Most of the circulating cells appear to be nondividing and the clonal excess of B cells is mainly caused by defects that prevent programmed cell death rather than by alterations in cell cycle regulation. 3 Glucocorticoids and other chemotherapeutic agents used clinically, including the nucleoside analogues 2-chloro-2Ј-deoxyadenosine and fludarabine, induce apoptosis in B-CLL lymphocytes, [4][5][6][7][8] suggesting that apoptosis is the mechanism of their therapeutic action. Several signaling pathways regulate apoptosis induced by chemotherapy. Thus, we recently demonstrated that phosphatidylinositol 3-kinase and protein kinase C play important roles in the survival of B-CLL cells. Furthermore, inhibition of these kinases increases glucocorticoid-and fludarabine-induced apoptosis ex vivo in the presence of survival factors. 9 The precursor of nucleotide biosynthesis acadesine or 5-aminoimidazole-4-carboxamide (AICA) riboside has various effects in several types of eukaryotic cells. These effects include inhibition of growth and depletion of pyrimidine nucleotide pools in fibroblasts, 10,11 accelerated repletion of purine nucleotide pools in heart, 12 reduction of endurance in skeletal muscle, 13 inhibition of fatty acid, sterol synthesis, and gluconeogenesis in hepatocytes, and increase in glucose uptake in muscle. 14 Acadesine is phosphorylated to AICA ribotide (ZMP), which mimics 5Ј-adenosine monophosphate (AMP) and activates both AMP-activated protein kinase (AMPK) and AMPK kinase (AMPKK). 14,15 The effects on glucose and lipid metabolism are mediated through activation of the AMPK cascade. 14 Previous studies report that acadesine inhibits glucocorticoidinduced apoptosis in quiescent thymocytes, 16 apoptosis caused by serum deprivation in fibroblasts overproducing fructose 2,6-bisphosphate, 17 and ceramide-induced apoptosis in primary astrocytes. 18 To contribute to the understanding of glucocorticoidinduced apoptosis in B-CLL cells, we attempted to block apoptosis with acadesine and, surprisingly, we found that acadesine induced apoptosis in B-CLL cells, whereas T cells from these patients were not affected. Here we study the mechanism of acadesine-induced apoptosis and propose a new pathway involving AMPK and AMPKK in the control of apoptosis in B-CLL cells. Reprints: Joan Gil, Departament de Ciè ncies Fisiolò giques II, Campus de Bellvitge, Universitat de Barcelona, c/ Feixa Llarga s/n, E-08907 L'Hospitalet de Llobregat, Spain; e-mail: joangil@bellvitge.bvg.ub.es.The publication costs of this article were defrayed in part by page charge payment. Therefore, and solely to indicate this fact, this article is hereby marked ''advertisement'' in accordance with 18 U.S.C. section 1734. Patients, materials, and methods
Patients with B-CLL and cell isolationSeventy samples from patients with B-CLL who had not received treatment in the previous 6 months were studied. B-CLL was diagnosed according to standard clinical and laboratory criteria. Cells were obtained from the Hospital Clinic, Barcelona, Spain. Written inf...