Doǧan, Ahmet

Abstract The amyloidoses are heterogeneous diseases associated with the deposition of insoluble proteins or peptides with a characteristic beta-diffraction pattern extracellularly. At the current time, over 27 different extracellular fibril proteins are known to cause disease in humans. Iatrogenic amyloidosis is a rare, often not sought diagnosis. On occasion, patients with drug induced amyloidosis can present with other systemic features reminiscent of systemic immunoglobulin-derived (AL) amyloidosis, and may present a diagnostic challenge. Treatment of the latter often involves chemotherapy and/or stem cell transplantation, while the former tends to remain localized and needs local therapy; thus accurate diagnosis is critical. To this end, proteomic analysis of amyloid tissue has proven to be an invaluable tool in amyloid typing. We have analyzed the biochemical composition of iatrogenic amyloid using laser capture/tandem mass spectrometry (LC-MS/MS)-based proteomic analysis in 52 cases of insulin and enfuvirtide (Fuzeon¨) associated amyloidosis. In brief, 10-μm-thick sections of formalin-fixed paraffin-embedded tissues were stained with Congo red. Congo red positively staining tissue as viewed with a fluorescent light source appeared bright red. Positive areas were dissected using laser microdissection to a volume of at least 60,000 μm2; three microdissections were analyzed for each case. The microdissected material was collected into 0.5-ml microcentrifuge tube caps containing 35 μL Tris/EDTA/0.002% Zwittergent buffer. Microdissected fragments were subjected to a heat-mediated antigen retrieval method (98C for 90minutes) before being denatured via sonication and subsequently digested into tryptic peptides overnight using 0.5ug of trypsin. The resulting digests were then analyzed with nanoflow LC-MS/MS. The MS/MS spectra of each case were matched against a composite protein sequence database using three different search algorithms (Sequest, X!Tandem, and Mascot). The composite database contained the human SwissProt entries but was also augmented with known immunoglobulin variant domains, known amyloidogenic mutations from literature, the enfuvirtide amino acid sequence, and common contaminants. Reversed protein sequences were appended to the database for estimating the false discovery rates of the identifications. The peptide identification results were filtered using Scaffold software (Proteome Software, Portland, OR) and then filtered peptides were assembled into protein identifications. Candidate proteins with at least one high-confident (probability of identification >90%) unique peptide identification and at least four MS/MS spectral matches were considered for clinical interpretation. For each case, we created a personalized proteomic profile that lists all the confident protein identifications in each of the microdissection along with their respective MS/MS spectral counts. The number of MS/MS spectra matching to a protein is considered as a semi-quantitative measure of its abundance. The most abundant amyloidogenic protein detected across all microdissections and as interpreted in the context of the clinical history is considered to be the amyloid subtype. Figure 1 shows the results of insulin amyloidosis. Figure 2 shows the results of enfuvirtide amyloidosis. Amyloid deposits are shown to be composed of the recombinant drug in addition to amyloid precursor proteins such as apolipoprotein A-I, A-IV, E and serum amyloid P (SAP).Figure 1. Insulin-associated amyloidosisFigure 1. Insulin-associated amyloidosisFigure 2Enfuvirtide (Fuzeon¨)-associated amyloidosisFigure 2. Enfuvirtide (Fuzeon¨)-associated amyloidosis In conclusion, we show the biochemical composition of all known drug-induced iatrogenic amyloidosis and provide the utility of proteomic analysis in elucidating amyloid subtyping for accurate diagnosis and management. Legend: A spectral count number of greater than 4 is significant. The green boxes denote protein identification at a probability of over 95%, and yellow 80-94%. In figure 1, insulin (# 2) and in figure 2, enfuvirtide (#5) are shown in abundance, additionally other amyloid precursors such as apolipoproteins A-IV, E, A-I and SAP are also seen. Disclosures: No relevant conflicts of interest to declare.

