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Nachtkamp K, Strupp C, Vukelja M, Kasprzak A, Haase D, Ganster C, Hildebrandt B, Betz B, Giagounidis A, Aul C, Blum S, Hofmann WK, Pfeilstöcker M, Valent P, Lübbert M, Seidl M, Rudelius M, Stauder R, Krieger O, Götze KS, Bobak J, Kündgen A, Schulz F, Dietrich S, Kobbe G, Gattermann N, Germing U. The new WHO 2022 and ICC proposals for the classification of myelodysplastic neoplasms. Validation based on the Düsseldorf MDS Registry and proposals for a merged classification. Leukemia 2024; 38:442-445. [PMID: 38263435 PMCID: PMC10844089 DOI: 10.1038/s41375-024-02157-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 12/28/2023] [Accepted: 01/12/2024] [Indexed: 01/25/2024]
Affiliation(s)
- K Nachtkamp
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine University, Düsseldorf, Germany.
| | - C Strupp
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine University, Düsseldorf, Germany
| | - M Vukelja
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine University, Düsseldorf, Germany
| | - A Kasprzak
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine University, Düsseldorf, Germany
| | - D Haase
- Department of Hematology and Medical Oncology, Georg August University, Göttingen, Germany
| | - C Ganster
- Department of Hematology and Medical Oncology, Georg August University, Göttingen, Germany
| | - B Hildebrandt
- Institute of Human Genetics, Heinrich Heine University, Düsseldorf, Germany
| | - B Betz
- Institute of Human Genetics, Heinrich Heine University, Düsseldorf, Germany
| | - A Giagounidis
- Department of Hematology, Oncology and Palliative Care, Marien Hospital, Duesseldorf, Germany
| | - C Aul
- Department of Hematology, Oncology and Clinical Immunology, Johannes Hospital, Duisburg, Germany
| | - S Blum
- Centre Hospitalier Universitaire Vaudois, Service d'hématologie, Département d'oncologie, and Lausanne University (UNIL), Lausanne, Switzerland
| | - W K Hofmann
- Department of Hematology and Oncology, University Hospital, Mannheim, Germany
| | - M Pfeilstöcker
- Medical Department for Hematology and Oncology, Hanusch Hospital, Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Hanusch Hospital and Medical University of Vienna, Vienna, Austria
| | - P Valent
- Ludwig Boltzmann Institute for Hematology and Oncology, Hanusch Hospital and Medical University of Vienna, Vienna, Austria
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - M Lübbert
- Department of Hematology and Oncology, University of Freiburg Medical Center, Freiburg, Germany
| | - M Seidl
- Institute of Pathology, Heinrich Heine University, Düsseldorf, Germany
| | - M Rudelius
- Institute of Pathology, Heinrich Heine University, Düsseldorf, Germany
| | - R Stauder
- Department of Internal Medicine, Medical University, Innsbruck, Austria
| | - O Krieger
- Elisabethinen Hospital, Linz, Austria
| | - K S Götze
- Department of Medicine III, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - J Bobak
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine University, Düsseldorf, Germany
| | - A Kündgen
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine University, Düsseldorf, Germany
| | - F Schulz
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine University, Düsseldorf, Germany
| | - S Dietrich
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine University, Düsseldorf, Germany
| | - G Kobbe
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine University, Düsseldorf, Germany
| | - N Gattermann
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine University, Düsseldorf, Germany
| | - U Germing
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine University, Düsseldorf, Germany
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2
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van der Kouwe E, Heller G, Czibere A, Pulikkan JA, Agreiter C, Castilla LH, Delwel R, Di Ruscio A, Ebralidze AK, Forte M, Grebien F, Heyes E, Kazianka L, Klinger J, Kornauth C, Le T, Lind K, Barbosa IAM, Pemovska T, Pichler A, Schmolke AS, Schweicker CM, Sill H, Sperr WR, Spittler A, Surapally S, Trinh BQ, Valent P, Vanura K, Welner RS, Zuber J, Tenen DG, Staber PB. Core-binding factor leukemia hijacks the T-cell-prone PU.1 antisense promoter. Blood 2021; 138:1345-1358. [PMID: 34010414 PMCID: PMC8525333 DOI: 10.1182/blood.2020008971] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 04/09/2021] [Indexed: 11/20/2022] Open
Abstract
The blood system serves as a key model for cell differentiation and cancer. It is orchestrated by precise spatiotemporal expression of crucial transcription factors. One of the key master regulators in the hematopoietic systems is PU.1. Reduced levels of PU.1 are characteristic for human acute myeloid leukemia (AML) and are known to induce AML in mouse models. Here, we show that transcriptional downregulation of PU.1 is an active process involving an alternative promoter in intron 3 that is induced by RUNX transcription factors driving noncoding antisense transcription. Core-binding factor (CBF) fusions RUNX1-ETO and CBFβ-MYH11 in t(8;21) and inv(16) AML, respectively, activate the PU.1 antisense promoter that results in a shift from sense toward antisense transcription and myeloid differentiation blockade. In patients with CBF-AML, we found that an elevated antisense/sense transcript and promoter accessibility ratio represents a hallmark compared with normal karyotype AML or healthy CD34+ cells. Competitive interaction of an enhancer with the proximal or the antisense promoter forms a binary on/off switch for either myeloid or T-cell development. Leukemic CBF fusions thus use a physiological mechanism used by T cells to decrease sense transcription. Our study is the first example of a sense/antisense promoter competition as a crucial functional switch for gene expression perturbation by oncogenes. Hence, this disease mechanism reveals a previously unknown Achilles heel for future precise therapeutic targeting of oncogene-induced chromatin remodeling.
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Affiliation(s)
- E van der Kouwe
- Department of Medicine I, Division of Hematology and Hemostaseology, and
| | - G Heller
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | | | | | - C Agreiter
- Department of Medicine I, Division of Hematology and Hemostaseology, and
| | - L H Castilla
- Department of Molecular, Cell and Cancer Biology, University of Massachusetts Medical School, Worcester, MA
| | - R Delwel
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Oncode Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - A Di Ruscio
- Cancer Research Institute, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School Initiative for RNA Medicine, Harvard Medical School, Boston, MA
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - A K Ebralidze
- Harvard Stem Cell Institute, Harvard Medical School, Boston, MA
| | - M Forte
- Department of Medicine I, Division of Hematology and Hemostaseology, and
| | - F Grebien
- Institute for Medical Biochemistry, University of Veterinary Medicine Vienna, Vienna, Austria
| | - E Heyes
- Institute for Medical Biochemistry, University of Veterinary Medicine Vienna, Vienna, Austria
| | - L Kazianka
- Department of Medicine I, Division of Hematology and Hemostaseology, and
| | - J Klinger
- Department of Medicine I, Division of Hematology and Hemostaseology, and
| | - C Kornauth
- Department of Medicine I, Division of Hematology and Hemostaseology, and
| | - T Le
- Department of Medicine I, Division of Hematology and Hemostaseology, and
| | - K Lind
- Department of Internal Medicine, Division of Hematology, Medical University of Graz, Graz, Austria
| | - I A M Barbosa
- Research Institute of Molecular Pathology (IMP), Vienna BioCenter (VBC), Vienna, Austria
| | - T Pemovska
- Department of Medicine I, Division of Hematology and Hemostaseology, and
| | - A Pichler
- Department of Medicine I, Division of Hematology and Hemostaseology, and
| | - A-S Schmolke
- Department of Medicine I, Division of Hematology and Hemostaseology, and
| | - C M Schweicker
- Department of Medicine I, Division of Hematology and Hemostaseology, and
| | - H Sill
- Department of Internal Medicine, Division of Hematology, Medical University of Graz, Graz, Austria
| | - W R Sperr
- Department of Medicine I, Division of Hematology and Hemostaseology, and
| | - A Spittler
- Core Facility Flow Cytometry and Surgical Research Laboratories, and
| | - S Surapally
- Versiti Blood Research Institute, Milwaukee, WI
| | - B Q Trinh
- Harvard Stem Cell Institute, Harvard Medical School, Boston, MA
| | - P Valent
- Department of Medicine I, Division of Hematology and Hemostaseology, and
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - K Vanura
- Department of Medicine I, Division of Hematology and Hemostaseology, and
| | - R S Welner
- Division of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL; and
| | - J Zuber
- Research Institute of Molecular Pathology (IMP), Vienna BioCenter (VBC), Vienna, Austria
| | - D G Tenen
- Harvard Stem Cell Institute, Harvard Medical School, Boston, MA
- Cancer Science Institute, National University of Singapore, Singapore
| | - P B Staber
- Department of Medicine I, Division of Hematology and Hemostaseology, and
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3
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Füreder W, Sperr WR, Heibl S, Zebisch A, Pfeilstöcker M, Stefanzl G, Jäger E, Greiner G, Schwarzinger I, Kundi M, Keil F, Hoermann G, Bettelheim P, Valent P. Prognostic factors and follow-up parameters in patients with paroxysmal nocturnal hemoglobinuria (PNH): experience of the Austrian PNH network. Ann Hematol 2020; 99:2303-2313. [PMID: 32856141 DOI: 10.1007/s00277-020-04214-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 08/10/2020] [Indexed: 11/29/2022]
Abstract
Paroxysmal nocturnal hemoglobinuria (PNH) is a rare hematologic disease characterized by a deregulated complement system, chronic Coombs-negative, intravascular hemolysis, and a variable clinical course with substantial risk to develop thromboembolic events. We analyzed diagnostic and prognostic parameters as well as clinical endpoints in 59 adult patients suffering from PNH in 5 hematology centers in Austria (observation period: 1978-2015). Median follow-up time was 5.6 years. The median clone size at diagnosis amounted to 55% and was higher in patients with classical PNH (81%) compared to patients with PNH associated with aplastic anemia (AA) or myelodysplastic syndromes (MDS) (50%). The clone size also correlated with lactate dehydrogenase (LDH) levels. In one patient, anemia improved spontaneously and disappeared with complete normalization of LDH after 16 years. Seventeen patients received therapy with eculizumab. The rate of thromboembolic events was higher in the pre-eculizumab era compared with eculizumab-treated patients but did not correlate with the presence of age-related clonal hematopoiesis or any other clinical or laboratory parameters. Peripheral blood colony-forming progenitor cell counts were lower in PNH patients compared with healthy controls. Only two patients with classical PNH developed MDS. Overall, 7/59 patients died after 0.5-32 years. Causes of death were acute pulmonary hypertension, Budd-Chiari syndrome, and septicemia. Overall survival (OS) was mainly influenced by age and was similar to OS measured in an age-matched healthy Austrian control cohort. Together, compared with previous times, the clinical course and OS in PNH are favorable, which may be due to better diagnosis, early recognition, and eculizumab therapy.
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Affiliation(s)
- Wolfgang Füreder
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Vienna, Austria. .,Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - W R Sperr
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - S Heibl
- Klinikum Wels-Grieskirchen, Wels, Austria
| | - A Zebisch
- Division of Hematology, Medical University of Graz, Graz, Austria.,Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Division of Pharmacology, Medical University of Graz, Graz, Austria
| | - M Pfeilstöcker
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Hanusch Hospital Vienna, Vienna, Austria
| | - G Stefanzl
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - E Jäger
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - G Greiner
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - I Schwarzinger
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - M Kundi
- Department of Environmental Health, Medical University of Vienna, Vienna, Austria
| | - F Keil
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Hanusch Hospital Vienna, Vienna, Austria
| | - G Hoermann
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria.,Central Institute of Medical and Chemical Laboratory Diagnostics, University Hospital Innsbruck, Innsbruck, Austria
| | - P Bettelheim
- Division of Hematology and Oncology, Elisabethinen Hospital Linz and Europa-Platz Labor Linz, Linz, Austria
| | - P Valent
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
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4
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Greiner G, Gurbisz M, Ratzinger F, Witzeneder N, Class S, Simonitsch-Klupp I, Esterbauer H, Mayerhofer M, Müllauer L, Sperr W, Valent P, Hoermann G. KIT D816V tissue mutation burden is a new biomarker and independent predictor of survival in mastocytosis. Clin Chim Acta 2019. [DOI: 10.1016/j.cca.2019.03.1222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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5
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Najafi N, Hofer G, Gattinger P, Smiljkovic D, Blatt K, Selb R, Stoecklinger A, Keller W, Valent P, Niederberger V, Thalhamer J, Valenta R, Flicker S. Fusion proteins consisting of Bet v 1 and Phl p 5 form IgE-reactive aggregates with reduced allergenic activity. Sci Rep 2019; 9:4006. [PMID: 30850635 PMCID: PMC6408504 DOI: 10.1038/s41598-019-39798-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 01/28/2019] [Indexed: 11/16/2022] Open
Abstract
The cross-linking of effector cell-bound IgE antibodies by allergens induces the release of inflammatory mediators which are responsible for the symptoms of allergy. We demonstrate that a recombinant hybrid molecule consisting of the major birch (Bet v 1) and grass (Phl p 5) pollen allergen exhibited reduced allergenic activity as compared to equimolar mixes of the isolated allergens in basophil activation experiments. The reduced allergenic activity of the hybrid was not due to reduced IgE reactivity as demonstrated by IgE binding experiments using sera from allergic patients. Physicochemical characterization of the hybrid by size exclusion chromatography, dynamic light scattering, negative-stain electron microscopy and circular dichroism showed that the hybrid occurred as folded aggregate whereas the isolated allergens were folded monomeric proteins. IgG antibodies raised in rabbits against epitopes of Bet v 1 and Phl p 5 showed reduced reactivity with the hybrid compared to the monomeric allergens. Our results thus demonstrate that aggregation can induce changes in the conformation of allergens and lead to the reduction of allergenic activity. This is a new mechanism for reducing the allergenic activity of allergens which may be important for modifying allergens to exhibit reduced side effects when used for allergen-specific immunotherapy.
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Affiliation(s)
- N Najafi
- Division of Immunopathology, Institute of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - G Hofer
- Institute of Molecular Biosciences, BioTechMed Graz, University of Graz, Graz, Austria
| | - P Gattinger
- Division of Immunopathology, Institute of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - D Smiljkovic
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - K Blatt
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - R Selb
- Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria
| | - A Stoecklinger
- Department of Molecular Biology, University of Salzburg, Salzburg, Austria
| | - W Keller
- Institute of Molecular Biosciences, BioTechMed Graz, University of Graz, Graz, Austria
| | - P Valent
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - V Niederberger
- Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria
| | - J Thalhamer
- Department of Molecular Biology, University of Salzburg, Salzburg, Austria
| | - R Valenta
- Division of Immunopathology, Institute of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.,NRC Institute of Immunology FMBA of Russia, Moscow, Russia.,Laboratory for Immunopathology, Department of Clinical Immunology and Allergy, Sechenov First Moscow State Medical University, Moscow, Russia
| | - S Flicker
- Division of Immunopathology, Institute of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.
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6
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Kaivers J, Lauseker M, Hildebrandt B, Fenaux P, Pfeilstöcker M, Valent P, Platzbecker U, Latagliata R, Oliva EN, Xicoy B, Götze K, Ganster C, Haase D, Bug G, Kündgen A, Gattermann N, Haas R, Germing U. The IPSS-R has prognostic impact in untreated patients with MDS del(5q). Leuk Res 2018; 72:27-33. [PMID: 30075323 DOI: 10.1016/j.leukres.2018.07.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 07/17/2018] [Accepted: 07/22/2018] [Indexed: 11/29/2022]
Abstract
The IPSS-R proved to be a powerful tool for the assessment of prognosis in MDS patients. We aimed at a validation of the IPSS-R for patients with MDS harboring deletion (5q) isolated or accompanied by additional aberrations. The study was based on 444 MDS patients from MDS centers in Europe. 67% of the patients were female, median age was 69 years. 43.5% had MDS del(5q), 5.9% were diagnosed with RCUD, 2.0% RARS, 18.4% RCMD, 14.6% RAEB-I and 15.5% RAEB-II. According to the IPSS-R, there were 9.9% very low, 39.6% low, 16.6% intermediate, 12.8% high, 20.9% very high risk patients. For very low risk patients survival was 7.5 years, low 9.0 years, intermediate 6.5 years, high 1.5 years and very high 0.7 years (p < 0.001). For low and intermediate risk, the probability of AML evolution was significantly different (p = 0.03) as well as for high versus very high risk groups (p = 0.002). The IPSS-R proved to be an appropriate prognostic tool for MDS with del(5q).
