Purpose: Constitutive signal transducer and activator of transcription 3 (STAT3) activity, observed in f50% of acute myelogenous leukemia cases and associated with adverse treatment outcome, is down-regulated by arsenic trioxide (ATO). Heat shock protein (HSP) 90 is a molecular chaperone involved in signal transduction pathways. We hypothesized that HSP90 inhibitors will potentiate ATO effect on constitutive STAT3 activity and cell killing. One concern was that the effect of ATO and HSP90 inhibitors will result in up-regulation of HSP70, a protein known to inhibit apoptosis. Experimental Design: We have used a semimechanistic pharmacodynamic model to characterize concentration-effect relationships of ATO and HSP90 inhibitors on constitutive STAT3 activity, HSP70 expression, and cell death in a cell line model. Results: Pharmacodynamic interaction of ATO and three HSP90 inhibitors showed synergistic interactions in inhibiting constitutive STAT3 activity and inducing cell death, in spite of a concurrent synergistic up-regulation of HSP70. Conclusions: These preliminary results provide a basis for studying the combined role of ATO with HSP90 inhibitors in acute myelogenous leukemia with constitutive STAT3 activity.Constitutive signal transducer and activator of transcription 3 (STAT3) activity has been shown to be present in leukemia cells in 50% of acute myelogenous leukemia (AML) cases and to correlate with adverse treatment outcome (1). We have shown that arsenic trioxide (ATO) down-regulates constitutive STAT3 activity in AML cells within 6 h, without affecting cell survival until 48 h (2). Heat shock protein (HSP) 90 is implicated in maintaining the conformation, stability, and function of key proteins involved in signal transduction pathways (3), and we therefore hypothesized that HSP90 inhibitors [geldanamycin,, and 17-(dimethylaminoethylamino)-17-demethoxygeldanamycin (NSC 707545, 17-DMAG)] would potentiate the effect of ATO on constitutive STAT3 activity in AML cells. One concern was that up-regulation of HSP70, a protein known to inhibit apoptosis (4, 5), by exposure to either ATO (6 -8) or HSP90 inhibitors (9, 10), might abrogate their effect on constitutive STAT3 activity and survival.Identifying the type and extent of drug-drug interactions has been a challenge since the early 1900s. When the mechanisms of action of two pharmacologic agents are not known, empirical drug-drug interaction models such as Loewe additivity (11), Bliss independence (12), or the Chou and Talalay method (13, 14) can be applied. When the true behavior is well appreciated, mechanistic models offer insight into the physiologic processes influencing the degree of interaction (15 -17). The HSP90 inhibitors act by binding HSP90 and preventing the stabilization of ''client'' protein complexes, involving cancer targets such as mutated p53, Raf-1, ErbB2, and other proteins associated with signal transduction. On the other hand, the mechanism of ATO action toward DNA fragmentation and cell death is not completely understood. It...