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Pgp and MRP Activities Using Calcein-AM Are Prognostic Factors in
Adult Acute Myeloid Leukemia Patients
Ollivier Legrand,
Ghislaine Simonin,
Jean-Yves Perrot,
Robert Zittoun, and
Jean-Pierre Marie
From the Service d'Hématologie Clinique, the Service
d'Hématologie Biologique, and the Formation de Recherche
Associée Claude Bernard sur le Traitement des Hémopathies
Malignes, Laboratoire Universitaire Paris VI, Paris,
France.
Thirteen cell lines with different levels of Pgp and MRP expression
were used to assess the ability of calcein acetoxymethyl ester
(calcein-AM) uptake and calcein efflux to measure Pgp and MRP
functions, respectively. There was a good correlation between MRP
expression and the modulatory effect of probenecid (a specific modulator of MRP) on the calcein efflux (r = .91, P
= .0003) and between Pgp expression and the modulatory effect of CsA
on calcein-AM uptake (r = .96, P < .0001). In light
of the high correlations for both proteins, we tested calcein-AM uptake
and efflux in fresh myeloid leukemic cells. In 53 acute myeloid
leukemia (AML) patients, there was also a good correlation between MRP
expression (measured by reverse transcription-polymerase chain
reaction and by MRPm6 expression by flow cytometry) and
the modulatory effect of probenecid on the calcein fluorescence
(r = .92, P < .0001) and between Pgp expression as
measured by UIC2 antibody binding on flow cytometry and the modulatory
effect of cyclosporin A on calcein-AM uptake (r = .83, P < .0001). Pgp activity was higher in CD34+
leukemia than in CD34 leukemia (2.26 ± 1.50 v
1.46 ± 1.21, respectively; P = .003), and MRP activity was
higher in CD34 leukemia than in CD34+
leukemia (1.77 ± 0.40 v 1.4 ± 0.29, respectively; P
= .004). Pgp expression and activity (P = .004 and
P = .01, respectively) and MRP activity (P = .03)
but not MRP expression were prognostic factors for achievement of
complete remission. These results suggest that functional
testing (with calcein-AM ± modulators) for the presence of both MRP
and Pgp activities is of prognostic value and that MRP contributes to
drug resistance in AML.
Blood, Vol. 91 No. 12 (June 15), 1998:
pp. 4480-4488
© 1998 by The American Society of Hematology.

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