | - James Liang
- a School of Biomedical Sciences, Faculty of Health and Medical Sciences , University of Western Australia , Crawley , WA , Australia.,b Department of Haematology , Sir Charles Gairdner Hospital , Nedlands , WA , Australia
| | - Richard J N Allcock
- a School of Biomedical Sciences, Faculty of Health and Medical Sciences , University of Western Australia , Crawley , WA , Australia.,c PathWest Laboratory Medicine , Nedlands , WA , Australia
| | - Bob Mirzai
- a School of Biomedical Sciences, Faculty of Health and Medical Sciences , University of Western Australia , Crawley , WA , Australia.,c PathWest Laboratory Medicine , Nedlands , WA , Australia
| | - Bradley Augustson
- b Department of Haematology , Sir Charles Gairdner Hospital , Nedlands , WA , Australia.,c PathWest Laboratory Medicine , Nedlands , WA , Australia
| | - Rebecca Howman
- b Department of Haematology , Sir Charles Gairdner Hospital , Nedlands , WA , Australia.,c PathWest Laboratory Medicine , Nedlands , WA , Australia
| | - Kathryn A Fuller
- a School of Biomedical Sciences, Faculty of Health and Medical Sciences , University of Western Australia , Crawley , WA , Australia.,c PathWest Laboratory Medicine , Nedlands , WA , Australia
| | - Wendy N Erber
- a School of Biomedical Sciences, Faculty of Health and Medical Sciences , University of Western Australia , Crawley , WA , Australia.,c PathWest Laboratory Medicine , Nedlands , WA , Australia.,d School of Medicine, Faculty of Health and Medical Sciences , University of Western Australia , Crawley , WA , Australia
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Gallagher T, Leahy MF, Darby S, Campbell L, Howman R, Watts S, Vodanovich M, Tovey J, Esson A, Koay A. Assembling a state-wide patient blood management program as a standard of care: the Western Australian experience. ACTA ACUST UNITED AC 2017. [DOI: 10.1111/voxs.12350] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- T. Gallagher
- Department of Health Western Australia; Perth WA Australia
| | - M. F. Leahy
- Fremantle Hospital; Fremantle WA Australia
- Royal Perth Hospital; Perth WA Australia
- PathWest Laboratory Medicine; Perth WA Australia
- The University of Western Australia; Perth WA Australia
| | - S. Darby
- Sir Charles Gairdner Hospital; Nedlands WA Australia
| | - L. Campbell
- Sir Charles Gairdner Hospital; Nedlands WA Australia
| | - R. Howman
- Sir Charles Gairdner Hospital; Nedlands WA Australia
| | - S. Watts
- Sir Charles Gairdner Hospital; Nedlands WA Australia
| | | | - J. Tovey
- Fremantle Hospital; Fremantle WA Australia
| | - A. Esson
- Department of Health Western Australia; Perth WA Australia
| | - A. Koay
- Department of Health Western Australia; Perth WA Australia
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Harding DJ, MacQuillan G, Howman R, de Boer B, Adams L, Mitchell A, Jeffrey G. Successful Use of Dasatinib After Liver Transplantation for Imatinib-Induced Fulminant Liver Failure in Chronic Myeloid Leukemia. J Clin Oncol 2016; 34:e97-8. [DOI: 10.1200/jco.2013.50.1320] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Damian J. Harding
- Western Australian Liver Transplantation Service, Sir Charles Gairdner Hospital, Perth, Australia
| | - Gerry MacQuillan
- Western Australian Liver Transplantation Service, Sir Charles Gairdner Hospital, Perth, Australia
| | | | | | - Leon Adams
- Western Australian Liver Transplantation Service, Sir Charles Gairdner Hospital, Perth, Australia
| | - Andrew Mitchell
- Western Australian Liver Transplantation Service, Sir Charles Gairdner Hospital, Perth, Australia
| | - Gary Jeffrey
- Western Australian Liver Transplantation Service, Sir Charles Gairdner Hospital, Perth, Australia
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Malherbe JAJ, Fuller KA, Mirzai B, Kavanagh S, So CC, Ip HW, Guo BB, Forsyth C, Howman R, Erber WN. Dysregulation of the intrinsic apoptotic pathway mediates megakaryocytic hyperplasia in myeloproliferative neoplasms. J Clin Pathol 2016; 69:jclinpath-2016-203625. [PMID: 27060176 PMCID: PMC5136711 DOI: 10.1136/jclinpath-2016-203625] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 03/08/2016] [Accepted: 03/10/2016] [Indexed: 12/24/2022]
Abstract
