The small molecule inhibitor of the MDM2/ p53 interaction Nutlin-3 significantly upregulated the steady-state mRNA and protein levels of Notch1 in TP53 wild-type (OCI, SKW6.4) but not in TP53 deleted (HL-60) or TP53 mutated (BJAB) leukemic cell lines. A direct demonstration that NOTCH1 was a transcriptional target of p53 in leukemic cells was obtained in experiments carried out with siRNA for p53. Moreover, inhibition of Notch1 expression using Notch1-specific siRNA significantly increased cytotoxicity in TP53 wild-type leukemic cells.
IntroductionThe activation of p53 is tightly regulated by the human homolog of murine double minute 2 (MDM2) gene, 1 which is an E3 ubiquitin ligase for p53 and itself and controls p53 half-life mainly via ubiquitindependent degradation. In response to a variety of stimuli, such as cellular stress, the p53-MDM2 interaction is disrupted and p53 rapidly accumulates within the cell. 1 Potent and selective small molecule inhibitors of the p53-MDM2 interaction, the Nutlins, have been recently reported. 2,3 These compounds bind MDM2 in the p53 binding pocket with high selectivity and can release p53 from negative control, leading to effective stabilization of p53 and activation of the p53 pathway. 2,3 It has been demonstrated that treatment with the active enantiomer Nutlin-3a results in rising levels of p53 protein and subsequent induction of cell cycle arrest and apoptosis in a variety of tumor cells. 2 In contrast to most solid tumors, TP53 is mutated in approximately 10% to 15% of both myeloid and lymphoid leukemias at diagnosis, 4 and several recent studies have demonstrated that Nutlin-3 induces ex vivo cytotoxic cell death of most TP53 wild-type primary hematologic malignancies, including acute myeloid leukemias, multiple myeloma, B-chronic lymphocytic leukemias (B-CLL), and B-cell lymphomas. [5][6][7][8][9][10][11][12][13][14][15] Although it is well established that p53 mediates a variety of cellular functions, such as cell cycle arrest, cellular senescence, and, only as ultimate choice, apoptosis, 16,17 some experimental evidence suggests that inhibition of the transcriptional activity of p53 might paradoxically result in an increase of the p53-mediated proapoptotic activity, 18 also in B-CLL cells. 19 Therefore, the aim of this study was to further investigate the relationship between the transcriptional and cytotoxic activities induced by Nutlin-3 and to elucidate whether Nutlin-3 promotes the transcription of antiapoptotic genes in leukemic cells, which might hamper and/or reduce its potential therapeutic efficacy. In this respect, it has recently emerged that a potential target gene of the p53 pathway is NOTCH1, 20 which belongs to an evolutionarily conserved pathway that profoundly impacts mammalian development. Of note, a recent study published while this article was under preparation has demonstrated that circulating B-CLL cells overexpress Notch1 and Notch2 family members with respect to circulating normal B lymphocytes. 21 The same study suggested that constitutively...