1 6688 119 VALPROATE SYNERGIZES WITH PURINE NUCLEOSIDE ANALOGUES TO INDUCE APOPTOSIS OF B-CHRONIC LYMPHOCYTIC LEUKAEMIA CELLS. RESISTANCE TO CHEMOTHERAPY AND DRUG TOXICITY ARE TWO MAJOR CONCERNS OF CHRONIC LYMPHOCYTIC LEUKAEMIA (B-CLL) TREATMENT BY PURINE NUCLEOSIDE ANALOGUES (PNA, I.E. FLUDARABINE AND CLADRIBINE). WE HYPOTHESIZED THAT TARGETING EPIGENETIC CHANGES MIGHT ADDRESS THESE ISSUES AND EVALUATED THE EFFECT OF THE HISTONE DEACETYLASE INHIBITOR VALPROATE (VPA) AT A CLINICALLY RELEVANT CONCENTRATION. VPA ACTED IN A HIGHLY SYNERGISTIC/ADDITIVE MANNER WITH FLUDARABINE AND CLADRIBINE TO INDUCE APOPTOSIS OF B-CLL CELLS. IMPORTANTLY, VPA ALSO RESTORED SENSITIVITY TO FLUDARABINE IN B CELLS FROM POOR PROGNOSIS CLL PATIENTS WHO BECAME RESISTANT TO CHEMOTHERAPY. MECHANISM OF APOPTOSIS INDUCED BY VPA ALONE OR COMBINED WITH FLUDARABINE OR TO CLADRIBINE WAS CASPASE-DEPENDENT AND INVOLVED THE EXTRINSIC PATHWAY. VPA, BUT NEITHER FLUDARABINE NOR CLADRIBINE, ENHANCED THE PRODUCTION OF REACTIVE OXYGEN SPECIES (ROS) AND INHIBITION OF ROS WITH N-ACETYLCYSTEINE DECREASES APOPTOSIS OF CLL CELLS. VPA STIMULATES HYPERPHOSPHORYLATION OF P42/P44 ERK, CYTOCHROME C RELEASE AND OVEREXPRESSION OF BAX AND FAS. TOGETHER, OUR DATA INDICATE THAT VPA MAY AMELIORATE THE OUTCOME OF PNA-BASED THERAPEUTIC PROTOCOLS AND PROVIDE A POTENTIAL ALTERNATIVE TREATMENT IN BOTH THE RELAPSED AND FRONT-LINE RESISTANT PATIENTS AND IN PATIENTS WITH HIGH RISK FEATURES. 2009 2 2619 32 EPIGENOME-WIDE ANALYSIS REVEALS FUNCTIONAL MODULATORS OF DRUG SENSITIVITY AND POST-TREATMENT SURVIVAL IN CHRONIC LYMPHOCYTIC LEUKAEMIA. BACKGROUND: CHRONIC LYMPHOCYTIC LEUKAEMIA (CLL) PATIENTS DISPLAY A HIGHLY VARIABLE CLINICAL COURSE, WITH PROGRESSIVE ACQUISITION OF DRUG RESISTANCE. WE SOUGHT TO IDENTIFY ABERRANT EPIGENETIC TRAITS THAT ARE ENRICHED FOLLOWING EXPOSURE TO TREATMENT THAT COULD IMPACT PATIENT RESPONSE TO THERAPY. METHODS: EPIGENOME-WIDE ANALYSIS OF DNA METHYLATION WAS PERFORMED FOR 20 PATIENTS AT TWO TIMEPOINTS DURING TREATMENT. THE PROGNOSTIC SIGNIFICANCE OF DIFFERENTIALLY METHYLATED REGIONS (DMRS) WAS ASSESSED IN INDEPENDENT COHORTS OF 139 AND 163 PATIENTS. THEIR FUNCTIONAL ROLE IN DRUG SENSITIVITY WAS ASSESSED IN VITRO. RESULTS: WE IDENTIFIED 490 DMRS FOLLOWING EXPOSURE TO THERAPY, OF WHICH 31 WERE CLL-SPECIFIC AND INDEPENDENT OF CHANGES OCCURRING IN NORMAL B-CELL DEVELOPMENT. SEVENTEEN DMR-ASSOCIATED GENES WERE IDENTIFIED AS DIFFERENTIALLY EXPRESSED FOLLOWING TREATMENT IN AN INDEPENDENT COHORT. METHYLATION OF THE HOXA4, MAFB AND SLCO3A1 DMRS WAS ASSOCIATED WITH POST-TREATMENT PATIENT SURVIVAL, WITH HOXA4 DISPLAYING THE STRONGEST ASSOCIATION. RE-EXPRESSION OF HOXA4 IN CELL LINES AND PRIMARY CLL CELLS SIGNIFICANTLY INCREASED APOPTOSIS IN RESPONSE TO TREATMENT WITH FLUDARABINE, IBRUTINIB AND IDELALISIB. CONCLUSION: OUR STUDY DEMONSTRATES ENRICHMENT FOR MULTIPLE CLL-SPECIFIC EPIGENETIC TRAITS IN RESPONSE TO CHEMOTHERAPY THAT PREDICT PATIENT OUTCOMES, AND PARTICULARLY IMPLICATE EPIGENETIC SILENCING OF HOXA4 IN REDUCING THE SENSITIVITY OF CLL CELLS TO THERAPY. 2021 3 439 35 ANTILEUKEMIC ACTIVITY OF VALPROIC ACID IN CHRONIC LYMPHOCYTIC LEUKEMIA B CELLS DEFINED BY MICROARRAY ANALYSIS. EPIGENETIC CODE MODIFICATIONS BY HISTONE DEACETYLASE INHIBITORS HAVE RECENTLY BEEN PROPOSED AS POTENTIAL NEW THERAPIES FOR HEMATOLOGICAL MALIGNANCIES. CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) REMAINS INCURABLE DESPITE THE INTRODUCTION OF NEW TREATMENTS. CLL B CELLS ARE CHARACTERIZED BY AN APOPTOSIS DEFECT RATHER THAN EXCESSIVE PROLIFERATION, BUT PROLIFERATION CENTERS HAVE BEEN FOUND IN ORGANS SUCH AS THE BONE MARROW AND LYMPH NODES. IN THIS STUDY, WE ANALYZED GENE EXPRESSION MODIFICATIONS IN CLL B CELLS AFTER TREATMENT WITH VALPROIC ACID (VPA), A WELL-TOLERATED ANTI-EPILEPTIC DRUG WITH HDAC INHIBITORY