Myelodysplastic syndromes (MDS) are clonal stem cell hematologic disorders that evolve to acute myeloid leukemia (AML) and thus model multistep leukemogenesis. Activating RAS mutations and overexpression of BCL-2 are prognostic features of MDS/AML transformation. Using NRASD12 and BCL-2, we created two distinct models of MDS and AML, where human (h)BCL-2 is conditionally or constitutively expressed. Our novel transplantable in vivo models show that expression of hBCL-2 in a primitive compartment by mouse mammary tumor virus-long terminal repeat results in a disease resembling human MDS, whereas the myeloid MRP8 promoter induces a disease with characteristics of human AML. Expanded leukemic stem cell (Lin À /Sca-1 + /c-Kit + ) populations and hBCL-2 in the increased RAS-GTP complex within the expanded Sca-1 + compartment are described in both MDS/AML-like diseases. Furthermore, the oncogenic compartmentalizations provide the proapoptotic versus antiapoptotic mechanisms, by activating extracellular signal-regulated kinase and AKT signaling, in determination of the neoplastic phenotype. When hBCL-2 is switched off with doxycycline in the MDS mice, partial reversal of the phenotype was observed with persistence of bone marrow blasts and tissue infiltration as RAS recruits endogenous mouse (m)BCL-2 to remain active, thus demonstrating the role of the complex in the disease. This represents the first in vivo progression model of MDS/AML dependent on the formation of a BCL-2:RAS-GTP complex. The colocalization of BCL-2 and RAS in the bone marrow of MDS/AML patients offers targeting either oncogene as a therapeutic strategy. [Cancer Res 2007;67(24):11657-67]

Key Points• BCL-2 homology domain 3 mimetic inhibitor ABT-737 targets leukemia initiating cells and progenitors.• Dephosphorylates RAS signaling proteins and regulates proliferation and differentiation genes detected by gene expression profiling.Myelodysplastic syndrome (MDS) transforms into an acute myelogenous leukemia (AML) with associated increased bone marrow (BM) blast infiltration. Using a transgenic mouse model, MRP8[NRASD12/hBCL-2], in which the NRAS:BCL-2 complex at the mitochondria induces MDS progressing to AML with dysplastic features, we studied the therapeutic potential of a BCL-2 homology domain 3 mimetic inhibitor, ABT-737. Treatment significantly extended lifespan, increased survival of lethally irradiated secondary recipients transplanted with cells from treated mice compared with cells from untreated mice, with a reduction of BM blasts, Lin-/Sca-1 1 /c-Kit 1 , and progenitor populations by increased apoptosis of infiltrating blasts of diseased mice assessed in vivo by technicium-labeled annexin V single photon emission computed tomography and ex vivo by annexin V/7-amino actinomycin D flow cytometry, terminal deoxynucleotidyltransferase-mediated dUTP nick end labeling, caspase 3 cleavage, and re-localization of the NRAS:BCL-2 complex from mitochondria to plasma membrane. Phosphoprotein analysis showed restoration of wild-type (WT) AKT or protein kinase B, extracellular signal-regulated kinase 1/2 and mitogen-activated protein kinase patterns in spleen cells after treatment, which showed reduced mitochondrial membrane potential. Exon specific gene expression profiling corroborates the reduction of leukemic cells, with an increase in expression of genes coding for stem cell development and maintenance, myeloid differentiation, and apoptosis. Myelodysplastic features persist underscoring targeting of BCL-2-mediated effects on MDS-AML transformation and survival of leukemic cells. (Blood. 2013; 122(16):2864-2876

IntroductionDespite improved molecular characterization of malignancies and development of targeted therapies, 1 acute leukemia is not curable and few patients survive more than 10 years after diagnosis. 2,3 To further improve outcome, we studied the potential efficacy of boosting the patient's immune response. Therapeutic vaccination aimed at promoting T-cell immunity requires: activation of the innate system, optimal presentation of major histocompatibility complex (MHC) class I-binding peptides, and provision of CD4 ϩ T-cell help. DNA vaccines have the potential to supply all of these. In an animal model of acute promyelocytic leukemia (APL), 4 we developed a promyelocytic leukemia-RAR␣ (PML/RAR␣)-targeted DNA-based vaccine 5 and show that DNA combined with all-trans retinoic acid (ATRA) has a pronounced survival advantage, concomitant with time-dependent antibody production, 5,6 and an increase in interferon-␥ (IFN-␥). 5 A similar approach confirmed these findings. 7 The role of ATRA as an immunomodulator is well documented. [8][9][10][11] Westervelt et al 12 show that ATRA responses are influenced by the presence of an intact adaptive immune response.The present study is aimed at investigating the immune responses involved in the antileukemic effect of the combined ATRA ϩ DNA therapy, particularly those mediated by CD4 ϩ and CD8 ϩ T cells. MethodsWe extended our previous study using the same protocol illustrated in supplemental Figure 1A (available on the Blood website; see the Supplemental Materials link at the top of the online article) where we combined ATRA (5 mg) and a PML-RAR␣FrC DNA construct in an APL mouse model. 5 Peripheral blood (PB) was collected approximately every 20 days from day 19 after APL engraftment to follow the mice clinically. At specific days, mice were killed to evaluate responses. Methods are detailed in the figure legends. Animal studies were undertaken according to the guidelines of the institutional animal care committee of Hôpital Saint-Louis. Results and discussion DNA vaccination combined with ATRA induces long-term survivalOur finding of ATRA ϩ DNA treatment significantly extending survival compared with ATRA alone was confirmed in additional protocols (Figure 1A-B; supplemental Figure 1B-C). We have previously reported that DNA alone elicited a modest survival advantage 5 and that FrC alone failed to give long-term survival 13 (supplemental Figure 1D).ATRA ϩ DNA-treated mice had increased white blood cell counts on day 21 after leukemia engraftment, possibly resulting from the For personal use only. on May 11, 2018. by guest www.bloodjournal.org From increases in CD4 ϩ and CD8 ϩ cells (supplemental Figure 2A). ATRAand nearly half of the ATRA ϩ DNA-treated mice had reduced platelets by day 60 (supplemental Figure 2A). Long-term survivors (LTSs) from the ATRA ϩ DNA-treated group (Ͼ 120 days) had significantly reduced bone marrow blast counts (2%-12%; supplemental Figure 2B). ATRA-alone-treated mice died by day 90.PB absolute counts of CD3 ϩ CD4 ϩ and CD3 ϩ CD8 ϩ subsets, as...

