Abstract
BACKGROUND:
MicroRNA-195 acts as a tumor suppressor in a variety of cancers. However, its clinical significance in pediatric acute myeloid leukemia (AML) remains largely undefined.
OBJECTIVE:
To investigate the diagnostic and prognostic relevance of miR-195 in this malignancy.
METHODS:
Expression levels of miR-195 in peripheral blood and bone marrow samples of patients with pediatric AML and normal controls were detected by real-time quantitative PCR. Then, receiver-operating characteristic (ROC) curve analysis, Kaplan-Meier method, and Cox regression analysis were performed to evaluate the diagnostic and prognostic relevance of serum miR-195 in pediatric AML.
RESULTS:
Compared to normal controls, the expression levels of miR-195 in both bone marrow and patients’ sera were significantly decreased (both
CONCLUSION:
The findings of this study suggest that the aberrant expression of miR-195 may play crucial roles in the development and progression of pediatric AML patients. Serum miR-195 may serve as a promising marker for monitoring the occurrence of this disease and predicting the clinical outcome of patients.
Introduction
Acute myeloid leukemia (AML) represent a heterogeneous group of clonal diseases arise from hematopo- ietic tissues due to malignant transformation of a bone marrow-derived, self-renewing stem cell or myeloid progenitor [2, 3]. AML is characterized by abnormal proliferation of progenitor cells of myeloid lineage, leading to the insufficient generation of normal mature blood cells [4]. AML contributes to about 25% of pediatric leukemia cases and accounts for approximately 30% of cancer-related deaths in this age range [5]. With the recent development of therapeutic strategies for this disease, such as chemotherapy and hematopoietic stem cell transplantation, the prognosis in patients with pediatric AML has improved and the long-term survival rate approaches 70% at this time [6]. Infections, bleeding episodes, leukostasis, and tumor lysis syndrome have been indicated to be the main causes of death, and disease relapse has been considered as the main cause affecting the mortality rate of patients with this disease [7]. Therefore, it is of great significance to identify novel prognostic factors and efficient risk-based post-remission therapeutic strategies for patients with pediatric AML.
MicroRNAs (miRNAs) is a class of small (with length in 18–26 nucleotides), non-coding, endogenous RNAs which regulate gene expression by directly binding to specific seed sequences in the 3’ untranslated region (UTR) of the corresponding target mRNAs [8]. MiRNAs were originally identified in C. elegans in 1993 [9]. With high conservation in mammals, miRNAs function as crucial regulators of various biological processes such as cell differentiation, growth, development, proliferation, and apoptosis [10]. Growing evidences show the involvement of miRNAs in a variety of human cancers and indicate that several miRNAs are widely deregulated in carcinogenesis and cancer progression [11]. Especially, a number of miRNAs have been reported to be involved into pediatric AML by recent studies [12]. For example, our previous findings indicated that the upregulation of miR-375 was one of the molecular mechanisms involved in the development and progression of pediatric AML, and this miRNA might function as an independent prognostic factor [13]; we reported the upregulation of miR-100 was significantly associated with poor relapse-free and overall survivals of patients with pediatric AML [14]; Our previous data also indicated that the downregulation of miR-29a was associated with advanced clinical features and poor prognosis of pediatric AML patients [15].
MiR-195, together with miR-15a, miR-15b, miR-16-1 and miR-16-2, belongs to the miR-15/16/195 family, and is localized in chromosome 17p13.1 [16]. The sequence of mature miR-195 is conserved across mammalian species [17]. Accumulating studies have indicated the roles of miR-195 in tumorigenesis and cancer therapy. The abnormal expression of miR-195 has been found in multiple cancer tissues, including breast cancer, lung cancer, hepatocellular carcinoma, gastric cancer, colorectal cancer, bladder cancer and prostate cancer [18, 19, 20, 21, 22, 23, 24]. Functionally, miR-195 has been demonstrated to act as a tumor suppressor during various cancer processes, including cancer cell proliferation, migration, invasion, apoptosis. However, its clinical significance in pediatric AML remains largely undefined. To address this problem, this study detected the expression levels of miR-195 in peripheral blood and bone marrow samples of patients with pediatric AML and healthy controls by real-time quantitative PCR. Then, receiver-operating characteristic (ROC) curve analysis, Kaplan-Meier method, and Cox regression analysis were performed to evaluate the diagnostic and prognostic relevance of serum miR-195 in pediatric AML.
Materials and methods
Patients and tissue samples
In this study, we used the same patient corhot with our previous studies [13, 14]. Our study was approved by Huai’an First People’s Hospital Ethics Committee. Prior informed consent was obtained from the patients for the collection of specimens in accordance with the guidelines of Huai’an First People’s Hospital, China. All specimens were handled and made anonymous according to the ethical and legal standards. The clinical characteristics of 106 patients with AML was summarized in Table 1.
Association of serum miR-195 level with clinical characteristics of 106 pediatric acute myeloid leukemia patients
Association of serum miR-195 level with clinical characteristics of 106 pediatric acute myeloid leukemia patients
Expression levels of miR-195 in bone marrow mon- onuclear cells and sera of patients with AML were detected by real-time quantitative RT-PCR according to the protocols described in our previous studies [13, 14]. RNU6B were used as an internal reference gene. The primer sequences were as following: for miR-195: forward 5’-GAT AGC AGC ACA GAA ATA TTG GC-3’, reverse 5’-ACA CGG ATA GTG TTG CTT GTC-3’; for RNU6B: forward 5’-CGC TTC GGC AGC ACA TAT AC-3’, reverse 5’-TTC ACG AAT TTG CGT GTC AT-3’. Relative quantification of target miRNA expression was evaluated using the comparative cycle threshold (CT) method. The raw data were presented as the relative quantity of target miRNA, normalized with respect to RNU6B. Each sample was examined in triplicate.
