Leonardo Enciso

Biguanides sensitize leukemia cells to ABT-737-induced apoptosis by inhibiting mitochondrial electron transport

Metformin displays antileukemic effects partly due to activation of AMPK and subsequent inhibition of mTOR signaling. Nevertheless, Metformin also inhibits mitochondrial electron transport at complex I in an AMPK-independent manner, Here we report that Metformin and rotenone inhibit mitochondrial electron transport and increase triglyceride levels in leukemia cell lines, suggesting impairment of fatty acid oxidation (FAO). We also report that, like other FAO inhibitors, both agents and the related biguanide, Phenformin, increase sensitivity to apoptosis induction by the bcl-2 inhibitor ABT-737 supporting the notion that electron transport antagonizes activation of the intrinsic apoptosis pathway in leukemia cells. Both biguanides and rotenone induce superoxide generation in leukemia cells, indicating that oxidative damage may sensitize toABT-737 induced apoptosis. In addition, we demonstrate that Metformin sensitizes leukemia cells to the oligomerization of Bak, suggesting that the observed synergy with ABT-737 is mediated, at least in part, by enhanced outer mitochondrial membrane permeabilization. Notably, Phenformin was at least 10-fold more potent than Metformin in abrogating electron transport and increasing sensitivity to ABT-737, suggesting that this agent may be better suited for targeting hematological malignancies. Taken together, our results suggest that inhibition of mitochondrial metabolism by Metformin or Phenformin is associated with increased leukemia cell susceptibility to induction of intrinsic apoptosis, and provide a rationale for clinical studies exploring the efficacy of combining biguanides with the orally bioavailable derivative of ABT-737, Venetoclax.

High expression of ID family and IGJ genes signature as predictor of low induction treatment response and worst survival in adult Hispanic patients with B-acute lymphoblastic leukemia

BackgroundB-Acute lymphoblastic leukemia (B-ALL) represents a hematologic malignancy with poor clinical outcome and low survival rates in adult patients. Remission rates in Hispanic population are almost 30 % lower and Overall Survival (OS) nearly two years inferior than those reported in other ethnic groups. Only 61 % of Colombian adult patients with ALL achieve complete remission (CR), median overall survival is 11.3 months and event-free survival (EFS) is 7.34 months. Identification of prognostic factors is crucial for the application of proper treatment strategies and subsequently for successful outcome. Our goal was to identify a gene expression signature that might correlate with response to therapy and evaluate the utility of these as prognostic tool in hispanic patients.MethodsWe included 43 adult patients newly diagnosed with B-ALL. We used microarray analysis in order to identify genes that distinguish poor from good response to treatment using differential gene expression analysis. The expression profile was validated by real-time PCR (RT-PCT).ResultsWe identified 442 differentially expressed genes between responders and non-responders to induction treatment. Hierarchical analysis according to the expression of a 7-gene signature revealed 2 subsets of patients that differed in their clinical characteristics and outcome.ConclusionsOur study suggests that response to induction treatment and clinical outcome of Hispanic patients can be predicted from the onset of the disease and that gene expression profiles can be used to stratify patient risk adequately and accurately. The present study represents the first that shows the gene expression profiling of B-ALL Colombian adults and its relevance for stratification in the early course of disease.

Prognostic stratification improvement by integrating ID1/ID3/IGJ gene expression signature and immunophenotypic profile in adult patients with B-ALL

BackgroundSurvival of adults with B-Acute Lymphoblastic Leukemia requires accurate risk stratification of patients in order to provide the appropriate therapy. Contemporary techniques, using clinical and cytogenetic variables are incomplete for prognosis prediction.MethodsTo improve the classification of adult patients diagnosed with B-ALL into prognosis groups, two strategies were examined and combined: the expression of the ID1/ID3/IGJ gene signature by RT-PCR and the immunophenotypic profile of 19 markers proposed in the EuroFlow protocol by Flow Cytometry in bone marrow samples.ResultsBoth techniques were correlated to stratify patients into prognostic groups. An inverse relationship between survival and expression of the three-genes signature was observed and an immunophenotypic profile associated with clinical outcome was identified. Markers CD10 and CD20 were correlated with simultaneous overexpression of ID1, ID3 and IGJ. Patients with simultaneous expression of the poor prognosis gene signature and overexpression of CD10 or CD20, had worse Event Free Survival and Overall Survival than patients who had either the poor prognosis gene expression signature or only CD20 or CD10 overexpressed.ConclusionBy utilizing the combined evaluation of these two immunophenotypic markers along with the poor prognosis gene expression signature, the risk stratification can be significantly strengthened. Further studies including a large number of patients are needed to confirm these findings.

Abstract B36: Biological and clinical significance of ID1/ID3/IGJ expression signature modulation in B-Acute lymphoblastic leukemia

