Chromosomal translocations in leukaemia.

Many haematologic malignancies carry characteristic chromosomal translocations, which are thought to play an important role in the pathogenesis of these tumours. The t(8; 14) translocation in Burkitt's lymphoma was one of the first characterized at the molecular level. In this translocation the c-myc oncogene at chromosome 8q24 becomes deregulated by enhancer elements of the immunoglobulin heavy chain locus at chromosome 14q32 leading to a very aggressive B cell malignancy. Translocations involving an overexpressed c-myc gene are also found in AIDS-associated lymphoma or in T cell leukaemias, or they develop during tumour progression of a low grade B cell malignancy into a high grade B cell tumour in an additional cytogenetic change. A different mechanism of oncogene activation in a leukaemia specific chromosomal abnormality is found for CML, where c-abl sequences are fused into the bcr locus, or in the t(4; 11) of acute childhood leukaemia involving the recently identified ALL-1 gene at chromosome 11q23 resulting in a malfunctioning, structurally altered oncogene. Thus, in the past molecular and somatic cell genetic studies have clarified many details in aetiology and progression of leukaemias and lymphomas which are useful for applications in clinical diagnostics, and which in the future will be helpful in designing a therapy based on a molecular understanding.

Molecular analysis of the BCL-3 locus at chromosome 17q22 in B-cell neoplasms.

To better understand the role of the BCL-3 locus at chromosome 17q22 in the pathogenesis and progression of leukemias and lymphomas, we examined its genomic configuration in 264 B-cell malignancies and its expression in a smaller subset. Cases studied included 39 chronic lymphocytic leukemias, 58 low-grade follicular lymphomas, 20 mantle cell lymphomas, 30 small noncleaved cell lymphomas, 25 acute lymphoblastic leukemias, 10 acquired immunodeficiency syndrome--related non-Hodgkin's lymphomas, and 44 diffuse mixed- or diffuse large-cell lymphomas. In addition, 38 aggressive lymphomas (transformed follicular lymphomas) derived from previously indolent follicular lymphomas were examined. Southern blot analysis showed BCL-3 locus rearrangement in 4 cases (1.5%), ie, in 3 transformed follicular lymphomas and in 1 indolent follicular lymphoma. All 4 also had BCL-2 rearrangements consistent with their follicular center cell origin. None of the BCL-3 rearranged cases showed MYC gene rearrangement, as reported for the original leukemia that led to the discovery of BCL-3. Pretransformation specimens of all three transformed follicular lymphomas showed the presence of the BCL-3 alteration before histologic progression. In 1 case, serial pretransformation biopsies showed that the BCL-3 rearrangement was acquired during the indolent follicular phase of the patient's disease. Thirty lymphomas, including 2 of the 4 with BCL-3 rearrangement, were also examined for BCL-3 message. All 30, including the 2 with BCL-3 rearrangements, expressed the normal 1.7-kb BCL-3 transcript, at approximately equivalent levels. The data indicate that, although BCL-3 locus alterations are found in only a small fraction of B-cell lymphoid malignancies, they occur primarily in a subset of follicular center cell lymphomas. Interestingly, these alterations appear to be acquired during the indolent (follicular) phase of the disease and they are maintained when histologic transformation takes place. The data also suggest that BCL-3 locus alterations do not result in gross changes of BCL-3 gene expression and do not necessarily involve the MYC gene. Although the preferential involvement of BCL-3 alterations in a small subset of follicular lymphomas that transform suggests a possible link between these abnormalities and progression, further studies are needed to ensure that these alterations are biologically relevant and not simply a manifestation of genomic instability.

Activation of MYC in a masked t(8;17) translocation results in an aggressive B-cell leukemia.

We have analyzed the oncogene rearrangements involving BCL2 and MYC in the leukemia cells of a patient with an aggressive prolymphocytic leukemia that had an abnormal karyotype including a t(14;18) translocation and a chromosome 17q+. Molecular analysis showed that BCL2 was rearranged in the major breakpoint cluster region and had joined into the immunoglobulin heavy chain gene as in follicular lymphoma. Cloning and sequence analysis of the rearranged MYC gene revealed that MYC was truncated at the Pvu II site at the end of the first exon of MYC and had joined into the regulatory elements of a gene that we called BCL3 (B-cell leukemia/lymphoma 3). The BCL3 locus was mapped to chromosome 17 band q22. We found BCL3 transcribed as a message of 1.7 kilobases in many hematopoietic cell lines representing all hematopoietic lineages. In the patient's leukemia cells, the truncated MYC gene was highly expressed under the influence of BCL3 regulatory elements, leading to an aggressive B-cell leukemia that presumably had been derived from an indolent lymphoma carrying a rearranged BCL2 gene.