AIMS Megakaryocyte expansion in myeloproliferative neoplasms (MPNs) is due to uncontrolled proliferation accompanied by dysregulation of proapoptotic and antiapoptotic mechanisms. Here we have investigated the intrinsic and extrinsic apoptotic pathways of megakaryocytes in human MPNs to further define the mechanisms involved. METHODS The megakaryocytic expression of proapoptotic caspase-8, caspase-9, Diablo, p53 and antiapoptotic survivin proteins was investigated in bone marrow specimens of the MPNs (n=145) and controls (n=15) using immunohistochemistry. The megakaryocyte percentage positivity was assessed by light microscopy and correlated with the MPN entity, JAK2V617F/CALR mutation status and platelet count. RESULTS The proportion of megakaryocytes in the MPNs expressing caspase-8, caspase-9, Diablo, survivin and p53 was significantly greater than controls. A greater proportion of myeloproliferative megakaryocytes expressed survivin relative to its reciprocal inhibitor, Diablo. Differences were seen between myelofibrosis, polycythaemia vera and essential thrombocythaemia for caspase-9 and p53. CALR-mutated cases had greater megakaryocyte p53 positivity compared to those with the JAK2V617F mutation. Proapoptotic caspase-9 expression showed a positive correlation with platelet count, which was most marked in myelofibrosis and CALR-mutated cases. CONCLUSIONS Disruptions targeting the intrinsic apoptotic cascade promote megakaryocyte hyperplasia and thrombocytosis in the MPNs. There is progressive dysfunction of apoptosis as evidenced by the marked reduction in proapoptotic caspase-9 and accumulation of p53 in myelofibrosis. The dysfunction of caspase-9, which is necessary for proplatelet formation, may be the mechanism for the excess thrombocytosis associated with CALR mutations. Survivin seems to be the key protein mediating the megakaryocyte survival signature in the MPNs and is a potential therapeutic target.
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Affiliation(s)
- Jacques A J Malherbe
- Schoolof Pathology and Laboratory Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - Kathryn A Fuller
- Schoolof Pathology and Laboratory Medicine, University of Western Australia, Crawley, Western Australia, Australia
- PathWest Laboratory Medicine, Nedlands, Western Australia, Australia
| | - Bob Mirzai
- Schoolof Pathology and Laboratory Medicine, University of Western Australia, Crawley, Western Australia, Australia
- PathWest Laboratory Medicine, Nedlands, Western Australia, Australia
| | - Simon Kavanagh
- Schoolof Pathology and Laboratory Medicine, University of Western Australia, Crawley, Western Australia, Australia
- PathWest Laboratory Medicine, Nedlands, Western Australia, Australia
| | - Chi-Chiu So
- Department of Pathology, Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Ho-Wan Ip
- Department of Pathology & Clinical Biochemistry, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Belinda B Guo
- Schoolof Pathology and Laboratory Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - Cecily Forsyth
- Jarrett Street Specialist Centre, North Gosford, New South Wales, Australia
| | - Rebecca Howman
- PathWest Laboratory Medicine, Nedlands, Western Australia, Australia
| | - Wendy N Erber
- Schoolof Pathology and Laboratory Medicine, University of Western Australia, Crawley, Western Australia, Australia
- PathWest Laboratory Medicine, Nedlands, Western Australia, Australia
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Malherbe JAJ, Fuller KA, Arshad A, Nangalia J, Romeo G, Hall SL, Meehan KS, Guo B, Howman R, Erber WN. Megakaryocytic hyperplasia in myeloproliferative neoplasms is driven by disordered proliferative, apoptotic and epigenetic mechanisms. J Clin Pathol 2015; 69:155-63. [PMID: 26290261 DOI: 10.1136/jclinpath-2015-203177] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 06/01/2015] [Accepted: 07/22/2015] [Indexed: 12/31/2022]
Abstract
AIMS Myeloproliferative neoplasms (MPN) are a heterogeneous group of clonal proliferative bone marrow diseases characterised by extensive megakaryocytic hyperplasia and morphological atypia. Despite knowledge of genomic defects, the pathobiological processes driving these megakaryocytic abnormalities in MPN remain poorly explained. We have explored the proliferative, apoptotic and epigenetic profiles of megakaryocytes in human MPN. METHODS Immunohistochemical staining was performed on bone marrow trephine biopsies of 81 MPN (with and without JAK2(V617F) and CALR mutations) and 15 normal controls to assess the megakaryocytic expression of biomarkers associated with proliferation (Ki67), apoptosis (Bcl-XL, BNIP-3) and epigenetic regulation (EZH2, SUZ12). RESULTS Myeloproliferative megakaryocytes showed significantly greater expression of proliferative Ki67 and anti-apoptotic Bcl-XL, reduced pro-apoptotic BNIP-3 and increased SUZ12 compared with controls. In essential thrombocythaemia, large-giant megakaryocytes with hyperlobated nuclei showed a trend towards a proliferative signature. In contrast, myelofibrotic megakaryocytes with condensed nuclear chromatin, and cases with CALR mutations, had significant reductions in pro-apoptotic BNIP-3. CONCLUSIONS Uncontrolled megakaryocytic expansion in MPN results from a combination of increased proliferation, attenuated apoptosis and defective epigenetic regulation with CALR mutations favouring apoptotic failure. The higher platelet counts reported to be seen in MPN with CALR mutations may be due to greater dysregulation of megakaryocyte apoptosis.
