In
Phase I of our two-phase strategy to characterize epigenetic phenomena in DLBCL, we measured DNA methylation levels in seven ABC-DLBCL and seven GCB-DLBCL tumors using CpG island microarray assays
12, 16, 17 (). This provided a rapid means of evaluating the methylation-dependent cleavage of 442 unique gene-associated CpG islands by McrBC endonuclease (
Supplementary Table 1 and
Supplementary Figure 2). Due to the semi-quantitative nature of CpG island microarray-based analyses,
18 we validated selected results using MethyLight, a quantitative bisulfite PCR platform ().
15, 19 | Table 1Summary of Phase I and Phase II analyses to identify DLBCL subtype-specific methylation |
Based on our
Phase I CpG island microarray analyses, fifteen candidate CpG islands revealed differences in methylation between subtypes of DLBCL (uncorrected Wilcoxon
P < 0.05 and greater than 5% difference in median methylation levels) ( and
Supplementary Table 1). We used modest criteria to identify differential methylation since cross-hybridization of CpG island sequences can artificially compress methylation estimates. In our
Phase I confirmatory analyses, we developed novel MethyLight assays for each of these fifteen candidate CpG islands and interrogated their methylation levels in the same group of fourteen DLBCL ( and
Supplementary Table 4). The methylation levels of six (
CPVL,
FLJ21062,
GNMT,
HOXC9,
ONECUT2, and
PRIMA1) of these fifteen CpG islands showed PMR (percentage of methylated reference) values greater than ten in more than one tumor. Interestingly, based on an uncorrected Wilcoxon signed-rank test, MethyLight assays for
FLJ21062 (HB-442,
P = 0.009),
GNMT (HB-426,
P = 0.005), and
ONECUT2 (HB-242,
P = 0.018; HB-446,
P = 0.025) showed differences between ABC-DLBCL and GCB-DLBCL (). The results from all replicate experiments were in excellent agreement (
Supplementary Table 4).
The fact that nine (CEBPG, CENPH, HTRA4, KHL14, NOSAP1, PFDN5, PHC2, TP53I11, and ZNF615) of fifteen CpG islands demonstrate methylation in DLBCL by CpG island microarray assays, but not by MethyLight, partially reflects fundamental differences in these platforms. Based on the McrBC endonuclease recognition sequence, our microarray assays can score a CpG island as being methylated if it contains at least two 5-methylcytosines that are between forty bases and thirty kilobases apart. In contrast, our MethyLight assays are designed to only score CpG islands as being methylated if they contain an average of eight closely spaced 5-methylcytosines. This highlights the complex nature of methylation within individual CpG islands and the advantages of using complimentary technologies to evaluate their status. Importantly, the CpG island microarrays succeeded in rapidly identifying viable candidates for confirmation using more quantitative methods.
In our
Phase II studies, we analyzed the DNA methylation status of a focused group of CpG islands proximal to genes whose methylation status is either known or suspected to be associated with the development and progression of cancer (). We first surveyed the methylation levels of 217 unique CpG island sequences in two ABC-DLBCL and three GCB-DLBCL using pre-existing MethyLight assays. We identified 80 unique CpG islands with at least moderate differences in methylation levels among these five randomly selected DLBCL (i.e. coefficient of variation greater than 5%) (
Supplementary Table 5). Next, we analyzed the DNA methylation levels of these 80 CpG islands in the fourteen DLBCL from the Phase I study. Twelve CpG islands (
AR,
CDKN1C,
DLC1,
DRD2,
GATA4,
GDNF,
GRIN2B,
MTHFR,
MYOD1,
NEUROD1,
ONECUT2, and
TFAP2A) showed substantial methylation (PMR>20) in over 85% of the samples (
Supplementary Table 6). Furthermore, seven CpG islands previously reported to be methylated in DLBCL (
AR,
20 CDKN2B (aka
TP15),
21 CDKN2A (aka
p16INK4),
21, 22 CYP27B1,
11 DLC1,
11 MGMT,
23-26 and
RARB (aka
RARβ2)
11) showed substantial methylation (PMR>20) in at least one tumor. However, note that the methylation status of AR could be influenced by gender since it is located on the X chromosome and subject to inactivation in females.
The ABC-DLBCL and GCB-DLBCL subtypes could not be discerned based on hierarchical clustering analysis of our Phase II MethyLight data (). However, this was not unexpected given that these subtypes also could not be discerned based on hierarchical clustering analysis of gene expression data for these same CpG islands (). Nevertheless, we identified six (CYP27B1, DRD1, KL, MINT2, NEUROG1, and ONECUT2) CpG islands in these Phase II analyses that showed subtype-specific differences in methylation levels (uncorrected Wilcoxon signed-rank test P<0.05 and >10 unit difference in median PMR) ().
