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Binding of Acridine Orange to DNA in Situ of Cells from Patients with Acute Leukemia1

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Binding of Acridine Orange to DNA in Situ of Cells from Patients with Acute Leukemia1 (CANCER RESEARCH 49. .1692-3695. July 1. 1989] Binding of Acridine Orange to DNA in Situ of Cells from Patients with Acute Leukemia1 Alexander J. Walle2 and George Y. Wong Cornell Õ'nirersily Medical (allege /A. J. H'./and Memorial Sloan-Kettering Cancer Ccaler ¡G.Y. W.], New York, New York 10021 ABSTRACT cytes bound AO in a manner significantly different from that of human leukemic blood lymphoblasts [L3 variety of the Fluorescence flow cytometry was used to generate DNA histograms of French-American-British classification (6)]. We quantitatively at nilim- orange stained leukemic cell populations in G(I-G| phase of the described the interaction of AO with DNA of leukemic cell cell cycle. Complexes of the intercalating agent, acridine orange, with populations in G0-G| phase of the cell cycle by measuring the double-stranded DNA in situ, emit green fluorescence upon excitation with blue laser light. The histograms were evaluated by tirsi determining standard deviation of green fluorescence intensity pulses emit ted from AO-DNA complexes in single cells around the mean the standard deviation of the fluorescence intensity relative to the mean channel of fluorescence, i.e., the coefficient of variation, and then dividing channel of the fluorescence histograms. This represents the CV the coefficient of variation of a patient's sample by that of a control of the fluorescence intensity histograms (Fig. 1). To standardize sample (rCV). The mean rCV of cell populations of acute lymphoblastic and calculate the CVs of patient cell histograms, and subse leukemia (31 patients) differed significantly from that of nonlymphoblas- quently to analyze the quantitative differences between the tic leukemia (21 patients). When cells were treated with a solution of mean CVs of different disease groups, we divided the CV of citric acid and magnesium sulfate prior to their staining with acridine each patient by that of a control, i.e., the CV of a lymphocyte orange, the mean rCV of cell populations of acute lymphoblastic leukemia population obtained from a healthy blood donor, measured on increased while that of acute nonlymphoblastic leukemia decreased com the same day and using identical machine settings and staining pared to their respective pretreatment values. The mean difference of rCVs between untreated and treated cells (rCVD) within each disease solutions. category was statistically significant. A logistic regression model, based In this study of ALL and ANLL cell populations by using on rCVD, confirmed the conventional classification of acute lymphoblas AO flow cytometry, we showed that the rCVs of the histograms tic leukemia and acute nonlymphoblastic leukemia cells in 90% of the of leukemic cells before and after treatment with citric acid and cases. magnesium were significantly associated with the type of dis ease. In particular, it was the difference between the rCV of cells before and after treatment with acid that carried a high INTRODUCTION power of differentiating ALL from ANLL. Acute leukemias are mainly differentiated by the use of light microscopic criteria outlined in the French-American-British MATERIALS AND METHODS classification of acute leukemia (1). One group of criteria is based on cytoplasmic features, and another group on nuclear Patients. Between 1981 and 1983 we selected 52 previously untreated features. Diagnostic uncertainty arises in a sizeable number of patients with the diagnoses of ALL and ANLL made by these criteria: cases because microscopic findings are subject to variations microscopic evaluation of tetrachrome (Sigma Chemical Co., St. Louis, MO)-stained smears of bone marrow aspiration specimens, sudan black stemming from both technical factors (2) and subjective inter and myeloperoxidase staining reactions, and biochemical quantitation pretation by different observers (1, 3). of the enzyme deoxynucleotidyl transferase (7). No cases equivocal by With respect to the group of nuclear criteria, differences between ALL' and ANLL in the appearance of nuclear chro- these criteria were included here. The monoclonal antibodies now in use to subclassify acute leukemias into immunological categories were matin have long been noted in Romanowsky-stained smears, not available at the time. such as the discernibly clumped, irregularly distributed areas of In a pediatrie group of 22 patients, 14 [mean age of 6.1 ±3.3 (SD) eliminatili in ALL, whereas in ANLL the nuclear chromatin years] had the diagnosis of ALL, and 8 patients (mean age of 7.6 ±3.7 may appear distinct but "lacy," or it may look very fine, non- years) had the diagnosis of ANLL. In an adult group of 30 patients, 17 clumped, or finely stippled (4). Moreover, the chromosomes (mean age of 35.3 ±18.6 years) had the