Background
Chronic lymphocytic leukemia (CLL) is the most common form of adult leukemia in Europe, Australia, and America [
1,
2]. The past decades have witnessed a massive revolution in targeted therapy of chronic lymphocytic leukemia, with the approval of novel agents, including small molecule inhibitors targeting Bruton’s tyrosine kinase, phosphatidylinositol-3-kinase, and B-cell lymphoma 2 [
3‐
5]. However, side effects and drug resistance of these agents are still difficult to avoid due in part to off-target effects [
6‐
8]. Further insights into the novel targets may therefore reveal essential pathophysiological clues that can lead to more individualized approaches to achieve durable disease control in the majority of patients in the future.
As the isozyme of cytidine triphosphate synthase (CTPS), it has been reported that Epstein-Barr virus could upregulate CTPS2 to meet CTP demand in newly EBV-infected B cells and to drive the pathogenesis of lymphoma [
9]. CTPS is the key regulatory enzyme in pyrimidine biosynthesis, with critical roles in the regulation of energy metabolism as well as the biosynthesis of nucleic acids, phospholipids and membranes [
10,
11]. CTPS catalyzes one of the key regulatory and rate-limiting steps of CTP synthesis by converting the uridine triphosphate to cytidine triphosphate [
12,
13]. While, glutamine (Gln) is an essential source of nitrogen atoms at the process of this CTP biosynthesis [
14]. Recently, there has been increasing evidence that CTPS is frequently mis-regulated in cancers [
15,
16]. There are two CTPS isoforms encoded on separate genes, CTPS1 and CTPS2, which share 75% identity. However, their relative roles remain unclear. Previous study has suggested that CTPS1 deletion could cause severe immune deficiency due to serious defects in lymphocyte proliferation [
17,
18]. The function and clinical significance of CTPS2 in tumorigenesis remains an open question.
Yet, the role of CTPS2 had not been explored in chronic lymphocytic leukemia. Hence, this study was aimed to investigate the role of CTPS2 in CLL pathogenesis and the mechanisms that underlie the association between CTPS2 and malignancy. In the work presented here, we provided compelling data that CTPS2 not only enhanced proliferation of CLL but also interacted with BRCA1 and there by impacted DNA damage response (DDR) in CLL. These data opened up new perspectives on key pathophysiological mechanisms that could be exploited for biomarker development to guide treatment choices in CLL.
Methods
Patient and sample characteristics
Blood samples of 96 de novo patients of CLL were collected at the Department of Hematology in Shandong Provincial Hospital after informed consent as approved by the ethics commission. The leukemic clone proportion in peripheral blood of the enrolled CLL patients was > 90%, which could be represented by peripheral blood mononuclear cells [
19]. All the participants were aged between 29 and 85 years (mean age = 60.29 years, s. d. = 11.45). Peripheral blood mononuclear cells (PBMCs) were isolated by Ficoll density gradient centrifugation, which was described in previous study [
20,
21]. CD19 + B cells from healthy donors were purified using CD19 + magnetic microbeads kit (Miltenyi Biotec, Bergisch Gladbach, Germany). Clinical characteristics of CLL patients, including age, stage, immunoglobulin mutational status, and cytogenetics (FISH) were recorded.
In silico analysis
1030 clinically annotated CLL patients from multiple cohorts were enrolled in this study. Normalized microarray and RNA-seq data from the GSE50006, GSE22529, GSE55288, GSE22762, GSE39671 datasets were downloaded from the Gene Expression Omnibus (GEO) database. For the ICGC cohort, gene expression and clinical data were obtained from the International Cancer Genome Consortium database (
https://icgc.org/). The cut-off value was assessed based on median mRNA expression level. The Kaplan‒Meier method was used for survival analysis.
Cell culture and reagents
Human CLL cell lines were routinely cultured in IMDM (MEC-1) and RPMI-1640 (EHEB) medium with 10% fetal bovine serum (Gibco, MD, USA). The medium contained a 1% penicillin/streptomycin mixture. Cells were incubated at 37 °C in humidified air containing 5% CO2. Complete medium without Gln was purchased from M&C GENE (Beijing, China). Cytidine-triphosphate (HY-125818, MCE) were soluble in sterile saline solution to the storage concentration at 10 mM.
