Disease relapse sometimes occurs after acute promyelocytic leukemia (APL) therapy with all-trans retinoic acid (ATRA). Among the diagnostic parameters predicting relapse, heterogeneity in the in vitro differentiation rate of blasts is an independent factor. To identify biologic networks involved in resistance, we conducted pharmacogenomic studies in APL blasts displaying distinct ATRA sensitivities. Although the expression profiles of genes invested in differentiation were similarly modulated in low-and high-sensitive blasts, low-sensitive cells showed higher levels of transcription of ATRA-target genes, transcriptional regulators, chromatin remodelers, and transcription factors. In opposition, only high-sensitive blasts expressed the CYP26A1 gene, encoding the p450 cytochrome which is known to be involved in retinoic acid catabolism. In NB4 cells, ATRA treatment activates a novel signaling pathway, whereby interleukin-8 stimulates the expression of the homeobox transcription factor HOXA10v2, an effective enhancer of CYP26A1 transcription. These data were corroborated in primary APL cells, as maturation levels correlated with CYP26A1 expression.
IntroductionHematopoiesis can be described as a balance between proliferation and differentiation. In 90% of acute promyelocytic leukemia (APL) cases, the t(15;17) translocation and consequent expression of the PML (promyelocytic leukemia protein)/RAR␣ (retinoic acid receptor ␣) fusion protein blocks differentiation at the promyelocytic stage. RAR␣ belongs to the nuclear receptor superfamily and functions as a ligand-dependent transcription factor, acting to establish the granulocytic lineage. Under normal conditions, binding of the ligand (all-trans retinoic acid, or ATRA) to the receptor provokes a conformational change in the receptor resulting in the disruption of a co-repression complex, recruitment of coactivators, binding to the retinoic acid response element (RARE), and finally the transcription of ATRA-dependent genes. 1 The PML portion of the PML/RAR␣ fusion protein has a high affinity for the corepression complex, preventing RAR␣ transcriptional activity. To induce complete remission in a high proportion of patients, a pharmacologic dose of ATRA is required to destabilize this interaction and reestablish the differentiation program. Combining ATRA with chemotherapy results in a significant prolongation of disease-free and overall survival. [2][3][4][5][6] Despite the general efficacy of ATRA-based therapy, 10% to 20% of patients with APL still relapse. Several mechanisms have been proposed to explain the involved retinoid resistance arising during cancer therapy. With the exception of primary resistance, which is extremely rare in PML/RAR␣ cells, 7,8 APL relapse has been suggested to be related to various processes observed in cell lines. These include variations in nuclear ATRA concentrations due to, for example, cytoplasm retinoid sequestration, 9,10 increased intracellular metabolism, 11 alterations in ATRA transcriptional efficiency via mutations in the P...