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. 2022 Apr 11;10:1003. Originally published 2021 Oct 4. [Version 3] doi: 10.12688/f1000research.73054.3

The association between FOXO3a rs4946936 gene polymorphism and the levels of FOXO3a among chronic granulocytic leukemia patients treated with imatinib mesylate

Shinta Oktya Wardhani 1,a, Hani Susianti 2, Puji Rahayu 3, Yuyun Prabowowati Yueniwati 4, Jonny Karunia Fajar 5,b
PMCID: PMC9005988  PMID: 35464180

Version Changes

Revised. Amendments from Version 2

In the version 3, we provide the revision of Introduction. The revision does not change the main findings of our study.

Abstract

Background: The gene  FOXO3a has been elucidated to govern the development of chronic granulocytic leukemia (CGL). Moreover, it has been suggested that the levels of  FOXO3a in circulation are affected by the  FOXO3a rs4946936 gene polymorphism. However, no study has assessed the correlation between the  FOXO3a rs4946936 gene polymorphism and the levels of  FOXO3a. The objective of this study was to assess the association between the  FOXO3a rs4946936 gene polymorphism and the levels of  FOXO3a in CGL patients treated with imatinib mesylate. 

Methods: A cross-sectional study was conducted from February 2019 to February 2020. The genotyping of  FOXO3a rs4946936 gene polymorphism was conducted using PCR-RFLP, and the levels of  FOXO3a were assessed using ELISA. The association between the  FOXO3a rs4946936 gene polymorphism and the levels of  FOXO3a were assessed using multiple logistic regression. 

Results: A total of 60 CGL patients were assessed in our study. Among them, the CC, CT, and TT genotypes of the  FOXO3a rs4946936 gene polymorphism were 35.0%, 48.3%, and 16.7% respectively. Our calculation revealed that elevated levels of  FOXO3a were found in CGL patients with the CC genotype of the  FOXO3a rs4946936 gene polymorphism. While we failed to clarify the association between either the CT or the TT genotype of  FOXO3a rs4946936 gene polymorphism and the levels of  FOXO3a

Conclusion: Our study identifies that the CC genotype of the  FOXO3a rs4946936 gene polymorphism affects the elevated levels of  FOXO3a in CGL patients treated with imatinib mesylate.

Keywords: chronic granulocytic leukemia, FOXO3a, FOXO3a rs4946936 gene polymorphism

Introduction

Chronic granulocytic leukemia (CGL), first recognized in 1845, is a myeloproliferative disease caused by a condition in which a single pluripotential haemopoetic stem cell acquires the Philadelphia chromosome. 1 A global report in 2015 revealed that the incidence of this disease was estimated between 0.7 and 1.0 per 100,000 inhabitants, 2 while mortality was reported at less than 15%. 3 The pathogenesis of CGL is a comprehensive process, and may involve a wide variety of biomarkers including cyclooxgenase 1 ( COX1), patched homolog 1 ( PTCH1), Forkhead Transcription Factor 3a ( FOXO3a), prostaglandin-endoperoxide synthase 1 ( PTGS1), and human organic cation transporter 1 ( hOCT1). 4 6 Of them, FOXO3a is proposed as one biomarker having a pertinent role in the pathogenesis of CGL, although evidence is limited. 6

FOXO3a belongs to the FOXO Forkhead transcription factors subfamily. The FOXO transcription factors have a various function in the cell stability, including the activation of target – gene expression and the inhibition of target – gene expression, depending on the type of their subfamily and their interaction to the specific protein. 7 The subfamily of FOXO includes FOXO1, FOXO3a, FOXO3b, FOXO4 and FOXO6. 8 Of them, FOXO3a palys a dominant role to activate the expression of target gene in the pathogenesis of CGL, and may contribute to the progression of CGL. 6 , 7 , 9 Moreover, the existence of FOXO3a in the circulation is governed by the FOXO3a gene, which has several single nucleotide polymorphisms (SNPs) such as rs2802292, rs2764264, rs4945816, rs9400239, rs4946936, and rs13217795. 10 Of them, the FOXO3a rs4946936 gene variant is suggested to have a crucial role in affecting the levels of FOXO3a in circulation, and therefore may have a potential role in the pathogenesis of CGL. While the gene polymorphism of FOXO3a rs4946936 has been investigated in the case of vitiligo, 11 chronic obstructive pulmonary disease (COPD), 12 acute lymphoblastic leukemia, 13 thyroid cancer, 14 and hepatocellular carcinoma, 15 the role of FOXO3a rs4946936 gene polymorphisms in the development of CGL has never been examined. Therefore, we aimed to assess the correlation between FOXO3a rs4946936 gene polymorphism and the levels of FOXO3a in patients with CGL treated with imatinib mesylate. Our report may serve as an initial insight into the role of the FOXO3a rs4946936 gene polymorphism in the pathogenesis of CGL.

