1 5666 108 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 2 622 24 BIOETHICS IN HUMAN EMBRYOLOGY: THE DOUBLE-EDGED SWORD OF EMBRYO RESEARCH. THERE HAS BEEN A SIGNIFICANT INCREASE IN THE USE OF ASSISTED REPRODUCTIVE THERAPIES (ARTS) OVER THE PAST SEVERAL DECADES, ALLOWING MANY COUPLES WITH INFERTILITY TO CONCEIVE. DESPITE THE ACHIEVEMENTS IN THIS FIELD, A MOUNTING BODY OF EVIDENCE CONCERNING THE EPIGENETIC RISKS ASSOCIATED WITH ART INTERVENTIONS SUCH AS OVARIAN HORMONAL STIMULATION, INTRACYTOPLASMIC SPERM INJECTION (ICSI), AND IN VITRO CULTURE (IVC) OF OOCYTES AND EMBRYOS HAS ALSO EMERGED. INDUCED DEVELOPMENT OF MULTIPLE FOLLICLES, THE IVC MEDIA ITSELF, AND EXTENDED CULTURE MAY ALTER THE EPIGENOME OF BOTH GAMETES AND EMBRYOS, RESULTING IN YET TO BE FULLY UNDERSTOOD DEVELOPMENTAL, POSTNATAL, AND ADULT LIFE HEALTH CONSEQUENCES. INVESTIGATORS HAVE ATTEMPTED TO DECIPHER THE MOLECULAR MECHANISMS MEDIATING ART-INDUCED EPIGENETIC CHANGES USING EITHER HUMAN SAMPLES OR ANIMAL MODELS WITH SOME SUCCESS. AS RESEARCH IN THIS FIELD CONTINUES TO EXPAND, THE ETHICAL RESPONSIBILITIES OF EMBRYOLOGISTS AND RESEARCHERS HAVE BECOME CRITICALLY IMPORTANT. HERE, WE BRIEFLY DISCUSS THE ETHICAL ASPECTS OF ART RESEARCH, CONCENTRATING ON THE CONSTRAINTS ARISING FROM THE PERCEIVED 'UNNATURALNESS' OF MANY OF THESE PROCEDURES. SECONDLY, WE FOCUS ON THE BIOETHICS AND MORALITY OF HUMAN EMBRYO RESEARCH IN GENERAL AND HOW ETHICALLY ACCEPTABLE MODEL SYSTEMS MAY BE USED TO MIMIC EARLY HUMAN EMBRYOGENESIS. LASTLY, WE REVIEW THE 14-DAY CULTURE LIMIT OF HUMAN EMBRYOS AND THE NOTION THAT THIS RULE COULD BE CONSIDERED OF TAKEN INTO ACCOUNT USING NEW TECHNOLOGIES AND CUES FROM ANIMAL MODELS. THE 'BLACK BOX' OF EARLY POST-IMPLANTATION EMBRYOGENESIS MIGHT BE REVEALED USING EMBRYO MODELS. AS LONG AS THIS DISTINCT MORAL LINE HAS BEEN DRAWN AND CLOSELY FOLLOWED, WE SHOULD NOT FEAR SCIENTIFIC GROWTH IN EMBRYO RESEARCH. ALTHOUGH IN VITRO FERTILIZATION (IVF) IS ETHICALLY ACCEPTABLE, RESEARCH WITH HUMAN EMBRYOS TO IMPROVE ITS SUCCESS RAISES SERIOUS ETHICAL CONCERNS THAT ARE IN NEED OF CONSTANT REVISITING.GLOSSARY INDEX: MORAL STATUS: THE ASCRIPTION OF OBLIGATIONS AND RIGHTS TO EMBRYOS ON THE BASIS OF SENTIENCE; SENTIENCE: THE CAPACITY OF THE DEVELOPING EMBRYO TO EXPERIENCE FEELINGS AND SENSATIONS, SUCH AS THE AWARENESS OF PAIN; ECTOGENESIS: THE GROWTH OF THE EMBRYO IN AN ARTIFICIAL ENVIRONMENT OUTSIDE THE MOTHER'S BODY. 2022 3 3304 23 HIGH-GLUCOSE CONCENTRATIONS CHANGE DNA METHYLATION LEVELS IN HUMAN IVM OOCYTES. STUDY QUESTION: WHAT ARE THE EFFECTS OF HIGH-GLUCOSE CONCENTRATIONS ON DNA METHYLATION OF HUMAN OOCYTES? SUMMARY ANSWER: HIGH-GLUCOSE CONCENTRATIONS ALTERED DNA METHYLATION LEVELS OF PEG3 AND ADIPONECTIN IN HUMAN IN VITRO MATURATION OOCYTES. WHAT IS KNOWN ALREADY: MATERNAL DIABETES HAS A DETRIMENTAL INFLUENCE ON OOCYTE QUALITY INCLUDING EPIGENETIC MODIFICATIONS, AS SHOWN IN NON-HUMAN MAMMALIAN SPECIES. STUDY DESIGN, SIZE, DURATION: IMMATURE METAPHASE I (MI) STAGE OOCYTES OF GOOD QUALITY WERE RETRIEVED FROM PATIENTS WHO HAD NORMAL OVARIAN POTENTIAL AND WHO UNDERWENT ICSI IN THE REPRODUCTIVE MEDICINE CENTER OF PEOPLE'S HOSPITAL OF ZHENGZHOU UNIVERSITY. MI OOCYTES WERE CULTURED IN MEDIUM WITH DIFFERENT GLUCOSE CONCENTRATIONS (CONTROL, 10 MM AND 15 MM) IN VITRO AND 48 H LATER, OOCYTES WITH FIRST POLAR BODY EXTRUSION WERE COLLECTED TO CHECK THE DNA METHYLATION LEVELS. PARTICIPANTS/MATERIALS, SETTING, METHODS: MI OOCYTES UNDERWENT IN VITRO MATURATION (IVM) AT 37 DEGREES C WITH 5% MIXED GAS FOR 48 H. THEN THE MATURE OOCYTES WERE TREATED WITH BISULFITE BUFFER. TARGET SEQUENCES WERE AMPLIFIED USING NESTED OR HALF-NESTED PCR AND THE DNA METHYLATION STATUS WAS TESTED USING COMBINED BISULFITE RESTRICTION ANALYSIS (COBRA) AND BISULFITE SEQUENCING (BS). MAIN RESULTS AND THE ROLE OF CHANCE: HIGH-GLUCOSE CONCENTRATIONS SIGNIFICANTLY DECREASED THE FIRST POLAR BODY EXTRUSION RATE. COMPARED TO