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  • 1
    In: Journal of Hematology & Oncology, Springer Science and Business Media LLC, Vol. 8, No. 1 ( 2015-12)
    Type of Medium: Online Resource
    ISSN: 1756-8722
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2015
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  • 2
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 75, No. 15_Supplement ( 2015-08-01), p. 1624-1624
    Abstract: Methotrexate (MTX) is an essential component of contemporary ALL treatment regimens. This antifolate eradicates leukemic cells by disrupting de novo biosynthesis of nucleotides, leading to inhibition of DNA replication and consequent cell death. Over the past decades, MTX-containing chemotherapy has proven to be crucial in achieving curation in ALL. However, drug resistance continues to be a major obstacle to curative ALL treatment. A number of alterations in MTX metabolism, resulting in impaired accumulation of this antifolate in cancer cells, have been identified as determinants of MTX resistance. However, it remains unclear which of these molecular mechanisms have clinical relevance. Therefore, the current study aimed at determining the relation between MTX resistance and long-term clinical outcome of ALL. Towards this end, we collected the available clinical data of 235 childhood ALL patients, including clinical data with a follow-up time of 10 years. For these patients, samples obtained at the time of diagnosis were also characterized with respect to MTX resistance. This included determination of MTX polyglutamate levels in leukemic cells, mRNA expression of enzymes involved in (anti)folate metabolism and transport (i.e. FPGS, FPGH, DHFR, TS and RFC); MTX sensitivity was determined by the thymidylate synthase inhibition assay (TSIA) and in vitro FPGS activity assay was performed. High levels of long-chain MTX polyglutamates was strongly associated with favorable long-term event-free survival (EFS, p = 0.029) and overall survival (OS, p = 0.008) of ALL patients (10-year EFS 81% and OS 91%, compared to EFS 58% and OS 64% in patients with low levels of this active metabolite). Similar relations were observed for the total accumulation of MTX polyglutamates and FPGS activity, which were associated with overall survival (p = 0.018 and p = 0.039, respectively). In the multivariate Cox regression model, including clinical variables, the level of long chain MTX polyglutamates showed a trend towards an association with event-free survival (p = 0.073) but not with overall survival (p = 0.465). In addition, we assessed the association between MTX resistance-related variables and the treatment outcome in patients with different cytogenetic alterations. High MTX sensitivity was associated with hyperdiploid ALL (P & lt;0.001), which was also associated with increased MTX accumulation (p = 0.03) and elevated RFC expression (p = 0.049). Moreover, cells characterized by TEL-AML1 fusion displayed elevated MTX resistance (p = 0.023) compared to samples devoid of this aberration, while MLL-rearrangements were associated with low accumulation of cellular MTX polyglutamates (p = 0.012). These findings emphasize the central role which MTX lays in ALL treatment thereby highlighting the necessity for further exploration of the molecular mechanisms underlying MTX resistance in ALL patients. Financial support by Kika (Children cancer-free) Citation Format: Anna Wojtuszkiewicz, Godefridus J. Peters, Nicole L. van Woerden, Boas Dubbelman, Gabrielle Escherich, Kjeld Schmiegelow, Edwin Sonneveld, Rob Pieters, Peter M. van de Ven, Gerrit Jansen, Yehuda G. Assaraf, Gertjan J L Kaspers, Jacqueline Cloos. Methotrexate resistance in relation to treatment outcome in childhood acute lymphoblastic leukemia. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 1624. doi:10.1158/1538-7445.AM2015-1624
    Type of Medium: Online Resource
    ISSN: 0008-5472 , 1538-7445
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    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2015
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  • 3
    In: Blood, American Society of Hematology, Vol. 113, No. 10 ( 2009-03-05), p. 2284-2289
