A subgroup of patients with unmutated IgHV 1-69; 3-30; 1-02; 4-39 and high expression of AID enzyme require earlier treatment
Resumen:
Chronic lymphocytic leukemia (CLL) is characterized by its clinical and molecular heterogeneity. The practical challenge presented by this diverse landscape is the difficulty in predicting leukemia progression. Despite extensive efforts employing various clinical and/or molecular prognostic tools, accurate prediction of disease progression remains elusive for a significant number of patients. Our group and others described that activation-induced cytidine deaminase (AID) is abnormally expressed in the peripheral blood (PB) of patients with poor clinical outcomes, predominantly in unmutated cases (U-CLL). This enzyme is necessary to initiate somatic hypermutation (SHM) and class-switch recombination process in B- lymphocytes. Additionally, deamination of “off-target” genes by AID can result in oncogenic mutations or translocations. Nevertheless, the role of this enzyme in the origins and evolution of CLL as well as why AID is predominantly expressed in U-CLL, remains a topic of ongoing debate. Previous studies from our laboratory demonstrated the loss of superantigenic and polyreactive binding of B-cell receptor (BCR) following SHM, (Oppezzo et al., 2004 EJI). Furthermore, findings from (Hervé et al. 2005, JCI), provide evidence that both U-CLLs and M-CLLs may originate from self-reactive B cell precursors. Collectively, these studies highlight SHM as a pivotal process in the origins/development of B-cell lymphoid neoplasms by altering the original autoreactivity of the BCR. Based on this concept, we hypothesize that the absence of SHM in U-CLL may result in continuous BCR stimulation and constitutive AID expression, contributing to a poorer clinical outcome. In this work, we characterized CLL patients based on AID expression in PB, its association with immunoglobulin heavy chain gene (IgVH) status/use and disease progression, assessed as time to first treatment (TTFT). PB samples were collected from patients meeting the clinical/immunophenotypic criteria for CLL, following the iwCLL guidelines. The cohort included 279 patients from Uruguay and 33 from Argentina. Written informed consent was obtained, and the study was approved by the Institutional Ethics Committees of each institution. Peripheral blood mononuclear cells were isolated using Ficoll-Hypaque, and RNA extraction and cDNA synthesis performed. From 312 studied cases, 56% were Binet's stage A, 23% were stage B, and 21% were stage C. The IgHV gene status was mutated in 52% of cases, cytogenetic aberrations were observed in 70.5% of patients, including 13q14_deletion (36.5%), trisomy_12 (13%), 11q22_deletion (9.7%), and 17p_deletion (8.3%). The median age at diagnosis was 66 years old, and the median follow-up was 5 years. Our results identify a novel CLL subgroup characterized by clonal expression of an unmutated BCR with specific rearrangements (IgHV_1-02, 1-69, 3-30, 4-39), high expression of AID enzyme and earlier treatment. Moreover, our results suggest that AID expression in U-CLL could be linked with antigen restriction and clinical outcome. This subset constitutes approximately 38% of the U-CLL (15% of the total cohort) and can be identified in advance by integrating AID mRNA expression and IgVH profile assessment into routine testing. We propose a new and practical prognostic tool, assessed in PB, which enables the identification of a novel CLL entity requiring early treatment initiation, typically within the first year.
