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Objective: To investigate the effects of simvastatin (SV) plus all-trans retinoic acid (ATRA) on the proliferation, differentiation, apoptosis and WT1/hDMP1 gene expression profiles of human promyelocytic leukemia cell line NB4., Methods: The NB4 cell was incubated with simvastatin and ATRA alone or in combination. And the NB4 cell without any treatment was adopted as a normal control. The cells of different groups were collected at 24, 48 and 72 h post-incubation. Their morphological changes were observed after Wright staining. The method of MTT was employed to assay the growth inhibition rate and flow cytometry was used to detect the early-stage ratios of apoptosis and cell necrosis. Real-time quantitative reverse transcriptase-polymerase chain reaction (RT-PCR) was used to detect the WT1/hDMP1 gene expression levels., Results: The cell inhibition rates increased gradually (F = 7.15, P = 0.000) at 15, 10 and 5 µmol/L SV respectively. And so did the expression levels of CD11b (F = 3.41, P = 0.014) and Annexin-V (F = 43.38, P = 0.000). However the expression levels of WT1 decreased gradually (F = 5.35, P = 0.001) reversely with the elevated levels of hDMP1 (F = 22.61, P = 0.000). Furthermore the NB4 cell exhibited the most significant changes at 15 µmol/L SV. After a 72-hour incubation, the expression levels of CD11b (89.46% ± 9.13%)and hDMP1 (626.9 ± 56.9) in NB4 cells at 15 µmol/L SV plus 0.5 µmol/L ATRA were significantly higher than those with ATRA(71.27% ± 7.27%, P = 0.000 and 421.8 ± 38.3, P = 0.003 in each) and SV alone(62.41% ± 6.37%, P = 0.003 and 241.4 ± 21.9, P = 0.003 in each). A combination of 15 µmol/L SV with 0.5 µmol/L ATRA displayed obvious interactions with the expressions of CD11b and hDMP1 (F = 4.09, P = 0.025 and F = 29.58, P = 0.000 in each). And there was no significant interaction for cell inhibition rates and Annexin-V expression., Conclusion: Simvastatin in vitro inhibits the proliferation of NB4 cell, induces its differentiation and promotes its apoptosis. And the lowered expression of WT1 has a dose-dependent correlation with the elevated expression of hDMP1. It indicates that simvastatin has the synergistic in vitro anti-promyelocytic potency.

Objective: To investigate the effects of targeting elimination of the leukemic CD34+ progenitor cells by using cytotoxic T lymphocytes (CTLs) specifically against Wilms tumor gene (WT1)-derived peptide., Methods: A 9-mer WT1 peptide (CMTWNQMNL) containing HLA-A * 0201-binding anchor motifs was synthesized. The suspended cells were collected from the culture of the peripheral blood mononuclear cells and divided into 2 groups: Group D (pure T cells) and Group C (IL2 + T cells). The dendritic cells (DCs) generated from the peripheral blood mononuclear cells of an HLA-A* 0201-positive healthy donor were repeatedly loaded with WT1 peptide so as to elicit cytotoxic T cells (CTLs) specifically for WT1 peptide, and restricted by HLA-A * 0201 (Group A). The specific lysis effects of WT1 peptide specific CTLs upon leukemic bone marrow CD34+ progenitor cells positively expressing WT1 (3 being HLA-A * 0201(+) and 3 being HLA-A*0201(-)), peripheral blood CD34+ cells from healthy persons (2 being HLA-A * 0201(+) and 1 being HLA-A * 0201(-)), and leukemia cells of the lines of NB4 (HLA-A * 0201(+)/WT1(+)), U937 (HLA-A * 0201(+)/WT1(-)), and K562 (HLA-A * 0201(-)/WT1(+)) were measured by methyl thiazolyl tetrazolium (MTT) chromatometry assay. The colony-forming unit-granulocyte macrophage (CFU-GM) forming capability of the leukemic bone marrow CD34+ progenitor cells and peripheral blood CD34+ cells from healthy persons treated with WT1 peptide specific CTLs were also determined by methylcellulose medium colony-forming unit assay. The CTLs elicited by DCs without WT1 peptide loading(Group B)and T cells cultured with IL-2 (Group C) were taken as controls., Results: The CTLs specific for WT1 peptide and restricted by HLA-A * 0201 (Group A) exerted a specific lysis upon the 3 cases with HLA-A * 0201(+)/WT1(+) leukemic bone marrow CD34+ progenitor cells and NB4 leukemia cells, the specific lysis levels were 55.3% +/- 2.8%, 67.1% +/- 3.2%, 49.4% +/- 3.8% and 55.0% +/- 3.7% respectively, all significantly higher than those upon the 3 cases with HLA-A * 0201(-)/WT1(+) leukemic bone marrow CD34+ progenitor cells, normal healthy peripheral blood CD34+ cells of the healthy persons, and leukemia cell of the lines K562 and U937 (the specific lysis levels were all < 20%). The specific lysis level of Group A CTLs