Charlotte V. Cox

Expression of CD133 on leukemia-initiating cells in childhood ALL

Optimization of therapy for childhood acute lymphoblastic leukemia (ALL) requires a greater understanding of the cells that proliferate to maintain this malignancy because a significant number of cases relapse, resulting from failure to eradicate the disease. Putative ALL stem cells may be resistant to therapy and subsequent relapses may arise from these cells. We investigated expression of CD133, CD19, and CD38 in pediatric B-ALL. Cytogenetic and molecular analyses demonstrated that karyotypically aberrant cells were present in both CD133(+)/CD19(+) and CD133(+)/CD19(-) subfractions, as were most of the antigen receptor gene rearrangements. However, ALL cells capable of long-term proliferation in vitro and in vivo were derived from the CD133(+)/CD19(-) subfraction. Moreover, these CD133(+)/CD19(-) cells could self-renew to engraft serial nonobese diabetic-severe combined immunodeficient recipients and differentiate in vivo to produce leukemias with similar immunophenotypes and karyotypes to the diagnostic samples. Furthermore, these CD133(+)/CD19(-) ALL cells were more resistant to treatment with dexamethasone and vincristine, key components in childhood ALL therapy, than the bulk leukemia population. Similar results were obtained using cells sorted for CD133 and CD38, with only the CD133(+)/CD38(-) subfraction demonstrating xenograft repopulating capacity. These data suggest that leukemia-initiating cells in childhood B-ALL have a primitive CD133(+)/CD19(-) and CD38(-) phenotype.

Interleukin-15 enhances cellular proliferation and upregulates CNS homing molecules in pre-B acute lymphoblastic leukemia

Genome-wide association studies have consistently implicated the interleukin-15 (IL-15) gene in acute lymphoblastic leukemia (ALL) biology, including associations with disease susceptibility, and increased risk of central nervous system (CNS) involvement. However, whether pre-B ALL blasts directly respond to IL-15 is unknown. Here, we show that most pre-B ALL primary samples and cell lines express IL-15 and components of its receptor and that primary pre-B ALL cells show increased growth in culture in response to IL-15. Investigation of mechanisms of action using IL-15-responsive SD-1 cells shows this growth advantage is maximal under low-serum conditions, mimicking those found in cerebrospinal fluid. IL-15 also upregulates PSGL-1 and CXCR3, molecules associated with CNS trafficking. Investigation of downstream signaling pathways indicates that IL-15 induces signal transducer and activator of transcription 5 (STAT5), extracellular signal-regulated kinase (ERK) 1/2, and to a lesser extent phosphatidylinositol 3-kinase (PI3K) and nuclear factor κB (NF-κB) phosphorylation. The IL-15-mediated growth advantage is abolished by mitogen-activated protein kinase kinase/extracellular signal-regulated kinase (MEK/ERK), PI3K, and NF-κB inhibitors but preserved in the presence of STAT5 inhibition. Together, these observations provide a mechanistic link between increased levels of IL-15 expression and leukemogenesis, high-risk disease, and CNS relapse and suggest potential therapeutic targets.

Parthenolide eliminates leukemia initiating cell populations and improves survival in xenografts of childhood acute lymphoblastic leukemia

Approximately 20% of children with acute lymphoblastic leukemia (ALL) relapse because of failure to eradicate the disease. Current drug efficacy studies focus on reducing leukemia cell burden. However, if drugs have limited effects on leukemia-initiating cells (LICs), then these cells may expand and eventually cause relapse. Parthenolide (PTL) has been shown to cause apoptosis of LIC in acute myeloid leukemia. In the present study, we assessed the effects of PTL on LIC populations in childhood ALL. Apoptosis assays demonstrated that PTL was effective against bulk B- and T-ALL cells, whereas the CD34(+)/CD19(-), CD34(+)/CD7(-), and CD34(-) subpopulations were more resistant. However, functional analyses revealed that PTL treatment prevented engraftment of multiple LIC populations in NOD/LtSz-scid IL-2Rγ(c)-null mice. PTL treatment of mice with established leukemias from low- and high-risk patients resulted in survival and restoration of normal murine hemopoiesis. In only 3 cases, disease progression was significantly slowed in mice engrafted with CD34(+)/CD19(-) or CD34(+)/CD7(-) and CD34(-) cells, but was not prevented, demonstrating that individual LIC populations within patients have different responses to therapy. These observations indicate that PTL may have therapeutic potential in childhood ALL and provide a basis for developing effective therapies that eradicate all LIC populations to prevent disease progression and reduce relapse.

