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Ravalet N, Guermouche H, Hirsch P, Picou F, Foucault A, Gallay N, Martignoles JA, Beaud J, Suner L, Deswarte C, Lachot S, Rault E, Largeaud L, Gissot V, Béné MC, Gyan E, Delhommeau F, Herault O. Modulation of bone marrow and peripheral blood cytokine levels by age and clonal hematopoiesis in healthy individuals. Clin Immunol 2023; 255:109730. [PMID: 37562724 DOI: 10.1016/j.clim.2023.109730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 07/10/2023] [Accepted: 07/20/2023] [Indexed: 08/12/2023]
Abstract
Aging is associated with bone marrow (BM) inflammaging and, in some individuals, with the onset of clonal hematopoiesis (CH) of indeterminate potential. In this study conducted on 94 strictly healthy volunteers (18 to 80 yo), we measured BM and peripheral blood (PB) plasma levels of 49 hematopoietic and inflammatory cytokines. With aging, 7 cytokines increased in BM (FLT3L, CXCL9, HGF, FGF-2, CCL27, IL-16, IL-18) and 8 decreased (G-CSF, TNF, IL-2, IL-15, IL-17A, CCL7, IL-4, IL-10). In PB, 10 cytokines increased with age (CXCL9, FLT3L, CCL27, CXCL10, HGF, CCL11, IL-16, IL-6, IL-1 beta, CCL2). CH was associated with higher BM levels of MIF and IL-1 beta, lower BM levels of IL-9 and IL-5 and higher PB levels of IL-15, VEGF-A, IL-2, CXCL8, CXCL1 and G-CSF. These reference values provide a useful tool to investigate anomalies related to inflammaging and potentially leading to the onset of age-related myeloid malignancies or inflammatory conditions.
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Affiliation(s)
- Noémie Ravalet
- CNRS EMR 7001 LNOx "Leukemic niche and redox metabolism", EA7501 GICC, Tours, France; Tours University Hospital, Department of Biological Hematology, Tours, France
| | - Hélène Guermouche
- Sorbonne University, INSERM, Saint-Antoine Research Center, CRSA, AP-HP, Saint-Antoine Hospital, Paris, France
| | - Pierre Hirsch
- Sorbonne University, INSERM, Saint-Antoine Research Center, CRSA, AP-HP, Saint-Antoine Hospital, Paris, France
| | - Frédéric Picou
- CNRS EMR 7001 LNOx "Leukemic niche and redox metabolism", EA7501 GICC, Tours, France; Tours University Hospital, Department of Biological Hematology, Tours, France
| | - Amélie Foucault
- CNRS EMR 7001 LNOx "Leukemic niche and redox metabolism", EA7501 GICC, Tours, France; Tours University Hospital, Department of Biological Hematology, Tours, France
| | - Nathalie Gallay
- CNRS EMR 7001 LNOx "Leukemic niche and redox metabolism", EA7501 GICC, Tours, France; Tours University Hospital, Department of Biological Hematology, Tours, France
| | - Jean-Alain Martignoles
- Sorbonne University, INSERM, Saint-Antoine Research Center, CRSA, AP-HP, Saint-Antoine Hospital, Paris, France
| | - Jenny Beaud
- Sorbonne University, INSERM, Saint-Antoine Research Center, CRSA, AP-HP, Saint-Antoine Hospital, Paris, France
| | - Ludovic Suner
- Sorbonne University, INSERM, Saint-Antoine Research Center, CRSA, AP-HP, Saint-Antoine Hospital, Paris, France
| | - Caroline Deswarte
- Sorbonne University, INSERM, Saint-Antoine Research Center, CRSA, AP-HP, Saint-Antoine Hospital, Paris, France
| | - Sébastien Lachot
- Tours University Hospital, Department of Biological Hematology, Tours, France
| | - Emmanuelle Rault
- Tours University Hospital, Department of Biological Hematology, Tours, France
| | - Laëtitia Largeaud
- Sorbonne University, INSERM, Saint-Antoine Research Center, CRSA, AP-HP, Saint-Antoine Hospital, Paris, France
| | - Valérie Gissot
- INSERM CIC 1415, Tours University Hospital, Tours, France
| | - Marie-Christine Béné
- Nantes University Hospital, Hematology Biology and INSERM CRCI2NA, Nantes, France; FHU GOAL "Grand Ouest Against Leukemia", Angers, France
| | - Emmanuel Gyan
- CNRS EMR 7001 LNOx "Leukemic niche and redox metabolism", EA7501 GICC, Tours, France; Tours University Hospital, Department of Hematology and Cell Therapy, Tours, France
| | - François Delhommeau
- Sorbonne University, INSERM, Saint-Antoine Research Center, CRSA, AP-HP, Saint-Antoine Hospital, Paris, France; OPALE Carnot Institute, Paris, France; CNRS GDR3697 Micronit "Microenvironment of tumor niches", Tours, France.
