title: Expression of BAX in plasma cell dyscrasias.
abstract: Several studies demonstrate that the BCL-2 and BCL-XL antiapoptotic genes are variably expressed in plasma cells of patients with multiple myeloma (MM). However, the plasma cell expression of BAX protein, their major proapoptotic partner, has not been investigated. Our initial Western blot analysis of myeloma cell extracts also suggested patient variability in the expression of BAX, which was not altered by exposure to interleukin 6. To further investigate the significance of BAX expression, we performed immunohistochemistry on archival bone marrow biopsies and compared BAX staining to BCL-2 immunostaining. Expression was first evaluated in 104 patients with reactive plasmacytosis, monoclonal gammopathy of undetermined significance/smoldering MM, or active MM. An increase (P < 0.05) in expression of both BAX and BCL-2 was detected in MM patients compared with patients with reactive plasmacytosis. Patients with monoclonal gammopathy of undetermined significance/smoldering MM had intermediate values. For correlations with outcome, expression was assessed in 43 patients at diagnosis who were treated with melphalan and prednisone; 30 at diagnosis who were treated with vincristine, Adriamycin, and dexamethasone; and 29 at relapse who were treated with second-line therapy. There was no correlation between BAX or BCL-2 expression and response to chemotherapy or duration of response or between BCL-2 expression and survival. However, patients who demonstrated extremely low plasma cell BAX expression had significantly increased survival. This was true for patients initially treated with melphalan and prednisone or vincristine, Adriamycin, and dexamethasone, as well as patients studied at relapse. BAX expression did not correlate with expression of proliferating cell nuclear antigen used as a marker of proliferation. These data indicate a myeloma-specific increase in BAX expression in plasma cells and suggest that low BAX expression identifies a cohort of patients with long survival, which is not specifically associated with low proliferating cell nuclear antigen expression.
authors.affiliation: Department of Medicine, Veterans Affairs West Los Angeles Hospital and University of California at Los Angeles Medical School, 90073, USA.
authors.forename: S
authors.initials: S
authors.lastname: Renner
authors.forename: J
authors.initials: J
authors.lastname: Weisz
authors.forename: S
authors.initials: S
authors.lastname: Krajewski
authors.forename: M
authors.initials: M
authors.lastname: Krajewska
authors.forename: J C
authors.initials: JC
authors.lastname: Reed
authors.forename: A
authors.initials: A
authors.lastname: Lichtenstein
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D017209:Apoptosis; D001706:Biopsy; D015153:Blotting, Western; D001853:Bone Marrow / Q000378:metabolism; D002455:Cell Division / Q000187:drug effects; D003907:Dexamethasone / Q000008:administration & dosage; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D006801:Humans; D007150:Immunohistochemistry; D008558:Melphalan / Q000008:administration & dosage; D009101:Multiple Myeloma / Q000378:metabolism / Q000473:pathology; D010265:Paraproteinemias / Q000378:metabolism* / Q000473:pathology; D010950:Plasma Cells / Q000378:metabolism / Q000473:pathology; D011241:Prednisone / Q000008:administration & dosage; D018809:Proliferating Cell Nuclear Antigen / Q000096:biosynthesis; D011518:Proto-Oncogene Proteins / Q000096:biosynthesis*; D019253:Proto-Oncogene Proteins c-bcl-2 / Q000096:biosynthesis; D012008:Recurrence; D013997:Time Factors; D014750:Vincristine / Q000008:administration & dosage; D051028:bcl-2-Associated X Protein
chemical_list: C494826:BAX protein, human; D018809:Proliferating Cell Nuclear Antigen; D011518:Proto-Oncogene Proteins; D019253:Proto-Oncogene Proteins c-bcl-2; D051028:bcl-2-Associated X Protein; D014750:Vincristine; D003907:Dexamethasone; D004317:Doxorubicin; D008558:Melphalan; D011241:Prednisone