| 2024 | |
| Agencia Nacional de Investigación e Innovación | |
|
Leucemia Linfoide Crónica Citidina deaminasa Inducida por Activación (AID) Ciencias Médicas y de la Salud Medicina Básica Inmunología Medicina Clínica Hematología |
|
| Inglés | |
| Institut Pasteur de Montevideo | |
| IPMON en REDI | |
|
https://hdl.handle.net/20.500.12381/3878
https://lag-cll2024.opc.uy/en/trabajos?area=&numero=&search |
|
| Acceso abierto | |
| Reconocimiento 4.0 Internacional. (CC BY) |
| _version_ | 1876566459748974592 |
|---|---|
| author | Souto, Jorge |
| author2 | Landoni, Ana Ines Remedi, Victoria dos Santos, Gimena Oliver, Carolina Irigoin, Victoria Lema, Virginia Ranero, Sabrina Stanganelli, Carmen Puelma, Jorge Gonzales Payque, Eugenia Uria, Rita Querol, Juliana Marquez, Maria Elena de Galvez, Gabriela Pierri, Silvia Kollar, Patricia Stevenazzi, Mariana Moro, Isabel Viana, Marcelo Naya, Hugo Slavutsky, Irma Diaz, Lilian Kescherman, Francis Muxi, Pablo Grille, Sofia Guillermo, Cecilia Lassus, Mercedes Dighiero, Guillermo Gabus, Raúl Palacios, Florencia Navarrete, Marcelo Oppezzo, Pablo |
| author2_role | author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author |
| author_facet | Souto, Jorge Landoni, Ana Ines Remedi, Victoria dos Santos, Gimena Oliver, Carolina Irigoin, Victoria Lema, Virginia Ranero, Sabrina Stanganelli, Carmen Puelma, Jorge Gonzales Payque, Eugenia Uria, Rita Querol, Juliana Marquez, Maria Elena de Galvez, Gabriela Pierri, Silvia Kollar, Patricia Stevenazzi, Mariana Moro, Isabel Viana, Marcelo Naya, Hugo Slavutsky, Irma Diaz, Lilian Kescherman, Francis Muxi, Pablo Grille, Sofia Guillermo, Cecilia Lassus, Mercedes Dighiero, Guillermo Gabus, Raúl Palacios, Florencia Navarrete, Marcelo Oppezzo, Pablo |
| author_role | author |
| bitstream.checksum.fl_str_mv | 710ccfef5cb01d54b75d1d847d6b6b7b 12514d99af289a611f93947fc960dac6 |
| bitstream.checksumAlgorithm.fl_str_mv | MD5 MD5 |
| bitstream.url.fl_str_mv | https://redi.anii.org.uy/jspui/bitstream/20.500.12381/3878/2/license.txt https://redi.anii.org.uy/jspui/bitstream/20.500.12381/3878/1/5thLAG-CLL.pdf |
| collection | IPMON en REDI |
| dc.creator.none.fl_str_mv | Souto, Jorge Landoni, Ana Ines Remedi, Victoria dos Santos, Gimena Oliver, Carolina Irigoin, Victoria Lema, Virginia Ranero, Sabrina Stanganelli, Carmen Puelma, Jorge Gonzales Payque, Eugenia Uria, Rita Querol, Juliana Marquez, Maria Elena de Galvez, Gabriela Pierri, Silvia Kollar, Patricia Stevenazzi, Mariana Moro, Isabel Viana, Marcelo Naya, Hugo Slavutsky, Irma Diaz, Lilian Kescherman, Francis Muxi, Pablo Grille, Sofia Guillermo, Cecilia Lassus, Mercedes Dighiero, Guillermo Gabus, Raúl Palacios, Florencia Navarrete, Marcelo Oppezzo, Pablo |
| dc.date.accessioned.none.fl_str_mv | 2025-02-25T17:06:29Z |
| dc.date.available.none.fl_str_mv | 2025-02-25T17:06:29Z |
| dc.date.issued.none.fl_str_mv | 2024-11 |
| dc.description.abstract.none.fl_txt_mv | Chronic lymphocytic leukemia (CLL) is characterized by its clinical and molecular heterogeneity. The practical challenge presented by this diverse landscape is the difficulty in predicting leukemia progression. Despite extensive efforts employing various clinical and/or molecular prognostic tools, accurate prediction of disease progression remains elusive for a significant number of patients. Our group and others described that activation-induced cytidine deaminase (AID) is abnormally expressed in the peripheral blood (PB) of patients with poor clinical outcomes, predominantly in unmutated cases (U-CLL). This enzyme is necessary to initiate somatic hypermutation (SHM) and class-switch recombination process in B- lymphocytes. Additionally, deamination of “off-target” genes by AID can result in oncogenic mutations or translocations. Nevertheless, the role of this enzyme in the origins and evolution of CLL as well as why AID is predominantly expressed in U-CLL, remains a topic of ongoing debate. Previous studies