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Affiliation(s)
- Jacques A J Malherbe
- School of Pathology and Laboratory Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - Kathryn A Fuller
- School of Pathology and Laboratory Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - Ayesha Arshad
- School of Pathology and Laboratory Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - Jyoti Nangalia
- Cambridge Institute for Medical Research and Wellcome Trust/MRC Stem Cell Institute, University of Cambridge, Cambridge, UK
| | - Giuliana Romeo
- School of Pathology and Laboratory Medicine, University of Western Australia, Crawley, Western Australia, Australia PathWest Laboratory Medicine, Western Australia, Australia
| | - Sara L Hall
- School of Pathology and Laboratory Medicine, University of Western Australia, Crawley, Western Australia, Australia PathWest Laboratory Medicine, Western Australia, Australia
| | - Katie S Meehan
- School of Pathology and Laboratory Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - Belinda Guo
- School of Pathology and Laboratory Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - Rebecca Howman
- School of Pathology and Laboratory Medicine, University of Western Australia, Crawley, Western Australia, Australia PathWest Laboratory Medicine, Western Australia, Australia
| | - Wendy N Erber
- School of Pathology and Laboratory Medicine, University of Western Australia, Crawley, Western Australia, Australia PathWest Laboratory Medicine, Western Australia, Australia
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Howman R, Thakerer A, Pitman M, Ding N, Thompson PA, Khot A, Harrison SJ. Bortezomib, cyclophosphamide, and dexamethasone: highly effective for rapid reversal of myeloma-associated hyperammonemic encephalopathy. Leuk Lymphoma 2010; 51:2299-302. [DOI: 10.3109/10428194.2010.518654] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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11
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Ingram PR, Howman R, Leahy MF, Dyer JR. Cryptococcal immune reconstitution inflammatory syndrome following alemtuzumab therapy. Clin Infect Dis 2007; 44:e115-7. [PMID: 17516390 DOI: 10.1086/518168] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2006] [Accepted: 03/05/2007] [Indexed: 02/03/2023] Open
Abstract
Alemtuzumab is a lymphocyte ablative agent that may cause susceptibility to severe opportunistic infections similar to those seen in AIDS. Pathogen-specific immune reconstitution syndromes can complicate antiretroviral therapy and immune recovery in HIV-infected patients. We present the first reported case of immune reconstitution syndrome associated with T lymphocyte recovery after alemtuzumab therapy.
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MESH Headings
- Alemtuzumab
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal, Humanized
- Antibodies, Neoplasm/adverse effects
- Antineoplastic Agents/adverse effects
- Cryptococcus neoformans/immunology
- Cryptococcus neoformans/pathogenicity
- Humans
- Immune System Diseases/immunology
- Immune System Diseases/microbiology
- Leukemia, Prolymphocytic/complications
- Leukemia, Prolymphocytic/drug therapy
- Leukemia, Prolymphocytic/immunology
- Leukemia, T-Cell/complications
- Leukemia, T-Cell/drug therapy
- Leukemia, T-Cell/immunology
- Male
- Middle Aged
- Salvage Therapy/adverse effects
- Syndrome
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Affiliation(s)
- Paul R Ingram
- Department of Infectious Diseases, Fremantle Hospital, Fremantle, Western Australia, Australia
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Affiliation(s)
- Rebecca Howman
- Department of Haemotology, Fremantle Hospital, 2 Alma Street, Fremantle, Western Australia 6160
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