In preliminary confirmatory studies, we conducted MethyLight analyses of eight candidate CpG islands (
FLJ21062,
GNMT,
ONECUT2, CYP27B1,
DRD1,
KL,
MINT2, and
NEUROG1) identified by our Phase I and/or Phase II analyses as having subtype-specific methylation levels on a new test group of fourteen ABC-DLBCL, seventeen GCB-DLBCL, and six normal peripheral blood lymphocytes (PBLs) (,
Supplementary Table 7). When we pooled all MethyLight data conducted on these eight CpG islands (i.e. data from twenty-one ABC-DLBCL and twenty-four GCB-DLBCL cases), only the
FLJ21062 (HB-442, ABC-DLBCL median PMR= 0, GCB-DLBCL median PMR = 27.6,
P = 0.001) and
ONECUT2 (HB-446, median ABC-DLBCL PMR = 67.7, median GCB-DLBCL PMR = 46.8,
P = 0.012) MethyLight reactions showed differences between the DLBCL subtypes (
Supplementary Table 7). When considering MethyLight data only from the new test group of fourteen ABC-DLBCL and seventeen GCB-DLBCL, only
FLJ21062 (HB-442, ABC-DLBCL median PMR= 4.6, GCB-DLBCL median PMR = 28.0,
P = 0.025) showed a difference between the DLCBL subtypes (
Supplementary Table 7). Thus, the CpG island proximal to
FLJ21062 is a more promising candidate for having subtype-specific methylation levels than the CpG island proximal to
ONECUT2. Larger-scale validation studies of
ONECUT2 and
FLJ21062 CpG island methylation levels in DLBCL are warranted in order to rigorously address questions concerning their subtype-specificity. Lastly, the MethyLight assays for
ONECUT2 and
FLJ21062 displayed little DNA methylation in the six normal PBLs (i.e. PMR<5 in all cases).
To further elucidate the nature of DNA methylation in the
ONECUT2 and
FLJ21062 CpG islands, we performed bisulfite sequencing analysis of these CpG islands in four ABC-DLBCL, four GCB-DLBCL, and two normal PBL (, , and
Supplementary Figure 3). Overall, bisulfite sequencing of
ONECUT2 and
FLJ21062 CpG island subclones (average twenty-five per case) yielded results that are in excellent agreement with the MethyLight PMR values (). While the methylation status of CpG dinucleotides centered within these two islands reflected an all-or-none phenomenon, the status of CpG dinucleotides on their edges was less reflective of the status of the island as a whole ( and
Supplementary Figure 3).
| Table 2Confirmatory bisulfite sequencing analyses |
Next, we investigated the relationships between DNA methylation and expression levels of
ONECUT2,
FLJ21062, and other genes in DLBCL. We were able to compare MethyLight PMR values and oligonucleotide microarray-based gene expression values for 67 genes in thirteen DLBCL (see ,
Supplementary Table 3, and
Supplementary Figure 4, where one hundred thirty-four plots are provided that reflect multiple gene expression probe tilings and/or MethyLight reactions for some genes). A total of 39 CpG islands proximal (i.e. within 500-bp in either direction) to the transcription start site of genes showed sufficient variation in PMR values among our DLBCL to justify comment (i.e. greater than twenty unit difference in the second lowest and second highest PMR). For 32 of 39 (82%) of these CpG islands (including
ONECUT2), increasing levels of DNA methylation did not result in proportional decreases in gene expression. This was influenced by the fact that genes proximal to CpG islands often showed weak or modest expression (i.e. every log
2 expression score was below seven units) regardless of methylation level (e.g.
CALCA,
CDX1,
DRD1,
GABRA2,
GATA3,
GNMT,
KL,
LDLR,
MTHFR,
NEUROD1,
NOS1AP,
ONECUT2,
TFPI2, and
TWIST1) (
Supplemental Figure 4). It is possible that such genes are strongly expressed in normal precursor cells, but are silenced in all DLCBL via genetic and/or epigenetic mechanisms. Alternatively, such genes could be weakly or modestly expressed in normal precursor cells prior to methylation incurred during the development of cancer. The latter possibility would be consistent with a study showing that 69% (118/170) of genes that are methylated in colon tumor samples are expressed at low levels in normal colon as well as in colorectal adenocarcinomas.
27 Overall, we favor the interpretation that DNA methylation is not frequently involved in initiating the silencing of highly expressed genes.
It should also be noted that specific probe tilings for
DLC1,
GATA4,
NKD2, and
RARRES1 indicated at least modest expression levels (i.e. log
2 expression score above eight units) even when CpG islands located within 500-bp (in either direction) of their transcription start sites had PMR values greater than 80 units. There are many possible explanations for these observations. For example, we may not be interrogating CpG islands or CpG dinucleotides relevant to the transcriptional regulation of the transcripts pertaining to these probe tilings. Alternatively, if copies of these genes proximal to the residual unmethylated CpG islands were highly expressed, the gene silencing signature associated with methylated CpG islands could be masked. More intriguingly, it is formally possible that these methylated CpG islands are not attracting the appropriate cadre of factors responsible for methylation-associated gene silencing. This could be meaningful given that the relationship of the various nucleic and protein components (e.g. histone modifications
28) involved in epigenetic gene silencing have still not been fully defined.