CONTROLS, THE DNA METHYLATION LEVELS OF PEG3 IN HUMAN IVM OOCYTES WERE SIGNIFICANTLY HIGHER IN 10 MM (P < 0.001) AND 15 MM (P < 0.001) CONCENTRATIONS OF GLUCOSE. BUT THE DNA METHYLATION LEVEL OF H19 WAS NOT AFFECTED BY HIGH-GLUCOSE CONCENTRATIONS IN HUMAN IVM OOCYTES. WE ALSO FOUND THAT THERE WAS A DECREASE IN DNA METHYLATION LEVELS IN THE PROMOTER OF ADIPONECTIN IN HUMAN IVM OOCYTES BETWEEN CONTROLS AND OOCYTES EXPOSED TO 10 MM GLUCOSE (P = 0.028). LARGE SCALE DATA: N/A. LIMITATIONS REASONS FOR CAUTION: IT IS NOT CLEAR WHETHER THE ALTERATIONS ARE BENEFICIAL OR NOT FOR THE EMBRYO DEVELOPMENT AND OFFSPRING HEALTH. THE EFFECTS OF HIGH-GLUCOSE CONCENTRATIONS ON THE WHOLE PROCESS OF OOCYTE MATURATION ARE STILL NOT ELUCIDATED. ANOTHER ISSUE IS THAT THE NUMBER OF OOCYTES USED IN THIS STUDY WAS LIMITED. WIDER IMPLICATIONS OF THE FINDINGS: THIS IS THE FIRST TIME THAT THE EFFECTS OF HIGH-GLUCOSE CONCENTRATION ON DNA METHYLATION OF HUMAN OOCYTES HAVE BEEN ELUCIDATED. OUR RESULT INDICATES THAT IN HUMANS, THE HIGH RISK OF CHRONIC DISEASES IN OFFSPRING FROM DIABETIC MOTHERS MAY ORIGINATE FROM ABNORMAL DNA MODIFICATIONS IN OOCYTES. STUDY FUNDING/COMPETING INTEREST(S): THIS WORK WAS SUPPORTED BY THE FUND OF NATIONAL NATURAL SCIENCE FOUNDATION OF CHINA (81401198) AND DOCTOR FOUNDATION OF QINGDAO AGRICULTURAL UNIVERSITY (1116008).THE AUTHORS DECLARE THAT THERE ARE NO POTENTIAL CONFLICTS OF INTEREST RELEVANT TO THIS ARTICLE. 2018 4 1888 20 ENDOMETRIOSIS AND IN VITRO FERTILISATION. THE AIM OF THE PRESENT REVIEW WAS TO DISCUSS A MATTER OF CONCERN IN THE CLINICAL FIELD OF OBSTETRICS/GYNECOLOGY, NAMELY THE POTENCY OF IN VITRO FERTILIZATION (IVF) IN THE MANAGEMENT OF ENDOMETRIOSIS-ASSOCIATED INFERTILITY. ENDOMETRIOSIS IS A MEDICAL CONDITION AFFECTING ONE TENTH OF WOMEN IN THEIR FERTILE YEARS, AND ACCOUNTS FOR UP TO 50% OF INFERTILE WOMEN. THUS, SUCH HIGH PREVALENCE HAS ESTABLISHED THE NECESSITY FOR INVESTIGATING THE EFFECTIVENESS OF AVAILABLE TECHNIQUES IN ERADICATING THE DISEASE AND CONSTRAINING INFERTILITY AS WELL AS THE ACCOMPANYING PAIN SYMPTOMS OF ENDOMETRIOSIS. THE UNDERLYING MECHANISMS CONNECTING ENDOMETRIOSIS WITH LOW FECUNDITY HAVE BEEN EXTENSIVELY STUDIED, BOTH IN TERMS OF GENETIC ALTERATIONS AND EPIGENETIC EVENTS THAT CONTRIBUTE TO THE MANIFESTATION OF AN INFERTILITY PHENOTYPE IN WOMEN WITH THE DISEASE. SEVERAL STUDIES HAVE DEALT WITH THE IMPACT OF IVF IN PREGNANCY RATES (PRS) ON PATIENTS WITH ENDOMETRIOSIS, PARTICULARLY REGARDING WOMEN WHO WISH TO CONCEIVE. RESULTS RETRIEVED FROM STUDIES AND META-ANALYSES DEPICT A DIVERSE PATTERN OF IVF SUCCESS, UNDERLINING THE INVOLVEMENT OF INDIVIDUAL PARAMETERS IN THE CONFIGURATION OF THE FINAL OUTCOME. THE ULTIMATE DECISION ON UNDERGOING IVF TREATMENT SHOULD BE BASED ON OBJECTIVE CRITERIA AND CLINICIANS' EXPERIENCE, CUSTOMIZED ACCORDING TO PATIENTS' INDIVIDUAL NEEDS. 2018 5 1737 29 EARLY DETECTION OF ACCELERATED AGING AND CELLULAR DECLINE (AACD): A CONSENSUS STATEMENT. THE CELLULAR HALLMARKS OF ACCELERATED AGING AND THEIR CLINICAL EXPRESSION MAY BE GROUPED USING THE TERMS 'ACCELERATED AGING AND CELLULAR DECLINE' (AACD) AND/OR 'AGE-ASSOCIATED CELLULAR DECLINE'. THIS CONSTRUCT IS DESIGNED TO CAPTURE THE BIOLOGICAL BACKGROUND PREDISPOSING THE DEVELOPMENT OF AGE-RELATED CONDITIONS. BY CLASSIFYING RISK FACTORS, EARLY INDICATORS, AND CLINICAL DIFFERENTIATORS OF AACD THROUGH EXPERT CONSENSUS, THIS STUDY AIMED TO IDENTIFY THE SIGNS, SYMPTOMS, AND MARKERS INDICATIVE OF AACD. IN DOING SO, THIS WORK PAVES THE WAY FOR FUTURE IMPLEMENTATION OF THE AACD CONCEPT IN THE CLINICAL AND RESEARCH SETTINGS. AN INTERDISCIPLINARY PANEL OF EXPERTS WITH CLINICAL AND RESEARCH EXPERTISE WAS SELECTED TO PARTICIPATE IN A VIRTUAL WORKSHOP TO DISCUSS AACD. A MODIFIED NOMINAL GROUP TECHNIQUE WAS USED TO ESTABLISH CONSENSUS AMONG THE GROUP. AN EXTENDED GROUP OF INTERNATIONAL EXPERTS CRITICALLY REVIEWED AN EARLY DRAFT OF THE MANUSCRIPT, AND THEIR FEEDBACK WAS