Maria Verrucci

Clinical implications of the JAK2 V617F mutation in essential thrombocythemia.

istic upmodulation of CD20 and downmodulation of CD10, comparable to the immunophenotypic modulation observed in vivo. In contrast, the viable 7-AAD-negative cells retained their original immunophenotype (Figure 2e, f). For each antibody, the MFI differed between the viable and dead cells, but within these two populations the MFI was not affected by the type and dose of the cytotoxic agents to which the cells were exposed (data not shown). Further analysis of dead and viable cells showed that dead cells had a higher MFI for each isotype control antibody than viable cells. This increase in background staining was comparable to the upmodulation of CD20 on CD20-negative leukemic cells observed in day 15 and 28 samples. Altogether, these data indicate that the immunophenotypic modulation observed in vitro is due to the induction of cell kill, resulting in a higher aspecific staining and a decreased expression of membrane antigens. Our data suggest that in ALL patients undergoing treatment, immunophenotypic modulation is caused by drug-induced cell death, resulting in loss of membrane antigens and higher aspecific staining. Our data are in agreement with a recent study, which showed that the loss of expression of lineage antigens (such as CD19) is a common feature of lymphocytes undergoing apoptosis and that the MFI for different antigens might drop to undetectable levels during different stages of apoptosis. Antigens coexpressed on the same cells showed different degrees of loss in the different stages of apoptosis, suggesting that it is a specific, active process, rather than a general degradation of cell components. Our observation that immunophenotypic modulation is due to apoptotic cells also explains why ALL blast cells in resistant patients show no modulation. In conclusion, our data indicate that immunophenotypic modulation in ALL patients undergoing treatment can (at least in part) be explained by the induction of cell death. As the presence of these dying cells may still be clinically relevant, usage of strict gating procedures, based on the exact immunophenotype of the blast cells at diagnosis, should be avoided for the analysis of MRD.

Altered SDF-1/CXCR4 axis in patients with primary myelofibrosis and in the Gata1low mouse model of the disease

OBJECTIVE To assess whether alterations in the stromal cell-derived factor-1 (SDF-1)/CXCR4 occur in patients with primary myelofibrosis (PMF) and in Gata1 low mice, an animal model for myelofibrosis, and whether these abnormalities might account for increased stem/progenitor cell trafficking. MATERIALS AND METHODS In the mouse, SDF-1 mRNA levels were assayed in liver, spleen, and marrow. SDF-1 protein levels were quantified in plasma and marrow and CXCR4 mRNA and protein levels were evaluated on stem/progenitor cells and megakaryocytes purified from the marrow. SDF-1 protein levels were also evaluated in plasma and in marrow biopsy specimens obtained from normal donors and PMF patients. RESULTS In Gata1 low mice, the plasma SDF-1 protein was five times higher than normal in younger animals. Furthermore, SDF-1 immunostaining of marrow sections progressively increased with age. Similar abnormalities were observed in PMF patients. In fact, plasma SDF-1 levels in PMF patients were significantly higher (by twofold) than normal (p < 0.01) and SDF-1 immunostaining of marrow biopsy specimens demonstrated increased SDF-1 deposition in specific areas. In two of the patients, SDF-1 deposition was normalized by curative therapy with allogenic stem cell transplantation. Similar to what already has been reported for PMF patients, the marrow from Gata1 low mice contained fewer CXCR4 pos CD117 pos cells and these cells expressed low levels of CXCR4 mRNA and protein. CONCLUSION Similar abnormalities in the SDF-1/CXCR4 axis are observed in PMF patients and in the Gata1 low mice model of myelofibrosis. We suggest that these abnormalities contribute to the increased stem/progenitor cell trafficking observed in this mouse model as well as patients with PMF.

Gata1 expression driven by the alternative HS2 enhancer in the spleen rescues the hematopoietic failure induced by the hypomorphic Gata1low mutation.

Rigorously defined reconstitution assays developed in recent years have allowed recognition of the delicate relationship that exists between hematopoietic stem cells and their niches. This balance ensures that hematopoiesis occurs in the marrow under steady-state conditions. However, during development, recovery from hematopoietic stress and in myeloproliferative disorders, hematopoiesis occurs in extramedullary sites whose microenvironments are still poorly defined. The hypomorphic Gata1(low) mutation deletes the regulatory sequences of the gene necessary for its expression in hematopoietic cells generated in the marrow. By analyzing the mechanism that rescues hematopoiesis in mice carrying this mutation, we provide evidence that extramedullary microenvironments sustain maturation of stem cells that would be otherwise incapable of maturing in the marrow.

