Takaaki Hosoki

Loss of ABCB7 gene: pathogenesis of mitochondrial iron accumulation in erythroblasts in refractory anemia with ringed sideroblast with isodicentric (X)(q13)

An isodicentric (X)(q13) (idicXq13) is a rare, acquired chromosomal abnormality originated by deletion of the long arm from Xq13 (Xq13-qter), and is found in female patients with hematological disorders involving increased ringed sideroblasts (RSs), which are characterized by mitochondrial iron accumulation around the erythroblast nucleus. The cause of increased RSs in idicXq13 patients is not fully understood. Here, we report the case of a 66-year-old female presenting with refractory anemia with ringed sideroblasts (RARS), and idicXq13 on G-banded analysis. We identify the loss of the ABCB7 (ATP-binding cassette subfamily B member-7) gene, which is located on Xq13 and is involved in mitochondrial iron transport to the cytosol, by fluorescent in situ hybridization (FISH) analysis and the decreased expression level of ABCB7 mRNA in the patient’s bone marrow cells. Further FISH analyses showed that the ABCB7 gene is lost only on the active X-chromosome, not on the inactive one. We suggest that loss of ABCB7 due to deletion of Xq13-qter at idicXq13 formation may have contributed to the increased RSs in this patient. These findings suggest that loss of the ABCB7 gene may be a pathogenetic factor underlying mitochondrial iron accumulation in RARS patients with idicXq13.

Induction of leukemia-specific antibodies by immunotherapy with leukemia-cell-derived heat shock protein 70

Cancer immunotherapy using heat shock protein (HSP) derived from autologous tumor requires cluster of differentiation (CD)4+ as well as CD8+ T‐cells for the prolongation of patient survival, suggesting that a humoral immune response through CD4+ T‐cells is important in addition to cellular immunity. However, the role of humoral responses in HSP‐based autologous tumor immunotherapy remains unclear. In the present study, we investigated whether leukemia‐specific antibodies and antibody‐mediated cytotoxicity against autologous leukemia cells have a crucial role in a mouse A20 leukemia model by immunizing A20‐derived HSP70. Immunization with A20‐derived HSP70 induced the production of anti‐A20‐antibodies and the antibodies recognized HSP70‐binding peptides derived from A20. One of those was a major histocompatibility complex (MHC) class‐I binding peptide, which has been clarified as the target peptide of CD8+ cytotoxic T‐cells (CTL) against A20. The anti‐A20‐antibodies produced by immunization with A20‐derived HSP70 induced complement‐dependent cytotoxicity (CDC) against A20 in vitro. In addition, immunization with A20‐derived HSP70 increased intracellular interleukin‐4 (IL4)‐production of CD4+ T‐cells, confirming the activation of type‐2 helper T‐cells. Taken together, immunization with leukemia‐cell‐derived HSP70 induces antibodies against leukemia‐cell‐specific peptides and might play a crucial role in the eradication of leukemia cells by CDC in mice. These findings will enable future establishment of a novel therapeutic strategy using antileukemia antibodies in HSP‐based autologous tumor immunotherapy. (Cancer Sci 2008; 99: 1427–1434)

Heterogeneous expressions of hepcidin isoforms in hepatoma‐derived cells detected using simultaneous LC‐MS/MS

Hepcidin, a key regulator of iron homeostasis, is known to have three isoforms: hepcidin‐20, ‐22, and ‐25. Hepcidin‐25 is thought to be the major isoform and the only one known to be involved in iron metabolism; the physiological roles of other isoforms are poorly understood. Because of its involvement in the pathophysiology of hereditary hemochromatosis and the anemia of chronic disease, the regulatory mechanisms of hepcidin expression have been extensively investigated, but most studies have been performed only at the transcriptional level. Difficulty in detecting hepcidin has impeded in vitro research. In the present study, we developed a novel method for simultaneous quantification of hepcidin‐20, ‐22, and ‐25 in the media from hepatoma‐derived cell lines. Using this method, we determined the expression patterns of hepcidin isoforms and the patterns of responses to various stimuli in human hepatoma‐derived cultured cells. We found substantial differences among cell lines. In conclusion, a novel method for simultaneous quantification of hepcidin isoforms is presented. Heterogeneous expressions of hepcidin isoforms in human hepatoma‐derived cells were revealed by this method. We believe our method will facilitate quantitative investigation of the role hepcidin plays in iron homeostasis.

A novel five-way chromosomal translocation observed in chronic myelogenous leukemia

Most patients with chronic myelogenous leukemia (CML) show a Philadelphia (Ph) chromosome with a characteristic translocation between chromosomes 9 and 22. However, there are variant complex translocations involving other chromosomes in addition to the standard translocation. We describe a case of CML showing a complex and novel chromosomal translocation involving five chromosomes, t(4;12;7;9;22).

