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Blood, 11 June 2009, Vol. 113, No. 24, pp. 6215-6224.
Prepublished online as a Blood First Edition Paper on October 27, 2008; DOI 10.1182/blood-2008-05-158311.
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MYELOID NEOPLASIA
Targeting the leukemia microenvironment by CXCR4 inhibition overcomes resistance to kinase inhibitors and chemotherapy in AML
Zhihong Zeng1,
Yue Xi Shi1,
Ismael J. Samudio1,
Rui-Yu Wang1,
Xiaoyang Ling1,
Olga Frolova1,
Mark Levis2,
Joshua B. Rubin3,
Robert R. Negrin4,
Elihu H. Estey5,
Sergej Konoplev6,
Michael Andreeff1,5, and
Marina Konopleva5
1 Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M. D. Anderson Cancer Center, Houston;
2 Department of Oncology and Hematology, Johns Hopkins University, Baltimore, MD;
3 Department of Pediatrics, Divisions of Pediatric Hematology/Oncology, Washington University School of Medicine, St Louis, MO;
4 Department of Medicine, Division of Bone Marrow Transplantation, Stanford University, CA; and
Departments of 5 Leukemia and
6 Hematopathology, The University of Texas M. D. Anderson Cancer Center, Houston
SDF-1 /CXCR4 signaling plays a key role in leukemia/bone marrow microenvironment interactions. We previously reported that bone marrow–derived stromal cells inhibit chemotherapy-induced apoptosis in acute myeloid leukemia (AML). Here we demonstrate that the CXCR4 inhibitor AMD3465 antagonized stromal-derived factor 1 (SDF-1)–induced and stroma-induced chemotaxis and inhibited SDF-1–induced activation of prosurvival signaling pathways in leukemic cells. Further, CXCR4 inhibition partially abrogated the protective effects of stromal cells on chemotherapy-induced apoptosis in AML cells. Fetal liver tyrosine kinase-3 (FLT3) gene mutations activate CXCR4 signaling, and coculture with stromal cells significantly diminished antileukemia effects of FLT3 inhibitors in cells with mutated FLT3. Notably, CXCR4 inhibition increased the sensitivity of FLT3-mutated leukemic cells to the apoptogenic effects of the FLT3 inhibitor sorafenib. In vivo studies demonstrated that AMD3465, alone or in combination with granulocyte colony-stimulating factor, induced mobilization of AML cells and progenitor cells into circulation and enhanced antileukemic effects of chemotherapy and sorafenib, resulting in markedly reduced leukemia burden and prolonged survival of the animals. These findings indicate that SDF-1/CXCR4 interactions contribute to the resistance of leukemic cells to signal transduction inhibitor– and chemotherapy-induced apoptosis in systems mimicking the physiologic microenvironment. Disruption of these interactions with CXCR4 inhibitors represents a novel strategy of sensitizing leukemic cells by targeting their protective bone marrow microenvironment.
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