CXCR4-SERINE339 Regulates Cellular Adhesion, Retention and Mobilization, and Is a Marker for Poor Prognosis in Acute Myeloid Leukemia
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Leukemia (2014) 28, 566–576 & 2014 Macmillan Publishers Limited All rights reserved 0887-6924/14 www.nature.com/leu ORIGINAL ARTICLE CXCR4-SERINE339 regulates cellular adhesion, retention and mobilization, and is a marker for poor prognosis in acute myeloid leukemia L Brault1, A Rovo´ 2, S Decker3, C Dierks3, A Tzankov4,5 and J Schwaller1,5 The CXCR4 receptor is a major regulator of hematopoietic cell migration. Overexpression of CXCR4 has been associated with poor prognosis in acute myelogenous leukemia (AML). We have previously shown that ligand-mediated phosphorylation of the Serine339 (CXCR4-S339) residue of the intracellular domain by PIM1 is implicated in surface re-expression of this receptor. Here, we report that phosphorylation of CXCR4-S339 in bone marrow (BM) biopsies correlated with poor prognosis in a cohort of AML patients. To functionally address the impact of CXCR4-S339 phosphorylation, we generated cell lines-expressing CXCR4 mutants that mimic constitutive phosphorylation (S339E) or abrogate phosphorylation (S339A). Whereas the expression of CXCR4 significantly increased, both CXCR4-S339E and the CXCR4-S339A mutants significantly reduced the BM homing and engraftment of Kasumi-1 AML cells in immunodeficient mice. In contrast, only expression of the CXCR4-S339E mutant increased the BM retention of the cells and resistance to cytarabine treatment, and impaired detachment capacity and AMD3100-induced mobilization of engrafted leukemic cells. These observations suggest that the poor prognosis in AML patients displaying CXCR4-S339 phosphorylation can be the consequence of an increased retention to the BM associated with an enhanced chemoresistance of leukemic cells. Therefore, CXCR4-S339 phosphorylation could serve as a novel prognostic marker in human AML. Leukemia (2014) 28, 566–576; doi:10.1038/leu.2013.201 Keywords: CXCR4; serine339; AML; homing; retention; resistance INTRODUCTION receptor signaling, CXCR4 endocytosis seems to control down- The G protein-coupled receptor CXCR4 is activated by CXCL12 stream signaling pathways, including ERK cascade activation, 8,10 (stromal cell-derived factor 1) and is involved in the control of intracellular calcium flux and chemotaxis. Despite the wide migration and homing of cells notably for engraftment of normal range of factors that are known to be activated after CXCL12 and neoplastic hematopoietic cells in the bone marrow (BM).1,2 binding to CXCR4, there is limited information about the critical CXCR4 receptor activation enhances the proliferation and/or intracellular residues of CXCR4 and the associated activation of 11,12 metastasis formation (that is, to the BM) of many tumors and downstream signal transduction pathways. also functions as an entry receptor for HIV-1. All CXCR4 functions Although CXCR4 signaling was shown as being controlled by critically depend on its cell-surface expression, which is regulated G protein-regulated protein kinases targeting the C-terminal tail, at the transcriptional level and at the protein level by endocytosis, the intracellular signals specifically evoked by phosphorylation intracellular trafficking and recycling.3,4 of distinct residues and their functional consequences remain 13 The surface expression level of CXCR4 on acute myelogenous unclear. We previously identified ligand-mediated phosphorylation leukemia (AML) blasts has been previously associated with a poor of CXCR4-S339 to have a key role for in vitro migration and in vivo 14 prognosis, and analogous to normal hematopoietic cells, the level homing and engraftment of murine BM cells. Here we investigated of CXCR4 expression also correlated with the CXCL12-induced the clinical impact and the functional consequence of the CXCR4- chemotaxis.5–7 In addition, interference with the CXCL12/CXCR4 S339 status in AML. Our results suggest that CXCR4-S339 axis through treatment with granulocyte colony-stimulating factor phosphorylation might be a novel prognostic marker in AML and/or CXCR4 antagonist like AMD3100 (Plerixafor) increased the patients and a critical regulator of migration, homing and retention cellular mobilization from the BM.8 CXCR4 inhibition is a novel of leukemic cells. strategy to not only mobilize hematopoietic stem cells for autologous transplantation but also tumor cells in order to increase the effectiveness of chemotherapy notably in AML.9 MATERIALS AND METHODS Several studies have demonstrated that internalization of the Patients and immunohistochemistry CXCR4 receptor involves endocytosis provoked by phospho- Patient’s characteristics are summarized in Table 1. All patients had given rylation of the CXCR4 C-terminal domain. Beside its role for general