from our laboratory demonstrated the loss of superantigenic and polyreactive binding of B-cell receptor (BCR) following SHM, (Oppezzo et al., 2004 EJI). Furthermore, findings from (Hervé et al. 2005, JCI), provide evidence that both U-CLLs and M-CLLs may originate from self-reactive B cell precursors. Collectively, these studies highlight SHM as a pivotal process in the origins/development of B-cell lymphoid neoplasms by altering the original autoreactivity of the BCR. Based on this concept, we hypothesize that the absence of SHM in U-CLL may result in continuous BCR stimulation and constitutive AID expression, contributing to a poorer clinical outcome. In this work, we characterized CLL patients based on AID expression in PB, its association with immunoglobulin heavy chain gene (IgVH) status/use and disease progression, assessed as time to first treatment (TTFT). PB samples were collected from patients meeting the clinical/immunophenotypic criteria for CLL, following the iwCLL guidelines. The cohort included 279 patients from Uruguay and 33 from Argentina. Written informed consent was obtained, and the study was approved by the Institutional Ethics Committees of each institution. Peripheral blood mononuclear cells were isolated using Ficoll-Hypaque, and RNA extraction and cDNA synthesis performed. From 312 studied cases, 56% were Binet's stage A, 23% were stage B, and 21% were stage C. The IgHV gene status was mutated in 52% of cases, cytogenetic aberrations were observed in 70.5% of patients, including 13q14_deletion (36.5%), trisomy_12 (13%), 11q22_deletion (9.7%), and 17p_deletion (8.3%). The median age at diagnosis was 66 years old, and the median follow-up was 5 years. Our results identify a novel CLL subgroup characterized by clonal expression of an unmutated BCR with specific rearrangements (IgHV_1-02, 1-69, 3-30, 4-39), high expression of AID enzyme and earlier treatment. Moreover, our results suggest that AID expression in U-CLL could be linked with antigen restriction and clinical outcome. This subset constitutes approximately 38% of the U-CLL (15% of the total cohort) and can be identified in advance by integrating AID mRNA expression and IgVH profile assessment into routine testing. We propose a new and practical prognostic tool, assessed in PB, which enables the identification of a novel CLL entity requiring early treatment initiation, typically within the first year. |
| dc.description.sponsorship.none.fl_txt_mv | Agencia Nacional de Investigación e Innovación |
| dc.identifier.anii.es.fl_str_mv | FCE_1_2021_1_166493 |
| dc.identifier.uri.none.fl_str_mv | https://hdl.handle.net/20.500.12381/3878 |
| dc.identifier.url.none.fl_str_mv | https://lag-cll2024.opc.uy/en/trabajos?area=&numero=&search |
| dc.language.iso.none.fl_str_mv | eng |
| dc.rights.*.fl_str_mv | Acceso abierto |
| dc.rights.license.none.fl_str_mv | Reconocimiento 4.0 Internacional. (CC BY) |
| dc.rights.none.fl_str_mv | info:eu-repo/semantics/openAccess |
| dc.source.es.fl_str_mv | 5th Latin-American group on CLL_2024 (LAG-CLL) |
| dc.source.none.fl_str_mv | reponame:IPMON en REDI instname:Institut Pasteur de Montevideo instacron:Institut Pasteur de Montevideo |
| dc.subject.anii.none.fl_str_mv | Ciencias Médicas y de la Salud Medicina Básica Inmunología Medicina Clínica Hematología |
| dc.subject.es.fl_str_mv | Leucemia Linfoide Crónica Citidina deaminasa Inducida por Activación (AID) |
| dc.title.none.fl_str_mv | A subgroup of patients with unmutated IgHV 1-69; 3-30; 1-02; 4-39 and high expression of AID enzyme require earlier treatment |
| dc.type.es.fl_str_mv | Documento de conferencia |
| dc.type.none.fl_str_mv | info:eu-repo/semantics/conferenceObject |
| dc.type.version.es.fl_str_mv | Aceptado |
| dc.type.version.none.fl_str_mv | info:eu-repo/semantics/acceptedVersion |
