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Prepublished online as a Blood First Edition Paper on October 3, 2002; DOI 10.1182/blood-2002-08-2434.
NEOPLASIA
From the Skin Tumour Unit and Dermatopathology
Department, St John's Institute of Dermatology, St Thomas' Hospital,
Cancer Research UK Medical Oncology Unit, Saint Bartholomew's
Hospital, London, United Kingdom.
Primary cutaneous lymphomas (PCLs) represent a heterogeneous group
of extranodal T- and B-cell malignancies. The underlying molecular
pathogenesis of this malignancy remains unclear. This study aimed to
characterize oncogene abnormalities in PCLs. Using genomic microarray,
we detected oncogene copy number gains of RAF1
(3p25), CTSB (8p22),
PAK1 (11q13), and JUNB (19p13) in 5 of 7 cases of mycosis fungoides (MF)/Sezary syndrome (SS) (71%), gains
of FGFR1 (8p11), PTPN (20q13), and
BCR (22q11) in 4 cases (57%), and gains of
MYCL1 (1p34), PIK3CA (3q26), HRAS
(11p15), MYBL2 (20q13), and ZNF217 (20q13) in 3 cases (43%). Amplification of JUNB was studied in 104 DNA
samples from 78 PCL cases using real-time polymerase chain
reaction. Twenty-four percent of cases, including 7 of 10 cases
of primary cutaneous CD30+ anaplastic large-cell lymphoma
(C-ALCL), 4 of 14 MF, 4 of 22 SS, and 2 of 23 primary
cutaneous B-cell lymphoma (PCBCL) showed amplification of
JUNB, and high-level amplification of this oncogene was
present in 3 C-ALCL and 2 MF cases. JUNB protein expression was
analyzed in tissue sections from 69 PCL cases, and 44% of cases,
consisting of 21 of 23 SS, 6 of 8 C-ALCL, 5 of 10 MF, and 9 of 21 PCBCL, demonstrated nuclear expression of JUNB by tumor cells.
Overexpression of JUNB also was detected in 5 C-ALCL and 2 SS cases.
These results have revealed, for the first time, amplification and
expression patterns of JUNB in PCL, suggesting that
JUNB may be critical in the pathogenesis of primary
cutaneous T-cell lymphomas.
(Blood. 2003;101:1513-1519) Primary cutaneous lymphomas (PCLs) represent a
heterogeneous group of extranodal T- and B-cell malignancies with an
annual incidence of 0.5-1 per 100 000.1-3 This group of
lymphomas has been classified into mycosis fungoides (MF)/Sezary
syndrome (SS), accounting for 70% of PCL cases, primary cutaneous
B-cell lymphoma (PCBCL), constituting more than 20% of cases, primary
cutaneous CD30+ anaplastic large cell lymphoma (C-ALCL),
constituting 10% of cases, and blastic natural killer cell lymphoma
(NK), accounting for 1% of cases.1-3 These subtypes of
PCL have distinctive clinicopathologic and immunophenotypic
features.1-3 However, the underlying etiology and
pathogenesis remains unclear.
Most malignancies accumulate a series of genetic events including
activation of oncogenes and loss of tumor suppressor genes, which lead
to a malignant phenotype. Previous studies have shown allelic losses at
9p, 10q, and 17p; microsatellite instability and mutations of
p53 in primary cutaneous T-cell lymphomas
(CTCLs);4-6 and hypermethylation of p15 and
p16 in both CTCL and PCBCL.7,8 However, little
is known about genome-wide genetic alterations in PCL. We have studied
a series of PCL cases using comparative genomic hybridization (CGH) and
have identified consistent and distinctive patterns of chromosomal
imbalances (CI) in both MF and SS and in PCBCL.9,10
Genomic microarray is a novel technique of genomic analysis used to
rapidly screen for genomic imbalances (GI) in a tumor
genome.11 Previous studies have revealed oncogene copy
number changes in several epithelial cancers.11-14 We also have detected oncogene gains and losses in PCBCLs using this
technique,10 but at present there is no data available in CTCLs.
The aim of this study was to screen for oncogene abnormalities in PCLs.
We began with a study of 7 cases of MF/SS using genomic microarray,
which showed gains of several oncogenes, including JUNB. We
then analyzed 104 DNA samples from 78 PCL patients for JUNB
amplification using real-time-polymerase chain reaction (RT-PCR) and
correlated these findings with the results of immunohistochemistry (IHC) analysis of formalin-fixed, paraffin-embedded tissue sections from 69 PCL cases.