The sequences for CTPS2 shRNAs were as follows: shCTPS2#1, 5′-CCGAGGACCCTGTGAAATT-3′; shCTPS2#2,5′-GCAGTGATAGAGTTTGCAA -3′; shCTPS2#3, 5′-CCACAGAGTTTAGGCCAAA-3′. The shRNAs for CTPS2, lentivirus-BRCA1 and the negative control RNA (shControl) were synthesized and purified by OBIO (Shanghai, China). The shRNAs were cloned into lentiviral vectors and lentivirus infection was carried out according to the manufacturer’s instruction. Forty-eight hours after transfection, stably silenced clones were selected by 2 μg/ml puromycin. The medium was changed at twenty-four hours after transfection, and cells were harvested for subsequent analysis seventy-two hours after transfection. Plasmids delivery to overexpress CTPS2 was constructed by WZ Biosciences (Jinan, Shandong, China).
RNA isolation and quantitative real-time PCR
Total RNA was purified with Trizol reagent (Invitrogen, MA, USA) and reversed transcribed into cDNA using a reverse transcription kit (TaKaRa, Dalian, China). Real-time PCR was performed in a Light Cycler 480 II Real-Time PCR system (Roche Diagnostics, Basel, Switzerland) using TB Green (Takara). Real-time PCR of each sample was performed in triplicate. Results were obtained using the sequence detection software Light cycler 480 and analyzed using GraphPad Prism version 7.0 statistical software.
Western blot analysis
Whole cell lysates were extracted using radioimmunoprecipitation assay (RIPA) buffer together with a 1 × phosphatase inhibitor cocktail (PhosSTOP, Roche, Basel, Switzerland). The primary antibodies used were as follows: anti-CTPS2 (ab196016, Abcam, Cambridge, UK), anti-cyclin B1 (ab32053,Abcam), anti-CDK1 (ab18, Abcam), anti-phospho-H2AX (7631, Cell Signaling Technology, MA,USA), anti-phospho-ATM (13050, Cell Signaling Technology), anti-phospho-BRCA1 (14823, Cell Signaling Technology), anti-Bcl-2 (4223, Cell Signaling Technology), anti-Bax (14796, Cell Signaling Technology), anti-cleaved PARP (5625, Cell Signaling Technology), anti-p21 (2947, Cell Signaling Technology), β-actin (TA-08, Zhongshan Goldenbridge), and anti-GAPDH (TA-09, Zhongshan Goldenbridge, Beijing, China).
Cell proliferation assessment
Cell viability was assayed using the Cell Counting Kit-8 (CCK-8) (Dojindo, Japan) as previously described. Briefly, the cell density was adjusted to 1 × 104 cells/100 μl/well and inoculated in 96-well plates. Thereafter, CCK-8 reagents were added to each well and incubated for 3 h. Finally, optical density values were read using the SpectraMax M2 Microplate Reader (Molecular Devices, CA, USA) at 450 nm to ascertain cell proliferation capability.
Analyses of cell apoptosis and cell cycle
The analyses of the cell cycle distributions and the measurements of the percentage of apoptotic cells were performed by flow cytometry using Navios flow cytometer (Beckman Coulter, CA, USA). For cell cycle analysis, cells were washed with PBS, fixed with cold 70% alcohol at-20 °C overnight before stained with PI (BD Biosciences, MA, USA). The apoptosis detection was performed by using the Annexin V-PE/7AAD apoptosis detection kit and according to manufacturer’s instructions (BD Biosciences). The percentage of cells in the indicated cell cycle phase was calculated with ModFit LT software.