| | - Olivier Herault
- CNRS EMR 7001 LNOx "Leukemic niche and redox metabolism", EA7501 GICC, Tours, France; Tours University Hospital, Department of Biological Hematology, Tours, France; FHU GOAL "Grand Ouest Against Leukemia", Angers, France; OPALE Carnot Institute, Paris, France; CNRS GDR3697 Micronit "Microenvironment of tumor niches", Tours, France.
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Karimdadi Sariani O, Eghbalpour S, Kazemi E, Rafiei Buzhani K, Zaker F. Pathogenic and therapeutic roles of cytokines in acute myeloid leukemia. Cytokine 2021; 142:155508. [PMID: 33810945 DOI: 10.1016/j.cyto.2021.155508] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 03/14/2021] [Accepted: 03/15/2021] [Indexed: 02/07/2023]
Abstract
Acute myeloid leukemia (AML) is a heterogeneous disease with high mortality that accounts for the most common acute leukemia in adults. Despite all progress in the therapeutic strategies and increased rate of complete remission, many patients will eventually relapse and die from the disease. Cytokines as molecular messengers play a pivotal role in the immune system. The imbalance release of cytokine has been shown to exert a significant influence on the progression of hematopoietic malignancies including acute myeloid leukemia. This article aimed to summarize current knowledge about cytokines and their critical roles in the pathogenesis, treatment, and survival of AML patients.
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Affiliation(s)
- Omid Karimdadi Sariani
- Department of Genetics, College of Science, Islamic Azad University, Kazerun Branch, Kazerun, Iran
| | - Sara Eghbalpour
- School of Medicine, Iran University of Medical Science, Tehran, Iran
| | - Elahe Kazemi
- Biosensor Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Farhad Zaker
- Department of Hematology and Blood Banking, Faculty of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran.
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Conversion of AML-blasts to leukemia-derived dendritic cells (DCleu) in 'DC-culture-media' shifts correlations of released chemokines with antileukemic T-cell reactions. Immunobiology 2021; 226:152088. [PMID: 33838552 DOI: 10.1016/j.imbio.2021.152088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 02/21/2021] [Accepted: 03/10/2021] [Indexed: 11/22/2022]
Abstract
Dendritic cells (DC) and T-cells are mediators of CTL-responses. Autologous (from patients with acute myeloid leukaemia (AML) or myelodysplasia (MDS)) or allogeneic (donor)-T-cells stimulated by DCleu, gain an efficient lysis of naive blasts, although not in every case. CXCL8, -9, -10, CCL2, -5 and Interleukin (IL-12) were quantified by Cytometric Bead Array (CBA) in supernatants from 5 DC-generating methods and correlated with AML-/MDS-patients' serum-values, DC-/T-cell-interactions/antileukemic T-cell-reactions after mixed lymphocyte culture (MLC) and patients' clinical course. The blast-lytic activity of T-cells stimulated with DC or mononuclear cells (MNC) was quantified in a cytotoxicity assay. Despite great variations of chemokine-levels, correlations with post-stimulation (after stimulating T-cells with DC in MLC) improved antileukemic T-cell activity were seen: higher released chemokine-values correlated with improved T-cells' antileukemic activity (compared to stimulation with blast-containing MNC) - whereas with respect to the corresponding serum values higher CXCL8-, -9-, and -10- but lower CCL5- and -2-release correlated with improved antileukemic activity of DC-stimulated (vs. blast-stimulated) T-cells. In DC-culture supernatants higher chemokine-values correlated with post-stimulation improved antileukemic T-cell reactivity, whereas higher serum-values of CXCL8, -9, and -10 but lower serum-values of CCL5 and -2 correlated with post-stimulation improved antileukemic T-cell-reactivity. In a context of 'DC'-stimulation (vs serum) this might point to a change of (CCL5 and -2-associated) functionality from a more 'inflammatory' or 'tumor-promoting' to a more 'antitumor'-reactive functionality. This knowledge could contribute to develop immune-modifying strategies that promote antileukemic (adaptive) immune-responses.
