Up-regulation of folate receptor (FR) type- in acute myelogenous leukemia (AML) by all-trans retinoic acid (ATRA) and its restricted normal tissue distribution makes it a potential target for therapeutic intervention. The FR- in peripheral blood granulocytes was unable to bind folate and appeared to have a variant GPI membrane anchor, evident from its insensitivity to phosphatidylinositol-specific phospholipase C but not nitrous acid. Granulocyte FR- lacked mutations, and neither deglycosylation nor detergent solubilization restored folate binding. The posttranslational modification causing its nonfunctionality was evi-
IntroductionAcute myelogenous leukemia (AML) is the most common type of acute leukemia in adults. Standard chemotherapy results in a 70% complete remission rate in AML patients. 1 Treatment with drugs such as anthracyclines, however, is associated with severe side effects such as myelosuppression and dose-limiting cardiotoxicity and a high incidence of relapse. 2 Relapsed disease is frequently refractory to chemotherapy and exhibits multidrug resistance (MDR). 3 A potential means of treating AML is by targeted drug delivery through liposomes. Liposomal delivery of drugs has been shown to extend their systemic circulation time, reduce dose-limiting toxicity, and overcome MDR. [4][5][6][7] Liposomal anthracyclines have reached clinical use for the treatment of Kaposi sarcoma 5 and are in clinical trial for solid tumors and leukemias. [8][9][10][11][12][13][14] Liposomal delivery has also been shown to increase anthracycline cytotoxicity in tumor cells exhibiting MDR. 6,7,[15][16][17] The efficacy of liposomal drugs can potentially be further enhanced by selective targeting to tumor cells through a cell surface molecule that is differentially expressed on tumor cells. 18,19 The folate receptor (FR) is a promising target because of its narrow tissue specificity, its overexpression in malignant tissues, and its ability to bind and internalize folic acid conjugates. Of the 3 human folate receptor isoforms, 20-22 2 (FR-␣ and FR-) are attached to the cell surface through a glycosyl-phosphatidylinositol (GPI) membrane anchor, 20,23 whereas the third (FR-␥) is constitutively secreted. 24 The expression of FR-␣ in normal tissues is restricted to certain epithelial cells, where it is inaccessible by the circulation. 25,26 FR-␣ is found to be amplified in many epitheliallineage human tumors, including approximately 90% of ovarian carcinomas. [26][27][28][29] A wide variety of experimental therapies, 30 including drug-loaded liposomes, 31-34 have successfully targeted FR-␣ selectively in gynecologic and other tumors. The expression of FR- in normal tissues is restricted to placenta and hematopoietic cells, where it is expressed in the myelomonocytic lineage and is particularly elevated during neutrophil maturation or during monocyte or macrophage activation. 29,35,36 FR- is also known to be expressed in chronic myelogenous leukemia (CML) and in AML. 22,37,38 FR- from membrane preparations from CML and ...