THEN INCORPORATED INTO THE MODEL. EXPERTS IDENTIFIED 13 FACTORS PREDISPOSING TO OR CLINICALLY MANIFESTING AACD. AMONG THESE, CHRONIC DISEASES, OBESITY, AND UNFAVORABLE GENETIC BACKGROUND WERE CONSIDERED AS THE MOST IMPORTANT. THERE WAS A CONSENSUS THAT A GRADUAL AND NONSPECIFIC DEVELOPMENT OFTEN CHARACTERIZES AACD, MAKING ITS CLINICAL DETECTION POTENTIALLY CHALLENGING. IN ADDITION, SIGNS AND SYMPTOMS MIGHT HAVE MULTIFACTORIAL CAUSES AND OVERLAPPING ORIGINS, SUCH AS GENETIC AND EPIGENETIC PREDISPOSITIONS. AS A RESULT, AN INITIAL CHECKLIST WAS OUTLINED, LISTING CLINICAL FACTORS OF SPECIAL RELEVANCE (E.G., FATIGUE, LOW QUALITY OF SLEEP, AND LOW MOOD) TO REPRESENT EARLY MANIFESTATIONS OF THE ORGANISM'S EXHAUSTION, WHICH ARE ALSO FREQUENTLY NEGLECTED IN THE CLINICAL SETTING. DIFFERENTIATING AACD FROM OTHER CONDITIONS IS ESSENTIAL. THE USE OF A COMBINATION OF BIOMARKERS WAS PROPOSED AS A VIABLE METHOD IN A TWO-STEP PROCESS OF DIFFERENTIATION: 1) IDENTIFICATION OF EARLY AACD CLINICAL INDICATORS, FOLLOWED BY 2) SYMPTOM AND BIOMARKER CONFIRMATION WITH A FOCUS ON SYSTEM DOMAINS (TO BE POTENTIALLY TARGETED BY FUTURE SPECIFIC INTERVENTIONS). ALTHOUGH THE AACD CONSTRUCT IS NOT YET READY FOR ROUTINE USE IN CLINICAL PRACTICE, ITS OPERATIONALIZATION MAY SUPPORT THE EARLY IDENTIFICATION OF AGE-RELATED CONDITIONS (WHEN THIS MIGHT STILL BE AMENABLE TO REVERSION) AND ALSO ENCOURAGE PREVENTATIVE INTERVENTIONS. FURTHER INVESTIGATION IS NEEDED TO ESTABLISH SPECIFIC BIOMARKERS THAT CONFIRM INDEPENDENT RISK FACTORS FOR AACD AND PROVIDE A MORE DEFINITIVE STRUCTURE TO THE CONCEPT OF AACD (AND AGE-ASSOCIATED CELLULAR DECLINE). 2021 6 4729 40 NOTCH1 MUTATIONS ASSOCIATE WITH LOW CD20 LEVEL IN CHRONIC LYMPHOCYTIC LEUKEMIA: EVIDENCE FOR A NOTCH1 MUTATION-DRIVEN EPIGENETIC DYSREGULATION. IN CHRONIC LYMPHOCYTIC LEUKEMIA (CLL), NOTCH1 MUTATIONS HAVE BEEN ASSOCIATED WITH CLINICAL RESISTANCE TO THE ANTI-CD20 RITUXIMAB, ALTHOUGH THE MECHANISMS BEHIND THIS PECULIAR BEHAVIOR REMAIN TO BE CLARIFIED. IN A WIDE CLL SERIES (N=692), WE DEMONSTRATED THAT CLL CELLS FROM NOTCH1-MUTATED CASES (87/692) WERE CHARACTERIZED BY LOWER CD20 EXPRESSION AND LOWER RELATIVE LYSIS INDUCED BY ANTI-CD20 EXPOSURE IN VITRO. CONSISTENTLY, CD20 EXPRESSION BY CLL CELLS WAS UPREGULATED IN VITRO BY GAMMA-SECRETASE INHIBITORS OR NOTCH1-SPECIFIC SMALL INTERFERING RNA AND THE STABLE TRANSFECTION OF A MUTATED (C.7541-7542DELCT) NOTCH1 INTRACELLULAR DOMAIN (NICD-MUT) INTO CLL-LIKE CELLS RESULTED IN A STRONG DOWNREGULATION OF BOTH CD20 PROTEIN AND TRANSCRIPT. BY USING THESE NICD-MUT TRANSFECTANTS, WE INVESTIGATED PROTEIN INTERACTIONS OF RBPJ, A TRANSCRIPTION FACTOR ACTING EITHER AS ACTIVATOR OR REPRESSOR OF NOTCH1 PATHWAY WHEN RESPECTIVELY BOUND TO NICD OR HISTONE DEACETYLASES (HDACS). COMPARED WITH CONTROLS, NICD-MUT TRANSFECTANTS HAD RBPJ PREFERENTIALLY COMPLEXED TO NICD AND SHOWED HIGHER LEVELS OF HDACS INTERACTING WITH THE PROMOTER OF THE CD20 GENE. FINALLY, TREATMENT WITH THE HDAC INHIBITOR VALPROIC ACID UPREGULATED CD20 IN BOTH NICD-MUT TRANSFECTANTS AND PRIMARY CLL CELLS. IN CONCLUSION, NOTCH1 MUTATIONS ARE ASSOCIATED WITH LOW CD20 LEVELS IN CLL AND ARE RESPONSIBLE FOR A DYSREGULATION OF HDAC-MEDIATED EPIGENETIC REPRESSION OF CD20 EXPRESSION. 2016 7 961 24 CHRONIC MYELOMONOCYTIC LEUKEMIA: A GENETIC AND CLINICAL UPDATE. CHRONIC MYELOMONOCYTIC LEUKEMIA (CMML) IS A CLONAL STEM CELL DISORDER, CHARACTERIZED BY PERIPHERAL BLOOD MONOCYTOSIS AND OVERLAPPING FEATURES BETWEEN MYELODYSPLASTIC SYNDROMES (MDS) AND MYELOPROLIFERATIVE NEOPLASMS (MPNS). CLONAL CYTOGENETIC CHANGES ARE SEEN IN UP TO 30 % PATIENTS, WHILE APPROXIMATELY 90 % HAVE DETECTABLE MOLECULAR ABNORMALITIES. MOST PATIENTS ARE DIAGNOSED IN THE SEVENTH DECADE OF LIFE. GENE MUTATIONS IN TEN-ELEVEN TRANSLOCATION (TET) ONCOGENE FAMILY MEMBER 2 (TET2) (60 %), SRSF2 (50 %), ASXL1 (40 %), AND RAS (20-30 %) ARE FREQUENT, WITH ONLY FRAME SHIFT AND NONSENSE ASXL1 MUTATIONS