- Letter to the Editor
- Open Access
Inflammation-related genes S100s, RNASE3, and CYBB and risk of leukemic transformation in patients with myelodysplastic syndrome with myelofibrosis
Biomarker Research volume 9, Article number: 53 (2021)
Myelodysplastic syndrome with myelofibrosis (MDS-MF) has been associated with an inferior prognosis compared with MDS without MF. However, MDS-MF is not listed independently as a subtype of MDS, and its clinical and genetic characteristics remain poorly understood. We retrospectively compared 53 patients with MDS-MF (44 MF grade 1/MF1; 9 MF grade 2–3/MF2 − 3) and 31 with de novo MDS without MF (MDS). The leukemic transformation risks of both MDS-MF2 − 3 and MDS-MF1 were increased compared with the MDS group. To identify the potential mechanisms responsible for the leukemic transformation of MDS-MF, we performed single-cell sequencing for one MDS-MF2 − 3 patient before and after leukemic transformation to explore the variations in gene expression levels. In addition to upgraded expression levels of acute myeloid leukemia-related genes during leukemic transformation, expression levels of some inflammation-related genes (such as S100s, RNASE3, and CYBB) were also increased, and inflammation-related pathways were up-regulated. These results suggest that inflammation-related genes and pathways may play an important role in the leukemic transformation of MDS-MF.
To the Editor
Myelodysplastic syndrome (MDS) with myelofibrosis (MDS-MF) accounts for up to 50 % of cases of MDS , and differs from MDS without MF in terms of clinical performance, treatment tolerance, and survival . MDS with severe MF (MF grade = 2–3) is considered as an independent risk factor for de novo MDS ; however, MDS-MF is not independently listed as a subtype of MDS according to the 2016 World Health Organization classification, indicating the need for further investigation.
We retrospectively enrolled 53 patients with MDS-MF (44 MF grade 1/MF1; 9 MF2 − 3) and 31 patients with de novo MDS without MF (MDS). There were no significant differences among the MDS, MDS-MF1, and MDS-MF2 − 3 groups in terms of age, sex, MDS subtypes, IPSS risk levels, and treatment strategies, except for a higher rate of poor karyotypes in the MDS-MF2 − 3 compared with the MDS and MDS-MF1 groups (with no difference between the MDS and MDS-MF1 groups) (Supplementary Table 1). Not only MDS-MF2 − 3, but also MDS-MF1 at IPSS low/int-1 risk, had a shorter leukemic transformation time compared to the MDS group (Fig. 1), suggesting that patients with low/int-1 MDS with even mild MF required chemotherapy to avoid disease progression. Detailed patients’ clinical data are shown in Supplementary file 1.
Cytogenetic abnormalities or genomic mutations are related to the leukemic transformation of MDS-MF but cannot account for the role of MF in this process. The leukemia clonal revolution is influenced by many factors in the bone marrow (BM) microenvironment, including inflammation and abnormal immunity. Chronic inflammation is believed to promote malignant hematopoiesis in myeloproliferative neoplasms through pro-inflammatory /fibrogenic /angiogenic cytokines [4,5,6]. Reactive oxygen species also play a major role in tumor progression of myeloproliferative neoplasms . However, the processes responsible for the clonal myeloproliferation of MDS-MF remain unclear. It is therefore necessary to determine the variations in gene expression levels responsible for the leukemic transformation of MDS-MF. We conducted single-cell sequencing of BM mononuclear cells (BMMCs) from a patient with MDS-MF2 − 3 (CN) in the MDS phase (CN1) and leukemic phase (CN2). A healthy donor (NC) and a patient with de novo acute myeloid leukemia (AML) with the same FAB subtype (M2) were used as controls. Patients’ clinical information and detailed methods are provided in Supplementary File 1. Cell clusters were identified based on 13,280 healthy cells and BMMCs from 40 patients with newly diagnosed AML in our previous study  and were checked with the Human Cell Landscape (http://bis.zju.edu.cn/HCL/index.html) established by our institute . Marker genes for the cell clusters are listed in Supplementary Table 2.
