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Pattern of ABCC Transporter Gene Expression in Pediatric Patients with Relapsed Acute Lymphoblastic Leukemia

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Pattern of ABCC Transporter Gene Expression in Pediatric Patients with Relapsed Acute Lymphoblastic Leukemia Reports of Biochemistry & Molecular Biology Vol.8, No.2, July 2019 Original article www.RBMB.net Pattern of ABCC Transporter Gene Expression in Pediatric Patients with Relapsed Acute Lymphoblastic Leukemia Narjes Mehrvar1, Hassan Abolghasemi2, Mohammad Reza Rezvany3, 4, Mohammad Esmaeil Akbari1, Javad Saberynejad5, Azim Mehrvar5, 6, Mohammad Ali Ehsani7, Mahyar Nourian6, Ibrahim Qaddoumi8, Abolfazl Movafagh*1, 9 Abstract Background: Abnormal expression of ABCC transporter genes has been associated with treatment failure in pediatric patients with acute lymphoblastic leukemia (ALL). The aim of this study was to evaluate the expression pattern of ABCC1-6 and ABCC10 genes in Iranian pediatric patients with ALL relapse and determine the potential predictive value of determining ALL relapse from ABCC expression. Methods: Patients with ALL were divided into two separate groups, either the case group with relapsed ALL or the control group in which ALL patients have been in progression-free survival for at least 3 years A total of thirty-nine participants (23 with relapsed ALL; 16 controls) were enrolled over 26 months. To determine the levels of ABCC1-6 and ABCC10 transporter gene expression RT-PCR was used. Cumulative doses of the chemotherapy drugs, VCR, DNR and L-ASP, were calculated for each patient. Results: Our findings showed elevated expression of ABCC2-6 and decreased expression of ABCC1 and ABCC10 to be associated with an increased risk of ALL relapse. The mean-fold expression of ABCC2 was significantly increased in the ALL relapse group. Additionally, the expression pattern of the ABCC transporter genes was associated with high doses of three chemotherapy drugs, VCR, DNR and L-ASP. Downloaded from rbmb.net at 9:45 +0330 on Monday October 4th 2021 Conclusions: Evaluating the expression pattern of ABCC transporter genes may be a potential biomarker for predicting the occurrence of ALL relapse in Iranian pediatric patients and improve cancer prognosis. Keywords: ABC transporters, Childhood, Gene expression, Pattern, Recurrence. Introduction The Iranian Cancer Registry has previously reported involved in treatment failure is the occurrence of that in 2007, the incidence of pediatric cancer was cancer relapse, often leading to a poor prognosis 176 cases per 1 million children in Tehran, Iran (1). (3) The chemotherapy treatment is often rendered In patients with ALL, the most common factor ineffective due to the development of multidrug 1: Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2: Pediatric Congenital Hematologic Disorders Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 3: Hematology department, Faculty of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran. 4: Department of Oncology-Pathology, Immune and Gene Therapy Lab, Cancer Center Karolinska (CCK), Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden. 5: AJA University of Medical Sciences, Tehran, Iran. 6: Mahak Hematology Oncology Research Center (Mahak-HORC), Mahak Hospital, Tehran, Iran. 7: Bahrami Hospital, Tehran University of Medical Sciences, Tehran, Iran. 8: Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN USA. 9: Department of Medical Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran *Corresponding author: Abolfazl Movafagh; Tel: +98 9121307881, Fax: +98 21 23501000; E-mail: [email protected]. Received: 19 Feb, 2019; Accepted: 3 Mar, 2019 Mehrvar N et al resistance (MDR). This can be a result of abnormal to the MAHAL’s Pediatric Cancer Treatment ATP-binding cassette (ABC) transporter gene and Research Center in Tehran, Iran, with expression (4-6). The ABCC transporter subfamily either a previous or current diagnosis of ALL. of the ABC transporters is also known as multidrug Patients included in this study were under the resistance proteins (MRPs). These membrane age of 15, had an immunophenotyping report proteins are able to render the chemotherapeutic of ALL, and had previously completed their agents ineffective due to their ability to transport chemotherapy treatment. The case group anticancer agents across membranes and excrete included patients who have had ALL relapse substances out of the cell (7). Due to their ability to immediately following or during their interfere with treatments, MRPs are an attractive chemotherapy regimen. The control group target for improving the treatment of ALL and consisted of patients who successfully preventing the development of cancer cell completed their chemotherapy treatment and resistance to chemotherapy (8). Important genes of had at least 3 years of progression-free this subfamily which relate to multidrug resistance survival. in patients with malignancy are ABCC1-6 and Informed consent was obtained from each ABCC10 (9). patient’s parent prior to enrollment in the