C/EBPα Confers Dependence to Fatty Acid Anabolic Pathways and Vulnerability to Lipid Oxidative Stress-Induced Ferroptosis in FLT3-Mutant Leukemia.

Although transcription factor CCAAT-enhancer binding protein α (C/EBPα) is critical for normal and leukemic differentiation, its role in cell and metabolic homeostasis is largely unknown in cancer. Here, multiomics analyses uncovered a coordinated activation of C/EBPα and Fms-like tyrosine kinase 3 (FLT3) that increased lipid anabolism in vivo and in patients with FLT3-mutant acute myeloid leukemia (AML). Mechanistically, C/EBPα regulated the fatty acid synthase (FASN)-stearoyl-CoA desaturase (SCD) axis to promote fatty acid (FA) biosynthesis and desaturation. We further demonstrated that FLT3 or C/EBPα inactivation decreased monounsaturated FA incorporation to membrane phospholipids through SCD downregulation. Consequently, SCD inhibition enhanced susceptibility to lipid redox stress that was exploited by combining FLT3 and glutathione peroxidase 4 inhibition to trigger lipid oxidative stress, enhancing ferroptotic death of FLT3-mutant AML cells. Altogether, our study reveals a C/EBPα function in lipid homeostasis and adaptation to redox stress, and a previously unreported vulnerability of FLT3-mutant AML to ferroptosis with promising therapeutic application. SIGNIFICANCE: FLT3 mutations are found in 30% of AML cases and are actionable by tyrosine kinase inhibitors. Here, we discovered that C/EBPα regulates FA biosynthesis and protection from lipid redox stress downstream mutant-FLT3 signaling, which confers a vulnerability to ferroptosis upon FLT3 inhibition with therapeutic potential in AML. This article is highlighted in the In This Issue feature, p. 1501.

Reference Values for Hematology, Plasma Biochemistry, Bone Marrow Cytology and Bone Histology of NOD.Cg-Prkdcscid Il2rgtm1Wjl/ SzJ Immunodeficient Mice.

Highly immunodeficient NSG mice (NOD.Cg-Prkdcscid Il2rgtm1Wjl/SzJ) are commonly used as a models in preclinical studies for patient-derived engraftment. However, despite the frequency of their use, reference values for their clinical pathology markers have not been determined. In accordance with the American Society of Veterinary Clinical Pathology (ASVCP) recommendations, we established de novo reference values for hematologic and biochemical variables and evaluated bone marrow cytology and histology in forty 9-wk-old male and female NSG mice. Hematologic analyses were performed using 2 separate analyzers (IDEXX ProCyte Dx, Sysmex XT-2000iV) and biochemical values were measured using a Scil VetScan2. The primary hematologic characteristic seen in NSG mice was a very low white blood cell (WBC) count (below 1.6 109/L). Lymphocyte and monocyte counts were respectively over- and under-estimated by the analyzers, as compared with manual counts, likely due to misidentification of the very low concentrations of these cell types by the analyzers. This analytical bias highlights the need for confirmatory microscopic observation of blood smears from these mice for WBC differential identification. Results for all other hematology and biochemistry variables were similar to those previously reported in inbred mice, except for MPV and an unexpectedly high glucose concentration (11.5 to 19.0 mmol/L), potentially due to the nonfasting status of the animals. The differential bone marrow cell count and Myeloid:Erythroid ratio (median 1.76) were also established. Megakaryocyte and adipocyte count differed significantly between the femoral diaphysis and metaphysis and between genders. These results provide a reliable resource of baseline data for hematologic variables for researchers monitoring graft rejection studies in NSG mice.

Abnormal Sysmex XT-2000iV DIFF scattergram in a cat with a prominent mastocytemia.

