| Summary: | Acute myeloid leukemia (AML) with granulocytic sarcoma (GS) is characterized by poor prognosis; however, its underlying mechanism is unclear. Bone marrow samples from 64 AML patients (9 with GS and 55 without GS) together with AML cell lines PL21, THP1, HL60, Kasumi-1, and KG-1 were used to elucidate the pathology of AML with GS. RNA-Seq analyses were performed on samples from seven AML patients with or without GS. Gene set enrichment analyses revealed significantly upregulated candidates on the cell surface of the GS group. Expression of the adhesion integrin α7 (<i>ITGA7</i>) was significantly higher in the GS group, as seen by RT-qPCR (<i>p</i> = 0.00188) and immunohistochemistry of bone marrow formalin-fixed, paraffin-embedded (FFPE) specimens. Flow cytometry revealed enhanced proliferation of PL21 and THP1 cells containing surface <i>ITGA7</i> in the presence of laminin 211 and stimulated ERK phosphorylation; this effect was abrogated following <i>ITGA7</i> knockdown or ERK inhibition. Overall, high <i>ITGA7</i> expression was associated with poor patient survival (<i>p</i> = 0.0477). In summary, <i>ITGA7</i> is highly expressed in AML with GS, and its ligand (laminin 211) stimulates cell proliferation through ERK signaling. This is the first study demonstrating the role of integrin α7 and extracellular matrix interactions in AML cell proliferation and extramedullary disease development.
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