Methods

Study design and patients

During the period from February 2019 to February 2020, we conducted a cross-sectional study in Saiful Anwar General Hospital, Malang, Indonesia. A total sampling method was applied to recruit the study participants (a total of 26 participants was needed as the minimum sample size according to the estimation that the prevalence of CGL was 10–12 per 100,000 inhabitants with a 5% margin of error and 95% confidence level). The patients were included in our study if they met the following inclusion criteria: (1) all CGL patients (confirmed by a positive Bcr-ABL test) treated with imatinib mesylate for at least six months in our hospital during the study period, (2) aged more than 18 years old, and (3) willing to participate in the study, proven by giving written informed consent. Patients were excluded from our study if they had a history of the following conditions: prostate cancer, gynecological cancer, COPD, breast cancer, vitiligo, and thyroid cancer. 16 Our present study was conducted following the ethics code of the Helsinki Declaration and was registered and approved by the Ethical Committee of Universitas Brawijaya (No. 400/098/k.3/302/2019).

Genotyping of FOXO3a rs4946936 gene polymorphism

We collected venous blood in plastic vacutainer tubes containing EDTA. We separated the blood samples, and they were stored at −20 °C. We centrifuged the blood samples in EDTA at 1000 ×g for 10 min, and we separated the plasma and stored it at −20 °C until it was used to measure FOXO3a levels. A polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method was applied to genotype the FOXO3a rs4946936 gene polymorphism. The procedures in FOXO3a genotyping including the primer used, amplification, and PCR cycles (initial denaturation, denaturation, annealing, and extension) were adapted from previous studies, 11 , 12 using the CFX96 TouchTM Real-Time PCR Detection System (Bio-Rad, California, USA). The FOXO3a primer ( FOXO3a F: 5′-GGGTCCTGAGAACTTCTGAGT-3′; FOXO3a R: 5′-GACATTCTGTAAGACATTCTGCCT-3′) used in our present study was MyTaq HS Mix, 2X (Bioline, Meridian BioscienceTM, OH, USA). We used SfcI (New England Biolabs, Massachusetts, USA) as the restriction enzyme. PCR was conducted in a 50 μl volume with 20–100 ng DNA, 20 pmol of each primer, 50 μM KCl, 100 μm dNTPs, 20 μM Tris-HCl pH 8.6.

1 mM MgCl 2, and 1 U Taq polymerase (MBI Fermentas, Vilnius, Lithuania). Amplification was carried out using an automated thermal cycler (Techne-Genius, Princeton, NJ). The PCR cycles consisted of initial denaturation at 94 °C for 3 min; 35 cycles of denaturation at 94 °C for 1 min, annealing at 53 °C for 1 min, and extension at 72 °C for 1 min, followed by final extension at 72 °C for 7 min. The amplified products were digested with one unit of Sfcl (rs4946936; C/T). The digested fragments were separated on 2% agarose gel by electrophoresis. The genotypes were identified according to their fragment sizes. The TT genotype was characterized by 224 bp sized bands, the TC genotype was characterized by 224, 152, and 72 bp sized bands, and the size bands of 152 and 72 indicated the CC genotype ( Figure 1).

Figure 1. A visualization of the FOXO3a rs4946936 gene polymorphism.

Figure 1.

The 224bp sized band indicated TT genotype, the 152bp size band indicated CT genotype, and the 72bp sized band indicated CC genotype.

The measurement of FOXO3a levels

The measurement of serum FOXO3a levels was conducted by the enzyme-linked immunosorbent assay (ELISA) method, using the Cusabio kit (Cusabio Biotech Co., New York, USA), with the procedures conforming to the manual instructions from the company. The 100 μl standard liquid and blood sample were added to the tubes, and incubated for 90 min. The liquid from each tube was then shucked. The 100 μl biotinylated detection antibody was added to each tube and incubated at 37 °C for 1h. The liquid of each tube was shucked and washed three times. The 100 μl 1x HRP conjugate was then added to each tube and incubated at 37 °C for 30 min. The liquid was shucked and washed five times. The 90 μl TMB substrate was added to each tube and incubated at 37 °C for 15 min. The 50 μl stoper liquid was added to each tube. At this step, a change from blue to yellow might occur. Measurement of optic density at 450 nm was conducted. The results were then interpreted to the standard curve to determine the levels of FOXO3a and expressed in units of pg/mL.