    Abstract: Polymorphisms in folate pathway genes may influence the susceptibility to acute lymphoblastic leukemia (ALL). DNA was isolated from 245 pediatric ALL patients (cases) and from 500 blood bank donors (controls). Polymorphisms in methylene-tetrahydrofolate reductase (MTHFR 677C 〉 T, 1298A 〉 C), methionine synthase (MTR 2756A 〉 G), methionine synthase reductase (MTRR 66A 〉 G), methylenetetrahydrofolate dehydrogenase (MTHFD1 1958G 〉 A), nicotinamide N-methyltransferase (NNMT IVS −151C 〉 T), serine hydroxymethyl transferase (SHMT1 1420C 〉 T), thymidylate synthase (TS 2R3R), and the reduced folate carrier (RFC1 80G 〉 A) were detected. In ALL patients, an increased occurrence was observed of the RFC1 80AA variant (odds ratio [OR] = 2.1; 95% confidence interval [CI] = 1.3-3.2; P = .002) and the RFC1 80A allele (OR = 1.5; 95% CI, 1.1-2.1; P = .02). Likewise, the NNMT IVS −151TT genotype showed a 2.2-fold increased ALL risk (OR = 2.2; 95% CI, 1.1-4.6; P = .04). A 1.4-fold reduction in ALL risk was observed for (heterozygous or homozygous) carriers of the TS 2R allele and the MTHFR 677T allele (OR = 0.7; 95% CI, 0.5-1.0; P 〈 .05). Furthermore, interactions between NNMT and MTHFR 677C 〉 T and RFC1 were observed. NNMT IVS −151CC/MTHFR 677CT + TT patients exhibited a 2-fold reduction in ALL risk whereas RFC1 80AA/NNMT IVS −151CT + TT subjects had a 4.2-fold increase in ALL risk (P = .001). For the first time, we associate the RFC1 80G 〉 A and NNMT IVS −151C 〉 T variants to an increased ALL susceptibility.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2009
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  • 4
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 76, No. 14_Supplement ( 2016-07-15), p. 4336-4336
    Abstract: Spliceosome targeting is a novel therapeutic strategy, showing promising results in solid tumors and hematological malignancies. Aberrant splicing of genes involved in apoptosis regulation and drug metabolism was shown to confer chemoresistance in various tumor cells, including acute leukemia. Moreover, increased expression of abnormal splice variants cause reduced sensitivity of leukemic cells to crucial components of current treatment protocols, such as glucocorticoids or methotrexate. Therefore, targeting the spliceosome holds potential to modulate drug resistance-related splicing and to eradicate cells, which do not respond to conventional therapy. In this study, we assessed the in vitro sensitivity of acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) cells to spliceosome inhibitors, including meayamycin B (MAMB), pladienolide B (PB) and spliceostatin A (SSA). First, the growth inhibitory activity of MAMB was determined using a 72 h MTT assay in a panel of ALL and AML cell lines, including sublines with acquired resistance to conventional chemotherapeutics. Mechanistically, the effect of MAMB, PB and SSA on splicing profiles, cell cycle distribution and apoptosis induction was assessed in time course experiments. Finally, we compared MAMB sensitivity between 10 primary ALL, 10 AML specimens, and 6 healthy bone marrow (BM) specimens. Remarkably, both ALL and the notoriously apoptosis-resistant AML cell lines responded to subnanomolar concentrations of MAMB, with IC50 values (50% growth inhibition in the MTT assay) ranging between 0.07 and 0.16 nM. Moreover, MAMB retained full sensitivity towards leukemic sublines resistant to conventional chemotherapeutics with various modes of action, including methotrexate, dexamethasone, bortezomib and imatinib. MAMB, PB and SSA-induced growth inhibition was associated with time and dose-dependent alterations in splicing profiles of selected apoptosis-related genes (including Mcl-1, Bcl-X, FAS and Casp2), concomitant cell cycle arrest (in G1 and G2/M phases) and apoptosis induction (up to 40% after 24 h exposure to 1nM MAMB). Consistent with cell line observations, both primary ALL and AML specimens showed remarkable response to MAMB (mean LC50 = 0.42 nM, range: 0.26-0.69 nM and 0.43 nM, range: 0.33-0.44 nM, respectively), with a significantly lower MAMB sensitivity of healthy BM samples (mean lethal concentration causing 50% cell kill [LC50] value 0.57, range: 0.39-1.13 nM, p = 0.02). Collectively, this is the first study to demonstrate that spliceosome inhibition constitutes a promising therapeutic option for both ALL and AML patients, including those with acquired resistance to other anti-leukemic drugs. Financial support by KiKa (Children Cancer Free) Citation Format: Anna Wojtuszkiewicz, Rocco Sciarrillo, Gerrit Jansen, Yehuda G. Assaraf, Kazunori Koide, Robert K. Bressin, Upamanyu Basu, Edwin Sonneveld, Godefridus J. Peters, Gertjan J L Kaspers, Jacqueline Cloos. Spliceosome inhibition as a novel therapeutic option in acute leukemia. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 4336.
