1 557 126 B-CELL ANTIGEN RECEPTOR SIGNALING IN CHRONIC LYMPHOCYTIC LEUKEMIA: THERAPEUTIC TARGETS AND TRANSLATIONAL OPPORTUNITIES. B-CELL CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) IS CHARACTERIZED BY CLONALLY EXPANDED AND MOLECULARLY HETEROGENEOUS POPULATIONS OF B LYMPHOCYTES WITH IMPAIRED APOPTOTIC MECHANISMS. THIS OCCURS AS A RESULT OF MULTIPLE GENETIC AND EPIGENETIC ABNORMALITIES, INCLUDING CHROMOSOMAL ABERRATIONS AND ENHANCER REGION HYPOMETHYLATION, OFTEN IMPINGING ON INTRACELLULAR SIGNALING PATHWAYS THAT ARE ESSENTIAL TO NORMAL B-CELL ACTIVATION, PROLIFERATION, AND SURVIVAL. THE B-CELL ANTIGEN RECEPTOR (BCR) SIGNALING IS ONE SUCH PATHWAY USURPED BY MALIGNANT B CELLS, AS EXEMPLIFIED BY THE EARLY PHASE CLINICAL SUCCESS ACHIEVED BY SMALL-MOLECULE AGENTS TARGETING KEY PLAYERS INVOLVED IN THE PATHWAY. SUCH NEW TARGETED AGENTS, INCLUDING THOSE THAT INHIBIT THE FUNCTION OF SPLEEN TYROSINE KINASE (SYK), BRUTON'S TYROSINE KINASE (BTK), PHOSPHATIDYLINOSITOL 3-KINASES (PI3K), AND B-CELL LYMPHOMA 2 (BCL-2), ALONG WITH THE CURRENT STANDARD THERAPY COMPRISING CHEMO-IMMUNOTHERAPIES WITH OR WITHOUT B-CELL DEPLETING BIOLOGIC AGENT RITUXIMAB (ANTI-CD20 MONOCLONAL ANTIBODY), SHOULD EXPAND THE ARMAMENTARIUM FOR CLL THERAPY. WE REVIEW THE THERAPEUTIC AGENTS CURRENTLY IN CLINICAL DEVELOPMENT WHICH TARGET DIFFERENT EFFECTORS OF THE MALIGNANT BCR SIGNALING, AND DISCUSS THEIR OVERLAPPING AND DISCRIMINATING TRANSLATIONAL OPPORTUNITIES IN THE CONTEXT OF CLL TREATMENT. 2013 2 4874 39 OVERCOMING ACQUIRED EPIGENETIC RESISTANCE TO BTK INHIBITORS. THE USE OF BRUTON TYROSINE KINASE (BTK) INHIBITORS TO BLOCK B-CELL RECEPTOR (BCR)-DEPENDENT NF-KAPPAB ACTIVATION IN LYMPHOID MALIGNANCIES HAS BEEN A MAJOR CLINICAL ADVANCE, YET ACQUIRED THERAPEUTIC RESISTANCE IS A RECURRING PROBLEM. WE MODELED THE DEVELOPMENT OF RESISTANCE TO THE BTK INHIBITOR IBRUTINIB IN THE ACTIVATED B-CELL (ABC) SUBTYPE OF DIFFUSE LARGE B-CELL LYMPHOMA, WHICH RELIES ON CHRONIC ACTIVE BCR SIGNALING FOR SURVIVAL. THE PRIMARY MODE OF RESISTANCE WAS EPIGENETIC, DRIVEN IN PART BY THE TRANSCRIPTION FACTOR TCF4. THE RESULTANT PHENOTYPIC SHIFT ALTERED BCR SIGNALING SUCH THAT THE GTPASE RAC2 SUBSTITUTED FOR BTK IN THE ACTIVATION OF PHOSPHOLIPASE CGAMMA2, THEREBY SUSTAINING NF-KAPPAB ACTIVITY. THE INTERACTION OF RAC2 WITH PHOSPHOLIPASE CGAMMA2 WAS ALSO INCREASED IN CHRONIC LYMPHOCYTIC LEUKEMIA CELLS FROM PATIENTS WITH PERSISTENT OR PROGRESSIVE DISEASE ON BTK INHIBITOR TREATMENT. WE IDENTIFIED CLINICALLY AVAILABLE DRUGS THAT CAN TREAT EPIGENETIC IBRUTINIB RESISTANCE, SUGGESTING COMBINATION THERAPEUTIC STRATEGIES. SIGNIFICANCE: IN DIFFUSE LARGE B-CELL LYMPHOMA, WE SHOW THAT PRIMARY RESISTANCE TO BTK INHIBITORS IS DUE TO EPIGENETIC RATHER THAN GENETIC CHANGES THAT CIRCUMVENT THE BTK BLOCKADE. WE ALSO OBSERVED THIS RESISTANCE MECHANISM IN CHRONIC LYMPHOCYTIC LEUKEMIA, SUGGESTING THAT EPIGENETIC ALTERATIONS MAY CONTRIBUTE MORE TO BTK INHIBITOR RESISTANCE THAN CURRENTLY THOUGHT.SEE RELATED COMMENTARY BY PASQUALUCCI, P. 555. THIS ARTICLE IS HIGHLIGHTED IN THE IN THIS ISSUE FEATURE, P. 549. 2021 3 5229 29 PRO-APOPTOTIC TP53 HOMOLOG TAP63 IS REPRESSED VIA EPIGENETIC SILENCING AND B-CELL RECEPTOR SIGNALLING IN CHRONIC LYMPHOCYTIC LEUKAEMIA. CHRONIC LYMPHOCYTIC LEUKAEMIA (CLL) IS AN ACCUMULATIVE DISORDER MARKED BY DEFICIENT APOPTOSIS. THE TP53 HOMOLOG TAP63 PROMOTES APOPTOSIS AND CHEMOSENSITIVITY IN SOLID TUMOURS AND ITS DEREGULATION MAY CONTRIBUTE TO CLL CELL SURVIVAL. WE FOUND THAT TAP63ALPHA WAS THE MOST PREVALENT TP63 ISOFORM IN CLL. COMPARED TO HEALTHY B CELLS, TAP63 MRNA WAS REPRESSED IN 55.7% OF CLL SAMPLES. TP63 PROMOTER METHYLATION WAS HIGH IN CLL AND INVERSELY CORRELATED WITH TP63 