Abstract To further understand the molecular biology of mucosa-associated lymphoid tissue (MALT) lymphoma, we conducted a comprehensive gene expression study on the Affymetrix platform using total RNA extracted from biopsy specimen of 35 well-characterized pulmonary MALT lymphoma samples and compared them to gene expression profiles of a range of B and T cell lymphoma, such as Burkitt’s lymphoma, diffuse large B-cell lymphoma, Waldenstrom macroglobulinemia, chronic lymphocytic leukemia, multiple myeloma, and peripheral T-cell lymphoma, and normal cellular counterparts, such as different B-cell and T-cell populations, normal plasma cells and lung tussue. Analytical strategies were adopted to negate tissue specific effect such that our results can be generalized to MALT lymphoma from other anatomical sites. We further analyzed the data using functional tools such as gene-set enrichment analysis and gene ontology. Network/pathway analysis was performed using Metacore. Unsupervised clustering of whole dataset (including other lymphoid malignancies and normal cellular counterpart) using genes with variable expression, showed that compared to other B-cell lymphoid malignancies, MALT lymphoma have a prominent T-cell signature. Using established gene expression of different B-cell compartment, we confirmed that MALT has a marginal zone B-cell and memory B-cell cell-of-origin signature. Using ANOVA with post-hoc pair-wise comparison, we identified 4 novel transcripts over-expressed in MALT but not other B-cell tumors, and validated one of these using immunohistochemistry. MALT lymphoma with t(11;18) or t(14;18) over-expressed genes enriched for pathways other than the NFKB pathway such as JAK-STAT and SRC signaling pathways, which may represent novel therapeutic targets. We identified a number of genes with ‘outlier’ expression including RARA and RGS13. However, translocation involving RARA and the immunoglobulin heavy chain locus was not detected by FISH, suggesting other mechanisms of deregulating gene expression were involved. Using unsupervised clustering of only the MALT samples, we found that the molecular heterogeneity within MALT is composed of a group characterized by MALT1 translocations and another group with plasmacytic differentiation. Interestingly, further refinement of this grouping can be achieved by clustering the samples based on ‘outlier’ gene expression. Samples with MALT1 translocations have high expression of RARA, samples with plasmacytic differentiation have high FKBP11 expression and samples with high RGS13 expression tend to have trisomy 3 and reactive follicles. Our study therefore identified novel molecular markers, deregulated pathways and genetic defects in MALT. Furthermore, subgroups with distinct pathological features and anchored by unique pattern of ‘outlier’ gene expression were identified.

Abstract Background Immunoglobulin light chain-associated amyloidosis (AL) is caused by deposition of immunoglobulin light chain molecules with unique, clonotypic variable (V) regions. Detection and identification of the V region, however, has been challenging due heterogeneity inherent in V regions. We developed a new method for detecting IGKV and IGLV region fragments in AL deposits using protein mass spectrometry and novel bioinformatics approach. We report distinct IGKV and IGLV usage in localized versus systemic AL. Methods Shotgun protein mass spectrometry on amyloid plaques was performed as previously described (Blood. 2009; 114: 4957-9). Peptide tandem mass spectra (MS/MS) were searched against a composite sequence database containing SwissProt's human complete proteome augmented with 1764 IG V region sequences obtained from ImMunoGeneTics database and a Mayo Clinic internal database. Reversed sequences were appended to the database for estimating identification false discovery rates (FDRs). Peptide identifications were processed with Scaffold software. Confident protein identifications (probability > 0.9) with at least one unique peptide identifications and five MS/MS matches were considered. Detected variable gene family (if any) with most number of peptide and spectral matches is considered to be present in the deposit. The method was first validated in 8 cases of AL amyloidosis with known IGKV and IGLV region sequences and then applied on 1238 systemic and 393 localized AL cases. Differences between groups were measured by generating hypergeometric p-values. Results In all 8 AL cases with known IGKV and IGLV region usage, gene family identified in the AL deposit via proteomics matched the gene family inferred from bone marrow plasma cells by Sanger sequencing of IGLC genes. Armed with this method, we analyzed the amyloid proteomics data from 1238 patients with systemic AL amyloidosis and 393 patients with localized AL amyloidosis. The anatomical site distribution in systemic cohort was 296 GI tract, 364 heart, 225 kidney, 81 liver and 272 fat aspirate; Localized cohort has 78 bladder, 158 lung and 157 skin cases. Figure 1 shows the normalized frequency of the variable gene families detected between the systemic and localized AL amyloidosis. For AL-kappa, KV1 was more prevalent in systemic cases when compared to localized cases (p=7.2E-12) suggesting KV1 clones as a hallmark for systemic AL-kappa amyloidosis. KV3 was