| description | Chronic lymphocytic leukemia (CLL) is characterized by its clinical and molecular heterogeneity. The practical challenge presented by this diverse landscape is the difficulty in predicting leukemia progression. Despite extensive efforts employing various clinical and/or molecular prognostic tools, accurate prediction of disease progression remains elusive for a significant number of patients. Our group and others described that activation-induced cytidine deaminase (AID) is abnormally expressed in the peripheral blood (PB) of patients with poor clinical outcomes, predominantly in unmutated cases (U-CLL). This enzyme is necessary to initiate somatic hypermutation (SHM) and class-switch recombination process in B- lymphocytes. Additionally, deamination of “off-target” genes by AID can result in oncogenic mutations or translocations. Nevertheless, the role of this enzyme in the origins and evolution of CLL as well as why AID is predominantly expressed in U-CLL, remains a topic of ongoing debate. Previous studies from our laboratory demonstrated the loss of superantigenic and polyreactive binding of B-cell receptor (BCR) following SHM, (Oppezzo et al., 2004 EJI). Furthermore, findings from (Hervé et al. 2005, JCI), provide evidence that both U-CLLs and M-CLLs may originate from self-reactive B cell precursors. Collectively, these studies highlight SHM as a pivotal process in the origins/development of B-cell lymphoid neoplasms by altering the original autoreactivity of the BCR. Based on this concept, we hypothesize that the absence of SHM in U-CLL may result in continuous BCR stimulation and constitutive AID expression, contributing to a poorer clinical outcome. In this work, we characterized CLL patients based on AID expression in PB, its association with immunoglobulin heavy chain gene (IgVH) status/use and disease progression, assessed as time to first treatment (TTFT). PB samples were collected from patients meeting the clinical/immunophenotypic criteria for CLL, following the iwCLL guidelines. The cohort included 279 patients from Uruguay and 33 from Argentina. Written informed consent was obtained, and the study was approved by the Institutional Ethics Committees of each institution. Peripheral blood mononuclear cells were isolated using Ficoll-Hypaque, and RNA extraction and cDNA synthesis performed. From 312 studied cases, 56% were Binet's stage A, 23% were stage B, and 21% were stage C. The IgHV gene status was mutated in 52% of cases, cytogenetic aberrations were observed in 70.5% of patients, including 13q14_deletion (36.5%), trisomy_12 (13%), 11q22_deletion (9.7%), and 17p_deletion (8.3%). The median age at diagnosis was 66 years old, and the median follow-up was 5 years. Our results identify a novel CLL subgroup characterized by clonal expression of an unmutated BCR with specific rearrangements (IgHV_1-02, 1-69, 3-30, 4-39), high expression of AID enzyme and earlier treatment. Moreover, our results suggest that AID expression in U-CLL could be linked with antigen restriction and clinical outcome. This subset constitutes approximately 38% of the U-CLL (15% of the total cohort) and can be identified in advance by integrating AID mRNA expression and IgVH profile assessment into routine testing. We propose a new and practical prognostic tool, assessed in PB, which enables the identification of a novel CLL entity requiring early treatment initiation, typically within the first year. |
| eu_rights_str_mv | openAccess |
| format | conferenceObject |
| id | IPMON_e2a432b59dd7bdea00ff81d2697edf3c |
| identifier_str_mv | FCE_1_2021_1_166493 |
| instacron_str | Institut Pasteur de Montevideo |
| institution | Institut Pasteur de Montevideo |
| instname_str | Institut Pasteur de Montevideo |
| language | eng |
| network_acronym_str | IPMON |
| network_name_str | IPMON en REDI |
| oai_identifier_str | oai:redi.anii.org.uy:20.500.12381/3878 |
| publishDate | 2024 |
| reponame_str | IPMON en REDI |
| repository.mail.fl_str_mv | msarroca@pasteur.edu.uy |
