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Prepublished online as a Blood First Edition Paper on June 7, 2002; DOI 10.1182/blood-2002-02-0614.

Submitted February 25, 2002
Accepted May 15, 2002
Response to histone deacetylase inhibition of novel PML/RAR mutants detected in retinoic acid resistant APL cells
Sylvie Cote, Angelika Rosenauer, Andrea Bianchini, Karen Seiter, Jonathan Vandewiele, Clara Nervi, and Wilson H Miller*
Lady Davis Institute for Medical Research and McGill University Department of Oncology and Medicine, Sir Mortimer B Davis Jewish General Hospital, Montreal, PQ, Canada
Dipartimento di Istologia ed Embriologia Medica, Universita di Roma, Rome, Italy
Department of Medicine/Neoplastic Diseases, New York Medical College, Valhalla, NY, USA
* Corresponding author; email: wmiller{at}ldi.jgh.mcgill.ca.
Resistance to all-trans retinoic acid (RA) remains a clinical problem in the treatment of acute promyelocytic leukemia (APL) and provides a model for the development of novel therapies. Molecular alterations in the ligand-binding domain (LBD) of the PML/RAR fusion gene that characterizes APL constitute one mechanism by which leukemic cells may acquire resistance to RA. We identified missense mutations in the RAR portion of PML/RAR from an additional RA-resistant patient at relapse and in a novel RA-resistant cell line, NB4-MRA1. These cause altered binding to ligand and transcriptional coregulators, leading to a dominant-negative block of transcription of a retinoid-responsive element. The mutations we describe are in regions of the LBD that appear to be mutational "hot spots" occurring repeatedly in RA-resistant APL patient cells. We evaluated whether the histone deacetylase (HDAC) inhibition could overcome the effects of these mutations on RA-induced gene expression. Co-treatment with RA and TSA restored RARß gene expression in NB4-MRA1 cells, whose PML/RAR mutation is in helix 12 of the LBD, but not in an APL cell line harboring the patient-derived PML/RAR mutation, which was between helix 5 and 6. Furthermore, RA combined with TSA increases histone 4 acetylation on the RARß promoter only in NB4-MRA1 cells. Consistent with these results, the combined treatment induces differentiation of NB4-MRA1 only. Thus, the ability of an HDAC inhibitor to restore RA sensitivity in resistant cells may depend on their specific molecular defects. The variety of PML/RAR mutations arising in RA-resistant patients begins to explain how relapsed APL patients may differ in response to "transcription therapy" with HDAC inhibitors.

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