title: Role of alpha1 acid glycoprotein in the in vivo resistance of human BCR-ABL(+) leukemic cells to the abl inhibitor STI571.
abstract: BACKGROUND
  Chronic myeloid leukemia is caused by a chromosomal translocation that results in an oncogenic fusion protein, Bcr-Abl. Bcr-Abl is a tyrosine kinase whose activity is inhibited by the antineoplastic drug STI571. This drug can cure mice given an injection of human leukemic cells, but treatment ultimately fails in animals that have large tumors when treatment is initiated. We created a mouse model to explore the mechanism of resistance in vivo. METHODS Nude mice were injected with KU812 Bcr-Abl(+) human leukemic cells. After 1 day (no evident tumors), 8 days, or 15 days (tumors >1 g), mice were treated with STI571 (160 mg/kg every 8 hours). Cells recovered from relapsing animals were used for in vitro experiments. Statistical tests were two-sided.
  
  
  RESULTS
  Tumors regressed initially in all STI571-treated mice, but all mice treated 15 days after injection of tumor cells eventually relapsed. Relapsed animals did not respond to further STI571 treatment, and their Bcr-Abl kinase activity in vivo was not inhibited by STI571, despite high plasma concentrations of the drug. However, tumor cells from resistant animals were sensitive to STI571 in vitro, suggesting that a molecule in the plasma of relapsed animals may inactivate the drug. The plasma protein alpha1 acid glycoprotein (AGP) bound STI571 at physiologic concentrations in vitro and blocked the ability of STI571 to inhibit Bcr-Abl kinase activity in a dose-dependent manner. Plasma AGP concentrations were strongly associated with tumor load. Erythromycin competed with STI571 for AGP binding. When animals bearing large tumors were treated with STI571 alone or with a combination of STI571 and erythromycin, greater tumor reductions and better long-term tumor-free survival (10 of 12 versus one of 13 at day 180; P:<.001) were observed after the combination treatment.
  
  
  CONCLUSIONS
  AGP in the plasma of relapsed animals binds to STI571, preventing this compound from inhibiting the Bcr/Abl tyrosine kinase. Molecules such as erythromycin that compete with STI571 for binding to AGP may enhance the therapeutic potential of this drug.
authors.affiliation: Department of Experimental Oncology, Istituto Nazionale Tumori, Milan, Italy. Gambacorti@isitutotumori.mi.it
authors.forename: C
authors.initials: C
authors.lastname: Gambacorti-Passerini
authors.forename: R
authors.initials: R
authors.lastname: Barni
authors.forename: P
authors.initials: P
authors.lastname: le Coutre
authors.forename: M
authors.initials: M
authors.lastname: Zucchetti
authors.forename: G
authors.initials: G
authors.lastname: Cabrita
authors.forename: L
authors.initials: L
authors.lastname: Cleris
authors.forename: F
authors.initials: F
authors.lastname: Rossi
authors.forename: E
authors.initials: E
authors.lastname: Gianazza
authors.forename: J
authors.initials: J
authors.lastname: Brueggen
authors.forename: R
authors.initials: R
authors.lastname: Cozens
authors.forename: P
authors.initials: P
authors.lastname: Pioltelli
authors.forename: E
authors.initials: E
authors.lastname: Pogliani
authors.forename: G
authors.initials: G
authors.lastname: Corneo
authors.forename: F
authors.initials: F
authors.lastname: Formelli
authors.forename: M
authors.initials: M
authors.lastname: D'Incalci
mesh_terms: D000818:Animals; D000970:Antineoplastic Agents / Q000494:pharmacology*; D001549:Benzamides; D015153:Blotting, Western; D019008:Drug Resistance, Neoplasm; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D004791:Enzyme Inhibitors / Q000494:pharmacology; D004917:Erythromycin / Q000494:pharmacology; D005260:Female; D016044:Fusion Proteins, bcr-abl / Q000187:drug effects* / Q000378:metabolism; D006801:Humans; D000068877:Imatinib Mesylate; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy* / Q000201:enzymology / Q000378:metabolism*; D051379:Mice; D008819:Mice, Nude; D009961:Orosomucoid / Q000187:drug effects* / Q000378:metabolism*; D010766:Phosphorylation / Q000187:drug effects; D010879:Piperazines / Q000494:pharmacology*; D011505:Protein-Tyrosine Kinases / Q000037:antagonists & inhibitors*; D011743:Pyrimidines / Q000494:pharmacology*; D013997:Time Factors; D014407:Tumor Cells, Cultured
chemical_list: D000970:Antineoplastic Agents; D001549:Benzamides; D004791:Enzyme Inhibitors; D009961:Orosomucoid; D010879:Piperazines; D011743:Pyrimidines; D004917:Erythromycin; D000068877:Imatinib Mesylate; D011505:Protein-Tyrosine Kinases; D016044:Fusion Proteins, bcr-abl