CXCR4-independent rescue of the myeloproliferative defect of the Gata1low myelofibrosis mouse model by Aplidin.

The discovery of JAK2 mutations in Philadelphia‐negative myeloproliferative neoplasms has prompted investigators to evaluate mutation‐targeted treatments to restore hematopoietic cell functions in these diseases. However, the results of the first clinical trials with JAK2 inhibitors are not as promising as expected, prompting a search for additional drugable targets to treat these disorders. In this paper, we used the hypomorphic Gata1low mouse model of primary myelofibrosis (PMF), the most severe of these neoplasms, to test the hypothesis that defective marrow hemopoiesis and development of extramedullary hematopoiesis in myelofibrosis is due to insufficient p27Kip1 activity and is treatable by Aplidin®, a cyclic depsipeptide that activates p27Kip1 in several cancer cells. Aplidin® restored expression of Gata1 and p27Kip1 in Gata1low hematopoietic cells, proliferation of marrow progenitor cells in vitro and maturation of megakaryocytes in vivo (reducing TGF‐β/VEGF levels released in the microenvironment by immature Gata1low megakaryocytes). Microvessel density, fibrosis, bone growth, and marrow cellularity were normal in Aplidin®‐treated mice and extramedullary hematopoiesis did not develop in liver although CXCR4 expression in Gata1low progenitor cells remained low. These results indicate that Aplidin® effectively alters the natural history of myelofibrosis in Gata1low mice and suggest this drug as candidate for clinical evaluation in PMF. J. Cell. Physiol. 225: 490–499, 2010.

Removal of the spleen in mice alters the cytokine expression profile of the marrow micro-environment and increases bone formation.

Splenectomized mice express progressively increased numbers of platelets in the blood and reduced numbers of megakaryocytes in the marrow with age. The megakaryocytes in the marrow of these animals express reduced levels of Gata1, a transcription factor necessary for their maturation. In addition, the marrow from these animals expresses greater levels of cytokines (TGF‐β, PDGF‐α, and VEGF) known to be produced at high levels by megakaryocytes expressing reduced levels of Gata1. This high level of cytokine expression is in turn associated with active osteoblast proliferation localized to areas of the femur, where megakaryocytes expressing reduced Gata1 levels are also found. These results confirm the role of megakaryocytes as regulator of bone formation in mice and suggest that a cross‐talk between the spleen and marrow may regulate the total numbers of hemopoietic niches present in an animal.

Evidence for Organ-Specific Stem Cell Microenvironments

The X‐linked Gata1low mutation in mice induces strain‐restricted myeloproliferative disorders characterized by extramedullary hematopoiesis in spleen (CD1 and DBA/2) and liver (CD1 only). To assess the role of the microenvironment in establishing this myeloproliferative trait, progenitor cell compartments of spleen and marrow from wild‐type and Gata1low mice were compared. Phenotype and clonal assay of non‐fractionated cells indicated that Gata1low mice contain progenitor cell numbers 4‐fold lower and 10‐fold higher than normal in marrow and spleen, respectively. However, progenitor cells prospectively isolated from spleen, but not from marrow, of Gata1low mice expressed colony‐forming function in vitro. Therefore, calculation of cloning activity of purified cells demonstrated that the total number of Gata1low progenitor cells was 10‐ to 100‐fold lower than normal in marrow and >1,000 times higher than normal in spleen. This observation indicates that Gata1low hematopoiesis is favored by the spleen and is in agreement with our previous report that removal of this organ induces wild‐type hematopoiesis in heterozygous Gata1low/+ females (Migliaccio et al., 2009, Blood 114:2107). To clarify if rescue of wild‐type hematopoiesis by splenectomy prevented extramedullary hematopoiesis in liver, marrow cytokine expression profile and liver histopathology of splenectomized Gata1low/+ females were investigated. After splenectomy, the marrow expression levels of TGF‐β, VEGF, osteocalcin, PDGF‐α, and SDF‐1 remained abnormally high while Gata1low hematopoiesis was detectable in liver of both CD1 and DBA/2 mutants. Therefore, in the absence of the spleen, Gata1low hematopoiesis is supported by the liver suggesting that treatment of myelofibrosis in these animals requires the rescue of both stem cell and microenvironmental functions. J. Cell. Physiol. 223: 460–470, 2010.

