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Prepublished online as a Blood First Edition Paper on December 27, 2002; DOI 10.1182/blood-2002-07-2283.
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Blood, 1 May 2003, Vol. 101, No. 9, pp. 3628-3634
NEOPLASIA
Cholesterol-modulating agents kill acute myeloid leukemia cells
and sensitize them to therapeutics by blocking adaptive cholesterol
responses
Henry Y. Li,
Frederick R. Appelbaum,
Cheryl L. Willman,
Richard A. Zager, and
Deborah E. Banker
From the Clinical Research Division, Fred Hutchinson
Cancer Research Center, Seattle, WA; the Department of Medicine,
University of Washington, Seattle; and the Department of Pathology,
University of New Mexico and UNM Cancer Center, Albuquerque.
The mevalonate pathway produces many critical substances in cells,
including sterols essential for membrane structure and isoprenoids
vital to the function of many membrane proteins.
3-Hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase is a
rate-limiting enzyme in the mevalonate pathway. Because cholesterol is
a product of this pathway, HMG-CoA reductase inhibitors (statins) are
used to treat hypercholesterolemia. Statins are also toxic to several
malignancies, including acute myeloid leukemia (AML). Although this
toxicity has been attributed to the inhibition of Ras/Rho
isoprenylation, we have previously shown that statin toxicity in
primary AML cells (AMLs) does not correlate with Ras isoprenylation or
with activating Ras mutations. In other studies, we
have shown that hypoxic and oxidant injuries induce cholesterol
increments in renal tubule cells and that statins sensitize
these cells to injury by blocking protective cholesterol responses. We now demonstrate that exposing particular AMLs to radiochemotherapy induces much greater cellular cholesterol increments than those seen in similarly treated normal bone marrow. Treatment of
these AMLs with mevastatin or zaragozic acid (which inhibits cholesterol synthesis but not isoprenoid synthesis) attenuates the
cholesterol increments and sensitizes cells to radiochemotherapy. The
extent of toxicity is affected by the availability of extracellular lipoproteins, further suggesting that cellular cholesterol is critical
to cell survival in particular AMLs. Because zaragozic acid does not
inhibit isoprenoid synthesis, these data suggest that cholesterol
modulation is an important mechanism whereby statins exert toxic
effects on some AMLs and that cholesterol modulators may improve
therapeutic ratios in AML by impacting cholesterol-dependent cytoresistance.

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