Background. Acute lymphoblastic leukemia (ALL) in Hispanic populations represents a public health problem that requires priority attention because its incidence and mortality increase annually. Intensive chemotherapeutic schemes in the last decade in the United States and other countries and have led to higher rates of durable remissions. However, these schemes have shown disappointing results in Hispanic populations. In Colombia, for example, the median overall survival (OS) is less than 11.3 months, the event-free survival (EFS) is 7.34 months, and only 61% of patients achieve complete remission (CR). Therefore, it is interesting to explore the underlying molecular characteristics of the disease in Hispanic patients. Previously we identified a gene expression signature associated with response to induction treatment and outcome of adult Hispanic patients with B-ALL. These ID1, ID3 and IGJ seem to be involved in many tumorigenic processes. The goal of our study is identify the role of these genes in B-ALL and its relevance in the prognosis and progression of disease in an in vitro model. Methods. CRISPR-Cas9 Gene Engineering and expression-ready ORF cDNA clones were used to either down-regulate or over-express, respectively, the expression of ID1, ID3 and IGJ genes in the adult B-ALL cell line NALM6. We used TaqMan to quantify the levels of mRNA expression of ID1/ID3/IGJ genes after over-expression. Protein expression by Flow Cytometry was used to verify silencing and over-expression of our 3-genes signature. Cell viability and proliferation were determined by anexin V-PI and MTT assay, respectively at 0, 24, 48, 72 and 96 hours after modulation. Cell cycle analysis was performed using BrdU and 7-AAD. Separately, increasing doses of cyclophosphamide, doxorubicin and cytarabine were used to determine the role of ID1, ID3, and IGJ genes in chemo resistance at 24, 48, 72, 96, and 144 hours. Total RNA from leukemic cells was isolated using Trizol method. We used microarray analysis to identify genes differentially expressed after silencing/overexpression. We performed Immunophenotype analysis of 43 B-ALL adult Hispanic patient Bone Marrow samples using the panel of antibodies recommended and standardized by the European consortium Euroflow. Correlation analysis were used to establish the association between our 3-Gene expression signature and the expression of surface markers currently used for diagnostic and follow-up of B-ALL patients. Results. We observed that both overexpression and silencing of ID1, ID3 and IGJ modulated B-ALL cells cell cycle. ID1/ID3/IGJ overexpression resulted in a loss of S phase and arrest of the cells in the G0/G1 phase of the cell cycle. On the contrary, ID1/ID3/IGJ silencing induced a loss of G0/G1 phase and gain in the number of cells in G2/M and S phases. Gain-of-expression and loss-of-expression analyses using incremental doses of chemotherapy agents currently used in the B-ALL treatment, demonstrate that ID1/ID3/IGJ signature promotes drug resistance of the NALM6 B-ALL cell line. Clinically, patients with higher ID1/ID3/IGJ expression have high expression of CD20 and CD10 markers (aberrantly expressed in immature cells) and shorter OS and EFS. In addition, more than 2,000 genes that are differentially expressed in the cells with modulation of the expression of ID1/ID3/IGJ suggesting a complex network of biological processes implicated in the drug resistance and poor prognosis present in the patients with this 3-gene signature. Conclusions. Our data identify the ID1/ID3/IGJ signature as possible modulator of molecular events during B-ALL differentiation, proliferation and drug resistance. These results highlight the potential role of this gene signature both as a risk stratification tool and as a candidate therapeutic target in Hispanic population. Citation Format: Nataly Cruz-Rodriguez, Alba Lucia Combita, Jone Garai, Leonardo Jose Enciso, Sandra Milena Quijano, Silvia Serrano-Gomez, Li Li, Jovanny Zabaleta. Biological and clinical significance of ID1/ID3/IGJ expression signature modulation in B-Acute lymphoblastic leukemia. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr B36.

Abstract 3121: Gene expression signature predicts induction treatment response and clinical outcome in adult Colombian patients with acute lymphoblastic leukemia

Background. In Colombia ALL in adults represents a public health problem because its incidence and mortality increase annually. Only 61% of Colombian adult patients with ALL achieve complete remission. The median overall survival to the disease is less than 11.3 months and the event-free survival is 7.34 months. Identification of prognostic factors in patients with ALL is crucial for the proper planning of treatment strategies and the optimal results of therapy. Our goal was to determine gene expression signatures correlated with response to therapy and to evaluate the utility of these expression patterns as predictors of risk prior to therapy of adult Colombian patients with B-ALL. Methods. This study included 43 adult patients newly diagnosed with B-cell precursor or common B-ALL. Patients were recruited at the Colombian National Cancer Institute and Hospital Universitario San Ignacio, both in Bogota, Colombia. The leukemic blast population from diagnostic samples was separated with magnetic microbeads coated with either anti-CD19 or anti-CD34 antibodies followed by column enrichment using standard procedures and MACS (Miltenyi, Bergisch Gladbach,Germany). Total RNA from purified leukemic cells was isolated using the RNeasy Mini Kit (Qiagen) according to the manufacturer9s protocols. We used microarray analysis to identify genes that distinguish poor from good response to induction treatment using differential gene expression analysis and the response group as reference and the Illumina Custom algorithm embedded in the GenomeStudio software (Illumina). The expression profile was validated by real-time PCR (RT-PCT) using TaqMan probes. The 2-ΔΔCT method was used to estimate the fold induction of each gene using GAPDH and an internal calibrator as controls. Assays were done in triplicate. Results. We identified 442 genes differentially expressed between 22 leukemia patients who responded and 5 who did not respond to induction chemotherapeutic treatment. Hierarchical analysis with the 99 most differentially expressed genes between the two groups revealed 3 sets of patients that differed in their clinical characteristics giving these genes high prognostic clinical outcome impact capacity. We validated the expression of 7 genes by RT PCR in 43 patients and, in addition to finding a correlation with gene expression profiles, we established correlations with good and poor prognosis from the time of diagnosis. Conclusions. Our study suggests that the response to induction treatment and clinical outcome of patients can be predicted from the onset of the disease and that gene expression profiles can be used to stratify patient risk adequately and accurately. The present study represents the first showing that gene expression profiling could become a clinically relevant tool for stratification in the early course of disease of Colombian adults B-ALL. Citation Format: Nataly Cruz-Rodriguez, Sandra M. Quijano, Leonardo J. Enciso, Alba L. Combita, Jovanny Zabaleta. Gene expression signature predicts induction treatment response and clinical outcome in adult Colombian patients with acute lymphoblastic leukemia. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 3121.