Statistical analysis

The correlation between the FOXO3a rs4946936 gene polymorphism and FOXO3a levels was assessed using multiple logistic regression. A p-value of less than 0.05 indicated a significant association. The effect estimates between groups were presented by calculation of the mean difference. We used the R stats package statistical software to analyze the data in our study (R Project for Statistical Computing, RRID:SCR_001905).

Results

Baseline characteristics

A total of 60 CGL patients were analyzed. Of them, 21 (35.0%), 29 (48.3%), and 10 (16.7%) patients had a CC, CT, and TT genotype, respectively. Initially, we employed a total of 68 CGL patients, however, eight patients were excluded due to having a history of gynecological cancer and COPD. Table 1 describes the baseline characteristics of patients included in our study. The detailed data are presented as underlying data. 17

Table 1.

Baseline characteristics of chronic granulocytic leukemia patients treated with imatinib mesylate included in the study examining the association between FOXO3a rs4946936 gene polymorphism and the levels of FOXO3a.

Characteristics FOXO3a gene polymorphism p
CC CT TT Total
Gender
Male 11 (18.30) 15 (25.00) 5 (8.30) 31 (51.70) 0.992
Female 10 (16.70) 14 (23.30) 5 (8.30) 29 (48.30)
Age 43.62 ± 11.75 41.9 ± 12.53 43.4 ± 14.18 10.12 ± 4.04 0.877
Spleen
S3 4 (6.70) 4 (6.70) 0 (0.00) 8 (13.30) 0.455
S4 6 (10.00) 7 (11.70) 4 (6.70) 17 (28.30)
S5 5 (8.30) 13 (21.70) 5 (8.30) 23 (38.30)
S6 6 (10.00) 5 (8.30) 1 (1.70) 12 (20.00)
Hemoglobin 11.59 ± 4.18 10.9 ± 3 10.12 ± 4.04 11.01 ± 3.6 0.559
Leucocyte 25698.1 ± 56533.51 42165.55 ± 94168.6 138092 ± 162617.05 52389.68 ± 104285.9 0.013
Thrombocyte 218047.62 ± 102640.38 423241.38 ± 963616.32 306900 ± 183752.52 332033.33 ± 676914.46 0.575

Note: Total no. of patients = 60. Data were presented as mean ± SD or no. (%).

Main findings

Our findings identified that elevated levels of FOXO3a were observed among CGL patients with CC (CC vs. CT + TT) genotype (MD: 26.56; 95% CI: 0.48, 52.64). While the association between the CT (CT vs. CC + TT) and TT (TT vs. CC + CT) genotypes and the levels of FOXO3a were unverified ( Figure 2).

Figure 2. The summary of FOXO3a levels and the gene polymorphism of FOXO3a in chronic granulocytic leukemia patients treated with imatinib mesylate.

Figure 2.

A). CC vs. CT+TT, MD: 26.56, 95%CI: 0.48, 52.64, p: 0.0460; B). CT vs. CC+TT, MD: −8.45, 95%CI: −34.09, 17.19, p: 0.5180; C). TT vs. CC+CT, MD: −28.33, 95%CI: −62.06, 5.39, p: 0.1000.

Discussion

Our study identified that the CC genotype of the FOXO3a rs4946936 gene polymorphism was associated with increased levels of FOXO3a among patients with CGL treated with imatinib mesylate. The study in the context of the association between the FOXO3a rs4946936 gene polymorphism and the levels of FOXO3a in patients with CGL treated with imatinib mesylate had, to our knowledge, never been performed previously, therefore, an holistic comparison including the gene-ethnicity or gene-environment interaction could not be discussed. Previous studies in this context had been performed in the case of COPD 12 and vitiligo. 11 In the case of vitiligo, a study failed to clarify the correlation between the levels of FOXO3a and the gene polymorphism of FOXO3a rs4946936. 11 Moreover, in the case of COPD, no association was observed between the levels of FOXO3a and the gene polymorphism of FOXO3a rs4946936. 12 The different findings between our study in the case of CGL and previous studies in the case of vitiligo and COPD are contradictory and debatable, and a possible reason might be proposed. Briefly, vitiligo and COPD are known as conditions that affect the levels of FOXO3a, and the mechanism of FOXO3a production in the case of CGL might differ to the case of vitiligo and COPD. In the case of vitiligo, FOXO3a may interrupt the oxidative pathway by controlling the target gene expression. 11 In the case of COPD, FOXO3a may stimulate the expression of Atrogin-1/MAFbx, a biological marker having a pivotal role in the development of COPD. 12 On the other hand, the role of FOXO3a in the case of CGL occurs through establishing the phosphorylation by p210BCR-ABL tyrosine kinase, and may contribute to the proliferation of leukemic progenitors. 18 , 19