NEGATIVELY IMPACTING OVERALL SURVIVAL. WITH THE LACK OF FORMAL GUIDELINES, MANAGEMENT AND RESPONSE CRITERIA ARE OFTEN EXTRAPOLATED FROM MDS AND MPN. CONTEMPORARY MOLECULARLY INTEGRATED CMML-SPECIFIC PROGNOSTIC MODELS INCLUDE THE GROUPE FRANCAIS DES MYELODYSPLASIES (GFM) MODEL AND THE MOLECULAR MAYO MODEL, BOTH INCORPORATING ASXL1 MUTATIONAL STATUS. HYPOMETHYLATING AGENTS AND ALLOGENEIC STEM CELL TRANSPLANT REMAIN THE TWO MOST COMMONLY USED TREATMENT STRATEGIES, WITH SUBOPTIMAL RESULTS. CLINICAL TRIALS EXPLOITING EPIGENETIC AND SIGNAL PATHWAY ABNORMALITIES, FREQUENT IN CMML, OFFER HOPE AND PROMISE. 2015 8 6171 31 THE HDAC INHIBITOR VALPROATE INDUCES A BIVALENT STATUS OF THE CD20 PROMOTER IN CLL PATIENTS SUGGESTING DISTINCT EPIGENETIC REGULATION OF CD20 EXPRESSION IN CLL IN VIVO. TREATMENT WITH ANTI-CD20 ANTIBODIES IS ONLY MODERATELY EFFICIENT IN CHRONIC LYMPHOCYTIC LEUKEMIA (CLL), A FEATURE WHICH HAS BEEN EXPLAINED BY THE INHERENTLY LOW CD20 EXPRESSION IN CLL. IT HAS BEEN SHOWN THAT CD20 IS EPIGENETICALLY REGULATED AND THAT HISTONE DEACETYLASE INHIBITORS (HDACIS) CAN INCREASE CD20 EXPRESSION IN VITRO IN CLL. TO ASSESS WHETHER HDACIS CAN UPREGULATE CD20 ALSO IN VIVO IN CLL, THE HDACI VALPROATE WAS GIVEN TO THREE DEL13Q/NOTCH1WT CLL PATIENTS AND CD20 LEVELS WERE ANALYSED (THE PREVAIL STUDY). VALPROATE TREATMENT RESULTED IN EXPECTED GLOBAL ACTIVATING HISTONE MODIFICATIONS SUGGESTING HDAC INHIBITORY EFFECTS. HOWEVER, ALTHOUGH VALPROATE INDUCED EXPRESSION OF CD20 MRNA AND PROTEIN IN THE DEL13Q/NOTCH1WT I83-E95 CLL CELL LINE, NO SUCH EFFECTS WERE OBSERVED IN THE PATIENTS STUDIED. IN CONTRAST TO THE CELL LINE, IN PATIENTS VALPROATE TREATMENT RESULTED IN TRANSIENT RECRUITMENT OF THE TRANSCRIPTIONAL REPRESSOR EZH2 TO THE CD20 PROMOTER, CORRELATING TO AN INCREASE OF THE REPRESSIVE HISTONE MARK H3K27ME3. THIS SUGGESTS THAT VALPROATE-MEDIATED INDUCTION OF CD20 MAY BE HAMPERED BY EZH2 MEDIATED H3K27ME3 IN VIVO IN CLL. MOREOVER, VALPROATE TREATMENT RESULTED IN INDUCTION OF EZH2 AND GLOBAL H3K27ME3 IN PATIENT CELLS, SUGGESTING TRANSCRIPTIONALLY REPRESSIVE EFFECTS OF VALPROATE IN CLL. OUR RESULTS SUGGEST NEW IN VIVO MECHANISMS OF HDACIS WHICH MAY HAVE IMPLICATIONS ON THE DESIGN OF FUTURE CLINICAL TRIALS IN B-CELL MALIGNANCIES. 2017 9 962 27 CHRONIC MYELOMONOCYTIC LEUKEMIA: FOCUS ON CLINICAL PRACTICE. CHRONIC MYELOMONOCYTIC LEUKEMIA (CMML) IS A CLONAL STEM CELL DISORDER WITH FEATURES THAT OVERLAP THOSE OF MYELODYSPLASTIC SYNDROMES (MDSS) AND MYELOPROLIFERATIVE NEOPLASMS (MPNS). CHRONIC MYELOMONOCYTIC LEUKEMIA OFTEN RESULTS IN PERIPHERAL BLOOD MONOCYTOSIS AND HAS AN INHERENT TENDENCY TO TRANSFORM TO ACUTE MYELOID LEUKEMIA. CLONAL CYTOGENETIC CHANGES ARE SEEN IN APPROXIMATELY 30% OF PATIENTS, AND MOLECULAR ABNORMALITIES ARE SEEN IN MORE THAN 90%. GENE MUTATIONS INVOLVING TET2 ( APPROXIMATELY 60%), SRSF2 ( APPROXIMATELY 50%), ASXL1 ( APPROXIMATELY 40%), AND RAS ( APPROXIMATELY 30%) ARE FREQUENT, WITH NONSENSE AND FRAMESHIFT ASXL1 MUTATIONS BEING THE ONLY MUTATIONS IDENTIFIED THUS FAR TO HAVE AN INDEPENDENT NEGATIVE PROGNOSTIC EFFECT ON OVERALL SURVIVAL. CONTEMPORARY MOLECULARLY INTEGRATED PROGNOSTIC MODELS (INCLUSIVE OF ASXL1 MUTATIONS) INCLUDE THE MOLECULAR MAYO MODEL AND THE GROUPE FRANCAIS DES MYELODYSPLASIES MODEL. GIVEN THE LACK OF FORMAL TREATMENT AND RESPONSE CRITERIA, MANAGEMENT OF CMML IS OFTEN EXTRAPOLATED FROM MDS AND MPN, WITH ALLOGENEIC STEM CELL TRANSPLANT BEING THE ONLY CURATIVE OPTION. HYDROXYUREA AND OTHER CYTOREDUCTIVE AGENTS HAVE BEEN USED TO CONTROL MPN-LIKE FEATURES, WHILE EPIGENETIC MODIFIERS SUCH AS HYPOMETHYLATING AGENTS HAVE BEEN USED FOR MDS-LIKE FEATURES. GIVEN THE RELATIVELY POOR RESPONSE TO THESE AGENTS AND THE INHERENT RISKS ASSOCIATED WITH HEMATOPOIETIC STEM CELL TRANSPLANT, NEWER DRUGS EXPLOITING MOLECULAR AND EPIGENETIC ABNORMALITIES IN CMML ARE BEING DEVELOPED. THE CREATION OF CMML-SPECIFIC RESPONSE CRITERIA IS A MUCH NEEDED STEP IN ORDER TO IMPROVE CLINICAL OUTCOMES. 