Yvonne Zimmermann

3’UTR mediated regulation of the cyclin D1 proto-oncogene

In mantle cell lymphoma (MCL), over-expression of cyclin D1 is the hallmark of malignant transformation and results from it’s juxtaposition to the immunoglobulin heavy chain enhancer. In addition, genomic deletions or point mutations leading to premature truncation of the cyclin D1 3’UTR have been reported in a several MCL patients as well as in cell lines isolated from various tumors types. We demonstrate that the expression of cyclin D1 with or without the 3’UTR has different phenotypic consequences in stably transduced fibroblasts, with the hyper-proliferative phenotype of cyclin D1 closely linked to the deletion of its 3’UTR. In our study, the loss of the cyclin D1 3’UTR led to a significant upregulation of the protein. However, the loss of AU-rich elements (AREs) from the cyclin D1 UTR results in a significant decrease in cyclin D1 protein and UTR-tagged reporter expression. In contrast, the levels of cyclin D1 protein can be significantly reduced by microRNAs of the miR15/16 family and the miR17-92 cluster that directly target the cyclin D1 3’UTR. Most importantly, these microRNAs regulated the levels of the endogenous cyclin D1 protein encoded by an mRNA with a full 3’UTR but not with 3’ UTR deletions. Taken together, our data highlight the regulatory role of the cyclin D1 3’UTR in the expression and phenotype of cyclin D1 and suggest that in MCL and solid tumors with cyclin D1 3’UTR mutations, the loss of microRNA target sites, rather than ARE elements contribute to the pathogenic over-expression of the cyclin D1 protein.

Differential effect of epigenetic alterations and genomic deletions of CDK inhibitors [p16(INK4a), p15(INK4b), p14(ARF)] in mantle cell lymphoma

Mantle cell lymphoma (MCL) is characterized by the chromosomal translocation t(11;14)(q13;q32), resulting in overexpression of CCND1 in the vast majority of cases. In addition, alterations of other cell‐cycle‐regulating signal pathways (CDKN2B/CDKN2A‐CCND1 and ARF‐MDM2‐TP53) are frequently observed. However, the hierarchy of promoter methylations and genomic alterations as well as the interaction with other cell‐cycle regulator CDKN1A is poorly understood. A complete methylation‐specific PCR coupled with direct sequencing of 71 MCL patient samples previously characterized for TP53 alterations, Ki67 expression by immunohistochemistry, and other genomic alterations was performed. In contrast to rare p16(INK4a) promoter methylation (9%), frequent p15(INK4b) (62%) and p14(ARF) (70%) promoter methylation was detectable in MCL. In an additional 16% of MCL cases, LOH for p16(INK4a) was detected. However, MCL cases with p15(INK4b) methylation tended to have lower proliferation (73% vs. 57%), and p15(INK4b) and p14(ARF) promoter methylation was also detected in normal stem cells. Therefore, epigenetic changes of those genes seem not to represent primary oncogenic mechanisms but physiological mechanisms of cell regulation. The rare p16(INK4a) promoter methylation and p16(INK4a) genetic alterations were directly correlated to cell proliferation and therefore are regarded as additional molecular alterations involved in the cell‐cycle dysregulation of MCL.

The proteasome inhibitor bortezomib targets cell cycle and apoptosis and acts synergistically in a sequence-dependent way with chemotherapeutic agents in mantle cell lymphoma

Single-agent bortezomib, a potent, selective, and reversible inhibitor of the 26S proteasome, has demonstrated clinical efficacy in relapsed and refractory mantle cell lymphoma (MCL). Objective response is achieved in up to 45% of the MCL patients; however, complete remission rates are low and duration of response proved to be relatively short. These limitations may be overcome by combining proteasome inhibition with conventional chemotherapy. Rational combination treatment and schedules require profound knowledge of underlying molecular mechanisms. Here we show that single-agent bortezomib treatment of MCL cell lines leads to G2/M arrest and induction of apoptosis accompanied by downregulation of EIF4E and CCND1 mRNA but upregulation of p15(INK4B) and p21 mRNA. We further present synergistic efficacy of bortezomib combined with cytarabine in MCL cell lines. Interestingly this sequence-dependent synergistic effect was seen almost exclusively in combination with AraC, indicating that pretreatment with cytarabine, followed by proteasome inhibition, may be the preferred approach.