A 2-year-old neutered male domestic shorthair cat was presented to the emergency service of the National Veterinary School of Toulouse (France) for acute vomiting and diarrhea with lethargy, inappetence, and adypsia for the past 48 hours. Complete blood counts were performed with the ProCyte DX at the emergency department and with the Sysmex XT-2000iV at the laboratory 2 weeks later. The scattergrams from the two analyzers revealed similar unusual and abnormal dot plots. The Sysmex XT-2000iV DIFF scattergram also showed no clear separation between different leukocyte populations. The eosinophil cluster was in an abnormal location compared with that of the "typical" location in a normal cat. A blood smear evaluation revealed the presence of numerous mast cells. Thus, we hypothesized that the Sysmex XT-2000iV had detected the mast cell population, and this led to errors in the differential counts. To explore this hypothesis, we manually gated on the DIFF scattergram and performed a manual differential on the blood smear. With this new gating strategy, the Sysmex XT-2000iV and manual differentials were similar. Thus, in the case of systemic mastocytosis, mast cells can be located between the lymphocyte, monocyte, and eosinophil clusters on scattergrams.

Evaluation of CTAD (citrate-theophylline-adenosine-dipyridamole) as a universal anticoagulant in dogs.

CTAD (citrate-theophylline-adenosine-dipyridamole) has been shown to be an almost universal anticoagulant in human and feline medicine, allowing most hematology, coagulation, and biochemical analyses. Forty canine blood specimens were collected in CTAD, EDTA, heparin, and citrate for hematology, biochemistry, and coagulation analyses. CTAD partially limited platelet aggregation observed in EDTA blood smears. CTAD specimens gave similar and well-correlated results for most variables of a complete blood cell count, except for mean corpuscular volume, which was moderately higher, and mean corpuscular hemoglobin concentration, which was moderately lower in CTAD than in EDTA; reticulocyte and platelet indexes were poorly correlated. CTAD plasma gave similar results to citrate for fibrinogen, antithrombin, and D-dimers, and relatively similar results for prothrombin time, but activated partial thromboplastin time was poorly correlated. Triglycerides, cholesterol, glucose, total proteins, phosphate, iron, alanine aminotransferase, γ-glutamyl transferase, and lipase were similar and well correlated in CTAD and heparin plasmas. Urea, creatinine, albumin, alkaline phosphatase, amylase, and aspartate aminotransferase showed moderate-to-marked bias, but these variables could be measured in CTAD plasma if new reference intervals were determined. Creatine kinase activity, potassium, chloride, and total carbon dioxide measurements are not recommended in CTAD plasma. CTAD is a prospective candidate as an almost universal anticoagulant for routine hematology, some plasma coagulation, and many biochemistry variables in dogs. Definitive recommendations will require study of abnormal canine blood specimens.

Comparison of different anticoagulant associations on haemostasis and biochemical analyses in feline blood specimens.

Objectives Universal anticoagulant could be an alternative to the multiple blood sampling required for clinical pathology investigations in cats. An association of citrate, theophylline, adenosine and dipyridamole (CTAD) has been reported to be a good substitute for EDTA for haematology analysis in cats, limiting platelet clumping, and has also been shown to be valid for haematology, secondary haemostasis and some biochemical variables in humans. The aim of the study was therefore to investigate the effects of CTAD on in vitro platelet aggregation and compare results of secondary haemostasis and biochemistry tests, excluding a priori those variables not reliably measured in CTAD, such as sodium, chloride and divalent cations, in feline blood specimens collected in CTAD and paired citrate and heparin tubes. Methods Thirty blood specimens sampled in citrate and CTAD were analysed for in vitro platelet aggregation, and 60 blood specimens sampled in citrate or heparin and CTAD were analysed for plasma coagulation and a biochemistry panel. Results In vitro platelet aggregation was inhibited in CTAD compared with citrate specimens. Prothrombin time, activated partial thromboplastin time, antithrombin and fibrinogen results were similar, despite some significant differences. Measurements of triglycerides, cholesterol, glucose, urea, creatinine, phosphate, total proteins and alanine aminotransferase activity were similar and well correlated in CTAD and heparin plasmas, despite some significant differences and moderate biases. Albumin showed a marked positive proportional bias, and creatine kinase and alkaline phosphatase activities a moderate and marked negative mixed bias, respectively, but could be measured in CTAD if new reference intervals were calculated. Aspartate aminotransferase activity showed a marked negative proportional bias, along with a poor correlation and some clinical misclassifications just like the potassium concentration, and thus cannot be recommended to be measured in CTAD specimens. Conclusions and relevance In cats, CTAD cannot be used for primary haemostasis investigation but could be a suitable (almost) universal anticoagulant for routine haematology, as well as for plasma coagulation and many biochemistry variables.