    Type of Medium: Online Resource
    ISSN: 0008-5472 , 1538-7445
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    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2016
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  • 5
    In: Cancer Chemotherapy and Pharmacology, Springer Science and Business Media LLC
    Type of Medium: Online Resource
    ISSN: 0344-5704 , 1432-0843
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2014
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    SSG: 15,3
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  • 6
    In: International Journal of Cancer, Wiley, Vol. 138, No. 7 ( 2016-04), p. 1645-1656
    Abstract: What's new? Folate antagonist methotrexate (MTX) is an anchor drug in acute lymphoblastic leukemia (ALL) treatment. However, drug resistance is a primary hindrance to curative chemotherapy and its molecular mechanisms remain poorly understood. This study is the first to demonstrate that folylpolyglutamate synthetase ( FPGS) splicing aberrations frequently occur in pediatric and adult ALL and likely result in MTX resistance. Interestingly, aberrant FPGS splicing was enhanced in MTX‐resistant cell lines upon exposure to antifolates and other chemotherapeutics, suggesting a broader splicing defect possibly affecting other genes. The findings have important implications for the development of novel strategies to overcome drug resistance in patients.
    Type of Medium: Online Resource
    ISSN: 0020-7136 , 1097-0215
    URL: Issue
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    Language: English
    Publisher: Wiley
    Publication Date: 2016
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  • 7
    In: Nucleosides, Nucleotides & Nucleic Acids, Informa UK Limited, Vol. 39, No. 10-12 ( 2020-12-01), p. 1379-1388
    Type of Medium: Online Resource
    ISSN: 1525-7770 , 1532-2335
    Language: English
    Publisher: Informa UK Limited
    Publication Date: 2020
    detail.hit.zdb_id: 2043255-0
    SSG: 12
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  • 8
    In: Blood, American Society of Hematology, Vol. 112, No. 6 ( 2008-09-15), p. 2489-2499
    Abstract: The proteasome inhibitor bortezomib is a novel anticancer drug that has shown promise in the treatment of refractory multiple myeloma. However, its clinical efficacy has been hampered by the emergence of drug-resistance phenomena, the molecular basis of which remains elusive. Toward this end, we here developed high levels (45- to 129-fold) of acquired resistance to bortezomib in human myelomonocytic THP1 cells by exposure to stepwise increasing (2.5-200 nM) concentrations of bortezomib. Study of the molecular mechanism of bortezomib resistance in these cells revealed (1) an Ala49Thr mutation residing in a highly conserved bortezomib-binding pocket in the proteasome β5-subunit (PSMB5) protein, (2) a dramatic overexpression (up to 60-fold) of PSMB5 protein but not of other proteasome subunits including PSMB6, PSMB7, and PSMA7, (3) high levels of cross-resistance to β5 subunit-targeted cytotoxic peptides 4A6, MG132, MG262, and ALLN, but not to a broad spectrum of chemotherapeutic drugs, (4) no marked changes in chymotrypsin-like proteasome activity, and (5) restoration of bortezomib sensitivity in bortezomib-resistant cells by siRNA-mediated silencing of PSMB5 gene expression. Collectively, these findings establish a novel mechanism of bortezomib resistance associated with the selective overexpression of a mutant PSMB5 protein.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2008
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  • 9
    In: Cancers, MDPI AG, Vol. 13, No. 23 ( 2021-11-26), p. 5963-
    Abstract: Renal function-based carboplatin dosing using measured glomerular filtration rate (GFR) results in more consistent drug exposure than anthropometric dosing. We aimed to validate the Newell dosing equation using estimated GFR (eGFR) and study which equation most accurately predicts carboplatin clearance in children with retinoblastoma. In 13 children with retinoblastoma 38 carboplatin clearance values were obtained from individual fits using MWPharm++. Carboplatin exposure (AUC) was calculated from administered dose and observed carboplatin clearance and compared to predicted AUC calculated with a carboplatin dosing equation (Newell) using different GFR estimates. Different dosing regimens were compared in terms of accuracy, bias and precision. All patients had normal eGFR. Carboplatin exposure using cystatin C-based eGFR equations tended to be more accurate compared to creatinine-based eGFR (30% accuracy 76.3–89.5% versus 76.3–78.9%, respectively), which led to significant overexposure, especially in younger (aged ≤ 2 years) children. Of all equations, the Schwartz cystatin C-based equation had the highest accuracy and lowest bias. Although anthropometric dosing performed comparably to many of the eGFR equations overall, we observed a weight-dependent change in bias leading to underdosing in the smallest patients. Using cystatin C-based eGFR equations for carboplatin dosing in children leads to more accurate carboplatin-exposure in patients with normal renal function compared to anthropometric dosing. In children with impaired kidney function, this trend might be more pronounced. Anthropometric dosing is hampered by a weight-dependent bias.