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Affiliation(s)
- J Kaivers
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Düsseldorf, Germany.
| | - M Lauseker
- Institute for Medical Informatics and Biometry, Ludwig-Maximilians-Universität, Munich, Germany
| | - B Hildebrandt
- Department of Human Genetics, University Hospital Düsseldorf, Germany
| | - P Fenaux
- Hôpital St. Louis, Université Paris 7, France
| | - M Pfeilstöcker
- Hanusch-Krankenhaus Vienna and L. Boltzmann Cluster Oncology, Vienna, Austria
| | - P Valent
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna and L. Boltzmann Cluster Oncology, Vienna, Austria
| | - U Platzbecker
- Department of Hematology and Oncology, University of Dresden, Germany
| | | | - E N Oliva
- Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | - B Xicoy
- Department of Hematology, Hospital Germans Trias i Pujol and Institut Català d'Oncologia-José Carreras Leukemia Research Institute, Badalona, Spain
| | - K Götze
- Department of Hematology and Oncology, Technical University of Munich, Munich, Germany
| | - C Ganster
- Clinics of Hematology and Medical Oncology, University Medical Center Göttingen, Germany
| | - D Haase
- Clinics of Hematology and Medical Oncology, University Medical Center Göttingen, Germany
| | - G Bug
- Department of Medicine, Hematology/Oncology, University Hospital, Frankfurt, Germany
| | - A Kündgen
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Düsseldorf, Germany
| | - N Gattermann
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Düsseldorf, Germany
| | - R Haas
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Düsseldorf, Germany
| | - U Germing
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Düsseldorf, Germany
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7
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Gadermaier E, Marth K, Lupinek C, Campana R, Hofer G, Blatt K, Smiljkovic D, Roder U, Focke-Tejkl M, Vrtala S, Keller W, Valent P, Valenta R, Flicker S. Isolation of a high-affinity Bet v 1-specific IgG-derived ScFv from a subject vaccinated with hypoallergenic Bet v 1 fragments. Allergy 2018; 73:1425-1435. [PMID: 29315611 PMCID: PMC6032869 DOI: 10.1111/all.13394] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2017] [Indexed: 12/11/2022]
Abstract
Background Recombinant hypoallergenic allergen derivatives have been used in clinical immunotherapy studies, and clinical efficacy seems to be related to the induction of blocking IgG antibodies recognizing the wild‐type allergens. However, so far no treatment‐induced IgG antibodies have been characterized. Objective To clone, express, and characterize IgG antibodies induced by vaccination with two hypoallergenic recombinant fragments of the major birch pollen allergen, Bet v 1 in a nonallergic subject. Methods A phage‐displayed combinatorial single‐chain fragment (ScFv) library was constructed from blood of the immunized subject and screened for Bet v 1‐reactive antibody fragments. ScFvs were tested for specificity and cross‐reactivity to native Bet v 1 and related pollen and food allergens, and epitope mapping was performed. Germline ancestor genes of the antibody were analyzed with the ImMunoGeneTics (IMGT) database. The affinity to Bet v 1 and cross‐reactive allergens was determined by surface plasmon resonance measurements. The ability to inhibit patients’ IgE binding to ELISA plate‐bound allergens and allergen‐induced basophil activation was assessed. Results A combinatorial ScFv library was obtained from the vaccinated donor after three injections with the Bet v 1 fragments. Despite being almost in germline configuration, ScFv (clone H3‐1) reacted with high affinity to native Bet v 1 and homologous allergens, inhibited allergic patients’ polyclonal IgE binding to Bet v 1, and partially suppressed allergen‐induced basophil activation. Conclusion Immunization with unfolded hypoallergenic allergen derivatives induces high‐affinity antibodies even in nonallergic subjects which recognize the folded wild‐type allergens and inhibit polyclonal IgE binding of allergic patients.
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Affiliation(s)
- E. Gadermaier
- Division of Immunopathology; Institute of Pathophysiology and Allergy Research; Center for Pathophysiology, Infectiology and Immunology; Vienna General Hospital; Medical University of Vienna; Vienna Austria
| | - K. Marth
- Division of Immunopathology; Institute of Pathophysiology and Allergy Research; Center for Pathophysiology, Infectiology and Immunology; Vienna General Hospital; Medical University of Vienna; Vienna Austria
| | - C. Lupinek
- Division of Immunopathology; Institute of Pathophysiology and Allergy Research; Center for Pathophysiology, Infectiology and Immunology; Vienna General Hospital; Medical University of Vienna; Vienna Austria
| | - R. Campana
- Division of Immunopathology; Institute of Pathophysiology and Allergy Research; Center for Pathophysiology, Infectiology and Immunology; Vienna General Hospital; Medical University of Vienna; Vienna Austria
| | - G. Hofer
- Institute of Molecular Biosciences; BioTechMed, University of Graz; Graz Austria
| | - K. Blatt
- Division of Hematology and Hemostaseology; Department of Internal Medicine I; Vienna General Hospital; Medical University of Vienna; Vienna Austria
| | - D. Smiljkovic
- Division of Hematology and Hemostaseology; Department of Internal Medicine I; Vienna General Hospital; Medical University of Vienna; Vienna Austria
| | - U. Roder
- GE Healthcare Europe GmbH; Freiburg Germany
| | - M. Focke-Tejkl
- Division of Immunopathology; Institute of Pathophysiology and Allergy Research; Center for Pathophysiology, Infectiology and Immunology; Vienna General Hospital; Medical University of Vienna; Vienna Austria
| | - S. Vrtala
- Division of Immunopathology; Institute of Pathophysiology and Allergy Research; Center for Pathophysiology, Infectiology and Immunology; Vienna General Hospital; Medical University of Vienna; Vienna Austria
| | - W. Keller
- Institute of Molecular Biosciences; BioTechMed, University of Graz; Graz Austria
| | - P. Valent
- Division of Hematology and Hemostaseology; Department of Internal Medicine I; Vienna General Hospital; Medical University of Vienna; Vienna Austria
| | - R. Valenta
- Division of Immunopathology; Institute of Pathophysiology and Allergy Research; Center for Pathophysiology, Infectiology and Immunology; Vienna General Hospital; Medical University of Vienna; Vienna Austria
- NRC Institute of Immunology FMBA of Russia; Moscow Russia
| | - S. Flicker
- Division of Immunopathology; Institute of Pathophysiology and Allergy Research; Center for Pathophysiology, Infectiology and Immunology; Vienna General Hospital; Medical University of Vienna; Vienna Austria
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8
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Eckl-Dorna J, Fröschl R, Lupinek C, Kiss R, Gattinger P, Marth K, Campana R, Mittermann I, Blatt K, Valent P, Selb R, Mayer A, Gangl K, Steiner I, Gamper J, Perkmann T, Zieglmayer P, Gevaert P, Valenta R, Niederberger V. Intranasal administration of allergen increases specific IgE whereas intranasal omalizumab does not increase serum IgE levels-A pilot study. Allergy 2018; 73:1003-1012. [PMID: 29083477 PMCID: PMC5969304 DOI: 10.1111/all.13343] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2017] [Indexed: 02/06/2023]
Abstract
Background Administration of the therapeutic anti‐IgE antibody omalizumab to patients induces strong increases in IgE antibody levels. Objective To investigate the effect of intranasal administration of major birch pollen allergen Bet v 1, omalizumab or placebo on the levels of total and allergen‐specific IgE in patients with birch pollen allergy. Methods Based on the fact that intranasal allergen application induces rises of systemic allergen‐specific IgE, we performed a double‐blind placebo‐controlled pilot trial in which birch pollen allergic subjects were challenged intranasally with omalizumab, placebo or birch pollen allergen Bet v 1. Total and allergen‐specific IgE, IgG and basophil sensitivity were measured before and 8 weeks after challenge. For control purposes, total, allergen‐specific IgE levels and omalizumab‐IgE complexes as well as specific IgG levels were studied in subjects treated subcutaneously with either omalizumab or placebo. Effects of omalizumab on IgE production by IL‐4/anti‐CD40‐treated PBMCs from allergic patients were studied in vitro. Results Intranasal challenge with Bet v 1 induced increases in Bet v 1‐specific IgE levels by a median of 59.2%, and this change differed significantly from the other treatment groups (P = .016). No relevant change in allergen‐specific and total IgE levels was observed in subjects challenged with omalizumab. Addition of omalizumab did not enhance IL‐4/anti‐CD40‐induced IgE production in vitro. Significant rises in total IgE (mean IgE before: 131.83 kU/L to mean IgE after: 505.23 kU/L) and the presence of IgE‐omalizumab complexes were observed after subcutaneous administration of omalizumab. Conclusion Intranasal administration of allergen induced rises of allergen‐specific IgE levels, whereas intranasal administration of omalizumab did not enhance systemic total or allergen‐specific IgE levels.
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Affiliation(s)
- J. Eckl-Dorna
- Department of Otorhinolaryngology; Medical University of Vienna; Vienna Austria
| | - R. Fröschl
- Clinical Institute for Laboratory Medicine; Medical University of Vienna; Vienna Austria
| | - C. Lupinek
- Division of Immunopathology; Department of Pathophysiology and Allergy Research; Center for Pathophysiology, Infectiology and Immunology; Medical University of Vienna; Vienna Austria
| | - R. Kiss
- Division of Immunopathology; Department of Pathophysiology and Allergy Research; Center for Pathophysiology, Infectiology and Immunology; Medical University of Vienna; Vienna Austria
| | - P. Gattinger
- Division of Immunopathology; Department of Pathophysiology and Allergy Research; Center for Pathophysiology, Infectiology and Immunology; Medical University of Vienna; Vienna Austria
| | - K. Marth
- Division of Immunopathology; Department of Pathophysiology and Allergy Research; Center for Pathophysiology, Infectiology and Immunology; Medical University of Vienna; Vienna Austria
| | - R. Campana
- Division of Immunopathology; Department of Pathophysiology and Allergy Research; Center for Pathophysiology, Infectiology and Immunology; Medical University of Vienna; Vienna Austria
| | - I. Mittermann
- Division of Immunopathology; Department of Pathophysiology and Allergy Research; Center for Pathophysiology, Infectiology and Immunology; Medical University of Vienna; Vienna Austria
| | - K. Blatt
- Division of Hematology and Hemostaseology; Department of Internal Medicine I; Medical University of Vienna; Vienna Austria
| | - P. Valent
- Division of Hematology and Hemostaseology; Department of Internal Medicine I; Medical University of Vienna; Vienna Austria
| | - R. Selb
- Department of Otorhinolaryngology; Medical University of Vienna; Vienna Austria
| | - A. Mayer
- Department of Otorhinolaryngology; Medical University of Vienna; Vienna Austria
| | - K. Gangl
- Department of Otorhinolaryngology; Medical University of Vienna; Vienna Austria
| | - I. Steiner
- Center for Medical Statistics, Informatics, and Intelligent Systems; Section for Medical Statistics; Medical University of Vienna; Vienna Austria
| | - J. Gamper
- Center for Medical Statistics, Informatics, and Intelligent Systems; Section for Medical Statistics; Medical University of Vienna; Vienna Austria
| | - T. Perkmann
- Clinical Institute for Laboratory Medicine; Medical University of Vienna; Vienna Austria
| | | | - P. Gevaert
- Upper Airway Research Laboratory (URL); Ghent University Hospital; Ghent Belgium
| | - R. Valenta
- Division of Immunopathology; Department of Pathophysiology and Allergy Research; Center for Pathophysiology, Infectiology and Immunology; Medical University of Vienna; Vienna Austria
| | - V. Niederberger
- Department of Otorhinolaryngology; Medical University of Vienna; Vienna Austria
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9
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Baghestanian M, Bankl HC, Sillaber C, Sperr WR, Wojta J, Binder BR, Lechner K, Valent P. New Aspects in Thrombosis Research: Possible Role of Mast Cells as Profibrinolytic and Antithrombotic Cells. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1613084] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryVenous thromboembolism represents a significant cause of morbidity worldwide. The factors that underly thrombophilia are manifold. The concept of Virchow defines the well known triad of stasis, humoral factors, and pathologies of the vascular wall. In the current article, an additional factor, the “accumulation of repair cells” is discussed. This novel concept highlights the mast cell that accumulates around thrombosed vessels and provides a number of important repair molecules including heparin, profibrinolytic tPA, and fibrinogenolytic β-tryptase. Thus, mast cell recruitment and activation may result in local thrombolysis and prevention of coagulation. In line with this concept, mast cell-deficient mice are more susceptible to lethal thrombogenic stimuli compared to normal mice. The factors (cytokines) that trigger mast cell accumulation and release of repair molecules have also been identified – the most important one appears to be stem cell factor (SCF). All in all, our novel concept suggests that the patho-physiology of thrombosis may involve a “physiologic” cell that provides the same repair molecules that are used for treatment of thrombotic disorders by the physician. Whether an altered availability of components of this cellular repair system can predispose for thrombophilia remains to be determined.
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10
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Peter B, Bibi S, Eisenwort G, Wingelhofer B, Berger D, Stefanzl G, Blatt K, Herrmann H, Hadzijusufovic E, Hoermann G, Hoffmann T, Schwaab J, Jawhar M, Willmann M, Sperr WR, Zuber J, Sotlar K, Horny HP, Moriggl R, Reiter A, Arock M, Valent P. Drug-induced inhibition of phosphorylation of STAT5 overrides drug resistance in neoplastic mast cells. Leukemia 2017; 32:1016-1022. [PMID: 29249817 PMCID: PMC6037300 DOI: 10.1038/leu.2017.338] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 10/31/2017] [Accepted: 11/13/2017] [Indexed: 12/20/2022]
Abstract
Systemic mastocytosis (SM) is a mast cell (MC) neoplasm with complex pathology and a variable clinical course. In aggressive SM (ASM) and MC leukemia (MCL) responses to conventional drugs are poor and the prognosis is dismal. R763 is a multi-kinase inhibitor that blocks the activity of Aurora-kinase-A/B, ABL1, AKT and FLT3. We examined the effects of R763 on proliferation and survival of neoplastic MC. R763 produced dose-dependent inhibition of proliferation in the human MC lines HMC-1.1 (IC50 5-50 nM), HMC-1.2 (IC50 1-10 nM), ROSAKIT WT (IC50 1-10 nM), ROSAKIT D816V (IC50 50-500 nM) and MCPV-1.1 (IC50 100-1000 nM). Moreover, R763 induced growth inhibition in primary neoplastic MC in patients with ASM and MCL. Growth-inhibitory effects of R763 were accompanied by signs of apoptosis and a G2/M cell cycle arrest. R763 also inhibited phosphorylation of KIT, BTK, AKT and STAT5 in neoplastic MC. The most sensitive target appeared to be STAT5. In fact, tyrosine phosphorylation of STAT5 was inhibited by R763 at 10 nM. At this low concentration, R763 produced synergistic growth-inhibitory effects on neoplastic MC when combined with midostaurin or dasatinib. Together, R763 is a novel promising multi-kinase inhibitor that blocks STAT5 activation and thereby overrides drug-resistance in neoplastic MC.
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Affiliation(s)
- B Peter
- Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria.,Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - S Bibi
- Laboratoire de Biologie et Pharmacologie Appliquée, CNRS UMR 8113, Ecole Normale Superieure de Cachan, Cachan, France
| | - G Eisenwort
- Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria.,Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - B Wingelhofer
- Ludwig Boltzmann Institute for Cancer Research, Institute of Animal Breeding and Genetics, University of Veterinary Medicine Vienna, Medical University of Vienna, Vienna, Austria
| | - D Berger
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - G Stefanzl
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - K Blatt
- Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria.,Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - H Herrmann
- Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria
| | - E Hadzijusufovic
- Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria.,Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Vienna, Austria.,Department for Companion Animals and Horses, Clinical Unit of Internal Medicine, University of Veterinary Medicine Vienna, Vienna, Austria
| | - G Hoermann
- Department of Laboratory Medicine, Medical University of Vienna, Vienna,Austria
| | - T Hoffmann
- Research Institute of Molecular Pathology (IMP), Vienna, Austria
| | - J Schwaab
- Department of Hematology and Oncology, University Medical Center Mannheim and Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - M Jawhar
- Department of Hematology and Oncology, University Medical Center Mannheim and Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - M Willmann
- Department for Companion Animals and Horses, Clinical Unit of Internal Medicine, University of Veterinary Medicine Vienna, Vienna, Austria
| | - W R Sperr
- Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria.,Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - J Zuber
- Research Institute of Molecular Pathology (IMP), Vienna, Austria
| | - K Sotlar
- University Institute of Pathology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - H-P Horny
- Institute of Pathology, Ludwig-Maximilians-University, Munich, Germany
| | - R Moriggl
- Ludwig Boltzmann Institute for Cancer Research, Institute of Animal Breeding and Genetics, University of Veterinary Medicine Vienna, Medical University of Vienna, Vienna, Austria
| | - A Reiter
- Department of Hematology and Oncology, University Medical Center Mannheim and Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - M Arock
- Laboratoire de Biologie et Pharmacologie Appliquée, CNRS UMR 8113, Ecole Normale Superieure de Cachan, Cachan, France.,Laboratory of Hematology, Pitié-Salpêtrière Hospital, Paris, France
| | - P Valent
- Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria.,Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Vienna, Austria
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11
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Smiljkovic D, Blatt K, Stefanzl G, Dorofeeva Y, Skrabs C, Focke‐Tejkl M, Sperr WR, Jaeger U, Valenta R, Valent P. BTK inhibition is a potent approach to block IgE-mediated histamine release in human basophils. Allergy 2017; 72:1666-1676. [PMID: 28328081 PMCID: PMC5655929 DOI: 10.1111/all.13166] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2017] [Indexed: 12/29/2022]
Abstract
Background Recent data suggest that Bruton's tyrosine kinase (BTK) is an emerging therapeutic target in IgE receptor (IgER)‐cross‐linked basophils. Methods We examined the effects of four BTK inhibitors (ibrutinib, dasatinib, AVL‐292, and CNX‐774) on IgE‐dependent activation and histamine release in blood basophils obtained from allergic patients (n=11) and nonallergic donors (n=5). In addition, we examined the effects of these drugs on the growth of the human basophil cell line KU812 and the human mast cell line HMC‐1. Results All four BTK blockers were found to inhibit anti‐IgE‐induced histamine release from basophils in nonallergic subjects and allergen‐induced histamine liberation from basophils in allergic donors. Drug effects on allergen‐induced histamine release were dose dependent, with IC50 values ranging between 0.001 and 0.5 μmol/L, and the following rank order of potency: ibrutinib>AVL‐292>dasatinib>CNX‐774. The basophil‐targeting effect of ibrutinib was confirmed by demonstrating that IgE‐dependent histamine release in ex vivo blood basophils is largely suppressed in a leukemia patient treated with ibrutinib. Dasatinib and ibrutinib were also found to counteract anti‐IgE‐induced and allergen‐induced upregulation of CD13, CD63, CD164, and CD203c on basophils, whereas AVL‐292 and CNX‐774 showed no significant effects. Whereas dasatinib and CNX‐774 were found to inhibit the growth of HMC‐1 cells and KU812 cells, no substantial effects were seen with ibrutinib or AVL‐292. Conclusions BTK‐targeting drugs are potent inhibitors of IgE‐dependent histamine release in human basophils. The clinical value of BTK inhibition in the context of allergic diseases remains to be determined.
