| Note | |
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| Entity | Hematological malignancies |
| Disease | BMI1 overexpression has been demonstrated in several hematological malignancies, mainly including mantle cell lymphoma, myeloid dysplastic syndrome (MDS), chronic myeloid leukemia (CML) and acute myeloid leukemia (AML). |
| Prognosis | In general, high BMI1 expression levels are associated with a poor prognosis and increased aggressiveness of the tumors. In CML, the level of BMI1 at diagnosis correlated with time to transformation to blast crisis. In MDS, patients with RA and RARS with a higher percentage of BMI1-positive cells showed disease progression to RAEB. Intriguingly, in CML post allo-SCT, high BMI1 at diagnosis predicts better overall survival, which might be ascribed to the neutralized effects against BMI1 by an immune response in donor cells. |
| Cytogenetics | Different chromosomal translocations involving the 10p11-13 region have also been identified in infant leukemias, occurring in children < 12 months of age and T cell lymphoproliferative disorders, including mainly adult T cell leukemia/lymphomas and occasional cutaneous T cell lymphomas. It was demonstrated that BMI1 was overexpressed with MEIS1 in 11q23 (MLL) rearrangements, suggesting that p16/p19 suppression maybe involved in MLL-associated leukemia. |
| Oncogenesis | See below. |
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| Entity | Solid tumors |
| Disease | BMI1 overexpression was implicated in various solid tumors, including ovarian cancer, bladder cancer, squamous cell carcinoma, prostate cancer, breast carcinomas, non-small-cell lung cancer and GI cancer. |
| Prognosis | The oncogenic role of the BMI1 activation may contribute to progression of many types of solid tumors. The median survival is 46 months and 5-year survival is 37.5% in BMI1/EZH2-positive prostate cancer patients after radical prostatectomy (The 5-year survival is 72.4% in BMI1/EZH2-negative prostate cancer patients). But in breast cancer, increased BMI1 expression is associated with a good prognosis, which might be because BMI1 overexpression correlates with higher ER expression and lower TP53 mutations. |
| Oncogenesis | See below. |
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| Entity | Neural stem cells renewal |
| Note | BMI1 promotes the maintenance of adult neural stem cells (NSCs) by repressing the cyclin-dependent kinase inhibitors, p16Ink4a and p19ARF. Recent study showed that BMI1 was also important for NSCs in the embryo, using lentiviral-delivered shRNAs in vitro and in vivo. These defects caused by BMI1 downregulation were unexpectedly mediated by p21. |
| Oncogenesis | Gene-profiling studies show that BMI-/- HSC displayed altered expression of multiple genes important for stem cell fate decisions. The tumor suppressor locus p16Ink4a/p19ARF is one of the important targets that is repressed by BMI1. The p16Ink4a protein blocks the cyclinD-CDK complexes by binding directly to CDK4 and CDK6, enabling p21CIP1 and p27KIP1 to associate with and inhibit cyclin E-CDK2 and cyclin A-CDK2, which results the hypophosphorylated pRb. The E2F transcription factors will be sequestered and their target genes will be repressed, ultimately leading to G1-phase cell cycle arrest, senescence, or apoptosis. p19ARF binds to MDM2 and inhibits its ubiquitin ligase activity, resulting in activation of p53 target genes, including Wig1 and p21, leading to cell cycle arrest and apoptosis. Furthermore, cells might undergo apoptosis as a result of downregulated apoptosis inhibitor AI-6 in the absence of BMI1. BMI1 was also demonstrated to upregulate the human telomerase RT gene (hTERT), which might also be relevant for the self-renewal ability of HSCs or LSCs. Deregulated Hox gene expression caused by chromosomal translocations and MLL rearrangements, is involved in some types of leukemia. The skeletal defects of PcG mutant mice revealed PcG genes as Hox gene regulators. Knockout of BMI1 results in alterations in Hox gene expression, with 12 Hox genes significantly upregulated (for example, HoxA7-HoxA13 ; HoxC10-HoxC13) and 13 downregulated (for example, HoxA1-HoxA4 ). This study demonstrated that BMI1 and RING1A play important roles in H2A ubiquitylation and Hox gene silencing. Overexpression of BMI1 is involved in tumor development and is used as an important marker for predicting prognosis. The mechanisms regulating BMI1 expression are not fully elucidated yet. In AML, BMI1 was demonstrated to be a direct target gene of SALL4, a zinc-finger transcription factor, which is expressed constitutively in human leukemia cell lines and primary AML cells. High levels of H3-K4 trimethylation and H3-K79 dimethylation were observed in the SALL4 binding region of the BMI1promoter. In normal and malignant human mammary stem cells activation of hedgehog signaling increases BMI1 expression and BMI1 overexpression promotes mammary stem cell self-renewal and proliferation. In CML, it was suggested that BMI1 was positively regulated by BCR-ABL as well as by additional posttranscriptional modification in the course of the disease progression. Chromatin association and dissociation of BMI1 was also studied. BMI1 can be phosphorylated by 3pk (MAPKAP kinase 3), a convergence point downstream of activated ERK and p38 signaling pathways which are implicated in differentiation and developmental processes. BMI1 phosphorylation results in dissociation of BMI1 from chromatin, followed by de-repression of target genes. |
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