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Entity | Various hematological disorders and malignancies |
Note | p15INK4B is frequently epigenetically silenced in leukemias, myelodysplastic syndromes and myeloproliferative diseases by mechanisms involving aberrant DNA methylation and/or histone modifications. These diseases are subcategorized by the French-American-British (FAB) co-operative group, based on the percentage of blast cells in bone marrow and peripheral blood, degree of cytopenia, and in accordance to the direction of differentiation along the myeloid or lymphoid lineages as well as the degree of maturation of the hematopoietic cells. |
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Entity | Myelodysplastic syndromes (MDS) |
Disease | Myelodysplastic syndromes are heterogeneous clonal hematologic disorders characterized by dysplasia of the myeloid bone marrow cells accompanied with peripheral blood cytopenia and increased risk of transformation to acute myeloid leukemia (AML). MDS transforms into AML once the percentage of blasts in the bone marrow has exceeded 30% (FAB). MDS can arise in patients de novo (primary MDS), or following chemotherapy or exposure to toxins (secondary MDS). According to the Leukemia and Lymphoma Society reports, MDS most commonly affects males aged 70 and above, and is considered to be a disease of the elderly. About 11000 new cases are diagnosed each year, resulting in an incidence rate of 4 cases per 100000 population for both genders. |
Prognosis | p15INK4B is silenced by promoter hypermethylation in > 50% of MDS cases. Levels of p15INK4B methylation increase as the disease progresses and provide a marker that can predict occurrence of AML. |
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Entity | Chronic myelomonocytic leukemia (CMML) |
Disease | The defining features of CMML are an absolute monocytosis in peripheral blood ( > 1x109/L), increased numbers of monocytes in bone marrow, a variable degree of dysplasia and less than 5% and 20% of blasts in peripheral blood and bone marrow, respectively. There are two types of CMML: proliferative and dysplastic. Roughly half of CMML diagnosed patients have an elevated white blood cell count commonly associated with hepatomegaly and splenomegaly (myeloproliferative form of the disease). Patients lacking these features are generally considered to have the myelodysplastic form of the disease. |
Prognosis | Hypermethylation is found in up to 60% of CMML cases and correlates with a more aggressive form of disease. Experimentally, a LysMCre mouse model was developed in which p15INK4B gene is deleted specifically in cells of the myeloid lineage, to better mimic the loss of the gene expression the way it is observed in humans. The mice develop non-reactive monocytosis of the peripheral blood as well as increased myeloid blast progenitors in the bone marrow. In this way the mice develop symptoms that closely resemble CMML in human patients. |
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Entity | Acute myeloid leukemia (AML) |
Disease | AML is the most common type of leukemia among adults with 14000 new cases diagnosed each year, and with 9000 deaths per year in the United States. AML classification into ten different subtypes was originally defined by the FAB cooperative group according to the direction of differentiation along the different myeloid lineages as well as the degree of maturation of the cells. However, AML exemplifies a genetically heterogeneous cancer with more than a hundred genetic aberrations implicated in the disease. |
Prognosis | Despite the great genetic and phenotypic heterogeneity of AML, hypermethylation of the p15INK4B promoter region (CpG island) is found to occur in up to 80% of AML cases across all FAB subtypes. It correlates with a loss of p15INK4B expression, poor prognosis and shorter survival time in patients. The p15INK4B methylation status in AML patients in clinical remission is now monitored and used as a reliable prognostic marker for relapse. These findings were further experimentally confirmed in a conditional knockout mouse model where myeloid-specific gene inactivation resulted in an increased susceptibility to retrovirus-induced myeloid leukemia. |
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Entity | Acute lymphoblastic leukemia (ALL) |
Disease | There are about 4000 new cases of ALL in the United States each year. It appears most often in children younger than age 10. ALL is the most common leukemia in children. However, it can appear in people of any age. About one-third of cases are adults. |
Prognosis | In B and T acute lymphoblastic leukemia the p15INK4B promoter methylation as well as deletion of the entire locus has been reported. |
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Entity | Chronic leukemia |
Disease | Chronic leukemia can be subdivided into two subtypes, chronic myelogenous leukemia (CML) and chronic lymphocytic leukemia (CLL). CLL is primarily an adult disease; it is very rare in children and young adults. The median age of diagnosis is 72 years, and about 60% of patients are male. In the United States, about 15000 people are diagnosed with CLL each year. This disease is also commonly referred to as B-cell chronic lymphocytic leukemia (B-CLL). |
Prognosis | Promoter hypermethylation has been reported in a small subset of B-CLL (11%) at all stages of the disease. In CML, silencing of p15INK4B either by deletion or hypermethylation of its promoter was not found to be a very frequent event. |
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Entity | Glioblastoma multiforme (GBM) |
Disease | GBM is the most common and very aggressive brain tumor in adults. It involves glial cells and accounts for more than 50% of parenchymal brain tumors approximately 20% of all intracranial tumors. Glioblastoma growth is characterized by a high motility of tumor cells that display broad chemoresistance leading to frequent post-surgical tumor recurrence. It is one of the most dreaded cancer diagnoses due to its poor prognosis and the limited treatment options, with the median survival duration after diagnosis varying from 6 months to 2 years. |
Prognosis | Homozygous deletion of the p15INK4B/p14ARF/p16INK4A locus on chromosome 9p21.3 is a signature genetic event that drives the pathogenesis of GBM. The deletion of this locus is the most common homozygous deletion present in GBM (> 75% of samples). Specific p15INK4B promoter methylation was also detected in 37% of patients diagnosed with glioblastoma and it correlated with shorter survival. |
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Entity | Hepatocellular carcinoma (HCC) |
Disease | HCC is a primary malignancy of the liver that mostly arises secondary to hepatitis B or C viral infections. Outcome of the disease is poor, because only 10 - 20% of hepatocellular carcinomas can be removed completely using surgery, and the cancer is usually deadly within 3 to 6 months. |
Prognosis | The suppression of the C-MYC oncogene induces cellular senescence in diverse tumor types including hepatocellular carcinoma and correlates with increased p15INK4b expression. In primary HCC, p15INK4B promoter is hypermethylated in about 50% of the cases, and homozygous deletions of both p16INK4A and p15INK4B have been reported in 30% HCC patients and cell lines. This suggests that p15INK4B might be contributing to human hepatocarcinogenesis through a pathway associated with cellular senescence. |
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