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Affiliation(s)
- D. Smiljkovic
- Department of Internal Medicine I Division of Hematology & Hemostaseology Medical University of Vienna Vienna Austria
| | - K. Blatt
- Department of Internal Medicine I Division of Hematology & Hemostaseology Medical University of Vienna Vienna Austria
- Ludwig Boltzmann Cluster Oncology Medical University of Vienna Vienna Austria
| | - G. Stefanzl
- Department of Internal Medicine I Division of Hematology & Hemostaseology Medical University of Vienna Vienna Austria
- Ludwig Boltzmann Cluster Oncology Medical University of Vienna Vienna Austria
| | - Y. Dorofeeva
- Division of Immunopathology Department of Pathophysiology and Allergy Research Center for Pathophysiology, Immunology and Infectiology Medical University of Vienna Vienna Austria
| | - C. Skrabs
- Department of Internal Medicine I Division of Hematology & Hemostaseology Medical University of Vienna Vienna Austria
| | - M. Focke‐Tejkl
- Division of Immunopathology Department of Pathophysiology and Allergy Research Center for Pathophysiology, Immunology and Infectiology Medical University of Vienna Vienna Austria
| | - W. R. Sperr
- Department of Internal Medicine I Division of Hematology & Hemostaseology Medical University of Vienna Vienna Austria
- Ludwig Boltzmann Cluster Oncology Medical University of Vienna Vienna Austria
| | - U. Jaeger
- Department of Internal Medicine I Division of Hematology & Hemostaseology Medical University of Vienna Vienna Austria
- Ludwig Boltzmann Cluster Oncology Medical University of Vienna Vienna Austria
| | - R. Valenta
- Division of Immunopathology Department of Pathophysiology and Allergy Research Center for Pathophysiology, Immunology and Infectiology Medical University of Vienna Vienna Austria
| | - P. Valent
- Department of Internal Medicine I Division of Hematology & Hemostaseology Medical University of Vienna Vienna Austria
- Ludwig Boltzmann Cluster Oncology Medical University of Vienna Vienna Austria
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12
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Valent P, Akin C, Hartmann K, George TI, Sotlar K, Peter B, Gleixner KV, Blatt K, Sperr WR, Manley PW, Hermine O, Kluin-Nelemans HC, Arock M, Horny HP, Reiter A, Gotlib J. Midostaurin: a magic bullet that blocks mast cell expansion and activation. Ann Oncol 2017; 28:2367-2376. [PMID: 28945834 PMCID: PMC7115852 DOI: 10.1093/annonc/mdx290] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Clinically relevant features in patients with systemic mastocytosis (SM) include the cosmetic burden of lesional skin, mediator-related symptoms, and organ damage resulting from mast cell (MC) infiltration in advanced forms of SM. Regardless of the SM variant, expansion of neoplastic MC in the skin and other organs is triggered by mutant forms of KIT, the most prevalent being D816V. Activation of MC with subsequent release of chemical mediators is often caused by IgE-dependent mechanisms in these patients. Midostaurin, also known as PKC412, blocks the kinase activity of wild-type KIT and KIT D816V, counteracts KIT-dependent growth of neoplastic MC, and inhibits IgE-dependent mediator secretion. Based on this activity-profile, the drug has been used for treatment of patients with advanced SM. Indeed, encouraging results have been obtained with the drug in a recent multi-center phase II trial in patients with advanced SM, with an overall response rate of 60% and a substantial decrease in the burden of neoplastic MC in various organs. Moreover, midostaurin improved the overall survival and relapse-free survival in patients with advanced SM compared with historical controls. In addition, midostaurin was found to improve mediator-related symptoms and quality of life, suggesting that the drug may also be useful in patients with indolent SM suffering from mediator-related symptoms resistant to conventional therapies or those with MC activation syndromes. Ongoing and future studies will determine the actual value of midostaurin-induced MC depletion and MC deactivation in these additional indications.
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Affiliation(s)
- P Valent
- Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria;; Division of Hematology & Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria;.
| | - C Akin
- Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, USA
| | - K Hartmann
- Department of Dermatology, University of Luebeck, Luebeck, Germany
| | - T I George
- Department of Pathology, University of New Mexico, Albuquerque, USA
| | - K Sotlar
- Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - B Peter
- Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria;; Division of Hematology & Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - K V Gleixner
- Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria;; Division of Hematology & Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - K Blatt
- Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria;; Division of Hematology & Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - W R Sperr
- Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria;; Division of Hematology & Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | | | - O Hermine
- Centre National de Référence des Mastocytoses, Imagine Institute Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - H C Kluin-Nelemans
- Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M Arock
- LBPA CNRS UMR8113, Ecole Normale Supérieure de Cachan, Cachan, France
| | - H-P Horny
- Institute of Pathology, Ludwig-Maximilians-University, Munich, Germany
| | - A Reiter
- Department of Hematology and Oncology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - J Gotlib
- Stanford University School of Medicine/Stanford Cancer Institute, Stanford, USA
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13
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Martinelli G, Mancini M, De Benedittis C, Rondoni M, Papayannidis C, Manfrini M, Meggendorfer M, Calogero R, Guadagnuolo V, Fontana MC, Bavaro L, Padella A, Zago E, Pagano L, Zanotti R, Scaffidi L, Specchia G, Albano F, Merante S, Elena C, Savini P, Gangemi D, Tosi P, Ciceri F, Poletti G, Riccioni L, Morigi F, Delledonne M, Haferlach T, Cavo M, Valent P, Soverini S. SETD2 and histone H3 lysine 36 methylation deficiency in advanced systemic mastocytosis. Leukemia 2017; 32:139-148. [PMID: 28663576 PMCID: PMC5770597 DOI: 10.1038/leu.2017.183] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 05/16/2017] [Accepted: 05/26/2017] [Indexed: 12/23/2022]
Abstract
The molecular basis of advanced systemic mastocytosis (SM) is not fully understood and despite novel therapies the prognosis remains dismal. Exome sequencing of an index-patient with mast cell leukemia (MCL) uncovered biallelic loss-of-function mutations in the SETD2 histone methyltransferase gene. Copy-neutral loss-of-heterozygosity at 3p21.3 (where SETD2 maps) was subsequently found in SM patients and prompted us to undertake an in-depth analysis of SETD2 copy number, mutation status, transcript expression and methylation levels, as well as functional studies in the HMC-1 cell line and in a validation cohort of 57 additional cases with SM, including MCL, aggressive SM and indolent SM. Reduced or no SETD2 protein expression—and consequently, H3K36 trimethylation—was found in all cases and inversely correlated with disease aggressiveness. Proteasome inhibition rescued SETD2 expression and H3K36 trimethylation and resulted in marked accumulation of ubiquitinated SETD2 in SETD2-deficient patients but not in patients with near-normal SETD2 expression. Bortezomib and, to a lesser extent, AZD1775 alone or in combination with midostaurin induced apoptosis and reduced clonogenic growth of HMC-1 cells and of neoplastic mast cells from advanced SM patients. Our findings may have implications for prognostication of SM patients and for the development of improved treatment approaches in advanced SM.
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Affiliation(s)
- G Martinelli
- Department of Experimental, Diagnostic and Specialty Medicine, Hematology/Oncology 'L. e A. Seràgnoli', University of Bologna, Bologna, Italy
| | - M Mancini
- Department of Experimental, Diagnostic and Specialty Medicine, Hematology/Oncology 'L. e A. Seràgnoli', University of Bologna, Bologna, Italy
| | - C De Benedittis
- Department of Experimental, Diagnostic and Specialty Medicine, Hematology/Oncology 'L. e A. Seràgnoli', University of Bologna, Bologna, Italy
| | - M Rondoni
- Ospedale Santa Maria delle Croci, Ravenna, Italy
| | - C Papayannidis
- Department of Experimental, Diagnostic and Specialty Medicine, Hematology/Oncology 'L. e A. Seràgnoli', University of Bologna, Bologna, Italy
| | - M Manfrini
- Department of Experimental, Diagnostic and Specialty Medicine, Hematology/Oncology 'L. e A. Seràgnoli', University of Bologna, Bologna, Italy
| | | | - R Calogero
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - V Guadagnuolo
- Department of Experimental, Diagnostic and Specialty Medicine, Hematology/Oncology 'L. e A. Seràgnoli', University of Bologna, Bologna, Italy
| | - M C Fontana
- Department of Experimental, Diagnostic and Specialty Medicine, Hematology/Oncology 'L. e A. Seràgnoli', University of Bologna, Bologna, Italy
| | - L Bavaro
- Department of Experimental, Diagnostic and Specialty Medicine, Hematology/Oncology 'L. e A. Seràgnoli', University of Bologna, Bologna, Italy
| | - A Padella
- Department of Experimental, Diagnostic and Specialty Medicine, Hematology/Oncology 'L. e A. Seràgnoli', University of Bologna, Bologna, Italy
| | - E Zago
- Personal Genomics, University of Verona, Verona, Italy.,Department of Biotechnologies, University of Verona, Verona, Italy
| | - L Pagano
- Institute of Hematology, Catholic University S. Cuore, Rome, Italy
| | - R Zanotti
- Section of Hematology, Department of Medicine, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy.,Multidisciplinary Outpatients Clinics for Mastocytosis (GISM), Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - L Scaffidi
- Section of Hematology, Department of Medicine, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy.,Multidisciplinary Outpatients Clinics for Mastocytosis (GISM), Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - G Specchia
- Department of Emergency and Organ Transplantation, Hematology Section, University of Bari, Bari, Italy
| | - F Albano
- Department of Emergency and Organ Transplantation, Hematology Section, University of Bari, Bari, Italy
| | - S Merante
- Department of Oncology-Hematology, Hematology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - C Elena
- Department of Oncology-Hematology, Hematology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - P Savini
- Department of Internal Medicine, Faenza Hospital, Faenza, Italy
| | | | - P Tosi
- Hematology Unit, Rimini, Italy
| | - F Ciceri
- University Vita-Salute San Raffaele, Milan, Italy.,IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - G Poletti
- Department of Clinical Pathology, Centro Servizi Pievesestina, AUSL Romagna, Pievesestina di Cesena, Italy
| | - L Riccioni
- Unit of Anatomic Pathology, 'M. Bufalini' Hospital, Cesena, Italy
| | - F Morigi
- Unit of Anatomic Pathology, 'M. Bufalini' Hospital, Cesena, Italy
| | - M Delledonne
- Personal Genomics, University of Verona, Verona, Italy.,Department of Biotechnologies, University of Verona, Verona, Italy
| | - T Haferlach
- MLL Munich Leukemia Laboratory, Munich, Germany
| | - M Cavo
- Department of Experimental, Diagnostic and Specialty Medicine, Hematology/Oncology 'L. e A. Seràgnoli', University of Bologna, Bologna, Italy
| | - P Valent
- Department of Medicine I, Division of Hematology and Hemostaseology and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria
| | - S Soverini
- Department of Experimental, Diagnostic and Specialty Medicine, Hematology/Oncology 'L. e A. Seràgnoli', University of Bologna, Bologna, Italy
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14
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Valent P, Sotlar K, Blatt K, Hartmann K, Reiter A, Sadovnik I, Sperr WR, Bettelheim P, Akin C, Bauer K, George TI, Hadzijusufovic E, Wolf D, Gotlib J, Mahon FX, Metcalfe DD, Horny HP, Arock M. Proposed diagnostic criteria and classification of basophilic leukemias and related disorders. Leukemia 2017; 31:788-797. [PMID: 28090091 DOI: 10.1038/leu.2017.15] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 12/14/2016] [Accepted: 12/19/2016] [Indexed: 01/09/2023]
Abstract
Basophils form a distinct cell lineage within the hematopoietic cell family. In various myeloid neoplasms, including chronic myeloid leukemia, basophilia is frequently seen. Acute and chronic basophilic leukemias, albeit rare, have also been described. However, no generally accepted criteria and classification of basophilic leukemias have been presented to date. To address this unmet need, a series of Working Conferences and other meetings were organized between March 2015 and March 2016. The current article provides a summary of consensus statements from these meetings, together with proposed criteria to delineate acute basophilic leukemia (ABL) from chronic basophilic leukemia (CBL) and primary forms of the disease where no preceding myeloid malignancy is detected, from the more common 'secondary' variants. Moreover, the term hyperbasophilia (HB) is proposed for cases with a persistent peripheral basophil count ⩾1000 per μl of blood. This condition, HB, is highly indicative of the presence of an underlying myeloid neoplasm. Therefore, HB is an important checkpoint in the diagnostic algorithm and requires a detailed hematologic investigation. In these patients, an underlying myeloid malignancy is often found and is then labeled with the appendix -baso, whereas primary cases of ABL or CBL are very rare. The criteria and classification proposed in this article should facilitate the diagnosis and management of patients with unexplained basophilia and basophil neoplasms in routine practice, and in clinical studies.
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Affiliation(s)
- P Valent
- Department of Internal Medicine I, Division of Hematology and Hemostaseology and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria
| | - K Sotlar
- Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - K Blatt
- Department of Internal Medicine I, Division of Hematology and Hemostaseology and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria
| | - K Hartmann
- Department of Dermatology, University of Luebeck, Luebeck, Germany
| | - A Reiter
- Department of Hematology and Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - I Sadovnik
- Department of Internal Medicine I, Division of Hematology and Hemostaseology and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria
| | - W R Sperr
- Department of Internal Medicine I, Division of Hematology and Hemostaseology and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria
| | - P Bettelheim
- Division of Laboratory Medicine, Elisabethinen Hospital Linz, Linz, Austria
| | - C Akin
- Division of Rheumatology, Immunology and Allergy, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - K Bauer
- Department of Internal Medicine I, Division of Hematology and Hemostaseology and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria
| | - T I George
- Department of Pathology, University of New Mexico, Albuquerque, NM, USA
| | - E Hadzijusufovic
- Department of Internal Medicine I, Division of Hematology and Hemostaseology and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria
| | - D Wolf
- Medical Clinic III for Oncology, Haematology and Rheumatology, University Hospital Bonn, Bonn, Germany
| | - J Gotlib
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - F-X Mahon
- Laboratoire d'Hématologie, CHU de Bordeaux, France
| | - D D Metcalfe
- Laboratory of Allergic Diseases, NIAID, NIH, Bethesda, MD, USA
| | - H-P Horny
- Institute of Pathology, Ludwig-Maximilians University, Munich, Germany
| | - M Arock
- LBPA CNRS UMR8113, Ecole Normale Supérieure de Cachan, Cachan, France
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15
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Gschwandtner M, Paulitschke V, Mildner M, Brunner PM, Hacker S, Eisenwort G, Sperr WR, Valent P, Gerner C, Tschachler E. Proteome analysis identifies L1CAM/CD171 and DPP4/CD26 as novel markers of human skin mast cells. Allergy 2017; 72:85-97. [PMID: 27091730 DOI: 10.1111/all.12919] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND The function of skin mast cells has been well documented in IgE-mediated allergic reactions, whereas other mast cell functions are poorly defined. This study aimed at identifying novel mast cell proteins by proteome analysis of primary human skin mast cells. METHODS The proteome of skin mast cells was compared to other cell types and analyzed using bioinformatics. The expression and function of two proteins hitherto not described in skin mast cells was investigated in isolated mast cells as well as in mast cells in situ. RESULTS Within the mast cell proteome, we identified 49 highly expressed proteins previously not described in mast cells; 21 of these proteins were found to be selectively expressed in mast cells. Two proteins, the neural cell adhesion molecule L1 and dipeptidyl peptidase 4, were further studied. L1 was found to be highly expressed in mast cells in normal, psoriasis, and mastocytosis skin. Dipeptidyl peptidase 4 was found to be expressed in mast cells in normal, psoriasis, and mastocytosis skin as well as in bone marrow mast cells in patients with systemic mastocytosis. In normal skin, mast cells were identified as a major source of dipeptidyl peptidase 4 and we also found that skin mast cells and fibroblasts secrete an active form of this enzyme. CONCLUSIONS In a systematic proteomics approach we identified two novel mast cell proteins potentially relevant to skin homeostasis: neural cell adhesion molecule L1 and dipeptidyl peptidase 4.
