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Prepublished online as a Blood First Edition Paper on April 10, 2003; DOI 10.1182/blood-2003-02-0396.

Submitted February 6, 2003
Accepted April 3, 2003
Multidrug resistance protein (MRP) attenuates gemtuzumab ozogamicin-induced cytotoxicity in acute myeloid leukemia cells
Roland B Walter*, Brian W Raden, Tom C Hong, David A Flowers, Irwin D Bernstein, and Michael L Linenberger
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Pediatrics, University of Washington, Seattle, WA, USA
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA
* Corresponding author; email: rwalter{at}fhcrc.org.
Gemtuzumab ozogamicin (GO) is a novel immunoconjugate therapy for AML. P-glycoprotein (Pgp) confers resistance to GO and is associated with a worse clinical response. To address whether multidrug resistance protein (MRP) affects GO susceptibility we characterized Pgp, MRP1, and MRP2 expression in CD33+ cell lines and CD33+ AML samples and analyzed the effect of the Pgp inhibitor cyclosporine (CSA) and the MRP inhibitor MK-571 on GO-induced cytotoxicity. MRP1 expression, but not MRP2, correlated with MRP activity. MK-571 enhanced GO-induced cytotoxicity in Pgp-negative/MRP-positive NB4 and HL-60 cells. CSA, but not MK-571 alone, restored GO susceptibility in Pgp-positive/MRP-positive TF1 cells; however, MK-571 enhanced cytotoxicity in the presence of CSA. All patient samples exhibited MRP activity and 17/23 exhibited Pgp activity. CSA increased GO-induced cytotoxicity in 12 Pgp-positive samples, whereas MK-571 alone was effective in only one case with minimal Pgp activity. In 3 Pgp-positive/MRP-positive samples, MK-571 enhanced GO-induced cytotoxicity in the presence of CSA. Thus, MRP1 may attenuate susceptibility to GO. This effect was comparatively less than Pgp and required inhibition of Pgp to detect in cells that co-expressed both transporters. Because MK-571 and/or CSA failed to affect cytotoxicity in a portion of Pgp-positive/MRP-positive AML samples, additional resistance mechanisms are likely important.

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