Junctional Adhesion Molecule-A Is Highly Expressed on Human Hematopoietic Repopulating Cells and Associates with the Key Hematopoietic Chemokine Receptor CXCR4.

Hematopoietic stem/progenitor cells (HSPCs) reside in specialized bone marrow microenvironmental niches, with vascular elements (endothelial/mesenchymal stromal cells) and CXCR4‐CXCL12 interactions playing particularly important roles for HSPC entry, retention, and maintenance. The functional effects of CXCL12 are dependent on its local concentration and rely on complex HSPC‐niche interactions. Two Junctional Adhesion Molecule family proteins, Junctional Adhesion Molecule‐B (JAM)‐B and JAM‐C, are reported to mediate HSPC‐stromal cell interactions, which in turn regulate CXCL12 production by mesenchymal stromal cells (MSCs). Here, we demonstrate that another JAM family member, JAM‐A, is most highly expressed on human hematopoietic stem cells with in vivo repopulating activity (p < .01 for JAM‐Ahigh compared to JAM‐AInt or Low cord blood CD34+ cells). JAM‐A blockade, silencing, and overexpression show that JAM‐A contributes significantly (p < .05) to the adhesion of human HSPCs to IL‐1β activated human bone marrow sinusoidal endothelium. Further studies highlight a novel association of JAM‐A with CXCR4, with these molecules moving to the leading edge of the cell upon presentation with CXCL12 (p < .05 compared to no CXCL12). Therefore, we hypothesize that JAM family members differentially regulate CXCR4 function and CXCL12 secretion in the bone marrow niche. Stem Cells 2016;34:1664–1678

Dual targeting of Hsp90 in childhood acute lymphoblastic leukaemia

Survival rates for children with acute lymphoblastic leukaemia (ALL) have improved considerably to over 90% in recent years but despite these advances, 15–20% of patients relapse. Current chemotherapeutic regimens are designed around the properties of bulk leukaemia cells, which differ from those of the leukaemia-initiating cell (LIC) populations (Cox et al, 2009). If drugs have no effect on LIC, these cells may proliferate and cause relapse. Given that several populations in childhood ALL have been shown to have LIC properties (Cox et al, 2009; Diamanti et al, 2013) the development of therapies that are effective against all leukaemia cells, with minimal toxicity to normal cells, is of utmost importance. Efforts to uncover the biological pathways that mediate drug resistance and promote cell survival have lead to the targeting of heat shock protein 90 (Hsp90). Hsp90 is a molecular chaperone protein involved in the maturation and stabilisation of a range of oncogenic client proteins, such as Bcr-Abl, Akt and IKK, that are known to be mutated and/or overexpressed in leukaemias (Mjahed et al, 2012). Targeting Hsp90 could have an impact on several oncogenic pathways and the use of Hsp90 inhibitors is a promising approach for cancer therapy (Hassane et al, 2008; Hertlein et al, 2010; Lancet et al, 2010; Hong et al, 2013). Alvespimycin (17-DMAG) targets the binding site of ATP in Hsp90 and has shown clinical activity in acute myeloid leukaemia (AML)(Lancet et al, 2010; Mjahed et al, 2012). Celastrol has been shown to increase tumour necrosis factorinduced apoptosis (Sethi et al, 2007) and disrupt the Hsp90/ Cdc37 complex (Zhang et al, 2008). Celastrol significantly impairs viability and engraftment of AML LIC by inhibiting nuclear factor-jB survival signals and inducing oxidative stress (Hassane et al, 2008). However, there are no reports on the efficacy of alvespimycin or celastrol in childhood ALL. The aim of this study was to examine the effects of these structurally and functionally distinct Hsp90 inhibitors (Hsp90i) on primary ALL cells and evaluate their potential when used in combination. Cells from 3 B-cell precursor (BCP)-ALL, 3 T-cell ALL (TALL) cases and 3 cord blood (CB) samples were incubated with alvespimycin for 24 h and celastrol for 48 h then compared for survival (Fig 1A). Clinical characteristics of ALL samples are shown in Table SI. The 50% inhibitory concentration (IC50) for alvespimycin was 10 2 nmol/l in

Jam‐a is highly expressed on human hematopoietic repopulating cells and associates with the key hematopoietic chemokine receptor cxcr4

