Análise dos nichos da medula óssea na leucemia mieloide crônica
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Data
2019-03-01
Autores
Vieira, Thiago Henrique
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Introdução: A Leucemia Mieloide Crônica (LMC) consiste em uma neoplasia hematopoiética maligna de células-tronco, caracterizada pela aquisição do gene de fusão BCR-ABL1 associado à translocação [t(9;22) (q34;q11)]. O início é insidioso com progressão lenta seguida por uma fase acelerada, que culmina na crise blástica. Os nichos da medula óssea estão relacionados com o microambiente tumoral, afetando a sobrevivência e a proliferação das células-tronco leucêmicas. Objetivos: Análise da quantidade e distribuição de células-tronco hematopoiéticas nos diferentes nichos na LMC em diferentes fases e correlação destes achados com a distribuição de galectina-3 nas fases acelerada e blástica. Material e métodos: Revisão clínico-morfológica de 20 pacientes na fase crônica da LMC, 1 paciente na fase acelerada e 1 paciente na crise blástica. Análise imunofenotípica (CD34, CD31, CD44, CD117 e galectina-3) em Tissue Microarrays para avaliação dos diferentes nichos e sua correlação com a matriz proteica. Resultados: Observou-se aumento na expressão de todos os marcadores na fase crônica quando comparados ao controle. Na fase acelerada há aumento na expressão de CD44 e galectina-3 quando comparado ao controle enquanto que na crise blástica há aumento na expressão de CD44 e CD117. Conclusão: A LMC constitui uma neoplasia mieloproliferativa em que o remodelamento dos nichos malignos favorece a manutenção das células-tronco leucêmicas. O presente estudo demonstrou elevação em todos os marcadores imuno-histoquímicos avaliados nas diferentes fases da doença de modo que os achados significativos foram que os altos níveis de CD44, CD31 e galectina-3 associados à mudança na expressão desses marcadores nos nichos se correlacionam com desfecho desfavorável e propensão à evolução para crise blástica.
Introduction: Chronic Myeloid Leukemia (CML) is a malignant hematopoietic stem cell neoplasm, characterized by the acquisition of the translocation-associated BCR-ABL1 gene [t(9;22)(q34;q11)]. The onset is insidious with the slow progression followed by an accelerated phase, culminating in the blast crisis. The bone marrow niches are related to the tumor microenvironment, the survival and proliferation of the leukemic stem cells. Objectives: To analyze the amount and distribution of hematopoietic stem cells in different niches in CML in different phases and correlate these findings with the galectin-3 distribution in the accelerated and blastic phases. Material and methods: Clinical-morphological review of 20 patients in CML chronic phase, 1 patient in the accelerated phase and 1 patient in the blast crisis. Immunophenotypic analysis (CD34, CD31, CD44 and galectin-3) in Tissue Microarrays to evaluate the different niches and correlation with the protein matrix. Results: We observed the presence of all markers in the chronic phase when compared to the control. In the accelerated phase there is an increase in expression of CD44 and galectin-3, when compared to control while in blast crisis there is an increase in expression of CD44 and CD117. Conclusion: CML is a myeloproliferative neoplasm in which remodeling of malignant niches favors the maintenance of leukemic stem cells. The present study demonstrated an increase in expression of all immunohistochemical markers at different stages of the disease so that the relevant findings were the high levels of CD44, CD31 and galectin-3 associated with change in the expression of these markers at the niches are related to unfavorable outcome and propensity to blast crisis.
Introduction: Chronic Myeloid Leukemia (CML) is a malignant hematopoietic stem cell neoplasm, characterized by the acquisition of the translocation-associated BCR-ABL1 gene [t(9;22)(q34;q11)]. The onset is insidious with the slow progression followed by an accelerated phase, culminating in the blast crisis. The bone marrow niches are related to the tumor microenvironment, the survival and proliferation of the leukemic stem cells. Objectives: To analyze the amount and distribution of hematopoietic stem cells in different niches in CML in different phases and correlate these findings with the galectin-3 distribution in the accelerated and blastic phases. Material and methods: Clinical-morphological review of 20 patients in CML chronic phase, 1 patient in the accelerated phase and 1 patient in the blast crisis. Immunophenotypic analysis (CD34, CD31, CD44 and galectin-3) in Tissue Microarrays to evaluate the different niches and correlation with the protein matrix. Results: We observed the presence of all markers in the chronic phase when compared to the control. In the accelerated phase there is an increase in expression of CD44 and galectin-3, when compared to control while in blast crisis there is an increase in expression of CD44 and CD117. Conclusion: CML is a myeloproliferative neoplasm in which remodeling of malignant niches favors the maintenance of leukemic stem cells. The present study demonstrated an increase in expression of all immunohistochemical markers at different stages of the disease so that the relevant findings were the high levels of CD44, CD31 and galectin-3 associated with change in the expression of these markers at the niches are related to unfavorable outcome and propensity to blast crisis.
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Palavras-chave
LMC, célula-tronco, nicho, medula óssea, marcadores, CML, stem cell, niche, bone marrow, markers