ACTIVITY. CLL B CELLS OBTAINED FROM 14 PATIENTS WERE TREATED IN VITRO WITH A CONCENTRATION OF 1 MM VPA FOR 4 H. VPA EFFECTS ON GENE EXPRESSION WERE THEREAFTER STUDIED USING AFFYMETRIX TECHNOLOGY, AND SOME IDENTIFIED GENES WERE VALIDATED BY REAL-TIME PCR AND WESTERN BLOT. WE OBSERVED THAT VPA INDUCED APOPTOSIS BY DOWNREGULATING SEVERAL ANTI-APOPTOTIC GENES AND BY UPREGULATING PRO-APOPTOTIC GENES. FURTHERMORE, VPA SIGNIFICANTLY INCREASED CHEMOSENSITIVITY TO FLUDARABINE, FLAVOPIRIDOL, BORTEZOMIB, THALIDOMIDE AND LENALIDOMIDE. VPA INHIBITED THE PROLIFERATION OF CPG/IL2-STIMULATED CLL B CELLS AND MODULATED MANY CELL CYCLE MESSENGER RNAS. IN CONCLUSION, EXPOSURE OF CLL B CELLS TO VPA INDUCED APOPTOSIS, POTENTIATED CHEMOTHERAPEUTIC AGENT EFFECTS AND INHIBITED PROLIFERATION. THESE DATA STRONGLY SUGGEST THE USE OF VPA IN CLL TREATMENT, PARTICULARLY IN COMBINATION WITH ANTILEUKEMIA AGENTS. 2009 4 4907 27 P53 ABERRATIONS DO NOT PREDICT INDIVIDUAL RESPONSE TO FLUDARABINE IN PATIENTS WITH B-CELL CHRONIC LYMPHOCYTIC LEUKAEMIA IN ADVANCED STAGES RAI III/IV. ABNORMALITIES OF P53 HAVE BEEN ASSOCIATED WITH SHORT SURVIVAL AND NON-RESPONSE TO THERAPY IN CHRONIC LYMPHOCYTIC LEUKAEMIA (CLL). WE HAVE EVALUATED THE RATE OF RESPONSE TO FLUDARABINE AS FIRST-LINE THERAPY IN 54 PATIENTS WITH ADVANCED STAGE CLL, ANALYSING THE CYTOGENETIC PROFILE, ABERRATIONS IN P53, INCLUDING THE METHYLATION STATUS OF ITS PROMOTER, AND THE IMMUNOGLOBULIN HEAVY-CHAIN VARIABLE-REGION (IGVH) MUTATION STATUS. ACCORDING TO THE ADVANCED STAGE OF THE DISEASE IN THIS SERIES, 75% OF PATIENTS PRESENTED GENETIC ABERRATIONS ASSOCIATED WITH POOR PROGNOSIS: DEL(17P) AND/OR DEL(11Q), AND NO-MUTATED IGVH GENES. TEN PATIENTS (18.5%) HAD METHYLATION IN THE PROMOTER REGION OF P53. EIGHTY-THREE PER CENT OF PATIENTS TREATED ACHIEVED A RESPONSE, WITH A HIGH RATE OF COMPLETE REMISSION (47.6%). ALTHOUGH WE FOUND A SIGNIFICANT CORRELATION BETWEEN FAILURES AND THE PRESENCE OF P53 ABERRATIONS (P = 0.0065), EITHER WITH METHYLATION (P = 0.018) OR DELETION (P = 0.015), 64% OF THE PATIENTS WITH ABERRATIONS IN THIS GENE RESPONDED TO TREATMENT (11/17), SUGGESTING THAT FLUDARABINE INDUCES HIGH REMISSION RATES, EVEN IN THESE PATIENTS. THIS IS THE FIRST TIME THAT THE SIGNIFICANCE OF P53 PROMOTER METHYLATION STATUS IS DESCRIBED IN THIS PATHOLOGY, AND OUR DATA SUPPORT THAT THIS EPIGENETIC PHENOMENON COULD BE INVOLVED IN THE PATHOGENESIS AND CLINICAL EVOLUTION OF CLL. 2005 5 1581 24 DNA METHYLATION PROFILES IN CHRONIC LYMPHOCYTIC LEUKEMIA PATIENTS TREATED WITH CHEMOIMMUNOTHERAPY. BACKGROUND: IN ORDER TO GAIN INSIGHT INTO THE CONTRIBUTION OF DNA METHYLATION TO DISEASE PROGRESSION OF CHRONIC LYMPHOCYTIC LEUKEMIA (CLL), USING 450K ILLUMINA ARRAYS, WE DETERMINED THE DNA METHYLATION PROFILES IN PAIRED PRE-TREATMENT/RELAPSE SAMPLES FROM 34 CLL PATIENTS TREATED WITH CHEMOIMMUNOTHERAPY, MOSTLY (N = 31) WITH THE FLUDARABINE-CYCLOPHOSPHAMIDE-RITUXIMAB (FCR) REGIMEN. RESULTS: THE EXTENT OF IDENTIFIED CHANGES IN CLL CELLS VERSUS MEMORY B CELLS FROM HEALTHY DONORS WAS TERMED "EPIGENETIC BURDEN" (EB) WHEREAS THE NUMBER OF CHANGES BETWEEN THE PRE-TREATMENT VERSUS THE RELAPSE SAMPLE WAS TERMED "RELAPSE CHANGES" (RC). SIGNIFICANT (P < 0.05) ASSOCIATIONS WERE IDENTIFIED BETWEEN (I) HIGH EB AND SHORT TIME-TO-FIRST-TREATMENT (TTFT); AND, (II) FEW RCS AND SHORT TIME-TO-RELAPSE. BOTH THE EB AND THE RC CLUSTERED IN SPECIFIC GENOMIC REGIONS AND CHROMATIN STATES, INCLUDING REGULATORY REGIONS CONTAINING BINDING SITES OF TRANSCRIPTION FACTORS IMPLICATED IN B CELL AND CLL BIOLOGY. CONCLUSIONS: OVERALL, WE SHOW THAT DNA METHYLATION IN CLL FOLLOWS DIFFERENT DYNAMICS IN RESPONSE TO CHEMOIMMUNOTHERAPY. THESE EPIGENETIC ALTERATIONS WERE LINKED WITH SPECIFIC CLINICAL AND BIOLOGICAL FEATURES. 