Theoretically, the association between the levels of FOXO3a and the gene polymorphism of FOXO3a rs4946936 remain conflicting. However, several mechanisms might be proposed. First, the gene-gene interaction or gene-protein interaction might underly our findings. This possible mechanism was supported by a previous study. 20 The authors revealed that a dominant homozygote genotype of the FOXO3a rs4946936 gene variant was reported to associate with elevated levels of immunoglobulin (Ig) E in the case of asthma. They proposed that FOXO3a might regulate the production of proinflammatory cytokine, and cause elevated levels of IgE. 20 Second, free energy levels between genotypes of the FOXO3a rs4946936 gene polymorphism might affect the levels of FOXO3a in the circulation. In an in silico study, the free energy levels of the CC and TT genotype of the FOXO3a rs4946936 gene variant were −320.80 Kcal/mol and −301.10 Kcal/mol, respectively, indicating that the CC genotype had lower free energy levels. 21 Low free energy levels were associated with the mRNA structure and translation, and the changes of mRNA translation at the 5′ and 3′ UTR locations were correlated to affect protein synthesis. 21 23 This explanation might describe the possible underlying mechanism that the CC genotype of the FOXO3a rs4946936 gene variant had an association with increased levels of FOXO3a in the case of CGL compared to the CT and TT genotype. Moreover, previous study also supported our findings. They found that elevated levels of FOXO3a was associated with treatment failure of CGL patient treated with imatinib mesylate, suggesting that the levels of FOXO3a might play an important role to contribute the progression of CGL. 16 Furthermore, studies also found that elevated levels of FOXO3a was associated with adverse prognosis of leukemia. 24 , 25 However, gene – environment interaction should also be considered to affect the disease progression since it was proven that the FOXO transcription factors had various impact in different population, for example: the role of FOXO transcription factors were found inconclusive to affect the human longevity in the population of Japan, Germany, Italia, and Indonesia. 26 , 27

To the best of our knowledge, our study is the first to report the association between the levels of FOXO3a and the gene polymorphism of FOXO3a rs4946936 in the case of CGL patients. Our findings may serve as an initial investigation regarding the role of FOXO3a rs4946936 gene polymorphism in affecting the levels of FOXO3a, compared to different findings in the case of COPD and vitiligo. In the future, our results may contribute to a better understanding regarding the role of FOXO3a rs4946936 gene polymorphism and the levels of FOXO3a in the pathogenesis of CGL patients. However, understanding the role of genetics in a disease is problematic and further studies involving gene-gene, gene-environment, and gene-disease interaction are warranted to determine the holistic role of FOXO3a gene polymorphism in the pathogenesis of CGL.

Several pertinent limitations to this study should be assessed. First, several factors that might contribute to the severity of CGL in patients including smoking, physical activity, dietary factors, the history of previous medication, and the history of radiation were not analyzed. Second, the small sample size in our study should be interpreted with caution due to the possibility of false positive results. Third, the short time period of the study might not be sufficient to define the real correlation.

Conclusion

Our study indicates that the CC genotype of the FOXO3a rs4946936 gene variant is associated with elevated levels of FOXO3a. Our findings may be used as an initial investigation and may provide a better understanding of the role of the FOXO3a rs4946936 gene variant in the pathogenesis of CGL.

Data availability

Underlying data

Figshare: Underlying data for ‘The association between FOXO3a rs4946936 gene polymorphism and the levels of FOXO3a among chronic granulocytic leukemia patients treated with imatinib mesylate’, https://doi.org/10.6084/m9.figshare.16529160. 17

This project contains the following underlying data:

  • Data file.xlsx

  • Gel electrophoresis.pdf

Reporting guidelines

Figshare: STROBE checklist for ‘The association between FOXO3a rs4946936 gene polymorphism and the levels of FOXO3a among chronic granulocytic leukemia patients treated with imatinib mesylate’, https://doi.org/10.6084/m9.figshare.16529160. 17

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0)

Consent

Written informed consent for publication of the patients’ details was obtained from the patients.

Acknowledgements

We thank RSUD Dr Saiful Anwar Malang for supporting our study.

Funding Statement

The author(s) declared that no grants were involved in supporting this work.