diagnosis of ALL, whereas 13 are known to have a "fuzzy" appearance in metaphase spreads (mean age of 45.5 ±17.1 years) had the diagnosis of ANLL. more often in ALL than in ANLL, even if the karyotype is The lymphocytes of 36 healthy blood donors served as controls. Blood lymphocytes of healthy individuals are quiescent cells residing normal (5). in the Go compartment of the cell cycle. We measured at least one In line with our hypothesis that microscopically different control specimen on each day when one or more patient specimens chromatin structures may exhibit different binding patterns of were measured. the intercalating agent, AO, to DNA, we found that the densely Preparation of Cell Specimens. We evaluated 52 leukemic cell sus packed chromatin of normal human peripheral blood lympho- pensions. Heparinized bone marrow aspirates (0.9-4.0 ml) were diluted with 20 ml of PBS, and heparinized blood samples (10-20 ml) were Received 8/12/88; revised 12/7/88. 3/8/89: accepted 3/29/89. diluted with double their volumes of PBS prior to the Ficoll-Hypaque The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked advertisement in (Lymphoprep, Nyegaard; Oslo, Norway) gradient centrifugation. The accordance with 18 U.S.C. Section 1734 solely to indicate this fact. resulting mononuclear cell preparations were adjusted to 1-2 x IO6 1Supported in part by grants \Va460/l-2 from the Deutsche Forschungsge cells per ml of PBS, and stored at 2-4°Cuntil used. The cell suspensions meinschaft, and C'A-08748 and CA-05826 from the National Cancer Institute. J To whom requests for reprints should be addressed, at The New York contained between 6 and 100% (median, 69%; mean, 59%) blast cells Hospital and The Rogosin Institute. 430 East 71 St.. New York, NY 10021. on tetrachrome stained cytocentrifuge (Shandon-Elliot, Broomall, PA) 'The abbreviations used are: ALL. acute lymphoblastic leukemia: ANLL. preparations. Two of 21 ANLL and 3 of 31 ALL had <40% blast cells. acute nonlymphoblastic leukemia; AO, acridine orange: CV. coefficient of varia The percentage of blast counts did not differ statistically between ALL tion; MCF, mean channel of fluorescence intensity; PBS, phosphate-buffered saline: rCV. coefficient of variation of a patient's sample divided by that of a and ANLL. There was no significant correlation of the percentages of control sample: rCVC, rCVN, rCVD. relative CV of cells, nuclei, and the blasts in the cell suspensions with the measured CVs. This observation difference in rC'V between cells and nuclei, respectively. suggests that the morphological blast cell count may be inaccurate or 3692 Downloaded from cancerres.aacrjournals.org on September 23, 2021. © 1989 American Association for Cancer Research. DIFFERENTIATION OF ALL FROM ANLL BY DNA FLOW CYTOMETRV ANLL ALL or nuclei, populations. This relationship was depicted in Fig. 2, where each of 3 specimens was measured at different MCFs as indicated on the ordinate. During the study, the machine settings were adjusted such cells that the G0-G, cell subpopulations of interest were always measured ir between channels 30 and 40 of the F-.Mphotomultiplier tube. Moreover, Z the flow rate of cells was kept at about 200/s. 13 50 100 O 50 100 Evaluation of Fluorescence Measurements. /•'..„,measurementswere CV3.4ICV'3.511 ui used to identify the ploidy levels, to calculate the CVs, and to analyze o nuclei the cell cycle phases of the malignant cell populations. The cell cycle evaluation with respect to the delineation of the G0-G, population was performed according to previously described software programs (10- 50 100 0 50 100 12). Aneuploid populations were detected and defined as previously MEAN CHANNEL OF GREEN FLUORESCENCE described (6). The incidence of aneuploidy in the current study was Fig. 1. Histograms of green fluorescence emitted by AO-DNA complexes in 26% with 3 of 21 ANLL and 10 of 31 ALL specimens displaying cells from ANLL and ALL cell populations prior to (cells) and after (nuclei) aneuploid stem lines. The present number of samples was too small for treatment with citric acid and magnesium. The peaks represent the G0-G, sub- a separate statistical analysis of the influence of aneuploidy on AO- populations. Note that treatment with citric acid and magnesium decreases the DNA binding patterns. The CV was calculated for each G0-G, DNA CV in ANLL but increases it in ALL. peak of control and patients' cell populations. The relative CVs of nuclei and cells of G0-G, cell populations were calculated by determin that some morphologically nonmalignant-appearing cells may be en ing the ratio of the CV of patient cells, or nuclei, to that of control dowed with abnormal AO-DNA binding features, thus obfuscating a cells. Moreover, the difference between the rCVs of cells and nuclei of statistically prominent correlation of blast cell counts with AO-DNA the same specimen was calculated: rCVD = rCVC - rCVN. The binding patterns of leukemic G0-G, cell populations.
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