DNA-damaging chemotherapy is the backbone of cancer treatment, although it is not clear how such treatments kill tumor cells. In nontransformed lymphoid cells, the combined loss of 2 proapoptotic p53 target genes, Puma and Noxa, induces as much resistance to DNA damage as loss of p53 itself. In E-Myc lymphomas, however, lack of both Puma and Noxa resulted in no greater drug resistance than lack of Puma alone. A third B-cell lymphoma-2 homology domain (BH)3-only gene, Bim, although not a direct p53 target, was up-regulated in E-Myc lymphomas incurring DNA damage, and knockdown of Bim levels markedly increased the drug resistance of E-Myc/Puma ؊/؊ Noxa ؊/؊ lymphomas both in vitro and in vivo. Remarkably, c-MYC-driven lymphoma cell lines from Noxa ؊/؊ Puma ؊/؊ Bim ؊/؊ mice were as resistant as those lacking p53. Thus, the combinatorial action of Puma, Noxa, and Bim is critical for optimal apoptotic responses of lymphoma cells to 2 commonly used DNA-damaging chemotherapeutic agents, identifying Bim as an additional biomarker for treatment outcome in the clinic.
IntroductionDefects in apoptosis are major contributors to the development of cancer and the impaired response of tumor cells to cancer therapy. 1 The apoptotic response to a diverse range of damage signals requires the intrinsic (also called stress, mitochondrial, or B-cell lymphoma [BCL]-2-regulated) pathway, which is controlled by the interaction of pro-and antiapoptotic members of the BCL-2 family. The prosurvival members (BCL-2, BCL-X L , BCL-W, myeloid cell leukemia [MCL]-1, and A1) inhibit apoptosis by keeping the multi-B-cell lymphoma-2 homology (BH) domain proapoptotic BCL-2 family members, BCL-2-associated X protein (BAX) and BCL-2 homologous antagonist/killer (BAK), in check, thereby preventing mitochondrial outer membrane permeabilization (MOMP) and activation of the destructive caspase cascade. 2 The proapoptotic BH3-only BCL-2 family members (BIM, PUMA/BBC3, NOXA, BID, BAD, BMF, BlK/BLK/NBK, HRK/DP5) are essential for apoptosis initiation and are transcriptionally and/or posttranslationally activated in a death stimulus-and cell type-specific manner. 3 Some BH3-only proteins, including PUMA and BIM, bind avidly to all prosurvival BCL-2-like proteins, whereas others display selective binding activity. For example, NOXA binds only MCL-1 and A1, whereas BAD interacts selectively with BCL-2, BCL-X L, and BCL-W. 4 The role of BH3-only proteins for activation of BAX and BAK remains controversial. One view is that BAX/BAK activation is caused by direct binding of BIM, truncated BID (tBID), and, perhaps, PUMA, in a "hit-and-run" mechanism, 5 while another holds that they have no direct activating role, but trigger apoptosis by binding to and neutralizing prosurvival BCL-2 family members, thereby liberating BAX and BAK. 6 Commonly used chemotherapy drugs, such as cyclophosphamide (CTX) and etoposide, unleash the intrinsic apoptotic pathway by causing DNA damage, thereby activating the tumor suppressor, p53. The BH3-only genes, Puma and Noxa, are direct ...