[version 3; peer review: 2 approved]

References

  • 1. Frazer R, Irvine AE, McMullin MF: Chronic Myeloid Leukaemia in The 21st Century. Ulster Med J. 2007;76:8–17. [PMC free article] [PubMed] [Google Scholar]
  • 2. Hoglund M, Sandin F, Simonsson B: Epidemiology of chronic myeloid leukaemia: an update. Ann Hematol. 2015;94(Suppl 2):241–247. 10.1007/s00277-015-2314-2 [DOI] [PubMed] [Google Scholar]
  • 3. Granatowicz A, Piatek CI, Moschiano E, et al. : An Overview and Update of Chronic Myeloid Leukemia for Primary Care Physicians. Korean J Fam Med. 2015;36:197–202. 10.4082/kjfm.2015.36.5.197 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4. Clark RE, Davies A, Pirmohamed M, et al. : Pharmacologic markers and predictors of responses to imatinib therapy in patients with chronic myeloid leukemia. Leuk Lymphoma. 2008;49:639–642. 10.1080/10428190701858823 [DOI] [PubMed] [Google Scholar]
  • 5. Alonso-Dominguez JM, Casado LF, Anguita E, et al. : PTCH1 is a reliable marker for predicting imatinib response in chronic myeloid leukemia patients in chronic phase. PLoS One. 2017;12:e0181366. 10.1371/journal.pone.0181366 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6. Stefanetti RJ, Voisin S, Russell A, et al. : Recent advances in understanding the role of FOXO3. F1000Res. 2018;7:7. 10.12688/f1000research.15258.1 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7. Calnan D, Brunet A: The FoxO code. Oncogene. 2008;27:2276–2288. [DOI] [PubMed] [Google Scholar]
  • 8. Schmitt-Ney M: The FOXO’s Advantages of Being a Family: Considerations on Function and Evolution. Cells. 2020;9. 10.3390/cells9030787 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9. Liu Y, Ao X, Ding W, et al. : Critical role of FOXO3a in carcinogenesis. Mol Cancer. 2018;17:104. 10.1186/s12943-018-0856-3 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10. Daumer C, Flachsbart F, Caliebe A, et al. : Adjustment for smoking does not alter the FOXO3A association with longevity. Age (Dordr). 2014;36:911–921. 10.1007/s11357-013-9578-z [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11. Ozel Turkcu U, Solak Tekin N, Gokdogan Edgunlu T, et al. : The association of FOXO3A gene polymorphisms with serum FOXO3A levels and oxidative stress markers in vitiligo patients. Gene. 2014;536:129–134. 10.1016/j.gene.2013.11.055 [DOI] [PubMed] [Google Scholar]
  • 12. Kalemci S, Edgunlu TG, Turkcu U, et al. : FOXO3a gene polymorphism and serum FOXO3a levels in patients with chronic obstructive pulmonary disease and healthy controls: Effects of genetic polymorphism in chronic obstructive pulmonary disease. Smyrna Med J. 2014;1:1–5. 24333267 [Google Scholar]
  • 13. Wang Y, Zhou L, Chen J, et al. : Association of the 3'UTR FOXO3a polymorphism rs4946936 with an increased risk of childhood acute lymphoblastic leukemia in a Chinese population. Cell Physiol Biochem. 2014;34:325–332. 10.1159/000363002 [DOI] [PubMed] [Google Scholar]
  • 14. Roehlen N, Doering C, Hansmann ML, et al. : Vitamin D, FOXO3a, and Sirtuin1 in Hashimoto's Thyroiditis and Differentiated Thyroid Cancer. Front Endocrinol (Lausanne). 2018;9:527. 10.3389/fendo.2018.00527 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15. Tan C, Liu S, Tan S, et al. : Polymorphisms in microRNA target sites of forkhead box O genes are associated with hepatocellular carcinoma. PLoS One. 2015;10:e0119210. 10.1371/journal.pone.0119210 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16. Wardhani SO, Susanti H, Rahayu P, et al. : The Levels of FoxO3a Predict the Failure of Imatinib Mesylate Therapy among Chronic Myeloid Leukemia Patients. Open Access Macedonian J Med Sci. 2021;9:255–259. 10.3889/oamjms.2021.5852 [DOI] [Google Scholar]
  • 17. Wardhani SO, Susanti H, Rahayu P, et al. : Underlying data for 'The association between FOXO3a rs4946936 gene polymorphism and the levels of FOXO3a among chronic granulocytic leukemia patients treated with imatinib mesylate'. Figshare. 2021. 10.6084/m9.figshare.16529160 [DOI] [Google Scholar]
  • 18. Li L: The Role of MicroRNAs in Vitiligo: Regulators and Therapeutic Targets. Ann Dermatol. 2020;32:441–451. 10.5021/ad.2020.32.6.441 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19. Hwang JW, Rajendrasozhan S, Yao H, et al. : FOXO3 deficiency leads to increased susceptibility to cigarette smoke-induced inflammation, airspace enlargement, and chronic obstructive pulmonary disease. J Immunol. 2011;187:987–998. 10.4049/jimmunol.1001861 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20. Imraish A, Abu-Thiab T, Zihlif M: IL-13 and FOXO3 genes polymorphisms regulate IgE levels in asthmatic patients. Biomed Rep. 2021;14:55. 10.3892/br.2021.1431 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21. Uddin SN, Majumder A, Islam KK, et al. : Minimum free energy based evaluation of mRNAs secondary structures constructed by 18 clinically significant exonic single nucleotide polymorphisms (SNPs) and haplotypes of 5 missense SNPs of RB1 gene. Am J Biochemistry Biotechnol. 2015;11:191–199. 10.3844/ajbbsp.2015.191.199 [DOI] [Google Scholar]
  • 22. Salari R, Kimchi-Sarfaty C, Gottesman MM, et al. : Sensitive measurement of single-nucleotide polymorphism-induced changes of RNA conformation: application to disease studies. Nucleic Acids Res. 2013;41:44–53. 10.1093/nar/gks1009 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23. Sionov RV, Vlahopoulos SA, Granot Z: Regulation of Bim in Health and Disease. Oncotarget. 2015;6:23058–23134. 10.18632/oncotarget.5492 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24. Kornblau SM, Singh N, Qiu Y, et al. : Highly phosphorylated FOXO3A is an adverse prognostic factor in acute myeloid leukemia. Clin Cancer Res. 2010;16(6):1865–1874. 10.1158/1078-0432.CCR-09-2551 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 25. Gurnari C, Falconi G, De Bellis E, et al. : The Role of Forkhead Box Proteins in Acute Myeloid Leukemia. Cancers (Basel). 2019;11(6):865. 10.3390/cancers11060865 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 26. Li Y, Wang WJ, Cao H, et al. : Genetic association of FOXO1A and FOXO3A with longevity trait in Han Chinese populations. Hum Mol Genet. 2009;18(24):4897–4904. 10.1093/hmg/ddp459 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 27. Hardiany NS, Paramita R: The mRNA expression of Forkhead box O3a (FOXO3a) as a longevity-associated gene in leucocytes of elderly women. JPMA. The Journal of the Pakistan Medical Association. 2021;71(2):S74–S77. [PubMed] [Google Scholar]
F1000Res. 2022 Apr 12. doi: 10.5256/f1000research.126363.r134582