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Liu Q, Hua M, Yan S, Zhang C, Wang R, Yang X, Han F, Hou M, Ma D. Immunorelated gene polymorphisms associated with acute myeloid leukemia. Clin Exp Immunol 2020; 201:266-278. [PMID: 32349161 PMCID: PMC7419888 DOI: 10.1111/cei.13446] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/14/2020] [Accepted: 04/23/2020] [Indexed: 12/11/2022] Open
Abstract
Although the pathogenesis of acute myeloid leukemia (AML) is still unknown, accumulating evidence has revealed that immune response plays a vital part in the pathogenesis. Here, we investigated the involvement of 21 single nucleotide polymorphisms (SNPs) of immunorelated genes, including cytokines [interleukin (IL)-2, IL-4, IL-9, IL-12A, IL-22, interferon (IFN-α) and transforming growth factor (TGF)-β1], transcriptional regulatory genes (TBX21, STAT1, STAT3, STAT5B, STAT6, GATA3, FOXP3 and IRF4) and others (IL2RA, IL6R, NFKBIA) in 269 AML in-patients and 200 healthy controls. Furthermore, we analyzed the relationship between the SNPs and clinical characteristics. Immunorelated SNP genotyping was performed on the Sequenom MassARRAY iPLEX platform. All the SNPs in healthy controls were consistent with Hardy-Weinberg equilibrium. All final P-values were adjusted by Bonferroni multiple testing. Our results showed that IL-22 (rs2227491) was significantly associated with the white blood cell (WBC) counts. Signal transducer and activator of transcription 5B (STAT-5B) (rs6503691) showed a close relationship with the recurrent genetic abnormalities in patients with AML. We verified the negatively independent effect of age and risk of cytogenetics on overall survival (OS). More importantly, the GG genotype of IL-12A (rs6887695) showed a negative impact on AML prognosis independently. Furthermore, the relative expression of IL-12 was decreased in GG genotype, no matter under a co-dominant or recessive model. However, no correlation was observed between the SNPs mentioned above and disease susceptibility, risk stratification and survival. Our findings suggest that immunorelated gene polymorphisms are associated with prognosis in AML, which may perform as novel inspection targets for AML patients.
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Affiliation(s)
- Q. Liu
- Department of HematologyQilu HospitalShandong UniversityJinanChina
- Department of HematologyQilu Hospital, Cheeloo College of MedicineShandong UniversityJinanChina
- Department of HematologyTaian Central HospitalTaianShandongChina
| | - M. Hua
- Department of HematologyQilu HospitalShandong UniversityJinanChina
| | - S. Yan
- Department of HematologyQilu HospitalShandong UniversityJinanChina
| | - C. Zhang
- Department of HematologyQilu HospitalShandong UniversityJinanChina
| | - R. Wang
- Department of HematologyQilu HospitalShandong UniversityJinanChina
| | - X. Yang
- Department of HematologyQilu HospitalShandong UniversityJinanChina
| | - F. Han
- Department of HematologyQilu HospitalShandong UniversityJinanChina
| | - M. Hou
- Department of HematologyQilu HospitalShandong UniversityJinanChina
| | - D. Ma
- Department of HematologyQilu HospitalShandong UniversityJinanChina
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Cardiopulmonary Failure Requiring ECMO Bypass Resulting from Leukemia Cell Lysis in a Patient with Childhood Acute Myelomonocytic Leukemia. Case Rep Hematol 2015; 2015:640528. [PMID: 26124967 PMCID: PMC4466370 DOI: 10.1155/2015/640528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 05/11/2015] [Indexed: 12/05/2022] Open
Abstract
Background. Childhood AML patients are at increased risk for early fatal pulmonary complications. Pulmonary leukostasis and systemic inflammatory response syndrome (SIRS) following leukemia cell lysis are the likely etiologies. Observation. Soon after initiation of AML chemotherapy, an 18-month-old female who met SIRS criteria sustained cardiopulmonary failure requiring ECMO support. Upon recovery, the patient went on to complete therapy and remains in remission without permanent neurologic or cardiac sequelae. Conclusion. Cytokine release syndrome from rapid cell lysis was the likely cause as infectious workup failed to reveal a definitive etiology and drug hypersensitivity testing to the chemotherapy agents was negative.