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Affiliation(s)
- M. Gschwandtner
- Research Division of Biology and Pathobiology of the Skin; Department of Dermatology; Medical University of Vienna; Vienna Austria
| | - V. Paulitschke
- Department of Dermatology; Medical University of Vienna; Vienna Austria
| | - M. Mildner
- Research Division of Biology and Pathobiology of the Skin; Department of Dermatology; Medical University of Vienna; Vienna Austria
| | - P. M. Brunner
- Department of Dermatology; Medical University of Vienna; Vienna Austria
| | - S. Hacker
- Department of Plastic and Reconstructive Surgery; Medical University of Vienna; Vienna Austria
| | - G. Eisenwort
- Department of Internal Medicine I; Division of Hematology and Hemostaseology; Medical University of Vienna; Vienna Austria
- Ludwig Boltzmann Cluster Oncology; Medical University of Vienna; Vienna Austria
| | - W. R. Sperr
- Department of Internal Medicine I; Division of Hematology and Hemostaseology; Medical University of Vienna; Vienna Austria
- Ludwig Boltzmann Cluster Oncology; Medical University of Vienna; Vienna Austria
| | - P. Valent
- Department of Internal Medicine I; Division of Hematology and Hemostaseology; Medical University of Vienna; Vienna Austria
- Ludwig Boltzmann Cluster Oncology; Medical University of Vienna; Vienna Austria
| | - C. Gerner
- Institute of Analytical Chemistry; Faculty of Chemistry; University of Vienna; Vienna Austria
- Institute of Cancer Research; Comprehensive Cancer Center; Medical University of Vienna; Vienna Austria
| | - E. Tschachler
- Research Division of Biology and Pathobiology of the Skin; Department of Dermatology; Medical University of Vienna; Vienna Austria
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16
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Geissler K, Jäger E, Barna A, Alendar T, Ljubuncic E, Sliwa T, Valent P. Chronic myelomonocytic leukemia patients with RAS pathway mutations show high in vitro myeloid colony formation in the absence of exogenous growth factors. Leukemia 2016; 30:2280-2281. [PMID: 27585952 PMCID: PMC5097063 DOI: 10.1038/leu.2016.235] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- K Geissler
- Fifth Medical Department with Hematology, Oncology and Palliative Medicine, Hospital Hietzing, Vienna, Austria
| | - E Jäger
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - A Barna
- Blood Transfusion Service for Upper Austria, Austrian Red Cross, Linz, Austria
| | - T Alendar
- Fifth Medical Department with Hematology, Oncology and Palliative Medicine, Hospital Hietzing, Vienna, Austria
| | - E Ljubuncic
- Fifth Medical Department with Hematology, Oncology and Palliative Medicine, Hospital Hietzing, Vienna, Austria
| | - T Sliwa
- Third Medical Department, Hanusch Hospital, Vienna, Austria
| | - P Valent
- Division of Hematology and Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
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17
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Bauer K, Hadzijusufovic E, Cerny-Reiterer S, Hoermann G, Reifinger M, Pirker A, Valent P, Willmann M. IL-4 downregulates expression of the target receptor CD30 in neoplastic canine mast cells. Vet Comp Oncol 2016; 15:1240-1256. [PMID: 27507155 DOI: 10.1111/vco.12260] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 05/24/2016] [Accepted: 07/11/2016] [Indexed: 12/15/2022]
Abstract
CD30 is a novel therapeutic target in human mast cell (MC) neoplasms. In this 'comparative oncology' study, we examined CD30 expression and regulation in neoplastic canine MC using a panel of immunomodulatory cytokines [interleukin-2 (IL-2), IL-4, IL-5, IL-6, IL-13 and stem cell factor (SCF)] and the canine mastocytoma cell lines NI-1 and C2. Of all cytokines tested IL-4 was found to downregulate expression of CD30 in NI-1 and C2 cells. We also found that the CD30-targeting antibody-conjugate brentuximab vedotin induces growth inhibition and apoptosis in both MC lines. Next, we asked whether IL-4-induced downregulation of CD30 interferes with brentuximab vedotin-effects. Indeed, pre-incubation of NI-1 cells with IL-4 decreased responsiveness towards brentuximab vedotin. To overcome IL-4-mediated resistance, we applied drug combinations and found that brentuximab vedotin synergizes with the Kit-targeting drugs masitinib and PKC412 in inhibiting growth of NI-1 and C2 cells. In summary, CD30 is a new marker and IL-4-regulated target in neoplastic canine MC.
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Affiliation(s)
- K Bauer
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - E Hadzijusufovic
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria.,Department/Clinic for Companion Animals and Horses, Clinic for Small Animals, Clinical Unit of Internal Medicine, University of Veterinary Medicine Vienna, Vienna, Austria
| | - S Cerny-Reiterer
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria
| | - G Hoermann
- Department for Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - M Reifinger
- Department of Pathobiology, University of Veterinary Medicine Vienna, Vienna, Austria
| | - A Pirker
- Department/Clinic for Companion Animals and Horses, Clinic for Small Animals, Clinical Unit of Surgery, University of Veterinary Medicine Vienna, Vienna, Austria
| | - P Valent
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria
| | - M Willmann
- Department/Clinic for Companion Animals and Horses, Clinic for Small Animals, Clinical Unit of Internal Medicine, University of Veterinary Medicine Vienna, Vienna, Austria
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18
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Mayerhofer M, Aichberger KJ, Florian S, Valent P. Recognition Sites for Microbes and Components of the Immune System on Human Mast Cells: Relationship to CD Antigens and Implications for Host Defense. Int J Immunopathol Pharmacol 2016; 20:421-34. [PMID: 17880756 DOI: 10.1177/039463200702000301] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Traditionally, mast cells (MCs) have been considered to play an important role in allergic disorders and helminth infections. More recently, MCs have been implicated in a variety of different infectious diseases including life-threatening disorders caused by viruses and bacteria. Apart from recognition through specific IgE, MCs are considered to recognize such bacteria and viruses via specific cell surface binding sites. In addition, MCs interact with diverse components and cells of the immune system and thereby may facilitate the targeting and the elimination of invading microbes in the tissues. The current article provides an overview on MC antigens contributing to microbe recognition and targeting as an important element of natural host-defense.
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Affiliation(s)
- M Mayerhofer
- Division of Hematology & Hemostaseology, Medical University of Vienna, Vienna, Austria
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19
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Koschmieder S, Mughal TI, Hasselbalch HC, Barosi G, Valent P, Kiladjian JJ, Jeryczynski G, Gisslinger H, Jutzi JS, Pahl HL, Hehlmann R, Maria Vannucchi A, Cervantes F, Silver RT, Barbui T. Myeloproliferative neoplasms and inflammation: whether to target the malignant clone or the inflammatory process or both. Leukemia 2016; 30:1018-24. [PMID: 26854026 DOI: 10.1038/leu.2016.12] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 11/28/2015] [Accepted: 12/01/2015] [Indexed: 02/07/2023]
Abstract
The Philadelphia-negative myeloproliferative neoplasms (MPNs) are clonal disorders involving hematopoietic stem and progenitor cells and are associated with myeloproliferation, splenomegaly and constitutional symptoms. Similar signs and symptoms can also be found in patients with chronic inflammatory diseases, and inflammatory processes have been found to play an important role in the pathogenesis and progression of MPNs. Signal transduction pathways involving JAK1, JAK2, STAT3 and STAT5 are causally involved in driving both the malignant cells and the inflammatory process. Moreover, anti-inflammatory and immune-modulating drugs have been used successfully in the treatment of MPNs. However, to date, many unresoved issues remain. These include the role of somatic mutations that are present in addition to JAK2V617F, CALR and MPL W515 mutations, the interdependency of malignant and nonmalignant cells and the means to eradicate MPN-initiating and -maintaining cells. It is imperative for successful therapeutic approaches to define whether the malignant clone or the inflammatory cells or both should be targeted. The present review will cover three aspects of the role of inflammation in MPNs: inflammatory states as important differential diagnoses in cases of suspected MPN (that is, in the absence of a clonal marker), the role of inflammation in MPN pathogenesis and progression and the use of anti-inflammatory drugs for MPNs. The findings emphasize the need to separate the inflammatory processes from the malignancy in order to improve our understanding of the pathogenesis, diagnosis and treatment of patients with Philadelphia-negative MPNs.
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Affiliation(s)
- S Koschmieder
- Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | - T I Mughal
- Division of Hematology/Oncology, Tufts University Medical Center, Boston, MA, USA
| | - H C Hasselbalch
- Department of Hematology, Roskilde Hospital, Copenhagen University Hospital, Roskilde, Denmark
| | - G Barosi
- Center for the Study and Treatment of Myelofibrosis, Biotechnology Research Laboratories, Fondazione IRCCS 'Policlinico San Matteo', Pavia, Italy
| | - P Valent
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria
| | - J-J Kiladjian
- Clinical Investigations Center (INSERM CIC 1427), Hôpital Saint-Louis and Paris Diderot University, Paris, France
| | - G Jeryczynski
- Division of Hematology and Blood Coagulation, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - H Gisslinger
- Division of Hematology and Blood Coagulation, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - J S Jutzi
- Division of Molecular Hematology, University Hospital Freiburg, Center for Clinical Research, Freiburg, Germany.,Spemann Graduate School of Biology and Medicine (SGBM) and Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - H L Pahl
- Division of Molecular Hematology, University Hospital Freiburg, Center for Clinical Research, Freiburg, Germany
| | - R Hehlmann
- Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - A Maria Vannucchi
- CRIMM, Centro di Ricerca e Innovazione e Laboratorio Congiunto per le Malattie Mieloproliferative, Dipartimento di Medicina Sperimentale e Clinica, Centro Denothe, Azienda Ospedaliera Universitaria Careggi, Università degli Studi, Firenze, Italy
| | - F Cervantes
- Department of Hematology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - R T Silver
- Myeloproliferative Neoplasm Center, Division of Hematology-Oncology, Weill Cornell Medical College, New York, NY, USA
| | - T Barbui
- Clinical Research Center and Hematology, Ospedale Papa Giovanni XXIII, Bergamo, Italy
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20
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Gadermaier E, James LK, Shamji MH, Blatt K, Fauland K, Zieglmayer P, Garmatiuk T, Focke‐Tejkl M, Villalba M, Beavil R, Keller W, Valent P, Durham SR, Gould HJ, Flicker S, Valenta R. Epitope specificity determines cross-protection of a SIT-induced IgG4 antibody. Allergy 2016. [PMID: 26221749 PMCID: PMC4716291 DOI: 10.1111/all.12710] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background The calcium‐binding 2EF‐hand protein Phl p 7 from timothy grass pollen is a highly cross‐reactive pollen pan‐allergen that can induce severe clinical symptoms in allergic patients. Recently, a human monoclonal Phl p 7‐specific IgG4 antibody (mAb102.1F10) was isolated from a patient who had received grass pollen‐specific immunotherapy (SIT). Methods We studied epitope specificity, cross‐reactivity, affinity and cross‐protection of mAb102.1F10 towards homologous calcium‐binding pollen allergens. Sequence comparisons and molecular modelling studies were performed with ClustalW and SPADE, respectively. Surface plasmon resonance measurements were made with purified recombinant allergens. Binding and cross‐reactivity of patients' IgE and mAb102.1F10 to calcium‐binding allergens and peptides thereof were studied with quantitative RAST‐based methods, in ELISA, basophil activation and IgE‐facilitated allergen presentation experiments. Results Allergens from timothy grass (Phl p 7), alder (Aln g 4), birch (Bet v 4), turnip rape (Bra r 1), lamb's quarter (Che a 3) and olive (Ole e 3, Ole e 8) showed high sequence similarity and cross‐reacted with allergic patients' IgE. mAb102.1F10 bound the C‐terminal portion of Phl p 7 in a calcium‐dependent manner. It cross‐reacted with high affinity with Ole e 3, whereas binding and affinity to the other allergens were low. mAb102.1F10 showed limited cross‐inhibition of patients' IgE binding and basophil activation. Sequence comparison and surface exposure calculations identified three amino acids likely to be responsible for limited cross‐reactivity. Conclusions Our results demonstrate that a small number of amino acid differences among cross‐reactive allergens can reduce the affinity of binding by a SIT‐induced IgG and thus limit cross‐protection.
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Affiliation(s)
- E. Gadermaier
- Division of Immunopathology Department of Pathophysiology and Allergy Research Centre for Pathophysiology, Infectiology and Immunology Vienna General Hospital Medical University of Vienna Vienna Austria
| | - L. K. James
- Randall Division of Cell and Molecular Biophysics King's College London London UK
| | - M. H. Shamji
- Allergy and Clinical Immunology National Heart and Lung Institute Imperial College London London UK
| | - K. Blatt
- Division of Hematology and Hemostaseology Department of Internal Medicine I Vienna General Hospital Medical University of Vienna Vienna Austria
| | - K. Fauland
- Institute of Molecular Biosciences University of Graz Graz Austria
| | - P. Zieglmayer
- Vienna Challenge Chamber Allergy Centre Vienna West Vienna Austria
| | - T. Garmatiuk
- Division of Immunopathology Department of Pathophysiology and Allergy Research Centre for Pathophysiology, Infectiology and Immunology Vienna General Hospital Medical University of Vienna Vienna Austria
| | - M. Focke‐Tejkl
- Division of Immunopathology Department of Pathophysiology and Allergy Research Centre for Pathophysiology, Infectiology and Immunology Vienna General Hospital Medical University of Vienna Vienna Austria
| | - M. Villalba
- Departamento de Bioquımica y Biologıa Molecular I Universidad Complutense de Madrid Madrid Spain
| | - R. Beavil
- Randall Division of Cell and Molecular Biophysics King's College London London UK
| | - W. Keller
- Institute of Molecular Biosciences University of Graz Graz Austria
| | - P. Valent
- Division of Hematology and Hemostaseology Department of Internal Medicine I Vienna General Hospital Medical University of Vienna Vienna Austria
| | - S. R. Durham
- Allergy and Clinical Immunology National Heart and Lung Institute Imperial College London London UK
| | - H. J. Gould
- Randall Division of Cell and Molecular Biophysics King's College London London UK
| | - S. Flicker
- Division of Immunopathology Department of Pathophysiology and Allergy Research Centre for Pathophysiology, Infectiology and Immunology Vienna General Hospital Medical University of Vienna Vienna Austria
| | - R. Valenta
- Division of Immunopathology Department of Pathophysiology and Allergy Research Centre for Pathophysiology, Infectiology and Immunology Vienna General Hospital Medical University of Vienna Vienna Austria
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21
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Jawhar M, Schwaab J, Schnittger S, Meggendorfer M, Pfirrmann M, Sotlar K, Horny HP, Metzgeroth G, Kluger S, Naumann N, Haferlach C, Haferlach T, Valent P, Hofmann WK, Fabarius A, Cross NCP, Reiter A. Additional mutations in SRSF2, ASXL1 and/or RUNX1 identify a high-risk group of patients with KIT D816V(+) advanced systemic mastocytosis. Leukemia 2015; 30:136-43. [PMID: 26464169 DOI: 10.1038/leu.2015.284] [Citation(s) in RCA: 160] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 09/25/2015] [Accepted: 09/29/2015] [Indexed: 12/21/2022]
Abstract
Most patients with KIT D816V(+) advanced systemic mastocytosis (SM) are characterized by somatic mutations in additional genes. We sought to clarify the prognostic impact of such mutations. Genotype and clinical characteristics of 70 multi-mutated KIT D816V(+) advanced SM patients were included in univariate and multivariate analyses. The most frequently identified mutated genes were TET2 (n=33 of 70 patients), SRSF2 (n=30), ASXL1 (n=20), RUNX1 (n=16) and JAK2 (n=11). In univariate analysis, overall survival (OS) was adversely influenced by mutations in SRSF2 (P<0.0001), ASXL1 (P=0.002) and RUNX1 (P=0.03), but was not influenced by mutations in TET2 or JAK2. In multivariate analysis, SRSF2 and ASXL1 remained the most predictive adverse indicators concerning OS. Furthermore, we found that inferior OS and adverse clinical characteristics were significantly influenced by the number of mutated genes in the SRSF2/ASXL1/RUNX1 (S/A/R) panel (P<0.0001). In conclusion, the presence and number of mutated genes within the S/A/R panel are adversely associated with advanced disease and poor survival in KIT D816V(+) SM. On the basis of these findings, inclusion of molecular markers should be considered in upcoming prognostic scoring systems for patients with SM.
