ABSTRACT(aCGH) and sequencing of candidate genes. 7,8 According to the French-American-British (FAB) 6 and WHO 3 classifications, the CMML series was made up of 31 MP and 22 MD cases (Online Supplementary Table S1) and the MDS panel 8 refractory anemia (RA) with ring sideroblasts (RARS), 13 RA with excess of blasts type 1 (RAEB1) and 11 RAEB type 2 (RAEB2). CMML and MDS cases selected for gene expression profiling were collected at the time of diagnosis or in therapeutic abstention; none had been treated. All patients signed an informed consent for research and the study was approved by our institutional review board ("Comité d'Orientation Scientifique" of the Institut PaoliCalmettes).
CD34 enrichmentSamples were enriched in CD34-positive (CD34 + ) cells for 12 CMML and 32 MDS cases. Leukocytes were obtained after bone marrow red cell lysis and washing with PBS, and labeled with magnetic bead-conjugated anti-CD34 monoclonal antibody (AC34 MicroBead; Miltenyi Biotec, Auburn, CA, USA). CD34 + hematopoietic stem cell populations were then purified through a miniMACS magnetic cell separation column (Miltenyi Biotec).
RNA/DNA extractionRNAs and DNAs were extracted from whole BM CMML samples. After BM aspiration, a red cell lysis was carried out, followed by rinses with PBS. Leukocytes were processed immediately or cryopreserved at -80°C at the sample bank of the Institute and processed later. DNA and RNA were extracted using Nucleobond RNA/DNA kit from Macherey-Nagel (Düren, Germany) as recommended by the supplier. RNA from CD34 + cells were similarly extracted using Nucleobond RNA/DNA kit from Macherey-Nagel.
Sequencing of 18 candidate genesMutations in ASXL1 (exon 12), CBL (exons 8, 9), DNMT3A (exons 15-23), EZH2 (all exons), FLT3 (exons 14, 15, 20), IDH1/2 (exons 4), JAK2 (exon 14), NF1 (exons 1-50), N/KRAS (exons 1, 2), PTPN11 (exons 3, 11) ), RUNX1 (exons 1-8), SF3B1 (exons 12-16), SUZ12 (exons 14-16), SRSF2 (exon 2), TET2 (exons 3-11), U2AF35/U2AF1 (exons 2, 6), and ZRSR2 (exons 1-11) were analyzed using BM DNA as previously described.
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Gene expression profilingGene expression profiles of 39 CMML (out of the 53) and 32 MDS (all from CD34 + cells) mRNAs were established. Among the 39 CMML cases, 37 were studied as BM (10 of these were also studied as CD34 + ) and 2 as CD34 + RNAs. In other words, 10 CMML samples were studied as both CD34 + and whole BM RNAs, and 2 as CD34 + only (12 CD34 + in total). RNA quality and purity were assessed with Agilent Bioanalyzer 2100 (Agilent Technologies, Palo Alto, CA, USA). Preparation of cRNA, hybridizations onto Affymetrix U133 Plus 2.0 human oligonucleotide microarrays, washes and detection were carried out as recommended by the supplier and as previously described. Data were analyzed by the Robust Multichip Average (RMA) method in R using Bioconductor and associated package, as previously described.12 Before analysis, a first filtering process removed from the data set the probe sets with low and poorly measured expression as defined by an expression value inferior to ...