more frequently seen in localized AL-kappa cases when compared to systemic AL-kappa cases (p =2.8E-11). For AL-lambda, LV1 and LV2 gene families were more prevalent in localized cases when compared to systemic cases (p= 0.039 and 2.7E-05). LV6 was more prevalent in systemic AL-lambda cases (p=1.4E-07). We also detected a higher incidence of mixed AL/AH type in localized AL (18%) when compared to systemic AL (5%; Odds Ratio=4.2673, p<0.0001). We next turned to the organ specific IGKV and IGLV gene family usage patterns in patients with localized amyloidosis. For 147 localized AL-kappa cases, KV3 was most dominant in lung (64%) and KV1 was dominant in skin (38%). For 246 localized AL-lambda cases, LV2 was most prevalent in lung (34%) and LV3 was most prevalent in skin (36%). For bladder, both LV1 and LV2 had comparable prevalence (42% and 32%). For 361 systemic AL-kappa cases, KV1 consistently ranked at the top of gene families used in GI tract (55%), heart (71%), kidney (59%), liver (75%) and fat aspirate (50%). For 877 systemic AL-lambda cases, LV2 was predominant in GI tract (30%), LV3 in heart (35%) and LV6 in kidney (33%). The prevalence of LV1, LV2 and LV3 in liver is comparable (36%, 22% and 31%). LV6 and LV3 had comparable prevalence (22% and 24%) in AL-lambda fat aspirates. Conclusion The novel proteomics method detects IGLC V family usage in large cohorts of AL patients. It identifies unique profiles in systemic and localized cases, and in different organ sites. This information will be helpful in determining systemic versus localized nature of AL amyloidosis at diagnosis and to assess risk of specific end organ involvement. We found also a strong association between IGKV and IGLV gene usage and organ involvement. Disclosures: No relevant conflicts of interest to declare.

Abstract Amyloidosis is a group of hereditary and acquired disorders of diverse pathogenesis united by end organ damage due to tissue deposition of misfolded proteins. The diagnosis is typically based on demonstrating Congo red positive amyloid deposits in tissue biopsies of clinically involved sites. Because treatment options for amyloidosis patients are highly varied and intricately tied to the identity of the protein that constitutes the amyloid deposits, adequate diagnostic evaluation now requires identification of the amyloidogenic protein. Traditionally, immunohistochemistry with antibodies to amyloid-associated proteins was the clinical technique of choice for subtyping amyloid deposits in tissue sections. This technique suffers from poor analytical sensitivity and specificity and is a suboptimal technique on which to base treatment decisions for amyloidosis patients. We developed a highly accurate and reproducible liquid chromatography electrospray tandem mass spectrometery (LC-MS/MS)-based shotgun proteomics assay for subtyping amyloid deposits (Blood. 2009; 114: 4957-9) from microdissected paraffin embedded tissue samples. Implementation of this assay in a CAP/CLIA clinical laboratory has subsequently transformed the standard of amyloidosis care at Mayo Clinic. Since 2008, we utilized the assay in routine practice to identify 20 different amyloid types in tissue samples from diverse anatomic sites from 4139 patients (Table 1). Although AL and ATTR were most common, the cases include a large variety of unusual, and in many cases clinically unsuspected amyloid types. In addition, the amyloid protein subtypes had different frequencies in different anatomic sites (A partial list of tissue sites and their amyloid types analyzed in this study includes: bone marrow: AL 82%, ATTR 15%, AA 2%, other 1%; kidney: AL 51%, ALect2 18%, AA 17%, AH 5%, AFib 4%, other 5%; liver: AL 64%, ALect2 23%, AApoA1 6%, AA 3%, ATTR 2%, other 2%; heart: ATTR 60%, AL 37%, AANF1%, other 2%; GI tract: AL 78%, ATTR 13%, AA 6% AApoA4 1%, other 2%; eye [primarily adnexae] AL 63%; eye [primarily cornea] TGFB induced protein ig-h3 34%, other 3%). One caveat is that these distributions of amyloid types may not accurately reflect population prevalence. More likely, the findings reflected a composite prevalence that included challenging amyloidosis cases.Table 1Frequency of amyloid subtypes observed in the Mayo Amyloid Cohort (n=4139). Asterisk denotes non-canonical subtypesAmyloid SubtypeNumber (%) of casesAL2553 (61.68)ATTR1015 (24.52)AA151 (3.65)ALect2148 (3.58)AIns48 (1.09)Keratin*36 (0.87)AApoA130 (0.72)AH27 (0.65)AFib26 (0.63)TGFB1-IP*22 (0.53)AApoA420 (0.48)AANF14 (0.34)Ab2M12 (0.29)AGel12 (0.29)ASem112 (0.29)APro7 (0.17)ALys3 (0.07)ACal2 (0.05)Enfuvirtide*2 (0.05)AIAPP2 (0.05) The prevalence of diverse and unexpected amyloid types in many tissues suggest that shotgun proteomic-based analysis may be the only way to accurately assign amyloid subtype in tissue samples. The technique avoids the analytical problems of immunohistochemistry and the bias introduced by assigning probable amyloid type based on clinical presentation and disease distribution. It provides the clinician with an amyloid subtype that allows for confident individualized patient management. Accurate amyloid subtyping by LC-MS/MS is not only possible, but has proven to be a robust routine clinical tool for the evaluation of numerous amyloidosis patients in our practice. Disclosures: No relevant conflicts of interest to declare.