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Affiliation(s)
- M Jawhar
- Department of Hematology and Oncology, University Medical Centre Mannheim, Mannheim, Germany
| | - J Schwaab
- Department of Hematology and Oncology, University Medical Centre Mannheim, Mannheim, Germany
| | | | | | - M Pfirrmann
- Institute for Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians University, Munich, Germany
| | - K Sotlar
- Institute of Pathology, Ludwig-Maximilians University, Munich, Germany
| | - H-P Horny
- Institute of Pathology, Ludwig-Maximilians University, Munich, Germany
| | - G Metzgeroth
- Department of Hematology and Oncology, University Medical Centre Mannheim, Mannheim, Germany
| | - S Kluger
- Department of Hematology and Oncology, University Medical Centre Mannheim, Mannheim, Germany
| | - N Naumann
- Department of Hematology and Oncology, University Medical Centre Mannheim, Mannheim, Germany
| | - C Haferlach
- MLL Munich Leukemia Laboratory, Munich, Germany
| | - T Haferlach
- MLL Munich Leukemia Laboratory, Munich, Germany
| | - P Valent
- Division of Hematology and Ludwig Boltzmann Cluster Oncology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - W-K Hofmann
- Department of Hematology and Oncology, University Medical Centre Mannheim, Mannheim, Germany
| | - A Fabarius
- Department of Hematology and Oncology, University Medical Centre Mannheim, Mannheim, Germany
| | - N C P Cross
- Wessex Regional Genetics Laboratory, Salisbury, UK.,Faculty of Medicine, University of Southampton, Southampton, UK
| | - A Reiter
- Department of Hematology and Oncology, University Medical Centre Mannheim, Mannheim, Germany
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22
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Byrgazov K, Kastner R, Gorna M, Hoermann G, Koenig M, Lucini CB, Ulreich R, Benesch M, Strenger V, Lackner H, Schwinger W, Sovinz P, Haas OA, van den Heuvel-Eibrink M, Niemeyer CM, Hantschel O, Valent P, Superti-Furga G, Urban C, Dworzak MN, Lion T. NDEL1-PDGFRB fusion gene in a myeloid malignancy with eosinophilia associated with resistance to tyrosine kinase inhibitors. Leukemia 2015; 31:237-240. [PMID: 27573554 PMCID: PMC5220134 DOI: 10.1038/leu.2016.250] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- K Byrgazov
- Children's Cancer Research Institute, Vienna, Austria
| | - R Kastner
- Children's Cancer Research Institute, Vienna, Austria
| | - M Gorna
- CeMM, Research Center for Molecular Medicine of the Austrian Academy of Science, Vienna, Austria
| | - G Hoermann
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - M Koenig
- Children's Cancer Research Institute, Vienna, Austria
| | - C B Lucini
- Children's Cancer Research Institute, Vienna, Austria
| | - R Ulreich
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - M Benesch
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - V Strenger
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - H Lackner
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - W Schwinger
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - P Sovinz
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - O A Haas
- Children's Cancer Research Institute, Vienna, Austria
| | - M van den Heuvel-Eibrink
- Department of Pediatric Hemato-Oncology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - C M Niemeyer
- Department of Pediatrics and Adolescent Medicine, University of Freiburg, Freiburg, Germany
| | - O Hantschel
- Swiss Institute for Experimental Cancer Research (ISREC), School of Life Sciences, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - P Valent
- Division of Hematology and Hemostaseology, Department of Internal Medicine, Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria
| | - G Superti-Furga
- CeMM, Research Center for Molecular Medicine of the Austrian Academy of Science, Vienna, Austria
| | - C Urban
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - M N Dworzak
- Children's Cancer Research Institute, Vienna, Austria.,St Anna Children's Hospital, Vienna, Austria
| | - T Lion
- Children's Cancer Research Institute, Vienna, Austria.,Department of Pediatrics, Medical University of Vienna, Vienna, Austria
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23
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Jayavelu AK, Müller JP, Bauer R, Böhmer SA, Lässig J, Cerny-Reiterer S, Sperr WR, Valent P, Maurer B, Moriggl R, Schröder K, Shah AM, Fischer M, Scholl S, Barth J, Oellerich T, Berg T, Serve H, Frey S, Fischer T, Heidel FH, Böhmer FD. NOX4-driven ROS formation mediates PTP inactivation and cell transformation in FLT3ITD-positive AML cells. Leukemia 2015; 30:473-83. [DOI: 10.1038/leu.2015.234] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 08/04/2015] [Accepted: 08/14/2015] [Indexed: 12/21/2022]
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Della Porta MG, Tuechler H, Malcovati L, Schanz J, Sanz G, Garcia-Manero G, Solé F, Bennett JM, Bowen D, Fenaux P, Dreyfus F, Kantarjian H, Kuendgen A, Levis A, Cermak J, Fonatsch C, Le Beau MM, Slovak ML, Krieger O, Luebbert M, Maciejewski J, Magalhaes SMM, Miyazaki Y, Pfeilstöcker M, Sekeres MA, Sperr WR, Stauder R, Tauro S, Valent P, Vallespi T, van de Loosdrecht AA, Germing U, Haase D, Greenberg PL, Cazzola M. Validation of WHO classification-based Prognostic Scoring System (WPSS) for myelodysplastic syndromes and comparison with the revised International Prognostic Scoring System (IPSS-R). A study of the International Working Group for Prognosis in Myelodysplasia (IWG-PM). Leukemia 2015; 29:1502-13. [PMID: 25721895 DOI: 10.1038/leu.2015.55] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 02/10/2015] [Accepted: 02/16/2015] [Indexed: 02/03/2023]
Abstract
A risk-adapted treatment strategy is mandatory for myelodysplastic syndromes (MDS). We refined the World Health Organization (WHO)-classification-based Prognostic Scoring System (WPSS) by determining the impact of the newer clinical and cytogenetic features, and we compared its prognostic power to that of the revised International Prognostic Scoring System (IPSS-R). A population of 5326 untreated MDS was considered. We analyzed single WPSS parameters and confirmed that the WHO classification and severe anemia provide important prognostic information in MDS. A strong correlation was found between the WPSS including the new cytogenetic risk stratification and WPSS adopting original criteria. We then compared WPSS with the IPSS-R prognostic system. A highly significant correlation was found between the WPSS and IPSS-R risk classifications. Discrepancies did occur among lower-risk patients in whom the number of dysplastic hematopoietic lineages as assessed by morphology did not reflect the severity of peripheral blood cytopenias and/or increased marrow blast count. Moreover, severe anemia has higher prognostic weight in the WPSS versus IPSS-R model. Overall, both systems well represent the prognostic risk of MDS patients defined by WHO morphologic criteria. This study provides relevant in formation for the implementation of risk-adapted strategies in MDS.
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Affiliation(s)
- M G Della Porta
- 1] Department of Hematology Oncology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy [2] Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - H Tuechler
- Hanusch Hospital, Boltzmann Institute for Leukemia Research, Vienna, Austria
| | - L Malcovati
- 1] Department of Hematology Oncology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy [2] Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - J Schanz
- Georg August Universität, Göttingen, Germany
| | - G Sanz
- Hospital Universitario La Fe, Valencia, Spain
| | - G Garcia-Manero
- The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - F Solé
- Institut de Recerca contra la Leucèmia Josep Carreras, Barcelona, Spain
| | - J M Bennett
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - D Bowen
- St James's University Hospital, Leeds, UK
| | - P Fenaux
- Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris (AP-HP)/University Paris XIII, Bobigny, France
| | - F Dreyfus
- Hôpital Cochin, AP-HP University of Paris V, Paris, France
| | - H Kantarjian
- The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - A Kuendgen
- Heinrich-Heine University Hospital, Düsseldorf, Germany
| | - A Levis
- Fondazione Italiana Sindromi Mielodisplastiche c/o SS Antonio e Biagio Hospital, Alessandria, Italy
| | - J Cermak
- Institute of Hematology and Blood Transfusion, Praha, Czech Republic
| | - C Fonatsch
- Medical University of Vienna, Vienna, Austria
| | - M M Le Beau
- University of Chicago Comprehensive Cancer Research Center, Chicago, IL, USA
| | - M L Slovak
- Quest Diagnostics Nichols Institute, Chantilly, VA, USA
| | - O Krieger
- Elisabethinen Hospital, Linz, Austria
| | - M Luebbert
- University of Freiburg Medical Center, Freiburg, Germany
| | | | | | - Y Miyazaki
- Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - M Pfeilstöcker
- Hanusch Hospital and L. Boltzmann Cluster Oncology, Vienna, Austria
| | | | - W R Sperr
- Medical University of Vienna, Vienna, Austria
| | - R Stauder
- Hanusch Hospital and L. Boltzmann Cluster Oncology, Vienna, Austria
| | - S Tauro
- University of Dundee, Dundee, Scotland, UK
| | - P Valent
- Medical University of Vienna, Vienna, Austria
| | - T Vallespi
- Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | | | - U Germing
- Heinrich-Heine University Hospital, Düsseldorf, Germany
| | - D Haase
- Georg August Universität, Göttingen, Germany
| | - P L Greenberg
- Division of Hematology, Stanford University Cancer Center, Stanford, CA, USA
| | - M Cazzola
- 1] Department of Hematology Oncology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy [2] Department of Molecular Medicine, University of Pavia, Pavia, Italy
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Pfeilstöcker M, Tuechler H, Nachtkamp K, Platzbecker U, Schönmetzler A, Sperr W, Stauder R, Strupp C, Valent P, Germing U. 240 DYSPLASIAS REVISITED – CONSIDERATIONS FOR A MULTIDIMENSIONAL APPROACH TO HETEROGENEITY OF MDS: DATA ON 1979 PATIENTS FROM THE GERMAN AUSTRIAN DATA BASE. Leuk Res 2015. [DOI: 10.1016/s0145-2126(15)30241-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sperr W, Sperr M, Wimazal F, Wiesinger P, Stauder R, Germing U, Valent P. 295 IDIOPATHIC CYTOPENIA OF UNKNOWN SIGNIFICANCE (ICUS) AND IDIOPATHIC DYSPLASIA OF UNKNOWN SIGNIFICANCE (IDUS): A MULTI-CENTER REGISTRY STUDY. Leuk Res 2015. [DOI: 10.1016/s0145-2126(15)30296-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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27
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Schemenau J, Lauseker M, Hildebrandt B, Fenaux P, Pfeilstöcker M, Valent P, Platzbecker U, Kündgen A, Bug G, Haas R, Germing U. 318 THE IPSS-R HAS PROGNOSTIC IMPACT IN UNTREATED PATIENTS WITH MDS DEL(5Q). Leuk Res 2015. [DOI: 10.1016/s0145-2126(15)30319-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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28
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Valent P. Risk factors and management of severe life-threatening anaphylaxis in patients with clonal mast cell disorders. Clin Exp Allergy 2015; 44:914-20. [PMID: 24702655 DOI: 10.1111/cea.12318] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 03/28/2014] [Accepted: 03/31/2014] [Indexed: 01/08/2023]
Abstract
Several different risk factors and conditions may predispose to severe life-threatening anaphylaxis. Systemic mastocytosis (SM) is one such condition. Although many SM patients are suffering from mild or even no mediator-related symptoms, others have recurrent episodes of severe anaphylaxis, with clear signs of a mast cell activation syndrome (MCAS) despite prophylactic therapy with anti-mediator-type drugs. In several of these patients, an IgE-dependent allergy is diagnosed. The severity and frequency of MCAS reactions neither correlate with the burden of neoplastic mast cells nor with the levels of specific IgE or the basal tryptase level. However, there is a relationship between severe anaphylaxis in SM and the type of allergen. Notably, many of these patients suffer from hymenoptera venom allergy. Currently recommended therapies include the prophylactic use of anti-mediator-type drugs, long-term immunotherapy for hymenoptera venom allergic patients, and epinephrine-self-injector treatment for emergency situations. In patients who present with an excess burden of mast cells, such as smouldering SM, cytoreductive therapy with cladribine (2CdA) may reduce the frequency of severe events. For the future, additional treatment options, such as IgE-depletion or the use of tyrosine kinase inhibitors blocking IgE-dependent mediator secretion as well as KIT activation, may be useful alternatives.
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Affiliation(s)
- P Valent
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Austria and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria
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29
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Heuser M, Meggendorfer M, Cruz MMA, Fabisch J, Klesse S, Köhler L, Göhring G, Ganster C, Shirneshan K, Gutermuth A, Cerny-Reiterer S, Krönke J, Panagiota V, Haferlach C, Koenecke C, Platzbecker U, Thiede C, Schroeder T, Kobbe G, Ehrlich S, Stamer K, Döhner K, Valent P, Schlegelberger B, Kroeger N, Ganser A, Haase D, Haferlach T, Thol F. Frequency and prognostic impact of casein kinase 1A1 mutations in MDS patients with deletion of chromosome 5q. Leukemia 2015; 29:1942-5. [PMID: 25792355 DOI: 10.1038/leu.2015.49] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- M Heuser
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | | | - M M A Cruz
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - J Fabisch
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - S Klesse
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - L Köhler
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - G Göhring
- Institute of Human Genetics, Hannover Medical School, Hannover, Germany
| | - C Ganster
- Department of Hematology and Oncology, Georg-August-Universität Göttingen, Göttingen, Germany
| | - K Shirneshan
- Department of Hematology and Oncology, Georg-August-Universität Göttingen, Göttingen, Germany
| | - A Gutermuth
- Department of Hematology and Oncology, Georg-August-Universität Göttingen, Göttingen, Germany
| | - S Cerny-Reiterer
- Department of Hematology and Hemostasis, Medical University Vienna, Vienna, Austria
| | - J Krönke
- Department of Internal Medicine III, University of Ulm, Ulm, Germany
| | - V Panagiota
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - C Haferlach
- MLL Munich Leukemia Laboratory, Munich, Germany
| | - C Koenecke
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - U Platzbecker
- Medical Department I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - C Thiede
- Medical Department I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - T Schroeder
- Department of Hematology, Oncology and Clinical Immunology, University of Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - G Kobbe
- Department of Hematology, Oncology and Clinical Immunology, University of Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - S Ehrlich
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - K Stamer
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - K Döhner
- Department of Internal Medicine III, University of Ulm, Ulm, Germany
| | - P Valent
- Department of Hematology and Hemostasis, Medical University Vienna, Vienna, Austria
| | - B Schlegelberger
- Institute of Human Genetics, Hannover Medical School, Hannover, Germany
| | - N Kroeger
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Ganser
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - D Haase
- Department of Hematology and Oncology, Georg-August-Universität Göttingen, Göttingen, Germany
| | - T Haferlach
- MLL Munich Leukemia Laboratory, Munich, Germany
| | - F Thol
- MLL Munich Leukemia Laboratory, Munich, Germany
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30
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Curin M, Weber M, Thalhamer T, Swoboda I, Focke-Tejkl M, Blatt K, Valent P, Marth K, Garmatiuk T, Grönlund H, Thalhamer J, Spitzauer S, Valenta R. Hypoallergenic derivatives of Fel d 1 obtained by rational reassembly for allergy vaccination and tolerance induction. Clin Exp Allergy 2015; 44:882-94. [PMID: 24552249 DOI: 10.1111/cea.12294] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 10/30/2013] [Accepted: 02/05/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVE The major cat allergen Fel d 1 represents one of the most important respiratory allergens. Aim of this study was to engineer recombinant Fel d 1 derivatives with reduced IgE reactivity and preserved T cell epitopes for vaccination and tolerance induction. METHODS Seven recombinant mosaic proteins were generated by reassembly of non-IgE-reactive peptides of Fel d 1 which contained the sequence elements for induction of allergen-specific blocking IgG antibodies and T cell epitopes. Mosaic proteins were expressed in Escherichia coli using codon-optimized synthetic genes and compared with Fel d 1 regarding structural fold by circular dichroism, IgE-binding capacity, activation of allergic patients' basophils and ability to induce allergen-specific blocking IgG antibodies upon immunization. RESULTS Although each of the mosaic proteins had lost the alpha-helical fold typical for Fel d 1, a strong reduction in IgE reactivity as well as allergenic activity in basophil activation assays was only obtained for three constructs, two reassembled fragments (Fel d 1 MB, Fel d 1 MC) and a fusion of the latter two (Fel d 1 MF) in which the cysteines of Fel d 1 MC were replaced by serines. Immunization of rabbits with Fel d 1 MB, MC and MF induced high levels of IgG antibodies that inhibited IgE reactivity of cat-allergic patients to Fel d 1 in a comparable manner as IgG induced with the wild-type allergen. CONCLUSIONS We report the development of hypoallergenic reassembled Fel d 1 proteins suitable for vaccination and tolerance induction in cat-allergic patients.
