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      全反式维甲酸对NPM1突变的白血病细胞系U937细胞的作用及其机制研究 Translated title: Study of the effects and mechanism of all-trans retinoic acid on leukemic cell line U937 cells with NPM1 mutation

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          Abstract

          目的

          探讨全反式维甲酸(ATRA)对NPM1突变的白血病细胞系U937细胞的作用及其机制。

          方法

          转染NPM1突变型(A型)质粒至U937细胞系构建稳定克隆A1和A2,利用Western blot法和荧光共聚焦技术鉴定细胞。MTT法检测细胞增殖活性,流式细胞术检测细胞周期和细胞凋亡,显微镜下计数检测集落形成能力,Western blot法检测细胞增殖相关信号通路蛋白表达。

          结果

          ①NPM1突变型U937细胞A1和A2经ATRA处理后,细胞增殖活性分别为对照组(未经ATRA处理组)水平的52.6%和35.8%,差异均有统计学意义( t=3.649, P=0.010; t=4.906, P=0.002)。②突变型细胞A1和A2的G 0/G 1期比例经ATRA处理后较对照组分别增加20.1%和35.8%,差异均有统计学意义( t=4.544, P=0.010; t=15.850, P<0.001)。③U937细胞经ATRA处理后集落生长受抑制,其中空载体组集落数目下降了32.7%,野生型组下降了57.9%,突变型组(A1)下降了90.9%,差异均有统计学意义( t=8.507, P=0.010; t=22.090, P<0.001; t=90.200, P<0.001)。④突变型U937细胞经ATRA处理后p-ERK水平明显降低。⑤突变型U937细胞接受化疗药物联合ATRA处理后细胞凋亡率明显高于化疗药物单药处理组,在化疗药物处理后添加ATRA能导致更多的细胞凋亡。

          结论

          ATRA能够抑制NPM1突变的U937细胞增殖和克隆形成,将细胞阻滞于G 0/G 1期,显著降低其ERK磷酸化水平。在NPM1突变的U937细胞中,当ATRA在化疗药物处理后添加能够与化疗药物发挥更强的协同杀伤效果。

          Translated abstract

          Objective

          To investigate the effect and mechanism of all-trans retinoic acid (ATRA) on leukemic cell line U937 cells with NPM1 mutation.

          Methods

          Human acute myeloid leukemia cell line U937 was explored, NPM1 mutated (A type) plasmids were transfected into U937 to form stable clones A1 and A2, which were identified by Western blot and Co-immunoprecipitation. The cell proliferation was measured by methylthiazolyl tetrazolium bromide (MTT); cell cycle and cell apoptosis were explored by flow cytometric; cell colony formation was measured by microscope count, the molecular pathways related to cell proliferation were measured by Western blot.

          Results

          ①The cell proliferations of mutant A1 and A2 were inhibited significantly by 52.6% and 35.8% ( P<0.05), respectively under ATRA exposure. ②The percentages of G 0/G 1 stage of mutant A1 and A2 increased by 20.1% and 35.8%, respectively under ATRA exposure. ③All the U937 leukemic cells were inhibited under ATRA exposure; the decreased percentages of vector, wild-type and mutant NPM1 cells were 32.7%, 57.9% and 90.9% respectively. ④p-ERK decreased obviously after ATRA exposure in NPM1 mutated leukemic cells. ⑤More mutant NPM1 cells inclined to apoptosis under the exposure of ATRA and cytotoxic drugs than cytotoxic drugs alone, meanwhile more cells apoptosis occurred when ATRA was administrated after cytotoxic drugs exposure.

          Conclusion

          ATRA could inhibit cell proliferation and colony formation, blocked the cell cycle in the G 0/G 1 stage accompanied by the significant reduction of p-ERK in U937 leukemic cells with NPM1 mutation. Besides, ATRA could synergize with drugs to suppress the leukemic cells survival more effectively when ATRA was administered after the cytotoxic drugs exposure in U937 leukemic cells with NPM1 mutation.

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          Most cited references16

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          Mutations and treatment outcome in cytogenetically normal acute myeloid leukemia.

          Mutations occur in several genes in cytogenetically normal acute myeloid leukemia (AML) cells: the nucleophosmin gene (NPM1), the fms-related tyrosine kinase 3 gene (FLT3), the CCAAT/enhancer binding protein alpha gene (CEPBA), the myeloid-lymphoid or mixed-lineage leukemia gene (MLL), and the neuroblastoma RAS viral oncogene homolog (NRAS). We evaluated the associations of these mutations with clinical outcomes in patients. We compared the mutational status of the NPM1, FLT3, CEBPA, MLL, and NRAS genes in leukemia cells with the clinical outcome in 872 adults younger than 60 years of age with cytogenetically normal AML. Patients had been entered into one of four trials of therapy for AML. In each study, patients with an HLA-matched related donor were assigned to undergo stem-cell transplantation. A total of 53% of patients had NPM1 mutations, 31% had FLT3 internal tandem duplications (ITDs), 11% had FLT3 tyrosine kinase-domain mutations, 13% had CEBPA mutations, 7% had MLL partial tandem duplications (PTDs), and 13% had NRAS mutations. The overall complete-remission rate was 77%. The genotype of mutant NPM1 without FLT3-ITD, the mutant CEBPA genotype, and younger age were each significantly associated with complete remission. Of the 663 patients who received postremission therapy, 150 underwent hematopoietic stem-cell transplantation from an HLA-matched related donor. Significant associations were found between the risk of relapse or the risk of death during complete remission and the leukemia genotype of mutant NPM1 without FLT3-ITD (hazard ratio, 0.44; 95% confidence interval [CI], 0.32 to 0.61), the mutant CEBPA genotype (hazard ratio, 0.48; 95% CI, 0.30 to 0.75), and the MLL-PTD genotype (hazard ratio, 1.56; 95% CI, 1.00 to 2.43), as well as receipt of a transplant from an HLA-matched related donor (hazard ratio, 0.60; 95% CI, 0.44 to 0.82). The benefit of the transplant was limited to the subgroup of patients with the prognostically adverse genotype FLT3-ITD or the genotype consisting of wild-type NPM1 and CEBPA without FLT3-ITD. Genotypes defined by the mutational status of NPM1, FLT3, CEBPA, and MLL are associated with the outcome of treatment for patients with cytogenetically normal AML. Copyright 2008 Massachusetts Medical Society.
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            Management of acute promyelocytic leukemia: recommendations from an expert panel on behalf of the European LeukemiaNet.