Abstract Abstract 3927 Poster Board III-863 In previous studies we characterized the t(X;14)(p11.4;q32) translocation in a patient with MALT lymphoma and found that GPR34, an orphan G-protein coupled receptor (GPCR), was highly expressed due to its juxtaposition to the IGHSA2 switch region. As part of a larger MALT gene expression-profiling project, we have now acquired gene expression analysis on the patient carrying the t(X;14)(p11;q32) translocation and have confirmed overexpression of GPR34. We then measured GPR34 mRNA expression in a panel of MALT lymphomas (n=17) and found that GPR34 was expressed at levels higher than that seen in normal B cells (mean, 11.3 fold; median, 5.5; range, 1.4-64 fold). When analyzed separately, 70% (12/17) had an expression level greater than 3-fold over normal B cells. Of note, in a gastric MALT lymphoma specimen, we found a 64 fold increase in GPR34 mRNA expression. FISH studies performed on this specimen showed an extra intact GPR34 signal but no translocation involving IGH or GPR34, suggesting that other mechanisms, including gene dosage effect, can upregulate GPR34. Elevated expression of GPR34 mRNA was also detected in other histologic types of NHL, but not to the extent seen in MALT lymphoma. Taken together, these data suggest that GPR34 is commonly overexpressed in MALT lymphoma and that deregulation of GPR34 expression can occur independent of a t(X;14)(p11.4;q32) translocation. The receptor encoded by GPR34 is most similar to the PY2 receptor subfamily of GPCR and GPR34 mRNA transcripts are abundant in mast cells while lower levels were detected in other immune cells including B cells. Signals from GPR34 have been briefly described and the results to date suggest that overexpression of GPR34 results in an accumulation of inositol phosphates. To further characterize the impact of GPR34 overexpression on cell signaling, HeLa cells were transduced with a retroviral expression plasmid (pBMN-GFP) that expresses GPR34 and GFP. GFP expressing cells were isolated and overexpression of GPR34 mRNA was confirmed by PCR and GPR34 protein expression was detected by flow cytometry. When normalized to the isotype control, pBMN-GPR34 cells expressed 17-fold more GPR34 on their cell surface compared to the pBMN-vector control cells. To determine which signaling pathways were affected by GPR34 overexpression, pBMN-GPR34 or pBMN-vector control cells were transfected with an AP-1, CRE, NF-κB, E2F, SRE, NFAT, or ISRE- luciferase reporter plasmid. Upon normalization with renilla, pBMN-GPR34 expressing cells had increased luciferase activity (n=3) driven by AP-1 (5.35-fold), CRE (4.7), NF-κB (2.8-fold), and E2F (2.13) when compared to pBMN-vector control cells. ISRE, NFAT, and SRE mediated luciferase expression was similar in the GPR34 and control cells. AP-1 and CRE have been implicated in a large variety of cellular processes, including transformation, and both AP-1 and CRE activity is induced upon activation of MAP kinases. To determine if MAPK activity was also upregulated in GPR34 expressing cells, we analyzed the phosphorylation status of Erk1/2 in pBMN-GPR34 cells by western blot and found that Erk1/2 was constitutively phosphorylated in GRP34 expressing cells (1.8 fold increase) compared to vector control cells. Increased phosphorylation of PKC-α/β was also detected in pBMN-GPR34 cells (3.5 fold increase compared to control cells). To determine the biologic impact of GRP34 overexpression on cell growth, the proliferation rates of pBMN-control and pBMN-GPR34 cells were compared and it was found that proliferation of GPR34 expressing cells was 2.2 times higher than that seen in control cells. Because the MAPK kinase pathway was found to be active in the pBMN-GPR34 cells, we tested the effect of the MEK inhibitor PD98059 on proliferation and saw a dose dependent decrease in proliferation of GPR34 expressing cells. These results suggest that GPR34-mediated proliferation is Erk-dependent. In summary, these data suggest that deregulation of GPR34 is commonly found in MALT lymphoma and that overexpression of GPR34 results in activation of Erk1/2, phosphorylation of PKC, and results is AP-1 and CRE mediated transcription. Additionally, our data suggest that overexpression of GPR34 results in increased cell growth that is MAPK-dependent. Taken together, this studies indicate that overexpression of a GPCR, GPR34, may be a novel mechanism by which MALT, lymphoma, and potentially other subtypes of NHL, develop. Disclosures: No relevant conflicts of interest to declare.

