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Publisher Summary This chapter focuses on the molecular basis of lymphoid and myeloid diseases. Disorders of lymphocytes include deficiency of lymphocytes (lymphopenia) and over proliferation of lymphocytes. Over proliferation of lymphocytes is due to either reactive proliferation of lymphocytes (lymphocytosis) or to neoplastic problems. On the other hand, myeloid disorders include anemia, neutropenia, and Myelodysplastic Syndromes (MDS). Anemia is a condition in which the blood contains a lower than normal number of Red Blood Cells (RBCs) or RBCs that do not contain enough hemoglobin. Neutropenia may occur as chronic idiopathic neutropenia or severe congenital neutropenia. Chronic idiopathic neutropenia is defined as any RBC destruction. MDS are diagnosed at a rate of 3.6/100,000 people in the United States. It occurs primarily in older patients (>60 years), but occasionally in younger patients. Anemia, bleeding, easy bruising, and fatigue are common and splenomegaly or hepatosplenomegaly may occasionally be present. The MDS are characterized by abnormal bone marrow and blood cell morphology. It is classified according to cellular morphology, etiology, and clinical features. The morphological classification is largely based on percent myeloblasts in the bone marrow and blood, the type of myeloid dysplasia, and the presence of ringed side-roblasts. Myelodysplastic/myeloproliferative diseases have features of both myelodysplastic syndromes and myeloproliferative disorders. The three main types of myelodysplastic/myeloproliferative diseases are Chronic Myelomonocytic Leukemia (CMML), Juvenile Myelomonocytic Leukemia (JMML), and Atypical Chronic Myelomonocytic Leukemia (aCML).

Mutations of RUNX1 are detected in patients with myelodysplastic syndrome (MDS). In particular, C-terminal truncation mutations lack a transcription regulatory domain and have increased DNA binding through the runt homology domain. The expression of the runt homology domain, RUNX1(41-214), in mouse hematopoietic cells induced progression to MDS and acute myeloid leukemia. Analysis of premyelodysplastic animals found expansion of c-Kit+Sca-1+Lin− cells and skewed differentiation to myeloid at the expense of the lymphoid lineage. These abnormalities correlate with the phenotype of Runx1-deficient animals, as expected given the reported dominant-negative role of C-terminal mutations over the full-length RUNX1. However, MDS is not observed in Runx1-deficient animals. Gene expression profiling found that RUNX1(41-214) c-Kit+Sca-1+Lin− cells have an overlapping yet distinct gene expression profile from Runx1-deficient animals. Moreover, an unexpected parallel was observed between the hematopoietic phenotype of RUNX1(41-214) and aged animals. Genes deregulated in RUNX1(41-214), but not in Runx1-deficient animals, were inversely correlated with the aging gene signature of HSCs, suggesting that disruption of the expression of genes related to normal aging by RUNX1 mutations contributes to development of MDS. The data presented here provide insights into the mechanisms of development of MDS in HSCs by C-terminal mutations of RUNX1.

The 8;21 translocation is the most common chromosomal aberration occurring in acute myeloid leukemia (AML). This translocation causes expression of the RUNX1-ETO (AML1-ETO) fusion protein, which cooperates with additional mutations in leukemia development. We report here that interferons (IFNs) and IFN-stimulated genes are a group of genes consistently up-regulated by RUNX1-ETO in both human and murine models. RUNX1-ETO-induced up-regulation of IFN-stimulated genes occurs primarily via type I IFN signaling with a requirement for the IFNAR complex. Addition of exogenous IFN in vitro significantly reduces the increase in self-renewal potential induced by both RUNX1-ETO and its leukemogenic splicing isoform RUNX1-ETO9a. Finally, loss of type I IFN signaling via knockout of Ifnar1 significantly accelerates leukemogenesis in a t(8;21) murine model. This demonstrates the role of increased IFN signaling as an important factor inhibiting t(8;21) fusion protein function and leukemia development and supports the use of type I IFNs in the treatment of AML.

