Assessment of JC virus DNA in blood and urine from natalizumab-treated patients.

OBJECTIVE: Analyses were conducted to determine the clinical utility of measuring JC virus (JCV) DNA in blood or urine of natalizumab-treated multiple sclerosis (MS) patients to predict the risk of progressive multifocal leukoencephalopathy (PML). METHODS: A total of 12,850 blood and urine samples from nearly 1,400 patients participating in natalizumab clinical trials were tested for JCV DNA using a commercially available quantitative polymerase chain reaction (qPCR) assay. A subset of these samples was also tested using a more sensitive qPCR assay developed at the National Institutes of Health (NIH). RESULTS: At the time natalizumab dosing was suspended, JCV DNA was detected in plasma by the commercial assay in 4 of 1,397 (0.3%) patients; the NIH assay confirmed these positive samples and detected JCV DNA in an additional 2 of 205 (1%) patients who tested negative with the commercial assay. None of these 6 JCV DNA positive patients developed PML. In a 48-week study testing the safety of natalizumab redosing, JCV DNA was detected in plasma of 6 of 1,094 (0.3%) patients, none of whom developed PML. Urine at baseline and week 48 was assessed in 224 patients; 58 (26%) were positive at baseline, and 55 (25%) were positive after 48 weeks of natalizumab, treatment. JCV DNA was not detected in peripheral blood mononuclear cells from any of these 1,094 patients before or after natalizumab treatment. In 5 patients who developed PML, JCV DNA was not detected in blood at any time point before symptoms first occurred. INTERPRETATION: Measuring JCV DNA in blood or urine with currently available methods is unlikely to be useful for predicting PML risk in natalizumab-treated MS patients.

Dioxin-induced immortalization of normal human keratinocytes and silencing of p53 and p16INK4a.

Dioxin, a potent tumor promoter, activates the aryl hydrocarbon receptor (AHR), a ligand-activated transcription factor belonging to the basic helix-loop-helix-PAS family, to enhance tumorigenesis via unknown mechanisms. We undertook this study to determine the mechanisms underlying the impact of dioxin on cell fate, in particular senescence that occurs in normal human cells and is considered to play important tumor suppressive function. We have previously shown that in primary human keratinocytes, dioxin attenuates senescence while retaining the proliferative capacity and represses expression of the tumor suppressors, p16(INK4a) and p53. Here, we show that repression of p16(INK4a) and p53 transcriptional activity by dioxin absolutely requires the AHR and is accompanied by promoter methylation. Furthermore, dioxin alone is sufficient to immortalize normal human keratinocytes. Our data introduce a previously unrecognized regulatory pathway, that of the AHR, that impacts senescence. More importantly, this is the first report of a tumor promoter capable of inhibiting senescence in a receptor mediated manner and introduces a novel mechanism by which this carcinogen may contribute to human malignancies.

Alteration of keratinocyte differentiation and senescence by the tumor promoter dioxin.

Exposure to the environmental contaminant dioxin, elicits a variety of responses, which includes tumor promotion, embryotoxicity/teratogenesis, and carcinogenesis in both animals and humans. Many of the effects of dioxin are mediated by the aryl hydrocarbon receptor (AHR), a ligand-activated bHLH (basic helix-loop-helix)/PAS transcription factor. We initiated this study to determine whether dioxin's tumor-promoting activities may lie in its ability to alter proliferation, differentiation, and/or senescence using normal human epidermal keratinocytes (HEKs). Here, we report that dioxin appears to accelerate differentiation as measured by flow cytometry and by increased expression of the differentiation markers involucrin and filaggrin. In addition, dioxin appears to increase proliferation as indicated by an increase in NADH/NADPH production and changes in cell cycle. Finally, dioxin decreases SA (senescence associated) beta-galactosidase staining, an indicator of senescence, in the differentiating keratinocytes. These changes were accompanied by decreases in the expression levels of key cell cycle regulatory proteins p53, p16INK4a, and p14ARF. Our findings support the idea that dioxin may exert its tumor-promoting actions, in part, by downregulating the expression levels of key tumor suppressor proteins, which may impair the cell's ability to maintain its appropriate cellular status.