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Affiliation(s)
- M Curin
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria; Christian Doppler Laboratory for Allergy Research, Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
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31
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Jawhar M, Schwaab J, Schnittger S, Sotlar K, Horny HP, Metzgeroth G, Müller N, Schneider S, Naumann N, Walz C, Haferlach T, Valent P, Hofmann WK, Cross NCP, Fabarius A, Reiter A. Molecular profiling of myeloid progenitor cells in multi-mutated advanced systemic mastocytosis identifies KIT D816V as a distinct and late event. Leukemia 2015; 29:1115-22. [PMID: 25567135 DOI: 10.1038/leu.2015.4] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 10/17/2014] [Accepted: 11/07/2014] [Indexed: 12/12/2022]
Abstract
To explore the molecular profile and its prognostic implication in systemic mastocytosis (SM), we analyzed the mutation status of granulocyte-macrophage colony-forming progenitor cells (CFU-GM) in patients with KIT D816V(+) indolent SM (ISM, n=4), smoldering SM (SSM, n=2), aggressive SM (ASM, n=1), SM with associated clonal hematologic non-mast cell lineage disorder (SM-AHNMD, n=5) and ASM-AHNMD (n=7). All patients with (A)SM-AHNMD (n=12) carried 1-4 (median 3) additional mutations in 11 genes tested, most frequently TET2, SRSF2, ASXL1, CBL and EZH2. In multi-mutated (A)SM-AHNMD, KIT D816V(+) single-cell-derived CFU-GM colonies were identified in 8/12 patients (median 60%, range 0-95). Additional mutations were identified in CFU-GM colonies in all patients, and logical hierarchy analysis indicated that mutations in TET2, SRSF2 and ASXL1 preceded KIT D816V. In ISM/SSM, no additional mutations were detected and CFU-GM colonies were exclusively KIT D816V(-). These data indicate that (a) (A)SM-AHNMD is a multi-mutated neoplasm, (b) mutations in TET2, SRSF2 or ASXL1 precede KIT D816V in ASM-AHNMD,
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Affiliation(s)
- M Jawhar
- Department of Hematology and Oncology, University Hospital Mannheim, Mannheim, Germany
| | - J Schwaab
- Department of Hematology and Oncology, University Hospital Mannheim, Mannheim, Germany
| | | | - K Sotlar
- Department of Pathology, Ludwig-Maximilians-University, Munich, Germany
| | - H-P Horny
- Department of Pathology, Ludwig-Maximilians-University, Munich, Germany
| | - G Metzgeroth
- Department of Hematology and Oncology, University Hospital Mannheim, Mannheim, Germany
| | - N Müller
- Department of Hematology and Oncology, University Hospital Mannheim, Mannheim, Germany
| | - S Schneider
- Department of Clinical Chemistry, University Hospital Mannheim, Mannheim, Germany
| | - N Naumann
- Department of Hematology and Oncology, University Hospital Mannheim, Mannheim, Germany
| | - C Walz
- Department of Pathology, Ludwig-Maximilians-University, Munich, Germany
| | | | - P Valent
- Division of Hematology and Ludwig Boltzmann Cluster Oncology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - W-K Hofmann
- Department of Hematology and Oncology, University Hospital Mannheim, Mannheim, Germany
| | - N C P Cross
- 1] Wessex Regional Genetics Laboratory, Salisbury, UK [2] Faculty of Medicine, University of Southampton, Southampton, UK
| | - A Fabarius
- Department of Hematology and Oncology, University Hospital Mannheim, Mannheim, Germany
| | - A Reiter
- Department of Hematology and Oncology, University Hospital Mannheim, Mannheim, Germany
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32
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Valent P, Escribano L, Broesby-Olsen S, Hartmann K, Grattan C, Brockow K, Niedoszytko M, Nedoszytko B, Oude Elberink JNG, Kristensen T, Butterfield JH, Triggiani M, Alvarez-Twose I, Reiter A, Sperr WR, Sotlar K, Yavuz S, Kluin-Nelemans HC, Hermine O, Radia D, van Doormaal JJ, Gotlib J, Orfao A, Siebenhaar F, Schwartz LB, Castells M, Maurer M, Horny HP, Akin C, Metcalfe DD, Arock M. Proposed diagnostic algorithm for patients with suspected mastocytosis: a proposal of the European Competence Network on Mastocytosis. Allergy 2014; 69:1267-74. [PMID: 24836395 DOI: 10.1111/all.12436] [Citation(s) in RCA: 126] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2014] [Indexed: 01/08/2023]
Abstract
Mastocytosis is an emerging differential diagnosis in patients with more or less specific mediator-related symptoms. In some of these patients, typical skin lesions are found and the diagnosis of mastocytosis can be established. In other cases, however, skin lesions are absent, which represents a diagnostic challenge. In the light of this unmet need, we developed a diagnostic algorithm for patients with suspected mastocytosis. In adult patients with typical lesions of mastocytosis in the skin, a bone marrow (BM) biopsy should be considered, regardless of the basal serum tryptase concentration. In adults without skin lesions who suffer from mediator-related or other typical symptoms, the basal tryptase level is an important parameter. In those with a slightly increased tryptase level, additional investigations, including a sensitive KIT mutation analysis of blood leucocytes or measurement of urinary histamine metabolites, may be helpful. In adult patients in whom (i) KIT D816V is detected and/or (ii) the basal serum tryptase level is clearly increased (>25-30 ng/ml) and/or (iii) other clinical or laboratory features suggest the presence of 'occult' mastocytosis or another haematologic neoplasm, a BM investigation is recommended. In the absence of KIT D816V and other signs or symptoms of mastocytosis or another haematopoietic disease, no BM investigation is required, but the clinical course and tryptase levels are monitored in the follow-up. In paediatric patients, a BM investigation is usually not required, even if the tryptase level is increased. Although validation is required, it can be expected that the algorithm proposed herein will facilitate the management of patients with suspected mastocytosis and help avoid unnecessary referrals and investigations.
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Affiliation(s)
- P. Valent
- Division of Haematology; Department of Internal Medicine I; Medical University of Vienna; Vienna Austria
| | - L. Escribano
- Servicio Central de Citometria; Centro de Investigacion del Cancer (IBMCC; CSIC/USAL); IBSAL and Department of Medicine; University of Salamanca; Salamanca Spain
| | - S. Broesby-Olsen
- Department of Dermatology and Allergy Centre; Odense University Hospital; Odense Denmark
| | - K. Hartmann
- Department of Dermatology; University of Cologne; Cologne Germany
| | - C. Grattan
- Norfolk and Norwich University Hospital; Norwich UK
| | - K. Brockow
- Department of Dermatology and Allergy Biederstein; Technical University of Munich; Munich Germany
| | - M. Niedoszytko
- Department of Allergology; Medical University of Gdansk; Gdansk Poland
| | - B. Nedoszytko
- Department of Dermatology; Medical University of Gdansk; Gdansk Poland
| | - J. N. G. Oude Elberink
- Department of Allergology; University Medical Center of Groningen; University of Groningen; Groningen the Netherlands
| | - T. Kristensen
- Department of Pathology; Odense University Hospital; Odense Denmark
| | | | - M. Triggiani
- Division of Allergy and Clinical Immunology; University of Salerno; Salerno Italy
| | - I. Alvarez-Twose
- Instituto de Estudios de Mastocitosis de Castilla La Mancha (CLMast); Hospital Virgen del Valle; Toledo Spain
| | - A. Reiter
- III. Medizinische Klinik; Universitäts-Medizin Mannheim; Universität Heidelberg; Mannheim Germany
| | - W. R. Sperr
- Division of Haematology; Department of Internal Medicine I; Medical University of Vienna; Vienna Austria
| | - K. Sotlar
- Institute of Pathology; Ludwig-Maximilians-University; Munich Germany
| | - S. Yavuz
- Division of Haematology; Department of Internal Medicine; University of Istanbul; Istanbul Turkey
| | - H. C. Kluin-Nelemans
- Department of Haematology; University Medical Center Groningen; University of Groningen; Groningen the Netherlands
| | - O. Hermine
- Imagine Institute Université Paris Descartes, Sorbonne, Paris Cité; Centre national de référence des mastocytoses; Paris France
| | - D. Radia
- Department of Haematology; Guys and St Thomas' NHS Foundation Trust; Guys Hospital; London UK
| | - J. J. van Doormaal
- Department of Allergology; University Medical Center of Groningen; University of Groningen; Groningen the Netherlands
| | - J. Gotlib
- Stanford Cancer Institute; Stanford University School of Medicine; Stanford CA USA
| | - A. Orfao
- Servicio Central de Citometria; Centro de Investigacion del Cancer (IBMCC; CSIC/USAL); IBSAL and Department of Medicine; University of Salamanca; Salamanca Spain
| | - F. Siebenhaar
- Department of Dermatology & Allergy; Charité Universitätsmedizin Berlin; Berlin Germany
| | - L. B. Schwartz
- Division of Rheumatology, Allergy & Immunology; Department of Internal Medicine; Virginia Common-wealth University; Richmond VA USA
| | - M. Castells
- Division of Allergy and Immunology; Department of Medicine; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - M. Maurer
- Department of Dermatology & Allergy; Charité Universitätsmedizin Berlin; Berlin Germany
| | - H.-P. Horny
- Institute of Pathology; Ludwig-Maximilians-University; Munich Germany
| | - C. Akin
- Division of Allergy and Immunology; Department of Medicine; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - D. D. Metcalfe
- Laboratory of Allergic Diseases; NIAID; NIH; Bethesda MD USA
| | - M. Arock
- LBPA CNRS UMR8113; Ecole Normale Supérieure de Cachan; Cachan France
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33
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Valent P, Sotlar K, Sperr WR, Escribano L, Yavuz S, Reiter A, George TI, Kluin-Nelemans HC, Hermine O, Butterfield JH, Hägglund H, Ustun C, Hornick JL, Triggiani M, Radia D, Akin C, Hartmann K, Gotlib J, Schwartz LB, Verstovsek S, Orfao A, Metcalfe DD, Arock M, Horny HP. Refined diagnostic criteria and classification of mast cell leukemia (MCL) and myelomastocytic leukemia (MML): a consensus proposal. Ann Oncol 2014; 25:1691-1700. [PMID: 24675021 PMCID: PMC4155468 DOI: 10.1093/annonc/mdu047] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 01/09/2014] [Accepted: 01/17/2014] [Indexed: 01/08/2023] Open
Abstract
Mast cell leukemia (MCL), the leukemic manifestation of systemic mastocytosis (SM), is characterized by leukemic expansion of immature mast cells (MCs) in the bone marrow (BM) and other internal organs; and a poor prognosis. In a subset of patients, circulating MCs are detectable. A major differential diagnosis to MCL is myelomastocytic leukemia (MML). Although criteria for both MCL and MML have been published, several questions remain concerning terminologies and subvariants. To discuss open issues, the EU/US-consensus group and the European Competence Network on Mastocytosis (ECNM) launched a series of meetings and workshops in 2011-2013. Resulting discussions and outcomes are provided in this article. The group recommends that MML be recognized as a distinct condition defined by mastocytic differentiation in advanced myeloid neoplasms without evidence of SM. The group also proposes that MCL be divided into acute MCL and chronic MCL, based on the presence or absence of C-Findings. In addition, a primary (de novo) form of MCL should be separated from secondary MCL that typically develops in the presence of a known antecedent MC neoplasm, usually aggressive SM (ASM) or MC sarcoma. For MCL, an imminent prephase is also proposed. This prephase represents ASM with rapid progression and 5%-19% MCs in BM smears, which is generally accepted to be of prognostic significance. We recommend that this condition be termed ASM in transformation to MCL (ASM-t). The refined classification of MCL fits within and extends the current WHO classification; and should improve prognostication and patient selection in practice as well as in clinical trials.
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MESH Headings
- Bone Marrow Examination
- Diagnosis, Differential
- Disease Progression
- Humans
- Leukemia, Mast-Cell/classification
- Leukemia, Mast-Cell/diagnosis
- Leukemia, Myelomonocytic, Acute/classification
- Leukemia, Myelomonocytic, Acute/diagnosis
- Leukemia, Myelomonocytic, Chronic/classification
- Leukemia, Myelomonocytic, Chronic/diagnosis
- Mast Cells/pathology
- Mastocytosis/pathology
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Affiliation(s)
- P Valent
- Division of Hematology, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
| | - K Sotlar
- Institute of Pathology, Ludwig-Maximilians-University, Munich, Germany
| | - W R Sperr
- Division of Hematology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - L Escribano
- Servicio Central de Citometria, Centro de Investigacion del Cancer (IBMCC; CSIC/USAL) and Department of Medicine, University of Salamanca, Salamanca, Spain
| | - S Yavuz
- Division of Hematology, Department of Internal Medicine, University of Istanbul, Turkey
| | - A Reiter
- III. Medizinische Klinik, Universitätsmedizin Mannheim, Universität Heidelberg, Mannheim, Germany
| | - T I George
- Department of Pathology, University of New Mexico, Albuquerque, USA
| | - H C Kluin-Nelemans
- Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - O Hermine
- Imagine Institute Université Paris Descartes, Sorbonne, Paris Cité, Centre national de référence des mastocytoses, Paris, France
| | | | - H Hägglund
- Hematology Center Karolinska, Karolinska University Hospital, Stockholm, Sweden
| | - C Ustun
- Division of Hematology-Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis
| | - J L Hornick
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - M Triggiani
- Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - D Radia
- Department of Haematology, Guys and St Thomas' NHS Foundation Trust, Guys Hospital, London, UK
| | - C Akin
- Division of Allergy and Immunology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - K Hartmann
- Department of Dermatology, University of Cologne, Cologne, Germany
| | - J Gotlib
- Stanford Cancer Center, Stanford University School of Medicine, Stanford
| | - L B Schwartz
- Department of Internal Medicine, Division of Rheumatology, Allergy & Immunology, Virginia Commonwealth University, Richmond
| | - S Verstovsek
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston
| | - A Orfao
- Servicio Central de Citometria, Centro de Investigacion del Cancer (IBMCC; CSIC/USAL) and Department of Medicine, University of Salamanca, Salamanca, Spain
| | - D D Metcalfe
- Laboratory of Allergic Diseases, NIAID, NIH, Bethesda, USA
| | - M Arock
- LBPA CNRS UMR8113, Ecole Normale Supérieure de Cachan, Cachan, France
| | - H-P Horny
- Institute of Pathology, Ludwig-Maximilians-University, Munich, Germany
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34
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Porwit A, van de Loosdrecht AA, Bettelheim P, Brodersen LE, Burbury K, Cremers E, Della Porta MG, Ireland R, Johansson U, Matarraz S, Ogata K, Orfao A, Preijers F, Psarra K, Subirá D, Valent P, van der Velden VHJ, Wells D, Westers TM, Kern W, Béné MC. Revisiting guidelines for integration of flow cytometry results in the WHO classification of myelodysplastic syndromes-proposal from the International/European LeukemiaNet Working Group for Flow Cytometry in MDS. Leukemia 2014; 28:1793-8. [PMID: 24919805 DOI: 10.1038/leu.2014.191] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Revised: 04/06/2014] [Accepted: 05/02/2014] [Indexed: 12/22/2022]
Abstract
Definite progress has been made in the exploration of myelodysplastic syndromes (MDS) by flow cytometry (FCM) since the publication of the World Health Organization 2008 classification of myeloid neoplasms. An international working party initiated within the European LeukemiaNet and extended to include members from Australia, Canada, Japan, Taiwan and the United States has, through several workshops, developed and subsequently published consensus recommendations. The latter deal with preanalytical precautions, and propose small and large panels, which allow evaluating immunophenotypic anomalies and calculating myelodysplasia scores. The current paper provides guidelines that strongly recommend the integration of FCM data with other diagnostic tools in the diagnostic work-up of MDS.
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Affiliation(s)
- A Porwit
- Department of Pathobiology and Laboratory Medicine, University of Toronto, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - A A van de Loosdrecht
- Department of Hematology, Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - P Bettelheim
- First Medical Department, Elisabethinen Hospital, Linz, Austria
| | | | - K Burbury
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, East Melbourne, Melbourne, Victoria, Australia
| | - E Cremers
- Department of Hematology, Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - M G Della Porta
- Department of Hematology and Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, and University of Pavia, Pavia, Italy
| | | | | | - S Matarraz
- Servicio Central de Citometría, Centro de Investigación del Cáncer, Instituto de Biologia Celular y Molecular del Cáncer CSIC/USAL/IBSAL) and Department of Medicine, Universidad de Salamanca, Salamanca, Spain
| | - K Ogata
- Metropolitan Research Center for Blood Disorders MRC JAPAN, Midorigaoka, Chofu, Tokyo, Japan
| | - A Orfao
- Servicio Central de Citometría, Centro de Investigación del Cáncer, Instituto de Biologia Celular y Molecular del Cáncer CSIC/USAL/IBSAL) and Department of Medicine, Universidad de Salamanca, Salamanca, Spain
| | - F Preijers
- Department of Hematology, St Radboud University Medical Center, Nijmegen, The Netherlands
| | - K Psarra
- Department of Immunology-Histocompatibility, Evangelismos Hospital, Athens, Greece
| | - D Subirá
- Department of Hematology, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - P Valent
- Department of Internal Medicine I, Division of Hematology and Hemostaseology and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria
| | - V H J van der Velden
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - D Wells
- HematoLogics, Inc., Seattle, WA, USA
| | - T M Westers
- Department of Hematology, Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - W Kern
- MLL Munich Leukemia Laboratory, Munich, Germany
| | - M C Béné
- Service d'Hématologie Biologique, CHU de Nantes, Nantes, France
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35
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Hoermann G, Gleixner KV, Dinu GE, Kundi M, Greiner G, Wimazal F, Hadzijusufovic E, Mitterbauer G, Mannhalter C, Valent P, Sperr WR. The KIT D816V allele burden predicts survival in patients with mastocytosis and correlates with the WHO type of the disease. Allergy 2014; 69:810-3. [PMID: 24750133 DOI: 10.1111/all.12409] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2014] [Indexed: 12/11/2022]
Abstract
KIT D816V is present in a majority of patients with systemic mastocytosis (SM). We determined the KIT D816V allele burden by quantitative real-time PCR in bone marrow and peripheral blood of 105 patients with mastocytosis. KIT D816V was detected in 92/105 patients (88%). Significant differences in the median allele burden were observed between disease subgroups: cutaneous mastocytosis (0.042%), indolent SM (0.285%), smoldering SM (5.991%), aggressive SM (9.346%), and SM with associated hematologic non-mast cell lineage disease (3.761%) (P < 0.001). The KIT D816V burden also correlated with serum tryptase (R = 0.5, P < 0.005) but not with mast cell infiltration in bone marrow or mediator symptoms. Moreover, the allele burden was of prognostic significance regarding survival (P < 0.01). Patients responding to cytoreductive therapy showed a significant decrease in KIT D816V (P < 0.05). To conclude, the KIT D816V burden correlates with the variant of mastocytosis, predicts survival, and is a valuable follow-up parameter in SM.
