title: MicroRNAs involvement in fludarabine refractory chronic lymphocytic leukemia.
abstract: BACKGROUND
  Fludarabine, is one of the most active single agents in the treatment of chronic lymphocytic leukemia (CLL). Over time, however, virtually all CLL patients become fludarabine-refractory. To elucidate whether microRNAs are involved in the development of fludarabine resistance, we analyzed the expression of 723 human miRNAs before and 5-days after fludarabine mono-therapy in 17 CLL patients which were classified as responder or refractory to fludarabine treatment based on NCI criteria.
  
  
  RESULTS
  By comparing the expression profiles of these two groups of patients, we identified a microRNA signature able to distinguish refractory from sensitive CLLs. The expression of some microRNAs was also able to predict fludarabine resistance of 12 independent CLL patients. Among the identified microRNAs, miR-148a, miR-222 and miR-21 exhibited a significantly higher expression in non-responder patients either before and after fludarabine treatment. After performing messenger RNA expression profile of the same patients, the activation of p53-responsive genes was detected in fludarabine responsive cases only, therefore suggesting a possible mechanism linked to microRNA deregulation in non-responder patients. Importantly, inhibition of miR-21 and miR-222 by anti-miRNA oligonucleotides induced a significant increase in caspase activity in fludarabine-treated p53-mutant MEG-01 cells, suggesting that miR-21 and miR-222 up-regulation may be involved in the establishment of fludarabine resistance.
  
  
  CONCLUSIONS
  This is the first report that reveals the existence of a microRNA profile that differentiate refractory and sensitive CLLs, either before and after fludarabine mono-therapy. A p53 dysfunctional pathway emerged in refractory CLLs and could contribute in explaining the observed miRNA profile. Moreover, this work indicates that specific microRNAs can be used to predict fludarabine resistance and may potentially be used as therapeutic targets, therefore establishing an important starting point for future studies.
authors.affiliation: Dipartimento di Medicina Sperimentale e Diagnostica Università di Ferrara, Ferrara, Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Ferracin
authors.forename: Barbara
authors.initials: B
authors.lastname: Zagatti
authors.forename: Lara
authors.initials: L
authors.lastname: Rizzotto
authors.forename: Francesco
authors.initials: F
authors.lastname: Cavazzini
authors.forename: Angelo
authors.initials: A
authors.lastname: Veronese
authors.forename: Maria
authors.initials: M
authors.lastname: Ciccone
authors.forename: Elena
authors.initials: E
authors.lastname: Saccenti
authors.forename: Laura
authors.initials: L
authors.lastname: Lupini
authors.forename: Andrea
authors.initials: A
authors.lastname: Grilli
authors.forename: Cristiano
authors.initials: C
authors.lastname: De Angeli
authors.forename: Massimo
authors.initials: M
authors.lastname: Negrini
authors.forename: Antonio
authors.initials: A
authors.lastname: Cuneo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D019008:Drug Resistance, Neoplasm / Q000235:genetics*; D005260:Female; D015870:Gene Expression / Q000187:drug effects; D020869:Gene Expression Profiling; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy*; D008297:Male; D035683:MicroRNAs / Q000235:genetics*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000235:genetics; D020411:Oligonucleotide Array Sequence Analysis; D020133:Reverse Transcriptase Polymerase Chain Reaction; D016159:Tumor Suppressor Protein p53 / Q000235:genetics; D014740:Vidarabine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D000970:Antineoplastic Agents; D035683:MicroRNAs; D016159:Tumor Suppressor Protein p53; D014740:Vidarabine; C024352:fludarabine