PROTEIN EXPRESSION IN B-CELL LYMPHOMA CELL LINES. SIRNA-MEDIATED KNOCKDOWN OF TP63 RESULTED IN PARTIAL PROTECTION FROM SPONTANEOUS APOPTOSIS ACCOMPANIED BY REDUCTIONS IN PMAIP1 (NOXA), BBC3 (PUMA), AND BAX MRNA IN CLL CELLS AND INCREASED PROLIFERATION OF RAJI LYMPHOMA CELLS. TAP63 MRNA LEVELS WERE HIGHER IN CLL WITH UNMUTATED IGHV. B-CELL RECEPTOR (BCR) ENGAGEMENT LED TO REPRESSION OF TP63 MRNA EXPRESSION IN MALIGNANT B CELLS, WHILE PHARMACOLOGICAL INHIBITION OF BCR SIGNALLING PREVENTED TP63 DOWNREGULATION. MIR21, KNOWN TO TARGET TAP63, CORRELATED INVERSELY WITH TAP63 EXPRESSION IN CLL, AND BCR-MEDIATED DOWNREGULATION OF TP63 WAS ACCOMPANIED BY MIR21 UPREGULATION IN MOST CLL SAMPLES. OUR DATA ILLUSTRATE THE PRO-APOPTOTIC FUNCTION OF TP63, PROVIDE INSIGHTS INTO THE MECHANISMS OF BCR-TARGETING AGENTS, AND ESTABLISH A RATIONALE FOR DESIGNING NOVEL APPROACHES TO INDUCE TP63 IN CLL AND B-CELL LYMPHOMA. 2013 4 628 41 BIOLOGICAL AND CLINICAL INSIGHT FROM ANALYSIS OF THE TUMOR B-CELL RECEPTOR STRUCTURE AND FUNCTION IN CHRONIC LYMPHOCYTIC LEUKEMIA. THE B-CELL RECEPTOR (BCR) IS ESSENTIAL TO THE BEHAVIOR OF THE MAJORITY OF NORMAL AND NEOPLASTIC MATURE B CELLS. THE IDENTIFICATION IN 1999 OF THE TWO MAJOR CLL SUBSETS EXPRESSING UNMUTATED IMMUNOGLOBULIN (IG) VARIABLE REGION GENES (U-IGHV, U-CLL) OF PRE-GERMINAL CENTER ORIGIN AND POOR PROGNOSIS, AND MUTATED IGHV (M-CLL) OF POST-GERMINAL CENTER ORIGIN AND GOOD PROGNOSIS, IGNITED INTENSIVE INVESTIGATIONS ON STRUCTURE AND FUNCTION OF THE TUMOR BCR. THESE INVESTIGATIONS HAVE PROVIDED FUNDAMENTAL INSIGHT INTO CLL BIOLOGY AND EVENTUALLY THE MECHANISTIC RATIONALE FOR THE DEVELOPMENT OF SUCCESSFUL THERAPIES TARGETING BCR SIGNALING. U-CLL AND M-CLL ARE CHARACTERIZED BY VARIABLE LOW SURFACE IGM (SIGM) EXPRESSION AND SIGNALING CAPACITY. VARIABILITY OF SIGM CAN IN PART BE EXPLAINED BY CHRONIC ENGAGEMENT WITH (AUTO)ANTIGEN AT TISSUE SITES. HOWEVER, OTHER ENVIRONMENTAL ELEMENTS, GENETIC CHANGES, AND EPIGENETIC SIGNATURES ALSO CONTRIBUTE TO THE SIGM VARIABILITY. THE VARIABLE LEVELS HAVE CONSEQUENCES ON THE BEHAVIOR OF CLL, WHICH IS IN A STATE OF ANERGY WITH AN INDOLENT CLINICAL COURSE WHEN SIGM EXPRESSION IS LOW, OR PUSHED TOWARDS PROLIFERATION AND A MORE AGGRESSIVE CLINICAL COURSE WHEN SIGM EXPRESSION IS HIGH. EFFICACY OF THERAPIES THAT TARGET BTK MAY ALSO BE AFFECTED BY THE VARIABLE SIGM LEVELS AND SIGNALING AND, IN PART, EXPLAIN THE DEVELOPMENT OF RESISTANCE. 2022 5 954 25 CHRONIC MYELOID LEUKEMIA: CURRENT PERSPECTIVES. CHRONIC MYELOID LEUKEMIA (CML), CHARACTERIZED BY THE T(9;22) AND BCR/ABL1 FUSION, IS A DISEASE MODEL FOR STUDYING THE MECHANISMS OF GENETIC ABNORMALITIES IN LEUKEMOGENESIS. THE DETECTION OF THE T(9;22), CHARACTERIZATION OF THE BCR/ABL FUSION, AND THE DISCOVERY OF IMATINIB HAVE ELEGANTLY REFLECTED THE SUCCESS OF OUR RESEARCH EFFORTS IN CML. HOWEVER, GENOMIC INSTABILITIES THAT LEAD TO THE FORMATION OF THE BCR/ ABL1 FUSION ARE NOT FULLY UNDERSTOOD. IT IS IMPORTANT TO UNDERSTAND HOW VARIOUS GENES THAT ARE INVOLVED IN REGULATING THE SIGNALING PATHWAY AND EPIGENETIC DEREGULATION COOPERATE WITH THE BCR/ABL1 FUSION IN THE INITIATION AND PROGRESSION OF CML. 2011 6 3520 34 IGLV3-21R110 IDENTIFIES AN AGGRESSIVE BIOLOGICAL SUBTYPE OF CHRONIC LYMPHOCYTIC LEUKEMIA WITH INTERMEDIATE EPIGENETICS. B-CELL RECEPTOR (BCR) SIGNALING IS CRUCIAL FOR CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) BIOLOGY. IGLV3-21-EXPRESSING B CELLS MAY ACQUIRE A SINGLE POINT MUTATION (R110) THAT TRIGGERS AUTONOMOUS BCR SIGNALING, CONFERRING AGGRESSIVE BEHAVIOR. EPIGENETIC STUDIES HAVE DEFINED 3 CLL SUBTYPES BASED ON METHYLATION SIGNATURES REMINISCENT OF NAIVE-LIKE (N-CLL), INTERMEDIATE (I-CLL), AND MEMORY-LIKE (M-CLL) B CELLS WITH DIFFERENT BIOLOGICAL FEATURES. I-CLL CARRIES A BORDERLINE IGHV MUTATIONAL LOAD AND SIGNIFICANTLY HIGHER USE OF IGHV3-21/IGLV3-21. TO DETERMINE THE CLINICAL AND BIOLOGICAL FEATURES OF IGLV3-21R110 CLL AND ITS RELATIONSHIP TO THESE EPIGENETIC SUBTYPES, WE CHARACTERIZED THE IMMUNOGLOBULIN GENE OF 584 CLL CASES USING WHOLE-GENOME/EXOME AND RNA SEQUENCING. IGLV3-21R110 WAS DETECTED IN 6.5% OF CASES: 30 (38%) OF 79 I-CLLS, 5 (1.7%) OF 291 M-CLLS, AND 1 (0.5%) OF 189 N-CLLS. ALL STEREOTYPE SUBSET 2 CASES CARRIED IGLV3-21R110, WHEREAS 62% OF IGLV3-21R110 I-CLL CASES HAD NONSTEREOTYPED BCR IMMUNOGLOBULINS. IGLV3-21R110 I-CLL HAD A SIGNIFICANTLY HIGHER NUMBER OF SF3B1 AND ATM MUTATIONS AND TOTAL NUMBER OF DRIVER ALTERATIONS. HOWEVER, THE R110 MUTATION WAS THE SOLE ALTERATION IN 1 I-CLL AND WAS ACCOMPANIED ONLY BY DEL(13Q) IN 3. ALTHOUGH IGHV MUTATIONAL STATUS VARIED, IGLV3-21R110 I-CLL TRANSCRIPTOMICALLY RESEMBLED N-CLL/UNMUTATED IGHV CLL WITH A SPECIFIC SIGNATURE INCLUDING WNT5A/B OVEREXPRESSION. IN CONTRAST, I-CLL LACKING IGLV3-21R110 MIRRORED M-CLL/MUTATED IGHV. PATIENTS WITH IGLV3-21R110 I-CLL HAD A SHORT TIME TO FIRST TREATMENT AND OVERALL SURVIVAL SIMILAR TO THOSE OF N-CLL/UNMUTATED IGHV PATIENTS, WHEREAS PATIENTS WITH NON-IGLV3-21R110 I-CLL HAD A GOOD PROGNOSIS SIMILAR TO THAT OF PATIENTS WITH M-CLL/MUTATED IGHV. IGLV3-21R110 DEFINES A CLL SUBGROUP WITH SPECIFIC BIOLOGICAL FEATURES AND AN UNFAVORABLE PROGNOSIS INDEPENDENT OF IGHV MUTATIONAL STATUS AND EPIGENETIC SUBTYPE. 2021 7 5666 29 SF3B1-MUTATED CHRONIC LYMPHOCYTIC LEUKEMIA SHOWS EVIDENCE OF NOTCH1 PATHWAY ACTIVATION INCLUDING CD20 DOWNREGULATION. CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) IS CHARACTERIZED BY A LOW CD20 EXPRESSION, IN PART EXPLAINED BY AN EPIGENETIC-DRIVEN DOWNREGULATION TRIGGERED BY MUTATIONS OF THE NOTCH1 GENE. IN THE PRESENT STUDY, BY TAKING ADVANTAGE OF A WIDE AND WELL-CHARACTERIZED CLL COHORT (N=537), WE DEMONSTRATE THAT CD20 EXPRESSION IS DOWNREGULATED IN SF3B1-MUTATED CLL IN AN EXTENT SIMILAR TO NOTCH1-MUTATED CLL. IN FACT, SF3B1-MUTATED CLL CELLS SHOW COMMON FEATURES WITH NOTCH1-MUTATED CLL CELLS, INCLUDING A GENE EXPRESSION PROFILE ENRICHED OF NOTCH1-RELATED GENE SETS AND ELEVATED EXPRESSION OF THE ACTIVE INTRACYTOPLASMIC NOTCH1. ACTIVATION OF THE NOTCH1 SIGNALING AND DOWN-REGULATION OF SURFACE CD20 IN SF3B1-MUTATED CLL CELLS CORRELATE WITH OVER-EXPRESSION OF AN ALTERNATIVELY SPLICED FORM OF DVL2, A COMPONENT OF THE WNT PATHWAY AND NEGATIVE REGULATOR OF THE NOTCH1 PATHWAY. THESE FINDINGS ARE CONFIRMED BY SEPARATELY ANALYZING THE CD20-DIM AND CD20-BRIGHT CELL FRACTIONS FROM SF3B1-MUTATED CASES AS WELL AS BY DVL2 KNOCK-OUT EXPERIMENTS IN CLL-LIKE CELL MODELS. ALTOGETHER, THE CLINICAL AND BIOLOGICAL FEATURES THAT CHARACTERIZE NOTCH1-MUTATED CLL MAY ALSO BE RECAPITULATED IN SF3B1-MUTATED CLL, CONTRIBUTING TO EXPLAIN THE POOR PROGNOSIS OF THIS CLL SUBSET AND PROVIDING THE RATIONALE FOR EXPANDING NOVEL AGENTS-BASED THERAPIES TO SF3B1-MUTATED CLL. 2021 8 4432 27 MOLECULAR CHARACTERIZATION OF RICHTER SYNDROME IDENTIFIES DE NOVO DIFFUSE LARGE B-CELL LYMPHOMAS WITH POOR PROGNOSIS. RICHTER SYNDROME (RS) IS THE TRANSFORMATION OF CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) INTO AGGRESSIVE LYMPHOMA, MOST COMMONLY DIFFUSE LARGE B-CELL LYMPHOMA (DLBCL). WE CHARACTERIZE 58 PRIMARY HUMAN RS SAMPLES BY GENOME-WIDE DNA METHYLATION AND WHOLE-TRANSCRIPTOME PROFILING. OUR COMPREHENSIVE APPROACH DETERMINES RS DNA METHYLATION PROFILE AND UNRAVELS A CLL EPIGENETIC IMPRINT, ALLOWING CLL-RS CLONAL RELATIONSHIP ASSESSMENT WITHOUT THE NEED OF THE INITIAL CLL TUMOR DNA. DNA METHYLATION- AND TRANSCRIPTOMIC-BASED CLASSIFIERS WERE DEVELOPED, AND TESTING ON LANDMARK DLBCL DATASETS IDENTIFIES A POOR-PROGNOSIS, ACTIVATED B-CELL-LIKE DLBCL SUBSET IN 111/1772 SAMPLES. THE CLASSIFICATION ROBUSTLY IDENTIFIES PHENOTYPES VERY SIMILAR TO RS WITH A SPECIFIC GENOMIC PROFILE, ACCOUNTING FOR 4.3-8.3% OF DE NOVO DLBCLS. IN THIS WORK, RS MULTI-OMICS CHARACTERIZATION DETERMINES ONCOGENIC MECHANISMS, ESTABLISHES A SURROGATE MARKER FOR CLL-RS CLONAL RELATIONSHIP, AND PROVIDES A CLINICALLY RELEVANT CLASSIFIER FOR A SUBSET OF PRIMARY "RS-TYPE DLBCL" WITH UNFAVORABLE PROGNOSIS. 