was significantly higher than those of Group B and Group C CTLs (both P < 0.01). The relative colony formation rates of WT1-CTLs in Group A upon the 2 cases with HLA-A * 0201(+)/WT1(+) leukemic CD34+ progenitor cells were 17.8% +/- 4.0% and 20.8% +/- 3.41% respectively, both significantly lower than those of the none WT1-CTLs in Group B (88.9% +/- 3.4% and 91.8% +/- 5.7% respectively, both P < 0.01). There was no significant difference in the relative colony formation rate upon HLA-A * 0201(+)/WT1(-) leukemic bone marrow CD34+ progenitor cells and the HLA-A * 0201(-)/WT1(-) or HLA-A * 0201(+)/WT1(-) normal peripheral blood CD34+ progenitor cells between the CTLs of Groups A and B., Conclusions: The CTLs specific for WT1 and restricted by HLA-A * 0201 can exert specific lysis upon leukemic CD34+ progenitor cells highly expressing WT1 gene, and can inhibit the CFU-GM colony formation of such leukemic CD34+ progenitor cells. The product of expression of WT1 gene may be used as a target in the leukemic CD34+ cells.

Objective: To investigate the clinical and laboratory features of acute promyelocytic leukemia (APL)., Methods: 513 APL patients in the last two decades were retrospectively analyzed in this research. We investigated the clinical features including age, sex, abnormality of peripheral hemogram before treatment, therapeutic effect and follow-up and laboratory data such as morphology, immunology, cytogenetics and molecular biology (MICM)., Results: The median age of the APL patients was 33 years old and the ratio of male and female was 1.21:1. Before treatment, the median level of WBC was 4.3 x 10(9)/L and the detection rate of abnormal promyelocyte on blood film was 85.8%; with immunophenotypic detection, the expression levels of CD117, CD34, HLA-DR, CD7, CD14 and CD19 in APL were found to be lower and the expression levels of CD2, CD33 and MPO higher than those in other subtypes of acute myelocytic leukemia (AML) (both P < 0.01). Specific abnormal chromosome t (15;17) was detected in 91.7% of the patients, of whom 75.9% had standard translocation of t (15;17), being the most common one and 15.8% of the patients had t (15;17) with additional abnormal chromosome. There was only 7.5% of the patients with normal karyotype. However, the presence of both simple translocation and complex translocation was seldom seen. With molecular biological detection, PML/RARalpha fusion gene positive rate was 99.6%. In a relatively long clinical follow-up, we found that the complete remission (CR) rate in APL patients was 84.7%, incidence of DIC was 13.4% and five-year survival rate was 30.7%. The median count of WBC in CR group was lower than that non-remission group (P < 0.01). There were no significant differences on expressions of CD34 and CD2 and changes of cytogenetics between the two groups (P > 0.05)., Conclusions: Comprehensive evaluation of MICM could be of important significance in the diagnosis and prognosis judgment for APL patients. The CR rate in these patients with high WBC count was considerable low.

Objective: To investigate the clinical significance of Wilms tumor gene (WT1) expression levels in the bone marrow (BM) of chronic myelogenous leukemia patients., Methods: Real-time quantitative retroversion polymerase chain reaction (RQ-RT-PCR) method was established for detecting WT1 and GAPDH expression levels in the BM of 109 CML and 23 non-leukemic patients with Light Cycler. Normalized WT1 expression level (WT1(N)) was determined as a ratio between WT1 and GAPDH expression times 10(4)., Results: The median expression levels of WT1(N) in 23 CML patients of accelerate phase (CML-AP) and 22 CML patients of blast crisis (CML-BC) were statistically higher than those of 64 CML patients of chronic phase (CML-CP) and 23 non-leukemic controls (103.71 and 129.44 vs 3.44 and 1.47). No statistic differences were found between the CML-CP group and control group, nor between the CML-AP group and CML-BC group. Furthermore, the WT1(N) levels were correlated to the BCR/ABL fusion gene expression levels. Dynamic change of WT1(N) levels in 7 CML patients before or after allogeneic bone marrow transplantation showed that WT1 expression levels could predict relapse of leukemia., Conclusion: WT1 expression levels in CML patients in accelerate phase or blast crisis were strikingly higher than those in non-leukemic patients or CML patients in chronic phase, in whom WT1 expression was undetectable or showed low expression. WT1 gene could be an useful marker for detecting MRD and evaluating therapeutic efficacy in CML.