Reviewer response for version 3

Kazuhito Naka 1

Thank you very much for giving me the opportunity to review the revised manuscript to “F1000Research”. I feel that the authors well answered my concern. Thus, I agree to accept this paper to be indexed on “F1000Research”.

Is the work clearly and accurately presented and does it cite the current literature?

Partly

If applicable, is the statistical analysis and its interpretation appropriate?

I cannot comment. A qualified statistician is required.

Are all the source data underlying the results available to ensure full reproducibility?

No source data required

Is the study design appropriate and is the work technically sound?

Yes

Are the conclusions drawn adequately supported by the results?

Yes

Are sufficient details of methods and analysis provided to allow replication by others?

Yes

Reviewer Expertise:

NA

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

F1000Res. 2022 Apr 7. doi: 10.5256/f1000research.121907.r125948

Reviewer response for version 2

Kazuhito Naka 1

While the authors improved the description, they have not corrected the introduction yet. The authors described that “FOXO3a plays a dominant role in carcinogenesis including cell cycle progression, proliferation, the activation of reactive oxygen species, DNA damage, apoptosis, and tumorigenesis." However, it has been known that FOXO3a is implicated in “cell cycle arrest”, “detoxification of reactive oxygen species”, and “DNA damage repair”. Thus, please correct the descriptions.

Is the work clearly and accurately presented and does it cite the current literature?

Partly

If applicable, is the statistical analysis and its interpretation appropriate?

I cannot comment. A qualified statistician is required.

Are all the source data underlying the results available to ensure full reproducibility?

No source data required

Is the study design appropriate and is the work technically sound?

Yes

Are the conclusions drawn adequately supported by the results?

Yes

Are sufficient details of methods and analysis provided to allow replication by others?

