Abstract
Imatinib mesylate, a Bcr-Abl kinase inhibitor, has been very successful in the treatment of chronic myelogenous leukemia (CML). However, the majority of patients achieving cytogenetic remissions with imatinib treatment have molecular evidence of persistent disease, and residual BCR/ABL+ progenitors can be detected. There is a need to develop new approaches that enhance elimination of malignant progenitors in imatinib-treated patients. Here we show that CML CD34+ progenitors are sensitive to several apoptosis-inducing stimuli including the chemotherapeutic agents Ara-C and VP-16, radiation, arsenic trioxide, ceramide, growth factor withdrawal, and the death receptor activators TNFα and TRAIL. Bcr-Abl kinase inhibition by imatinib did not enhance sensitivity of CML progenitors to Ara-C, VP-16, ceramide, radiation or TRAIL-induced apoptosis but did enhance arsenic and TNFα-induced apoptosis. We further demonstrate that apoptosis was restricted to dividing cells, whereas nonproliferating BCR/ABL+ CD34+ cells were resistant to apoptosis induced by imatinib, Ara-C or arsenic, either alone or in combination. Resistance of quiescent CML progenitors to imatinib-induced apoptosis could contribute to persistence of residual malignant progenitors in imatinib-treated patients. Combination treatment with Ara-C or arsenic may not enhance targeting of nonproliferating CML progenitors. The assay described here may be useful for identifying agents targeting quiescent CML progenitors.
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Acknowledgements
We would like to thank Lucy Brown and Claude Spalla of the Analytical Cytometry Core for assistance with cell sorting and Dr Marilyn L Slovak and Bill Poehner of the Cytogenetics Core Laboratory for FISH analysis. In addition, we are indebted to Tinisha McDonald for sample processing, Helen Xu for Q-PCR analysis, and Allen Lin and the physicians and staff in Division of Hematology/HCT for assistance with patient samples. This work was supported in part by NIH Grant R01 CA95684, Translational Research Grant 6468 (Leukemia and Lymphoma Society) and General Clinical Research Center Grant #5M01 RR00043. Ravi Bhatia is a Clinical Scholar of the Leukemia and Lymphoma Society.
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Holtz, M., Forman, S. & Bhatia, R. Nonproliferating CML CD34+ progenitors are resistant to apoptosis induced by a wide range of proapoptotic stimuli. Leukemia 19, 1034–1041 (2005). https://doi.org/10.1038/sj.leu.2403724
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DOI: https://doi.org/10.1038/sj.leu.2403724
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