The intracellular form of the coagulation factor XIII has previously been identified by immunomorphological techniques using polyclonal antibodies. In these studies, only the A subunit (FXIII-A) was detectable in megakaryocytes/platelets and in monocytes/ macrophages. We developed several novel monoclonal antibody clones directed to both subunits (FXIII-A and FXIII-B) and investigated their appearance in normal and leukemic cells. By using 3-and 4-color flow cytometry FXIII expression was investigated in normal peripheral blood and bone marrow samples and in acute myeloblastic (AML) and lymphoblastic (ALL) leukemia cases. Samples were studied by Western blotting and confocal laser scanning microscopy. With a previously published ELISA assay applying two monoclonal antibodies directed to different epitopes in FXIII-A, we were able to measure the intracytoplasmic content of FXIII-A in normal cells and leukemic blasts. FXIII-A was detectable in normal peripheral blood monocytes and in large quantities in platelets, but both cell types were negative for FXIII-B. There was no surface staining for FXIII-A, it only appeared intracellularly. In samples derived from patients with AML M4 and M5, FXIII-A sensitively identified blast cells. Although normal lymphocytes do not express FXIII-A, 40% of ALL cases showed significant FXIII-A expression as determined by flow cytometry. FXIII-A positivity of lymphoblasts was verified by Western blotting, ELISA, and confocal laser scanning microscopy cytometry. These data provide evidence that FXIII-A is a sufficiently sensitive marker in differentiating myeloblasts and monoblasts and is suitable for identifying leukemia-associated phenotypes in ALL. '
International Society for Analytical CytologyKey terms factor XIII; flow cytometry; acute leukemia phenotype HEMATOLOGICAL malignancies are exceptional in the sense that unlike solid tumors, right from the beginning they are spread all over the body since cancer cells appear in the blood. Acute leukemias represent 85% of all leukemias in children and 45% in adults. In childhood, $80% of acute leukemias are lymphoblastic and 15-20% are myeloblastic (1), whereas this proportion is basically reversed in adults. Leukemic cells display phenotypes that are either present in normal precursors or is unique for the leukemic population also referred to as leukemia-associated immunophenotype (LAIP) or aberrant phenotype. Several publications described LAIP on blasts in acute leukemias (2-5). The major features are lineage infidelity and lineage promiscuity, where leukemic cells express antigens associated with a different cell line, e.g., CD13 and CD33 myeloid-associated antigens in precursor-B acute lymphoblastic leukemia (ALL) (6) or CD7 T-cell marker expression in neoplastic myeloblasts (7). In case of asynchronous differentiation, markers of different maturational stages are expressed simultaneously, like the coexpression of CD10 and CD20 in B-ALL (8) or CD117/CD15 coexpression in acute myeloid leukemia (AML) (9). Antigen