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Blood, 1 October 2004, Vol. 104, No. 7, pp. 2143-2148.
Prepublished online as a Blood First Edition Paper on May 25, 2004; DOI 10.1182/blood-2004-01-0339.


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Submitted January 28, 2004
Accepted April 5, 2004

A urokinase activated-recombinant diphtheria toxin targeting the granulocyte-macrophage colony-stimulating factor receptor is selectively cytotoxic to human acute myeloid leukemia blasts

Ralph J Abi-Habib, Shihui Liu, Thomas H Bugge, Stephen H Leppla, and Arthur E Frankel*

Biochemistry and Molecular Biology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
Microbial Pathogenesis Section, National Institutes of Allergy and Infectious Diseases, Bethesda, MD, USA
Oral and Pharyngeal Cancer Branch, National Institute of Dental and Craniofacial Research, Bethesda, MD, USA
Cancer Biology, Wake Forest University School of Medicine, Winston-Salem, NC, USA

* Corresponding author; email: afrankel{at}wfubmc.edu.

Novel agents to treat acute myeloid leukemia (AML) are needed with increased efficacy and specificity. We have synthesized a dual specificity fusion toxin DTU2GMCSF composed of the catalytic and translocation domains of diphtheria toxin (DT) fused to the granulocyte macrophage colony stimulating factor (GMCSF) in which the DT furin cleavage site (163RVRRSV170) is modified to a urokinase plasminogen activator (uPA) cleavage site termed U2 (163GSGRSA170). DTU2GMCSF was highly toxic to the TF1-vRaf AML cell line (proliferation inhibition assay; IC50=3.14 pM), and this toxicity was greatly inhibited following pretreatment with anti-uPA and anti-GMCSF antibodies. The activity of this toxin was then tested on a larger group of 13 human AML cell lines and 5 of the 13 cell lines were sensitive to DTU2GMCSF. An additional 5 of the 13 cell lines became sensitive when exogenous pro-uPA was added. Sensitivity to DTU2GMCSF strongly correlated with the expression levels of uPA receptors (uPAR) and GMCSF receptors (GMCSFR) as well as with total uPA levels. DTU2GMCSF was less toxic to normal cells expressing uPAR or GMCSFR alone, i.e. HUV-EC and peripheral macrophages, respectively. These results indicate that DTU2GMCSF may be a selective and potent agent for the treatment of patients with AML.


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