Dynamic regulation of Gata1 expression during the maturation of conventional dendritic cells

OBJECTIVES To identify the regulatory sequences driving Gata1 expression in conventional dendritic cells (cDC). MATERIALS AND METHODS The number and expression levels of Gata1, Gata1-target genes and hypersensitive site (HS) 2 (the eosinophil-specific enhancer)-driven green fluorescent protein (GFP) reporter of cDCs from mice lacking HS1 (the erythroid/megakaryocytic-specific enhancer, Gata1(low) mutation) and wild-type littermates, as well as the response to lipopolysaccharide of ex vivo-generated wild-type and Gata1(low) DCs were investigated. RESULTS cDC maturation was associated with bell-shaped changes in Gata1 expression that peaked in cDCs precursors from blood. The Gata1(low) mutation did not affect Gata1 expression in cDC precursors and these cells expressed the HS2-driven reporter, indicating that Gata1 expression is HS2-driven in these cells. By contrast, the Gata1(low) mutation reduced Gata1 expression in mature cDCs and these cells did not express GFP, indicating that mature cDCs express Gata1 driven by HS1. In blood, the number of cDC precursors expressing CD40/CD80 was reduced in Gata1(low) mice, while CD40(pos)/CD80(pos) cDC precursors from wild-type mice expressed the HS2-GFP reporter, suggesting that Gata1 expression in these cells is both HS1- and HS2-driven. In addition, the antigen and accessory molecules presentation process induced by lipopolysaccharide in ex vivo-generated wild-type DC was associated with increased acetylated histone 4 occupancy of HS1, while ex vivo-generated Gata1(low) cDCs failed to respond to lipopolysaccharide, suggesting that HS1 activation is required for cDC maturation. CONCLUSION These results identify a dynamic pattern of Gata1 regulation that switches from an HS1 to an HS2-dependent phase during the maturation of cDCs associated with the antigen-presentation process in the blood.

Abnormal P-selectin localization during megakaryocyte development determines thrombosis in the gata1low model of myelofibrosis

Abstract Patients with primary myelofibrosis have increased risk for bleeding and thrombosis. It is debated whether propensity to thrombosis is due to increased numbers of platelet microparticles and/or to pathological platelet-neutrophil interactions. Platelet neutrophil interactions are mediated by P-selectin and even though the megakaryocytes of myelofibrosis patients express normal levels of P-selectin, it remains abnormally localized to the demarcation membrane system rather than being assembled into the α-granules in platelets. Mice carrying the hypomorphic Gata1low mutation express the same megakaryocyte abnormalities presented by primary myelofibrosis patients, including abnormal P-selectin localization to the DMS and develop with age myelofibrosis, a disease that closely resembles human primary myelofibrosis. Whether these mice would also develop thrombosis has not been investigated as yet. The aim of this study was to determine whether Gata1low mice would develop thrombosis with age and, in this case, the role played by P-selectin in the development of the trait. To this aim, Gata1low mice were crossed with P-selnull mice according to standard genetic protocols and Gata1lowP-selwt, Gata1lowP-selnull and Gata1WTP-selnull or Gata1wtP-selwt (as controls) littermates obtained. It was shown that platelet counts, but not hematocrit, are reduced in Gata1low mice. Moreover, platelet microparticles are reduced in Gata1low mice and P-selectin positive platelet microparticles were not found. To determine the phenotypic implications of the different mutations, bleeding time was estimated by a tail cut procedure. Mutant mice were sacrificed and presence of thrombosis was determined by immunohistological staining of organs. Gata1low mice with or without the P-selectin null trait had a prolonged bleeding time compared to wild type mice. However, in Gata1low mice significantly higher frequency of thrombotic events was seen in adult and old Gata1low mice compared to Gata1lowP-selnull mice. Thus, presence of the P-selectin null trait rescued Gata1low mice from the thrombotic phenotype, but did not change the level of platelet microparticles. Taken together these data indicate that abnormal localization of P-selectin, induced by the Gata1low mutation, and thus, increased pathological interactions with leucocytes, is responsible for the increased presence of thrombosis seen in these mice.

