Effect of Erythropoietin Treatment on Lipid Signalling Pathways in Low-Risk MDS Patients.

Phosphoinositide-phospholipase (PI-PLC) C beta1, PI-PLCgamma1 and Akt are key enzymes in nuclear signal transduction pathways, affecting both cell cycle and differentiation in normal physiology and neoplastic transformation. Our group previously showed not only that the Akt/mTOR axis is activated in patients with high-risk MDS (Follo MY et al, Cancer Res 2007), but also that there is an inverse correlation between PI-PLCbeta1 expression and Akt activation (Follo MY et al, Leukemia 2008). Moreover, we recently demonstrated that patients belonging to all of the IPSS risk groups can display a PI-PLCbeta1 mono-allelic deletion, and that this cytogenetic alteration is associated with a higher risk of evolution into Acute Myeloid Leukemia (AML) (Follo MY et al, J Clin Oncol 2009). Erythropoietin (EPO) is an effective treatment of anemia in 40-60% of low-risk MDS, often inducing a prolonged response. Interestingly, the activation of the EPO receptor has been correlated to the PI3K/Akt axis, which in turn is linked to either PI-PLCbeta1 or PI-PLCgamma1 signalling, so that EPO could affect cell proliferation and apoptosis. The aim of this study was therefore to clarify the relationship between EPO treatment and lipid signalling pathways, to investigate their role as molecular targets or predictive factors during EPO therapy. In fact, in patients who are refractory or lose response to EPO there could be a specific activation or inhibition of pathways involved in both cell cycle and differentiation.

In this study we examined the effect of EPO treatment on lipid signal transduction pathways in MDS patients. The study included 16 patients (IPSS risk: low or intermediate-1), with a favourable response to EPO in 8/16 (50%) of the cases. For each patient we had the opportunity to analyze the expression of PI-PLCbeta1, PI-PLCgamma1, p-Akt and PIP2, which is involved in both PI-PLCbeta1 and PI3K/Akt activation processes, before and during EPO treatment, in order to detect every change in both clinical and biological features. By FISH analysis, we firstly assessed the presence of PI-PLCbeta1 mono-allelic deletion. Then, we quantified PI-PLCbeta1 and PI-PLCgamma1 gene and protein expression, as well as PIP2 and the degree of Akt activation; mRNA levels were quantified by real-time PCR, whereas the protein amount was detected by both a immunocytochemical and a flow cytometric detection approach.

The PI-PLCbeta1 mono-allelic deletion was found in 5/16 (31%) low-risk MDS patients: 2 of them showed a rapid evolution into AML, whilst the remaining 3 cases did not respond to EPO treatment. The molecular analyses showed a specific increase in Akt/PI-PLCgamma1 pathway for responder patients, whereas most of the patients refactory to EPO displayed a slight decrease in p-Akt levels and an activation of PI-PLCbeta1 signalling during EPO administration, so that these patients seem to counteract the lack of one PI-PLCbeta1 allele by increasing PI-PLCbeta1 gene and protein expression.

Our results, although obtained in a small number of cases, confirm the possible involvement of PI-PLCbeta1 pathways in the EPO signalling. Moreover, our data suggest that the presence of the PI-PLCbeta1 mono-allelic deletion is associated with a worse clinical outcome and with a lack of response to EPO treatment, even in low-risk MDS patients who apparently have a good response profile for EPO (recent diagnosis, absence of long-term transfusion dependence, low or intermediate-1 IPSS risk, serum EPO levels<500 U/L). In fact, in our series, patients with the PI-PLCbeta1 mono-allelic deletion showed an unfavourable outcome (either a rapid evolution into AML or refractoriness to EPO treatment). Moreover, our findings indicate that not only PI-PLCbeta1, but also Akt/PI-PLCgamma1 pathways are critical for cell survival and proliferation in MDS patients treated with EPO. Therefore, these signal transduction pathways could become in the future an important target for the development of innovative strategies for MDS.

Finelli:Celgene: Consultancy.