In-depth characterization of NK cell markers from CML patients who discontinued tyrosine kinase inhibitor therapy.

Introduction: Treatment-free remission (TFR) in patients with chronic myeloid leukemia in chronic phase is considered a safe option if suitable molecular monitoring is available. However, the question arises as to which factors can contribute to the maintenance of TFR, and immunologic surveillance of the remaining leukemic cells is believed to be one of them. Argentina Stop Trial is an open-label, single-arm, multicenter trial assessing TFR after tyrosine kinase inhibitors interruption, that after more than 4 years showed a successful TFR rate of 63%. Methods: In this context, we set up an immunological study by flow cytometry in order to analyze specific NK cell subsets from peripheral blood patient samples both at the time of discontinuation as well as during the subsequent months. Results: At the time of discontinuation, patients show a mature NK cell phenotype, probably associated to TKI treatment. However, 3 months after discontinuation, significant changes in several NK cell receptors occurred. Patients with a higher proportion of CD56dim NK and PD-1+ NK cells showed better chances of survival. More interestingly, non-relapsing patients also presented a subpopulation of NK cells with features associated with the expansion after cytomegalovirus infection (expression of CD57+NKG2C+), and higher proportion of NKp30 and NKp46 natural cytotoxicity receptors, which resulted in greater degranulation and associated with better survival (p<0.0001). Discussion: This NK cell subset could have a protective role in patients who do not relapse, thus further characterization could be useful for patients in sustained deep molecular response.

Elevated plasma levels of IL-6 and MCP-1 selectively identify CML patients who better sustain molecular remission after TKI withdrawal.

Treatment-free remission (TFR) in chronic myeloid leukemia (CML) is safe under adequate molecular monitoring, but questions remain regarding which factors may be considered predictive for TFR. Argentina Stop Trial (AST) is a multicenter TFR trial showing that 65% of patients sustain molecular remission, and the prior time in deep molecular response (DMR) was associated with successful TFR. Luminex technology was used to characterize cytokines in plasma samples. Using machine learning algorithms, MCP-1 and IL-6 were identified as novel biomarkers and MCP-1low/IL-6low patients showed eightfold higher risk of relapse. These findings support the feasibility of TFR for patients in DMR and MCP-1/IL-6 plasma levels are strong predictive biomarkers.

Venetoclax-resistant CLL cells show a highly activated and proliferative phenotype.

Venetoclax treatment has demonstrated efficacy and a safety profile in chronic lymphocytic leukemia (CLL) patients, however the emergence of resistant cells is a current complication. We and others, previously reported that the activation of CLL cells by signals that mimic microenvironment stimuli favors the upregulation of anti-apoptotic proteins from B cell lymphoma-2 (BCL-2) family that are not targeted by venetoclax, reducing malignant cell sensitivity to the drug. We here studied venetoclax-resistant CLL cells generated in vitro by autologous activated T lymphocytes, and found that they showed an aggressive phenotype characterized by increased expression of activation and proliferation markers. Moreover, surviving cells expressed high levels of B cell lymphoma-extra-large (BCL-XL) and/or myeloid cell leukemia-1 (MCL-1), and a sustained resistance to a second treatment with the drug. Interestingly, the spleen tyrosine kinase (SYK) inhibitor entospletinib, and the phosphoinositide 3-kinase delta (PI3Kδ) inhibitor idelalisib, reduced T cell activation, impaired the generation of leukemic cells with this aggressive phenotype, and were able to restore CLL sensitivity to venetoclax. Our data highlight a novel combination to overcome resistance to venetoclax in CLL.

miRNome profiling of LSC-enriched CD34+CD38-CD26+ fraction in Ph+ CML-CP samples from Argentinean patients: a potential new pharmacogenomic tool.