2019 6 4601 30 NDRG2 MRNA LEVELS AND MIR-28-5P AND MIR-650 ACTIVITY IN CHRONIC LYMPHOCYTIC LEUKEMIA. BACKGROUND: NDRG2 IS IDENTIFIED AS A TUMOR SUPPRESSOR GENE IN MANY TUMORS, AND FUNCTIONS IN CELL PROLIFERATION, DIFFERENTIATION AND APOPTOSIS. RECENT DATA INDICATE THAT NDRG2 EXPRESSION IS UP-REGULATED BY TP53. MOREOVER, PROPOSED MECHANISMS OF NDRG2 INACTIVATION INCLUDE EPIGENETIC SILENCING OF THE NDRG2 PROMOTER AND DOWN-REGULATION BY MICRORNAS (MIRNAS). HOWEVER, FEW STUDIES HAVE EVER BEEN DONE ON THE ROLE OF NDRG2 AND THE NDRG2-REGULATING MIRNAS INTERFERENCE IN CHRONIC LYMPHOCYTIC LEUKEMIA (CLL). METHODS: NDRG2 AND MICRORNAS MRNA LEVELS IN CLL SUBJECTS WERE ASSESSED BY QUANTITATIVE REAL-TIME POLYMERASE CHAIN REACTION (QRT-PCR). THE DUAL-LUCIFERASE REPORTER ASSAY WAS PERFORMED TO DETERMINE NDRG2-RELATED MIRNAS. LOW EXPRESSION OF MATURE EXOGENOUS MIRNAS IN CLL CELLS WAS ESTABLISHED BY TRANSIENT TRANSFECTION. NDRG2 PROTEIN LEVELS IN CLL CELLS WERE DETECTED BY WESTERN BLOT. IN ADDITION, FLOW CYTOMETRY WAS CONDUCTED TO EXAMINE THE APOPTOSIS OF CLL CELLS. RESULTS: LOWER EXPRESSION OF NDRG2 WAS FOUND IN THE B-CELLS FROM 102 CLL PATIENTS COMPARED THE 40 NORMAL SUBJECTS (P < 0.001). PATIENTS WITH ADVANCED BINET STAGE (P = 0.001), HIGH LACTATE DEHYDROGENASE (LDH) LEVEL (P = 0.036), UN-MUTATED IMMUNOGLOBULIN HEAVY CHAIN VARIABLE REGION GENE (IGHV) (P = 0.004) AND THOSE WITH P53 ABERRATIONS (P < 0.001) HAD A MARKEDLY LOWER LEVELS OF NDRG2 MRNA. THIS DECREASE WAS ASSOCIATED WITH BRIEFER TIME-TO-TREATMENT (P = 0.001) AND POORER SURVIVAL (P < 0.001). HIGH EXPRESSION OF MIR-28-5P AND MIR-650 WAS ASSOCIATED WITH BINET B/C STAGE (P = 0.044) AND IGHV UN-MUTATED (P = 0.011), AS WELL AS BINET B/C STAGE (P = 0.013) AND P53 ABERRATIONS (P = 0.037), RESPECTIVELY. INHIBITION OF MIR-28-5P OR MIR-650 COULD INDUCE MORE APOPTOSIS IN CLL CELLS WITH GERMLINE TP53. CONCLUSIONS: NDRG2 MRNA LEVELS MIGHT BE A USEFUL PROGNOSTIC VARIABLE FOR PATIENTS OF CLL AND UP-REGULATING NDRG2 TRANSCRIPTION MAY BE A THERAPY APPROACH IN CLL WITHOUT P53 ABERRATIONS. 2018 7 3409 23 HOXA4 GENE PROMOTER HYPERMETHYLATION AS AN EPIGENETIC MECHANISM MEDIATING RESISTANCE TO IMATINIB MESYLATE IN CHRONIC MYELOID LEUKEMIA PATIENTS. DEVELOPMENT OF RESISTANCE TO IMATINIB MESYLATE (IM) IN CHRONIC MYELOID LEUKEMIA (CML) PATIENTS HAS EMERGED AS A SIGNIFICANT CLINICAL PROBLEM. THE OBSERVATION THAT INCREASED EPIGENETIC SILENCING OF POTENTIAL TUMOR SUPPRESSOR GENES CORRELATES WITH DISEASE PROGRESSION IN SOME CML PATIENTS TREATED WITH IM SUGGESTS A RELATIONSHIP BETWEEN EPIGENETIC SILENCING AND RESISTANCE DEVELOPMENT. WE HYPOTHESIZE THAT PROMOTER HYPERMETHYLATION OF HOXA4 COULD BE AN EPIGENETIC MECHANISM MEDIATING IM RESISTANCE IN CML PATIENTS. THUS A STUDY WAS UNDERTAKEN TO INVESTIGATE THE PROMOTER HYPERMETHYLATION STATUS OF HOXA4 IN CML PATIENTS ON IM TREATMENT AND TO DETERMINE ITS ROLE IN MEDIATING RESISTANCE TO IM. GENOMIC DNA WAS EXTRACTED FROM PERIPHERAL BLOOD SAMPLES OF 95 CML PATIENTS (38 GOOD RESPONDERS AND 57 RESISTANT) AND 12 NORMAL CONTROLS. ALL SAMPLES WERE BISULFITE TREATED AND ANALYSED BY METHYLATION-SPECIFIC HIGH-RESOLUTION MELT ANALYSIS. COMPARED TO THE GOOD RESPONDERS, THE HOXA4 HYPERMETHYLATION LEVEL WAS SIGNIFICANTLY HIGHER (P = 0.002) IN IM-RESISTANT CML PATIENTS. ON COMPARING THE RISK, HOXA4 HYPERMETHYLATION WAS ASSOCIATED WITH A HIGHER RISK FOR IM RESISTANCE (OR 4.658; 95% CI, 1.673-12.971; P = 0.003). THUS, IT IS REASONABLE TO SUGGEST THAT PROMOTER HYPERMETHYLATION OF HOXA4 GENE COULD BE AN EPIGENETIC MECHANISM MEDIATING IM RESISTANCE IN CML PATIENTS. 