| repository.name.fl_str_mv | IPMON en REDI - Institut Pasteur de Montevideo |
| repository_id_str | 9421_2 |
| rights_invalid_str_mv | Reconocimiento 4.0 Internacional. (CC BY) Acceso abierto |
| spelling | Reconocimiento 4.0 Internacional. (CC BY)Acceso abiertoinfo:eu-repo/semantics/openAccess2025-02-25T17:06:29Z2025-02-25T17:06:29Z2024-11https://hdl.handle.net/20.500.12381/3878FCE_1_2021_1_166493https://lag-cll2024.opc.uy/en/trabajos?area=&numero=&searchChronic lymphocytic leukemia (CLL) is characterized by its clinical and molecular heterogeneity. The practical challenge presented by this diverse landscape is the difficulty in predicting leukemia progression. Despite extensive efforts employing various clinical and/or molecular prognostic tools, accurate prediction of disease progression remains elusive for a significant number of patients. Our group and others described that activation-induced cytidine deaminase (AID) is abnormally expressed in the peripheral blood (PB) of patients with poor clinical outcomes, predominantly in unmutated cases (U-CLL). This enzyme is necessary to initiate somatic hypermutation (SHM) and class-switch recombination process in B- lymphocytes. Additionally, deamination of “off-target” genes by AID can result in oncogenic mutations or translocations. Nevertheless, the role of this enzyme in the origins and evolution of CLL as well as why AID is predominantly expressed in U-CLL, remains a topic of ongoing debate. Previous studies from our laboratory demonstrated the loss of superantigenic and polyreactive binding of B-cell receptor (BCR) following SHM, (Oppezzo et al., 2004 EJI). Furthermore, findings from (Hervé et al. 2005, JCI), provide evidence that both U-CLLs and M-CLLs may originate from self-reactive B cell precursors. Collectively, these studies highlight SHM as a pivotal process in the origins/development of B-cell lymphoid neoplasms by altering the original autoreactivity of the BCR. Based on this concept, we hypothesize that the absence of SHM in U-CLL may result in continuous BCR stimulation and constitutive AID expression, contributing to a poorer clinical outcome. In this work, we characterized CLL patients based on AID expression in PB, its association with immunoglobulin heavy chain gene (IgVH) status/use and disease progression, assessed as time to first treatment (TTFT). PB samples were collected from patients meeting the clinical/immunophenotypic criteria for CLL, following the iwCLL guidelines. The cohort included 279 patients from Uruguay and 33 from Argentina. Written informed consent was obtained, and the study was approved by the Institutional Ethics Committees of each institution. Peripheral blood mononuclear cells were isolated using Ficoll-Hypaque, and RNA extraction and cDNA synthesis performed. From 312 studied cases, 56% were Binet's stage A, 23% were stage B, and 21% were stage C. The IgHV gene status was mutated in 52% of cases, cytogenetic aberrations were observed in 70.5% of patients, including 13q14_deletion (36.5%), trisomy_12 (13%), 11q22_deletion (9.7%), and 17p_deletion (8.3%). The median age at diagnosis was 66 years old, and the median follow-up was 5 years. Our results identify a novel CLL subgroup characterized by clonal expression of an unmutated BCR with specific rearrangements (IgHV_1-02, 1-69, 3-30, 4-39), high expression of AID enzyme and earlier treatment. Moreover, our results suggest that AID expression in U-CLL could be linked with antigen restriction and clinical outcome. This subset constitutes approximately 38% of the U-CLL (15% of the total cohort) and can be identified in advance by integrating AID mRNA expression and IgVH profile assessment into routine testing. We propose a new and practical prognostic tool, assessed in PB, which enables the identification of a novel CLL entity requiring early treatment initiation, typically within the first year.Agencia Nacional de Investigación e Innovacióneng5th Latin-American group on