Samples
Genomic microarray
RT-PCR To further confirm amplification of JUNB in PCL, RT-PCR studies were performed. This experiment, based on the TaqMan assay,15 was carried out using the ABI Prism 7700 Sequence Detector System (ABI/Perkin Elmer, Foster City, CA) as previously reported.10,16 Primer and TaqMan probe sequences were designed using the Primer Express version 1.0 software (ABI/Perkin Elmer) and GenBank sequence numbers were M29039, M12523, and M17987 for JUNB, ALB, and B2M, respectively, with the following primer sequences: JUNB: forward CTACGGGATACGGCCGG, reverse AGGCTCGGTTTCAGGAGTTTG, ALB: forward AGGGTAAAGAGTCGTCGATATGCT, reverse CAATCTCAACCCACTGTCAGCTA, B2M: forward GGAATTGATTTGGGAGAGCATC, reverse CAGGTCCTGGCTCTACAATTTACTAA.The TaqMan probes were JUNB: 5'-(FAM)-CCCCTGGTGGCCTCTCTCTACACGACTA-(TAMRA)-3', ALB: 5'-(FAM)-CAAACGCATCCATTCTACCAACTTGAGCAT-(TAMRA)-3', B2M: 5'-(FAM)-AGTGTGACTGGGCAGATCATCCACCTTC-(TAMRA)-3'. PCR mixes (25 µL) contained 12.5 µL of 2 × TaqMan Universal PCR master mix, 2.5 µL of each primer, and 2.5 µL of TaqMan probe with 1 to 2.5 µL of DNA. The Universal master mix contains ROX (6-carboxy-X-rhodamine), the passive reference fluorochrome that normalizes for pipetting volume errors. Thermal cycling consisted of 2 minutes at 50°C, 10 minutes at 95°C, followed by 40 cycles at 95°C for 15 seconds, and 60°C for 1 minute. Each assay included a "no template" control and a standard curve for JUNB, ALB, and B2M produced by normal placental DNA, and all were carried out in triplicate (96-well maximum). The parameter CT is defined as the fractional cycle number at which the fluorescence generated by cleavage of the probe passes a fixed threshold above baseline. The target gene copy number (JUNB) is quantified by measuring CT and by using a standard curve to determine the starting copy number. The ratio of the target gene copy number to the reference gene copy number normalizes the amount and quality of genomic DNA. The ratio defining the level of increased copy number of the target gene was termed as "N" and was determined as follows: n = copy number of target gene/copy number of reference gene. An N value > 2 was set for gene amplification (+), > 4 (++), > 8 (+++), and > 16 (++++) (Table 2).10,15,16 An N value < 0.5 was regarded as decreased copy number (Table 2). IHC To further investigate the expression pattern of JUNB in PCL, immunohistochemical studies were performed using the DAKO ChemMate horseradish peroxidase system and DAKO DAB substrate system according to the supplier's instruction (DAKO, Carpinteria, CA).17 Briefly, deparaffinized tissue sections were first treated with 3% H2O2 for 10 minutes to inhibit endogenous peroxidase and then microwaved at 700 watts for 18 minutes in 0.01 M sodium citrate buffer solution (pH 6.0) for 30 minutes. After a series of washes, the sections were incubated with primary mouse monoclonal antibody against JUNB (C-11: sc-8051) (Santa Cruz Biotechnology, Santa Cruz, CA) at room temperature for 1 hour at a final antibody concentration of 2 µg/mL diluted in blocking serum solution. After further incubation with universal biotinylated link antibody and peroxidase-labeled streptavidin, the reaction was developed with DAB substrate-chromogen solution for 10 minutes, followed by counterstaining with Harris hematoxylin. To test the specific reactivity of antibody with JUNB, C-11, paraffin sections from colorectal adenocarcinoma, keratosis, and normal lymph nodes (5 samples each) were initially stained with C-11 and an antibody of nonhuman reactive rabbit IgG (Santa Cruz Biotechnology), which was used as the negative control. All colorectal adenocarcinomas and epidermal basal and suprabasal keratinocytes in keratosis showed strong nuclear JUNB expression as previously reported.17,18 However, 5 normal lymph nodes had negative staining for JUNB. In addition, all the samples tested were negative staining for the nonhuman reactive rabbit IgG. To further exclude false-positive and false-negative results in each experiment, a positive control consisting of a colorectal adenocarcinoma and epidermal basal and suprabasal keratinocytes in each sample with known expression of JUNB and a negative control consisting of the rabbit IgG and normal lymph nodes without expression of this oncoprotein were used. The slides were analyzed for the proportion of tumor cells showing nuclear positivity. The level of JUNB expression was qualitatively defined as (+) when 5%-45% of tumor cells were positive, (++) when 50%-90% of tumor cells were positive, and (+++) when 100% of tumor cells were positive.19
Genomic microarray All 7 MF/SS cases studied showed GI (100%). Oncogene copy number gains of RAF1 (3p25), CTSB (8p22), PAK1 (11q13), and JUNB (19p13) were identified in 5 cases (71%), gains of FGFR1 (8p11), PTPN (20q13), and BCR (22q11) in 4 cases (57%), gains of MYCL1 (1p34), PIK3CA (3q26), HRAS (11p15), MYBL2 (20q13), and ZNF217 (20q13) in 3 cases (43%), and gains of KRAS2 (12p12), GLI (12q13), IGFR1 (15q25), FES (15q26), and YES1 (18p11) in 2 cases (29%) (Table 1) (Figure 1). Two female patients showed gains of AR5' and AR3' as evidence for hybridization efficiency. There was a similar pattern of GI in SS and MF (Table 1) (Figure 1).