2013 8 1433 25 DIFFERENTIAL GENOME-WIDE ARRAY-BASED METHYLATION PROFILES IN PROGNOSTIC SUBSETS OF CHRONIC LYMPHOCYTIC LEUKEMIA. GLOBAL HYPOMETHYLATION AND REGIONAL HYPERMETHYLATION ARE WELL-KNOWN EPIGENETIC FEATURES OF CANCER; HOWEVER, IN CHRONIC LYMPHOCYTIC LEUKEMIA (CLL), STUDIES ON GENOME-WIDE EPIGENETIC MODIFICATIONS ARE LIMITED. HERE, WE ANALYZED THE GLOBAL METHYLATION PROFILES IN CLL, BY APPLYING HIGH-RESOLUTION METHYLATION MICROARRAYS (27,578 CPG SITES) TO 23 CLL SAMPLES, BELONGING TO THE IMMUNOGLOBULIN HEAVY-CHAIN VARIABLE (IGHV) MUTATED (FAVORABLE) AND IGHV UNMUTATED/IGHV3-21 (POOR-PROGNOSTIC) SUBSETS. OVERALL, RESULTS DEMONSTRATED SIGNIFICANT DIFFERENCES IN METHYLATION PATTERNS BETWEEN THESE SUBGROUPS. SPECIFICALLY, IN IGHV UNMUTATED CLL, WE IDENTIFIED METHYLATION OF 7 KNOWN OR CANDIDATE TUMOR SUPPRESSOR GENES (EG, VHL, ABI3, AND IGSF4) AS WELL AS 8 UNMETHYLATED GENES INVOLVED IN CELL PROLIFERATION AND TUMOR PROGRESSION (EG, ADORA3 AND PRF1 ENHANCING THE NUCLEAR FACTOR-KAPPAB AND MITOGEN-ACTIVATED PROTEIN KINASE PATHWAYS, RESPECTIVELY). IN CONTRAST, THESE LATTER GENES WERE SILENCED BY METHYLATION IN IGHV MUTATED PATIENTS. THE ARRAY DATA WERE VALIDATED FOR SELECTED GENES USING METHYLATION-SPECIFIC POLYMERASE CHAIN REACTION, QUANTITATIVE REVERSE TRANSCRIPTASE-POLYMERASE CHAIN REACTION, AND BISULFITE SEQUENCING. FINALLY, THE SIGNIFICANCE OF DNA METHYLATION IN REGULATING GENE PROMOTERS WAS SHOWN BY REINDUCING 4 METHYLATED TUMOR SUPPRESSOR GENES (EG, VHL AND ABI3) IN IGHV UNMUTATED SAMPLES USING THE METHYL-INHIBITOR 5-AZA-2'-DEOXYCYTIDINE. TAKEN TOGETHER, OUR DATA FOR THE FIRST TIME REVEAL DIFFERENCES IN GLOBAL METHYLATION PROFILES BETWEEN PROGNOSTIC SUBSETS OF CLL, WHICH MAY UNFOLD EPIGENETIC SILENCING MECHANISMS INVOLVED IN CLL PATHOGENESIS. 2010 9 1062 17 CLINICAL SIGNIFICANCE OF DNA METHYLATION IN CHRONIC LYMPHOCYTIC LEUKEMIA PATIENTS: RESULTS FROM 3 UK CLINICAL TRIALS. CHRONIC LYMPHOCYTIC LEUKEMIA PATIENTS WITH MUTATED IMMUNOGLOBULIN HEAVY-CHAIN GENES (IGHV-M), PARTICULARLY THOSE LACKING POOR-RISK GENOMIC LESIONS, OFTEN RESPOND WELL TO CHEMOIMMUNOTHERAPY (CIT). DNA METHYLATION PROFILING CAN SUBDIVIDE EARLY-STAGE PATIENTS INTO NAIVE B-CELL-LIKE CLL (N-CLL), MEMORY B-CELL-LIKE CLL (M-CLL), AND INTERMEDIATE CLL (I-CLL), WITH DIFFERING TIMES TO FIRST TREATMENT AND OVERALL SURVIVAL. HOWEVER, WHETHER DNA METHYLATION CAN IDENTIFY PATIENTS DESTINED TO RESPOND FAVORABLY TO CIT HAS NOT BEEN ASCERTAINED. WE CLASSIFIED TREATMENT-NAIVE PATIENTS (N = 605) FROM 3 UK CHEMO AND CIT CLINICAL TRIALS INTO THE 3 EPIGENETIC SUBGROUPS, USING PYROSEQUENCING AND MICROARRAY ANALYSIS, AND PERFORMED EXPANSIVE SURVIVAL ANALYSIS. THE N-CLL, I-CLL, AND M-CLL SIGNATURES WERE FOUND IN 80% (N = 245/305), 17% (53/305), AND 2% (7/305) OF IGHV-UNMUTATED (IGHV-U) CASES, RESPECTIVELY, AND IN 9%, (19/216), 50% (108/216), AND 41% (89/216) OF IGHV-M CASES, RESPECTIVELY. MULTIVARIATE COX PROPORTIONAL ANALYSIS IDENTIFIED M-CLL AS AN INDEPENDENT PROGNOSTIC FACTOR FOR OVERALL SURVIVAL (HAZARD RATIO [HR], 0.46; 95% CONFIDENCE INTERVAL [CI], 0.24-0.87; P = .018) IN CLL4, AND FOR PROGRESSION-FREE SURVIVAL (HR, 0.25; 95% CI, 0.10-0.57; P = .002) IN ARCTIC AND ADMIRE PATIENTS. THE ANALYSIS OF EPIGENETIC SUBGROUPS IN PATIENTS ENTERED INTO 3 FIRST-LINE UK CLL TRIALS IDENTIFIES M-CLL AS AN INDEPENDENT MARKER OF PROLONGED SURVIVAL AND MAY AID IN THE IDENTIFICATION OF PATIENTS DESTINED TO DEMONSTRATE PROLONGED SURVIVAL AFTER CIT. 2019 10 138 27 ABERRANT DNA METHYLATION AT HOXA4 AND HOXA5 GENES ARE ASSOCIATED WITH RESISTANCE TO IMATINIB MESYLATE AMONG CHRONIC MYELOID LEUKEMIA PATIENTS. BACKGROUND: IMATINIB MESYLATE IS A MOLECULARLY TARGETED TYROSINE KINASE INHIBITOR DRUG. IT IS EFFECTIVELY USED IN THE TREATMENT OF CHRONIC MYELOID LEUKEMIA (CML) PATIENTS. HOWEVER, DEVELOPMENT OF RESISTANCE TO IMATINIB MESYLATE AS A RESULT OF BCR-ABL DEPENDENT AND BCR-ABL INDEPENDENT MECHANISMS HAS EMERGED AS A DAUNTING PROBLEM IN THE MANAGEMENT OF CML PATIENTS. BETWEEN THESE MECHANISMS, BCR-ABL INDEPENDENT MECHANISMS ARE STILL NOT ROBUSTLY UNDERSTOOD. AIM: TO INVESTIGATE THE CORRELATION OF HOXA4 AND HOXA5 PROMOTER DNA