Hepcidin production in response to iron is controlled by monocyte-derived humoral factors

Hepcidin, which is mainly produced by the liver, is the key regulator in iron homeostasis. Hepcidin expression is up-regulated by iron loading in vivo, but the mechanism underlying this process is not completely understood. In the present study, we investigated the mechanism, following the hypothesis that hepcidin production in response to iron loading is regulated by extra-hepatic iron sensors. We measured serum hepcidin concentrations and iron indices in Wistar rats treated with saccharated ferric oxide (SFO). Human hepatoma-derived HepG2 cells were stimulated using SFO-administered rat sera, and co-cultured with rat spleen cells, human monocyte-derived THP-1 cells, or human monocytes with diferric transferrin (holo-Tf), and hepcidin concentrations in the conditioned media were measured. SFO elevated rat serum hepcidin concentrations. SFO-treated rat sera increased hepcidin production from HepG2 cells, and this induction correlated with serum hepcidin levels, but not with iron indices. Holo-Tf up-regulated hepcidin concentrations in media from HepG2 cells co-cultured with rat spleen cells, THP-1 cells, or human monocytes with or without cell-to-cell contacts, while holo-Tf did not up-regulate hepcidin from HepG2 cells alone. Our results suggest the existence of humoral factors capable of inducing hepcidin production that are secreted by extra-hepatic cells, such as reticuloendothelial monocytes, in response to iron.

Detection of soluble HFE associated with soluble transferrin receptor in human serum

Hereditary hemochromatosis is an autosomal recessive disease, and 80-90% of patients exhibit Cys282Tyr or His63Asp mutations in the HFE gene. HFE, also known as major histocompatibility complex (MHC) class I-like molecule, binds to transferrin receptor 1 (TfR1) and β2-microglobulin at the cell surface, forming a complex. Some MHC class I molecules are known to be soluble, raising the possibility that HFE also has a soluble form. However, it is not known whether soluble HFE (sHFE) is present in human serum, and there has been no report on the possible binding between sHFE and soluble TfR (sTfR), which is the fragment of the extracellular domain of TfR1 released into the blood. In the present study, we purified an sTfR complex from pooled serum collected from healthy volunteers, showing that the main components of the complex are sTfR and transferrin. We also confirmed the existence of sHFE in this complex. This is the first report on the existence of sHFE in human serum.

Development of POEMS syndrome after an initial manifestation of solitary plasmacytoma

A 44-year-old male was admitted for numbness in the left arm. CT showed a tumor impacting on the spinal cord with an adjacent thoracic vertebral osteosclerotic lesion. The histopathology of the tumor showed diffuse proliferation of atypical plasma cells with expressed vascular endothelial growth factor (VEGF), which is a known etiological factor in POEMS syndrome. Though serum VEGF (sVEGF) level was elevated, a diagnosis of solitary plasmacytoma with an osteosclerotic lesion was made as the patient presented no polyneuropathy, organomegaly, endocrinopathy, or skin changes. The patient experienced muscle weakness of the lower limbs and skin pigmentation/hemangioma one year after irradiation of the osteosclerotic lesion. Laboratory tests revealed hypothyroidism, hyperglycemia, serum monoclonal gammopathy, further elevation of sVEGF, and increased atypical bone marrow plasma cells. CT imaging showed splenomegaly, and a nerve conduction test revealed demyelinating motor peripheral neuropathy. The patient was therefore diagnosed with POEMS syndrome. Plasmacytoma is very rare as an initial manifestation of POEMS syndrome. Patients presenting with plasmacytoma with an osteosclerotic lesion should be carefully observed and evaluated for the expression of sVEGF and development of POEMS syndrome, as most bone plasmacytomas in POEMS syndrome patients are reported to be osteosclerotic. This is to our knowledge the first case of osteosclerotic plasmacytoma that progressed to POEMS syndrome, with an increase of sVEGF.

B-cell Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma, without the development of Richter's Syndrome, with Neoplastic Cells Lacking CD20 Antigen Expression after Rituximab Treatment

A 40-year-old man was admitted to our hospital with systemic swelling of the lymphnodes (LNs). The histopathological findings of the neck LNs revealed a diffuse proliferation of neoplastic small lymphocytes. LN and bone marrow (BM) cells were subjected to immunostaining and flow cytometric analysis of the cell surface, showing CD5, CD19, CD20, and CD23 positivity and CD3, CD10, and cyclin D1 negativity. The patient was diagnosed with B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma (B-CLL/SLL). He received a cycle of CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone) and 6 cycles of RFC (rituximab, fludarabine, and cyclophosphamide), after which complete remission was obtained. Fifteen months after the diagnosis, the lymphoma relapsed and massive systemic LN swelling and BM infiltration were observed, characterized by a lack of CD20 antigen expression in the neoplastic cells. Two salvage chemotherapy regimens proved ineffective and the lymphoma progressed. The patient died two months after the relapse. The pathological findings at autopsy revealed the multiple organ infiltration of CLL/SLL cells which lacked CD20 expression. There were no evidence of Richter’s syndrome. Patients with relapsed B-CLL/SLL who are undergoing rituximab-containing therapy should be monitored for the loss of CD20 antigen expression in the neoplastic cells.