We previously identified LDOC1 as one of the most significantly differentially expressed genes in untreated chronic lymphocytic leukemia (CLL) patients with respect to the somatic mutation status of the immunoglobulin heavy-chain variable region genes. However, little is known about the normal function of LDOC1, its contribution to the pathophysiology of CLL, or its prognostic significance. In this study, we have investigated LDOC1 mRNA expression in a large cohort of untreated CLL patients, as well as in normal peripheral blood B-cell (NBC) subsets and primary B-cell lymphoma samples. We have confirmed that LDOC1 is dramatically down-regulated in mutated CLL cases compared with unmutated cases, and have identified a new splice variant, LDOC1S. We show that LDOC1 is expressed in NBC subsets (naive > memory), suggesting that it may play a role in normal B-cell development. It is also expressed in primary B-cell lymphoma samples, in which its expression is associated with somatic mutation status. In CLL, we show that high levels of LDOC1 correlate with biomarkers of poor prognosis, including cytogenetic markers, unmutated somatic mutation status, and ZAP70 expression. Finally, we demonstrate that LDOC1 mRNA expression is an excellent predictor of overall survival in untreated CLL patients. (Blood. 2011; 117(15):4076-4084)
IntroductionIn chronic lymphocytic leukemia (CLL), one of the best predictors of outcome is the somatic mutation status of the immunoglobulin heavy-chain variable region (IGHV) genes. Patients whose CLL cells have unmutated IGHV genes, approximately 40% of patients, have a median survival of 8 years; patients whose CLL cells have mutated IGHV genes, approximately 60% of patients, have a median survival of 25 years. 1 To identify new prognostic biomarkers and molecular targets for therapy in untreated CLL patients, we reanalyzed the raw data from 4 published gene expression profiling microarray studies. [2][3][4][5] Of 88 candidate biomarkers associated with somatic mutation status, we confirmed the expression of 37 using a highly sensitive quantitative RT-PCR assay performed on microfluidics cards (MF-QRT-PCR). 6 Of these candidate biomarkers, the gene LDOC1 (leucine zipper down-regulated in cancer) was one of the most significantly differentially expressed genes that distinguished mutated from unmutated CLL cases.The LDOC1 gene, on chromosome Xq27, encodes a 17-kDa protein about which little is known. A leucine zipper motif in the N-terminal region is followed by a short proline-rich region, which contains an SH3-binding consensus sequence, and then an acidic region in the C-terminus. 7 Because leucine zipper and SH3-binding motifs mediate protein-protein interactions, LDOC1 protein may regulate transcription by homodimerization or by heterodimerization with other transcription factors through its leucine zipper domain. LDOC1 also may participate in cell signaling by providing a binding surface for signaling cascade proteins within its SH3 domain. Others have assessed LDOC1 mRNA expression in a ...