HYPERMETHYLATION WITH IMATINIB RESISTANCE AMONG CML PATIENTS. METHODS AND RESULTS: SAMPLES FROM 175 PHILADELPHIA POSITIVE CML PATIENTS (83 GOOD RESPONSE AND 92 BCR-ABL NON-MUTATED IMATINIB RESISTANT PATIENTS) WERE SUBJECTED TO METHYLATION SPECIFIC HIGH RESOLUTION MELT ANALYSIS FOR METHYLATION LEVELS QUANTIFICATION OF THE HOXA4 AND HOXA5 PROMOTER REGIONS. RECEIVER OPERATING CHARACTERISTIC CURVE ANALYSIS WAS DONE TO ELUCIDATE THE OPTIMAL METHYLATION CUT-OFF POINT FOLLOWED BY MULTIPLE LOGISTIC REGRESSION ANALYSIS. LOG-RANK ANALYSIS WAS DONE TO MEASURE THE OVERALL SURVIVAL DIFFERENCE BETWEEN CML GROUPS. THE OPTIMAL METHYLATION CUT-OFF POINT WAS FOUND TO BE AT 62.5% FOR BOTH HOXA4 AND HOXA5. CHRONIC MYELOID LEUKEMIA PATIENTS WITH >/=63% HOXA4 AND HOXA5 METHYLATION LEVEL WERE SHOWN TO HAVE 3.78 AND 3.95 TIMES THE ODDS, RESPECTIVELY, TO ACQUIRE RESISTANCE TO IMATINIB. HOWEVER, OVERALL SURVIVAL OF CML PATIENTS THAT HAVE /= 63% METHYLATION LEVELS OF HOXA4 AND HOXA5 GENES WERE FOUND TO BE NOT SIGNIFICANT (P-VALUE = 0.126 FOR HOXA4; P-VALUE = 0.217 FOR HOXA5). CONCLUSION: HYPERMETHYLATION OF THE HOXA4 AND HOXA5 PROMOTER IS CORRELATED WITH IMATINIB RESISTANCE AND WITH FURTHER INVESTIGATION, IT COULD BE A POTENTIAL EPIGENETIC BIOMARKER IN SUPPLEMENT TO THE BCR-ABL GENE MUTATION IN PREDICTING IMATINIB TREATMENT RESPONSE AMONG CML PATIENTS BUT COULD NOT BE CONSIDERED AS A PROGNOSTIC MARKER. 2018 11 5056 21 PHASE I TRIAL OF LOW DOSE DECITABINE TARGETING DNA HYPERMETHYLATION IN PATIENTS WITH CHRONIC LYMPHOCYTIC LEUKAEMIA AND NON-HODGKIN LYMPHOMA: DOSE-LIMITING MYELOSUPPRESSION WITHOUT EVIDENCE OF DNA HYPOMETHYLATION. TARGETING ABERRANT DNA HYPERMETHYLATION IN CHRONIC LYMPHOCYTIC LEUKAEMIA (CLL) AND NON-HODGKIN LYMPHOMA (NHL) WITH DECITABINE MAY REVERSE EPIGENETIC SILENCING IN B-CELL MALIGNANCIES. TWENTY PATIENTS WERE ENROLLED IN TWO PHASE I TRIALS TO DETERMINE THE MINIMUM EFFECTIVE PHARMACOLOGICAL DOSE OF DECITABINE IN PATIENTS WITH RELAPSED/REFRACTORY CLL (N = 16) AND NHL (N = 4). PATIENTS RECEIVED 1-3 CYCLES OF DECITABINE. DOSE-LIMITING TOXICITY (DLT) WAS OBSERVED IN 2 OF 4 CLL AND 2 OF 2 NHL PATIENTS RECEIVING DECITABINE AT 15 MG/M(2) PER D DAYS 1-10, CONSISTING OF GRADE 3-4 THROMBOCYTOPENIA AND HYPERBILIRUBINAEMIA. SIX PATIENTS WITH CLL RECEIVED DECITABINE AT 10 MG/M(2) PER D DAYS 1-10 WITHOUT DLT; HOWEVER, RE-EXPRESSION OF METHYLATED GENES OR CHANGES IN GLOBAL DNA METHYLATION WERE NOT OBSERVED. THEREFORE, A 5-DAY DECITABINE SCHEDULE WAS EXAMINED. WITH 15 MG/M(2) PER D DECITABINE DAYS 1-5, DLT OCCURRED IN 2 OF 6 CLL AND 2 OF 2 NHL PATIENTS, CONSISTING OF GRADE 3-4 NEUTROPENIA, THROMBOCYTOPENIA, AND FEBRILE NEUTROPENIA. EIGHT PATIENTS HAD STABLE DISEASE. IN 17 PATIENTS, THERE WERE NO SIGNIFICANT CHANGES IN GENOME-WIDE METHYLATION OR IN TARGET GENE RE-EXPRESSION. IN CONCLUSION, DOSE-LIMITING MYELOSUPPRESSION AND INFECTIOUS COMPLICATIONS PREVENTED DOSE ESCALATION OF DECITABINE TO LEVELS ASSOCIATED WITH CHANGES IN GLOBAL METHYLATION OR GENE RE-EXPRESSION IN CLL AND NHL. 2010 12 25 25 A 3' TRNA-DERIVED FRAGMENT PRODUCED BY TRNA(LEUAAG) AND TRNA(LEUTAG) IS ASSOCIATED WITH POOR PROGNOSIS IN B-CELL CHRONIC LYMPHOCYTIC LEUKEMIA, INDEPENDENTLY OF CLASSICAL PROGNOSTIC FACTORS. OBJECTIVE: 3' TRNA-DERIVED FRAGMENTS (3' TRFS) ARE IMPORTANT EPIGENETIC REGULATORS IN NORMAL AND PATHOLOGICAL CONDITIONS. IN THIS STUDY, WE AIMED TO EXPLORE THE POTENTIAL VALUE OF A 3' TRF AS A PROGNOSTIC AND/OR SCREENING BIOMARKER FOR B-CELL CHRONIC LYMPHOCYTIC LEUKEMIA (B-CLL). METHODS: PUBLICLY AVAILABLE NEXT-GENERATION SEQUENCING DATA FROM 20 B-CLL CASES WERE ANALYZED, FOLLOWED BY PREDICTION OF TARGETS OF THE MOST ABUNDANTLY AND UBIQUITOUSLY EXPRESSED 3' TRFS, LEADING TO SELECTION OF TRF-LEU(AAG/TAG) . PBMCS WERE ISOLATED FROM BLOOD SAMPLES OF 91 B-CLL PATIENTS AND 43 NON-LEUKEMIC DONORS, FOLLOWED