Caspase-independent programmed cell death can exhibit either an apoptosis-like or a necrosis-like morphology. The ABL kinase inhibitor, imatinib mesylate, has been reported to induce apoptosis of BCR-ABL-positive cells in a caspasedependent fashion. We investigated whether caspases alone were the mediators of imatinib mesylate-induced cell death. In contrast to previous reports, we found that a broad caspase inhibitor, zVAD-fmk, failed to prevent the death of imatinib mesylate-treated BCR-ABL-positive human leukemic cells. Moreover, zVAD-fmk-preincubated, imatinib mesylate-treated cells exhibited a necrosislike morphology characterized by cellular pyknosis, cytoplasmic vacuolization, and the absence of nuclear signs of apoptosis. These cells manifested a loss of the mitochondrial transmembrane potential, indicating the mitochondrial involvement in this caspase-independent necrosis. We excluded the participation of several mitochondrial factors possibly involved in caspase-independent cell death such as apoptosis-inducing factor, endonuclease G, and reactive oxygen species. However, we observed the mitochondrial release of the serine protease Omi/HtrA2 into the cytosol of the cells treated with imatinib mesylate or zVAD-fmk plus imatinib mesylate. Furthermore, serine protease inhibitors prevented the caspase-independent necrosis. Taken together, our results suggest that imatinib mesylate induces a caspase-independent, necrosis-like programmed cell death mediated by the serine protease activity of Omi/HtrA2.
IntroductionImatinib mesylate (imatinib, Gleevec) was developed as a potent and specific inhibitor of ABL tyrosine kinase. 1 Preclinical studies and clinical trials showed that imatinib exhibited a remarkable single-agent activity against BCR-ABL-expressing cells with acceptable toxicity in vitro and in vivo. 1,2 BCR-ABL tyrosine kinase activates several signaling pathways such as the Ras/mitogenactivated protein kinase, 2-4 signal transducer and activator of transcription 5, 2,4 and phosphatidylinositol 3 kinase/Akt pathways 2,4 ; enhances nuclear factor B (NF-B) activity 5 ; upregulates the level of 6 ; and suppresses the mitochondrial apoptotic pathway. 5,7 Imatinib counteracts BCR-ABL tyrosine kinase and induces apoptosis in BCR-ABL-positive cells [8][9][10] in a caspase-dependent fashion. 11,12 Recently, however, it has been revealed that responses to imatinib are not necessarily remarkable or durable in some patients with BCR-ABL-positive leukemia, [13][14][15][16][17][18][19][20][21][22] and thus an increasing number of studies have searched for a novel therapy targeting the BCR-ABL-induced signaling pathways. 5 Cell death is generally classified into 2 categories, apoptosis 23,24 and necrosis. Apoptosis is a well-documented active programmed cell death (PCD) in which the activation of caspases plays a central role. 25 In contrast, necrosis has been conceived as a passive cell death without established regulatory mechanisms. However, it has recently been reported that necrosis-like cell death may be re...