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Affiliation(s)
- G. Hoermann
- Department of Laboratory Medicine; Medical University of Vienna; Vienna Austria
| | - K. V. Gleixner
- Division of Hematology & Hemostaseology; Department of Medicine I; Medical University of Vienna; Vienna Austria
| | - G. E. Dinu
- University of Applied Sciences; Wiener Neustadt Austria
| | - M. Kundi
- Institute of Environmental Health; Medical University of Vienna; Vienna Austria
| | - G. Greiner
- Department of Laboratory Medicine; Medical University of Vienna; Vienna Austria
| | - F. Wimazal
- Department of Obstetrics and Gynecology; Medical University of Vienna; Vienna Austria
| | - E. Hadzijusufovic
- Division of Hematology & Hemostaseology; Department of Medicine I; Medical University of Vienna; Vienna Austria
- Ludwig Boltzmann Cluster Oncology; Medical University of Vienna; Vienna Austria
- Department of Companion Animals and Horses; Clinic for Internal Medicine and Infectious Diseases; University of Veterinary Medicine Vienna; Vienna Austria
| | - G. Mitterbauer
- Department of Laboratory Medicine; Medical University of Vienna; Vienna Austria
| | - C. Mannhalter
- Department of Laboratory Medicine; Medical University of Vienna; Vienna Austria
| | - P. Valent
- Division of Hematology & Hemostaseology; Department of Medicine I; Medical University of Vienna; Vienna Austria
- Ludwig Boltzmann Cluster Oncology; Medical University of Vienna; Vienna Austria
| | - W. R. Sperr
- Division of Hematology & Hemostaseology; Department of Medicine I; Medical University of Vienna; Vienna Austria
- Ludwig Boltzmann Cluster Oncology; Medical University of Vienna; Vienna Austria
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36
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Gadermaier E, Flicker S, Blatt K, Valent P, Valenta R. Possible therapeutic potential of a recombinant group 2 grass pollen allergen-specific antibody fragment. Allergy 2014; 69:261-4. [PMID: 24251384 DOI: 10.1111/all.12315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2013] [Indexed: 01/18/2023]
Abstract
The induction of blocking IgG antibodies that compete with IgE for allergen binding is one important mechanism of allergen-specific immunotherapy. The application of blocking antibodies may be an alternative treatment strategy. A synthetic gene coding for a single-chain fragment (ScFv) specific for the major timothy grass pollen allergen Phl p 2 was inserted into plasmid pCANTAB 5 E, and the recombinant ScFv was expressed in Escherichia coli and purified by affinity chromatography. The ScFv was tested for allergen binding by ELISA, and its association and dissociation were measured by surface plasmon resonance (Biacore) technology. The ability of the ScFv to inhibit allergic patients' IgE binding to Phl p 2 and Phl p 2-induced basophil degranulation was studied by ELISA competition and basophil activation (CD203c) assays. We report the expression, purification, biochemical and immunological characterization of a monomeric single-chain fragment (ScFv) of human origin specific for the major timothy grass pollen allergen, Phl p 2. The Phl p 2-ScFv showed high affinity binding to the allergen and blocked the binding of allergic patients' polyclonal IgE to Phl p 2 up to 98%. Furthermore, it inhibited allergen-induced basophil activation. The Phl p 2-ScFv inhibited allergic patients' IgE binding to Phl p 2 as well as Phl p 2-induced basophil activation and might be useful for passive immunotherapy of grass pollen allergy.
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Affiliation(s)
- E. Gadermaier
- Division of Immunopathology; Department of Pathophysiology and Allergy Research; Centre for Pathophysiology, Infectiology and Immunology; Medical University of Vienna; Vienna General Hospital; Vienna Austria
| | - S. Flicker
- Division of Immunopathology; Department of Pathophysiology and Allergy Research; Centre for Pathophysiology, Infectiology and Immunology; Medical University of Vienna; Vienna General Hospital; Vienna Austria
| | - K. Blatt
- Division of Hematology and Hemostaseology; Department of Internal Medicine I; Medical University of Vienna; Vienna General Hospital; Vienna Austria
| | - P. Valent
- Division of Hematology and Hemostaseology; Department of Internal Medicine I; Medical University of Vienna; Vienna General Hospital; Vienna Austria
| | - R. Valenta
- Division of Immunopathology; Department of Pathophysiology and Allergy Research; Centre for Pathophysiology, Infectiology and Immunology; Medical University of Vienna; Vienna General Hospital; Vienna Austria
- Christian Doppler Laboratory for Allergy Research; Division of Immunopathology; Department of Pathophysiology and Allergy Research; Centre for Pathophysiology, Infectiology and Immunology; Medical University of Vienna; Vienna General Hospital; Vienna Austria
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37
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Kastner R, Zopf A, Preuner S, Pröll J, Niklas N, Foskett P, Valent P, Lion T, Gabriel C. Rapid identification of compound mutations in patients with Philadelphia-positive leukaemias by long-range next generation sequencing. Eur J Cancer 2013; 50:793-800. [PMID: 24365090 DOI: 10.1016/j.ejca.2013.11.030] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 11/21/2013] [Accepted: 11/25/2013] [Indexed: 01/21/2023]
Abstract
An emerging problem in patients with Philadelphia (Ph)-positive leukaemias is the occurrence of cells with multiple mutations in the BCR-ABL1 tyrosine kinase domain (TKD) associated with high resistance to different tyrosine kinase inhibitors. Rapid and sensitive detection of leukaemic subclones carrying such changes, referred to as compound mutations, is therefore of increasing clinical relevance. However, current diagnostic methods including next generation sequencing (NGS) of short fragments do not optimally meet these requirements. We have therefore established a long-range (LR) NGS approach permitting massively parallel sequencing of the entire TKD length of 933bp in a single read using 454 sequencing with the GS FLX+ instrument (454 Life Sciences). By testing a series of individual and consecutive specimens derived from six patients with chronic myeloid leukaemia, we demonstrate that long-range NGS analysis permits sensitive identification of mutations and their assignment to the same or to separate subclones. This approach also facilitates readily interpretable documentation of insertions and deletions in the entire BCR-ABL1 TKD. The long-range NGS findings were reevaluated by an independent technical approach in select cases. Polymerase chain reaction (PCR) amplicons of the BCR-ABL1 TKD derived from individual specimens were subcloned into pGEM®-T plasmids, and >100 individual clones were subjected to analysis by Sanger sequencing. The NGS results were confirmed, thus documenting the reliability of the new technology. Long-range NGS analysis therefore provides an economic approach to the identification of compound mutations and other genetic alterations in the entire BCR-ABL1 TKD, and represents an important advancement of the diagnostic armamentarium for rapid assessment of impending resistant disease.
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Affiliation(s)
- R Kastner
- Children's Cancer Research Institute, Vienna, Austria; Labdia Labordiagnostik GmbH, Vienna, Austria
| | - A Zopf
- Red Cross Transfusion Service for Upper Austria, Linz, Austria
| | - S Preuner
- Children's Cancer Research Institute, Vienna, Austria; Labdia Labordiagnostik GmbH, Vienna, Austria
| | - J Pröll
- Red Cross Transfusion Service for Upper Austria, Linz, Austria
| | - N Niklas
- Red Cross Transfusion Service for Upper Austria, Linz, Austria
| | - P Foskett
- Imperial Molecular Pathology Laboratory, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - P Valent
- Department of Medicine I, Division of Hematology and Hemostaseology and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria
| | - T Lion
- Children's Cancer Research Institute, Vienna, Austria; Labdia Labordiagnostik GmbH, Vienna, Austria; Department of Pediatrics, Medical University of Vienna, Austria.
| | - C Gabriel
- Red Cross Transfusion Service for Upper Austria, Linz, Austria
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38
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Machherndl-Spandl S, Sega W, Bösmüller H, Germing U, Gruber C, Nachtkamp K, Reinecke P, Sperr WR, Wimazal F, Müllauer L, Sotlar K, Horny HP, Tüchler H, Valent P, Krieger O. Prognostic impact of blast cell counts in dysplastic bone marrow disorders (MDS and CMML I) with concomitant fibrosis. Ann Hematol 2013; 93:57-64. [PMID: 24241126 DOI: 10.1007/s00277-013-1945-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 10/29/2013] [Indexed: 02/05/2023]
Abstract
In a retrospective study, 43 patients with dysplastic neoplasms of the bone marrow (myelodysplastic syndromes and myelodysplastic/myeloproliferative-overlap neoplasms) associated with marked (grades 2-3) fibrosis were examined. Histopathologic and morphologic findings as well as cytogenetic and molecular results were correlated with clinical endpoints. Multilineage dysplasia (34 of 43 patients, 79 %) and hypercellular bone marrow (64 %) were found in most patients. In ten of 35 patients, poor risk karyotypes according to the International Prognostic Scoring System (IPSS) were recorded. The JAK2 V617F mutation was detected in four of 30 patients (13 %), and the KIT D816V mutation was found in two of 30 patients (6 %). Patients were mainly treated with palliative drugs and best supportive care. After an observation time of 1-41 (median 21) months, ten of 43 patients (23 %) had developed a secondary acute leukemia. The median survival of all 43 patients was 21.4 months (range 1.8-88.2 months). Of all prognostic parameters examined, the blast cell count at diagnosis was found to be a most reliable and most predictive marker concerning survival and leukemia progression. This confirms previous studies in dysplastic bone marrow neoplasms without fibrosis.
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Affiliation(s)
- Sigrid Machherndl-Spandl
- Department of Hematology, Stem Cell Transplantation, Haemostaseology and Internal Oncology, KH Elisabethinen, Linz, Austria
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39
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Schanz J, Tüchler H, Solé F, Mallo M, Luño E, Cervera J, Grau J, Hildebrandt B, Slovak ML, Ohyashiki K, Steidl C, Fonatsch C, Pfeilstöcker M, Nösslinger T, Valent P, Giagounidis A, Aul C, Lübbert M, Stauder R, Krieger O, Le Beau MM, Bennett JM, Greenberg P, Germing U, Haase D. Monosomal karyotype in MDS: explaining the poor prognosis? Leukemia 2013; 27:1988-95. [PMID: 23787396 DOI: 10.1038/leu.2013.187] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 05/30/2013] [Accepted: 06/04/2013] [Indexed: 11/09/2022]
Abstract
Monosomal karyotype (MK) is associated with an adverse prognosis in patients in acute myeloid leukemia (AML). This study analyzes the prognostic impact of MK in a cohort of primary, untreated patients with myelodysplastic syndromes (MDS). A total of 431 patients were extracted from an international database. To analyze whether MK is an independent prognostic marker in MDS, cytogenetic and clinical data were explored in uni- and multivariate models regarding overall survival (OS) as well as AML-free survival. In all, 204/431 (47.3%) patients with MK were identified. Regarding OS, MK was prognostically significant in patients with ≤ 4 abnormalities only. In highly complex karyotypes (≥ 5 abnormalities), MK did not separate prognostic subgroups (median OS 4.9 months in MK+ vs 5.6 months in patients without MK, P=0.832). Based on the number of abnormalities, MK-positive karyotypes (MK+) split into different prognostic subgroups (MK+ and 2 abnormalities: OS 13.4 months, MK+ and 3 abnormalities: 8.0 months, MK+ and 4 abnormalities: 7.9 months and MK+ and ≥ 5 abnormalities: 4.9 months; P<0.01). In multivariate analyses, MK was not an independent prognostic factor. Our data support the hypothesis that a high number of complex abnormalities, associated with an instable clone, define the subgroup with the worst prognosis in MDS, independent of MK.
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Affiliation(s)
- J Schanz
- Department of Hematology and Oncology, University of Göttingen, Göttingen, Germany
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40
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Hoermann G, Cerny-Reiterer S, Sadovnik I, Müllauer L, Bilban M, Gröger M, Horny HP, Reiter A, Schmitt-Graeff A, Mannhalter C, Valent P, Mayerhofer M. Oncostatin M is a FIP1L1/PDGFRA-dependent mediator of cytokine production in chronic eosinophilic leukemia. Allergy 2013; 68:713-23. [PMID: 23621172 DOI: 10.1111/all.12139] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2013] [Indexed: 01/11/2023]
Abstract
BACKGROUND Chronic eosinophilic leukemia (CEL) is a myeloproliferative neoplasm characterized by expansion of neoplastic eosinophils, tissue infiltration, and organ damage. In a subset of these patients, the FIP1L1/PDGFRA (F/P) oncoprotein is detectable. F/P exhibits constitutive tyrosine kinase activity and activates a number of signaling pathways. So far, however, little is known about the role of F/P-dependent proteins in the pathogenesis of CEL. METHODS A screen for F/P-dependent cytokines was performed in growth factor-dependent human cell lines lentivirally transduced with F/P. Signal transduction pathways were characterized in Ba/F3 cells with doxycycline-inducible expression of F/P and in EOL-1 cells. Cytokine expression was confirmed in patients' material by immunohistochemistry, immunofluorescence, and confocal microscopy. Gene expression analysis, proliferation assays, and chemotaxis assays were used to elucidate paracrine interactions between neoplastic eosinophils and stromal cells. RESULTS We show that F/P upregulates expression of oncostatin M (OSM) in various cell line models in a STAT5-dependent manner. Correspondingly, neoplastic eosinophils in the bone marrow were found to overexpress OSM. OSM derived from F/P + cells stimulated proliferation of stromal cells. Moreover, OSM-containing supernatants from F/P + cells were found to upregulate production of stromal cell-derived factor-1 (SDF-1)/CXCL12 in human fibroblasts. SDF-1, in turn, induced migration of EOL-1 cells in a dose-dependent manner. CONCLUSIONS We have identified a F/P-driven paracrine interaction between neoplastic eosinophils and stromal cells that may contribute to tissue fibrosis and accumulation of neoplastic eosinophils in CEL.
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Affiliation(s)
- G. Hoermann
- Department of Laboratory Medicine; Medical University of Vienna; Vienna; Austria
| | | | - I. Sadovnik
- Department of Internal Medicine I; Division of Hematology and Hemostaseology; Medical University of Vienna; Vienna; Austria
| | - L. Müllauer
- Department of Pathology; Medical University of Vienna; Vienna; Austria
| | - M. Bilban
- Department of Laboratory Medicine; Medical University of Vienna; Vienna; Austria
| | | | - H.-P. Horny
- Institute of Pathology; Ludwig-Maximilians-University; Munich; Germany
| | - A. Reiter
- Medizinische Universitätsklinik; Universitätsmedizin Mannheim; Mannheim; Germany
| | - A. Schmitt-Graeff
- Department of Pathology; Freiburg University Medical Center; Albert-Ludwigs-University; Freiburg; Germany
| | - C. Mannhalter
- Department of Laboratory Medicine; Medical University of Vienna; Vienna; Austria
| | | | - M. Mayerhofer
- Department of Laboratory Medicine; Hanusch-Hospital; Vienna; Austria
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41
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Sekeres M, Ades L, Tuechler H, Sanz G, Levis A, Malcovati L, Cazzola M, Magalhães S, Luebbert M, Haase D, Schanz J, Cermak J, Garcia-Manero G, Sole F, Benett J, Bowen D, Dreyfus F, Kantarjian H, Kuendgen A, Fonatsch C, Le Beau M, Slovak M, Krieger O, Maciejewski J, Miyazaki Y, Pfeilstoecker M, Sperr W, Stauder R, Tauro S, Valent P, Vallespi T, Van de Loosdrecht A, Germing U, Fenaux P, Greenberg P. P-113 Revised International Prognostic Scoring System (IPSS-R) for primary treated myelodysplastic syndromes (MDS) patients: A report from the IWG-PM. Leuk Res 2013. [DOI: 10.1016/s0145-2126(13)70161-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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42
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Neukirchen J, Nachtkamp K, Pfeilstöcker M, Valent P, Stauder R, Blum S, Lübbert M, Haase D, Götze K, Hofmann W, Schlenk R, Giagounidis A, Aul C, Schulte K, Lipke J, Nusch A, Krieger O, Hegener P, Weik C, Letsch A, Platzbecker U, Kreutzer K, Kobbe G, Germing U. O-023 Did the prognosis of MDS patients improve during the last 30 years? Leuk Res 2013. [DOI: 10.1016/s0145-2126(13)70045-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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43
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Abstract
Mast cell activation (MCA) occurs in a number of different clinical conditions, including IgE-dependent allergies, other inflammatory reactions, and mastocytosis. MCA-related symptoms may be mild, moderate, severe, or even life-threatening. The severity of MCA depends on a number of different factors, including genetic predisposition, the number and releasability of mast cells involved in the reaction, the type of allergen, presence of specific IgE, and presence of certain comorbidities. In severe reactions, MCA can be documented by a substantial increase in the serum tryptase level above baseline. When symptoms are recurrent, are accompanied by an increase in mast cell-derived mediators in biological fluids, and are responsive to treatment with mast cell-stabilizing or mediator-targeting drugs, the diagnosis of mast cell activation syndrome (MCAS) is appropriate. Based on the underlying condition, these patients can further be classified into i) primary MCAS where KIT-mutated, clonal mast cells are detected, ii) secondary MCAS where an underlying inflammatory disease, often in the form of an IgE-dependent allergy, but no KIT-mutated mast cells, is found, and iii) idiopathic MCAS, where neither an allergy or other underlying disease, nor KIT-mutated mast cells are detectable. It is important to note that in many patients with MCAS, several different factors act together to lead to severe or even life-threatening anaphylaxis. Detailed knowledge about the pathogenesis and complexity of MCAS, and thus establishing the exact final diagnosis, may greatly help in the management and therapy of these patients.