Yes

Reviewer Expertise:

Tyrosine kinase inhibitor (TKI) resistant relapse of chronic myelogenous leukaemia (CML) patients.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

F1000Res. 2022 Apr 8.
Jonny Fajar 1

  1. While the authors improved the description, they have not corrected the introduction yet. The authors described that “FOXO3a plays a dominant role in carcinogenesis including cell cycle progression, proliferation, the activation of reactive oxygen species, DNA damage, apoptosis, and tumorigenesis." However, it has been known that FOXO3a is implicated in “cell cycle arrest”, “detoxification of reactive oxygen species”, and “DNA damage repair”. Thus, please correct the descriptions..

Response: We have revised the above description.

F1000Res. 2022 Mar 2. doi: 10.5256/f1000research.121907.r125947

Reviewer response for version 2

Mardiah Hardianti 1

I found the responses from the authors were sufficient to answer all our questions. I hereby agree for the work to be indexed without any further reservation.

Is the work clearly and accurately presented and does it cite the current literature?

Yes

If applicable, is the statistical analysis and its interpretation appropriate?

Yes

Are all the source data underlying the results available to ensure full reproducibility?

Yes

Is the study design appropriate and is the work technically sound?

Yes

Are the conclusions drawn adequately supported by the results?

Yes

Are sufficient details of methods and analysis provided to allow replication by others?

Yes

Reviewer Expertise:

NA

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

F1000Res. 2022 Feb 10. doi: 10.5256/f1000research.76675.r120814

Reviewer response for version 1

Mardiah Hardianti 1

  1. The idea of this paper is original and highly appreciated. It aimed to elucidate one of the important molecular mechanism of CGL by assessing the target gene polymorphism and its protein FOXO3a. The finding that CC genotype was related to the higher level of FOXO3a which might be related with disease mechanism was explained well by referring to other disease mechanism such as vitiligo and COPD. However, it is still suggested to be explained more in the aspect of molecular mechanism of hematological malignancy. 

  2. Other possible explanations for the uninvolved role of CT or TT polymorphisms in CGL disease mechanism should be explained more rather than just comparing their biochemical aspect to the CC phenotype which stated that CC phenotype produced higher level of FOXO3a protein. Any technical or sampling issues could also be other explanations for this finding. 

  3. Is there any possible extrapolation for disease mechanism from Indonesian population regarding CC phenotype findings in this study? Please explain either when the answer is yes or no. 

Is the work clearly and accurately presented and does it cite the current literature?

Yes

If applicable, is the statistical analysis and its interpretation appropriate?

Yes

Are all the source data underlying the results available to ensure full reproducibility?

Yes

Is the study design appropriate and is the work technically sound?

Yes

Are the conclusions drawn adequately supported by the results?

Yes

Are sufficient details of methods and analysis provided to allow replication by others?

Yes

Reviewer Expertise:

Molecular mechanism of cancer

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

F1000Res. 2022 Feb 27.
Jonny Fajar 1

Reviewer2

1. The idea of this paper is original and highly appreciated. It aimed to elucidate one of the important molecular mechanism of CGL by assessing the target gene polymorphism and its protein FOXO3a. The finding that CC genotype was related to the higher level of FOXO3a which might be related with disease mechanism was explained well by referring to other disease mechanism such as vitiligo and COPD. However, it is still suggested to be explained more in the aspect of molecular mechanism of hematological malignancy.

Response: The additional explanation on the possible role of FOXO3a in the context of hematological malignancy has been provided.

2. Other possible explanations for the uninvolved role of CT or TT polymorphisms in CGL disease mechanism should be explained more rather than just comparing their biochemical aspect to the CC phenotype which stated that CC phenotype produced higher level of FOXO3a protein. Any technical or sampling issues could also be other explanations for this finding.

Response: The explanation regarding the possible reason why CC genotype may associate with the higher production of FOXO3a levels compared to CT and TT genotypes has been provided in the discussion paragraph 2 (the possible association between the genotype and free energy levels).

3. Is there any possible extrapolation for disease mechanism from Indonesian population regarding CC phenotype findings in this study? Please explain either when the answer is yes or no.

Response: The additional explanation on the possible gene – environment interaction including Indonesian population has been provided.

F1000Res. 2022 Jan 13. doi: 10.5256/f1000research.76675.r118690

Reviewer response for version 1

Kazuhito Naka 1

In the valuable manuscript, the authors investigated association between FOXO3a polymorphism and the levels of FOXO3a in serum from chronic granulocytic leukemia (CGL) patients after treatment with imatinib mesylate. They indicated that the CC, CT, and TT genotypes of the FOXO3a rs4946936 gene polymorphism were 35.0%, 48.3%, and 16.7%, respectively. Interestingly, the levels of FOXO3a were elevated in the CGL patients with CC genotype of the FOXO3a rs4946936 gene than those with the CT and TT genotypes. Collectively, the authors concluded that the CC genotype of the FOXO3a rs4946936 gene polymorphism affects the elevated levels the FOXO3a in CGL patients treated with imatinib mesylate.

