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Blood, 15 August 2006, Vol. 108, No. 4, pp. 1353-1362.
Prepublished online as a Blood First Edition Paper on May 2, 2006; DOI 10.1182/blood-2006-01-011833.


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NEOPLASIA

Leukemogenesis induced by wild-type and STI571-resistant BCR/ABL is potently suppressed by C/EBP{alpha}

Giovanna Ferrari-Amorotti, Karen Keeshan, Michela Zattoni, Clara Guerzoni, Giorgio Iotti, Sara Cattelani, Nick J. Donato, and Bruno Calabretta

From the Department of Microbiology and Immunology, Kimmel Cancer Center, Thomas Jefferson Medical College, Philadelphia, PA; the Department of Pathology, Institute for Medicine and Engineering, University of Pennsylvania, Philadelphia; and the Department of Bioimmunotherapy, University of Texas, M. D. Anderson Cancer Center, Houston.

Chronic phase–to–blast crisis transition in chronic myelogenous leukemia (CML) is associated with differentiation arrest and down-regulation of C/EBP{alpha}, a transcription factor essential for granulocyte differentiation. Patients with CML in blast crisis (CML-BC) became rapidly resistant to therapy with the breakpoint cluster region–Abelson murine leukemia (BCR/ABL) kinase inhibitor imatinib (STI571) because of mutations in the kinase domain that interfere with drug binding. We show here that the restoration of C/EBP{alpha} activity in STI571-sensitive or -resistant 32D-BCR/ABL cells induced granulocyte differentiation, inhibited proliferation in vitro and in mice, and suppressed leukemogenesis. Moreover, activation of C/EBP{alpha} eradicated leukemia in 4 of 10 and in 6 of 7 mice injected with STI571-sensitive or -resistant 32D-BCR/ABL cells, respectively. Differentiation induction and proliferation inhibition were required for optimal suppression of leukemogenesis, as indicated by the effects of p42 C/EBP{alpha}, which were more potent than those of K298E C/EBP{alpha}, a mutant defective in DNA binding and transcription activation that failed to induce granulocyte differentiation. Activation of C/EBP{alpha} in blast cells from 4 patients with CML-BC, including one resistant to STI571 and BMS-354825 and carrying the T315I Abl kinase domain mutation, also induced granulocyte differentiation. Thus, these data indicate that C/EBP{alpha} has potent antileukemia effects even in cells resistant to ATP-binding competitive tyrosine kinase inhibitors, and they portend the development of anti-leukemia therapies that rely on C/EBP{alpha} activation.


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