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Affiliation(s)
- P. Valent
- Department of Internal Medicine I; Division of Hematology & Hemostaseology; Medical University of Vienna; Vienna; Austria
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44
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Twaroch TE, Focke M, Fleischmann K, Balic N, Lupinek C, Blatt K, Ferrara R, Mari A, Ebner C, Valent P, Spitzauer S, Swoboda I, Valenta R. Carrier-bound Alt a 1 peptides without allergenic activity for vaccination against Alternaria alternata allergy. Clin Exp Allergy 2013; 42:966-75. [PMID: 22909168 DOI: 10.1111/j.1365-2222.2012.03996.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND The mould Alternaria alternata is a major elicitor of allergic asthma. Diagnosis and specific immunotherapy (SIT) of Alternaria allergy are often limited by the insufficient quality of natural mould extracts. OBJECTIVE To investigate whether recombinant Alt a 1 can be used for reliable diagnosis of Alternaria alternata allergy and to develop a safe, non-allergenic vaccine for SIT of Alternaria allergy. METHODS The qualitative sensitization profile of 80 Alternaria-allergic patients from Austria and Italy was investigated using an allergen micro-array and the amount of Alternaria-specific IgE directed to rAlt a 1 was quantified by ImmunoCAP measurements. Peptides spanning regions of predicted high surface accessibility of Alt a 1 were synthesized and tested for IgE reactivity and allergenic activity, using sera and basophils from allergic patients. Carrier-bound peptides were studied for their ability to induce IgG antibodies in rabbits which recognize Alt a 1 and inhibit allergic patients' IgE reactivity to Alt a 1. RESULTS rAlt a 1 allowed diagnosis of Alternaria allergy in all tested patients, bound the vast majority (i.e. >95%) of Alternaria-specific IgE and elicited basophil activation already at a concentration of 0.1 ng/mL. Four non-allergenic peptides were synthesized which, after coupling to the carrier protein keyhole limpet hemocyanin, induced Alt a 1-specific IgG and inhibited allergic patients' IgE binding to Alt a 1. CONCLUSIONS AND CLINICAL RELEVANCE rAlt a 1 is a highly allergenic molecule allowing sensitive diagnosis of Alternaria allergy. Carrier-bound non-allergenic Alt a 1 peptides are candidates for safe SIT of Alternaria allergy.
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Affiliation(s)
- T E Twaroch
- Christian Doppler Laboratory for Allergy Research, Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
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45
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Abstract
Mastocytosis and myeloid eosinophilic neoplasms are rare diseases of the bone marrow and are often a diagnostic challenge for hematopathologists. In mastocytosis, compact mast cell infiltrates represent the main diagnostic criterion and for myeloid eosinophilic neoplasms, eosinophilic granulocytes dominate the histological picture. Both disease groups include phenotypically and prognostically very different entities which are each defined by WHO criteria. For systemic mastocytosis (SM), a differentiation between indolent and aggressive or even leukemic forms is of prognostic importance. In indolent variants of SM, a local and/or systemic, usually reactive increase in eosinophilic granulocytes (SM-eo) is often observed. In contrast, an increase in neoplastic eosinophils is often observed in advanced SM, predominantly in diseases designated SM with associated non-mastocytic hematological neoplasms (SM-AHNMD), e.g. in SM with chronic eosinophilic leukemia (SM-CEL). Apart from mastocytoses, immunophenotypically aberrant tissue mast cells are only observed in certain rare forms of myeloid neoplasms with eosinophilia, in particular in myeloproliferative neoplasms (MPN-eo) with cytogenic anomalies in the platelet-derived growth factor receptor (PDGFR). The World Health Organization (WHO) classification of eosinophilic leukemias, however, fulfils the morphological and clinical requirements in a limited way only and needs an update.
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MESH Headings
- Biopsy, Needle
- Bone Marrow/pathology
- Choristoma/pathology
- Cytogenetic Analysis
- Diagnosis, Differential
- Eosinophils/pathology
- Hypereosinophilic Syndrome/classification
- Hypereosinophilic Syndrome/diagnosis
- Hypereosinophilic Syndrome/genetics
- Hypereosinophilic Syndrome/pathology
- Immunophenotyping
- Leukemia, Mast-Cell/classification
- Leukemia, Mast-Cell/diagnosis
- Leukemia, Mast-Cell/genetics
- Leukemia, Mast-Cell/pathology
- Mast Cells/pathology
- Mastocytosis/classification
- Mastocytosis/diagnosis
- Mastocytosis/genetics
- Mastocytosis/pathology
- Mastocytosis, Systemic/classification
- Mastocytosis, Systemic/diagnosis
- Mastocytosis, Systemic/genetics
- Mastocytosis, Systemic/pathology
- Myelodysplastic-Myeloproliferative Diseases/classification
- Myelodysplastic-Myeloproliferative Diseases/diagnosis
- Myelodysplastic-Myeloproliferative Diseases/genetics
- Myelodysplastic-Myeloproliferative Diseases/pathology
- Prognosis
- Receptors, Platelet-Derived Growth Factor/genetics
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Affiliation(s)
- K Sotlar
- Pathologisches Institut, Ludwig-Maximilians-Universität München, Thalkirchner Str 36, 80337 München, Deutschland
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Hadzijusufovic E, Peter B, Herrmann H, Rülicke T, Cerny‐Reiterer S, Schuch K, Kenner L, Thaiwong T, Yuzbasiyan‐Gurkan V, Pickl WF, Willmann M, Valent P. NI-1: a novel canine mastocytoma model for studying drug resistance and IgER-dependent mast cell activation. Allergy 2012; 67:858-68. [PMID: 22583069 PMCID: PMC3401908 DOI: 10.1111/j.1398-9995.2012.02833.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2012] [Indexed: 12/18/2022]
Abstract
BACKGROUND Advanced mast cell (MC) disorders are characterized by uncontrolled growth of neoplastic MC in various organs, mediator-related symptoms, and a poor prognosis. Kit mutations supposedly contribute to abnormal growth and drug resistance in these patients. METHODS We established a novel canine mastocytoma cell line, NI-1, from a patient suffering from MC leukemia. RESULTS NI-1 cells were found to form mastocytoma lesions in NOD/SCID IL-2Rgamma(null) mice and to harbor several homozygous Kit mutations, including missense mutations at nucleotides 107(C→T) and 1187(A→G), a 12-bp duplication (nucleotide 1263), and a 12-bp deletion (nucleotide 1550). NI-1 cells expressed several MC differentiation antigens, including tryptase, Kit, and a functional IgE receptor. Compared to the C2 mastocytoma cell line harboring a Kit exon 11 mutation, NI-1 cells were found to be less responsive against the Kit tyrosine kinase inhibitors (TKI) masitinib and imatinib, but were even more sensitive against proliferation-inhibitory effects of the mammalian target of rapamycin (mTOR) blocker RAD001 and PI3-kinase/mTOR blocker NVP-BEZ235. The Kit-targeting multikinase inhibitors PKC412 and dasatinib were also found to override TKI resistance in NI-1 cells, and produced growth inhibition with reasonable IC(50) values (<0.1 μM). CONCLUSION NI-1 may serve as a useful tool to investigate IgE-dependent reactions and mechanisms of abnormal growth and drug resistance in neoplastic MC in advanced mastocytosis.
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Affiliation(s)
- E. Hadzijusufovic
- Department for Companion Animals and Horses Clinic for Internal Medicine and Infectious Diseases University of Veterinary Medicine Vienna Vienna Austria
- Division of Hematology & Hemostaseology Department of Internal Medicine I Medical University of Vienna Vienna Austria
- Ludwig Boltzmann Cluster Oncology Vienna Austria
| | - B. Peter
- Department for Companion Animals and Horses Clinic for Internal Medicine and Infectious Diseases University of Veterinary Medicine Vienna Vienna Austria
- Division of Hematology & Hemostaseology Department of Internal Medicine I Medical University of Vienna Vienna Austria
| | - H. Herrmann
- Ludwig Boltzmann Cluster Oncology Vienna Austria
| | - T. Rülicke
- Institute of Laboratory Animal Science University of Veterinary Medicine Vienna Vienna Austria
| | - S. Cerny‐Reiterer
- Division of Hematology & Hemostaseology Department of Internal Medicine I Medical University of Vienna Vienna Austria
| | - K. Schuch
- Institute of Immunology Medical University of Vienna Vienna Austria
| | - L. Kenner
- Clinical Institute of Pathology Medical University of Vienna Vienna Austria
- Ludwig Boltzmann Institute for Cancer Research Vienna Austria
| | - T. Thaiwong
- Comparative Medicine and Integrative Biology Program Michigan State University East Lansing MI USA
| | - V. Yuzbasiyan‐Gurkan
- Comparative Medicine and Integrative Biology Program Michigan State University East Lansing MI USA
| | - W. F. Pickl
- Institute of Immunology Medical University of Vienna Vienna Austria
| | - M. Willmann
- Department for Companion Animals and Horses Clinic for Internal Medicine and Infectious Diseases University of Veterinary Medicine Vienna Vienna Austria
| | - P. Valent
- Division of Hematology & Hemostaseology Department of Internal Medicine I Medical University of Vienna Vienna Austria
- Ludwig Boltzmann Cluster Oncology Vienna Austria
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Eckl-Dorna J, Ellinger A, Blatt K, Ghanim V, Steiner I, Pavelka M, Valent P, Valenta R, Niederberger V. Basophils are not the key antigen-presenting cells in allergic patients. Allergy 2012; 67:601-8. [PMID: 22335568 DOI: 10.1111/j.1398-9995.2012.02792.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND Recent data obtained in mouse models have initiated a controversy whether basophils are the key antigen-presenting cells (APCs) in allergy. Here, we investigate whether basophils are of importance for the presentation of allergen and the induction of T cell proliferation in allergic patients. METHODS T cells, basophils, and APCs depleted of basophils were purified from allergic patients. Co-culture systems based on purified major allergens were established to study allergen-specific T cell responses using proliferation assays. RESULTS Only co-cultures of T cells with APCs depleted of basophils but not with basophils proliferated in response to allergen. Even addition of IL-3 to T cell-basophil co-cultures failed to induce allergen-specific T cell proliferation. CONCLUSIONS Our data demonstrate by classical in vitro proliferation assays that basophils are not key antigen-presenting cells that promote T cell proliferation in secondary immune responses to allergen in allergic patients.
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Affiliation(s)
- J. Eckl-Dorna
- Department of Otorhinolaryngology; Medical University of Vienna, AKH; Vienna; Austria
| | - A. Ellinger
- Department of Cell Biology and Ultrastructure Research; Center for Anatomy and Cell Biology; Medical University of Vienna; Vienna; Austria
| | - K. Blatt
- Division of Hematology and Hemostaseology; Department of Internal Medicine I; Medical University of Vienna, AKH; Vienna; Austria
| | - V. Ghanim
- Division of Hematology and Hemostaseology; Department of Internal Medicine I; Medical University of Vienna, AKH; Vienna; Austria
| | - I. Steiner
- Center for Medical Statistics, Informatics, and Intelligent Systems; Medical University of Vienna; Vienna; Austria
| | - M. Pavelka
- Department of Cell Biology and Ultrastructure Research; Center for Anatomy and Cell Biology; Medical University of Vienna; Vienna; Austria
| | - P. Valent
- Division of Hematology and Hemostaseology; Department of Internal Medicine I; Medical University of Vienna, AKH; Vienna; Austria
| | - R. Valenta
- Division of Immunopathology; Department of Pathophysiology and Allergy Research; Center for Pathophysiology, Infectiology and Immunology; Medical University of Vienna, AKH; Vienna; Austria
| | - V. Niederberger
- Department of Otorhinolaryngology; Medical University of Vienna, AKH; Vienna; Austria
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48
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Chen KW, Focke-Tejkl M, Blatt K, Kneidinger M, Gieras A, Dall'Antonia F, Faé I, Fischer G, Keller W, Valent P, Valenta R, Vrtala S. Carrier-bound nonallergenic Der p 2 peptides induce IgG antibodies blocking allergen-induced basophil activation in allergic patients. Allergy 2012; 67:609-21. [PMID: 22339348 DOI: 10.1111/j.1398-9995.2012.02794.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND More than 90% of house dust mite-allergic patients are sensitized to the major Dermatophagoides pteronyssinus allergen, Der p 2. The aim of this study was to develop and characterize an allergy vaccine based on carrier-bound Der p 2 peptides, which should allow reducing IgE- and T-cell-mediated side-effects during specific immunotherapy (SIT). METHODS Five Der p 2 peptides (P1-P5) were synthesized and analyzed regarding IgE reactivity and allergenic activity. Lymphoproliferative and cytokine responses induced with Der p 2 and Der p 2 peptides were determined in peripheral blood mononuclear cells from mite-allergic patients. Der p 2-specific IgG antibodies induced with carrier-bound Der p 2 peptides in mice and rabbits were tested for their capacity to inhibit IgE binding and basophil activation in allergic patients. RESULTS Of five overlapping peptides (P1-P5) covering the Der p 2 sequence, two peptides (P2 and P4) were identified, which showed no relevant IgE reactivity, allergenic activity, and induced lower Der p 2-specific T-cell activation than Der p 2. However, when coupled to a carrier, P2 and P4 induced Der p 2-specific IgG antibodies in animals, which inhibited allergic patients' IgE binding to the allergen and allergen-induced basophil activation similar as antibodies induced with Der p 2. CONCLUSIONS Carrier-bound Der p 2 peptides should allow avoiding IgE-mediated side-effects, and because of their low potential to activate allergen-specific T cells, they may reduce late-phase side-effects during SIT. Further, these peptides may be also useful for prophylactic vaccination.
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Affiliation(s)
| | - M. Focke-Tejkl
- Christian Doppler Laboratory for Allergy Research; Division of Immunopathology; Department of Pathophysiology and Allergy Research; Medical University of Vienna; Vienna; Austria
| | - K. Blatt
- Division of Hematology and Hemostaseology; Department of Internal Medicine I; Medical University of Vienna; Vienna; Austria
| | - M. Kneidinger
- Division of Hematology and Hemostaseology; Department of Internal Medicine I; Medical University of Vienna; Vienna; Austria
| | - A. Gieras
- Christian Doppler Laboratory for Allergy Research; Division of Immunopathology; Department of Pathophysiology and Allergy Research; Medical University of Vienna; Vienna; Austria
| | - F. Dall'Antonia
- Division of Structural Biology; Institute of Molecular Biosciences; Karl-Franzens-University; Graz; Austria
| | - I. Faé
- Department of Blood Group Serology; Medical University of Vienna; Vienna
| | - G. Fischer
- Department of Blood Group Serology; Medical University of Vienna; Vienna
| | - W. Keller
- Division of Structural Biology; Institute of Molecular Biosciences; Karl-Franzens-University; Graz; Austria
| | - P. Valent
- Division of Hematology and Hemostaseology; Department of Internal Medicine I; Medical University of Vienna; Vienna; Austria
| | | | - S. Vrtala
- Division of Immunopathology; Department of Pathophysiology and Allergy Research; Center for Pathophysiology, Infectiology and Immunology; Medical University of Vienna; Vienna; Austria
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49
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Horny HP, Sotlar K, Valent P. Evaluation of mast cell activation syndromes: impact of pathology and immunohistology. Int Arch Allergy Immunol 2012; 159:1-5. [PMID: 22555026 DOI: 10.1159/000336374] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Mast cell activation syndromes (MCAS) are clinically defined disease states with a largely unknown morphological background. Since mastocytosis may be associated with MCAS, it is crucial in every patient to document or exclude mastocytosis by appropriate histological, molecular, and serological investigations of tissues/organs that are commonly involved in mastocytosis like skin, mucosa of the gastrointestinal tract and bone marrow. Accordingly, histopathological investigation including immunohistological stains is crucial to reach the final diagnosis in such patients and to classify MCAS into primary MCAS, which can present with or without evidence of overt mastocytosis, or secondary MCAS, where an underlying disease with or without tissue inflammation is detected. Cases without evidence of mastocytosis, monoclonal mast cells, or any underlying disease should be termed idiopathic MCAS. When the activating point mutant KIT D816V is detectable but criteria for diagnosis of mastocytosis are not completely met, a so-called (mono)clonal MCAS as a subvariant of primary MCAS should be diagnosed.
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Affiliation(s)
- H-P Horny
- Institute of Pathology, Ludwig-Maximilians-University, Munich, Germany.
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50
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Westers TM, Ireland R, Kern W, Alhan C, Balleisen JS, Bettelheim P, Burbury K, Cullen M, Cutler JA, Della Porta MG, Dräger AM, Feuillard J, Font P, Germing U, Haase D, Johansson U, Kordasti S, Loken MR, Malcovati L, te Marvelde JG, Matarraz S, Milne T, Moshaver B, Mufti GJ, Ogata K, Orfao A, Porwit A, Psarra K, Richards SJ, Subirá D, Tindell V, Vallespi T, Valent P, van der Velden VHJ, de Witte TM, Wells DA, Zettl F, Béné MC, van de Loosdrecht AA. Standardization of flow cytometry in myelodysplastic syndromes: a report from an international consortium and the European LeukemiaNet Working Group. Leukemia 2012; 26:1730-41. [PMID: 22307178 DOI: 10.1038/leu.2012.30] [Citation(s) in RCA: 181] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Flow cytometry (FC) is increasingly recognized as an important tool in the diagnosis and prognosis of myelodysplastic syndromes (MDS). However, validation of current assays and agreement upon the techniques are prerequisites for its widespread acceptance and application in clinical practice. Therefore, a working group was initiated (Amsterdam, 2008) to discuss and propose standards for FC in MDS. In 2009 and 2010, representatives from 23, mainly European, institutes participated in the second and third European LeukemiaNet (ELN) MDS workshops. In the present report, minimal requirements to analyze dysplasia are refined. The proposed core markers should enable a categorization of FC results in cytopenic patients as 'normal', 'suggestive of', or 'diagnostic of' MDS. An FC report should include a description of validated FC abnormalities such as aberrant marker expression on myeloid progenitors and, furthermore, dysgranulopoiesis and/or dysmonocytopoiesis, if at least two abnormalities are evidenced. The working group is dedicated to initiate further studies to establish robust diagnostic and prognostic FC panels in MDS. An ultimate goal is to refine and improve diagnosis and prognostic scoring systems. Finally, the working group stresses that FC should be part of an integrated diagnosis rather than a separate technique.
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Affiliation(s)
- T M Westers
- Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands
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