Hypoxia is a hallmark of cancer and hematopoietic niche that maintains proliferation of cells. Hypoxia modulates cell cycle, transcriptome and cellular metabolism. The metabolic response to hypoxia results in shift of ATP production to glycolysis and lactic acid fermentation at the expense of oxidative phosphorylation [
22]. In this study, we aimed to describe how oncogenic miR-155 influences CLL cells in hypoxia in the term of transcriptome, miRNOme and metabolom. In general, there is not a uniform and exact opinion among researchers on the oxygen level (percentage) in the leukemic niche and its application for in vitro conditions in laboratory. From literature is known that oxygen level in normal tissues varies between 1 and 11 % and in tumor is below 2 % [
21]. The B-cells are characterized by intensive migration and circulation in our body, from blood stream with kvasi normoxia into tissues (spleen, lymph nodes) with different hypoxia level [
23]. In line with this Koczula KM et al, 2016 performed detailed analysis of oxygen level in CLL cells in vivo by NMR technique [
5]. Further, they find out that CLL cells are very flexible to oxygen level and could rapidly adapt by modulating their transcriptome and metabolome [
5]. The main message of this great work with primary CLL cells points on very heterogeneous oxygen level in our body and extreme plasticity of CLL cells. CLL cells migrate (blood stream, lymph nodes, spleen, bone marrow) from almost normoxia in the circulating blood into lymph nodes where is above 3 % of O2. In order to determine the best range of oxygen level concentrations to be used in further experiments, we optimized the oxygen levels (0.2 %, 1 % and 5 %) and time points (24 h - 120 h) (
Figure 1A,B). Based on the highest expression level of hypoxia-related genes as LDHA, EGLN1 and GLUT1, GLUT3 and the lowest expression of pro-apoptotic gene TP53INP1 we find out as the best in vitro hypoxia condition at 1 % oxygen and in the period of 24 and 48 h (
Figure 1C). Similarly, Koczula KM et al, 2016 confirmed hypoxia by overexpression of mRNAs of LDHA, VEGF and GLUT1 in primary CLL cells [
5]. In the blood stream, the CLL cells are used to hypoxia and characterized by high HIF-1α expression when entering into lymphoid tissues [
5]. In lymphoid tissues the CLL cells by its interaction with accessory cells, usually stromal cells, are constantly supplied by essential signals for their survival and proliferation that contribute to drug resistance and apoptosis [
24]. The HIF-1α expression is induced also by PI3K and ERK mitogen-activated protein kinase (MAPK) signaling in stromal cells [
25]. Surprisingly, we were not able to detect increased level of HIF1α at mRNA (
Figure 1C) and at the protein level (Supplemental
Figure S1). We assume that it could be due to the increased level of EGLN1, PI3K3CA and low level of VHL as this are the key regulators of HIF1α and direct targets of miR-155. Hypoxia modulates besides transcription factors and other molecules also microRNAs, which react by their extreme expression. Among the well-described hypoxamiRNAs belongs miR-210 [
10]. MEC-1 cells react on hypoxia with elevated level of miR-210 that is in concordance with others ([
10] and reviewed in [
26]). Another reason why we were not able to detect HIF1α could be its replacement by HIF-2 signaling after longer exposure of cells to hypoxia [
10]. Hypoxia condition could be induced experimentally by using different methods and molecules [
27]. To validate the in vitro hypoxia accomplished in the hypoxic flow box we induced hypoxia in CLL (MEC-1) cells chemically. Thus, MEC-1 cells were treated with 2-OG analogue, dimethyloxalylglycine (DMOG), a competitive inhibitor of prolyl hydroxylase domain-containing proteins and with deferoxamine mesylate salt (DFO), an iron-chelating agent, both for 3, 6 h and 24 h (
Figure 3). Both chemicals significantly induced hypoxia in vitro in similar actions. Surprisingly chemically induced hypoxia results in stronger expression of hypoxia-related genes as EGLN1, VEGF, HK2 and GLUT3 (
Figure 3A) with relatively low level of apoptosis (
Figure 3B). This is in accordance with others as mentioned in [
28]. Low level of apoptosis is likely caused by pro-apoptotic and anti-apoptotic biphasic effects that appear during hypoxia and seems to be dependent upon cell types and their microenvironment. Increased cell proliferation in hypoxia especially cancer cells is common hallmark. Under normal conditions, cell proliferation decreases by low oxygen level or stress. In addition, overexpression of HIF-1α results in cell cycle arrest in normal cells (lymphocytes, keratinocytes, embryonic stem cells, and hematopoietic stem cells) [
29]. However, the opposite situation happens in the malignant cells. In general, malignant cells proliferate in high rate and express high levels of HIF-1α not only due to hypoxia but also due to deregulated signaling pathways that increase their survival [
9]. Here we detected significantly higher proliferation rate of MEC-1 cells in hypoxia depending on the presence of miR-155 (
Figure 2A,B) and accompanied by relatively low apoptosis (
Figure 2C). One of the potential explanation could be deregulation of HIF-dependent miRNA regulatory network. Overexpression of HIF-1α induces the expression of oncomiRNAs in malignant cells [
9]. Sawai and colleagues selected 17 hypoxia related miRNAs (hypoxamiRNAs) in solid tumors, among them also miR-155 and miR-210. Similarly, these miRNAs were significantly changed in our MEC-1 cells (
Figure 1C and
Figure 3A). MiR-155 represents the key oncomiRNA and with its several combined roles in preventing apoptosis, modulated gene expression, blocking the phosphorylation of glucose, promotes many cancers and leukemia’s [
11]. There is evidence that miR-155 actively involves in the glucose metabolism in breast cancer, concretely deletion of miR-155 abolishes the glucose uptake [
7]. This is in line with our data, as MEC-1 cells reacts on the hypoxia by increased glucose uptake, more intensively in the presence of miR-155 (
Figure 4). Next, direct target of miR-155 is HK2 (hexokinase 2; by current MiRTarBase) which phosphorylates glucose, thereby committing it to the glycolytic pathway. This is another evidence that glucose metabolism is controlled by miR-155. We detected increased level of HK2 in miR-155 deficient MEC-1 cells (
Figure 1C and
Figure 3A). On the contrary to glucose metabolism, absence of miR-155 increased lactate production in MEC-1 cells in hypoxia (
Figure 4). This notion is in accordance with experiments performed on primary CLL cells, where the production of lactate was inversely correlated with glucose consumption [
5].
To conclude, CLL cells dispose with high flexibility to adapt on the different oxygen levels by using coordinated changes in the transcriptome and metabolome. One possible mechanism of this adaptation could be through upregulation of glucose transporters (e.g. GLUT3) mediated by miR-155 downregulation