2023 9 5512 31 RICHTER SYNDROME IN CHRONIC LYMPHOCYTIC LEUKEMIA: UPDATES ON BIOLOGY, CLINICAL FEATURES AND THERAPY. RICHTER SYNDROME (RS) OR RICHTER TRANSFORMATION IS THE DEVELOPMENT OF SECONDARY AGGRESSIVE LYMPHOMA IN THE SETTING OF UNDERLYING CHRONIC LYMPHOCYTIC LEUKEMIA/SMALL LYMPHOCYTIC LYMPHOMA (CLL/SLL). MOST FREQUENTLY CLL TRANSFORMS INTO DIFFUSE LARGE B-CELL LYMPHOMA (DLBCL) (90%) AND RARELY (10%) INTO HODGKIN LYMPHOMA, TERMED HODGKIN VARIANT OF RICHTER SYNDROME (HVRS). RS IS GENERALLY CHARACTERIZED BY AN AGGRESSIVE CLINICAL COURSE AND POOR PROGNOSIS. IN RECENT YEARS, MAJOR ADVANCES HAVE BEEN MADE IN UNDERSTANDING GENETIC EVENTS WHICH RELATE TO THE PROGRESSION OF CLL OR TRANSFORMATION INTO RS. BETTER UNDERSTANDING OF THE MOLECULAR PATHWAYS HAS REVEALED THAT RS IS NOT A SINGLE HOMOGENEOUS ENTITY. THE MAJORITY OF CASES ARE CLONALLY RELATED TO THE ORIGINAL CLL CLONE, WHILE A MINORITY DEVELOP FROM AN UNRELATED CLONE. THIS REVIEW SUMMARIZES NEW DATA RELATING TO THE MOLECULAR BIOLOGY AND THE GENETIC/EPIGENETIC CHANGES OCCURRING DURING RICHTER TRANSFORMATION, AND ALSO CONSIDERS THE CLINICAL FEATURES AND THERAPY FOR BOTH DLBCL-RS AND HODGKIN VARIANT-RS. 2015 10 5243 24 PROGNOSTIC IMPACT OF EPIGENETIC CLASSIFICATION IN CHRONIC LYMPHOCYTIC LEUKEMIA: THE CASE OF SUBSET #2. BASED ON THE METHYLATION STATUS OF 5 SINGLE CPG SITES, A NOVEL EPIGENETIC CLASSIFICATION OF CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) WAS RECENTLY PROPOSED, CLASSIFYING CLL PATIENTS INTO 3 CLINICO-BIOLOGICAL SUBGROUPS WITH DIFFERENT OUTCOME, TERMED MEMORY LIKE CLL (M-CLL), NAIVE LIKE CLL (N-CLL), AND A THIRD INTERMEDIATE CLL SUBGROUP (I-CLL). WHILE M-CLL AND N-CLL PATIENTS AT LARGE CORRESPONDED TO PATIENTS CARRYING MUTATED AND UNMUTATED IGHV GENES, RESPECTIVELY, LIMITED INFORMATION EXISTS REGARDING THE LESS DEFINED I-CLL GROUP. USING PYROSEQUENCING, WE INVESTIGATED THE PROGNOSTIC IMPACT OF THE PROPOSED 5 CPG SIGNATURE IN A WELL-CHARACTERIZED CLL COHORT (135 CASES), INCLUDING IGHV-MUTATED AND UNMUTATED PATIENTS AS WELL AS CLINICALLY AGGRESSIVE STEREOTYPED SUBSET #2 PATIENTS. OVERALL, WE CONFIRMED THE SIGNATURE'S ASSOCIATION WITH ESTABLISHED PROGNOSTIC MARKERS. MOREOVER, IN THE PRESENCE OF THE IGHV MUTATIONAL STATUS, THE EPIGENETIC SIGNATURE REMAINED INDEPENDENTLY ASSOCIATED WITH BOTH TIME-TO-FIRST-TREATMENT AND OVERALL SURVIVAL IN MULTIVARIATE ANALYSES. AS A PRIME FINDING, WE OBSERVED THAT SUBSET #2 PATIENTS WERE PREDOMINANTLY CLASSIFIED AS I-CLL, PROBABLY REFLECTING THEIR BORDERLINE IGHV MUTATIONAL STATUS (97-99% GERMLINE IDENTITY), THOUGH HAVING A SIMILARLY POOR PROGNOSIS AS N-CLL PATIENTS. IN SUMMARY, WE VALIDATED THE EPIGENETIC CLASSIFIER AS AN INDEPENDENT FACTOR IN CLL PROGNOSTICATION AND PROVIDE FURTHER EVIDENCE THAT SUBSET #2 IS A MEMBER OF THE I-CLL GROUP, HENCE SUPPORTING THE EXISTENCE OF A THIRD, INTERMEDIATE EPIGENETIC SUBGROUP. 