Key Event Relationship Overview
AOPs Referencing Relationship
|AOP Name||Adjacency||Weight of Evidence||Quantitative Understanding|
|Inhibitor binding to topoisomerase II leading to infant leukaemia||adjacent||High||Not Specified|
Life Stage Applicability
Key Event Relationship Description
There is evidence that the inappropriate joining of ‘hanging ends’ following DSB happens in the same transcriptional factory (hub), and the result is a fusion gene and ultimately protein product (Cowell & Austin 2012; Pendleton et al 2014; Sanjuan-Pla et al 2015). The first part of this description has not been shown in the putative target cell, which is still not unequivocally identified, but for the second part there is ample evidence of formation of MLL-AF4 fusion product that has been a result of a very early chromosomal translocation and rejoining. It is of interest that the simultaneously induced specific DSBs in the MLL gene and two different translocation partners (AF4 and AF9) by engineered nucleases in human HSPCs resulted in specific ‘patient-like’ chromosomal translocations (Breese et al 2016).
Evidence Supporting this KER
The KER as such is biologically plausible and strong. DNA strand breaks, if not resulting in cell death, may lead to chromosomal translocation in the surviving cell population (McClendon et al. 2007). DNA breaks and MLL rearrangements by etoposide and bioflavonoids have been demonstrated in human fetal liver haematopoietic stem cells, in human embryonic stem cells and in human prehaematopoietic mesenchymal stem cells as well as in cord blood mononuclear cells (Ishii et al 2002; Blanco et al 2004; Moneypenny et al 2006; Bueno et al 2009; Menendez et al 2009), which clearly shows that TopoII-associated MLL rearrangements are produced in appropriate human cells in utero.
Etoposide treatment in vivo in mice at day 13.5 of pregnancy induces MLL breakage in fetal liver haematopoietic stem cells in utero, but MLL-rearranged fusion mRNAs were detected only in mice which were defective in the DNA damage response, i.e. atm knockout mice. A fusion gene analogous to MLL-AF4 was not detectable in the wild type mice. In this study, an intraperitoneal injection of 10 mg/kg of etoposide into pregnant mice at day 13.5 of pregnancy resulted in a maximum fetal liver concentration of about 5 µM. A dose of 0.5 mg/kg did not result in a measurable concentration. A statistically significant increase (about 6-fold) in DSBs in the MLL gene of isolated fetal liver haematopoietic stem cells was observed after a single dose of 1 mg/kg to pregnant mice. A clear activation of DNA damage response was observed at the dose of 10 mg/kg (Nanya et al. 2016).
There is a lot of information about the interaction of etoposide with TopoII enzymes and MLL chromosomal translocation at the cell culture level and in connection with treatment-related leukaemia.
Uncertainties and Inconsistencies
· A target cell, i.e. leukaemia-initiating cell, has not been identified with sufficient confidence and consequently there is no target cell model to recapitulate the linkage between TopoII inhibition (‘poisoning’) and the production of DSB in an appropriate target. Recently, by the expression of engineered nucleases (TALENs) to induce simultaneous patient specific double strand breaks in the MLL gene and two different known translocation partners (AF4 and AF9), Breese et al (2015) were able to produce specific chromosomal translocations in K562 cells and in primary HSPCs.
Quantitative Understanding of the Linkage
Known modulating factors
Known Feedforward/Feedback loops influencing this KER
Domain of Applicability
DNA topoisomerases are ubiquitous enzymes, which control the integrity of double-stranded DNA. They are thus key enzymes at all levels of living organisms. The available evidence suggest that important differences in sensitivity to topoisomerase inhibition might exist among different cell types, depending on the amount of proliferative burden, of the TopoII enzymes and on physiological repair processes. Mesodermal precursor or hematopoietic stem and progenitor cells (HSPCs) are rapidly dividing cells with a high content of TopoII and for these reasons they can be a sensitive target during a critical developmental window (Hernandez and Menendez 2016). In addition, evidence from micronuclei assay studies conducted in untreated and chemical-treated foetuses and newborns show that both the baseline and chemically induced micronuclei frequencies are higher in the foetuses and infants than in adults (Udroiu et al 2016). This is possibly indicating a greater sensitivity to genotoxic insult during development which can be due to the higher proliferation rate and lower ability of DNA repair of the hematopoietic stem cells. However, the role that the different microenvironments (foetal liver, infant bone marrow and adult bone marrow) during ontogenesis can exert on cell sensitivity cannot be ruled out (Udroiu et al. 2016). The existence of relevant interspecies differences is unknown, but it cannot be ruled out presently.
Blanco JG, Edick MJ, Relling MV. Etoposide induces chimeric Mll gene fusions. FEDERATION OF AMERICAN SOCIETIES FOR EXPERIMENTAL BIOLOGY (FASEB) 2004; 18(1):173–5. doi: 10.1096/fj.03-0638fje
Breese EH, Buechele C, Dawson C, Cleary ML, Porteus MH. Use of Genome Engineering to Create Patient Specific MLL Translocations in Primary Human Hematopoietic Stem and Progenitor Cells. Public Library of Science (PLoS ONE) 2015 Sep 9;10(9):e0136644. doi: 10.1371/journal.pone.0136644.