Evolution of B-cell malignancy: pre-B-cell leukemia resulting from MYC activation in a B-cell neoplasm with a rearranged BCL2 gene.

We have analyzed the molecular genetics of the breakpoints involved in the t(8;14) and t(14;18) translocations of an acute pre-B-cell leukemia from a patient with a history of follicular lymphoma. In this patient's leukemic cells, the breakpoint of the t(14;18) translocation occurred in the major breakpoint-cluster region of the BCL2 gene and became linked to the JH4 joining-region gene segment of the immunoglobulin heavy-chain locus on the 14q+ chromosome as previously observed in follicular lymphoma. An N region and heptamer and nonamer signal sequences indicated that this translocation occurred as a mistake in VH-DH-JH joining (where VH and DH are the variable and diversity segments). In the t(8;14) translocation, the breakpoint was located immediately 5' of the first exon of the MYC protooncogene, which was juxtaposed with the C gamma 2 constant gene segment of the second 14q+ chromosome. The finding of repeated sequences typical of switch regions suggested that this translocation occurred during heavy-chain isotype switching, resulting in progression to pre-B-cell leukemia with both the t(8;14) and the t(14;18) translocations. The terminal deoxynucleotidyltransferase-positive phenotype of the patient's leukemic cells further suggests that the pre-B-cell leukemia was derived from a pre-B cell carrying a t(14;18) translocation in the original follicular lymphoma. The polymerase chain reaction method was then used to identify cancer cells in the bone marrow of the patient.

Pre-B-cell leukemia with a t(8; 14) and a t(14; 18) translocation is preceded by follicular lymphoma.

We have performed gene rearrangement studies on the leukemic blasts of a patient with acute pre-B-cell leukemia. The patient had a 5 year history of follicular lymphoma, which developed into acute pre-B-cell leukemia. The leukemic blasts revealed a karyotype with two translocations, t(8; 14) and t(14; 18), characteristic for Burkitt's lymphoma and follicular lymphoma. The cells are TdT positive, do not possess surface immunoglobulin, and they show immunoglobulin gene rearrangement. The mu heavy chain and kappa light chain constant (C mu and C kappa) loci are deleted, while the gamma and lambda light chain constant (C gamma and C lambda) region genes are rearranged. Both alleles of the heavy chain joining segment (JH) are rearranged on chromosome 14q+, one of them with the bcl-2 oncogene from chromosome 18. The breakpoint of the t(14; 18) translocation occurs in the major breakpoint cluster region in the 3' untranslated region of bcl-2. On chromosome 8 a c-myc rearrangement was mapped immediately 5' to the c-myc first exon in a region involved in sporadic Burkitt lymphoma. The data are consistent with our previous hypothesis on the evolution of B-cell malignancies: a rare pre-B cell develops a t(14; 18) translocation during immunoglobulin VDJ joining that results in an expansion of a follicular lymphoma clone carrying an activated bcl-2 gene. Within the clone of pre-B cells a second translocation, t(8; 14), occurs during heavy chain isotype switching that results in the deregulation of the c-myc involved in the translocation.

[Hematopoietic stem cells and their growth factors]. / Hämatopoetische Stammzellen und ihre Wachstumsfaktoren.

In vitro culture of haematopoietic cells has provided some surprising insight into humoral regulation of haematopoietic cell growth. Each stage of haematopoiesis is subject to strict regulatory mechanisms involving humoral modulators. These factors called haematopoietins are a family of polypeptide hormones that specifically regulate the proliferation and differentiation of stem cells giving rise to erythrocytes, granulocytes, monocytes, megacaryocytes, and T and B lymphocytes. Mixed colonies consisting of elements of all haematopoietic lineages can be grown from pluripotent progenitors in vitro. Erythropoietin is the primary regulator of the later stages in erythropoiesis, whereas factors with burst-promoting activity or erythroid-potentiating activity stimulate the growth of the more primitive erythroid cells. The in vitro proliferation and differentiation of granulocytic and macrophage cells is dependent on the stimulation by a granulocyte-macrophage colony-stimulating factor. The mode of action of these regulators can well be studied using the homogeneous cell populations of human myeloid and erythroleukemia cell lines. Observations indicate that these factors are likely to function in vivo as in vitro. Knowledge on the biochemistry and physiology of these factors will have substantial impact on the understanding of human diseases involving abnormal haematopoietic cell growth.