2016 11 437 30 ANTIGEN RECEPTOR STEREOTYPY IN CHRONIC LYMPHOCYTIC LEUKEMIA. THE DISCOVERY OF ALMOST IDENTICAL OR 'STEREOTYPED' B-CELL RECEPTOR IMMUNOGLOBULINS (BCR IG) AMONG UNRELATED PATIENTS WITH CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) CEMENTED THE IDEA OF ANTIGEN SELECTION IN DISEASE ONTOGENY AND EVOLUTION. THE SYSTEMATIC ANALYSIS OF THE STEREOTYPY PHENOMENON IN CLL REVEALED THAT AROUND ONE-THIRD OF CLL PATIENTS MAY BE GROUPED INTO SUBSETS BASED ON SHARED SEQUENCE MOTIFS WITHIN THE VARIABLE HEAVY COMPLEMENTARITY DETERMINING REGION 3. STEREOTYPED SUBSETS DISPLAY A STRIKINGLY SIMILAR BIOLOGY OF THE LEUKEMIC CLONES, REFERRING TO MANY DIFFERENT LEVELS, FROM THE IMMUNOGENETIC AND GENETIC AND EXTENDING TO THE EPIGENETIC AND FUNCTIONAL LEVELS. EVEN MORE IMPORTANTLY, THE HOMOGENEITY OF STEREOTYPED SUBSETS HAS CLINICAL CONSEQUENCES AS PATIENTS ASSIGNED TO THE SAME STEREOTYPED SUBSET GENERALLY EXHIBIT AN OVERALL SIMILAR DISEASE COURSE AND OUTCOME. IN OTHER WORDS, STEREOTYPY-BASED PATIENT CLASSIFICATION OF CLL HAS ALREADY PROVIDED A MORE COMPARTMENTALIZED VIEW OF THIS OTHERWISE HETEROGENEOUS DISEASE AND CAN ASSIST IN REFINING PROGNOSTICATION MODELS. WHILE THIS IS RELEVANT ONLY FOR THE ONE-THIRD OF CASES EXPRESSING STEREOTYPED BCR IG; IN PRINCIPLE, HOWEVER, THE FINDINGS FROM FURTHER ANALYSIS OF THE STEREOTYPED SUBSETS MAY ALSO CONTRIBUTE TOWARDS IMPROVED UNDERSTANDING OF THE REMAINING NON-STEREOTYPED FRACTION OF CLL PATIENTS. 2017 12 691 37 BRD4 PROFILING IDENTIFIES CRITICAL CHRONIC LYMPHOCYTIC LEUKEMIA ONCOGENIC CIRCUITS AND REVEALS SENSITIVITY TO PLX51107, A NOVEL STRUCTURALLY DISTINCT BET INHIBITOR. BROMODOMAIN AND EXTRA-TERMINAL (BET) FAMILY PROTEINS ARE KEY REGULATORS OF GENE EXPRESSION IN CANCER. HEREIN, WE UTILIZE BRD4 PROFILING TO IDENTIFY CRITICAL PATHWAYS INVOLVED IN PATHOGENESIS OF CHRONIC LYMPHOCYTIC LEUKEMIA (CLL). BRD4 IS OVEREXPRESSED IN CLL AND IS ENRICHED PROXIMAL TO GENES UPREGULATED OR DE NOVO EXPRESSED IN CLL WITH KNOWN FUNCTIONS IN DISEASE PATHOGENESIS AND PROGRESSION. THESE GENES, INCLUDING KEY MEMBERS OF THE B-CELL RECEPTOR (BCR) SIGNALING PATHWAY, PROVIDE A RATIONALE FOR THIS THERAPEUTIC APPROACH TO IDENTIFY NEW TARGETS IN ALTERNATIVE TYPES OF CANCER. ADDITIONALLY, WE DESCRIBE PLX51107, A STRUCTURALLY DISTINCT BET INHIBITOR WITH NOVEL IN VITRO AND IN VIVO PHARMACOLOGIC PROPERTIES THAT EMULATES OR EXCEEDS THE EFFICACY OF BCR SIGNALING AGENTS IN PRECLINICAL MODELS OF CLL. HEREIN, THE DISCOVERY OF THE INVOLVEMENT OF BRD4 IN THE CORE CLL TRANSCRIPTIONAL PROGRAM PROVIDES A COMPELLING RATIONALE FOR CLINICAL INVESTIGATION OF PLX51107 AS EPIGENETIC THERAPY IN CLL AND APPLICATION OF BRD4 PROFILING IN OTHER CANCERS.SIGNIFICANCE: TO DATE, FUNCTIONAL STUDIES OF BRD4 IN CLL ARE LACKING. THROUGH INTEGRATED GENOMIC, FUNCTIONAL, AND PHARMACOLOGIC ANALYSES, WE UNCOVER THE EXISTENCE OF BRD4-REGULATED CORE CLL TRANSCRIPTIONAL PROGRAMS AND PRESENT PRECLINICAL PROOF-OF-CONCEPT STUDIES VALIDATING BET INHIBITION AS AN EPIGENETIC APPROACH TO TARGET BCR SIGNALING IN CLL. CANCER DISCOV; 8(4); 458-77. (C)2018 AACR.THIS ARTICLE IS HIGHLIGHTED IN THE IN THIS ISSUE FEATURE, P. 371. 2018 13 6693 33 VARIABLE INDUCTION OF PRDM1 AND DIFFERENTIATION IN CHRONIC LYMPHOCYTIC LEUKEMIA IS ASSOCIATED WITH ANERGY. DESPITE ANTIGEN ENGAGEMENT AND INTACT B-CELL-RECEPTOR (BCR) SIGNALING, CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) CELLS FAIL TO UNDERGO TERMINAL DIFFERENTIATION. WE HYPOTHESIZED THAT SUCH FAILURE MAY BE DUE TO ANERGY, AS CLL CELLS EXHIBIT VARIABLE LEVELS OF NONRESPONSIVENESS TO SURFACE IGM STIMULATION THAT IS REVERSIBLE IN VITRO. MOREOVER, ANERGY IS ASSOCIATED WITH REDUCED DIFFERENTIATION CAPACITY IN NORMAL B CELLS. WE INVESTIGATED RESPONSES OF CLL CELLS TO TWO POTENT DIFFERENTIATION-PROMOTING AGENTS, IL-21 AND CYTOSINE GUANINE DINUCLEOTIDE-ENRICHED OLIGO-DEOXYNUCLEOTIDES. THE INDUCTION OF PR DOMAIN-CONTAINING PROTEIN 1 (PRDM1; ALSO KNOWN AS BLIMP-1), A CRITICAL REGULATOR OF