title: PO-46 - Influence of extracellular vesicles derived from AML patients on stem cells and their microenvironment.
abstract: BACKGROUND
  Acute myeloid leukemia (AML) is characterized by rapid growth of leukemic blast cells. Extracellular vesicles (EVs) are shed from normal and pathologic cells and express membrane proteins and antigens, reflecting their cellular origin.
  
  
  OBJECTIVE
  To explore whether bone marrow EVs of AML patients originate from blast cells and are capable of influencing hematopoietic stem cells (HSC) in a pseudo-natural microenvironment obtained by co-culture of HSC with mesenchymal stem cells (MSC).
  
  
  METHODS
  Bone marrow (BM) samples were collected from healthy controls and patients with newly diagnosed AML at three time points: diagnosis, nadir and remission. EV concentration, cell origin and expression of coagulation proteins were characterized by FACS. Stem cells were obtained from Ficoll gradient of cord blood (CB) followed by CD34+ isolation. Cord blood stem cells with or without MSC were co-incubated with AML EVs. EV internalization was demonstrated by FACS-AMNIS and confocal microscopy. Mir-125b and -155 expressions in the cells were analyzed by RT-PCR.
  
  
  RESULTS
  AML patients were enrolled in the study. The total BM-EVs number was higher in patients at first remission compared to controls, while blast EV counts (labeled with anti-CD34, CD33, CD117) were higher in patients at diagnosis compared to controls and to patients in remission. Internalization of CD117+/CD33+ BM-EVs to cord blood stem cells in the presence or absence of MSC was evaluated by FACS-AMNIS. Confocal microscopy of CD33+ stained EVs strengthens the findings and shows presence of EVs even in the cytoplasm and the nucleus. Quantitative analysis of mir-125b and mir-155 expression in cord blood stem cells incubated with AML EVs revealed a clear tendency of increased expression in case of cell exposure to AML EVs in comparison to healthy control EVs. This tendency was emphasized in the presence of MSC.
  
  
  CONCLUSIONS
  EVs of AML patients are generated from blast cells. By internalization into naïve stem cells they can influence their differentiation. Moreover, the presence of mesenchymal stem cells is likely to be essential to the process.
authors.affiliation: Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus; Internal Medicine C, Rambam Health Care Campus; Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology; Haifa, Israel.
authors.forename: I
authors.initials: I
authors.lastname: Tzoran
authors.affiliation: Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus; Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology; Haifa, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Rebibo-Sabbah
authors.affiliation: Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus; Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology; Haifa, Israel.
authors.forename: B
authors.initials: B
authors.lastname: Brenner
authors.affiliation: Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus; Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology; Haifa, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Aharon