Abstract. In this study we elucidated the role of ATPbinding cassette (ABC) multi-drug transporter proteins and cellular factors such as Bcl-2 expression and CD33 downmodulation contributing to free and hP67.6 mAb linked calicheamicin-Á1 (CalC-Á1) resistance. We analyzed in a well designed HL60 cell system the relationship between the expression of ABC proteins, Bcl-2 and CD33 modulation with the activity of free and mAb-linked CalC-Á1. The results herein reported and discussed, strongly suggest that both MDR1-Pgp and MRP1 efflux systems are engaged by CalC-Á1, but only MDR1-Pgp over-expression efficiently abrogates drug cytotoxicity in MDR cells. Paradoxically, Bcl-2 expression, as observed for other anticancer compounds belonging to the enediyne family of drugs, confers CalC-Á1 susceptibility rather than resistance in HL60 cells. Further, the isolation of a resistant HL60 subline (HL60AL) that was developed by exposing the parental sensitive cells to subeffective doses of gemtuzumab ozogamicin (GO) over an extended period of time shows a reduced level of CD33 expression that represents an important escape mechanism of HL60 MDR cells to the cytotoxic effect of GO.
IntroductionGemtuzumab ozogamicin (GO) is the first clinically validated cytotoxic immunoconjugate in which a humanised anti-CD33 antibody (hP67.6) is covalently linked to a derivative of Calicheamicin-Á1 (CalC-Á1) (1). More recently, the therapeutic potential of CD22-specific antibody-targeted chemotherapy using inotuzumab ozogamicin (CMC-544) is being evaluated at present in Phase I clinical trials in patients with non-Hodgkin's lymphoma (2). Further, a number of tumor-targeted immunoconjugates of CalC-Á1 is being explored preclinically for their therapeutic potential (3,4). However, several factors may affect the efficacy of CalC-Á1 immunoconjugates. These include the common issues of mAb therapy such as antibody specificity, heterogeneous target antigen expression and large inter-individual differences in cellular sensitivity to CalC-Á1 (5). Further, among individuals with de novo AML, the overexpression of the MDR1-P-glycoprotein (MDR1-Pgp), a 170-kDa protein that belongs to the ABC superfamily of proteins, is identified in the 20-75% of malignant cells (6). MDR1-Pgp acts as an efflux pump to remove anticancer drugs from cells, resulting in a simultaneous cross-resistance or multi-drug resistance (MDR) to various chemotherapeutics (7). Although MDR1-Pgp appears to be of biologic and clinical relevance (8), other ABC proteins may be involved in the outcome of GO-treated AML patients (9,10). One such protein, the multi-drug resistance-associated protein (MRP1), is distantly related to MDR1-Pgp, and like MDR1-Pgp, lowers intracellular drug accumulation by promoting drug efflux and MDR (11).Previous studies hypothesized an association between MDR1-Pgp and MRP1 expression and clinical responses to GO (8,12,13), others reported discrepant results attributed to the multi-factorial nature of drug resistance (14,15). Engagement of CD33 by GO results in im...