Spurious reticulocyte profiles in dogs with large form babesiosis: a retrospective study.

BACKGROUND: Erroneously high reticulocyte counts (pseudoreticulocytosis) have been reported in dogs with leukemia. Pseudoreticulocytosis and an abnormal reticulocyte profile were observed in a dog with large form babesiosis presented at our institution. OBJECTIVES: The aims of this retrospective study were to determine if dogs with babesiosis and other dogs had abnormal reticulocyte profiles, and to correlate these profiles with the primary diagnosis. METHODS: All canine CBCs obtained with the Sysmex XT-2000iV or Procyte DX were reviewed. Cases of large form babesiosis were identified and their reticulocyte dot plots were analyzed. Dogs with abnormal reticulocyte profiles but without microscopically apparent intraerythrocytic Babesia piroplasms were identified. The reticulocyte profiles and fluorescence ratios of dogs with and without babesiosis were compared. RESULTS: Twenty of 92 dogs with babesiosis had abnormal reticulocyte profiles, including 8 with a separation between the reticulocyte and mature RBC plots or a continuum of reticulocytes from the RBC plot but with a higher density of dots in the middle of the "comet tail" than in the left quarter of the dot plot. Thirteen of 6980 dogs without Babesia on the blood smear had abnormal reticulocyte profiles, including 3 with leukemia. The medium-fluorescence reticulocyte ratios tended to be higher in dogs with babesiosis and abnormal dot plots than in other dogs, whereas the high-fluorescence ratio was higher in one dog with leukemia. CONCLUSION: Abnormal reticulocyte dot plots and atypical reticulocyte fluorescence ratios may occur in dogs with babesiosis and alert clinical pathologists to consider this diagnosis.

Feline reference intervals for the Sysmex XT-2000iV and the ProCyte DX haematology analysers in EDTA and CTAD blood specimens.

Laser-based haematology analysers are routinely used in veterinary clinical pathology laboratories, and are available to practitioners. However, feline haematological reference intervals (RIs) determined according to international recommendations are, to our knowledge, not available. Furthermore, platelet count RI is difficult to establish in cats because of the frequent occurrence of platelet aggregation in blood specimens. The purpose of this study was to establish feline haematological RIs with the Sysmex XT-2000iV and ProCyte DX analysers, in ethylenediamine tetra-acetic acid (EDTA) and in citrate, theophylline, adenosine and dipyridamole (CTAD), which is a combination of anticoagulants limiting platelet aggregation. Blood specimens from 120 healthy cats were analysed in duplicate, and the degree of platelet aggregation was assessed on blood smears. After exclusion of inadequate specimens, 81 sets of results (from 44 males and 37 females, aged from 6 to 116 months) were available for the determination of RIs by the non-parametric method. The effects of the anticoagulant, analyser and aggregation score were assessed. When the aggregation effect was significant, the RIs were determined using the subgroup of blood specimens with no or little aggregation. The effects of sex, age and weight were also investigated, but were moderate. The different RIs obtained with the Sysmex XT-2000iV and ProCyte DX analysers, and the two anticoagulants, were very similar to previous RIs established in EDTA with the ADVIA 120, another laser-based analyser, except for the platelet count in CTAD specimens. Its lower reference limit was higher in CTAD vs EDTA specimens, which confirms the interest in this anticoagulant in cats.

Changes in haematology measurements with the Sysmex XT-2000iV during storage of feline blood sampled in EDTA or EDTA plus CTAD.