RT-PCR Of 78 PCL cases analyzed with RT-PCR, 19 cases showed amplification of JUNB (24%) (Table 2). This included 7 C-ALCL (70%), 4 MF (29%), 4 SS (18%), 2 PCBCL (9%), 1 NK cell lymphoma (14%), and 1 systemic FL (50%). High-level amplification of JUNB (+++) was present in 3 C-ALCL (30%) and 2 MF cases (14%) (Table 2). Decreased copy number of JUNB also was seen in 1 MF, 1 FCCL, and 1 NK cell lymphoma each (Table 2). When multiple samples such as blood and skin lesions from the same individual were analyzed, results were consistent. Three cases (nos. 5, 20, 21) showing gain of JUNB detected with genomic microarray also revealed amplification of JUNB using RT-PCR, but case 1 had gain of JUNB by genomic microarray without RT-PCR evidence of amplification of JUNB (Table 2).IHC Of 69 PCLs analyzed by IHC, 44 cases showed nuclear JUNB expression in a proportion of tumor cells (64%) (Table 2). This included 21 (91%) of 23 SS, 6 (75%) of 8 C-ALCL, 5 (50%) of 10 MF, 9 (43%) of 21 PCBCL, 2 (50%) of 4 NK cell lymphoma, and 1 (50%) of 2 systemic FL (Table 2). Seven cases (10%) revealed expression of JUNB by all tumor cells (+++) (overexpression), including 5 C-ALCL (63%) and 2 SS cases (9%) (Table 2; Figures 2-3). Epidermal basal and suprabasal keratinocytes also expressed JUNB, which represented a useful internal control to indicate the efficiency of immunohistochemistry (Figure 2). All the positively stained PCBCL cases showed only occasional cells expressing JUNB (+) (Table 2), and in this case it is difficult to conclusively establish whether expression is restricted to tumor cells or activated B cells on morphology.
There was a striking concordance between the results of RT-PCR and IHC (Table 2). Fifteen cases (6 C-ALCL, 4 SS, 2 MF, 2 PCBCL, and 1 systemic FL) with amplification of JUNB identified by RT-PCR also showed expression of JUNB by tumor cells (Table 2). In addition, 25 cases (12 PCBCL, 5 MF, 2 SS, 2 C-ALCL, 2 NK cell lymphoma, 1 systemic FL, and 1 LyP) without amplification of JUNB did not express JUNB protein by tumor cells (Table 2).