Seventeen cell clusters and eight cell types were identified (Fig. 2A,B). We used “blast-like” cells for the differentially expressed genes (DEGs) and gene enrichment analyses to avoid the influences of other cell types. The top 20 DEGs and their reported functions are listed in Supplementary Table 3. The top 20 increased genes during leukemic transformation included some AML-related genes, such as CD52, SRGN, BEX1, BASP1, SPINK2, NEAT1, and CEACAM6, and some proinflammatory mediators, such as S100 family genes, RNASE3, and CYBB. In contrast, expression levels of many ribosomal protein genes were decreased (Fig. 2C). The S100 family comprises proinflammatory mediators associated with acute and chronic inflammation and neoplasm metastasis . CYBB can produce superoxide, and trigger mitochondria transfer to stimulate BM stromal cells to form AML blast cells . RNASE3 participates in nucleolysis, cell binding, lipid instability, cytotoxicity, and antibacterial activity . However, none of these genes have previously been linked to leukemic transformation of MDS-MF. Gene enrichment analysis revealed that the upregulated pathways during leukemic transformation mainly contributed to inflammation /oxidation /energy metabolism-related signaling and tumor-related pathways (Fig. 2D). We also explored the DEGs between CN2 and M2 samples to detect the differences between secondary AML and de novo AML (Fig. 2E). Genes with higher expression in CN2 were significantly enriched in leukocyte transendothelial migration and the Rap1 signaling pathway (Fig. 2F). Leukocyte transendothelial migration is an inflammation pathway, while Rap1 acts as a molecular switch involved in many biological processes. S100A12, RNASE3, and CYBB were among the genes with higher expression levels in both CN2 compared with CN1, and in CN2 compared with M2 (Fig. 2G).
In conclusion, this study revealed that MDS-MF with even mild MF had a higher risk of leukemic transformation than MDS without MF, suggesting that MDS-MF should have a different risk classification algorithm and may need special treatment. Inflammatory and oxidation activation may be essential processes, while S100 family genes, RNASE3, and CYBB might be key genes involved in the leukemic transformation of MDS-MF.
Availability of data and materials
The data and materials will be available upon corresponding author approval. All data sets generated/analyzed for this study are included in the manuscript and the additional files.
MDS with myelofibrosis
International Prognostic Scoring System
Leukemic transformation time
BM mononuclear cell
Acute myeloid leukemia
Differentially expressed gene
MDS-MF2 − 3 patient for single-cell sequencing
Patient CN in MDS phase
Patient CN in leukemic phase
Patient with de novo AML-M2
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This work was supported by the Centre for Stem Cell and Regenerative Medicine, Zhejiang University School of Medicine. The authors thank the patients who participated in the study, their supporters, and the investigators. We also thank International Science Editing (http://www.internationalscienceediting.com) for editing a draft of this manuscript.
This study was funded by the National Nature Science foundation of China (82070200) and The Nature Science Foundation of Zhejiang Province (LQ20H160025). The funding bodies did not participate in the study design, data collection, analysis, interpretation, or writing of the manuscript.
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Informed consent was obtained from all patients and the protocol was approved by the Ethics Committee of the First Affiliated Hospital of Zhejiang University.
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Supplementary File 1. Patients and methods.
Supplementary Table 1. Characteristics of patients and treatment strategies.
Supplementary Table 2. Marker genes of overall t-stochastic neighbor embedding map.
Supplementary Table 3. Reported tumor-related functions of top-20 differentially expressed genes during leukemic transformation in the MDS-MF2 − 3 patient; and of top-20 differentially expressed genes between the leukemic phase of this MDS-MF2 − 3 patient and a de novo AML-M2 patient.
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Hong, M., Wu, J., Ma, L. et al. Inflammation-related genes S100s, RNASE3, and CYBB and risk of leukemic transformation in patients with myelodysplastic syndrome with myelofibrosis. Biomark Res 9, 53 (2021). https://doi.org/10.1186/s40364-021-00304-w
- Myelodysplastic syndrome
- Leukemic transformation
- Single-cell sequence