Retinoic acid (RA) binds and activates retinoid X receptor (RXR)/retinoic acid receptor (RAR) heterodimers, which regulate the transcription of genes that have retinoic acid response elements (RARE). The RAR isotypes (alpha, beta and gamma) are comprised of six regions designated A-F. Two isoforms of RARalpha, 1 and 2, have been identified in humans, which have different A regions generated by differential promoter usage and alternative splicing. We have isolated two new splice variants of RARalpha1 from human B lymphocytes. In one of these variants, exon 2 is juxtaposed to exon 5, resulting in an altered reading frame and a stop codon. This variant, designated RARalpha1DeltaB, does not code for a functional receptor. In the second variant, exon 2 is juxtaposed to exon 6, maintaining the reading frame. This isoform, designated RARalpha1DeltaBC, retains most of the functional domains of RARalpha1, but omits the transactivation domain AF-1 and the DNA-binding domain. Consequently, it does not bind nor transactivate RARE on its own. Nevertheless, RARalpha1DeltaBC interacts with RXRalpha and, as an RXRalpha/RARalpha1DeltaBC heterodimer, transactivates the DR5 RARE upon all-trans-RA binding. The use of RAR- and RXR-specific ligands shows that, whereas transactivation of the DR5 RARE through the RXRalpha/RARalpha1 heterodimer is mediated only by RAR ligands, transactivation through the RXRalpha/RARalpha1DeltaBC heterodimer is mediated by RAR and RXR ligands. Whilst RARalpha1 has a broad tissue distribution, RARalpha1DeltaBC has a more heterogeneous distribution, but with significant expression in myeloid cells. RARalpha1DeltaBC is an infrequent example of a functional nuclear receptor which deletes the DNA-binding domain.

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BackgroundIn spite of the recent discovery of genetic mutations in most myelodysplasic (MDS) patients, the pathophysiology of these disorders still remains poorly understood, and only few in vivo models are available to help unravel the disease.MethodsWe performed global specific gene expression profiling and functional pathway analysis in purified Sca1+ cells of two MDS transgenic mouse models that mimic human high-risk MDS (HR-MDS) and acute myeloid leukemia (AML) post MDS, with NRASD12 and BCL2 transgenes under the control of different promoters MRP8NRASD12/tethBCL-2 or MRP8[NRASD12/hBCL-2], respectively.ResultsAnalysis of dysregulated genes that were unique to the diseased HR-MDS and AML post MDS mice and not their founder mice pointed first to pathways that had previously been reported in MDS patients, including DNA replication/damage/repair, cell cycle, apoptosis, immune responses, and canonical Wnt pathways, further validating these models at the gene expression level. Interestingly, pathways not previously reported in MDS were discovered. These included dysregulated genes of noncanonical Wnt pathways and energy and lipid metabolisms. These dysregulated genes were not only confirmed in a different independent set of BM and spleen Sca1+ cells from the MDS mice but also in MDS CD34+ BM patient samples.ConclusionsThese two MDS models may thus provide useful preclinical models to target pathways previously identified in MDS patients and to unravel novel pathways highlighted by this study.Electronic supplementary materialThe online version of this article (doi:10.1186/s13045-016-0235-8) contains supplementary material, which is available to authorized users.

We have previously shown that a specific promyelocytic leukemia-retinoic acid receptor alpha (PML-RARA) DNA vaccine combined with all-trans retinoic acid (ATRA) increases the number of long term survivors with enhanced immune responses in a mouse model of acute promyelocytic leukemia (APL). This study reports the efficacy of a non-specific DNA vaccine, pVAX14Flipper (pVAX14), in both APL and high risk myelodysplastic syndrome (HR-MDS) models. PVAX14 is comprised of novel immunogenic DNA sequences inserted into the pVAX1 therapeutic plasmid. APL mice treated with pVAX14 combined with ATRA had increased survival comparable to that obtained with a specific PML-RARA vaccine. Moreover, the survival advantage correlated with decreased PML-RARA transcript levels and increase in anti-RARA antibody production. In HR-MDS mice, pVAX14 significantly improved survival and reduced biomarkers of leukemic transformation such as phosphorylated mitogen-activated protein/extracellular signal-regulated kinase kinase (MEK) 1. In both preclinical models, pVAX14 vaccine significantly increased interferon gamma (IFNγ) production, memory T-cells (memT), reduced the number of colony forming units (CFU) and increased expression of the adapter molecule signalling to NF-κB, MyD88. These results demonstrate the adjuvant properties of pVAX14 providing thus new approaches to improve clinical outcome in two different models of myeloid malignancies, which may have potential for a broader applicability in other cancers.

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