Abstract
Abundant bone marrow angiogenesis is present in almost all myeloma patients requiring therapy and correlated to treatment response and survival. We assessed the expression of 402 angiogenesis associated genes by Affymetrix DNA microarrays in 466 samples including CD138-purified myeloma cells (MMCs) from 300 previously untreated patients, in vivo microcirculation by dynamic contrast-enhanced magnetic resonance imaging, and in vitro angiogenesis (AngioKit-assay). Normal bone marrow plasma cells (BMPCs) express a median of 39 pro- (e.g. VEGFA, ADM, IGF-1) and 28 anti-angiogenic genes (e.g. TIMP1, TIMP2). Supernatants of BMPCs unlike those of memory B-cells induce angiogenesis in vitro. MMCs do not show a significantly higher median number of expressed pro- (45) or anti-angiogenic (31) genes, but 97 % of MMC samples aberrantly express at least one of the angiogenic factors HGF, IL-15, ANG, APRIL, CTGF or TGFA. Supernatants of MMCs and human myeloma cell lines induce significantly higher in vitro angiogenesis compared to BMPCs. In conclusion, BMPCs express a surplus of pro- over anti-angiogenic genes transmitting to the ability to induce in vitro angiogenesis. Aberrant expression of pro- and down-regulation of anti-angiogenic genes by MMCs further increases the angiogenic stimulus, together leading to bone marrow angiogenesis at varying degrees in all myeloma patients.