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Chen J, Li C, Zhu Y, Sun L, Sun H, Liu Y, Zhang Z, Wang C. Integrating GO and KEGG terms to characterize and predict acute myeloid leukemia-related genes. ACTA ACUST UNITED AC 2014; 20:336-42. [PMID: 25343280 DOI: 10.1179/1607845414y.0000000209] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND/OBJECTIVE Acute myeloid leukemia (AML) is a progressive and malignant cancer of myelogenous blood cells, which disturbs the production of normal blood cells. Although several risk and genetic factors (AML-related genes) have been investigated, the concrete mechanism underlying the development of AML remains unclear. In view of this, it is crucial to develop an effective computational method for meaningfully characterizing AML genes and accurately predicting novel AML genes. METHODS In this study, we integrated gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway annotations as features to characterize AML genes. We also provided an optimal set of features for predicting AML-related genes by using the minimum redundancy maximum relevance (mRMR) algorithm and dagging metaclassifier. RESULTS We obtained 26 optimal GO terms that characterized AML genes well. Finally, we predicted 464 novel genes to provide clinical researchers with additional candidates and useful insights for further analysis of AML. DISCUSSION An in-depth feature analysis indicated that the results are quite consistent with previous knowledge. We developed a systematic method to identify the possible underlying mechanism of AML by analyzing the related genes. Our method has the ability to identify the types of features that are optimal to meaningfully interpret AML and accurately predict more AML genes for further clinical researches.
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Agarwal A, MacKenzie RJ, Eide CA, Davare MA, Watanabe-Smith K, Tognon CE, Mongoue-Tchokote S, Park B, Braziel RM, Tyner JW, Druker BJ. Functional RNAi screen targeting cytokine and growth factor receptors reveals oncorequisite role for interleukin-2 gamma receptor in JAK3-mutation-positive leukemia. Oncogene 2014; 34:2991-9. [PMID: 25109334 PMCID: PMC4324389 DOI: 10.1038/onc.2014.243] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Revised: 05/23/2014] [Accepted: 06/15/2014] [Indexed: 01/25/2023]
Abstract
To understand the role of cytokine and growth factor receptor-mediated signaling in leukemia pathogenesis, we designed a functional RNA interference (RNAi) screen targeting 188 cytokine and growth factor receptors that we found highly expressed in primary leukemia specimens. Using this screen, we identified interleukin-2 gamma receptor (IL2Rγ) as a critical growth determinant for a JAK3(A572V) mutation-positive acute myeloid leukemia cell line. We observed that knockdown of IL2Rγ abrogates phosphorylation of JAK3 and downstream signaling molecules, JAK1, STAT5, MAPK and pS6 ribosomal protein. Overexpression of IL2Rγ in murine cells increased the transforming potential of activating JAK3 mutations, whereas absence of IL2Rγ completely abrogated the clonogenic potential of JAK3(A572V), as well as the transforming potential of additional JAK3-activating mutations such as JAK3(M511I). In addition, mutation at the IL2Rγ interaction site in the FERM domain of JAK3 (Y100C) completely abrogated JAK3-mediated leukemic transformation. Mechanistically, we found IL2Rγ contributes to constitutive JAK3 mutant signaling by increasing JAK3 expression and phosphorylation. Conversely, we found that mutant, but not wild-type JAK3, increased the expression of IL2Rγ, indicating IL2Rγ and JAK3 contribute to constitutive JAK/STAT signaling through their reciprocal regulation. Overall, we demonstrate a novel role for IL2Rγ in potentiating oncogenesis in the setting of JAK3-mutation-positive leukemia. In addition, our study highlights an RNAi-based functional assay that can be used to facilitate the identification of non-kinase cytokine and growth factor receptor targets for inhibiting leukemic cell growth.
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Affiliation(s)
- A Agarwal
- 1] Division of Hematology and Medical Oncology, Oregon Health & Science University, Portland, OR, USA [2] Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - R J MacKenzie
- 1] Division of Hematology and Medical Oncology, Oregon Health & Science University, Portland, OR, USA [2] Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - C A Eide
- 1] Division of Hematology and Medical Oncology, Oregon Health & Science University, Portland, OR, USA [2] Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA [3] Howard Hughes Medical Institute, Portland, OR, USA
| | - M A Davare
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
| | - K Watanabe-Smith
- 1] Division of Hematology and Medical Oncology, Oregon Health & Science University, Portland, OR, USA [2] Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - C E Tognon
- 1] Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA [2] Howard Hughes Medical Institute, Portland, OR, USA
| | - S Mongoue-Tchokote
- 1] Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA [2] Biostatistics Shared Resource, Oregon Health & Science University, Portland, OR, USA
| | - B Park
- 1] Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA [2] Biostatistics Shared Resource, Oregon Health & Science University, Portland, OR, USA
| | - R M Braziel
- Department of Pathology, Oregon Health & Science University, Portland, OR, USA
| | - J W Tyner
- 1] Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA [2] Department of Cell & Developmental Biology, Oregon Health & Science University, Portland, OR, USA
| | - B J Druker
- 1] Division of Hematology and Medical Oncology, Oregon Health & Science University, Portland, OR, USA [2] Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA [3] Howard Hughes Medical Institute, Portland, OR, USA
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Abstract
Acute leukaemias are a group of malignancies characterised by the invasion of the bone marrow by immature haematopoietic precursors and differentiation arrest at various maturation steps. Multiplicity of intrinsic and extrinsic factors influences the transformation and progression of leukaemia. The intrinsic factors encompass genetic alterations of cellular pathways leading to the activation of, among others, inflammatory pathways (such as nuclear factor kappa B). The extrinsic components include, among others, the inflammatory pathways activated by the bone marrow microenvironment and include chemokines, cytokines and adhesion molecules. In this chapter, we review the role of inflammatory processes in the transformation, survival and proliferation of leukaemias, particularly the role of nuclear factor kappa B and its downstream signalling in leukaemias and the novel therapeutic strategies that exploit potentially unique properties of inflammatory signalling that offer interesting options for future therapeutic interventions.