Objective: To investigate the functional role of human tissue inhibitor of metalloprotease (TIMP)-2 gene on the proliferation and infiltrating capability of human monocytic leukemic cells., Methods: Human monocytic leukemic cells of the line SHI-1 were cultured and the TIMP-2 expression on the cell membrane was detected by flow cytometry (FCM). The SHI-1 cells were transfected with human TIMP-2 gene (SHI-1/TIMP-2 cells) or blank vector (SHI-1/MSCV cells). The TIMP-2 expressed on the surface of the cell membranes of SHI-1/TIMP-2 and SHI-1/MSCV cells was detected by FCM. The SHI-1/TIMP-2 and SHI-1/MSCV cells were inoculated into the 96-well plate, 24, 48, 72, and 96 hours later MMT method and ELISA were used, and the cell growth curve was drawn to detect the proliferation ability of the cells. Matrigel was put into the upper layer of Transwell chamber. Human bone marrow matrix cells (BMMC) of leukemia patient and SHI-1/TIMP-2 cells or SHI-1/MSCV cells were put into the upper layers as experimental groups, and SHI-1/TIMP-2 cells or SHI-1/MSCV cells only, without human BMMC, were put into the upper layers as control groups. 72 hours later blood cell counting plate was used to measure the number of cells migrating through Matrigel. SHI-1/TIMP-2 cells or SHI-1/MSCV cells were injected intravenously into pre-treated BALB/c nu/nu mice. Thirty days later 8 mice from each group were killed to observe the tumorigenesis in the organs, especially the central nervous system leukemia (CNL). The survival of the other mice was observed., Results: The expression level of TIMP-2 on the cell membrane of the SHI-1/TIMP-2 cells was 99.3% +/- 0.1%, significantly higher than that of the SHI-1/MSCV cells (85.9% +/- 2.6%, P < 0.05). The A values 24, 48, 72, and 96 hours later of the SHI-1/TIMP-2 cells were 0.34 +/- 0.05, 0.6 +/- 0.05, 0.97 +/- 0.12, and 1.28 +/- 0.06 respectively, all significantly higher than those of the SHI-1/MSCV cells (0.28 +/- 0.03, 0.36 +/- 0.03, 0.54 +/- 0.09, and 0.99 +/- 0.03 respectively, all P < 0.05). The SHI-1/TIMP-2 cells and SHI-1/MSCV cells only could not migrate through Matrigel basically. 24 - 48 hours after co-cultivation Shi-1 cells began to appear in the lower layer of Transwell chambers, 72 hours later the trans-Matrigel SHI-1/TIMP-2 cells accounted for 24.7% +/- 6.9% of the inoculated SHI-1/TIMP-2 cells, a proportion significantly higher than that in the case of the SHI-1/MSCV cells (12% +/- 1.4%, P < 0.05). 24 days after the inoculation the mean body weight of the mice inoculated with SHI-1/TIMP-2 cells was 21.5 g +/- 0.4 g, significantly higher than that of the mice inoculated with SHI-1/MSCV cells (17.4 g +/- 0.6 g, P < 0.01). The mice inoculated with SHI-1/TIMP-2 cells showed much more tumors in different organs and much more severe infiltration in the CNS in comparison with the mice inoculated with SHI-1/MSCV cells The mean survival time of the mice inoculated with the SHI-1/TIMP-2 cells was 33.7 days, significantly shorter than that of the mice inoculated with SHI-1/MSCV cells (40 days)., Conclusion: TIMP-2 expressed on the cell membrane is critical to promote the proliferation and infiltration of SHI-1 cells.