BY TOTAL RNA EXTRACTION, IN-VITRO POLYADENYLATION, AND FIRST-STRAND CDNA SYNTHESIS. NEXT, A REAL-TIME QUANTITATIVE PCR (QPCR) ASSAY WAS DEVELOPED FOR THE ACCURATE QUANTIFICATION OF TRF-LEU(AAG/TAG) AND APPLIED IN ALL SAMPLES, PRIOR TO BIOSTATISTICAL ANALYSIS. RESULTS: HIGH TRF-LEU(AAG/TAG) LEVELS ARE ASSOCIATED WITH INFERIOR OVERALL SURVIVAL (OS) OF B-CLL PATIENTS. THE UNFAVORABLE SIGNIFICANCE OF TRF-LEU(AAG/TAG) WAS INDEPENDENT OF ESTABLISHED PROGNOSTIC FACTORS IN B-CLL. STRATIFIED KAPLAN-MEIER OS ANALYSIS UNCOVERED THE UNFAVORABLE PROGNOSTIC ROLE OF HIGH TRF-LEU(AAG/TAG) LEVELS FOR PATIENTS IN BINET A OR RAI I STAGE, NEGATIVE CD38 EXPRESSION, MUTATED, OR UNMUTATED IGHV GENOMIC LOCUS. CONCLUSION: OUR APPROACH REVEALED THE INDEPENDENT PROGNOSTIC VALUE OF A PARTICULAR 3' TRF, DERIVED FROM TRNA(LEUAAG) AND TRNA(LEUTAG) (TRF-LEU(AAG/TAG) ) IN B-CLL. 2021 13 337 28 ALTERATIONS IN DNA METHYLATION/DEMETHYLATION INTERMEDIATES PREDICT CLINICAL OUTCOME IN CHRONIC LYMPHOCYTIC LEUKEMIA. CYTOSINE DERIVATIVE DYSREGULATIONS REPRESENT IMPORTANT EPIGENETIC MODIFICATIONS WHOSE IMPACT ON THE CLINICAL OUTCOME IN CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) IS INCOMPLETELY UNDERSTOOD. HENCE, GLOBAL LEVELS OF 5-METHYLCYTOSINE (5-MCYT), 5-HYDROXYMETHYLCYTOSINE (5-HMCYT), 5-CARBOXYLCYTOSINE (5-CACYT) AND 5-HYDROXYMETHYLURACIL WERE TESTED IN PURIFIED B CELLS FROM CLL PATIENTS (N = 55) AND CONTROLS (N = 17). THE DNA METHYLATION 'WRITERS' (DNA METHYLTRANSFERASES [DNMT1/3A/3B]), 'READERS' (METHYL-CPG-BINDING DOMAIN [MBD2/4]), 'EDITORS' (TEN-ELEVEN TRANSLOCATION [TET1/2/3]) AND 'MODULATORS' (SAT1) WERE ALSO EVALUATED. ACCORDINGLY, PATIENTS WERE STRATIFIED INTO THREE SUBGROUPS. FIRST, A SUBGROUP WITH A GLOBAL DEFICIT IN CYTOSINE DERIVATIVES CHARACTERIZED BY HYPERLYMPHOCYTOSIS, REDUCED MEDIAN PROGRESSION FREE SURVIVAL (PFS = 52 MONTHS) AND SHORTER TREATMENT FREE SURVIVAL (TFS = 112 MONTHS) WAS IDENTIFIED. IN THIS SUBGROUP, MAJOR EPIGENETIC MODIFICATIONS WERE HIGHLIGHTED INCLUDING A REDUCTION OF 5-MCYT, 5-HMCYT, 5-CACYT ASSOCIATED WITH DNMT3A, MBD2/4 AND TET1/2 DOWNREGULATION. SECOND, THE CYTOSINE DERIVATIVE ANALYSIS REVEALED A SUBGROUP WITH A PARTIAL DEFICIT (PFS = 84, TFS = 120 MONTHS), MAINLY AFFECTING DNA DEMETHYLATION (5-HMCYT REDUCTION, SAT1 INDUCTION). THIRD, A SUBGROUP EPIGENETICALLY SIMILAR TO CONTROLS WAS IDENTIFIED (PFS AND TFS > 120 MONTHS). THE PROGNOSTIC IMPACT OF STRATIFYING CLL PATIENTS WITHIN THREE EPIGENETIC SUBGROUPS WAS CONFIRMED IN A VALIDATION COHORT. IN CONCLUSION, OUR RESULTS SUGGEST THAT DYSREGULATIONS OF CYTOSINE DERIVATIVE REGULATORS REPRESENT MAJOR EVENTS ACQUIRED DURING CLL PROGRESSION AND ARE INDEPENDENT FROM IGHV MUTATIONAL STATUS. 2017 14 5243 22 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 15 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 16 2678 22 EVALUATION OF A PROGNOSTIC EPIGENETIC CLASSIFICATION SYSTEM IN CHRONIC LYMPHOCYTIC LEUKEMIA PATIENTS. BACKGROUND: METHYLATION AT 5 CPG SITES WAS PREVIOUSLY SHOWN TO CLASSIFY CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) INTO 3 PROGNOSTIC SUBGROUPS. HERE, WE AIMED TO VALIDATE THE MARKER SET IN AN ADDITIONAL COHORT AND TO EVALUATE ITS CLINICAL UTILITY FOR CLL PATIENT STRATIFICATION. METHODS: WE EVALUATED THIS EPIGENETIC MARKER SET IN 79 GERMAN PATIENTS USING BISULFITE TREATMENT FOLLOWED BY PYROSEQUENCING AND CLASSIFICATION USING A SUPPORT VECTOR MACHINE-LEARNING TOOL. RESULTS: THE N-CLL, I-CLL, AND M-CLL CLASSIFICATION WAS DETECTED IN 28 (35%), 10 (13%), AND 41 (51%) PATIENTS, RESPECTIVELY. EPIGENETIC GROUPING WAS ASSOCIATED WITH IGHV MUTATIONAL STATUS (P = 2 X 10(-12)), ISOLATED DEL13Q (P = 9 X 10(-6)), DEL17P (P = .015), COMPLEX KARYOTYPE (P = .005), VH-USAGE, AND CLINICAL OUTCOME AS TIME TO FIRST TREATMENT (P = 1.4 X 10(-12)) AND OVERALL SURVIVAL (P = .003). MULTIVARIATE COX REGRESSION ANALYSIS IDENTIFIED N-CLL AS A FACTOR FOR EARLIER TREATMENT HAZARD RATIO (HR), 6.3 (95% CONFIDENCE INTERVAL [CI] 2.4-16.4; P = .0002) COMPARED TO IGHV MUTATIONAL STATUS (HR 4.6, 95% CI 1.9-11.3, P = .0008). IN ADDITION, WHEN COMPARING THE PROGNOSTIC VALUE OF THE EPIGENETIC CLASSIFICATION SYSTEM WITH THE IGHV CLASSIFICATION, EPIGENETIC GROUPING PERFORMED BETTER COMPARED TO IGHV MUTATIONAL STATUS USING KAPLAN-MEIER ESTIMATION AND ALLOWED THE IDENTIFICATION OF A THIRD, INTERMEDIATE (I-CLL) GROUP. THUS, OUR STUDY CONFIRMED THE PROGNOSTIC VALUE OF THE EPIGENETIC MARKER SET FOR PATIENT STRATIFICATION IN ROUTINE CLINICAL DIAGNOSTICS. 2022 17 2131 23 EPIGENETIC INACTIVATION OF THE HSA-MIR-203 IN HAEMATOLOGICAL MALIGNANCIES. MIR-203 IS A TUMOUR SUPPRESSOR MICRORNA (MIRNA). WE STUDIED THE METHYLATION OF HSA-MIR-203 IN 150 SAMPLES INCLUDING ACUTE MYELOID LEUKAEMIA (AML), ACUTE LYMPHOBLASTIC LEUKAEMIA (ALL), CHRONIC MYELOID LEUKAEMIA (CML), CHRONIC LYMPHOCYTIC LEUKAEMIA (CLL) AND NON-HODGKIN'S LYMPHOMA (NHL) BY METHYLATION-SPECIFIC PCR, AND MIRNA EXPRESSION BY STEM-LOOP RT-QPCR. HSA-MIR-203 PROMOTER WAS UNMETHYLATED IN NORMAL CONTROLS BUT HOMOZYGOUSLY METHYLATED IN TWO AML AND FOUR LYMPHOMA CELL LINES, IN WHICH 5-AZA-2'-DEOXYCYTIDINE TREATMENT LED TO PROMOTER DEMETHYLATION AND MIR-203 RE-EXPRESSION. RESTORATION OF MIR-203 EXPRESSION IN LYMPHOMA CELLS INHIBITED CELLULAR PROLIFERATION AND INCREASED CELL DEATH, SUGGESTING AN INHERENT TUMOUR SUPPRESSOR ACTIVITY. IN PRIMARY SAMPLES, HSA-MIR-203 METHYLATION WAS ABSENT IN CML BUT DETECTED IN 5.0% ALL, 10.0% AML, 42.0% CLL AND 38.8% OF NHL (INCLUDING SIX [60.0%] NATURAL KILLER-CELL, NINE [40.9%] B-CELL AND FOUR [23.5%] T CELL NHL). MOREOVER, HSA-MIR-203 METHYLATION WAS ASSOCIATED WITH HYPERMETHYLATION OF HSA-MIR-34A, -124A AND -196B IN NHL BUT NOT CLL. IN CLL, HSA-MIR-203 METHYLATION WAS ASSOCIATED WITH A HIGHER PRESENTING HB LEVEL (P = 0.033). THE PROJECTED 10 YEAR OVERALL SURVIVAL OF THE CLL PATIENTS WAS 58.2%, WHICH WAS IMPACTED BY RAI STAGE AND HIGH-RISK KARYOTYPES BUT NOT HSA-MIR-203 METHYLATION. HSA-MIR-203 WAS MORE FREQUENTLY METHYLATED IN LYMPHOID THAN MYELOID MALIGNANCIES (P = 0.002). IN CONCLUSION, MIR-203, A TUMOUR SUPPRESSOR GENE, WAS HYPERMETHYLATED IN A TUMOUR-SPECIFIC MANNER WITH GENE SILENCING. HSA-MIR-203 WAS MORE FREQUENTLY HYPERMETHYLATED IN LYMPHOID THAN MYELOID MALIGNANCIES. IN NHL, HSA-MIR-203 METHYLATION WAS ASSOCIATED WITH CONCOMITANT METHYLATION OF OTHER TUMOUR SUPPRESSOR MIRNAS. THE FREQUENT HSA-MIR-203 METHYLATION IN LYMPHOID MALIGNANCIES SUGGESTED A PATHOGENETIC ROLE OF HSA-MIR-203 METHYLATION. 2011 18 1107 25 COMBINING CYTOGENETIC AND EPIGENETIC APPROACHES IN CHRONIC LYMPHOCYTIC LEUKEMIA IMPROVES PROGNOSIS PREDICTION FOR PATIENTS WITH ISOLATED 13Q DELETION. BACKGROUND: BOTH DEFECTIVE DNA METHYLATION AND ACTIVE DNA DEMETHYLATION PROCESSES ARE EMERGING AS IMPORTANT RISK FACTORS IN CHRONIC LYMPHOCYTIC LEUKEMIA (CLL). HOWEVER, ASSOCIATIONS BETWEEN 5-CYTOSINE EPIGENETIC MARKERS AND THE MOST FREQUENT CHROMOSOMAL ABNORMALITIES DETECTED IN CLL REMAIN TO BE ESTABLISHED. METHODS: CLL PATIENTS WERE RETROSPECTIVELY CLASSIFIED INTO A CYTOGENETIC LOW-RISK GROUP (ISOLATED 13Q DELETION), AN INTERMEDIATE-RISK GROUP (NORMAL KARYOTYPE OR TRISOMY 12), AND A HIGH-RISK GROUP (11Q DELETION, 17P DELETION, OR COMPLEX KARYOTYPE [>/= 3 BREAKPOINTS]). THE TWO 5-CYTOSINE DERIVATIVES, 5-METHYLCYTOSINE (5-MCYT) AND 5-HYDROXYMETHYLCYTOSINE (5-HMCYT), WERE TESTED BY ELISA (N = 60), WHILE REAL-TIME QUANTITATIVE PCR WAS USED FOR DETERMINING TRANSCRIPTIONAL EXPRESSION LEVELS OF DNMT AND TET (N = 24). RESULTS: BY USING GLOBAL DNA METHYLATION/DEMETHYLATION LEVELS, IN THE LOW-RISK DISEASE GROUP, TWO SUBGROUPS WITH SIGNIFICANTLY DIFFERENT CLINICAL OUTCOMES HAVE BEEN IDENTIFIED (MEDIAN