Previous reports have examined the study. Consent was also given to collect 3 relationship between ABCC transporter gene mL of peripheral blood (PB) in EDTA- expression and the prognosis of pediatric patients treated tubes before beginning the with ALL. Some research has found no significant chemotherapy cycle. relationship between the gene expression of For each participant a questionnaire about ABCC1 or ABCC3 and ALL prognosis in pediatric their clinical, pathological, and demographic patients (10-12). However, it has been found that characteristics was completed by a physician. one of the main functions of ABCC1-6 is the These characteristics included age at the time transportation of chemotherapeutic agents, such as of diagnosis, sex, French-American-British Adriamycin (ADR), Vincristine (VCR), Etoposide (FAB) classification and immunophenotype of (VP16), 6-Mercaptopurine (6-MP), and ALL, date chemotherapy regimen was Methotrexate (MTX) (13-16). initiated, date of first complete remission, and The aim of this study was to examine the gene the total doses of each chemotherapy agent expression profile of ABCC1-6 and ABCC10 in used during the treatment, prognostic factor Downloaded from rbmb.net at 9:45 +0330 on Monday October 4th 2021 Iranian pediatric patients with ALL and determine and National Cancer Institute (NCI) risk group if this expression pattern can predict ALL relapse. (17). In addition, the date, site, and number of Additionally, we examined the relationship recurrences were reported for the case group. between chemotherapy dose and ABCC gene expression. Cumulative dose of chemotherapy agents The chemotherapy regimen was based on the Materials and methods ALL-BFM (Berlin-Frankfurt-Munster) Ethics approval protocol 2009. Cumulative doses of the Permission to conduct this study and ethical chemotherapy drugs administered during the approval was obtained from the Ethics induction phase were calculated. The Committee of the Shahid Beheshti University cumulative dose of VCR was categorized as of Medical Science. The ethics approval code low (<20 mg/m2), intermediate (20-40 mg/m2), was IR.SBMU.RETECH.REC.1396.533. or high (>40 mg/m2) (18, 19). According to the standard dose of Daunorubicin (DNR) (20), Patient samples and demographic the cumulative dose was categorized as In this prospective case-control study, we standard (<100 mg/m2) or high (≥100 mg/m2). evaluated the gene expression of ABCC1-6 and The cumulative dose of L-Asparginase (L- ABCC10 in pediatric ALL patients. The ASP) was categorized as standard (<60,000 participants in this study were children referred u/m2) or high (≥60,000 u/m2). Rep. Biochem. Mol. Biol, Vol.8, No.2, July 2019 185 ABCC Transporter Gene Expression in Pediatric ALL Total RNA isolation Real-Time PCR Each PB sample was transferred to the The primers used for ABCC1-6 and ABCC10 laboratory immediately after collection. White genes are shown in Table 1 and designed as blood cells were separated by red blood cell previously described (22) . The GAPDH gene lysis buffer and suspended in PBS (21). Total was used to normalize the results through RT- RNA was isolated by YTzol Pure RNA reagent PCR with the forward primer (5'–3'): according to the manufacturer’s instructions GAAGGTGAAGGTCGGAGTC and reverse (Cat No: YT9063, Yekta Tajhiz Azma, Iran). primer (5'–3'): The concentration of total RNA was GAAGATGGTGATGGGATTTC. All primers determined by Thermo Scientific NanoDrop were obtained from Pishgam Biotech (Thermo Fisher Scientific, USA), and the Company, Iran. Primers had been purified using purity was examined via OD260/OD280 the Macrogen Oligonucleotide absorption. Total RNA samples were stored in Purification CartridgeTM purification method. -70 C until cDNA synthesis. Prior to beginning RT-PCR, products of cDNA synthesis were diluted at a ratio of 1:3. The mixture cDNA synthesis for RT-PCR consisted of 0.5 µL forward primer The cDNA was prepared using standard total (0.2 µM) + 0.5 µL reverse primer (0.2 µM) + cDNA RNA. A cDNA synthesis kit (Cat No: YT4500, template according to 1 µg/µL + 7.5 µL Syber Yekta Tajhiz Azma, Iran) was used according to Green QPCR master mix 2× (cat no: YT2551, the manufacturer’s instructions. The template Yekta Tajhiz Azma, Iran;) and nuclease-free water RNA (based on 1 µg) was mixed with 1 µL to achieve a final volume of 20 µL. The RT-PCR random hexamer primer (184.84 µl) and program was set up as follows: one cycle of pre- finalized with DEPC treated water to the volume incubation (95 C = 300 s), 38 cycles of 3-step of 13.4 µL. After incubation at 70 C for 5 amplification (95 C = 60 s, 60 C = 60 s, 72 C = minutes, each product was mixed with 4 µL 5× 30 s), and one cycle of melting (95 C = 10 s, 65 C first-strand buffer (200 µl), 1 µL dNTP (50 µl), = 60 s, 97 C = 1 s). Quantifications were 0.5 µL RNasin (25 µl), and 1 µL MMLV (50 µl). determined by Light Cycler 96 Real-Time PCR The mixture was incubated for 1 hour at 37 C Cycler (Hoffmann-La Roche AG, Basel, and was terminated by heating at 70 C for 5 Switzerland).
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