This genomic microarray study of CTCL variants has shown a global picture of oncogene copy number changes in MF and SS. Seventy-one percent of cases revealed gains of JUNB, RAF1, CTSB, and PAK1, and 57% demonstrated gains of FGFR1, PTPN, and BCR. In addition, a consistent pattern of GI was present in SS and MF, supporting our previous hypothesis that both SS and MF represent part of a spectrum of the same disease as suggested by a similar pattern of CI detected by CGH.9 In contrast, these results are different from our previous observations in PCBCL,10 which is consistent with a different pathogenesis. RT-PCR analysis of PCL showed amplification of JUNB in 70% of C-ALCL, 29% of MF, 18% of SS, 14% of cutaneous NK cell lymphoma, and 9% of PCBCL cases. JUNB expression in more than 50% of CTCL variants was present in a majority of tumor cells. In contrast, expression of JUNB in PCBCL was limited to a minority of the cellular infiltrate. There was general concordance between the results of JUNB detected by these 3 different techniques. For instance, high-level amplification and overexpression of JUNB was consistently detected in C-ALCL, MF, and SS using RT-PCR and IHC. Occasional rare discrepancies were noted and are likely to be due to the different detection sensitivity of these techniques. These findings suggest that amplification and overexpression of JUNB may be a key pathogenetic event in CTCL. JUNB protein is one of the principal components of the activating
protein-1 (AP-1) transcription factor complex, consisting of the JUN
(C-JUN, JUNB, and JUND) and FOS (C-FOS, FOSB, FRA1, and FRA2) families,
which has been implicated in a variety of biologic
processes.20,22-24 For example, previous studies have shown that JUNB is involved in control of the cell cycle by inducing high level expression of the cyclin-dependent kinase inhibitor p16(INK4a) and down-regulating cyclin D expression, producing a
decrease in pRb hyperphosphorylation and G1-phase extension leading to
premature cell senescence.21,25,26 In addition, in T
cells JUNB has been found to promote T-helper-2 cell (TH2) differentiation through up-regulation of interleukin-4
(IL-4).27-29 Transforming growth factor-beta1 (TGFB1) also
induces expression of JUNB in human leukemic cells,26 and
interestingly, a TH2 immunophenotype and overexpression of
TGFB1 are characteristic of CTCL.30-32 The TAX oncoprotein
of human T-cell leukemia virus type 1 (HTLV-1) also induces JUNB
expression,33,34 although all the cases in this study were
HTLV-1 negative, and HTLV-1 is not associated with
MF/SS.35 JUNB is expressed in epidermal keratinocytes,
consistent with our observation in this study, and is thought to have a
role in wound healing, photoaging, and UV-induced skin
carcinogenesis.18 It has been suggested that JUNB and JUND
are proliferation inhibitor or tumor
suppressors.20,22,23,36-39 In contrast, C-JUN functions as
a promoter of cell proliferation and as an apoptosis inhibitor due to
down-regulation of p53, p21, and p16, and up-regulation of
cyclin-dependent kinases.20,22,23,36-39 These studies
would appear to suggest that amplification and overexpression of
JUNB would be apoptotic and inhibit tumor cell proliferation in CTCL. However, recent knock-in mouse studies have shown that JUNB
can substitute for the absence of C-JUN during mouse development and
cell proliferation,39,40 and this is thought to be
through the constitutive activation of transcription factor NF- Apart from JUNB, other oncogenes such as RAF1, CTSB, and PAK1 also were frequently identified in MF/SS. RAF1 (v-raf-1 murine leukemia viral oncogene homolog 1) is a mitogen-activated protein kinase that acts downstream of RAS viral oncogene homolog and is regulated by BCL2 and other apoptosis-related proteins.46 CTSB encodes cathepsin B, a lysosomal cysteine protease that cleaves amyloid precursor protein and is involved in tumor invasion.46 PAK1 (p21/Cdc42/Rac1-activated kinase 1) belongs to the PAK family composed of serine/threonine p21-activating kinases, which are involved in cytoskeleton reorganization and nuclear signaling. PAK1 regulates cell motility and morphology.46 Previous studies have shown amplification of RAF1, CTSB, and PAK1 in breast, esophageal, and urinary bladder carcinomas, respectively.47-49 At present there are no data on alterations of these oncogenes in nodal lymphomas. Therefore, further studies are required to confirm amplification of these oncogenes in PCLs with functional studies to establish the significance of these findings. In summary, we have found consistent patterns of GI in MF/SS and frequent amplification and overexpression of JUNB in C-ALCL, MF, and SS, suggesting that this oncogene may play an important role in the pathogenesis of CTCL.
Submitted August 19, 2002; accepted September 14, 2002.
Prepublished online as Blood First Edition Paper, October 3, 2002; DOI 10.1182/blood-2002-08-2434.
Supported by grants from the British Skin Foundation, Dermatrust, and St John's Special Purpose Fund.
The publication costs of this article were defrayed in part by page charge payment. Therefore, and solely to indicate this fact, this article is hereby marked "advertisement" in accordance with 18 U.S.C. section 1734.
Reprints: Xin Mao, Skin Tumour Unit, St John's Institute of Dermatology, St Thomas' Hospital, Lambeth Palace Road, London SE1 7EH, United Kingdom; e-mail: mxmayo{at}hotmail.com or mxmayo{at}yahoo.co.uk.
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