Stimulation through the B-cell antigen receptor (BCR) is believed to be involved in the natural history of chronic lymphocytic leukemia (CLL). Some cases respond to the in vitro cross-linking of surface immunoglobulin (sIg) with effective activation. In contrast, the remaining cases do not respond to such stimulation, thereby resembling B cells anergized after antigen encounter in vivo. However the biochemical differences between the 2 groups are ill defined, and in humans the term B-cell anergy lacks a molecular definition. We examined the expression and activation of key molecules involved in signaling pathways originating from the BCR, and we report that a proportion of CLL patients (
IntroductionChronic lymphocytic leukemia (CLL) is a chronic lymphoid malignancy characterized by the accumulation of CD5 ϩ monoclonal B lymphocytes in primary and secondary lymphoid tissues. Several lines of evidence, including molecular and functional analysis of the monoclonal immunoglobulin (Ig), strongly support the hypothesis that a stimulation through the B-cell receptor (BCR) may be involved in the selection and expansion of the malignant clone. 1,2 At molecular level, the leukemic cells have a preferential IGHV gene usage; in at least half of the cases, they carry somatically mutated IGHV genes 3,4 ; in more than 20% of the cases, they express closely homologous if not identical ("stereotyped") complementarity-determining region 3 (CDR3) sequences on both heavy and light chains. 5-11 All these observations suggest that a limited set of antigenic elements may be specifically recognized by the leukemic Ig.At functional level, it is long known that CLL cells characteristically express low levels of surface Ig (sIg) a property shared by murine B cells anergized by the exposure to antigens (Ags). 1,2 This anergy-related feature does not necessarily indicate a functional impairment of BCR signaling, as at least half of the cases can actually be stimulated in vitro through their sIg, irrespective of their low level. 12 In contrast, the remaining CLL cases are unresponsive to BCR cross-linking, thereby resembling also at functional level B cells anergized in vivo after chronic stimulation by an antigen. 13 Still, and despite extensive studies, the molecular bases for this functional difference are ill defined.In normal B lymphocytes, BCR engagement triggers a cascade of signaling events resulting in enzymatic activation of various kinases and phosphorylation of the relevant substrates. 14 In particular, BCR-proximal Lyn and Syk kinases induce PLC␥2 phosphorylation and Ras activation. Ras binds to and activates Raf kinase that subsequently activates MEK1 and MEK2 that lay immediately upstream of extracellular signal-related kinase (ERK)1/2. In a parallel signaling cascade, PI3K phosphorylates and activates AKT kinase. BCR stimulation activates gene transcription also through activation of nuclear factor (NF)-kB and nuclear factor of activated T cells (NF-AT) transcription factors [14][15][16] (and see the Science STKE website fo...