Thrombotic events in models GATA-1 low myelofibrosis characterized by altered localization of P-selectin during megakaryocyte development

Patients with primary myelofibrosis (PMF) have increased risk for bleeding and thrombosis. It is debated whether propensity to thrombosis is due to increased numbers of platelet microparticles and/or to pathological platelet-neutrophil interactions.This interactions are mediated by P-selectin and even though the megakaryocytes(Mk)of MF patients express normal levels of P-selectin,it remains abnormally localized to the DMS rather than being assembled into the a-granules in platelets.Mice carrying the hypomorphic Gata1low mutation express the same Mk abnormalities presented by PMF patients,including abnormal P-selectin localization to the DMS and develop with age myelofibrosis,that closely resembles human PMF.The aim of this study was to determine whether Gata1low mice would develop thrombosis with age and,in this case,the role played by P-selectin in the development of the trait.To this aim,Gata1low mice were crossed with P-selnull mice according to standard genetic protocols and Gata1lowP-selWT,Gata1lowP-selnull and Gata1WTP-selnull or Gata1WTP-selWT littermates obtained.Platelet count,hematocrit as well as platelet microparticle levels were determined on all the different mutants.It was shown that platelet counts are reduced in Gata1low mice.Moreover,platelet microparticles are reduced in Gata1low mice and P-selectin positive platelet microparticles were not found.The presence of thrombosis was determined by immunohistological staining of organs.Gata1low mice with or without the P-selectin null trait had a prolonged bleeding time and thrombosis was seen adult and old Gata1low mice,but the Gata1low/P-selnull mice were rescued.Thus,presence of the P-selectin null trait rescued Gata1low mice from the thrombotic phenotype,but did not change level of platelet microparticles.All these data indicate that abnormal localization of P-selectin,induced by the Gata1low mutation,and thus, increased pathological interactions with leucocytes,is responsible for the increased presence of thrombosis seen in these mice.

Aplidin-treatment prevents development of myelofibrosis in Gata1low mouse model

Aplidin is a cyclic depsipeptide originally derived from the marine tunicate Aplidium albicans and currently obtained by chemical synthesis.This drug inhibits cancer growth through direct and indirect mechanisms.It has been reported to directly induce apoptosis and growth arrest of those tumor cells expressing low p27(Kip1)levels.In addition,Aplidin,by inhibiting secretion and/or response to VEGF, reduces endothelial cell proliferation in several in vitro and in vivo models of angiogenesis.The primary myelofibrosis(PMF)is associated with alterations of stem/progenitor cell trafficking which results in extramedullary hematopoiesis.The abnormal trafficking is caused by defective interactions between the stem/progenitor cells and their niches in the marrow.The stem/progenitor cells fail to express CXCR4,the receptor that recognizes the chemokine SDF-1 responsible for interaction with the vascular niche.In addition,in PMF,the marrow vascular niches are increased in numbers and abnormally coated with pericytes. Gata1low mice develop myelofibrosis with age and are considered an animal model for PMF.The Gata1low mice includes reduced expression of CXCR4 on the stem/progenitor cells,increased numbers of pericyte-coated vessel in the marrow and extramedullary hematopoiesis in the liver.To assess the effects of Aplidin-treatment in myelofibrosis,Gata1low mice received Aplidin or saline and were sacrified for analyses of disease development. Similar results were observed after each cycle and those obtained after the 4th cycle are summarized here.Gata1low stem/progenitor cells were found to express low levels of p27(Kip1),the proposed biomarker for Aplidin-sensitivity and responded to treatment by increasing their levels of p27(Kip1)(by 10–fold)and Gata1(2-fold)expression.Aplidintreated Gata1low progenitor cells acquired the ability to form Gata1pos megakaryocytes in vivo and hematopoietic colonies in vitro.Accordingly,Aplidin-treatment increased by 3-fold blood platelet counts significantly and prevented fibrosis and bone growth normalizing the femur cellularity.Although stem/progenitor cells from Aplidin-treated Gata1low mice did not express CXCR4 and were found in high numbers in the liver,they did not develop hematopoiesis in this organ.In conclusion,Aplidin-treatment,by restoring Gata1 expression in the stem/progenitor cells and reducing the numbers of vascular niches in the marrow,restored the functional interactions between Gata1low progenitor cells and their marrow niches,preventing development of myelofibrosis,including extramedullary hematopoiesis in liver.