Abstract | Zloćudne bolesti krvotvornog tkiva su klonalne bolesti koje nastaju zbog genetske promjene u jednoj krvotvornoj stanici koštane srži ili limfatičkog tkiva. Mehanizam nastanka klonalne promjene nije sasvim razjašnjen, ali se zna da je posljedica zajedničkog djelovanja genetskih i okolišnih čimbenika. Klonalna promjena nastaje kao krajnja posljedica nakupljanja naslijeđenih i stečenih somatskih mutacija u protoonkogenima i tumor-supresorskim genima. Treća skupina gena koja ima ključnu ulogu u patogenezi bolesti su geni za popravak oštećenja DNA, a njihova inaktivacija potiče klonalnu promjenu u smislu preživljenja i bujanja stanica. Produkt gena NQO1 sudjeluje u metaboličkom procesu detoksikacije kemijskih karcinogena, a produkt gena NSB1 sudjeluje u mehanizmu popravka oštećenja DNA, a time zajednički ostvaruju zaštitno djelovanje na stanice krvotvornog sustava. Istražili smo genske promjene (polimorfizam i delecijsku mutaciju) u dva konstitucijska gena NQO1 i NBS1. Polimorfizam C609T gena NQO1 i delecijsku mutaciju 657del5 gena NBS1 istraživali smo u 82 bolesnika koji boluju od različitih zloćudnih bolesti krvotvornog tkiva i 99 zdravih ispitanika standardnim postupcima. Za dokaz polimorfizma C609T proveli smo polimeraznu lančanu reakciju (PCR) i analizu duljine restrikcijskih ulomaka (RFLP) nakon cijepanja enzimom Hinf1 uz vizualizaciju produkata na agaroznom ili poliakrilamidnom gelu. Za dokaz delecijske mutacije 657del5 proveli smo postupak PCR i vizualizaciju PCR-produkata na visokorezolucijskom poliakrilamidnom gelu (kako bi razlikovali veličinu produkata od 5 parova baza). Dokazali smo da je polimorfizam C609T, genotipa T/T i C/T, gena NQO1 statistički značajno češće prisutan u skupini bolesnika (39%) nego u skupini zdravih kontrolnih ispitanika (21%) (p = 0,031, χ 2 ). Statistički značajna razlika uz povećani izgled (rizik) (omjer izgleda = 2,4) razvoja bolesti nađena je u bolesnika starije dobne skupine koji boluju od poremećaja mijeloidne loze (p = 0,026, χ 2 ). Analizirali smo i klonalne kariotipske promjene u bolesnika s obzirom na zastupljenost polimorfizma C609T gena NQO1. Nismo potvrdili značajnu razliku u zastupljenosti polimorfizma C609T, genotipa T/T ili C/T, gena NQO1 u bolesnika sa specifičnim citogenetskim klonalnim promjenama u kariotipu (41/77) od onih s normalnim kariotipom (36/77). Nadalje smo pokazali prisutnost Slavenske mutacije 657del5 gena NBS1 u 2 od 82 bolesnika. Ovu delecijsku mutaciju nismo našli u kontrolnih ispitanika, pa vjerujemo da bi ta mutacija mogla biti važna u leukemogenezi, tim više što se bolest očitovala već u ranoj dobi i to u dječaka (657del5/657del5), koji je obolio od MDS, i u djevojčice (657del5/N), koja je oboljela od ALL. Nismo mogli analizirati, niti ustvrditi važnost združenih (višestrukih) genotipskih promjena s nastankom zloćudne bolesti krvotvornog tkiva s obzirom na samo dva bolesnika sa Slavenskom mutacijom 657del5 gena NBS1, koji uz to nisu imali polimorfni genotip C609T (C/T ili T/T) gena NQO1 niti klonalne promjene u kariotipu. Zaključili smo da obje istraživane genotipske promjene imaju ulogu u patogenezi razvoja zloćudnih klonalnih bolesti krvotvornog tkiva. Buduća istraživanja bi mogla otkriti ulogu i drugih gena u održavanju stabilnosti genoma krvotvorne matične stanice, te međudjelovanje tih gena međusobno i s čimbenicima okoliša. |
Abstract (english) | Hematological malignancies are clonal diseases that develop due to the genetic aberration in a single hematopoietic cell in bone marrow or lymphoid tissue. The mechanism of this clonal aberration is not completely understood, but it is known to be caused by the combined effects of genetic factors and environmental influences. Clonal aberrations are result of the accumulation of inherited and acquired somatic mutations in proto-oncogenes and tumor suppressor genes. The third class of genes is the DNA reparation genes, which inactivation initiates clonal expansion due to the increased cell survival and proliferation. The NQO1 gene product participates in a metabolic process of detoxification of potential chemical carcinogens, whereas the NBS1 gene product participates in DNA reparation, thus both having the protective effects on hematopoietic cells. In our study we investigated genetic aberrations (polymorphism and deletional mutation) in two constitutional genes, NQO1 and NBS1. We investigated C609T polymorphism of the NQO1 gene and 657del5 mutation of the NBS1 gene in 82 patients with different hematopoietic malignancies and 99 healthy participants using standard methods. For detection of C609T polymorphism, we performed polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) after Hifn1 digestion. The products were visualized on agarose or polyacryamide gels. For detection of 657del5, we performed PCR with PCR-product visualization of high resolution polyacryamide gen (to distinguish between 5 base pair difference between PCR-products). We confirmed that the NQO1 gene C609T polymorphism, with T/T and T/C genotypes, significantly more frequent in the patients’ group (39%) compared with the healthy participants (21%) (p = 0.031, χ 2). The significant difference, with the increased likelihood (risk) (odd ratio = 2.4) of developing hematopoietic malignancy, was found in the group of adult (mostly elderly) patients with myeloid disorders (p=0.026, χ 2). Also, we analyzed clonal karyotype aberrations in patients in relation to the presence of NQO1 gene C609T polymorphism. Nevertheless, we could not confirm the significant difference regarding the frequency of C609T polymorphism, with T/T or C/T genotypes, between patients with the specific cytogenetic clonal aberrations in karyotype (41/77) and those with the normal karytype (36/77). Furthermore, we found the presence of the NBS1 gene 657del5 Slavic mutation in 2 out of 82 patients’ samples. This deletional mutation was not detected in the control group, therefore we believe that it could be important for leukemogenesis, particularly because disease developed in early age- in a boy (657del5/657del5) with MDS and a girl (657del5/N) with ALL. We could not analyze and evaluate the importance of the combined (multiple) genotype aberrations for the pathogenesis of hematopoieticl malignancies considering only two patients with the NBS1 gene 657del5 Slavic mutation, which was not accompanied neither with the NQO1 gene C609T polymorphism (C/T or T/T) nor with the karyotype clonal aberrations. Our study revealed that both of the analyzed genotype aberrations have a role in the pathogenesis of hematopoietic clonal malignancies. Further research should reveal the role of other genes in maintaining the stability of the genome of the hematopoietic stem cell, and the interaction of those genes with the environmental factors. |