RNA-sequencing
RNA was exacted using the Trizol reagent (Invitrogen, MA, USA). RNA-seq experiments were performed by Novogene (Beijing, China). After reverse transcription and cDNA library enrichment, six RNA-sequencing (RNA-seq) libraries (three for shCTPS2 group and three for shControl group) were generated following the manufacturer’s recommendations. Purified library DNA was captured on an Illumina flowcell for cluster generation and sequenced on an Illumina HiSeq platform, and the fragments per kilobase of transcript per million fragments mapped (FPKM) of each gene were calculated. Differentially expressed genes were determined by the DESeq2 Bioconductor/R package (
https://doi.org/10.18129/B9.bioc.DESeq2). The visualization of Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were implemented using the R package ClusterProfiler (v3.0.0). Gene counts for heatmap generation were converted into z-scores and input into the ComplexHeatmap Bioconductor/R package [
22].
Immunofluorescence
Cells were fixed with 4% paraformaldehyde/PBS for 15 min and permeabilized with 0.5% Triton X-100 (in 1 × PBS) for 20 min at room temperature. Primary antibodies for staining CTPS2 (ab32087, Abcam), BRCA1 (Santa Cruz, TX, USA) and p-H2AX (ab81299, Abcam) were used at 1:200 for 1 h at room temperature. After three washes with PBS, the sections were incubated with the secondary antibody in PBS with 2% normal serum for 1 h at room temperature, followed by three washes in PBST. Subsequently, cells were stained with 4, 6-diamidino-2-phenylindole dihydrochloride (DAPI; a DNA-specific fluorescent dye) for 5–10 min. Stained cells were covered with coverslips and visualized using confocal microscope.
Comet assay
Alkaline single-cell gel electrophoresis assay was performed according to the protocol from Trevigen (4250–050-K). Briefly, cells were plated on CometSlides after dilution in low melting point agarose. Lysis solution overnight allowed for electrophoretic separation of DNA fragments and DAPI was used to stain the DNA fragments. At least 50 cells per treatment group were imaged and images were analyzed with Comet Assay IV Software Version 4.3 to calculate the tail moment.
Statistical analysis
The data were expressed as mean values ± standard error of mean (SEM) from at least three independent experiments. The significance of differences between groups was analyzed using Students t-tests and one-way analysis of variance (ANOVA). The overall survival (OS) time was calculated from the date of diagnosis to the date of death or the last follow-up date. The Kaplan–Meier method and log-rank tests were used for survival analysis. Cox proportional hazards regression models were used for univariate and multivariable analysis. All statistical analyses were performed with SPSS Statistics version 20.0 and GraphPad Prism version 7.0 statistical software. p < 0.05 was considered statistically significant.
Discussion
Our current study provided the first comprehensive analysis of CTPS2 in CLL pathogenesis. CTPS2 was significantly over-expressed in CLL patients, portending a worse overall survival and treatment-free survival. Furthermore, it was demonstrated a precise molecular mechanism that links CTPS2 to the DDR pathway in CLL. Our results indicated that CTPS2 could promote cell survival by reducing DNA damage and increasing DNA repair via interacting with BRCA1.
Prior studies have noted that the activity of CTPS is low in normal tissues but elevated in highly proliferating cells [
23]. The cancer cells that exhibited increased cell proliferation also showed increased activity of CTPS2. Weber and co-workers found an elevated CTP synthase activity in hepatoma [
15]. Subsequent studies demonstrated that unregulated CTP levels and increased CTP synthase activity are features of many forms of cancer such as leukemia, hepatoma, and breast cancer [
24,
25]. Hongwu Fan et al.identified CTPS2 as a critical gene associated with osteosarcoma prognosis [
16]. In this study, we unraveled regulatory functions of CTPS2 in CLL by bioinformatic analysis of RNA-sequencing expression profiles, identifying CTPS2 as a crucial prognostic biomarker in CLL patients. For the first time, our data revealed the aberrant expression of CTPS2 in CLL clinical specimens and cell lines. Elevated expression of CTPS2 was significantly correlated with poor overall survival and treatment-free survival of CLL patients, indicating that CTPS2 contributed to the progression of CLL. Down-regulation of CTPS2 retarded CLL cell proliferation mainly by G2/M cell phase arrest and propelling apoptosis in vitro. Notably, the Bax and Bcl-2 expression as verified by qPCR were not consistent with the RNA‐seq results. This inconsistency could be ascribed to a relatively low number of reads for Bax and Bcl-2. Previous studies had reported the ubiquitinated and phosphorylated regulation of CTPS in
Schizosaccharomyces pombe [
26,
27]. These findings suggested a potential involvement of CTPS2 in post-transcriptional modification, which warrants further investigation.
