IntroductionChronic lymphocytic leukemia (CLL) follows either an indolent or an aggressive course 1 and clinical decompensation is often accompanied by the appearance of new or increasing numbers of genetic aberrations associated with shorter survival, "clonal evolution." 2 The mechanism(s) responsible for the generation of these genetic abnormalities are not defined in CLL, which is not the case in certain other human cancers, especially lymphoid malignancies of germinal center (GC) origin, in which activation-induced deaminase (AID) appears to be pathogenic. [3][4][5] AID is required for the beneficial generation of Ab diversity in normal B lymphocytes by inducing IGV somatic hypermutation (SHM) and helps in the development of protective effector mechanisms by mediating IGH class-switch recombination (CSR). 6,7 These beneficial on-target AID activities occur primarily during a GC reaction and involve conversion of cytidine to uridine on single-stranded DNA at the IG locus. Such on-target actions in CLL B cells have been a matter of interest for several years, primarily because the presence or absence of IGHV mutations (which require AID) in CLL cells is closely linked to clinical outcome. Patients with leukemic clones with minimal (Ͻ 2% difference from germline) or no mutation in the IGHV (unmutated CLL [U-CLL]) have a far worse prognosis than patients with IGHV-mutated CLL (M-CLL). 8,9 Despite this SHM-based subcategorization of CLL cases, some clones exhibit ongoing IGHV diversification in vivo and in vitro, [10][11][12] with an antigen-driven pattern present in some cases, 13 and up to 50% of patients exhibit molecular evidence for intraclonal isotype CSR. [14][15][16][17][18] AID activity focused elsewhere 19 ) can lead to mutations, deletions, or translocations outside of the IG locus, as in GC-derived lymphomas. [3][4][5] However, such a role for AID in CLL has been questioned for several reasons: (1) although circulating CLL cells can express AID mRNA, [20][21][22] the number of such cells is exceedingly low (0.01%-0.2%) 22 ; (2) AID protein synthesis by these same cells has not been demonstrated 18,[20][21][22][23] ; (3) demonstration of the full range of AID functions is lacking in CLL, for example, by failure of cells to demonstrate SHM, especially for U-CLL clones, even on stimulation and induction of AID mRNA, 21 thereby creating the apparent paradox that U-CLL patients express more AID mRNA than M-CLL patients yet exhibit no or minimal SHM; and (4) despite association with several prognostic markers, 20,21,[24][25][26] no prospective analysis linking AID expression and disease severity has been performed.In the present study, we aimed to address these issues as a means of determining whether AID could be involved in the evolution of CLL to a more aggressive disease. We report that CLL cells are able to produce AID protein, but synthesis is The online version of this article contains a data supplement.The publication costs of this article were defrayed in part by page charge payment. Therefore, and...