2‐D PAGE‐based comparison of proteasome inhibitor bortezomib in sensitive and resistant mantle cell lymphoma

Although gene expression following bortezomib treatment has been previously explored, direct effects of bortezomib‐induced proteasome inhibition on protein level has not been analyzed so far. Using 2‐D PAGE in five mantle cell lymphoma cell lines, we screened for cellular protein level alterations following treatment with 25 nM bortezomib for up to 4 h. Using MS, we identified 38 of the 41 most prominent reliably detected protein spots. Twenty‐one were affected in all cell lines, whereas the remaining 20 protein spots were exclusively altered in sensitive cell lines. Western blot analysis was performed for 17 of the 38 identified proteins and 70.6% of the observed protein level alterations in 2‐D gels was verified. All cell lines exhibited alterations of the cellular protein levels of heat shock‐induced protein species (HSPA9, HSP7C, HSPA5, HSPD1), whereas sensitive cell lines also displayed altered cellular protein levels of energy metabolism (ATP5B, AK5, TPI1, ENO‐1, ALDOC, GAPDH), RNA and transcriptional regulation (HNRPL, SFRS12) and cell division (NEBL, ACTB, SMC1A, C20orf23) as well as tumor suppressor genes (ENO‐1, FH). These proteins clustered in a tight interaction network centered on the major cellular checkpoints TP53. The results were confirmed in primary mantle cell lymphoma, thus confirming the critical role of these candidate proteins of proteasome inhibition.

Temsirolimus inhibits cell growth in combination with inhibitors of the B-cell receptor pathway.

Lately, mTOR inhibitors have gained clinical relevance in malignant lymphoma. Still, rapamycin derivatives may activate a pro-survival feedback loop through PI3K-Akt. In this current study, temsirolimus effectively reduced cell growth in GCB and ABC diffuse large cell B-cell lymphoma (GCB = 30–66%, ABC = 45–57%). Combination treatment with the PI3K-δ inhibitor idelalisib additively effected ABC and GCB lymphoma (GCB = 16–38%, ABC = 25–50%). Since Brutons Tyrosine Kinase (BTK) plays a significant role for the survival of ABC lymphoma, this study also combined the BTK inhibitor ibrutinib with temsirolimus, which resulted in additive cell growth reduction (ibrutinib 50%, temsirolimus 44%, combination 25%) in ABC lymphoma. In contrast, bortezomib, which has been shown previously to be efficient in ABC lymphoma, revealed an antagonistic effect with temsirolimus in some GCB lymphoma (temsirolimus 53%, temsirolimus + bortezomib 63%). Western blot analysis identified the increase of phosphorylated pro-survival kinases Akt and PDK as a possible underlying mechanism of this interaction.

Differential regulation patterns of the anti‐CD20 antibodies obinutuzumab and rituximab in mantle cell lymphoma

with a 6% response rate in 93 patients (Bensinger et al, 2009; Kumar et al, 2012), a choice that drives the difference in complete or near-complete response rates between VTD and VCD claimed by the authors. Regarding overall response, the modified arm of the study by Kumar et al (2012) was neglected by the authors. These choices appear quite arbitrary and did not take into account differences in patient characteristics among the studies, which could explain, at least partially, the variability in response rates. In conclusion, the authors used various methodologies developed for meta-analysis for an evaluation that differs fundamentally from the approach typically employed when conducting a meta-analysis, i.e. the inclusion of a number of randomized clinical trials. It is possible that the analysis which the authors intended to perform could be undertaken by using cohort individual data and propensity score methods in order to take into account differences in patient characteristics between the VTD and VCD cohorts.(Rosenbaum & Rubin, 1983) Regrettably, this work is an example of using inappropriate methods in an attempt to answer an interesting question and of a failure in the reviewing process of a well-respected journal. The ongoing Intergroupe Francophone du My elome (IFM) 2013–04 prospective randomized trial comparing four cycles of VTD versus four cycles of VCD (NCT01971658) will try to solve this important issue.