Abstract Abstract 4908 Insulin resistance can be a major problem in patients with diabetes mellitus. Although multiple reasons can result in this problem, one of the rare causes is localized insulin induced cutaneous amyloidosis. Lack of recognition of this may result in fatal hypoglycemia if a higher dose of insulin is given at a different site. A 43-year-old female diagnosed with diabetes mellitus in 1986 after acute pancreatitis secondary to hypertriglyceridemia presented to our hospital in December of 2008 with a 2 year history of low grade fever of 99-100F. This was associated with chills and fatigue. Over the same time period she had noticed anterior abdominal wall nodularity, particularly at sites where she has been injecting her insulin. Her insulin requirement had also increased from a total of 60 units of NPH in a day to 170 units per day. Because of the subcutaneous nodularity at the site of injection a decision was made to switch the site of the insulin which resulted in lower blood glucose level and subsequently significant decrease in her insulin requirement to 120 units a day. This suggested poor absorption from the infiltrated site. At our clinic laboratory data showed normal white count of 5.4 × 10(9)/L with normal differential, normal hemoglobin of 12.9 g/dL with an ESR of 11 mm/hour, creatinine of 0.8 mg/dL and C-reactive protein of less than 3. As part of the work up for fever of unknown origin a CT-scan of the abdomen was obtained which showed infiltrative lesion in the anterior abdominal subcutaneous tissue with few calcifications Fig 1 & 2. Biopsy of the anterior abdominal wall nodular infiltrate was performed. Tissue cultures came out negative for infection. The biopsy showed eosinophilic material positive with Congo red staining and showing apple green birefringence when viewed under polarized light. Immunohistochemical staining showed this to be negative for AA, AL, or TTR amyloidosis. Liquid chromatography tandem mass spectrometry (LC MS/MS) detected peptides representing apolipoprotein E, apolipoprotein A-IV, SAP and Insulin. The amyloid deposits stained positive with anti-insulin. The presence of peptides from insulin and immunohistochemical reactivity with an anti-insulin antibody indicated that the amyloid deposits were caused by insulin injection at this site. Work up for systemic amyloidosis including serum protein electrophoresis with immunofixation was negative for a monoclonal protein. Quantitative immunoglobulins were within normal range. Her 24-hour urine protein was 65 mg within normal range. Her serum free light chains were unremarkable. Echocardiogram did not show any evidence of infiltrative cardiomyopathy. This was therefore consistent with localized insulin induced cutaneous amyloidosis. The recommendation was to change the insulin type and to rotate the insulin injection site. Because of occasional hemorrhage and pain the long term plan will be to surgically remove the amyloid deposits. Insulin mediated iatrogenic localized amyloidosis has been described previously in the literature at the sites of insulin injection in patients with diabetes. This is a rare complication of insulin therapy and must be considered in the differential diagnosis of patients with insulin resistance to prevent fatal hypoglycemia. Fig 1. Amyloid infiltration in subcutaneous tissue of upper abdomen at insulin injection site Fig 1. Amyloid infiltration in subcutaneous tissue of upper abdomen at insulin injection site Fig 2. Amyloid infiltration in subcutaneous tissue of lower abdomen at insulin injection site Fig 2. Amyloid infiltration in subcutaneous tissue of lower abdomen at insulin injection site Disclosures No relevant conflicts of interest to declare.