PLASMACYTIC DIFFERENTIATION, BY THESE AGENTS WAS CLOSELY CORRELATED BUT VARIED BETWEEN INDIVIDUAL CASES, DESPITE FUNCTIONALLY INTACT IL-21 RECEPTOR- AND TOLL-LIKE RECEPTOR 9-MEDIATED SIGNAL TRANSDUCER AND ACTIVATOR OF TRANSCRIPTION 3, AND NUCLEAR FACTOR-KAPPAB PATHWAYS. PRDM1 INDUCTION WAS INVERSELY CORRELATED WITH THE EXTENT OF ANERGY AS MEASURED BY THE ABILITY TO MOBILIZE INTRACELLULAR CA(2+) FOLLOWING BCR CROSSLINKING. PRDM1 RESPONSIVENESS WAS ASSOCIATED WITH OTHER MARKERS OF DIFFERENTIATION AND PROLIFERATION BUT NOT WITH DIFFERENCES IN APOPTOSIS. THE ABILITY TO INDUCE PRDM1 DID CORRELATE WITH DIFFERENTIAL TRANSCRIPTIONAL AND EPIGENETIC REGULATION OF THE PRDM1 GENE. THESE STUDIES EXTEND OUR UNDERSTANDING OF CLL PATHOBIOLOGY, DEMONSTRATING THAT REDUCED DIFFERENTIATION CAPACITY MAY BE A CONSEQUENCE OF ANERGY. EPIGENETIC DRUGS MAY OFFER POSSIBILITIES TO REACTIVATE PRDM1 EXPRESSION AS PART OF NOVEL DIFFERENTIATION THERAPY APPROACHES. 2014 14 3522 29 IL-10 PRODUCTION BY CLL CELLS IS ENHANCED IN THE ANERGIC IGHV MUTATED SUBSET AND ASSOCIATES WITH REDUCED DNA METHYLATION OF THE IL10 LOCUS. CHRONIC LYMPHOCYTIC LEUKEMIAS (CLLS) WITH UNMUTATED (U-CLL) OR MUTATED (M-CLL) IGHV HAVE VARIABLE FEATURES OF IMMUNOSUPPRESSION, POSSIBLY INFLUENCED BY THOSE CLL CELLS ACTIVATED TO PRODUCE INTERLEUKIN 10 (IL-10). THE TWO SUBSETS DIFFER IN THEIR LEVELS OF ANERGY, DEFINED BY LOW SURFACE IMMUNOGLOBULIN M LEVELS/SIGNALING CAPACITY, AND IN THEIR DNA METHYLATION PROFILE, PARTICULARLY VARIABLE IN M-CLL. WE HAVE NOW FOUND THAT LEVELS OF IL-10 PRODUCED BY ACTIVATED CLL CELLS WERE HIGHLY VARIABLE. LEVELS WERE HIGHER IN M-CLL THAN IN U-CLL AND CORRELATED WITH ANERGY. DNA METHYLATION ANALYSIS OF IL10 LOCUS REVEALED TWO PREVIOUSLY UNCHARACTERIZED 'VARIABLY METHYLATED REGIONS' (CLL-VMRS1/2) IN THE GENE BODY, BUT SIMILARLY LOW METHYLATION IN THE PROMOTER OF BOTH U-CLL AND M-CLL. CLL-VMR1/2 METHYLATION WAS LOWER IN M-CLL THAN IN U-CLL AND INVERSELY CORRELATED WITH IL-10 INDUCTION. A FUNCTIONAL SIGNAL TRANSDUCER AND ACTIVATOR OF TRANSCRIPTION 3 (STAT3) BINDING SITE IN CLL-VMR2 WAS CONFIRMED BY PROXIMITY LIGATION AND LUCIFERASE ASSAYS, WHEREAS INHIBITION OF SYK-MEDIATED STAT3 ACTIVATION RESULTED IN SUPPRESSION OF IL10. THE DATA SUGGEST EPIGENETIC CONTROL OF IL-10 PRODUCTION. HIGHER TUMOR LOAD MAY COMPENSATE THE REDUCED IL-10 PRODUCTION IN U-CLL, ACCOUNTING FOR CLINICAL IMMUNOSUPPRESSION IN BOTH SUBSETS. THE OBSERVATION THAT SYK INHIBITION ALSO SUPPRESSES IL-10 PROVIDES A POTENTIAL NEW RATIONALE FOR THERAPEUTIC TARGETING AND IMMUNOLOGICAL RESCUE BY SYK INHIBITORS IN CLL. 2017 15 941 33 CHRONIC LYMPHOCYTIC LEUKEMIA B-CELL NORMAL CELLULAR COUNTERPART: CLUES FROM A FUNCTIONAL PERSPECTIVE. CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) IS CHARACTERIZED BY THE CLONAL EXPANSION OF SMALL MATURE-LOOKING CD19+ CD23+ CD5+ B-CELLS THAT ACCUMULATE IN THE BLOOD, BONE MARROW, AND LYMPHOID ORGANS. TO DATE, NO CONSENSUS HAS BEEN REACHED CONCERNING THE NORMAL CELLULAR COUNTERPART OF CLL B-CELLS AND SEVERAL B-CELL TYPES HAVE BEEN PROPOSED. CLL B-CELLS HAVE REMARKABLE PHENOTYPIC AND GENE EXPRESSION PROFILE HOMOGENEITY. IN RECENT YEARS, THE MOLECULAR AND CELLULAR BIOLOGY OF CLL HAS BEEN ENRICHED BY SEMINAL INSIGHTS THAT ARE LEADING TO A BETTER UNDERSTANDING OF THE NATURAL HISTORY OF THE DISEASE. IMMUNOPHENOTYPIC AND MOLECULAR APPROACHES (INCLUDING IMMUNOGLOBULIN HEAVY-CHAIN VARIABLE GENE MUTATIONAL STATUS, TRANSCRIPTIONAL AND EPIGENETIC PROFILING) COMPARING THE NORMAL B-CELL SUBSET AND CLL B-CELLS PROVIDE SOME NEW INSIGHTS INTO THE NORMAL CELLULAR COUNTERPART. FUNCTIONAL CHARACTERISTICS (INCLUDING ACTIVATION REQUIREMENTS AND PROPENSITY FOR PLASMA CELL DIFFERENTIATION) OF