2016 10 4442 25 MOLECULAR GENETICS OF MDS/MPN OVERLAP SYNDROMES. THE MYELODYSPLASTIC/MYELOPROLIFERATIVE NEOPLASMS (MDS/MPN) ARE A HETEROGENOUS GROUP OF MYELOID MALIGNANCIES HALLMARKED BY CLINICOPATHOLOGIC FEATURES THAT OVERLAP WITH MYELODYSPLASTIC SYNDROMES AND MYELOPROLIFERATIVE NEOPLASMS. FORMALLY RECOGNIZED BY THE WORLD HEALTH ORGANIZATION, THIS GROUP INCLUDES THE ENTITIES CHRONIC MYELOMONOCYTIC LEUKEMIA, JUVENILE MYELOMONOCYTIC LEUKEMIA, ATYPICAL CHRONIC MYELOID LEUKEMIA, MDS/MPN WITH RING SIDEROBLASTS AND THROMBOCYTOSIS AND MDS/MPN, UNCLASSIFIABLE. ADVANCEMENTS IN NEXT GENERATION SEQUENCING HAVE BEGUN TO UNRAVEL THE MOLECULAR UNDERPINNINGS OF THESE DISEASES, IDENTIFYING AN ARRAY OF RECURRENTLY MUTATED GENES INVOLVED IN EPIGENETIC REGULATION, RNA SPLICING, TRANSCRIPTION, AND CELL SIGNALING. DESPITE MOLECULAR OVERLAP WITH OTHER MYELOID MALIGNANCIES, EACH ENTITY DISPLAYS A UNIQUE SPECTRUM OF SOMATIC MUTATIONS SUPPORTING THEIR UNIQUE PATHOBIOLOGY AND CLINICAL FEATURES. IMPORTANTLY, MOLECULAR PROFILING IS BECOMING AN INTEGRAL TOOL UTILIZED IN ROUTINE CLINICAL PRACTICE. THIS REVIEW SUMMARIZES OUR CURRENT UNDERSTANDING OF THE MOLECULAR PATHOGENESIS OF OVERLAP SYNDROMES AND DETAILS THE IMPACT OF SOMATIC MUTATIONS IN DIAGNOSTIC, PROGNOSTIC, AND THERAPEUTIC DECISION-MAKING. 2020 11 940 27 CHRONIC LYMPHOCYTIC LEUKEMIA AND MANTLE CELL LYMPHOMA: CROSSROADS OF GENETIC AND MICROENVIRONMENT INTERACTIONS. CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) AND MANTLE CELL LYMPHOMA (MCL) ARE 2 WELL-DEFINED ENTITIES THAT DIVERGE IN THEIR BASIC PATHOGENIC MECHANISMS AND CLINICAL EVOLUTION BUT THEY SHARE EPIDEMIOLOGICAL CHARACTERISTICS, CELLS OF ORIGIN, MOLECULAR ALTERATIONS, AND CLINICAL FEATURES THAT DIFFER FROM OTHER LYMPHOID NEOPLASMS. CLL AND MCL ARE CLASSICALLY CONSIDERED INDOLENT AND AGGRESSIVE NEOPLASMS, RESPECTIVELY. HOWEVER, THE CLINICAL EVOLUTION OF BOTH TUMORS IS VERY HETEROGENEOUS, WITH SUBSETS OF PATIENTS HAVING STABLE DISEASE FOR A LONG TIME WHEREAS OTHERS REQUIRE IMMEDIATE INTERVENTION. BOTH CLL AND MCL INCLUDE 2 MAJOR MOLECULAR SUBTYPES THAT SEEM TO DERIVE FROM ANTIGEN-EXPERIENCED CD5(+) B CELLS THAT RETAIN A NAIVE OR MEMORY-LIKE EPIGENETIC SIGNATURE AND CARRY A VARIABLE LOAD OF IMMUNOGLOBULIN HEAVY-CHAIN VARIABLE REGION SOMATIC MUTATIONS FROM TRULY UNMUTATED TO HIGHLY MUTATED, RESPECTIVELY. THESE 2 SUBTYPES OF TUMORS DIFFER IN THEIR MOLECULAR PATHWAYS, GENOMIC ALTERATIONS, AND CLINICAL BEHAVIOR, BEING MORE AGGRESSIVE IN NAIVE-LIKE THAN MEMORY-LIKE-DERIVED TUMORS IN BOTH CLL AND MCL. THE PATHOGENESIS OF THE 2 ENTITIES INTEGRATES THE RELEVANT INFLUENCE OF B-CELL RECEPTOR SIGNALING, TUMOR CELL MICROENVIRONMENT INTERACTIONS, GENOMIC ALTERATIONS, AND EPIGENOME MODIFICATIONS THAT CONFIGURE THE EVOLUTION OF THE TUMORS AND OFFER NEW POSSIBILITIES FOR THERAPEUTIC INTERVENTION. THIS REVIEW WILL FOCUS ON THE SIMILARITIES AND DIFFERENCES OF THESE 2 TUMORS BASED ON RECENT STUDIES THAT ARE ENHANCING THE UNDERSTANDING OF THEIR PATHOGENESIS AND CREATING SOLID BASES FOR NEW MANAGEMENT STRATEGIES. 2018 12 5513 30 RICHTER SYNDROME: NOVEL INSIGHTS INTO THE BIOLOGY OF TRANSFORMATION. ALTHOUGH THE GENETIC LANDSCAPE OF CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) HAS BEEN BROADLY PROFILED BY LARGE-SCALE SEQUENCING STUDIES PERFORMED OVER THE PAST DECADE, THE MOLECULAR BASIS OF THE TRANSFORMATION OF CLL INTO AGGRESSIVE LYMPHOMA, OR RICHTER SYNDROME (RS), HAS REMAINED INCOMPLETELY CHARACTERIZED. RECENT ADVANCES IN COMPUTATIONAL METHODS OF CLONAL DECONVOLUTION, AS WELL AS EXTENSIVE SAMPLE COLLECTION EFFORTS IN THIS RAPIDLY PROGRESSIVE MALIGNANCY, HAVE NOW ENABLED COMPREHENSIVE ANALYSIS OF PAIRED CLL AND RS SAMPLES AND HAVE LED TO MULTIPLE NEW STUDIES INVESTIGATING THE GENETIC, TRANSCRIPTOMIC, AND EPIGENETIC ORIGINS OF RS. IN PARALLEL, NEW GENETICALLY ENGINEERED AND XENOGRAFT MOUSE MODELS HAVE PROVIDED THE OPPORTUNITY