In veterinary medicine a complete blood cell count (CBC) cannot always be performed within 24 h as usually recommended, particularly for specimens shipped to a reference laboratory. This raises the question of the stability of the variables, especially in ethylenediamine tetra-acetic acid (EDTA) feline blood specimens, known to be prone to in vitro platelet aggregation. Citrate, theophylline, adenosine and dipyridamole (CTAD) has been reported to limit platelet aggregation in feline blood specimens. The aim of this study was to measure the stability of the haematological variables and the platelet aggregation score in EDTA and EDTA plus CTAD (EDCT) feline blood specimens during 48 h of storage at room temperature. Forty-six feline EDTA and EDCT blood specimens were analysed with a Sysmex XT-2000iV analyser, and the platelet count and score of platelet aggregation were estimated immediately and after 24 and 48 h of storage. A significant increase in mean corpuscular volume, haematocrit, reticulocyte and eosinophil counts, and a significant decrease in mean corpuscular haemoglobin concentration and monocyte count were observed. Haemoglobin, mean corpuscular haemoglobin, and red blood cell, white blood cell, neutrophil and lymphocyte counts remained stable. Changes in reticulocyte indexes with time (low fluorescence ratio, medium fluorescence ratio, high fluorescence ratio and immature reticulocyte fraction) were not significant. Changes were generally more pronounced in EDTA than in EDCT. Platelet aggregation decreased markedly in initially highly aggregated EDTA specimens, and increased slightly in initially non- or mildly-aggregated EDTA or EDCT specimens. Platelet counts increased and decreased, or remained stable, respectively. CTAD can reduce storage-induced changes of the haematological variables in feline samples, thus improving the reliability of a CBC and limiting clinical misinterpretations.

Time-of-flight secondary ion mass spectrometry imaging demonstrates the specific localization of deca-bromo-diphenyl-ether residues in the ovaries and adrenal glands of exposed rats.

Deca-bromo-diphenyl ether (DBDE) is one of the most efficient brominated flame retardant (BFR) available on the market. We recently demonstrated that when administered to female rat by oral route, DBDE is efficiently absorbed, with the highest residual concentrations found in two endocrine glands, namely the adrenal glands and the ovaries. Time-of-flight secondary ion mass spectrometry (TOF-SIMS) imaging, a technique usually used for the study of endogenous compounds, was applied for the first time to a persistent organic pollutant, allowing to detect and to precisely localize DBDE residues in these two target tissues. The detection of the bromide ion ((81)Br isotope) by TOF-SIMS mass spectrometry imaging allowed us to demonstrate a marked cortical tropism of DBDE residues for the adrenal glands in female rats dosed per os 2 mg·kg(-1) DBDE, daily, over 96 h. In ovaries, DBDE residues were found to be concentrated in spots corresponding to part of the corpora lutea. Hepatic residues of DBDE were found to be homogeneously distributed. Due to the intrinsic toxicity of DBDE, its accumulation in the adrenal glands and the ovaries may be connected to the mechanisms of actions by which DBDE could trigger endocrine disruption in mammals.

Comparison of cytologic and histologic evaluations of the conjunctiva in the normal equine eye.

OBJECTIVE: To describe the cells observed in conjunctival brush cytology (CBC) from normal horses and compare these findings with conjunctival structural histology so as to understand which cells are recovered from CBC. METHODS: This study was divided into three parts. (1) Conjunctival brush smears were collected from 20 healthy horses on both eyes and a differential count on 300 cells was carried out on May Grünwald-Giemsa (MGG) smears. (2) A similar protocol was used for whole eyes from five horses obtained rapidly after death from a slaughterhouse. The eyes were then assessed for conjunctival histology. (3) Cytobrush smears were collected from five healthy horses. Smears were examined after MGG or periodic acid Schiff (PAS) staining. RESULTS: The differential cell count showed a majority of deep and intermediate epithelial cells with very few superficial and goblet cells in both eyes. A stratified columnar to cuboidal epithelium was observed on nearly the whole surface of the conjunctiva. A stratified squamous type was observed at the palpebral and bulbar edges. Areas with highest mucus cell indices were found from the nasal to the temporal edge of the equine inferior conjunctiva in the upper palpebral segment near the fornix and in a part of the nasal fornix. In MGG smears no mucus cells were identified; however, they were numerous in PAS smears (22.6% +/- 11) and were mostly cylindrical cells (42.5% +/- 14.4 PAS positive). CONCLUSIONS: Cytobrush smears in the healthy horse are characterized by a majority of polyhedral and cylindrical cells and a few squamous cells. The cylindrical cells may be mucous cells and probably originate from the main stratified columnar to cuboidal epithelium.