title: Down-regulation of bcl-2 in AML blasts by all-trans retinoic acid and its relationship to CD34 antigen expression.
abstract: High levels of expression of the bcl-2 oncoprotein in acute myeloblastic leukaemia (AML) cells have been associated with low complete remission rates and poor survival. The sensitivity of AML blasts to drugs such as Ara-C can be increased by the down-regulation of bcl-2 expression by antisense oligonucleotides. All-trans retinoic acid (ATRA) has been reported to increase the sensitivity of AML cell lines to Ara-C and to induce differentiation in the HL60 promyelocytic cell line, with both effects being accompanied by a decrease in bcl-2 expression. Using flow cytometry and a monoclonal antibody to bcl-2, we have investigated the effects of ATRA (1 microM) on bcl-2 expression in the blast cells of 25 AML patients and the K562 cell line after incubation for 72 or 24 h, respectively. Using Kolmogorov-Smirnov statistical analysis where a D value of > 0.12 was statistically significant, we found that in 8/25 AML samples and the K562 cells there was a significant decrease in bcl-2 protein expression after incubation with ATRA (D value range 0.14-0.44). The mean peak fluorescence (MPF) values for the bcl-2 levels of the ATRA responders (n = 8) was reduced to 35.5 +/- 6.9 following incubation with ATRA compared to 47.6 +/- 8.2 (mean +/- SEM) for control samples incubated in the absence of ATRA (P = 0.014). There was no significant difference between the baseline bcl-2 molecules of equivalent soluble fluorochrome (MESF) levels in the ATRA responders (48.9 +/- 5.7, n = 8) and the non-responders (41.3 +/- 3.9, n = 17) (mean +/- SEM) (P = 0.28). The down-regulation of bcl-2 expression by ATRA was particularly associated with CD34-negative AML and of the eight AML patients' cells that responded to ATRA by down-regulating bcl-2, seven were CD34 negative (P < 0.05). Our data suggest that the addition of ATRA to combination chemotherapy would increase the chemosensitivity of some patients with AML, particularly CD34-negative AML, due to down-regulation of bcl-2 expression.
authors.affiliation: Department of Haematology, Nottingham City Hospital.
authors.forename: D A
authors.initials: DA
authors.lastname: Bradbury
authors.forename: S
authors.initials: S
authors.lastname: Aldington
authors.forename: Y M
authors.initials: YM
authors.lastname: Zhu
authors.forename: N H
authors.initials: NH
authors.lastname: Russell
mesh_terms: D018952:Antigens, CD34 / Q000378:metabolism*; D015536:Down-Regulation; D019254:Genes, bcl-2 / Q000187:drug effects*; D018922:HL-60 Cells; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000378:metabolism*; D014212:Tretinoin / Q000494:pharmacology*
chemical_list: D018952:Antigens, CD34; D014212:Tretinoin