Objective: To investigate the effect of targeting immunotherapy for leukemia cells by using cytotoxic T lymphocyte (CTL) specifically against WT (Wilm's tumor) 1-derived peptide., Methods: A 9-mer WT1 peptide (CMTWNQMNL) containing HLA-A*0201-binding anchor motifs was synthesized. Dendritic cells (DCs) generated from the peripheral blood mononuclear cells of an HLA-A*0201-positive healthy donor were cultured and divided into 2 groups: experimental group to be loaded with Wilms' tumor 1 (WT1) peptide so as to elicit CTL's specifically for WT1 peptide, restricted by HLA-A*0201, and control group. Six days later rhTNF-alpha was added for 3 days more to promote the maturation of DCs. Before loading of WT1 peptide and 2 days after the addition of rhTNF-alpha direct immunofluorescence labeling method was used with PE or FITC labeled mono-antibodies to detect the expression of the surface antigens: CD83, CD1alpha, CD80, CD86, CD14, and HLA-DR. DCs suspended and attached to wall were collected and then divided into 2 groups: pure T cell group (group D) to be cultured in culture medium without IL-2, and IL-2 + T cell group (Group C) to be cultured in 1640 culture medium with IL-2. Eight days later the T cells of Group C were co-cultured with the DCs of the experimental group (WTI peptide + DC + IL-2 + T cells, Group A) or the DCs of the control group (DC + IL-2 + T cells, Group B). Five days later the killing activity was detected. The CTLs of Groups A, B, and C at logarithmic growth phase were mixed with leukemic cells of the lines: NB4/WT1D, NB4WT1A, NB4 (all HLA-A*0201 +, WT1 +), U937 (HLA-A*0201 +, WTl -), and K562 (HLA-A*0201 -, WTI +), and mononuclear cells of the bone marrow of leukemic patients at different effector cell-target cell of 20:1 and 10:1. MTT method was used to examine the killing rate of CTL to the target cells., Results: (1) The killing rates of Group A cells to NB4/WT1 D, NB4WTA, and NB4, leukemic cells were 60.4% +/- 3.1%, 56.4% +/- 5.7%, and 55.0% +/- 3.7%, all significantly higher than those of the Group B cells (10.9% +/- 1.6%, 11.1% +/- 2.7%, and 11.9% +/- 2.5%), and those of Group C cells (9.1% +/- 1.0%, 9.2% +/- 1.7%, and 9.4% +/- 1.8%) (all P < 0.01). There were no significant differences in the killing rates to U937 and K562 leukemic cells among the 3 groups. (2) When the effect-target ratio was 20: 2, the killing activity of the CTLs of Group A to the HLA-A*0201 +, WT1 + NB4/WT1 D, NB4/WT1A and NB4 leukemic cells was significantly higher than those to the HLA-A*0201 +, WT1 - U937 cells and the HLA-A*0201 -, WT1 + K562 cells (both P < 0.001), however, not significantly different from that to the U937 and K562 cells. (3) There were no significant differences in the killing activity of Group A cells to NB4/WT1D, NB4/WT1A, and NB4 cells (P = 0. 065, P = 0.621). (4) When the effect-target ratio was 10:2, the killing rates of Group A cells to the NB4/ WT1D, NB4/WT1A, and NB4 cells were 45.9% +/- 3.9%, 43.9% +/- 3.7%, and 44.1% +/- 3.2% respectively, all significantly lower than those when the effect-target ratio was 20:1 (all P < 0.01)., Conclusion: CTLs specific for WT1 and restricted by HLA-A*0201 exert specific lysis upon leukemia cell lines and primary leukemia cells, but not upon normal hematopoietic cells, which provides a rationale for developing a strategy of WT1 peptide-based adoptive T-cell therapy and vaccination for human leukemia and solid tumors.