            The introduction of all-trans retinoic acid (ATRA) and, more recently, arsenic trioxide (ATO) into the therapy of acute promyelocytic leukemia (APL) has revolutionized the management and outcome of this disease. Several treatment strategies using these agents, usually in combination with chemotherapy, but also without or with minimal use of cytotoxic agents, have provided excellent therapeutic results. Cure of APL patients, however, is also dependent on peculiar aspects related to the management and supportive measures that are crucial to counteract life-threatening complications associated with the disease biology and molecularly targeted treatment. The European LeukemiaNet recently appointed an international panel of experts to develop evidence- and expert opinion-based guidelines on the diagnosis and management of APL. Together with providing current indications on genetic diagnosis, modern risk-adapted front-line therapy and salvage treatment, the review contains specific recommendations for the identification and management of most important complications such as the bleeding disorder, APL differentiation syndrome, QT prolongation and other ATRA- and ATO-related toxicities, as well as for molecular assessment of response to treatment. Finally, the approach to special situations is also discussed, including management of APL in children, elderly patients, and pregnant women.
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              Acute myeloid leukemia carrying cytoplasmic/mutated nucleophosmin (NPMc+ AML): biologic and clinical features.

              The nucleophosmin (NPM1) gene encodes for a multifunctional nucleocytoplasmic shuttling protein that is localized mainly in the nucleolus. NPM1 mutations occur in 50% to 60% of adult acute myeloid leukemia with normal karyotype (AML-NK) and generate NPM mutants that localize aberrantly in the leukemic-cell cytoplasm, hence the term NPM-cytoplasmic positive (NPMc+ AML). Cytoplasmic NPM accumulation is caused by the concerted action of 2 alterations at mutant C-terminus, that is, changes of tryptophan(s) 288 and 290 (or only 290) and creation of an additional nuclear export signal (NES) motif. NPMc+ AML shows increased frequency in adults and females, wide morphologic spectrum, multilineage involvement, high frequency of FLT3-ITD, CD34 negativity, and a distinct gene-expression profile. Analysis of mutated NPM has important clinical and pathologic applications. Immunohistochemical detection of cytoplasmic NPM predicts NPM1 mutations and helps rationalize cytogenetic/molecular studies in AML. NPM1 mutations in absence of FLT3-ITD identify a prognostically favorable subgroup in the heterogeneous AML-NK category. Due to their frequency and stability, NPM1 mutations may become a new tool for monitoring minimal residual disease in AML-NK. Future studies should focus on clarifying how NPM mutants promote leukemia, integrating NPMc+ AML in the upcoming World Health Organization leukemia classification, and eventually developing specific antileukemic drugs.
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                Author and article information

                Journal
                Zhonghua Xue Ye Xue Za Zhi
                Zhonghua Xue Ye Xue Za Zhi
                CJH
                Chinese Journal of Hematology
                Editorial office of Chinese Journal of Hematology (No. 288, Nanjing road, Heping district, Tianjin )
                0253-2727
                2707-9740
                October 2017
                : 38
                : 10
                : 863-868
                Affiliations
                [1]300020 天津,中国医学科学院、北京协和医学院血液学研究所、血液病医院Institute of Hematology & Blood Disease Hospital, CAMS & PUMC, Tianjin 300020, China
                Author notes
                通信作者:王建祥(Wang Jianxiang),Email: wangjx@ 123456ihcams.ac.cn
                Article
                cjh-38-10-863
                10.3760/cma.j.issn.0253-2727.2017.10.008
                7364968
                29166739
                410e3154-fdf5-46bf-b5da-f1239198d5fe
                2017年版权归中华医学会所有Copyright © 2017 by Chinese Medical Association

                This work is licensed under a Creative Commons Attribution 3.0 License (CC-BY-NC). The Copyright own by Publisher. Without authorization, shall not reprint, except this publication article, shall not use this publication format design. Unless otherwise stated, all articles published in this journal do not represent the views of the Chinese Medical Association or the editorial board of this journal.

                History
                : 29 January 2017
                Funding
                基金项目:国家自然科学基金重点项目(81430004);天津市应用基础与前沿技术研究计划(16JCQNJC12200);天津市血液病临床医学研究中心建设(15ZXLCSY00010)
                Fund program: National Natural Science Foundation of China(81430004); Tianjin Research Program of Application Foundation and Advanced Technology(16JCQNJC12200); Tianjin Hematology Clinical Medicine Research Center Construction(15ZXLCSY00010)
                Categories
                论著

                npm1突变,白血病,髓样,急性,全反式维甲酸,npm1 mutation,leukemia, myeloid, acute,all-trans retinoic acid

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