Hematopoietic stem/progenitor cells (HSPCs) reside in specialized bone marrow microenvironmental niches, with vascular elements (endothelial/mesenchymal stromal cells) and CXCR4‐CXCL12 interactions playing particularly important roles for HSPC entry, retention, and maintenance. The functional effects of CXCL12 are dependent on its local concentration and rely on complex HSPC‐niche interactions. Two Junctional Adhesion Molecule family proteins, Junctional Adhesion Molecule‐B (JAM)‐B and JAM‐C, are reported to mediate HSPC‐stromal cell interactions, which in turn regulate CXCL12 production by mesenchymal stromal cells (MSCs). Here, we demonstrate that another JAM family member, JAM‐A, is most highly expressed on human hematopoietic stem cells with in vivo repopulating activity (p < .01 for JAM‐Ahigh compared to JAM‐AInt or Low cord blood CD34+ cells). JAM‐A blockade, silencing, and overexpression show that JAM‐A contributes significantly (p < .05) to the adhesion of human HSPCs to IL‐1β activated human bone marrow sinusoidal endothelium. Further studies highlight a novel association of JAM‐A with CXCR4, with these molecules moving to the leading edge of the cell upon presentation with CXCL12 (p < .05 compared to no CXCL12). Therefore, we hypothesize that JAM family members differentially regulate CXCR4 function and CXCL12 secretion in the bone marrow niche. Stem Cells 2016;34:1664–1678

Investigating CD99 Expression in Leukemia Propagating Cells in Childhood T Cell Acute Lymphoblastic Leukemia

A significant number of children with T-lineage acute lymphoblastic leukemia (T-ALL) fail to respond to therapy and experience early relapse. CD99 has been shown to be overexpressed on T-ALL cells and is considered to be a reliable detector of the disease. However, the relevance of CD99 overexpression in ALL has not been investigated in a functional context. The aim of this study was to investigate the functional capacity of CD99+ cells in childhood ALL and determine the suitability of CD99 as a therapeutic target. Flow cytometric analyses confirmed higher expression of CD99 in ALL blasts (81.5±22.7%) compared to normal hemopoietic stem cells (27.5±21.9%) and T cells (3.1±5.2%, P≤0.004). When ALL cells were sorted and assessed in functional assays, all 4 subpopulations (CD34+/CD99+, CD34+/CD99-, CD34-/CD99+ and CD34-/CD99-) could proliferate in vitro and establish leukemia in NSG mice. Leukemia propagating cell frequencies ranged from 1 in 300 to 1 in 7.4x104 but were highest in the CD34+/CD99- subpopulation. In addition, all four subpopulations had self-renewal ability in secondary NSG mice. Cells in each subpopulation contained patient specific TCR rearrangements and karyotypic changes that were preserved with passage through serial NSG transplants. Despite high levels of CD99 antigen on the majority of blast cells, leukemia initiating capacity in vivo was not restricted to cells that express this protein. Consequently, targeting CD99 alone would not eliminate all T-ALL cells with the ability to maintain the disease. The challenge remains to develop therapeutic strategies that can eliminate all leukemia cells with self-renewal capacity in vivo.

Junctional Adhesion Molecule-A Is Highly Expressed on Human Hematopoietic Repopulating Cells and Associates with the Key Hematopoietic Chemokine Receptor CXCR4: JAM-A on Human Hematopoietic Stem Cells

Hematopoietic stem/progenitor cells (HSPCs) reside in specialized bone marrow microenvironmental niches, with vascular elements (endothelial/mesenchymal stromal cells) and CXCR4‐CXCL12 interactions playing particularly important roles for HSPC entry, retention, and maintenance. The functional effects of CXCL12 are dependent on its local concentration and rely on complex HSPC‐niche interactions. Two Junctional Adhesion Molecule family proteins, Junctional Adhesion Molecule‐B (JAM)‐B and JAM‐C, are reported to mediate HSPC‐stromal cell interactions, which in turn regulate CXCL12 production by mesenchymal stromal cells (MSCs). Here, we demonstrate that another JAM family member, JAM‐A, is most highly expressed on human hematopoietic stem cells with in vivo repopulating activity (p < .01 for JAM‐Ahigh compared to JAM‐AInt or Low cord blood CD34+ cells). JAM‐A blockade, silencing, and overexpression show that JAM‐A contributes significantly (p < .05) to the adhesion of human HSPCs to IL‐1β activated human bone marrow sinusoidal endothelium. Further studies highlight a novel association of JAM‐A with CXCR4, with these molecules moving to the leading edge of the cell upon presentation with CXCL12 (p < .05 compared to no CXCL12). Therefore, we hypothesize that JAM family members differentially regulate CXCR4 function and CXCL12 secretion in the bone marrow niche. Stem Cells 2016;34:1664–1678