We report the cloning of a cDNA encoding GliPR (glioma pathogenesis-related protein), a protein that is structurally similar to plant pathogenesis-related proteins. The GLIPR gene is highly expressed in the human brain tumor, glioblastoma multiforme/astrocytoma, but neither in normal fetal or adult brain tissue, nor in other nervous system tumors. GliPR shares up to 50% amino acid (aa) homology with plant pathogenesis-related proteins, group 1, over a region that comprises almost two thirds of the protein. We speculate that there may be functional similarities between the human and plant proteins as well.

A reciprocal translocation involving chromosomes 8 and 21 generates the AML1/ETO oncogenic transcription factor that initiates acute myeloid leukemia by recruiting co-repressor complexes to DNA. AML1/ETO interferes with the function of its wild-type counterpart, AML1, by directly targeting AML1 binding sites. However, transcriptional regulation determined by AML1/ETO probably relies on a more complex network, since the fusion protein has been shown to interact with a number of other transcription factors, in particular E-proteins, and may therefore target other sites on DNA. Genome-wide chromatin immunoprecipitation and expression profiling were exploited to identify AML1/ETO-dependent transcriptional regulation. AML1/ETO was found to co-localize with AML1, demonstrating that the fusion protein follows the binding pattern of the wild-type protein but does not function primarily by displacing it. The DNA binding profile of the E-protein HEB was grossly rearranged upon expression of AML1/ETO, and the fusion protein was found to co-localize with both AML1 and HEB on many of its regulated targets. Furthermore, the level of HEB protein was increased in both primary cells and cell lines expressing AML1/ETO. Our results suggest a major role for the functional interaction of AML1/ETO with AML1 and HEB in transcriptional regulation determined by the fusion protein., Author Summary Acute myeloid leukemias (AML) are a group of hematologic malignancies initiated by chromosomal abnormalities that often give origin to oncogenic proteins with transcriptional regulatory functions. These aberrant transcription factors bind to specific sequences on DNA and influence the activity of adjacent genes. The result is that leukemic blasts display abnormalities in their gene expression programs, which are ultimately responsible for the malignant phenotype. In this study, genome-wide approaches were exploited not only to identify target genes, but also to discover interactions among different transcription factors, with the aim of defining disease-linked regulatory networks. We performed a detailed analysis of the DNA binding pattern of an oncogenic transcription factor, AML1/ETO, which is responsible for approximately 10–15% of AML. We identified a specific signature, which is characterized by the presence of binding regions for AML1/ETO and for other transcription factors, AML1 and HEB, and found that the DNA binding pattern of AML1 and HEB is significantly affected in cells expressing AML1/ETO. Our results, therefore, describe genes regulated by AML1/ETO and demonstrate that this oncogenic protein can significantly interfere with the function of other transcriptional regulators.

The 8;21 chromosomal translocation occurs in 15% to 40% of patients with the FAB M2 subtype of acute myeloid leukemia (AML). This chromosomal abnormality fuses part of the AML1/RUNX1 gene to the ETO/MTG8 gene and generates the AML1-ETO protein. We previously identified a C-terminal truncated AML1-ETO protein (AEtr) in a mouse leukemia model. AEtr is almost identical to the AML1-ETO exon 9a isoform expressed in leukemia patients. Here, we describe a novel function of AEtr in the development of aneuploidy through spindle checkpoint attenuation. AEtr cells had a reduced mitotic index following nocodazole treatment, suggesting a failure in a subset of cells to arrest in mitosis with a functional spindle checkpoint. Additionally, primary leukemia cells and cell lines expressing AEtr were aneuploid. Moreover, AEtr cells had reduced levels of several spindle checkpoint proteins including BubR1 and securin following treatment with the spindle poison nocodazole. These results suggest that inactivation of the spindle checkpoint may contribute to the development of aneuploidy described in t(8;21) leukemia patients.