Allelic genotyping reveals a hierarchy of genomic alterations in mantle cell lymphoma associated to cell proliferation

Mantle cell lymphoma (MCL) is a distinct subentity of non-Hodgkin lymphoma, characterized by the chromosomal translocation t(11;14)(q13;q32) leading to an overexpression of cyclin D1 in virtually all cases. However, additional cytogenetic aberrations are apparent in the vast majority of MCL. Applying LOH analysis in 52 MCL patient samples, we confirmed frequent alterations in 9p21 (28.6%) and p53 (28.9%) but also detected allelic losses in 1p21, 9q21, 13q13-14, 13q31-32, 17p13.1, and 17p13.3 in 28–45% of cases and allelic gains in 3q27-28 and 19p13.3 in 14–22% of cases. In addition, losses in the 2p23 and 7q22-35 genomic regions not previously described to be altered in MCL were identified in up to 20% of cases. Applying multivariate analysis, a cluster of genomic aberrations including 1p21, 3q27, 7q22-36, 6p24, 9p21, 9q31, and 16p12 alterations was identified which was closely associated to cell proliferation as determined by Ki67 immunostaining. This proliferation-dependent network of oncogenic alterations complements the previously identified proliferation expression signature described by RNA expression profiling in MCL.

Genomic deletion and promoter methylation status of Hypermethylated in Cancer 1 (HIC1) in mantle cell lymphoma.

Mantle cell lymphomas (MCL), characterized by the t(11;14)(q13;q32), frequently carry secondary genetic alterations such as deletions in chromosome 17p involving the TP53 locus. Given that the association between TP53-deletions and concurrent mutations of the remaining allele is weak and based on our recent report that the Hypermethylated in Cancer 1 (HIC1) gene, that is located telomeric to the TP53 gene, may be targeted by deletions in 17p in diffuse large B-cell lymphoma (DLBCL), we investigated whether HIC1 inactivations might also occur in MCL. Monoallelic deletions of the TP53 locus were detected in 18 out of 59 MCL (31%), while overexpression of p53 protein occurred in only 8 out of 18 of these MCL (44%). In TP53-deleted MCL, the HIC1 gene locus was co-deleted in 11 out of 18 cases (61%). However, neither TP53 nor HIC1 deletions did affect survival of MCL patients. In most analyzed cases, no hypermethylation of the HIC1 exon 1A promoter was observed (17 out of 20, 85%). However, in MCL cell lines without HIC1-hypermethylation, the mRNA expression levels of HIC1 were nevertheless significantly reduced, when compared to reactive lymph node specimens, pointing to the occurrence of mechanisms other than epigenetic or genetic events for the inactivation of HIC1 in this entity.

Combined RNA-expression and 2D-PAGE-screening identifies comprehensive interaction networks affected after bortezomib or enzastaurin exposure of mantle cell lymphoma

Despite recent advances in treatment, mantle cell lymphoma (MCL) still represents a disease with dismal prognosis due to its progressive clinical course, high rate of therapy refractory cases and frequent relapses. During recent years, the proteasome inhibitor bortezomib and enzastaurin, an inhibitor of protein kinase c have been explored in MCL. In relapsed disease enzastaurin achieved disease stabilization in a subset of patients. Bortezomib in relapsed and refractory MCL achieves response rates of 30-40%. To identify signal pathways and manifold interactions regulating cellular response to molecular targeted approaches several high throughput screening methods were applied. A combined network analysis of the identified target molecules based on both RNA array expression data and a survey of cellular protein levels resulted in a unified interaction network more comprehensive (bortezomib: 394 and enzastaurin: 174 molecules) than the networks of the individual screening techniques (329/44 and 117/36 molecules respectively). Interestingly, although none of the target molecules were matched in both RNA-expression and protein level analysis they were mapped nonetheless to common pathways. Additionally, the ranking of identified pathways allowed an improved characterization of the observed induction of cell apoptosis.

Temsirolimus acts as additive with bendamustine in aggressive lymphoma

The mammalian target of rapamycin (mTOR) is a protein kinase involved in the phosphatidylinositol 3-kinase (PI3K)/AKT signalling pathway. It plays a pivotal role in the control of cell proliferation, survival, and angiogenesis with multiple and frequent dysregulations of this pathway in human tumors. Temsirolimus is an intravenous drug, specifically inhibiting the mTOR pathway. Bendamustine is well known for its clinical activity in indolent non-Hodgkin-lymphoma (NHL) and has lately shown clinical activity in mantle cell lymphoma (MCL). Here, we present a case report of temsirolimus in combination with bendamustine and rituximab leading to a CR in a pretreated male. In addition, our in vitro data underlines the additive and synergistic efficacy in cell growth reduction of temsirolimus combined with bendamustine in MCL cell lines and in DLBCL cell lines. Furthermore, as an underlying mechanism of this additive, effects on cell cycle inhibition and apoptosis induction could be identified.