Buechele C, Breese EH, Schneidawind D, Lin CH, Jeong J, Duque-Afonso J, Wong SH, Smith KS, Negrin RS, Porteus M, Cleary ML. MLL leukemia induction by genome editing of human CD34+ hematopoietic cells. Blood 2015 Oct 1;126(14):1683-1694. doi: 10.1182/blood-2015-05-646398.
Chen W, Li Q, Hudson WA, Kumar A, Kirchhof N, Kersey JH. A murine Mll-AF4 knock-in model results in lymphoid and myeloid deregulation and hematologic malignancy. Blood Journal 2006; 108(2):669–77. doi: 10.1182/blood-2005-08-3498
Cowell IG and AustinInt CA. Mechanism of Generation of Therapy Related Leukemia in Response to Anti-Topoisomerase II Agents. J. Environ. Res. Public Health 2012, 9(6), 2075-2091; https://doi.org/10.3390/ijerph9062075
Hernandez Jerez AF, Menendez P. Linking pesticide exposure with pediatric leukemia: potential underlying mechanisms. Int J Mol Sci 2016; 17: 461.
Ishii E, Eguchi M, Eguchi-Ishimae M, Yoshida N, Oda M, Zaitsu M, et al. In vitro cleavage of the MLL gene by topoisomerase II inhibitor (etoposide) in normal cord and peripheral blood mononuclear cells. International journal of hematology. 2002; 76(1):74–9.
Li Z, Sun B, Clewell RA, Adeleye Y, Andersen ME, Zhang Q. Dose-response modeling of etoposide-induced DNA damage response. Toxicological Sciences 2014 Feb;137(2):371-84. doi: 10.1093/toxsci/kft259.
Libura J, Slater DJ, Felix CA, Richardson C. Therapy-related acute myeloid leukemia-like MLL rearrangements are induced by etoposide in primary human CD34+ cells and remain stable after clonal expansion. Blood Journal 2005; 105(5):2124–31. doi: 10.1182/blood-2004-07-2683
Libura J, Ward M, Solecka J, Richardson C. Etoposide-initiated MLL rearrangements detected at high frequency in human primitive hematopoietic stem cells with in vitro and in vivo long-term repopulating potential. European Journal of Haematology 2008; 81(3):185–95. doi: 10.1111/j.1600-0609.2008.01103.x
McClendon AK, Osheroff N. DNA Topoisomerase II, Genotoxicity and Cancer. Mutation Research 2007; 623 (1-2): 83-97.
Moneypenny CG, Shao J, Song Y, Gallagher EP. MLL rearrangements are induced by low doses of etoposide in human fetal hematopoietic stem cells. Carcinogenesis. 2006; 27(4):874–81. Epub 2005/12/27. doi: 10.1093/carcin/bgi322
Montecucco A, Zanetta F, Biamonti G. Molecular mechanisms of etoposide. JOURNAL OF EXPERIMENTAL AND CLINICAL SCIENCES. 2015 Jan 19;14:95-108. doi: 10.17179/Journal - Experimental and Clinical Sciences (EXCLI)2015-561.
Nanya M, Sato M, Tanimoto K, Tozuka M, Mizutani S, Takagi M. Dysregulation of the DNA Damage Response and KMT2A Rearrangement in Fetal Liver Hematopoietic Cells. Public Library of Science (PLoS ONE). 2015 Dec 11;10(12):e0144540. doi: 10.1371/journal.pone.0144540.
Pendleton M1, Lindsey RH Jr, Felix CA, Grimwade D, Osheroff N. Topoisomerase II and leukemia. Ann N Y Acad Sci. 2014 Mar;1310:98-110. doi: 10.1111/nyas.12358. Epub 2014 Feb 3.
Pitz MW, Desai A, Grossman SA, Blakeley JO. Tissue concentration of systemically administered antineoplastic agents in human brain tumors. Journal of Neuro-Oncology 2011 Sep;104(3):629-38. doi: 10.1007/s11060-011-0564-y.
Relling MV, Yanishevski Y, Nemec J, Evans WE, Boyett JM, Behm FG, Pui CH.Etoposide and antimetabolite pharmacology in patients who develop secondary acute myeloid leukemia. Leukemia. 1998 Mar;12(3):346-52.
Stremetzne S, Jaehde U, Kasper R, Beyer J, Siegert W, Schunack W. Considerable plasma levels of a cytotoxic etoposide metabolite in patients undergoing high-dose chemotherapy. European Journal of Cancer 1997 May;33(6):978-9.
Udroiu I., Sgura A. Genotoxicity sensitivity of the developing hematopoietic system. 2012. Mutation Research 2012; 767: 1-7.