Abstract Abstract 3933 Poster Board III-869 Background Non-Hodgkin Lymphoma (NHL) is a malignancy of lymphocytes with few known risk factors identified to date. Members of the BCL2 and caspase gene families are known regulators of programmed cell death in these cells, and the t(14;18)(q32;q21) is the most commonly observed chromosomal translocation in NHL, a somatic event which results in constitutive BCL2 expression and inhibition of apoptosis. Further, recent pooled analyses of three case-control studies reported gene level associations for both BCL2L11 (Cancer Epidemiol Biomarkers Prev 2009;18:1259) and CASP9 (Blood 2009;114:264) with NHL risk. We therefore evaluated the hypothesis that germline variation in genes from the apoptosis pathway is associated with risk of developing NHL. Methods We genotyped 226 single nucleotide polymorphisms (SNPs) within 36 candidate BCL2-family and capsase-family member genes within the apoptosis pathway in a clinic-based study of 441 newly diagnosed NHL cases (within 9 months of first NHL diagnosis) and 475 frequency matched controls from Minnesota, Iowa, and Wisconsin who were seen at the Mayo Clinic from 2002-2005. Tagging SNPs were selected from HapMap for the following candidate genes: BCL2; BCLAF1; BCL2LA1; BCL2L1, 2, 10, 11, 12, 13, 14; BAD; BAX; BAG1, 3, 4, 5; BAK1; BID; BIK; BNIP2, 3; HRK; CASP1 – CASP10; APAF1; BIRC3; AIF1; and DFFB. Genotyping was completed using the ParAllele (now Affymetrix) Immune and Inflammation SNP panel, supplemented with 9 SNPs from a custom Illumina OPA. SNP call rate and per person call rate were >95% for all SNPs evaluated. The most prevalent homozygous genotype was used as the reference group, and each SNP was modeled individually as having a log-additive effect in a logistic regression model adjusted for age, sex, and residence. We used principal components analysis to assess the association with NHL risk at the gene level. Genes at p<0.05 were declared statistically significant, as were SNPs at p<0.05 from significant genes. Results The mean age at diagnosis for cases was 60.1 years, and 58% were male; among controls, the mean age at enrollment into the study was 61.7 years, and 55% were male. The most common NHL subtypes were chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL, 29%), follicular lymphoma (FL, 27%), and diffuse large B-cell lymphoma (DLBCL, 16%). In gene level analyses, BCL2L11 (also know as BIM) (p=0.0019), BLCAF1 (p=0.0097), BAG5 (p=0.026), and CASP9 (p=0.0022) were statistically significant at p<0.05. For BCL2L11, 2 of the 5 tagSNPs (both intronic) were significant at p<0.05 (rs6746608 and rs12613243). Both genotyped BCLAF1 tagSNPs (rs797558 and rs703193, both intronic) were significant, as was the single genotyped BAG5 tagSNP (rs7042474) from the non-coding region interval of an mRNA transcript. Three of the 7 genotyped CASP9 tagSNPs were significant (rs6685648, rs2020902, rs2042370, all intronic). Similar associations (as assessed by ordinal odds ratios) were observed for significant SNPs from BCLAF1, BAG5, BCL2L11 and CASP9 within the subtypes of CLL/SLL, FL, and DLBCL; however, caution is warranted in interpreting the subtype results due to small sample sizes. Conclusions Three genes from the BCL2 family (BCL2L11, BCLAF1, and BAG5) and one gene from the caspase family (CASP9) were associated with risk of NHL. This confirms gene level results for BCL2L11 and CASP9 in NHL overall and suggests a role for additional BCL2 family members in NHL etiology. In addition to extending these results to other populations, investigation of the functional significance of these genes and consideration of their upstream regulators and downstream targets should assist in clarifying the role of this pathway in lymphomagenesis. Furthermore, in the era of targeted therapeutics, identification of genetic variation in the apoptotic pathway may also assist in predicting prognosis as therapies targeting this pathway are developed. Disclosures: No relevant conflicts of interest to declare.

