title: Arsenic trioxide as an inducer of apoptosis and loss of PML/RAR alpha protein in acute promyelocytic leukemia cells.
abstract: BACKGROUND
  Retinoids, which are derivatives of vitamin A, induce differentiation of acute promyelocytic leukemia (APL) cells in vitro and in patients. However, APL cells develop resistance to retinoic acid treatment. Arsenic trioxide (As2O3) can induce clinical remission in patients with APL, including those who have relapsed after retinoic acid treatment, by inducing apoptosis (programmed cell death) of the leukemia cells. In this study, we investigated the molecular mechanisms by which As2O3 induces apoptosis in retinoic acid-sensitive NB4 APL cells, in retinoic acid-resistant derivatives of these cells, and in fresh leukemia cells from patients.
  
  
  METHODS
  Apoptosis was assessed by means of DNA fragmentation analyses, TUNEL assays (i.e., deoxyuridine triphosphate labeling of DNA nicks with terminal deoxynucleotidyl transferase), and flow cytometry. Expression of the PML/RAR alpha fusion protein in leukemia cells was assessed by means of western blotting, ligand binding, and immunohistochemistry. Northern blotting and ribonuclease protection assays were used to evaluate changes in gene expression in response to retinoic acid and As2O3 treatment.
  
  
  CONCLUSIONS
  As2O3 induces apoptosis without differentiation in retinoic acid-sensitive and retinoic acid-resistant APL cells at concentrations that are achievable in patients. As2O3 induces loss of the PML/RAR alpha fusion protein in NB4 cells, in retinoic-acid resistant cells derived from them, in fresh APL cells from patients, and in non-APL cells transfected to express this protein. As2O3 and retinoic acid induce different patterns of gene regulation, and they inhibit the phenotypes induced by each other. Understanding the molecular basis of these differences in the effects of As2O3 and retinoic acid may guide the clinical use of arsenic compounds and provide insights into the management of leukemias that do not respond to retinoic acid.
authors.affiliation: Lady Davis Institute for Medical Research, Sir Mortimer B. Davis Jewish General Hospital and McGill University, Department of Oncology, Montréal, Québec, Canada.
authors.forename: W
authors.initials: W
authors.lastname: Shao
authors.forename: M
authors.initials: M
authors.lastname: Fanelli
authors.forename: F F
authors.initials: FF
authors.lastname: Ferrara
authors.forename: R
authors.initials: R
authors.lastname: Riccioni
authors.forename: A
authors.initials: A
authors.lastname: Rosenauer
authors.forename: K
authors.initials: K
authors.lastname: Davison
authors.forename: W W
authors.initials: WW
authors.lastname: Lamph
authors.forename: S
authors.initials: S
authors.lastname: Waxman
authors.forename: P G
authors.initials: PG
authors.lastname: Pelicci
authors.forename: F
authors.initials: F
authors.lastname: Lo Coco
authors.forename: G
authors.initials: G
authors.lastname: Avvisati
authors.forename: U
authors.initials: U
authors.lastname: Testa
authors.forename: C
authors.initials: C
authors.lastname: Peschle
authors.forename: C
authors.initials: C
authors.lastname: Gambacorti-Passerini
authors.forename: C
authors.initials: C
authors.lastname: Nervi
authors.forename: W H
authors.initials: WH
authors.lastname: Miller
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000494:pharmacology* / Q000627:therapeutic use; D017209:Apoptosis / Q000187:drug effects*; D000077237:Arsenic Trioxide; D001152:Arsenicals / Q000494:pharmacology* / Q000627:therapeutic use; D015152:Blotting, Northern; D015153:Blotting, Western; D015536:Down-Regulation; D004591:Electrophoresis, Polyacrylamide Gel; D005434:Flow Cytometry; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000188:drug therapy* / Q000503:physiopathology*; D010087:Oxides / Q000494:pharmacology* / Q000627:therapeutic use; D018168:Receptors, Retinoic Acid / Q000187:drug effects*; D000072482:Retinoic Acid Receptor alpha; D011503:Transglutaminases / Q000378:metabolism; D014212:Tretinoin / Q000494:pharmacology* / Q000627:therapeutic use; D014407:Tumor Cells, Cultured
chemical_list: D001152:Arsenicals; D010087:Oxides; C000607071:RARA protein, human; D018168:Receptors, Retinoic Acid; D000072482:Retinoic Acid Receptor alpha; D014212:Tretinoin; D011503:Transglutaminases; D000077237:Arsenic Trioxide