| Objective: Survivin is a member of the inhibitor of apoptosis protein(IAP) family and considered to play a pivotal role in many solid tumors, in which the expression of Survivin correlates with the apoptosis, proliferation, angiogenesis and always regarded as a poor prognostic index. Just as in solid tumors, in many hematologic malignances, including acute myeloid leukaemia chronic myeloid leukinia lymphoma acute lymphoid leukaemia etc, the expression of Survivin are also up-regulated. Disturbed apoptosis is one of the pathogenesis of MDS and it has been repeatedly reported that the expression of the anti-apoptotic protein of Bcl-2 family in the high risk group (RAEB, RAEB-T and CMML) are significantly higer than those in the low risk group (RA and RAS) and vice versa. In addition, the ratio of pro-apoptotic protein and anti-apoptotic protein is decreased with the progression of MDS. But as to the role Survivin played in MDS, there are few reports and the results are controversial. Bcl-2 and Survivin, which are both anti-apoptotic proteins and have higher expression in many cancer cells, have been reported have some relationship in colorectal cancer, gastric cancer, non-hodgkin lymphoma, breast cancer and neuroblastoma. In addition, some researches indicated that apoptosis maybe related to angiogenesis, which is another mechanism of MDS. In order to determin the potentialrole of Survivin played in the occurrence and progression of MDS and explore the relationship between deregulated apoptosis and angiogenesis in MDS, the expression of Survivin, Bcl-2 and VEGF will be studied in the BM cells of untreated patients with MDS by immunochemical staining and analysed their relationship will be analyzed.Materials and method: (1) Subjects were divided into four groups: (1) The low-risk group of MDS (n=17, Male 6 , Female 11, Mean age 39.8Y) including refractory anemia (RA) 16 cases and refractory anemia with ringed sideroblasts (RARS) 1 cases. (2) The high-risk group of MDS (n=14, Male 8, Female 6, Mean age 40.7Y) including refractory anemia with excess blasts (RAEB) 9 cases, refractory anemia with excess blasts in transformation (RAEB-t) 4 cases, chronic myelomonocytic leukemia (CMML) 1 case. (3) The untreated acute leukemia (AL) group (n=15, Male 10 , Female 5, Mean age 36.8Y) including ALL 4 cases and AML 11 cases. According to the diagnostic standard worked out by Suzhou meeting in 1987, AML were further subdivided into M2 6 cases, M3 2 cases, M4 3 cases. (4) The control group (n=10, Male 4 , Female 6, Mean age 32.7Y). (2) Collecting the mononuclear cells of bone marrow of all subjects, test the positive rate of Survivin Bcl-2 and VEGF by in immunocytochemical staining. (3) The results were analyzed with ANOVA analysis by SPSS 10.0, and we established the standard of statistic significance as a=0.05.Results:(1) The expression of Surviving Bcl-2 and VEGF protein in the bone marrow mononuclear cells from all cases: the expression of all the three proteins in the low-risk group of MDS % high-risk group of MDS and untreated acute leukemia cases increased gradually and ANOVA analysis identified a significant difference in every two groups. The expression of Survivin and VEGF in low [(54.88 + 14.79) %, 109.41 +32.32 and (36.21 +8.88) %, 86.65 +30.78 respectively] and high-risk groups of MDS [(69.39+ 18.19) %, 162.86+47.38 and (50.89+ 15.34) %, 140.71 +28.21 respectively]and untreated acute leukemia group [ (80.97 + 12.13) %, 207.67 +30.15and (62.90+ 13.94)%, 150.07+34.72 respectively]were significantly higer (p<0.05) than those in control group[ (27.00+11.49) %, 60.70 + 25.11 and (16.05 + 9.60) %, 50.50 + 28.06 respectively]. So were the expression of Bcl-2 in the high-risk group of MDS[(50.89+15.34) %, 140.71 +28.21; (72.10+15.38) %] and untreated acute leukemia group [(72.10+15.38)%, 226.53 + 34.99]but there was no significant difference (p>0.05) of Bcl-2 expression in the low-risk MDS group[ (26.82 +11.12) %, 49.12+17.87] and control group[ (17.65+ 10.81) %, 42.00+15.49].(2)The correlation of the Survivin...
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