Abstract In multiple myeloma, the neoplastic plasma cells are either dispersed throughout the red marrow spaces of the axial and proximal appendicular skeleton or concentrated in discrete, well vascularlized plasmacytomas that stimulate osteoclastic bone resorption and erode into cortical bone. Interactions between bone marrow stromal cells (BMSC) and myeloma cells are clearly important in the pathogenesis of myeloma that diffusely infiltrates the bone marrow and where plasmacytomas are in contact with the bone marrow space. However, these interactions cannot be of major relevance at the centers of expanding plasmacytomas since these sites are devoid of osteoclasts, osteoblasts and other BMSC. Histological sections of skeletal plasmacytomas from 22 patients with multiple myeloma were therefore examined after immunostaining with anti-macrophage antibodies. Hematoxylin and eosin stained sections showed sheets of plasma cells interspersed with numerous small blood vessels. Immunostained sections revealed abundant CD68+, CD163+ macrophage infiltrates in all tumors, and scattered collections of CD3+ T lymphocytes. Tumor-associated macrophages (TAM) accounted for 2 to 12 percent of nucleated cells in these plasmacytomas and were evenly distributed through the parenchyma or clustered around CD34+ blood vessels. In general the TAM had dendritic morphology, and each dendrite was in close contact with multiple plasma cells. In a small percentage of cases, there was a subpopulation of TAM strikingly clustered around CD34+ positive blood vessels. However, vascular mimicry was not seen. Abundant murine CD68+ TAM were also found in subcutaneous KAS6/1 and MM1 myeloma xenografts in SCID mice. To determine whether cells of the monocytic lineage might be exploitable as carriers for systemic delivery of therapeutic agents to plasmacytomas, monocyte-derived dendritic cells were infected with oncolytic measles viruses and administered intravenously to SCID mice bearing subcutaneous KAS6/1 xenografts. Immunostaining for human MHC II antigen revealed that the infused DCs could localize to the KAS6/1 tumors where they heterofused with and transferred MV infection to the myeloma cells. This is the first report of TAM in skeletal plasmacytomas of myeloma patients. Further research into the role of TAM in supporting myeloma growth is warranted since they may offer many potential opportunities for the development of novel approaches to myeloma therapy.

Abstract Abstract 259 Despite recent progress, our understanding of the genomic basis of diffuse large B cell lymphoma (DLBCL) is incomplete. We have performed massively parallel whole exome sequencing with deep coverage of 57 primary tumor samples from patients with DLBCL and compared them to matched normal tissue to gain insight into the genetic defects leading to DLBCL. We define genes that are significantly enriched for somatic mutations, and thus, may be drivers of the disease. In addition to identifying genes that are well established to be functionally relevant in DLBCL, such as MyD88, CARD11, EZH2, and BCL2, we also discovered new genes that are significantly mutated that have not been described to play a role in DLBCL previously, such as MLL2, 3 and4 genes and PCLO. One of the challenges for the understanding of DLBCL biology is to determine the relative contribution of different genes with somatic mutations to the pathogenesis of the disease in an individual patient. Identification of functionally relevant mutated genes that only occur in a small number of patients based on prevalence alone may require thousands of patient samples. We therefore devise several strategies to discover genes with a high likelihood of functionally relevant mutations independent of their prevalence. Genes that do not co-occur with other mutated genes in the same patients, i.e. are mutually exclusive, are more likely to represent strong drivers, and to occur early in the development of DLBCL. We determined that TP53, BCL2, PIM1, and CD79B fall into this group. We apply pathway-focused analysis to identify mutated genes with low prevalence that are highly likely to have a functional impact. For instance, we identified G13D mutations in KRAS in two patients, and mutations in BRAF, NOTCH1, SOCS1, and PTEN in other patients that were previously described in other malignancies. These mutated genes are identified as part of significantly enriched gene sets, including the B cell receptor signaling/NFkB pathway, JAK/STAT, and antigen processing gene sets. In addition to these pathways that are important for physiological B cell activation, we find that many histone methyltransferases are enriched as a geneset in addition to MLL2. We identified a number of hotspots that are subject to somatic mutation. Our data imply that many of these hotspots may be targets of activation-induced cytidine deaminase (AID), which is usually involved in somatic hypermutation, suggesting a possible mechanism of how somatic mutation in DLBCL is mediated. In summary, our data define novel genetic defects in DLBCL by whole exome sequencing of 57 patients. Our data suggest that driver mutations may not be randomly distributed across the genome, but may occur in a directed fashion. We identified new genes not previously implicated in DLBCL, and have developed strategies to prioritize mutations that are most likely to be drivers of the disease. Disclosures: No relevant conflicts of interest to declare.

