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Atlas of Genetics and Cytogenetics in Oncology and Haematology OPEN ACCESS JOURNAL AT INIST-CNRS Gene Section Review MLL (myeloid/lymphoid or mixed lineage leukemia) Jean-Loup Huret Genetics, Dept Medical Information, UMR 8125 CNRS, University of Poitiers, CHU Poitiers Hospital, F86021 Poitiers, France Published in Atlas Database: October 2005 Online updated version: http://AtlasGeneticsOncology.org/Genes/MLL.html DOI: 10.4267/2042/38290 This article is an update of: Marschalek R. MLL (myeloid/lymphoid or mixed lineage leukemia). Atlas Genet Cytogenet Oncol Haematol.2003;7(1):16-18. Hess JL, Huret JL. MLL (myeloid/lymphoid or mixed lineage leukemia). Atlas Genet Cytogenet Oncol Haematol.2001;5(1):12-14. Huret JL. MLL (myeloid/lymphoid or mixed lineage leukemia). Atlas Genet Cytogenet Oncol Haematol.1997;1(2):68-69. This work is licensed under a Creative Commons Attribution-Non-commercial-No Derivative Works 2.0 France Licence. © 2006 Atlas of Genetics and Cytogenetics in Oncology and Haematology Identity Protein Hugo: MLL Other names: ALL1, HRX, Htrx (human trithorax), TRX1 Location: 11q23 Local order: telomeric to PLZF, centromeric from RCK. Description 3969 amino acids; 431 KDa; contains from N-term to C-term 3 AT hooks homologous to high mobility group proteins HMGA1 and HMGA2, binding to the minor grove of DNA; 2 speckled nuclear localisation signals; 2 repression domains RD1 and RD2: RD1 or CXXC: cystein methyl transferase, binds CpG rich DNA, has a transcriptional repression activity; RD2 recruits histone desacetylases HDAC1 and 2; 3 plant homeodomains (cystein rich zinc finger domains, with homodimerization properties), 1 bromodomain (may bind acetylated histones), and 1 plant homeodomain; these domains may be involved in protein-protein interaction; a FYRN and a FRYC domain; a transactivation domain which binds CBP; may acetylates H3 and H4 in the HOX area; a SET domain: methyltransferase; methyltates H3, including histones in the HOX area for allowing chromatin to be open to transcription. MLL is cleaved by taspase 1 into 2 proteins before entering the nucleus: a p300/320 Nterm protein called MLL-N, and a p180 C-term protein, called MLL-C. The FYRN and a FRYC domains of native MLL associate MLL-N and MLL-C in a stable complex; they form a multiprotein complex with transcription factor TFIID. DNA/RNA MLL (11q23) - Courtesy Mariano Rocchi, Resources for Molecular Cytogenetics. Description 37 exons, spanning over 100 kb Transcription In a centromeric to telomeric direction; 13 and 15 kb; coding sequence: 11.9 kb Expression Wide; especially in: brain, kidney, thyroid; expressed in Taned B lymphocytes and myeloid cells. Atlas Genet Cytogenet Oncol Haematol. 2006;10(2) 83 MLL (myeloid/lymphoid or mixed lineage leukemia) Huret JL MLL partner genes - Rolf Marschalek Nov 2002. Implicated in Localisation Nuclear, in punctate spots. t(4;11)(q21;q23)/acute leukaemias → MLL-AFF1 (AF4) Function Transcriptional regulatory factor; MLL may have yinyang functions though actions of MLL-N and MLL-C (e.g. desacetylation/acetylation); MLL-N acts as a transcriptional repressor; MLL can be associated with more than 30 proteins, including the core components of the SWI/SNF chromatin remodeling complex and the transcription complex TFIID. MLL binds promotors of HOX genes through acetylation and methylation of