The Expression of mRNA and Enzyme Activity of Deoxycytidine- and Deoxyguanosine Kinases in Cell from Patients with Untreated B-Cell Chronic Lymphocytic Leukemia.

Chronic lymphocytic leukemia (CLL) is the most common leukemia in Europe and North America. The purine analogues fludarabine and cladribine have earned an important place in the treatment of CLL. Yet, the alkylating agent chlorambucil still remains as cornerstone of treatment. A gradual shift towards the use of purine analogues as the central component has become apparent however it is of greatest importance to strictly compare the efficacy of fludarabine and cladribine to have a basis for future clinical studies with these agents. In this study 59 patients included in the international Phase III Trial for untreated B-cell CLL, were randomized in order to evaluate the efficacy of chlorambucil, fludarabine, and cladribine, as primary treatment of patients with symptomatic B-cell CLL. Both fludarabine and cladribine are prodrugs and must be phosphorylated intracellularly to monophosphates by the nuclear/cytosol enzyme deoxycytidine kinase (dCK) and possibly by the mitochondrial enzyme deoxyguanosine kinase (dGK). DCK plays a pivotal roll in the activation of fludarabine and cladribine and it has previously been reported that resistance to these drugs is mainly due to deficiency of the dCK.

Before treatment, peripheral blood cells were isolated and the activity of dCK and dGK enzymes were analyzed in patient cells together with the dCK and dGK mRNA levels using the real-time quantitative PCR method.

The dGK activity was considerably lower (6 fold) than the dCK activity. The enzyme activities in samples from CLL patients varied about 20 and 30 folds for dCK and dGK, respectively.

The mRNA expression for dCK and dGK in patients showed also a large inter individual variability from 0,011 to 0,189 and 0,001 to 0,154 respectively.

There was no correlation between enzyme activity and mRNA levels in the studied CLL patients. We could not found any spliced mRNA dCK variant in our materiel or any mutation, which could explain the discrepancy between dCK activity, and mRNA levels. In conclusion, the results suggest that dCK and dGK expression is regulated at the (post) translational level in leukemic cells. However, studies of the relationship between enzyme activities and/or mRNA levels with clinical response to chemotherapy are underway and will be reported.