Abstract Abstract 633 Background: To date, the only well characterized chromosomal translocations among peripheral T-cell lymphomas (PTCLs) are those involving ALK, which occur in about half of anaplastic large cell lymphomas (ALCLs). ALK-negative ALCLs remain poorly understood, despite morphology and phenotype similar to ALK-positive ALCLs. We recently described translocations near IRF4 on 6p25.3 in cutaneous ALK-negative ALCLs. In the present study, we utilized massively parallel (Next Generation) sequencing to answer three questions about these translocations: (1) Were they recurrent in the more lethal systemic form of ALK-negative ALCL? (2) What was the translocation partner? (3) What were the likely genetic consequences? Methods: We used a mate pair library approach to juxtapose DNA sequences originally lying ~5 kb apart: these paired sequences map to distinct areas of the genome if a translocation breakpoint lies between them. Because only the ends of the original DNA fragments are sequenced, this approach is more resource efficient than whole genome sequencing. Genomic DNA from a systemic ALK-negative ALCL with an uncharacterized 6p25.3 rearrangement was fragmented to 2–5 kb, biotinylated, and separated on an agarose gel. Fragments ~5-5.5 kb were excised, purified, circularized, and further fragmented to ~300-600 bp. Fragments containing biotin (representing the ends of the original 5 kb fragments) were immobilized on streptavidin beads and amplified using the Illumina library protocol. Paired end sequencing was performed on one lane of a flow cell on an Illumina GAIIx. Sequencing data were mapped to the genome using a binary indexing algorithm. Non-mapping and duplicate sequences were discarded. Candidate translocations suggested by >4 unique mate pairs were examined by BLAT to exclude false positives explained by mapping to homologous regions. PCR and Sanger sequencing of tumor DNA was used for validation. Fluorescence in situ hybridization (FISH) was performed on additional PTCLs. mRNA and miRNA expression was quantified using real-time PCR. Results: Of 28.90×106 paired sequences, 8.61×106 were non-duplicate pairs in which both ends mapped to the human genome (bridged coverage, ~7x). Only one candidate translocation involved 6p25.3, represented by 10 unique mate pairs. PCR and Sanger sequencing confirmed a balanced translocation: one breakpoint disrupted the dual-specificity phosphatase gene, DUSP22, telomeric to IRF4 on 6p25.3; the other was telomeric to the FRAH7 fragile site on 7q32.3. Additional ALK-negative ALCLs with known 6p25.3 rearrangements were tested using a 7q32.3 breakapart FISH probe, which showed a 7q32.3 rearrangement in 13/29 (45%; 7 systemic and 6 cutaneous). Dual fusion FISH confirmed t(6;7)(p25.3;q32.3) in 11/11 cases tested. None of 120 PCTLs (including 39 ALCLs) lacking 6p25.3 rearrangements had a 7q32.3 rearrangement. Levels of 5′ and 3′ DUSP22 mRNA in cases with 6p25.3 rearrangements were decreased relative to those in non-rearranged cases (5′: 0.02±0.01 vs 1.00±0.74, p=.002; 3′: 0.09±0.08 vs 1.00±0.55, p=.0002; mean±SD, t test). IRF4 mRNA levels were similar in both groups. Levels of MIR29A and MIR29B1 within FRAH7 in cases with 7q32.3 rearrangements were increased relative to those in non-rearranged cases (MIR29A: 2.44±2.20 vs 1.00±1.34, p=.15; MIR29B: 4.93±4.68 vs 1.00±1.05, p=.007). Conclusions: The t(6;7)(p25.3;q32.3) is the first recurrent translocation characterized in systemic and cutaneous ALK-negative ALCLs. This translocation was entirely specific for ALK-negative ALCLs, and was present in 45% of cases with 6p25.3 rearrangements. The t(6;7)(p25.3;q32.3) was associated with down-regulation of DUSP22 and up-regulation of MIR29, but not dysregulation of IRF4. DUSP22 inhibits mitogen activated protein kinase activity in T cells, and may represent a novel tumor suppressor in ALCLs. Increased MIR29 levels may additionally contribute to tumorigenesis, as recently shown in acute myeloid leukemias. Finally, clinical testing for t(6;7)(p25.3;q32.3) may aid in differentiating ALK-negative ALCL from other PTCLs. Our findings highlight the utility of mate-pair library sequencing to discover novel translocations in lymphoma and other cancers. Disclosures: No relevant conflicts of interest to declare.