Malignant Lymphomas |
* HMDS, Academic Unit of Haematology and Oncology, Leeds General Infirmary, Leeds, LS1 3EX, United Kingdom
° University of Oxford, Nuffield Department of Clinical Laboratory Sciences, LRF Lymphoma Antigens Programme, John Radcliffe Hospital, Oxford, UK;
# Epidemiology and Genetics Unit, University of York, York, UK
Correspondence: Sharon L Barrans, HMDS, Academic Unit of Haematology and Oncology, Leeds General Infirmary, Leeds, LS1 3EX, United Kingdom. Phone: international + 44.11.33926285. Fax: international +44.11.33926286. E-mail: sharonb{at}hmds.org.uk
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FOXP1 protein is expressed in a significant number of predominately non-GC phenotype DLBCL, with strong uniform expression identifying a subgroup of patients with notably poor outcome1,2 and suggesting a role for FOXP1 in the pathogenesis of this sub-group of tumours. The mechanism by which FOXP1 expression is deregulated is presently unclear, but characterization of t(3;14)(p14;q32) involving the IgH and FOXP1 loci in DLBCL3,5,6,7 and marginal zone (MALT) lymphomas4,8 gives one possible mechanism, placing FOXP1 under the influence of the IgH enhancers.
We have examined FOXP1 protein expression in an extended series of 499 presentation DLBCL and have used FISH analysis to specifically investigate cases showing strong uniform expression of FOXP1 protein to determine whether FOXP1 deregulation occurs as a result of gene rearrangement. Presentation biopsies were lymph node (n=321, 64% of patients), extranodal (n=150, 30% of patients), or unknown (n=28, 6% of patients). FOXP1 expression was scored as negative; weak expression in a variable proportion of cells; or uniform, strong expression in all tumour cells, as previously described.1 This classification of FOXP1 expression was highly reproducible, with 100% concordance between observers. Uniform, strong FOXP1 expression was demonstrated in 121/499 (24%) cases and was significantly associated with a non-GC phenotype, BCL2 expression, and an adverse outcome that was independent of IPI, BCL2 and GC status as previously demonstrated,1 extended analysis (not shown).
FISH for FOXP1 gene rearrangement (Figure 1A) was investigated in 58 cases with uniform, strong FOXP1 protein expression. An index case of gastric DLBCL, previously characterised as a t(3;14)(p14;q32) using FIBRE-FISH and inverse PCR,3 provided a positive control for the FISH assay. No rearrangements were found in any case of DLBCL in conjunction with high expression of FOXP1 protein, with the exception of the control case that showed rearrangement of FOXP1 as demonstrated by a split FISH signal pattern (1F1R1G) (Figure 1B(ii)). Extra copies of the gene were frequently observed in 39/58 (67%) cases (Figure 2B and D). This is probably due to extra copies of chromosome 3, a common feature of DLBCL.4
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Figure 1. A. FOXP1 FISH Strategy. A dual color, break-apart assay was used. FISH was performed on either fresh lymph node touch preparations or thin paraffin sections using established methods. A dual color, Break-Apart FISH assay was devised using a mixture of a 5' FOXP1 Digoxigenin-labelled probe (detected using Anti-digoxigenein-Rhodamine) and a 3' FOXP1 Biotin-labelled probe (detected using Avidin-FITC) that flank the FOXP1 gene, including the reported breakpoint region (4,8). Reported breakpoints indicated by arrows. A normal result is defined by 2 red/green fusion signals, indicating an intact gene; and a rearrangement is defined by 1 fusion and a separate red and green signal, indicative of a break in the gene. B. Expected FISH patterns. i) Normal cell. The expected normal signal pattern is two fusion signals (2F); ii) FOXP1 gene rearrangement. FISH pattern of 1 fusion, and a separate red and green (breakapart pattern: 1F1R1G), demonstrating a rearrangement of the FOXP1 gene. Index case of gastric DLBCL with t(3;14).
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Figure 2. Representative FOXP1 interphase FISH images. A. FISH on a fresh touch preparation showing normal FISH pattern (2F). B. Touch preparation showing extra copies of FOXP1 (not rearranged) (4F). C. FISH on a thin paraffin section, showing a normal FISH pattern (2F). D. Thin paraffin section showing extra copies of FOXP1 (not rearranged) (3F).
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In summary, strong uniform expression of FOXP1 occurs in a subgroup of non-GC DLBCL. Although gene rearrangement is a potential mechanism that may cause deregulated expression of FOXP1, this does not appear to be the primary mechanism linked to expression of the protein in poor prognosis DLBCL.
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P. J. Brown, S. L. Ashe, E. Leich, C. Burek, S. Barrans, J. A. Fenton, A. S. Jack, K. Pulford, A. Rosenwald, and A. H. Banham Potentially oncogenic B-cell activation-induced smaller isoforms of FOXP1 are highly expressed in the activated B cell-like subtype of DLBCL Blood, March 1, 2008; 111(5): 2816 - 2824. [Abstract] [Full Text] [PDF] |
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