FOR GLEANING FRESH BIOLOGICAL AND MECHANISTIC INSIGHTS INTO RS DEVELOPMENT AND STEPWISE EVOLUTION FROM ANTECEDENT CLL. ALTOGETHER, THESE STUDIES HAVE DEFINED RS DRIVER LESIONS AND CLL RISK LESIONS AND IDENTIFIED PATHWAYS DYSREGULATED IN TRANSFORMATION. MOREOVER, UNIQUE MOLECULAR SUBTYPES OF RS HAVE BEEN REVEALED, INCLUDING A DISEASE MARKED BY PROFOUND GENOMIC INSTABILITY WITH CHROMOTHRIPSIS/CHROMOPLEXY AND WHOLE GENOME DUPLICATION. NOVEL PROFILING APPROACHES, INCLUDING SINGLE-CELL DNA AND TRANSCRIPTOME SEQUENCING OF RS BIOPSY SPECIMENS AND CELL-FREE DNA PROFILING OF PATIENT PLASMA, DEMONSTRATE PROMISE FOR THE TIMELY IDENTIFICATION OF RS CLONES AND MAY TRANSLATE TO NONINVASIVE IDENTIFICATION AND EARLY DIAGNOSIS OF RS. THIS REVIEW SUMMARIZES THE RECENT SCIENTIFIC ADVANCES IN RS AND SUPPORTS THE INTEGRATED STUDY OF HUMAN GENOMICS WITH MOUSE MODELING TO PROVIDE AN ADVANCED UNDERSTANDING OF THE BIOLOGICAL UNDERPINNINGS OF TRANSFORMATION. THESE RECENT STUDIES HAVE MAJOR IMPLICATIONS FOR MUCH-NEEDED NOVEL THERAPEUTIC STRATEGIES FOR THIS STILL LARGELY INCURABLE MALIGNANCY. 2023 13 483 30 ART AND HEALTH: CLINICAL OUTCOMES AND INSIGHTS ON MOLECULAR MECHANISMS FROM RODENT STUDIES. SINCE THE BIRTH OF THE FIRST IVF-CONCEIVED CHILD IN 1978, THE USE OF ASSISTED REPRODUCTIVE TECHNOLOGIES (ART) HAS GROWN DRAMATICALLY, CONTRIBUTING TO THE SUCCESSFUL BIRTH OF 5 MILLION INDIVIDUALS WORLDWIDE. HOWEVER, THERE ARE SEVERAL REPORTED ASSOCIATIONS OF ART WITH PREGNANCY COMPLICATIONS, SUCH AS LOW BIRTHWEIGHT (LBW), PRETERM BIRTH, BIRTH DEFECTS, EPIGENETIC DISORDERS, CANCER AND POOR METABOLIC HEALTH. WHETHER THIS IS ATTRIBUTED TO ART PROCEDURES OR TO THE SUBSET OF THE POPULATION SEEKING ART REMAINS A CONTROVERSY, BUT THE MOST RELEVANT QUESTION TODAY CONCERNS THE POTENTIAL LONG-TERM IMPLICATIONS OF ASSISTED CONCEPTION. RECENT EVIDENCE HAS EMERGED SUGGESTING THAT ART-CONCEIVED CHILDREN HAVE DISTINCT METABOLIC PROFILES THAT MAY PREDISPOSE TO CARDIOVASCULAR PATHOLOGIES IN ADULTHOOD. BECAUSE THE ELDEST IVF INDIVIDUALS ARE STILL TOO YOUNG TO EXHIBIT COMPONENTS OF CHRONIC MIDDLE-AGED SYNDROMES, THE USE OF ANIMAL MODELS HAS BECOME PARTICULARLY USEFUL IN DESCRIBING THE EFFECTS OF UNUSUAL OR STRESSFUL PREIMPLANTATION EXPERIENCES ON ADULT FITNESS. ELUCIDATING THE MOLECULAR MECHANISMS BY WHICH EMBRYOS INTEGRATE ENVIRONMENTAL SIGNALS INTO DEVELOPMENT AND METABOLIC GENE EXPRESSION PROGRAMS WILL BE ESSENTIAL FOR OPTIMIZING ART PROCEDURES SUCH AS IN VITRO CULTURE CONDITIONS, EMBRYO SELECTION AND TRANSFER. IN THE FUTURE, ADDITIONAL ANIMAL STUDIES TO IDENTIFY MECHANISMS UNDERLYING UNFAVORABLE ART OUTCOMES, AS WELL AS MORE EPIDEMIOLOGICAL REVIEWS TO MONITOR THE LONG-TERM HEALTH OF ART CHILDREN ARE REQUIRED, GIVEN THAT ART PROCEDURES HAVE BECOME ROUTINE MEDICAL PRACTICE. 2013 14 467 30 ARE WE FINALLY GETTING PERSONAL? MOVING TOWARDS A PERSONALIZED APPROACH IN CHRONIC LYMPHOCYTIC LEUKEMIA. WITH ITS HETEROGENEOUS BIOLOGICAL FEATURES AND CLINICAL COURSE, CHRONIC LYMPHOCYTIC LEUKEMIA (CLL), THE MOST FREQUENT ADULT LEUKEMIA IN THE WESTERN WORLD, IS A PARADIGMATIC CONDITION REQUIRING A TAILORED APPROACH AND A PRECISE KNOWLEDGE OF THE BIOLOGY BEHIND EACH INDIVIDUAL PATIENT. THIS PERSONALIZED MANAGEMENT IS BECOMING EVEN MORE CRUCIAL, SINCE, AFTER DECADES OF PRECLINICAL WORK UNRAVELLING THE KEY ROLE OF THE B-CELL RECEPTOR (BCR) SIGNALLING PATHWAYS AND THE ANTI-APOPTOTIC MECHANISMS IN CLL CELL SURVIVAL AND PROLIFERATION, WE HAVE NOW BCR AND BCL2 INHIBITORS AVAILABLE IN CLINICAL PRACTICE. THANKS TO THIS, WE ARE NOW ABLE TO EXPLOIT SPECIFIC BIOMARKERS TO TAILOR OUR TREATMENT STRATEGIES AND IMPROVE LONG-TERM DISEASE CONTROL, PATIENT OUTCOME AND QUALITY OF LIFE. THAT NOTWITHSTANDING, AS THE DISEASE ITSELF REMAINS INCURABLE, NOVEL CHALLENGES AND UNMET CLINICAL NEEDS HAVE RISEN FROM THE INTRODUCTION OF NOVEL TARGETED AGENTS, INCLUDING MECHANISMS OF RESISTANCE AT BOTH GENETIC AND EPIGENETIC LEVELS. IN THIS REVIEW, WE SUMMARIZE THE CURRENTLY ESTABLISHED PREDICTIVE BIOMARKERS (I.E. IGHV MUTATION STATUS AND TP53 GENE DISRUPTION) THAT SHOULD BE APPLIED IN CLINICAL PRACTICE TO INFORM TREATMENT DECISION IN 2021 BUT ALSO DISCUSS THE MOST PROMISING PROGNOSTIC BIOMARKERS (B-CELL RECEPTOR STEREOTYPY, COMPLEX KARYOTYPE, SOMATIC GENE MUTATIONS, MEASURABLE RESIDUAL DISEASE - MRD) THAT MIGHT BECOME KEY TO DEFINE THE MANAGEMENT OF OUR PATIENTS IN A NEAR FUTURE. 