Interestingly, the addition of an anti-IL-2R-␣ monoclonal antibody profoundly inhibited IL-9 expression, suggesting optimal expression of IL-9 was dependent on IL-2 signaling in these patients. To determine whether there would be autonomous proliferation of ATL leukemic cells, we purified leukemic cells from patients with smoldering/chronic ATL. Purified leukemic cells cultured alone produced IL-2/ IL-9, and the downstream Janus kinase/ signal transducer and activator of transcription pathway was activated. However, the leukemic cells did not proliferate independently, but required coculture with autologous monocytes to induce proliferation. Moreover, interaction between leukemic cells and monocytes was contact dependent, and major histocompatibility complex class II expression may have contributed to this interaction. In conclusion, our data provide evidence that there is autocrine/paracrine cytokine stimulation of leukemic cell proliferation in patients with smoldering/chronic ATL that could be targeted for treatment.
IntroductionAdult T-cell leukemia (ATL) that is caused by human T-cell lymphotropic virus I (HTLV-1) is an aggressive malignancy of CD4-and CD25-expressing leukemia, and lymphoma cells. ATL is a heterogeneous disease that can be divided broadly into 4 stages: smoldering, chronic, lymphoma, and acute-type ATL. The common clinical manifestations of ATL are skin lesions, hypercalcemia, immunologic anergy to antigen stimulation, and cells with "flowerlike" nuclei in the circulation. Smoldering/chronic ATL patients have normal or mildly increased white blood cell counts with a variable number of leukemic cells in the circulation and are generally associated with a better prognosis. Patients with acutetype ATL have organ dysfunction associated with circulating leukemic cells and are generally associated with a poor prognosis. The mechanisms underlying the progression from smoldering/chronic stage to the acute stage are unknown; however, the accumulation of molecular mutations is thought to play a role in this progression.Although the pathogenesis of ATL is unknown, the virally encoded regulatory protein, HTLV-1 Tax, seems to play a central role in the initial leukemogenesis of ATL. Hasegawa et al demonstrated that overexpression of Tax in immature thymocytes induced leukemia/lymphoma in mice with clinical, pathologic, and immunologic features characteristic of ATL after a long latency. 1 Subsequently, Ohsugi et al 2 showed that Tax is able to promote oncogenesis not only with immature T cells, but also with mature T cells. Both experiments highlighted the importance of Tax in the initial development of ATL.Beyond the in vivo mouse models, numerous in vitro studies have demonstrated the essential role of Tax in ATL initiation and shed light on the mechanism of Tax-mediated cellular transformation. 3 Tax deregulates the expression of genes involved in cellular proliferation, cell-cycle control, and apoptosis through physical interaction with cellular elements, including transcription factors such as nuc...