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APOPTOSIS AND CELL SURVIVAL IN THE IMMUNE SYSTEM

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a significant role in the homeostasis of the immune system, because concomitant loss of both Bim and Puma caused a hyperplasia of the lymphoid organ greater than that caused by loss of Bim alone.44 Combined loss of Bim and Puma also promoted spontaneous lymphomagenesis, confirming the tumor suppressor potential of these two proteins.44

3. IMPAIRED APOPTOSIS AND LEUKEMOGENESIS

Apoptosis serves as a barrier against oncogenic transformation. Resistance to apoptosis allows preneoplastic cells to acquire additional mutations and to grow in conditions that should normally signal their death, such as hypoxia.155 Deregulation of apoptosis-related genes has been found in many types of human tumors.156 Bcl-2 was initially identified because of its involvement in oncogenic chromosomal translocation in human follicular lymphoma.157 On its own, Bcl-2 proved to be a rather weak oncogene, but it was shown to dramatically accelerate Myc-induced lymphomagenesis.158 Myc over-expression has been shown to signal proliferation as well as apoptosis, and Bcl-2 is thought to cooperate with Myc by antagonizing its proapoptotic effect.159 Although Myc and Bcl-2 synergize in tumor development, particularly lymphomagenesis, the initiation, development, continued growth, and severity of Eμ-Myc lymphoma do not depend on endogenous Bcl- 2.160 Mice expressing an Mcl-1 transgene in hematolymphoid tissues were found to develop lymphoma with long latency and at high probability (>85% over 2 years). In most cases, the disease was widely disseminated and of clonal B-cell origin. A variety of histologic subtypes were seen, predominantly follicular lymphoma and diffuse large-cell lymphoma.161 Recently, Mcl-1 overexpression has also been shown to dramatically accelerate Myc-driven lymphomagenesis.162 Futher investigations will be required to evaluate the role of endogenous Mcl-1 in this model. A1 has been reported to be required for leukemogenesis mediated by BCR/ABL,163 and Bcl-xL has been implicated in mouse myeloid and T-cell leukemia.164 Because antiapoptotic proteins of the Bcl- 2 family displayed oncogenic potential, it was no surprise when Bim and Puma were found to be tumor suppressors.165,166 Similar to Bcl-2 over-expression, loss of Bim accelerated Myc-driven lymphomagenesis.165 Significantly, mutations inactivating the Bim gene were also described in human mantle cell lymphomas and many Burkitt’s lymphomas.167,168 Silencing of Bim in these tumors was achieved by gene deletion or promoter methylation.168 Downregulation of Puma with shRNAs promoted oncogenic transformation of primary murine

embryonic fibroblasts by the E1A/Ras combination and accelerated Myc-induced lymphomagenesis.166

Recent findings have indicated that Bim is regulated by the miR-17–92 microRNA cluster that is amplified in some human lymphomas.169,170

From a therapeutic point of view, it is rather convenient that deregulation of the apoptotic machinery tends to an increase of the ratio of prosurvival molecules/ proapoptotic BH3-only molecules rather than a destruction of the machine itself (which could be achieved by the loss of Bax and Bak, for example). Many of the commonly used cytotoxic agents work by reversing the skewed ratio in favor of proapoptotic molecules (reviewed in reference 171). For example, the kinase inhibitor imatinib used to counteract the effects of the Bcr/Abl oncogenic protein in chronic myelogenous leukemia kills cells through Bim and Bad,172,173 whereas glucocorticoids used for the treatment of acute lymphocytic leukemia rely on Bim and Puma to kill cells.27,28,171 Because BH3-only proteins antagonize their prosurvival relatives by binding to them through their BH3 α-helical domain, the development of small molecules mimicking the BH3 domain has generated a lot of enthusiasm and hope in the last few years. Several such molecules have been described and are presently tested in the clinic (for review, see Zhang drug resistance updates).174 Of particular interest, a small molecule developed by Abbott Laboratories using a structurebased approach, ABT-737, has been shown to have a very high affinity (nanomolar range) for Bcl-2, Bcl-xL, and Bcl-w.175 ABT-737 proved very efficient at killing cells with low Mcl-1 content, whereas cells with high Mcl-1 content were resistant to the drug. Inhibiting Mcl-1 by over-expression of Noxa in these cells rendered them sensitive to ABT-737, showing that a BH3-mimetic with a limited binding spectrum might be used in combination with conventional drugs to kill cancer cells.176 Understanding the subtleties in the relationships between Bcl-2 family members in the control of life and death in the immune system will be useful to design therapeutic regimes suited to each tumor type.

4. CONCLUSIONS

To become an active part of the immune system, hematopoietic stem cells have to undergo an educational program that will leave most of them dead before reaching their goal. This is the price to pay for the organism to avoid renegade cells taking over the system, leading to its ruin. The Bcl-2 regulated and death receptor pathways are in charge of the elimination of the cells that do not meet the stringent criteria of the system.

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Although a lot has been learned about the different signaling mechanisms that decide cell fate at the different checkpoints, some pieces of the puzzle are still missing. How, for example, does a membrane receptor signal death or survival depending on the strength of its interaction for its ligand? There is still much to learn about the mechanisms that control life and death in the immune system, but the work that has been accomplished since the discovery of Bcl-2 has provided valuable insight into the workings of the life/death switches, and strategies based on this knowledge are beginning to emerge.

There is much hope that a better understanding of the mechanisms that orchestrate survival and cell death of immune cells will lead to the development of novel pharmaceutical strategies to prevent inflammation, autoimmune diseases, and cancer.

ACKNOWLEDGMENTS

This work was supported by the NH&MRC (Program Grant, Career Development Award and Project Grant), the Charles and Sylvia Viertel Charitable Foundation and the Australian Research Council. We apologize to the authors who made important contributions to the field but have not been cited as a result of space limitations.

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