The acute myeloid leukemia 1 (AML1) transcription factors are key regulators of hematopoietic differentiation. Cellular AML1c protein is found in the nucleus and can be separated into two fractions, one soluble in buffers containing salt and nonionic detergent and the other insoluble and tightly bound to the nuclear matrix. We find that the AML1c protein is modified by both phosphorylation and ubiquitination. Our studies show that the majority of the ubiquitinated AML1c is associated with the insoluble nuclear matrix. Treatment of cells with the proteasome inhibitor PS341 (Velcade, Bortezomib) increases the levels of ubiquitinated AML1c. Mutation of the four phosphorylation sites necessary for transcriptional regulation (serine 276, serine 293, serine 303, and threonine 300) mimics the effects of the proteasome inhibitor, increasing the levels of ubiquitinated, matrix-bound AML1c. We find that the soluble and insoluble forms of AML1c are degraded at a similar rate. However, mutation of these four serine/threonine residues statistically increases the half-life of the matrix-associated AML1c. Thus, phosphorylation of AML1c on specific serine/threonine residues controls both transcriptional activity and rate of degradation.

Recent research has yielded a dramatic increase in the number of connections between oncogenesis and the proteins which regulate the cell cycle. Three classes of protein which inhibit the activity of cyclin-dependent kinases (CDKs) have emerged as potential targets for oncogenic inactivation. p16 and related proteins inhibit the cyclin/CDK complexes which regulate the transition from G1 to S phase; numerous studies have revealed that p16 is mutated in most tumor cell lines and in some types of primary tumor. p21/WAF1/Cip 1 and the related p27Kip protein inhibit a broader range of cyclin/CDK complexes than p16. Although the absence of p21/WAF1/Cip1 from cyclin/CDK complexes is correlated with cellular transformation, no mutations in this gene have been found in tumors or tumor-derived cell lines. A third class of genes which are potential targets for oncogenic inactivation are the kinases and phosphatases which regulate the activity of cyclin/CDK complexes by phosphorylation and dephosphorylation of the CDK proteins. Disruption of any of these genes would result in loss of normal regulation of cell growth.

The transcription factor AML1 (RUNX1) plays a critical role in normal hematopoiesis and in the development of leukemia. The phenotype generated by knockout of the AML1 gene demonstrates that AML1 is necessary for normal development of fetal hematopoietic cells. Conditional knockout of AML1 expression in adult bone marrow leads to lineage-specific effects on B- and T-cell maturation and pronounced inhibition of common lymphocyte progenitor production. In addition, the AML1-deficient adult mice exhibited inefficient platelet production and a mild myeloproliferative phenotype characterized by an increase in peripheral blood neutrophils, an increase in myeloid progenitor populations, and extramedullary hematopoiesis composed of maturing myeloid and erythroid elements. Previous studies have shown that phosphorylation of AML1, particularly at serines 276 and 303, can affect transcriptional activation. We have now shown that phosphorylation of AML1 serines 276 and 303 can be blocked in vivo by inhibitors of the cyclin-dependent kinases (Cdks) Cdk1 and Cdk2. In addition, these two sites can be phosphorylated in vitro by purified, active Cdk1/cyclin B and Cdk2/cyclin A, but not by Cdk4/cyclin D. Mutation of AML1 serines 276 and 303 reduces AML1 activity during most phases of the cell cycle. In addition, mutation of serines 276 and 303 prevents phosphorylation from occurring at two nearby sites (serine 293 and threonine 300). Mutation of serine 293 and threonine 300 causes an increase of AML1 activity, especially in cells arrested in G2/M by treatment with nocodazole. Since Cdk phosphorylation can be stimulatory (serines 276 and 303) or inhibitory (serine 293, threonine 300), the interplay of Cdk phosphorylation at different sites might confer a very fine level of regulation of AML1 activity.

Tumour metastasis is the principal cause of death for cancer patients. We have identified the nm23 gene, for which RNA levels are reduced in tumour cells of high metastatic potential. In this report we identify the cytoplasmic and nuclear Nm23 protein, and show that it also is differentially expressed in metastatic tumour cells. We also find that the human Nm23 protein has sequence homology over the entire translated region with a recently described developmentally regulated protein in Drosophila, encoded by the abnormal wing discs (awd) gene. Mutations in awd cause abnormal tissue morphology and necrosis and widespread aberrant differentiation in Drosophila, analogous to changes in malignant progression. The metastatic state may therefore be determined by the loss of genes such as nm23/awd which normally regulate development.