CLL_2024 (LAG-CLL)reponame:IPMON en REDIinstname:Institut Pasteur de Montevideoinstacron:Institut Pasteur de MontevideoLeucemia Linfoide CrónicaCitidina deaminasa Inducida por Activación (AID)Ciencias Médicas y de la SaludMedicina BásicaInmunologíaMedicina ClínicaHematologíaA subgroup of patients with unmutated IgHV 1-69; 3-30; 1-02; 4-39 and high expression of AID enzyme require earlier treatmentDocumento de conferenciaAceptadoinfo:eu-repo/semantics/acceptedVersioninfo:eu-repo/semantics/conferenceObjectInstitut Pasteur de MontevideoAdministración de Servicios de Salud del Estado, Hospital MacielUniversidad de Magallanes. Punta Arenas, Chile.Centro Asistencial del Sindicato Médico del UruguayUniversidad de la República, Facultad de Medicina, Hospital de ClínicasHospital BritánicoCOSEM, Departamento de HematologíaServicio Médico IntegralCONICET, Academia Nacional de Medicina, Argentina.Administración de Servicios de Salud del Estado, Hospital de Rocha, Servicio de Hematología, UE 027Universidad de la República, Facultad de AgronomíaHospital Central de las Fuerzas Armadas (FFAA), Departamento de Hematología//Ciencias Médicas y de la Salud/Medicina Básica/Inmunología//Ciencias Médicas y de la Salud/Medicina Clínica/HematologíaSouto, JorgeLandoni, Ana InesRemedi, Victoriados Santos, GimenaOliver, CarolinaIrigoin, VictoriaLema, VirginiaRanero, SabrinaStanganelli, CarmenPuelma, Jorge GonzalesPayque, EugeniaUria, RitaQuerol, JulianaMarquez, Maria Elenade Galvez, GabrielaPierri, SilviaKollar, PatriciaStevenazzi, MarianaMoro, IsabelViana, MarceloNaya, HugoSlavutsky, IrmaDiaz, LilianKescherman, FrancisMuxi, PabloGrille, SofiaGuillermo, CeciliaLassus, MercedesDighiero, GuillermoGabus, RaúlPalacios, FlorenciaNavarrete, MarceloOppezzo, PabloLICENSElicense.txtlicense.txttext/plain; charset=utf-85124https://redi.anii.org.uy/jspui/bitstream/20.500.12381/3878/2/license.txt710ccfef5cb01d54b75d1d847d6b6b7bMD52ORIGINAL5thLAG-CLL.pdf5thLAG-CLL.pdfPoster aceptado en el 5th LAG-CLL_2024application/pdf422709https://redi.anii.org.uy/jspui/bitstream/20.500.12381/3878/1/5thLAG-CLL.pdf12514d99af289a611f93947fc960dac6MD5120.500.12381/38782025-02-25 14:06:31.217oai:redi.anii.org.uy:20.500.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científico-tecnológicohttps://pasteur.uy/https://redi.anii.org.uy/oai/requestmsarroca@pasteur.edu.uyUruguayopendoar:9421_22025-02-25T17:06:31IPMON en REDI - Institut Pasteur de Montevideofalse |
| spellingShingle | A subgroup of patients with unmutated IgHV 1-69; 3-30; 1-02; 4-39 and high expression of AID enzyme require earlier treatment Souto, Jorge Leucemia Linfoide Crónica Citidina deaminasa Inducida por Activación (AID) Ciencias Médicas y de la Salud Medicina Básica Inmunología Medicina Clínica Hematología |
| status_str | acceptedVersion |
| title | A subgroup of patients with unmutated IgHV 1-69; 3-30; 1-02; 4-39 and high expression of AID enzyme require earlier treatment |
| title_full | A subgroup of patients with unmutated IgHV 1-69; 3-30; 1-02; 4-39 and high expression of AID enzyme require earlier treatment |
| title_fullStr | A subgroup of patients with unmutated IgHV 1-69; 3-30; 1-02; 4-39 and high expression of AID enzyme require earlier treatment |
| title_full_unstemmed | A subgroup of patients with unmutated IgHV 1-69; 3-30; 1-02; 4-39 and high expression of AID enzyme require earlier treatment |
| title_short | A subgroup of patients with unmutated IgHV 1-69; 3-30; 1-02; 4-39 and high expression of AID enzyme require earlier treatment |
| title_sort | A subgroup of patients with unmutated IgHV 1-69; 3-30; 1-02; 4-39 and high expression of AID enzyme require earlier treatment |
| topic | Leucemia Linfoide Crónica Citidina deaminasa Inducida por Activación (AID) Ciencias Médicas y de la Salud Medicina Básica Inmunología Medicina Clínica Hematología |
| url | https://hdl.handle.net/20.500.12381/3878 https://lag-cll2024.opc.uy/en/trabajos?area=&numero=&search |