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Civini S, Jin P, Ren J, Sabatino M, Castiello L, Jin J, Wang H, Zhao Y, Marincola F, Stroncek D. Leukemia cells induce changes in human bone marrow stromal cells. J Transl Med 2013; 11:298. [PMID: 24304929 PMCID: PMC3882878 DOI: 10.1186/1479-5876-11-298] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 11/27/2013] [Indexed: 12/24/2022] Open
Abstract
Background Bone marrow stromal cells (BMSCs) are multipotent cells that support angiogenesis, wound healing, and immunomodulation. In the hematopoietic niche, they nurture hematopoietic cells, leukemia, tumors and metastasis. BMSCs secrete of a wide range of cytokines, growth factors and matrix proteins which contribute to the pro-tumorigenic marrow microenvironment. The inflammatory cytokines IFN-γ and TNF-α change the BMSC secretome and we hypothesized that factors produced by tumors or leukemia would also affect the BMSC secretome and investigated the interaction of leukemia cells with BMSCs. Methods BMSCs from healthy subjects were co-cultured with three myeloid leukemia cell lines (TF-1, TF-1α and K562) using a trans-well system. Following co-culture, the BMSCs and leukemia cells were analyzed by global gene expression analysis and culture supernatants were analyzed for protein expression. As a control, CD34+ cells were also cocultured with BMSCs. Results Co-culture induced leukemia cell gene expression changes in stem cell pluripotency, TGF-β signaling and carcinoma signaling pathways. BMSCs co-cultured with leukemia cells up-regulated a number of proinflammatory genes including IL-17 signaling-related genes and IL-8 and CCL2 levels were increased in co-culture supernatants. In contrast, purine metabolism, mTOR signaling and EIF2 signaling pathways genes were up-regulated in BMSCs co-cultured with CD34+ cells. Conclusions BMSCs react to the presence of leukemia cells undergoing changes in the cytokine and chemokine secretion profiles. Thus, BMSCs and leukemia cells both contribute to the creation of a competitive niche more favorable for leukemia stem cells.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - David Stroncek
- Cell Processing Section, Department of Transfusion Medicine, Clinical Center, National Institutes of Health (NIH), Building 10, Room 3C720, 9000 Rockville Pike, Bethesda, MD 20892-1184, USA.
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10
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Nipp RD, Rao AV. Performance status in elderly patients with acute myeloid leukemia: exploring gene expression signatures of cytokines and chemokines. J Gerontol A Biol Sci Med Sci 2013; 70:714-21. [PMID: 23783402 DOI: 10.1093/gerona/glt039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 02/21/2013] [Indexed: 01/30/2023] Open
Abstract
Acute myeloid leukemia (AML) is an aggressive disease that predominantly affects elderly patients. Cytokines and chemokines are major players in the pathogenesis of AML. They regulate the disease course and play a deleterious role in the progression of AML. The geriatric population is particularly vulnerable to these mediators as these cytokines and chemokines are also implicated in the development of frailty, fatigue, and declining cognitive function. It is the combination of these adverse effects of cytokines and chemokines that affect performance status and, in turn, the poor prognosis in this age group. Cytokines and chemokines are emerging as therapeutic targets in AML. Future endeavors to treat AML will likely involve cytokines and chemokines as attempts are made to disrupt the bone marrow environment. By modulating the bone marrow stroma, the goal is to create an environment less favorable to AML cells and more favorable to the effects of chemotherapy against AML.
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Affiliation(s)
- Ryan D Nipp
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Arati V Rao
- Department of Medicine, Duke University Medical Center, Durham, North Carolina.
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