histones. MLL is a major regulator of hematopoesis and embryonic development, through regulation of HOX genes expression regulation (HOXA9 in particular). Disease Typically CD19+ CD10-precursor B-ALL, biphenotypic AL, at times ANLL (M4/M5); common in infants may be congenital; treatment related leukaemia (secondary to epipodophyllotoxins). Prognosis Median survival < 1 year Cytogenetics Additional chromosome anomalies are found in 1/4 of cases, one of which is the i(7q). Hybrid/Mutated Gene 5' MLL - 3' AF4; 12kb. Abnormal Protein 240 kDa protein with about 1400 aminoacids from NH2 MLL and 850 from COOH AF4 (variable breakpoints); the reciprocal may or may not be expressed. Homology Trithorax (Drosophila), ALR (human), MLL2 (human). Mutations Note: MLL is implicated in at least 10 % of acute leukaemias (AL) of various types: acute lymphoblastic leukemias (ALL), acute non lymphocytic leukemias (ANLL), biphenotypic ALs, treatment related leukemias, infant leukemias; the prognosis is poor. Atlas Genet Cytogenet Oncol Haematol. 2006;10(2) 84 MLL (myeloid/lymphoid or mixed lineage leukemia) Huret JL t(6;11)(q27;q23)/ANLL → MLL-MLLT4 (AF6) Cytogenetics May be overlooked; often as a sole anomaly. Hybrid/Mutated Gene Variable breakpoints on both genes. Abnormal Protein N-term - AT hook and DNA methyltransferase from MLL fused to the 192 C-term amino acids from AF9 (as breakpoints are variable, this is only an example). Disease M5/M4 de novo and therapy related ANLL, T-cell ALL. Prognosis Poor. t(9;11)(p22;q23) /ANLL → MLL-MLLT3 (AF9) t(10;11)(p12;q23)/ANLL → MLL-MLLT10 (AF10) Disease M5/M4 de novo and therapy related ANLL. Prognosis The prognosis may not be as poor as in other 11q23 leukaemias in de novo cases; very poor prognosis in secondary ANLL cases. Atlas Genet Cytogenet Oncol Haematol. 2006;10(2) Disease M4 or M5 ANLL; ALL at times; therapy related ANLL. Prognosis Poor 85 MLL (myeloid/lymphoid or mixed lineage leukemia) Huret JL • t(3;11)(q28;q23)/ANLL → MLL - LPP • t(4;11)(p12;q23) → MLL - AF4p12 • t(4;11)(q12;q23) → MLL - MIFL • t(4;11)(q21;q23)/atypical CML → MLL - SEPT11 • t(4;11)(q35;q23)→ MLL - ArgBP2 • t(5;11)(q31;q23)/ANLL, ALL → MLL - ARHGAP26 (GRAF) • ins(5;11)(q31;q13q23)/ALL → MLL - AFF4 (AF5q31) • t(6;11)(q12;q23)/ANLL → MLL - SMAP1 • t(6;11)(q21;q23)/ANLL → MLL - FOXO3A (AF6q21) • t(9;11)(q34;q23)/ANLL → MLL - DAB2IP (AF9q34) • t(10;11)(p11;q23)/ANLL → MLL - ABI1 • t(10;11)(q21;q23)/ANLL → MLL - CXXC6 (TET1) • t(11;11)(q21;q23)/ANLL → MLL - PICALM • trisomy 11/ANLL → MLL tandem duplication • t(11;11)(q23;q23)/ANLL → MLL - CBL • t(11;11)(q23;q23)/ANLL → MLL - ARHGEF12 (LARG) • t(11;11)(q23;q24)/ANLL → MLL - TIRAP • t(11;12)(q23;q13)/ANLL → MLL - CIP29 • t(11;14)(q23;q24)/ANLL, AUL → MLL - GPHN • t(11;15)(q23;q14)/ANLL, ALL → MLL - CASC5 (AF15q14) • t(11;15)(q23;q14) → MLL - MPFYVE • t(11;15)(q23;q15) → MLL - AF15 • t(11;16)(q23;p13)/MDS, ANLL, t-ANLL, ALL → MLL - CREBBP (CBP) • t(11;17)(q23;p13)/t-ANLL → MLL - GAS7 • t(11;17)(q23;q21)/ANLL → MLL - ACACA • t(11;17)(q23;q21)/ANLL → MLL - LASP1 • t(11;17)(q23;q21)/ANLL → MLL - MLLT6 (AF17) • t(11;17)(q23;q21)/ANLL → MLL - RARa • t(11;17)(q23;q25)/MDS, ANLL → MLL - SEPT9 (MSF1, AF17q25) • t(11;19)(q23;p13)/ANLL → MLL - SH3GLI1 (EEN) • t(11;19)(q23;p13)/ANLL → MLL - MYO1F • t(11;20)(q23;q11)/ALL → MLL - MAPRE1 (EB1) • t(11;22)(q23;q11.2)/ANLL → MLL - SEPT5 (hCDCRel) • t(11;22)(q23;q13)/ANLL → MLL - EP300 (P300) t(11;19)(q23;p13.1)/ANLL → MLL-ELL Disease Mainly M4/M5; treatment related leukemia; all ages. Prognosis Very poor. Cytogenetics Detected with R banding. Hybrid/Mutated Gene 5' MLL - 3' ELL. Abnormal Protein AT hook and DNA methyltransferase from MLL fused to most of ELL. Oncogenesis Potential transcription factor. t(11;19)(q23;p13.3)/acute leukaemias → MLL-MLLT1 (ENL) Disease ALL (CD19+), biphenotypic AL, ANLL (M4/M5); mainly congenital; treatment-related leukaemia. Prognosis Very poor, except in rare T-cell cases. Cytogenetics Detected with G banding. Hybrid/Mutated Gene 5' MLL - 3' ENL. Abnormal Protein AT hook and DNA methyltransferase from MLL fused to, most often, the nearly entire ENL. Other entities • t(X;11)(q13;q23)/ANLL, T-ALL → MLL - AFX1 • t(X;11)(q22;q23)/ANLL → MLL- Septin2 • t(1;11)(p32;q23)/ALL → MLL- EB15 (AF1p) • t(1;11)(q21;q23)/ANLL → MLL- MLLT11 (AF1q) • t(2;11)(q11;q23)/ALL → MLL- AFF3 (LAF4) • t(3;11)(p21;q23)/t-ANLL, ALL→ MLL- NCKIPSD (AF3p21) • t(3;11)(q21;q23)/ALL → MLL- EEFSEC (SELB) • t(3;11)(q25;q23)/t-ANLL → MLL - GMPS Atlas Genet Cytogenet Oncol Haematol. 2006;10(2) 86 MLL (myeloid/lymphoid or mixed lineage leukemia) Huret JL Breakpoints Note: spanning a 8 kb genomic region; between exons 5 to 11; highly variable on the partner, ranging from close to the NH2-term in MLLT1 (ENL), to near the COOH-term in MLLT3 (AF9). To be noted gene involved in translocations to chromosomal region 11q23 and acute leukaemias. Brit J Haematol 1996;93:966-972. Note: the card on 11q23 rearrangements, gives an overview on diseases implicating MLL, as well as 11q23 rearrangements in therapy related leukemias. See also 11q23 rearrangements in childhood acute lymphoblastic leukemia: Clinical aspects and congenital leukemias. Young BD, Saha V. Chromosome abnormalities in leukaemia: the 11q23 paradigm. Cancer Surv 1996;28:225-245. References Waring PM, Cleary ML. Disruption of a Homolog of Trithorax by 11q23 translocations: leukemogenic and transctiptional implications. Current Topics Microbiol Immunol 1997;220:1-23. Rubnitz JE, et al. 11q23 rearrangements in acute leukemia. Leukemia 1996;10:74-82. (Review). Prasad R, et al. Structure and expression pattern of human ALR, a novel gene with strong homology to ALL-1 involved in acute leukemia and to Drosophila trithorax. Oncogene 1997;15:549-560. Schichman SA, Canaani E, Croce CM. Self-fusion of the ALL1 gene. A new genetic mechanism for acute leukemia. JAMA 1995;273:571-576. DiMartino JF, Cleary ML. MLL rearrangements in hematological malignancies: lessons from clinical and biological studies. Br J Haemotol 1999;106:614-626. Bernard OA, Berger R. Molecular basis of 11q23 rearrangements in hematopoietic malignant proliferations. Genes Chromosom Cancer 1995;13:75-85. Huntsman DG, et al. MLL2, the second homolog of the Drosophila trithorax gene, maps to 19q13.1 and is amplified in solid tumor lines. Oncogene 1999;18:7975-7984. Rasio D, Schichman SA, Negrini M, Canaani E, Croce CM. Complete exon structure of the ALL1 gene. Cancer Res 1996;56:1766-1769. This article should be referenced as such: Huret JL. MLL (myeloid/lymphoid or mixed lineage leukemia). Atlas Genet Cytogenet Oncol Haematol.2006;10(2):83-87. Nilson I, Löchner K, Siegler G, Greil J, Beck JD, Fey GH, Marschalek R. Exon/intron structure of the human ALL-1 (MLL) Atlas Genet Cytogenet Oncol Haematol. 2006;10(2) 87