Lithium enhances growth of human leukaemia cells in vitro.

Lithium is known to cause leucocytosis in normal humans, and lithium salts have been used therapeutically in attenuating leucopenia in patients undergoing chemotherapy. Recent reports also described leukaemia development during lithium treatment. We have investigated the effect of lithium chloride on the proliferation of human myeloid, erythroblastic, and T- and B-lymphoblast leukaemia cells in vitro. Colony formation by cells of the myeloid leukaemia lines HL-60 and KG-1 was enhanced by lithium chloride, and maximal stimulation was seen at 5 X 10(-4) M. Lithium also increased the proliferation of KG-1a cells, a subline of KG-1 cells that does not respond to colony-stimulating factor, indicating a direct growth-promoting effect on myeloid leukaemia cells. Lithium was found to enhance colony formation by the T-lymphoblast cell line MOLT 4 and the B-lymphoblast line IM-9 at concentrations between 10(-6) and 10(-3) M. The addition of lithium chloride to murine Friend or human K-562 erythroleukaemia cells also caused an augmentation in colony formation. These observations may have relevance to the therapeutic use of lithium in patients with haematological malignancies.

Human leukemia cell line K562 responds to erythroid-potentiating activity.

We report that erythroid-potentiating activity (EPA), known to stimulate the proliferation of normal human erythroid precursors in vitro, has a growth-promoting effect on human K562 erythroleukemia cells and Friend mouse erythroleukemia cells. Detailed studies were carried out using an EPA produced by a human T-lymphoblast line (Mo). Although EPA has not been purified to homogeneity, several observations indicate that the factor elaborated by Mo cells that stimulates erythroleukemia cell growth is the EPA molecule. The erythroleukemia growth factor cofractionates with EPA using gel exclusion chromatography, isoelectric focusing, and ion exchange chromatography. In addition, the activities exhibit similar kinetics of heat inactivation. A granulocyte-macrophage colony-stimulating factor also elaborated by Mo cells had no effect on the growth of the erythroleukemia cells. Other sources of EPA, such as peripheral blood leukocyte-conditioned medium, preparations from urine of anemic patients, and medium conditioned by a human monocyte-like cell line, stimulated erythroleukemia cell growth. Mouse sources of EPA (termed "burst-promoting activity") stimulated mouse but not human erythroleukemia cells. The availability of cell lines apparently responsive to EPA should prove useful for examining the mode of action of this regulator of erythropoiesis.

Beta 2 receptor-mediated stimulation of Friend erythroleukemia cell growth by thyroid hormones.

Thyroid hormones are known to enhance normal erythroid colony growth (CFUE) and this enhancement depends on a functional beta 2-adrenergic receptor mechanism. we investigated the response of Friend cells to thyroid hormones, catecholamines, and other compounds influencing cellular cAMP activity. The thyroid hormones L-T3, L-T4, and "reverse T3" stimulated erythroleukemia colony growth in a serum-substituted methylcellulose culture system with peak activity at 10(-7) M. Various beta-adrenergic compounds enhanced Friend leukemia colony growth; however, the alpha-adrenergic agonist phenylephrine was inactive. Dibutyryl cyclic AMP and the phosphodiesterase inhibitor theophylline also enhanced Friend leukemia colony formation. Adrenergic antagonists with beta 2 specificity abrogated the stimulatory effect of L-T3, L-T4, and of "reverse T3" at equimolar concentrations. These experiments demonstrate that thyroid hormones, beta-adrenergic agonists, the phosphodiesterase inhibitor theophylline, and dbcAMP have a direct effect on the proliferation of Friend erythroleukemia cells. We conclude that thyroid hormones' action requires a functioning beta 2-adrenergic receptor mechanism. Thyroid hormones directly modulate the growth of neoplastic erythroid cells in a manner consistent with their effects on normal erythropoiesis.

Growth hormone polypeptides stimulate proliferation of K562 human erythroleukemia cells.