2022 15 963 27 CHRONIC MYELOMONOCYTIC LEUKEMIA: INSIGHTS INTO BIOLOGY, PROGNOSTIC FACTORS, AND TREATMENT. PURPOSE OF REVIEW: CHRONIC MYELOMONOCYTIC LEUKEMIA (CMML) IS A CLONAL HEMATOLOGICAL MALIGNANCY CHARACTERIZED BY BOTH DYSPLASTIC AND PROLIFERATIVE FEATURES, WITH AN INHERENT RISK FOR LEUKEMIC TRANSFORMATION. WITH THE HELP OF THIS REVIEW, WE AIM TO SUMMARIZE KEY CONCEPTS WITH REGARDS TO CMML BIOLOGY, DIAGNOSIS, RISK STRATIFICATION, AND THERAPEUTICS. RECENT FINDINGS: BASED ON RECENT STUDIES, CMML IS HALLMARKED BY A RELATIVELY LOW GENETIC COMPLEXITY, WHICH CONTRASTS WITH A COMPELLING PHENOTYPICAL HETEROGENEITY, LARGELY DRIVEN BY EPIGENETIC MECHANISMS. RECENT ADVANCES IN THE CHARACTERIZATION OF CMML BIOLOGY HAS LED TO AN IMPROVEMENT IN RISK-STRATIFICATION, BY MEANS OF INCORPORATING PROGNOSTICALLY RELEVANT GENE MUTATIONS. THIS, HOWEVER, HAS NOT SIGNIFICANTLY IMPACTED AVAILABLE THERAPIES AND OUTCOMES CONTINUE TO REMAIN POOR. ADVANCES IN CMML BIOLOGY HAVE BETTER EXPLAINED THE PHENOTYPIC HETEROGENEITY, WHILE CONTINUING TO DEFINE THE GENETIC AND EPIGENETIC LANDSCAPE. IN SPITE OF RECENT ADVANCES, LIMITED EFFECTIVE THERAPIES EXIST AND DEVELOPING RATIONALLY DERIVED THERAPEUTIC APPROACHES IS MUCH NEEDED. 2019 16 4473 29 MOLECULAR PATHOGENESIS OF CLL AND ITS EVOLUTION. IN SPITE OF BEING THE MOST PREVALENT ADULT LEUKEMIA IN WESTERN COUNTRIES, THE MOLECULAR MECHANISMS DRIVING THE ESTABLISHMENT AND PROGRESSION OF CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) REMAIN LARGELY UNKNOWN. IN RECENT YEARS, THE USE OF NEXT-GENERATION SEQUENCING TECHNIQUES HAS UNCOVERED NEW AND, IN SOME CASES, UNEXPECTED DRIVER GENES WITH PROGNOSTIC AND THERAPEUTIC VALUE. THE MUTATIONAL LANDSCAPE OF CLL IS CHARACTERIZED BY HIGH-GENETIC AND EPIGENETIC HETEROGENEITY, LOW MUTATION RECURRENCE AND A LONG TAIL OF CASES WITH UNDEFINED DRIVER GENES. ON THE OTHER HAND, THE USE OF DEEP SEQUENCING HAS ALSO REVEALED HIGH INTRA-TUMOR HETEROGENEITY AND PROVIDED A DETAILED PICTURE OF CLONAL EVOLUTION PROCESSES. THIS PHENOMENON, IN WHICH ABERRANT DNA METHYLATION CAN ALSO PARTICIPATE, APPEARS TO BE TIGHTLY ASSOCIATED TO POOR OUTCOMES AND CHEMO-REFRACTORINESS, THUS PROVIDING A NEW SUBJECT FOR THERAPEUTIC INTERVENTION. HENCE, AND HAVING IN MIND THE LIMITATIONS DERIVED FROM THE CLL COMPLEXITY THUS DESCRIBED, THE APPLICATION OF MASSIVELY PARALLEL SEQUENCING STUDIES HAS UNVEILED A WEALTH OF INFORMATION THAT IS EXPECTED TO SUBSTANTIALLY IMPROVE PATIENT STAGING SCHEMES AND CLL CLINICAL MANAGEMENT. 2015 17 4344 15 MINIREVIEW: TRANSLATIONAL ANIMAL MODELS OF HUMAN MENOPAUSE: CHALLENGES AND EMERGING OPPORTUNITIES. INCREASING IMPORTANCE IS PLACED ON THE TRANSLATIONAL VALIDITY OF ANIMAL MODELS OF HUMAN MENOPAUSE TO DISCERN RISK VS. BENEFIT FOR PREDICTION OF OUTCOMES AFTER THERAPEUTIC INTERVENTIONS AND TO DEVELOP NEW THERAPEUTIC STRATEGIES TO PROMOTE HEALTH. BASIC DISCOVERY RESEARCH CONDUCTED OVER MANY DECADES HAS BUILT AN EXTENSIVE BODY OF KNOWLEDGE REGARDING REPRODUCTIVE SENESCENCE ACROSS MAMMALIAN SPECIES UPON WHICH TO ADVANCE ANIMAL MODELS OF HUMAN MENOPAUSE. MODIFICATIONS TO EXISTING ANIMAL MODELS COULD RAPIDLY ADDRESS TRANSLATIONAL GAPS RELEVANT TO CLINICAL ISSUES IN HUMAN MENOPAUSAL HEALTH, WHICH INCLUDE THE IMPACT OF 1) CHRONIC OVARIAN HORMONE DEPRIVATION AND HORMONE THERAPY, 2) CLINICALLY RELEVANT HORMONE THERAPY REGIMENS (CYCLIC VS. CONTINUOUS COMBINED), 3) CLINICALLY RELEVANT HORMONE THERAPY FORMULATIONS, AND 4) WINDOWS OF OPPORTUNITY AND OPTIMAL DURATION OF