title: Endothelial progenitor cells display clonal restriction in multiple myeloma.
abstract: BACKGROUND
  In multiple myeloma (MM), increased neoangiogenesis contributes to tumor growth and disease progression. Increased levels of endothelial progenitor cells (EPCs) contribute to neoangiogenesis in MM, and, importantly, covary with disease activity and response to treatment. In order to understand the mechanisms responsible for increased EPC levels and neoangiogenic function in MM, we investigated whether these cells were clonal by determining X-chromosome inactivation (XCI) patterns in female patients by a human androgen receptor assay (HUMARA). In addition, EPCs and bone marrow cells were studied for the presence of clonotypic immunoglobulin heavy-chain (IGH) gene rearrangement, which indicates clonality in B cells; thus, its presence in EPCs would indicate a close genetic link between tumor cells in MM and endothelial cells that provide tumor neovascularization.
  
  
  METHODS
  A total of twenty-three consecutive patients who had not received chemotherapy were studied. Screening in 18 patients found that 11 displayed allelic AR in peripheral blood mononuclear cells, and these patients were further studied for XCI patterns in EPCs and hair root cells by HUMARA. In 2 patients whose EPCs were clonal by HUMARA, and in an additional 5 new patients, EPCs were studied for IGH gene rearrangement using PCR with family-specific primers for IGH variable genes (VH).
  
  
  RESULTS
  In 11 patients, analysis of EPCs by HUMARA revealed significant skewing (> or = 77% expression of a single allele) in 64% (n = 7). In 4 of these patients, XCI skewing was extreme (> or = 90% expression of a single allele). In contrast, XCI in hair root cells was random. Furthermore, PCR amplification with VH primers resulted in amplification of the same product in EPCs and bone marrow cells in 71% (n = 5) of 7 patients, while no IGH rearrangement was found in EPCs from healthy controls. In addition, in patients with XCI skewing in EPCs, advanced age was associated with poorer clinical status, unlike patients whose EPCs had random XCI.
  
  
  CONCLUSIONS
  Our results suggest that EPCs in at least a substantial subpopulation of MM patients are related to the neoplastic clone and that this is an important mechanism for upregulation of tumor neovascularization in MM.
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, State University of New York Downstate Medical Center, Brooklyn, NY, USA. marc.braunstein@downstate.edu
authors.forename: Marc
authors.initials: M
authors.lastname: Braunstein
authors.forename: Tayfun
authors.initials: T
authors.lastname: Ozçelik
authors.forename: Sevgi
authors.initials: S
authors.lastname: Bağişlar
authors.forename: Varsha
authors.initials: V
authors.lastname: Vakil
authors.forename: Eric L P
authors.initials: EL
authors.lastname: Smith
authors.forename: Kezhi
authors.initials: K
authors.lastname: Dai
authors.forename: Cemaliye B
authors.initials: CB
authors.lastname: Akyerli
authors.forename: Olcay A
authors.initials: OA
authors.lastname: Batuman
mesh_terms: D000367:Age Factors; D002999:Clone Cells; D042783:Endothelial Cells / Q000502:physiology*; D005260:Female; D015321:Gene Rearrangement; D006801:Humans; D007143:Immunoglobulin Heavy Chains / Q000235:genetics; D009101:Multiple Myeloma / Q000235:genetics* / Q000503:physiopathology*; D039902:Multipotent Stem Cells / Q000502:physiology*; D009389:Neovascularization, Pathologic / Q000503:physiopathology*; D011379:Prognosis; D011944:Receptors, Androgen / Q000032:analysis; D049951:X Chromosome Inactivation
chemical_list: D007143:Immunoglobulin Heavy Chains; D011944:Receptors, Androgen