TREATMENT-FREE SURVIVAL [TFS] 45 VERSUS > 120 MONTHS FOR 5-MCYT, P = 0.0008, AND 63 VERSUS > 120 MONTHS FOR 5-HMCYT, P = 0.04). A DEFECTIVE 5-MCYT STATUS WAS FURTHER ASSOCIATED WITH A HIGHER PERCENTAGE OF 13Q DELETED NUCLEI (> 80%), THUS SUGGESTING AN ACQUIRED PROCESS. WHEN CONSIDERING THE CYTOGENETIC INTERMEDIATE/HIGH-RISK DISEASE GROUPS, AN ASSOCIATION OF 5-MCYT STATUS WITH LYMPHOCYTOSIS (P = 0.0008) AND THE LYMPHOCYTE DOUBLING TIME (P = 0.04) BUT NOT WITH TFS WAS OBSERVED, AS WELL AS A REDUCTION OF DNMT3A, TET1, AND TET2 TRANSCRIPTS. CONCLUSIONS: COMBINING CYTOGENETIC STUDIES WITH 5-MCYT ASSESSMENT ADDS ACCURACY TO CLL PATIENTS' PROGNOSES AND PARTICULARLY FOR THOSE WITH 13Q DELETION AS A SOLE CYTOGENETIC ABNORMALITY. 2017 19 2438 22 EPIGENETIC SILENCING OF THE CIRCADIAN CLOCK GENE CRY1 IS ASSOCIATED WITH AN INDOLENT CLINICAL COURSE IN CHRONIC LYMPHOCYTIC LEUKEMIA. DISRUPTION OF CIRCADIAN RHYTHM IS BELIEVED TO PLAY A CRITICAL ROLE IN CANCER DEVELOPMENT. CRYPTOCHROME 1 (CRY1) IS A CORE COMPONENT OF THE MAMMALIAN CIRCADIAN CLOCK AND WE HAVE PREVIOUSLY SHOWN ITS DEREGULATED EXPRESSION IN A SUBGROUP OF PATIENTS WITH CHRONIC LYMPHOCYTIC LEUKEMIA (CLL). USING REAL-TIME RT-PCR IN A COHORT OF 76 CLL PATIENTS AND 35 NORMAL BLOOD DONORS WE NOW DEMONSTRATE THAT DIFFERENTIAL CRY1 MRNA EXPRESSION IN HIGH-RISK (HR) CD38+/IMMUNOGLOBULIN VARIABLE HEAVY CHAIN GENE (IGVH) UNMUTATED PATIENTS AS COMPARED TO LOW-RISK (LR) CD38-/IGVH MUTATED PATIENTS CAN BE ATTRIBUTED TO DOWN-MODULATION OF CRY1 IN LR CLL CASES. ANALYSIS OF THE DNA METHYLATION PROFILE OF THE CRY1 PROMOTER IN A SUBGROUP OF 57 PATIENTS REVEALED THAT CRY1 EXPRESSION IN LR CLL CELLS IS SILENCED BY ABERRANT PROMOTER CPG ISLAND HYPERMETHYLATION. THE METHYLATION PATTERN OF THE CRY1 PROMOTER PROVED TO HAVE HIGH PROGNOSTIC IMPACT IN CLL WHERE ABERRANT PROMOTER METHYLATION PREDICTED A FAVOURABLE OUTCOME. CRY1 MRNA TRANSCRIPT LEVELS DID NOT CHANGE OVER TIME IN THE MAJORITY OF PATIENTS WHERE SEQUENTIAL SAMPLES WERE AVAILABLE FOR ANALYSIS. WE ALSO COMPARED THE CRY1 EXPRESSION IN CLL WITH OTHER LYMPHOID MALIGNANCIES AND OBSERVED EPIGENETIC SILENCING OF CRY1 IN A PATIENT WITH B CELL ACUTE LYMPHOBLASTIC LEUKEMIA (B-ALL). 2012 20 27 24 A B-CELL EPIGENETIC SIGNATURE DEFINES THREE BIOLOGIC SUBGROUPS OF CHRONIC LYMPHOCYTIC LEUKEMIA WITH CLINICAL IMPACT. PROSPECTIVE IDENTIFICATION OF PATIENTS WITH CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) DESTINED TO PROGRESS WOULD GREATLY FACILITATE THEIR CLINICAL MANAGEMENT. RECENTLY, WHOLE-GENOME DNA METHYLATION ANALYSES IDENTIFIED THREE CLINICOBIOLOGIC CLL SUBGROUPS WITH AN EPIGENETIC SIGNATURE RELATED TO DIFFERENT NORMAL B-CELL COUNTERPARTS. HERE, WE DEVELOPED A CLINICALLY APPLICABLE METHOD TO IDENTIFY THESE SUBGROUPS AND TO STUDY THEIR CLINICAL RELEVANCE. USING A SUPPORT VECTOR MACHINE APPROACH, WE BUILT A PREDICTION MODEL USING FIVE EPIGENETIC BIOMARKERS THAT WAS ABLE TO CLASSIFY CLL PATIENTS ACCURATELY INTO THE THREE SUBGROUPS, NAMELY NAIVE B-CELL-LIKE, INTERMEDIATE AND MEMORY B-CELL-LIKE CLL. DNA METHYLATION WAS QUANTIFIED BY HIGHLY REPRODUCIBLE BISULFITE PYROSEQUENCING ASSAYS IN TWO INDEPENDENT CLL SERIES. IN THE INITIAL SERIES (N=211), THE THREE SUBGROUPS SHOWED DIFFERENTIAL LEVELS OF IGHV (IMMUNOGLOBULIN HEAVY-CHAIN LOCUS) MUTATION (P<0.001) AND VH USAGE (P<0.03), AS WELL AS DIFFERENT CLINICAL FEATURES AND OUTCOME IN TERMS OF TIME TO FIRST TREATMENT (TTT) AND OVERALL SURVIVAL (P<0.001). A MULTIVARIATE COX MODEL SHOWED THAT EPIGENETIC CLASSIFICATION WAS THE STRONGEST PREDICTOR OF TTT (P<0.001) ALONG WITH BINET STAGE (P<0.001). THESE FINDINGS WERE CORROBORATED IN A VALIDATION SERIES (N=97). IN THIS STUDY, WE DEVELOPED A SIMPLE AND ROBUST METHOD USING EPIGENETIC BIOMARKERS TO CATEGORIZE CLLS INTO THREE SUBGROUPS WITH DIFFERENT CLINICOBIOLOGIC FEATURES AND OUTCOME. 2015