Abstract
Despite receiving rituximab‐combined chemotherapy, follicular lymphoma (FL) patients often suffer tumor recurrence, and understand the cause of relapse in FL would thus significantly ameliorate the tumor therapeutics. Here we demonstrate that the TRA‐1‐60‐expressing cells are a unique population in FLs, converge to the conventional stem cell marker Oct3/4 and ALDH1‐positive population, and resist current B‐lymphoma agents. TRA‐1‐60 expression was observed only in scattered lymphoma cells in FL tissues as well as resting B‐lymphocytes inside germinal centers. Retrospective comparison between the recurrent and cognate primary tissues revealed that the number of TRA‐1‐60‐positive cells from R‐CHOP‐treated FL had increased relative to primary tissue, a finding corroborated by assays on different rituximab‐treated FL cell lines, FL‐18 and DOHH2, wherein TRA‐positive cell numbers increased over ten‐fold compared to the untreated sample. Concordantly, scanty TRA‐1‐60‐positive FL‐18 cells implanted subcutaneously into mice evinced potent tumor‐initiating capacity in vivo, where tumors were twelve‐fold larger in volume (p=0.0021<0.005) and thirteen‐fold heavier in weight (p=0.0015<0.005) compared to those xenografted from the TRA‐negative cells. To explain these, gene expression profiling and the qPCR analysis indicated that the TRA‐1‐60‐positive cells defined distinct population from that of the TRA‐negative cells, with upregulation of multiple drug transporters and therapeutic resistance genes. Hence, TRA‐1‐60‐expressing cells in FL are considered to be vigorously intractable against the conventional therapeutic agents, which may explain its refractory recurrence.
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