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Blood, 1 January 2009, Vol. 113, No. 1, pp. 149-153. Prepublished online as a Blood First Edition Paper on October 3, 2008; DOI 10.1182/blood-2008-02-138560.
LYMPHOID NEOPLASIA AT-101 induces apoptosis in CLL B cells and overcomes stromal cell–mediated Mcl-1 induction and drug resistanceDepartments of 1 Experimental Therapeutics and 2 Leukemia, University of Texas M. D. Anderson Cancer Center, Houston Resistance to apoptosis in CLL B cells is associated with overexpression of Bcl-2 family antiapoptotic proteins. Their expression is endogenous, but is also induced by signals from the microenvironment resulting in intrinsic and extrinsic drug resistance. Because AT-101 binds to the BH3 motif of all Bcl-2–family antiapoptotic proteins, we hypothesized that this molecule could overcome resistance. AT-101 treatment (20 µM for 24 hours) resulted in a median 72% apoptosis in CLL cells (patients; n = 32, P < .001). Stromal cells protected CLL B cells from spontaneous and fludarabine-induced apoptosis (P = .003) by increasing the Mcl-1 protein levels. However, AT-101 induced similar extent of down-regulation of Mcl-1 and apoptosis in CLL lymphocytes cultured in suspension or on stroma (P = .999). Stromal cells expressed undetectable levels of antiapoptotic but high levels of activated ERK and AKT proteins and had low or no apoptosis with AT-101. Collectively, these data demonstrate that AT-101 induces apoptosis in CLL B cells and overcomes microenvironment-mediated resistance while sparing normal stromal cells.
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