The bcr-abl gene in chronic myelogenous leukaemia

The observation made over 30 years ago that the Philadelphia chromosome is present in nearly all patients with CML led to the identification of a novel fusion gene bcr-abl. In the past few years, the biochemical and biological properties of bcr-abl have been extensively explored. Bcr sequences appear to activate c-abl for transformation by binding to the SH2 domain of c-abl in an intramolecular interaction, presumably interfering with the adjacent SH3 regulatory domain. Upon introduction into bone marrow cells, bcr-abl can cause acute or chronic leukaemias in mice and can stimulate the growth of many cell types, including multipotent stem cells, in vitro. Although their growth is stimulated, these cells are not fully malignant blastic leukaemias. The molecular events that occur during the progression to blast crisis of CML remain largely undefined, but existing animal models and in vitro culture systems will be useful for identifying or testing candidate genes. The study of tyrosine kinase oncogenes in general will probably lead to the identification of relevant bcr-abl substrates. The elucidation of these molecules as well as more downstream events in the bcr-abl signalling pathway offers the hope for novel therapeutic interventions to control Philadelphia chromosome leukaemias.