INTERVENTIONS. MODIFICATIONS IN EXISTING ANIMAL MODELS TO MORE ACCURATELY REPRESENT HUMAN MENOPAUSE AND CLINICAL INTERVENTIONS COULD RAPIDLY PROVIDE PRECLINICAL TRANSLATIONAL DATA TO PREDICT OUTCOMES REGARDING UNRESOLVED CLINICAL ISSUES RELEVANT TO WOMEN'S MENOPAUSAL HEALTH. DEVELOPMENT OF THE NEXT GENERATION OF ANIMAL MODELS OF HUMAN MENOPAUSE COULD LEVERAGE ADVANCES IN IDENTIFYING GENOTYPIC VARIATIONS IN ESTROGEN AND PROGESTERONE RECEPTORS TO DEVELOP PERSONALIZED MENOPAUSAL CARE AND TO PREDICT OUTCOMES OF INTERVENTIONS FOR PROTECTION AGAINST OR VULNERABILITY TO DISEASE. KEY TO THE SUCCESS OF THESE MODELS IS THE CLOSE COUPLING BETWEEN THE TRANSLATIONAL TARGET AND THE RANGE OF PREDICTIVE VALIDITY. PRECLINICAL TRANSLATIONAL ANIMAL MODELS OF HUMAN MENOPAUSE NEED TO KEEP PACE WITH CHANGES IN CLINICAL PRACTICE. WITH FOCUS ON PREDICTIVE VALIDITY AND STRATEGIC USE OF ADVANCES IN GENETIC AND EPIGENETIC SCIENCE, NEW ANIMAL MODELS OF HUMAN MENOPAUSE HAVE THE OPPORTUNITY TO SET NEW DIRECTIONS FOR MENOPAUSAL CLINICAL CARE FOR WOMEN WORLDWIDE. 2012 18 2695 21 EVOLVING UNDERSTANDING OF THE CLL GENOME. OVER THE PAST FEW YEARS, MASSIVELY PARALLEL SEQUENCING TECHNOLOGIES HAVE REVEALED WITH HIGH RESOLUTION THE TREMENDOUS GENETIC AND EPIGENETIC HETEROGENEITY IN CHRONIC LYMPHOCYTIC LEUKEMIA (CLL). WE HAVE LEARNED HOW THE MOLECULAR ARCHITECTURE DIFFERS NOT ONLY BETWEEN AFFECTED INDIVIDUALS BUT ALSO WITHIN SAMPLES AND OVER TIME. THESE INSIGHTS HAVE CATALYZED OUR UNDERSTANDING OF THE PATHOBIOLOGY OF CLL AND POINT TO CRITICAL SIGNALING PATHWAYS IN THE DEVELOPMENT AND PROGRESSION OF THE DISEASE. SEVERAL KEY DRIVER ALTERATIONS HAVE BEEN IDENTIFIED, WHICH SERVE TO REFINE PROGNOSTIC SCHEMATA BUT ALSO TO INSPIRE THE DEVELOPMENT OF NEW THERAPEUTIC STRATEGIES. ONGOING ADVANCES IN TECHNOLOGY PROMISE TO FURTHER ELUCIDATE THE MOLECULAR BASIS OF CLL, AND THIS KNOWLEDGE IS ANTICIPATED TO AID US IN UNDERSTANDING AND ADDRESSING THE CLINICAL CHALLENGE PRESENTED BY THE VAST VARIABILITY IN THE CLINICAL COURSE OF PATIENTS WITH CLL. 2014 19 5664 22 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 20 3575 34 IMPACT OF MOLECULAR PROFILING ON THE MANAGEMENT OF PATIENTS WITH MYELOFIBROSIS. MYELOFIBROSIS (MF) IS A CHRONIC MYELOPROLIFERATIVE NEOPLASM (MPN) CHARACTERIZED BY A HIGHLY HETEROGENEOUS CLINICAL COURSE, WHICH CAN BE COMPLICATED BY SEVERE CONSTITUTIONAL SYMPTOMS, MASSIVE SPLENOMEGALY, PROGRESSIVE BONE MARROW FAILURE, CARDIOVASCULAR EVENTS, AND DEVELOPMENT OF ACUTE LEUKEMIA. CONSTITUTIVE SIGNALING THROUGH THE JAK-STAT PATHWAY PLAYS A FUNDAMENTAL ROLE IN ITS PATHOGENESIS, GENERALLY DUE TO ACTIVATING MUTATIONS OF JAK2, CALR AND MPL GENES (I.E., THE MPN DRIVER MUTATIONS), PRESENT IN MOST MF PATIENTS. NEXT GENERATION SEQUENCING (NGS) PANEL TESTING HAS SHOWN THAT ADDITIONAL SOMATIC MUTATIONS CAN ALREADY BE DETECTED AT THE TIME OF DIAGNOSIS IN MORE THAN HALF OF PATIENTS, AND THAT THEY ACCUMULATE ALONG THE DISEASE COURSE. THESE MUTATIONS, MOSTLY AFFECTING EPIGENETIC MODIFIERS OR SPLICEOSOME COMPONENTS, MAY COOPERATE WITH MPN DRIVERS TO FAVOR CLONAL DOMINANCE OR INFLUENCE THE CLINICAL PHENOTYPE, AND SOME, SUCH AS HIGH MOLECULAR RISK MUTATIONS, CORRELATE WITH A MORE AGGRESSIVE CLINICAL COURSE WITH POOR TREATMENT RESPONSE. THE CURRENT MAIN ROLE OF MOLECULAR PROFILING IN CLINICAL PRACTICE IS PROGNOSTICATION, PRINCIPALLY FOR SELECTING HIGH-RISK PATIENTS WHO MAY BE CANDIDATES FOR TRANSPLANTATION, THE ONLY CURATIVE TREATMENT FOR MF TO DATE. TO THIS END, CONTEMPORARY PROGNOSTIC MODELS INCORPORATING MOLECULAR DATA ARE USEFUL TOOLS TO DISCRIMINATE DIFFERENT RISK CATEGORIES. ASIDE FROM CERTAIN CLINICAL SITUATIONS, DECISIONS REGARDING MEDICAL TREATMENT ARE NOT BASED ON PATIENT MOLECULAR PROFILING, YET THIS APPROACH MAY BECOME MORE RELEVANT IN NOVEL TREATMENT STRATEGIES, SUCH AS THE USE OF VACCINES AGAINST THE MUTANT FORMS OF JAK2 OR CALR, OR DRUGS DIRECTED AGAINST ACTIONABLE MOLECULAR TARGETS. 2022