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 Blood, 26 March 2009, Vol. 113, No. 13, pp. 3080-3087.
Prepublished online as a Blood First Edition Paper on November 6, 2008; DOI 10.1182/blood-2008-03-143784.

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MYELOID NEOPLASIA

Phorbol ester–induced PKC{epsilon} down-modulation sensitizes AML cells to TRAIL-induced apoptosis and cell differentiation

Giuliana Gobbi1, Prisco Mirandola1, Cecilia Carubbi1, Cristina Micheloni1, Chiara Malinverno1, Paolo Lunghi2, Antonio Bonati3, and Marco Vitale1

1 Department of Anatomy, Pharmacology and Forensic Medicine, Human Anatomy Section, and 2 Department of Clinical Sciences, University of Parma, Ospedale Maggiore, Parma; and 3 Department of Clinical Sciences, Unit of Hematology, University Hospital of Parma, Parma, Italy

Despite the relevant therapeutic progresses made in these last 2 decades, the prognosis of acute myeloid leukemia (AML) remains poor. Phorbol esters are used at very low concentrations as differentiating agents in the therapy of myeloid leukemias. Tumor necrosis factor–related apoptosis-inducing ligand (TRAIL), in turn, is a death ligand that spares normal cells and is therefore currently under clinical trials for cancer therapy. Emerging evidence, however, suggests that TRAIL is also involved in nonapoptotic functions, like cell differentiation. PKC{epsilon} is differentially modulated along normal hematopoiesis, and its levels modulate the response of hematopoietic precursors to TRAIL. Here, we investigated the effects of the combination of phorbol esters (phorbol ester 4-β-phorbol-12,13-dibutyrate [PDBu]) and TRAIL in the survival/differentiation of AML cells. We demonstrate here that PDBu sensitizes primary AML cells to both the apoptogenic and the differentiative effects of TRAIL via PKC{epsilon} down-modulation, without affecting TRAIL receptor surface expression. We believe that the use of TRAIL in combination with phorbol esters (or possibly more specific PKC{epsilon} down-modulators) might represent a significative improvement of our therapeutic arsenal against AML.


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