Chronic myeloid leukemia (CML) is a myeloid stem cell neoplasm characterized by an expansion of myeloid progenitor cells and the presence of BCR-ABL1 oncoprotein. Since the introduction of specific BCR-ABL1 tyrosine kinase inhibitors (TKI), overall survival has improved significantly. However, under long-term therapy patients may have residual disease that originates from TKI-resistant leukemic stem cells (LSC). In this work, we analyzed the miRNome of LSC-enriched CD34+CD38-CD26+ and normal hematopoietic stem cells (HSC) fractions obtained from the same chronic phase (CP) CML patients, and stem and progenitor cells obtained from healthy donors (HD) by next-generation sequencing. We detected a global decrease of microRNA levels in LSC-enriched CD34+CD38-CD26+ and HSC fractions from CML-CP patients, and decreased levels of microRNAs and snoRNAs from a genomic cluster in chromosome 14, suggesting a mechanism of silencing of multiple non-coding RNAs. Surprisingly, HSC from CML-CP patients, despite the absence of BCR-ABL1 expression, showed an altered miRNome. We confirmed by RT-qPCR that the levels of miR-196a-5p were increased more than nine-fold in CD26+ (BCR-ABL1 + ) vs. CD26- (BCR-ABL1 -) CD34+CD38- fractions from CML-CP patients at diagnosis, and in silico analysis revealed a significant association to lipid metabolism and hematopoiesis functions. In the light of recent descriptions of increased oxidative metabolism in CML LSC-enriched fractions, these results serve as a guide for future functional studies that evaluate the role of microRNAs in this process. Metabolic vulnerabilities in LSCs open the road for new therapeutic strategies. This is the first report of the miRNome of CML-CP CD34+CD38- fractions that distinguishes between CD26+ (BCR-ABL1 + ) and their CD26- (BCR-ABL1 - ) counterparts, providing valuable data for future studies.

Expresión de receptores de membrana plaquetaria en el síndrome urémico hemolítico / Expression of platelet membrane glycoproteins in hemolytic uremic syndrome

El objetivo de este trabajo fue el estudio de receptores de membrana plaquetaria en el Síndrome Urémico Hemolítico. Se estudiaron 20 niños de 17,3 ñ 5,2 meses de edad con diagnóstico clínico y de laboratorio de dicha enfermedad. En muestras obtenidas a los 15 días, al mes y a los dos meses del comienzo de la enfermedad se aislaron las plaquetas de los pacientes y también de controles normales de una población etaria comparable. Se solubilizaron las glicoproteínas (GP) de membranas y se procedió al análisis de las mismas por Western-blot. Se utilizaron anticuerpos monoclonales específicos. Se observaron niveles bajos de GPIb y GPlIbIIIa en la primera muestra. La GPIb, luego, aumentó rápidamente normalizándose al mes de evolución. En cambio, el complejo GPlIbIIIa, si bien aumentó ligeramente en la tercera muestra, se mantuvo francamente disminuido (5-25 por ciento). La GPlIb presentó niveles bajos no alcanzando la normalidad dentro del período estudiado, mientras que la GPIIIa mantuvo un nivel estable cercano al límite inferior normal (25-50 por ciento). De los resultados obtenidos se puede concluir que la síntesis de GP no estaría alterada ya que la GPIb se normaliza rápidamente; la integrina GPlIbIIIa es el principal receptor afectado. Esta alteración puede deberse a algún bloqueo por anticuerpos inespecíficos o por péptidos de secuencia RGD o bien a una alteración estructural de la GPlIb por proteólisis inespecífica

Expresión de receptores de membrana plaquetaria en el síndrome urémico hemolítico / Expression of platelet membrane glycoproteins in hemolytic uremic syndrome

El objetivo de este trabajo fue el estudio de receptores de membrana plaquetaria en el Síndrome Urémico Hemolítico. Se estudiaron 20 niños de 17,3 ñ 5,2 meses de edad con diagnóstico clínico y de laboratorio de dicha enfermedad. En muestras obtenidas a los 15 días, al mes y a los dos meses del comienzo de la enfermedad se aislaron las plaquetas de los pacientes y también de controles normales de una población etaria comparable. Se solubilizaron las glicoproteínas (GP) de membranas y se procedió al análisis de las mismas por Western-blot. Se utilizaron anticuerpos monoclonales específicos. Se observaron niveles bajos de GPIb y GPlIbIIIa en la primera muestra. La GPIb, luego, aumentó rápidamente normalizándose al mes de evolución. En cambio, el complejo GPlIbIIIa, si bien aumentó ligeramente en la tercera muestra, se mantuvo francamente disminuido (5-25 por ciento). La GPlIb presentó niveles bajos no alcanzando la normalidad dentro del período estudiado, mientras que la GPIIIa mantuvo un nivel estable cercano al límite inferior normal (25-50 por ciento). De los resultados obtenidos se puede concluir que la síntesis de GP no estaría alterada ya que la GPIb se normaliza rápidamente; la integrina GPlIbIIIa es el principal receptor afectado. Esta alteración puede deberse a algún bloqueo por anticuerpos inespecíficos o por péptidos de secuencia RGD o bien a una alteración estructural de la GPlIb por proteólisis inespecífica (AU)