informed consent for studies to be performed using tissue receptor internalization leading to desensitization that terminates materials that remained after diagnostic procedures. Tissue biopsies were 1Department of Biomedicine, University Children’s Hospital (UKBB), University of Basel, Basel, Switzerland; 2Department of Hematology, University Hospital Basel, Basel, Switzerland; 3Department of Hematology/Oncology, University Medical Center Freiburg, Freiburg, Germany and 4Institute for Pathology, University Hospital Basel, Basel, Switzerland. Correspondence: Dr J Schwaller, Department of Biomedicine, University Children’s Hospital (UKBB), University of Basel, Hebelstrasse 20, Basel 4031, Switzerland. E-mail: [email protected] 5Shared senior authorship. Received 8 November 2012; revised 21 June 2013; accepted 24 June 2013; accepted article preview online 2 July 2013; advance online publication, 26 July 2013 Role of CXCR4-S339 in AML L Brault et al 567 were killed 24 h, 7 and 46 days post-transplantation. Single-cell suspen- Table 1. Patient characteristics sions of indicated tissue samples were prepared by passing the tissue through 100-mm nylon mesh strainers (Falcon, Becton-Dickinson, Heidel- pCXCR4-S339 pCXCR4-S339 P- berg, Germany). Red blood cells of peripheral blood (PB) were lysed before positive negative value the analysis. Dead cells were excluded using 4’,6-diamidino-2-phenylindole staining, and the percentage of GFP-positive cells was monitored using N 39 36 flow cytometry and expressed as the percentage of all gated mononuclear Age median (range) 65 (26–95) 55 (19–83) 0.032 cells of the indicated tissue. Tissue samples were fixed in 4% phosphate- Male/female 20/19 14/22 buffered saline-formaldehyde, paraffin-embedded and 4-mm sections were Risk group 0.416 stained with hematoxylin-eosin or anti-human CD34 (Dako, Glostrup, Low 6 5 Denmark, M7165). A ratio between PB and BM (PB/BM) is determined as Intermediate 14 15 (PB GFP þ cells (%) Â WBC Â body weight (g) Â 0.08)/(BM GFP þ cells 18 High 17 10 (%) Â BM cellularity/0.056). Not evaluated 2 6 To test the ability of AMD3100 to mobilize leukemic cells, a 5 mg/kg dose was administrated subcutaneously 5 weeks after transplantation. FLT3-ITD mutated 22 14 0.051 Three hours after the treatment, the mice were killed and analyzed. Curative therapy yes/no 26/13 31/5 To test the in vivo resistance to cytarabine (Ara-C), a dose (75 mg/kg) per CR after induction 17 19 0.113 day for 5 consecutive days was administrated subcutaneously 5 weeks chemotherapy after transplantation. On the day after the last treatment, the mice were Post induction failure 7 7 killed and analyzed.19 Early relapse 6 7 0.139 Abbreviations: CR, complete remission; ITD, internal tandem duplication. Cellular detachment assay Kasumi-1 cells were added to confluent human umbilical vein endothelial cell (HUVEC) cells in six-well plates with or without activation by tumor necrosis factora (20 ng/ml). After 1 h, non-adherent Kasumi-1 cells were processed using an automated immunostainer (Nexes, Ventana Medical carefully removed and each well was monitored (12 microscopic fields) for Systems, Tucson, AZ, USA). The immunohistochemical staining of pCXCR4- GFP-positive cells. Then, CXCL12 (50 nM) was added to the medium for S339 (Abcam, Cambridge, UK, no.74012) was performed in all specimens 30 min and the detached cells were carefully removed and each well taken at diagnosis as previously described.15 The immunohistochemical (12 microscopic fields) was monitored using a live cell imaging microscope staining of CXCR4 was performed following the same procedure with a (IX81, Olympus, Tokyo, Japan). The surface area coverage of GFP was primary rabbit polyclonal antibody (Abcam, no. 2074). Sections were analyzed by ImageJ (National Institutes of Health). incubated 30 min with anti-CXCR4 at dilution of 1:50. At least 200 cells were assessed in each trephine biopsy, and the percentage of positive cells Viability assay (that is, cells with distinct staining) was calculated. Cases were considered Kasumi-1 cells were plated at 3 Â 104cells/well with or without the as pCXCR4-S339 positive when the percentage of stained cells per case support of MS-5 cells. Stromal cells (3.6 Â 105) were plated in six-well was above 15%, on the basis of the prognostically relevant cutoff score as plates in a-minimum essential medium with 10% fetal calf serum determined by receiver operating characteristic, see Supplementary the previous day. After 1 day of coculture, Ara-C was added for 48 h. Methods (area under the receiver operating characteristic curve, Cells were harvested, washed and stained with the PO-PRO-1 dye AUROC ¼ 0.641, 95% confidence interval 0.512–0.768, P ¼ 0.037). Cases (Invitrogen, Carlsbad, CA, USA) and 7-aminoactinomycin D before the were considered as CXCR4 positive when the percentage of stained blasts analysis