Nevertheless,
BNIP3,
MGMT,
RBP1,
GATA4,
IGSF4,
CRABP1, and
FLJ21062 showed significant (Benjamini-Hochberg corrected
P<0.05; see
Supplementary Table 8) trends for decreasing gene expression with increasing levels of DNA methylation (). These represent candidate genes for which the DNA methylation levels of a proximal CpG island is associated with gene silencing in DLBCL. However, some observations (e.g.
FLJ21062) could be influenced by experimental noise associated with measuring the abundance of rare transcripts. Nevertheless studies involving the demethylating agent 5-aza-2′-deoxycytidine demonstrate that
BNIP3,
29 MGMT,
30 RBP1 (aka
CRBP1),
31 GATA4,
32 IGSF4 (aka
TSLC1),
33 and
CRABP134 expression are dependent upon CpG island methylation status in various cancer cell culture models.
Next, we examined the expression of the seven (
BNIP3,
MGMT,
RBP1,
GATA4,
IGSF4,
CRABP1, and
FLJ21062) candidates as well as the twelve frequently methylated CpG islands (
AR,
CDKN1C,
DLC1,
DRD2,
GATA4,
GDNF,
GRIN2B,
MTHFR,
MYOD1,
NEUROD1,
ONECUT2, and
TFAP2A) in two tonsils and two peripheral blood CD19
+ B-cell preparations (
Supplementary Table 9). This data derives from published gene expression analyses (
http://wombat.gnf.org/index.html).
35 Four candidate genes (i.e.
BNIP3,
MGMT,
RBP1,
IGSF4) showing decreased expression with increasing methylation in tumors were expressed at ≥0.5% of tonsillar
β-actin transcript levels. In addition, two of the seven candidate genes (
MGMT and
IGSF4) were expressed at ≥0.5% of
β-actin transcript levels in CD19
+ B-cells. Meanwhile, five of the frequently methylated genes (i.e.
AR,
CDKN1C,
DRD2,
GRIN2B, and
TFAP2A) were expressed at ≥0.5% of tonsillar
β-actin transcript levels. However, only one (
DRD2) of the frequently methylated genes met that same criteria in CD19
+ B-cells. None of the eighteen unique genes discussed above were expressed at >1.2% of
β-actin levels in tonsils or CD19
+ B-cells. Although microarray-based comparisons of transcript levels within a single sample should be viewed with caution, we conclude that both the candidate genes showing decreased expression with increasing methylation and the frequently methylated genes in DLBCL are already expressed at low to modest levels in normal B-cells.
Lastly, we compared
ONECUT2 expression levels in GCB-DLCBL and ABC-DLCBL with those from normal PBLs and liver using quantitative PCR (qPCR) (
Supplementary Table 10). In agreement with our microarray-based gene expression analyses (
Supplementary Table 3),
ONECUT2 was expressed at low levels in four ABC-DLCBL and two GCB-DLBCL samples. However,
ONECUT2 expression was not detected in the four normal PBLs. This suggests that hypermethylation of this CpG island would not affect
ONECUT2 expression in a normal lymphocyte sample.
Overall, our epigenetic and genetic analyses have uncovered candidate genes that could warrant further investigation into their functional roles in the development of DLBCL and potential as biomarkers for early detection of disease recurrence. Interesting, the frequently methylated CpG islands we uncovered in DLBCL such as
CDKN1C,
DLC1,
DRD2,
GATA4,
GDNF,
GRIN2B,
MTHFR,
MYOD1,
NEUROD1,
ONECUT2, and
TFAP2A have been reported to be hypermethylated in cancers outside of DLBCL. This could reflect their status as known or suspected tumor suppressor genes that affect pathways common to multiple cancers. However, it is also possible these genes are not functionally relevant to DLBCL, but are simply located in hypermethylated chromosomal blocks that could contain one or more tumor suppressor genes directly relevant to DLBCL. Recently, hypermethylated chromosomal blocks have been detected in colorectal cancer
36 and acute lymphoblastic leukemia (ALL)
37. The continued development of technologies for genome-wide DNA methylation analyses is needed to address fundamental questions concerning nature and relevance of hypermethylated chromosome blocks in the development and progression of cancer.
Lastly, the DNA methylation levels observed for specific CpG islands suggest there is considerable epigenetic heterogeneity within the tumors analyzed. This could be related to histological heterogeneity (e.g. levels of tumor-infiltrating immune cells
38) or the heterogeneity of cancer cell populations comprising these tumors. Regardless of its origin, epigenetic heterogeneity could confound comparisons of gene expression and methylation profiles. This highlights the value of focusing on individual or limited numbers of cells in cancer genome and epigenome projects. The development of high-throughput DNA methylation profiling technologies that require limited starting materials would facilitate the identification of clinical biomarkers and accelerate studies aimed at defining the roles epigenetic phenomena play in the etiology of different cancers.