    Type of Medium: Online Resource
    ISSN: 2072-6694
    Language: English
    Publisher: MDPI AG
    Publication Date: 2021
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  • 10
    In: Blood, American Society of Hematology, Vol. 104, No. 11 ( 2004-11-16), p. 2086-2086
    Abstract: Ara-C is a key drug in the treatment of AML and ALL. However, resistance may occur, when it is associated with treatment failure. Resistance might be circumvented by other deoxynucleoside analogs. We previously reported increased resistance to ara-C in childhood leukemia subgroups, e.g. in T-cell ALL and AML FAB type M1 and M2. We have now studied subgroup-related differences in sensitivity to ara-C analogs in 362 untreated childhood leukemia and 32 normal pediatric bone marrow samples; all obtained with informed consent. To analyze group-differences the Mann-Whitney-U test was used. In addition, cross-resistance patterns were determined within a group of 60 AML samples in which all 4 deoxynucleoside analogs had been tested successfully, applying the Pearson correlation test after log-transformation of the data. Statistical significance was set at p 〈 0.01. The 4-days total cell kill colorimetric tetrazolium-based MTT assay was used to determine the cytotoxicity of ara-C, cladribine, fludarabine and gemcitabine, each tested at 6 concentrations in duplicate. After the 4 days, control wells had to contain at least 70% of leukemic blasts and the mean control optical density had to exceed 0.050 arbitrary units for an assay to be considered successful. Samples were all tested in Amsterdam but were provided by several study groups and many centers over a 10 year period. Normal BM mononuclear cell samples were significantly more resistant than leukemic samples to the deoxynucleotide analogs, except for gemcitabine, and in the case of ALL cladribine. Only cladribine was significantly more cytotoxic (1.4-fold) to AML compared to ALL cells, while the other drugs were equally active. Within AML subtypes, both ara-C and cladribine were significantly more cytotoxic (2-fold) in FAB type M5 samples than in M1/M2 and M4 samples, while fludarabine and gemcitabine showed similar cytotoxicity. Within ALL subtypes, T-cell ALL samples were more resistant to cladribine (7-fold, p=0.001) and borderline to ara-C (2-fold, p=0.04) than BCP-ALL samples. Too few (6) T-ALL samples were successfully tested for fludarabine and gemcitabine for statistical analysis. Finally, cross-resistance was observed between all 4 analogs, with the strongest correlations being between the structurally closest related drugs: ara-C vs gemcitabine: Rp=0.67, p 〈 0.0001, and fludarabine vs cladribine: Rp=0.72, p 〈 0.0001. Drugs other than deoxynucleoside analogs were tested against AML samples as well. Cross-resistance was also observed between ara-C and these drugs, although to a lesser extent: vs etoposide: Rp=0.54, p 〈 0.0001; vs daunorubicin: Rp=0.48, p 〈 0.0001; vs vincristine: Rp=0.33, p=0.01; and vs l-asparaginase: Rp=0.30, p=0.02. In conclusion, drug resistance in childhood leukemia can be explained by drug-type specific as well as more general mechanisms, e.g. apoptosis or DNA repair. Important subgroup-related differences in sensitivity to deoxynucleoside analogs exist and are not limited to ara-C. Increased resistance to ara-C in vitro could not be overcome by the substitution of an alternative analog; cladribine, fludarabine or gemcitabine. However, cladribine may have advantages in AML, particularly in FAB type M5.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2004
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