CTPS2 is a critical enzyme that controls the synthesis of cytosine nucleotides and serves a vital role in numerous metabolic processes [
28,
29]. CTPS2 has been reported to be involved in several solid tumors, such as osteosarcoma and colorectal cancer, but never in hematological malignancies [
16,
30]. The results presented here suggested that the robust activity of CTPS2 in CLL cells could utilize glutamine to support cytidine salvage metabolism and CTP synthesis for DNA replication needs. Following genotoxic damage, cells activate a kinase driven signaling network, referred to DNA damage response and repair [
31‐
33]. Numerous reports had shown that malignant tumors displayed signs of enhanced DNA damage and persistent DDR signaling, likely due to the oncogene-induced replication stress [
34,
35]. Ionizing radiation-induced DNA damage was found to accelerate the nucleotide synthesis, resulting in enhanced DNA repair [
39]. CTPS2 participated in ribonucleotide metabolic processes by promoting CTP production, suggesting an important role in the DNA replication and repair process. Since the closely clinical relation between the CTPS2 expression and 11q- (ATM gene locus), all of these prompted us to propose that CTPS2 could potentially function in DNA damage and repair. Notably, downregulation of CTPS2 resulted in elevated p-ATM and p-H2AX protein levels coinciding with reduced p-BRCA1 protein levels, which reflected abnormal activation of DDR signaling.
BRCA1 mediated homology-directed repair with other co-factors during DNA replication, thus to protect stressed DNA replication forks [
36]. Accumulating investigations have suggested that DDR pathway defects are associated with genomic instability and clonal evolution in CLL [
37]. It was reported that combined inactivation of CTPS1 and ATR is synthetic lethal to cancer cells, further highlighting the potential link between CTPS family and DDR signaling [
38]. Consistently with the hypothesis, we identified that silencing CTPS2 exhibited anti-leukemia effects and increased the activity of key kinases in the DDR pathway. Furthermore, we illustrated the interaction between CTPS2 and BRCA1 protein through Co-IP assay and immunofluorescence assays. Further experiments proved that BRCA1 could partially rescue the CTPS2 knockdown phenotype as the downstream of CTPS2. Our results provided evidence that the aberrant activation of DDR signaling induced by CTPS2 participated in the regulation of CLL initiation and progression. DDR inhibition showed excellent results in preclinical testing in acute and chronic leukemia [
23], which indicated the therapeutic potential of CTPS2 inhibition.
Patients with colorectal cancer accompanied by low CTPS2 expression did not receive a survival benefit from 5-fluorouracil treatment, whereas those with high expression did [
30]. Therefore, low CTPS2 expression may be a major determinant for drug resistance. However, the role of CTPS2 in the sensitivity of CLL targeted drugs, such as ibrutinib (Bruton’s tyrosine kinase inhibitor) and venetoclax (Bcl-2 inhibitor), remains unobvious in our work. Further investigation of drugs causing hereditary substance damage will provide more comprehensive conclusions.
Furthermore, the mutation status of IGHV reflected the stage of normal B cell differentiation from which they originate. IGHV mutational status was an important robust individual prognostic marker and related to whether the founder CLL cell clone is of pre- or post-germinal origin [
39,
40]. In chronic lymphocytic leukemia, patients with 11q (ATM gene locus) deletion generally displayed a more aggressive clinical course and inferior prognosis in a younger subgroup [
41]. However, the physiologic basis of 11q deletions and dysfunction of the ATM gene in the tumorigenesis of hematological malignancies remained unclear. Through the correlation analysis, we found that the overexpression of CTPS2 was associated with 11q deletion and the lack of IGHV mutation, which were indicators of inferior prognosis in CLL patients. And our observations demonstrated that CTPS2 could promote CLL cell survival through DDR pathway, suggesting an underlying molecular mechanism by which ATM functions as a tumor suppressor.
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