Statistical analysis
The software of SPSS version 11.0 for Windows (SPSS Inc, IL, USA) was used for all statistical analyses in the current study. Data were shown as mean
Univariate analysis of the impact of variables on relapse-free survival and overall survival in pediatric AML patients
Univariate analysis of the impact of variables on relapse-free survival and overall survival in pediatric AML patients
Decreased expression of miR-195 in patients with pediatric AML. (A) Compared to healthy controls, the expression levels of miR-195 were significantly decreased in bone marrow of patients with pediatric AML (AML vs. normal: 2.14 
Decreased expression of miR-195 in patients with pediatric AML
Compared to healthy controls, the expression levels of miR-195 in both bone marrow and patients’ sera were significantly decreased (in bone marrow, AML vs. normal: 2.14
Diagnostic value of serum miR-195 level in patients with pediatric AML
Based on the expression levels of miR-195 in patients and healthy controls’ sera, ROC curve was drawn and AUC value was calculated to assess the diagnostic efficiency of serum miR-195 level in pediatric AML. As shown in Fig. 1D, the AUC value was 0.910 (
Multivariate analysis of the impact of variables on relapse-free survival and overall survival in pediatric AML patients
Multivariate analysis of the impact of variables on relapse-free survival and overall survival in pediatric AML patients
Kaplan-Meier curves of relapse-free survival (RFS, A) and overall survival (OS, B) of patients with pediatric AML stratified by the serum miR-195 levels. Patients with low serum miR-195 levels had both shorter RFS and OS than those with high serum miR-195 levels (both 
To evaluate the associations of serum miR-195 levels with various clinical characteristics of patients with pediatric AML, all 106 patients with pediatric AML were divided into miR-195-low (
Low serum miR-195 level associates with unfavorable clinical outcome of patients with pediatric AML
Kaplan-Meier curves in Fig. 2 indicated that pediatric AML patients with low miR-195 level had shorter RFS and OS than those with high miR-195 level (both
Discussion
MiRNAs are involved into the onset and development of multiple human cancer types. Since stable miRNAs have been found in biofluids, such as serum and plasma, the detection of cancer-related miRNAs is emerging as a non-invasive tool for cancer detection and monitoring. In the current study, we firstly identified the serum miR-195 level as a diagnostic marker of pediatric AML, and also demonstrated that the decreased expression of miR-195 was significantly associated with cancer progression and patients’ prognosis. These findings highlight the critical role of miR-195 in occurrence, progression and clinical outcome of patients with pediatric AML.
Growing evidence shows the roles of miR-195 in carcinogenesis, development, progression and cancer therapy. MiR-195 functions as a tumor suppressor via regulating the corresponding target genes involved into cancer cell proliferation, migration and invasion. For example, Díaz-Beyá et al. [25] reported that mir-195 targeted the RET proto-oncogene in AML with t (8; 16); Cai et al. [26] identified miR-195 as an independent prognostic factor for biochemical recurrence-free survival of patients with prostate cancer, and found that miR-195 inhibited cancer cell invasion and migration, and induced cancer cell apoptosis by targeting RPS6KB1; Du et al. [27] indicated that miR-195 could suppress the proliferation, migration and invasion of cervical cancer cells via the inhibition of CCND2 and MYB expression; Liu et al. [21] reported that miR-195 expression was lower in lung cancer tissues and was associated with poor survival outcome, and discovered that the overexpression of miR-195 suppressed tumor cell growth, migration and invasion; Wang et al. [28] revealed that low expression of miR-195 in hepatocellular carcinoma was associated with tumor size, portal vein thrombosis, TNM stage and patients’ survival; Zhao et al. [29] showed that miR-195 could inhibit cell proliferation in bladder cancer via inhibition of cell division control protein 42 homolog/signal transducer and activator of transcription-3 signaling; Wang et al. [23] reported that miR-195 might function as a key negative regulator of thyroid cancer progression by targeting Rafl. In line with these previous studies, the decreased expression of miR-195 in both bone marrow and patients’ sera of pediatric AML were found based on our data. We also found the diagnostic efficacy of serum miR-195 level for pediatric AML patients was satisfactory according to AUC curve, implying serum miR-195 level may be a sensitive tumor biomarker for diagnosing or monitoring this malignancy. Moreover, our statistical analysis verified that pediatric AML patients with French-American-British classification subtype M7 and unfavorable karyotypes had lower miR-195 levels in serum, which is consistent with existing evidences based on other cancers. More interestingly, miR-195 showed significant association with patients’ prognosis in survival curve, univariate and multivariate analyses. Reduced miR-195 level in serum was related to poor RFS and OS of pediatric AML patients.
In conclusion, our data suggest that the aberrant expression of miR-195 may play crucial roles in the development and progression of pediatric AML patients. Serum miR-195 may serve as a promising marker for monitoring the occurrence of this disease and predicting the clinical outcome of patients. However, there are two limitations in this study. At first, the intermediate cytogenetic risk group in our cohort is small in this moderate-sized pediatric sample. Secondly, the exact molecular mechanisms on the involvement of miR-195 dysregulation in pediatric AMLs need further more comprehensive investigations.
Footnotes
Conflict of interest
None.