CLL B-CELLS HAVE NOW BEEN INVESTIGATED FOR 50 YEARS. B-CELL SUBSETS DIFFER SUBSTANTIALLY IN TERMS OF THEIR FUNCTIONAL FEATURES. ANALYSIS OF SHARED FUNCTIONAL CHARACTERISTICS MAY REVEAL SIMILARITIES BETWEEN NORMAL B-CELL SUBSETS AND CLL B-CELLS, ALLOWING SPECULATIVE ASSIGNMENT OF A NORMAL CELLULAR COUNTERPART FOR CLL B-CELLS. IN THIS REVIEW, WE SUMMARIZE CURRENT DATA REGARDING PERIPHERAL B-CELL DIFFERENTIATION AND HUMAN B-CELL SUBSETS AND SUGGEST POSSIBILITIES FOR A NORMAL CELLULAR COUNTERPART BASED ON THE FUNCTIONAL CHARACTERISTICS OF CLL B-CELLS. HOWEVER, A DEFINITIVE NORMAL CELLULAR COUNTERPART CANNOT BE ATTRIBUTED ON THE BASIS OF THE AVAILABLE DATA. WE DISCUSS THE FUNCTIONAL CHARACTERISTICS REQUIRED FOR A CELL TO BE LOGICALLY CONSIDERED TO BE THE NORMAL COUNTERPART OF CLL B-CELLS. 2018 16 5664 18 SF3B1 MUTATIONS IN CHRONIC LYMPHOCYTIC LEUKEMIA. SF3B1 IS A CRITICAL COMPONENT OF THE SPLICING MACHINERY, WHICH CATALYZES THE REMOVAL OF INTRONS FROM PRECURSOR MESSENGER RNA (MRNA). NEXT-GENERATION SEQUENCING STUDIES HAVE IDENTIFIED MUTATIONS IN SF3B1 IN CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) AT HIGH FREQUENCY. IN CLL, SF3B1 MUTATION IS ASSOCIATED WITH MORE AGGRESSIVE DISEASE AND SHORTER SURVIVAL, AND RECENT STUDIES SUGGEST THAT IT CAN BE INCORPORATED INTO PROGNOSTIC SCHEMA TO IMPROVE THE PREDICTION OF DISEASE PROGRESSION. MUTATIONS IN SF3B1 ARE PREDOMINANTLY SUBCLONAL GENETIC EVENTS IN CLL, AND HENCE ARE LIKELY LATER EVENTS IN THE PROGRESSION OF CLL. EVIDENCE OF ALTERED PRE-MRNA SPLICING HAS BEEN DETECTED IN CLL CASES WITH SF3B1 MUTATIONS. ALTHOUGH THE CAUSATIVE LINK BETWEEN SF3B1 MUTATION AND CLL PATHOGENESIS REMAINS UNCLEAR, SEVERAL LINES OF EVIDENCE SUGGEST SF3B1 MUTATION MIGHT BE LINKED TO GENOMIC STABILITY AND EPIGENETIC MODIFICATION. 2013 17 5462 32 RESEARCH PROGRESS ON EPIGENETICS OF SMALL B-CELL LYMPHOMA. SMALL B-CELL LYMPHOMA IS THE CLASSIFICATION OF B-CELL CHRONIC LYMPHOPROLIFERATIVE DISORDERS THAT INCLUDE CHRONIC LYMPHOCYTIC LEUKAEMIA/SMALL LYMPHOCYTIC LYMPHOMA, FOLLICULAR LYMPHOMA, MANTLE CELL LYMPHOMA, MARGINAL ZONE LYMPHOMA, LYMPHOPLASMACYTIC LYMPHOMA/WALDENSTROM MACROGLOBULINEMIA. THE CLINICAL PRESENTATION IS SOMEWHAT HETEROGENEOUS, AND ITS OCCURRENCE AND DEVELOPMENT MECHANISMS ARE NOT YET PRECISE AND MAY INVOLVE EPIGENETIC CHANGES. EPIGENETIC ALTERATIONS MAINLY INCLUDE DNA METHYLATION, HISTONE MODIFICATION, AND NON-CODING RNA, WHICH ARE ESSENTIAL FOR GENETIC DETECTION, EARLY DIAGNOSIS, AND ASSESSMENT OF TREATMENT RESISTANCE IN SMALL B-CELL LYMPHOMA. AS CHRONIC LYMPHOCYTIC LEUKEMIA/SMALL LYMPHOCYTIC LYMPHOMA HAS ALREADY BEEN REPORTED IN THE LITERATURE, THIS ARTICLE FOCUSES ON SMALL B-CELL LYMPHOMAS SUCH AS FOLLICULAR LYMPHOMA, MANTLE CELL LYMPHOMA, MARGINAL ZONE LYMPHOMA, AND WALDENSTROM MACROGLOBULINEMIA. IT DISCUSSES RECENT DEVELOPMENTS IN EPIGENETIC RESEARCH TO DIAGNOSE AND TREAT THIS GROUP OF LYMPHOMAS. THIS REVIEW PROVIDES NEW IDEAS FOR THE TREATMENT AND PROGNOSIS ASSESSMENT OF SMALL B-CELL LYMPHOMA BY EXPLORING THE CONNECTION BETWEEN SMALL B-CELL LYMPHOMA AND EPIGENETICS. 2022 18 3898 29 LARGE-SCALE TOPOLOGICAL DISRUPTION OF CHROMOSOME TERRITORIES 9 AND 22 IS ASSOCIATED WITH NONRESPONSE TO TREATMENT IN CML. CHRONIC MYELOID LEUKEMIA (CML) IS A MYELOPROLIFERATIVE NEOPLASM DEFINED BY THE PRESENCE OF T(9;22) TRANSLOCATION WHOSE ORIGIN HAS BEEN ASSOCIATED WITH THE TRIDIMENSIONAL GENOME ORGANIZATION. THIS REARRANGEMENT LEADS TO THE FUSION OF BCR AND ABL1 GENES GIVING RISE TO A CHIMERIC PROTEIN WITH CONSTITUTIVE KINASE ACTIVITY. IMATINIB, A TYROSINE KINASE INHIBITOR (TKI), IS USED AS A FIRST-LINE TREATMENT FOR CML, THOUGH ~40% OF CML PATIENTS DO NOT RESPOND. HERE, USING STRUCTURED ILLUMINATION