Major points

In table 2, it is difficult to understand what it means, while it indicates important findings in this study. Probably, first “Mean” reveals the expression levels of FOXO3a. But, I cannot understand the second “Mean”. Please explain each “Mean”. I strongly recommend that the authors reveal the data as “bar graphs” rather than table. It helps the understanding of a wide variety of readers.

I understood the authors' findings that the CC genotype of the FOXO3a rs4946936 gene polymorphism appears to be correlated with the expression of FOXO3a in the serum of CGL patients treated with imatinib mesylate. However, the authors should indicate clinical significance of the genotype. For example, they should compare the therapeutic effects of imatinib mesylate between the CC genotype and CT and TT genotypes, such as IS of BCR-ABL1 or deep molecular response (DMR) patients. They should also indicate whether or not the levels of FOXO3a in the CC genotypes are elevated post-imatinib administration than pre-imatinib therapy. These data may contribute to predict the therapeutic effect of imatinib mesylate in the patients.

Minor point

In the introduction, the authors described that “FOXO3a plays a dominant role in carcinogenesis including cell cycle progression, proliferation, the activation of reactive oxygen species, DNA damage, apoptosis, and tumorigenesis." However, it has been known that FOXO3a is implicated in “cell cycle arrest”, “detoxification of reactive oxygen species”, and “DNA damage repair”. Thus, please correct the descriptions.

Is the work clearly and accurately presented and does it cite the current literature?

Partly

If applicable, is the statistical analysis and its interpretation appropriate?

I cannot comment. A qualified statistician is required.

Are all the source data underlying the results available to ensure full reproducibility?

No source data required

Is the study design appropriate and is the work technically sound?

Yes

Are the conclusions drawn adequately supported by the results?

Yes

Are sufficient details of methods and analysis provided to allow replication by others?

Yes

Reviewer Expertise:

Tyrosine kinase inhibitor (TKI) resistant relapse of chronic myelogenous leukaemia (CML) patients.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

F1000Res. 2022 Feb 27.
Jonny Fajar 1

Reviewer1

1. In table 2, it is difficult to understand what it means, while it indicates important findings in this study. Probably, first “Mean” reveals the expression levels of FOXO3a. But, I cannot understand the second “Mean”. Please explain each “Mean”. I strongly recommend that the authors reveal the data as “bar graphs” rather than table. It helps the understanding of a wide variety of readers.

Response: We have provided Figure 2 instead of Table 2, as suggested by reviewer.

2. I understood the authors' findings that the CC genotype of the FOXO3a rs4946936 gene polymorphism appears to be correlated with the expression of FOXO3a in the serum of CGL patients treated with imatinib mesylate. However, the authors should indicate clinical significance of the genotype. For example, they should compare the therapeutic effects of imatinib mesylate between the CC genotype and CT and TT genotypes, such as IS of BCR-ABL1 or deep molecular response (DMR) patients. They should also indicate whether or not the levels of FOXO3a in the CC genotypes are elevated post-imatinib administration than pre-imatinib therapy. These data may contribute to predict the therapeutic effect of imatinib mesylate in the patients.

Response: In our present study, we did not compare the levels of FOXO3 between pre and post imatinib treatment. Therefore, we could not provide the holistic information regarding those comparison. However, we have added the additional discussion about the proposed effect of FOXO3a levels and the treatment of imatinib.

3. In the introduction, the authors described that “FOXO3a plays a dominant role in carcinogenesis including cell cycle progression, proliferation, the activation of reactive oxygen species, DNA damage, apoptosis, and tumorigenesis." However, it has been known that FOXO3a is implicated in “cell cycle arrest”, “detoxification of reactive oxygen species”, and “DNA damage repair”. Thus, please correct the descriptions.

Response: The above description has been revised.

Associated Data

    This section collects any data citations, data availability statements, or supplementary materials included in this article.

    Data Availability Statement

    Underlying data

    Figshare: Underlying data for ‘The association between FOXO3a rs4946936 gene polymorphism and the levels of FOXO3a among chronic granulocytic leukemia patients treated with imatinib mesylate’, https://doi.org/10.6084/m9.figshare.16529160. 17

    This project contains the following underlying data:

    • Data file.xlsx

    • Gel electrophoresis.pdf


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