The growth-promoting effect of growth hormones and related polypeptides was examined in vitro with a clonogenic assay using human erythroleukemic cells (K562). The erythroleukemia cells were grown in a serum-substituted methylcellulose culture system and colonies counted after 4 days' incubation. Human growth hormone (hGH) was a potent stimulant for K562 cell growth (60% augmentation). The cys(Cam)53-hGH(1-134) fragment of hGH and human chorionic somatomammotropin had less than half the activity of the intact hGH molecule. Bovine growth hormone was inactive in enhancing K562 colony formation. K562 cell proliferation was stimulated by hGH at concentrations as low as 0.1 ng/ml. Insulin stimulated K562 cell proliferation most effectively at a concentration of 1 ng/ml. The K562 culture system may conveniently be employed for determining the in vitro bioactivity of hGH.

Hormonal effects on cell proliferation in a human erythroleukemia cell line (K562).

We have investigated the hormonal responsiveness of K562 cells using a serum-substituted in vitro clonogenic assay. Dexamethasone inhibited colony formation by the K562 cells, and the inhibitory effect could be reversed by progesterone (10(-6) M). Fluoxymesterone caused a prominent enhancement of K562 colony growth, whereas estriol had no effect. Stimulation by triiodothyronine was maximal at 10(-7) M, and the thyroid effect could be abrogated by the beta 2-adrenergic antagonist butoxamine in equimolar concentrations. Using standard tissue culture conditions, the beta-adrenergic agent isoproterenol, but not the alpha catecholamine phenylephrine, enhanced the proliferation of K562 cells. When K562 cells were grown under hormone-depleted conditions, they developed responsiveness to phenylephrine and were no longer stimulated by isoproterenol. DbcAMP and prostaglandins of the E series also caused K562 colony enhancement. Prostaglandin F2 alpha had no effect on cell proliferation. Insulin was an effective stimulant of colony formation of K562 cells, as were human growth hormone and ovine prolacin. Bovine growth hormone had no effect. Our results are consistent with the identificaiton of K562 as an erythroid line, and they indicate that K562 cells respond to endocrine hormones in a manner analogous to normal erythroid progenitors.

Erythroid-potentiating activity: characterization and target cells.

We established a human T-lymphoblast cell line (Mo) that produces factors stimulating the proliferation of hematopoietic cells. These include a colony-stimulating factor for normal human granulocytes and macrophages, and a factor with erythroid-potentiating activity (EPA) that enhances the proliferation of normal human erythroid progenitors in vitro. Erythroid-potentiating activity has been partially purified and characterized. It is an acidic glycoprotein of 45,000 daltons molecular weight and it has remarkable heat stability. Erythroid-potentiating activity is physically separable from the colony-stimulating factor. Partially purified EPA was found to stimulate the proliferation of human K-562 and murine Friend erythroleukemia cells. These erythroleukemia cell lines may therefore prove useful for studying the action of EPA on target cells. Erythroid-potentiating factors from other human and murine sources stimulated erythroleukemia cell proliferation in a manner indicating some species restriction. Purification and structural analysis of the EPA molecule will ultimately be required in order to determine the details of its biologic action and to define its relationship to other erythropoietic factors.

[New protease-inhibitors with broad specificity in the polychaet Sabellastarte indica (Savingny), I (author's transl)]. / Uber neue Proteaseinhibitoren mit breiter Wirkungsspezifität bei dem Polychaeten Sabellastarte indica (Savingny), I. Mitteilung

In this paper we describe new and so far unknown protease inhibitors present in the tentacles of the annelid Sabellastarte indica Savingny. At least five different isoinhibitors with inhibitory activity towards trypsin, plasmin, chymotrypsin and kallikrein can be separated electrophoretically. Our protease inhibitor active material differs from the other well known protease inhibitors found in invertebrates in its high molecular weight, in that it is heat-labile and in the occurrence of the isoelectric point in the weakly acid region. On the other hand, the new protease inhibitors have some similarities to the soybean inhibitor described by Kunitz, and to ovomucoid. We also discuss the possibility that these inhibitors may influence the fibrinolytic system.

[Electrode problems in pacemaker wearers (experiences with three electrode types) (author's transl)]. / Elektrodenprobleme bei Schrittmacherträgern (Erfahrungen mit 3 Elektrodentypen)

3 types of electrodes (Medtronic 6903, EMT 588, MIP 2000) of 123 patients are examined by following criterial 1. rate of dislocation, 2. development of threshold, 3. time of application. We found: The Medtronic has the smallest rate of dislocation, the lowest range of threshold and is quickly placed in the right ventricle. The rate of dislocation of the EMT 588 is still just acceptable and it also has a sufficient low threshold, but in comparison to the other helical-wire electrodes the disadvantage of being rather difficult to place in the right ventricle. The MIP 2000 has not proved to be useful due to its large rate of dislocation.