MICROSCOPY (SIM) AND 3D RECONSTRUCTION, WE STUDIED THE 3D ORGANIZATION PATTERNS OF THE ABL1 AND BCR GENES, AND THEIR CHROMOSOME TERRITORIES (CTS) CT9 AND CT22, IN CD34+ CELLS FROM CML PATIENTS THAT RESPONDED OR NOT TO TKI. WE FOUND THAT TKI RESISTANCE IN CML IS ASSOCIATED WITH HIGH LEVELS OF STRUCTURAL DISRUPTION OF CT9 AND CT22 IN CD34+ CELLS, INCREASED CT VOLUMES (ESPECIALLY FOR CT22), INTERMINGLING BETWEEN CT9 AND CT22, AND AN OPEN-CHROMATIN EPIGENETIC MARK IN CT22. ALTOGETHER OUR RESULTS SUGGEST THAT LARGE-SCALE DISRUPTION OF CT9 AND CT22 CORRELATES WITH THE CLINICAL RESPONSE OF CML PATIENTS, WHICH COULD BE TRANSLATED INTO A POTENTIAL PROGNOSTIC MARKER OF RESPONSE TO TREATMENT IN THIS DISEASE AND PROVIDE NOVEL INSIGHTS INTO THE MECHANISMS UNDERLYING RESISTANCE TO TKI IN CML. 2022 19 6390 28 THE ROLE OF THE GENETIC ABNORMALITIES, EPIGENETIC AND MICRORNA IN THE PROGNOSIS OF CHRONIC LYMPHOCYTIC LEUKEMIA. CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) IS INCREASED PROLIFERATION OF B-CELLS WITH PERIPHERAL BLOOD AND BONE MARROW INVOLVEMENT, WHICH IS USUALLY OBSERVED IN OLDER PEOPLE. GENETIC MUTATIONS, EPIGENETIC CHANGES AND MIRS PLAY A ROLE IN CLL PATHOGENESIS. DEL 11Q, DEL L17Q, DEL 6Q, TRISOMY 12, P53 AND IGVH MUTATIONS ARE THE MOST IMPORTANT GENETIC CHANGES IN CLL. DELETION OF MIR-15A AND MIR-16A CAN INCREASE BCL2 GENE EXPRESSION, MIR-29 AND MIR-181 DELETIONS DECREASE THE EXPRESSION OF TCL1, AND MIR-146A DELETION PREVENTS TUMOR METASTASIS. EPIGENETIC CHANGES SUCH AS HYPO- AND HYPERMETHYLATION, UBIQUITINATION, HYPO- AND HYPERACETYLATION OF GENE PROMOTERS INVOLVED IN CLL PATHOGENESIS CAN ALSO PLAY A ROLE IN CLL. EXPRESSION OF CD38 AND ZAP70, PRESENCE OR ABSENCE OF MUTATION IN IGVH AND P53 MUTATION ARE AMONG THE FACTORS INVOLVED IN CLL PROGNOSIS. USE OF MONOCLONAL ANTIBODIES AGAINST SURFACE MARKERS OF B-CELLS LIKE ANTI-CD20 AS WELL AS TYROSINE KINASE INHIBITORS ARE THE MOST IMPORTANT THERAPEUTIC APPROACHES FOR CLL. 2018 20 690 28 BRD4 DEGRADATION BLOCKS EXPRESSION OF MYC AND MULTIPLE FORMS OF STEM CELL RESISTANCE IN PH(+) CHRONIC MYELOID LEUKEMIA. IN MOST PATIENTS WITH CHRONIC MYELOID LEUKEMIA (CML) CLONAL CELLS CAN BE KEPT UNDER CONTROL BY BCR::ABL1 TYROSINE KINASE INHIBITORS (TKI). HOWEVER, OVERT RESISTANCE OR INTOLERANCE AGAINST THESE TKI MAY OCCUR. WE IDENTIFIED THE EPIGENETIC READER BRD4 AND ITS DOWNSTREAM-EFFECTOR MYC AS GROWTH REGULATORS AND THERAPEUTIC TARGETS IN CML CELLS. BRD4 AND MYC WERE FOUND TO BE EXPRESSED IN PRIMARY CML CELLS, CD34(+) /CD38(-) LEUKEMIC STEM CELLS (LSC), AND IN THE CML CELL LINES KU812, K562, KCL22, AND KCL22(T315I) . THE BRD4-TARGETING DRUG JQ1 WAS FOUND TO SUPPRESS PROLIFERATION IN KU812 CELLS AND PRIMARY LEUKEMIC CELLS IN THE MAJORITY OF PATIENTS WITH CHRONIC PHASE CML. IN THE BLAST PHASE OF CML, JQ1 WAS LESS EFFECTIVE. HOWEVER, THE BRD4 DEGRADER DBET6 WAS FOUND TO BLOCK PROLIFERATION AND/OR SURVIVAL OF PRIMARY CML CELLS IN ALL PATIENTS TESTED, INCLUDING BLAST PHASE CML AND CML CELLS EXHIBITING THE T315I VARIANT OF BCR::ABL1. MOREOVER, DBET6 WAS FOUND TO BLOCK MYC EXPRESSION AND TO SYNERGIZE WITH BCR::ABL1 TKI IN INHIBITING THE PROLIFERATION IN THE JQ1-RESISTANT CELL LINE K562. FURTHERMORE, BRD4 DEGRADATION WAS FOUND TO OVERCOME OSTEOBLAST-INDUCED TKI RESISTANCE OF CML LSC IN A CO-CULTURE SYSTEM AND TO BLOCK INTERFERON-GAMMA-INDUCED UPREGULATION OF THE CHECKPOINT ANTIGEN PD-L1 IN LSC. FINALLY, DBET6 WAS FOUND TO SUPPRESS THE IN VITRO SURVIVAL OF CML LSC AND THEIR ENGRAFTMENT IN NSG MICE. TOGETHER, TARGETING OF BRD4 AND MYC THROUGH BET DEGRADATION SENSITIZES CML CELLS AGAINST BCR::ABL1 TKI AND IS A POTENT APPROACH TO OVERCOME MULTIPLE FORMS OF DRUG RESISTANCE IN CML LSC. 2022