title: Flavopiridol displays preclinical activity in acute lymphoblastic leukemia.
abstract: BACKGROUND
  New agents are needed for treatment of children with relapsed acute lymphoblastic leukemia (ALL). Based on altered expression of cell cycle regulatory proteins, including frequent p16 (INK4A) and p15 (INK4B) deletions, flavopiridol (FP; Alvocidib) is an attractive agent for relapsed ALL.
  
  
  METHODS
  We evaluated the efficacy of FP in ALL cell lines using cell proliferation assays, determined the effects of FP treatment on cell growth and viability in cell lines and patient samples, examined cell cycle kinetics, and evaluated the effect of FP on endogenous cyclin-dependent kinase (CDK) activity, Mcl-1 expression, and RNA polymerase II expression and phosphorylation.
  
  
  RESULTS
  ALL cell lines are sensitive to FP. At lower concentrations, FP induces transient G(1)-S cell cycle arrest and modest levels of apoptosis in cell lines. In contrast, a sustained G(1)-S and G(2)-M arrest and substantial apoptosis are observed following exposure to higher FP concentrations. After treatment with FP, ALL cell lines have decreased expression of retinoblastoma protein phosphorylated at serines 795 and 807/811, indicating reduced CDK activity. We also show that ALL cell lines are sensitive to clinically achievable concentrations of FP in medium supplemented with human serum and that FP reduces the expression of Mcl-1 and phosphorylated forms of the C-terminal domain of RNA polymerase II. FP also increases cell death by approximately twofold over baseline in primary ALL blasts.
  
  
  CONCLUSIONS
  These data provide a biological rationale for testing FP in relapsed ALL.
authors.affiliation: Department of Pediatrics, University of Florida College of Medicine and the University of Florida Shands Cancer Center, Gainesville, Florida, USA.
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Jackman
authors.forename: Carole B
authors.initials: CB
authors.lastname: Frye
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Hunger
mesh_terms: D000970:Antineoplastic Agents / Q000494:pharmacology*; D017209:Apoptosis / Q000187:drug effects; D015153:Blotting, Western; D002453:Cell Cycle / Q000187:drug effects; D045744:Cell Line, Tumor; D005419:Flavonoids / Q000494:pharmacology*; D006801:Humans; D064549:Myeloid Cell Leukemia Sequence 1 Protein; D009363:Neoplasm Proteins / Q000187:drug effects; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy; D010880:Piperidines / Q000494:pharmacology*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D019253:Proto-Oncogene Proteins c-bcl-2 / Q000187:drug effects; D012319:RNA Polymerase II / Q000187:drug effects; D016160:Retinoblastoma Protein / Q000187:drug effects
chemical_list: D000970:Antineoplastic Agents; D005419:Flavonoids; D064549:Myeloid Cell Leukemia Sequence 1 Protein; D009363:Neoplasm Proteins; D010880:Piperidines; D019253:Proto-Oncogene Proteins c-bcl-2; D016160:Retinoblastoma Protein; C077990:alvocidib; D012319:RNA Polymerase II