Objective: To investigate the significance of monitoring Wilms' tumor gene (WT1) expression level in bone marrow of leukemia patients following allogeneic bone marrow transplantation (allo-BMT)., Methods: Real-time quantitative reverse transcription polymerase chain reaction method was established for measuring WT1 and GAPDH expression levels in bone marrow cells of 15 patients with leukemia, including a total of 111 specimens during the follow-up, and in 23 non-leukemia patients by using LightCycler. Normalized WT1 expression level (WT1(N)) was determined as a ratio of WT1 to GAPDH times 10(4)., Results: The median expression levels of WT1(N) in 17 samples of newly diagnosed patients, 6 samples of relapsed patients, 88 samples from leukemia patient in complete remission and 23 samples of non-leukemic controls were 40.18 (5.48 to 510.27), 125.89 (34.50 to 273.95), 4.80 (0 to 56.96) and 1.47 (0 to 8.56) respectively. Nonparameter statistic analysis (Mann-Whitney U test) showed that the WT1(N) expression levels in the newly diagnosed group and relapsed group were statistically higher than in those in the complete remission group and non-leukemic controls (all P < 0.01), without significant differences between the complete remission group and control group (P = 0.692) and between the newly diagnosed group and relapsed group (P = 0.595). In general, the dynamic curves of WT1(N) levels following allo-BMT were consistent with the tendency of changes in expression levels of corresponding fusion genes for minimal residual disease (MRD) monitoring. Spearman Rho correlation analysis revealed that the correlation coefficient between the WT1(N) expression levels and BCR/ABL, AML/ETO, PML/RARalpha and MLL/AF17 fusion genes expression were 0.678 (P = 0.00), 0.677 (P = 0.00), 0.806 (P = 0.00) and 0.553 (P = 0.049) respectively. Three patients relapsed after allo-BMT and one patient relapsed before allo-BMT during the follow-up. A re-increment of WT1(N) expression level during follow-up could be detected 40 to 180 days earlier to hematological relapse., Conclusion: The WT1 expression level of leukemia patients following allo-BMT measured by real time RT-PCR can be a useful tool for monitoring MRD and warning the clinical relapse during follow-up.

Objective: To study the gene expression profiles of patients with myelodysplastic syndrome (MDS) and try to identify some genes with pathogenetic and diagnostic relevance., Methods: The bone marrow mononuclear cells (BMMNCs) of 10 patients with MDS, including 4 cases of refractory anemia (RA), 1 case of refractory thrombocytopenia (RTC), 4 cases of RA with excess blasts (RAEB), and 1 case of RAEB in transformation (RAEBt), were isolated and the total RNA was extracted and underwent transcriptome analysis by using customized cDNA microarray with 500 gene clones. Seventeen specimens of normal bone marrow, as controls, were collected from the ribs of 17 patients with chest tumors. Cluster software was used to make analysis. Semiquantitative RT-PCR was carried out to confirm the results of microarray analysis., Results: 95 genes, such as the genes of thrombospondin 1 (THBS1), phosphatase and tensin homolog (PTEN), MAX dimerization protein (MAD), DNA-damage-inducible transcript 3 (DDIT3), ets variant gene 1 (ETV1), G1 to S phase transition 1 (GSPT1), were shown to be abnormally expressed in at least 5 MDS patients compared to the normal controls, involving cell growth and differentiation regulation, cell cycle control, signaling, and redox. The 10 MDS patients in different stages were clustered into two distinct groups, whereas a case with refractory thrombocytopenia and other RA patients were clustered into two subgroups. Semiquantitative RT-PCR revealed the identical results in 3 (60%) of the 5 genes determined by microarray analysis. Further analysis on samples from 50 MDS patients confirmed the different expression levels of RNA helicase-related protein (RNAHP), GSPT1, and DDIT3 between the MDS patients and the normal controls., Conclusion: The technology of microarray can reveal the intrinsic molecular features of MDS patients and the detection of DDIT3 and RNAHP expression may be useful for the diagnosis of MDS.

Objective: To study the expression of gelatinase A (MMP2) in acute leukemic cells and its clinical implication., Methods: The bone marrow samples from 46 acute leukemia patients were investigated by reverse transcription polymerase chain reaction (RT-PCR) and Gelatin Zymography method. Matrigel invasion assay was studied on U937, NB4, K562 and SHI1 cells in vitro., Results: The expression of MMP2 was positive in 24 of 46 patients with AL (52.2%). In MMP2 positive and negative groups of AL, the extramedullary infiltration rates were 50.0% and 18.2% (P < 0.05), whilst the percentage of blast cell in peripheral white blood cells were (77.21 +/- 13.9)% and (62.95 +/- 17.2)% (P < 0.01), respectively. The positive expression of TIMP2 and MT1-MMP in 46 AL patients were 27 (58.7%) and 33 (71.7)%. The matrigel invasion assay suggested that MMP2 is involved in migration of leukemic cell through extracellular matrix (Matrigel)., Conclusion: The active form of MMP2 might be essential to the egress of leukemic cells from bone marrow into peripheral blood, followed by an extramedullary infiltration.