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Blood, Vol. 94 No. 6 (September 15), 1999: pp. 2102-2111

Arsenic Trioxide Selectively Induces Acute Promyelocytic Leukemia Cell Apoptosis Via a Hydrogen Peroxide-Dependent Pathway

Yongkui Jing, Jie Dai, Ruth M.E. Chalmers-Redman, Willam G. Tatton, and Samuel Waxman

From the Rochelle Belfer Chemotherapy Foundation Laboratory, Division of Neoplastic Diseases, Department of Medicine, and the Department of Neurology, Mount Sinai Medical Center, New York, NY.

Low concentrations of As2O3 (<= 1 µmol/L) induce long-lasting remission in patients with acute promyelocytic leukemia (APL) without significant myelosuppressive side effects. Several groups, including ours, have shown that 0.5 to 1 µmol/L As2O3 induces apoptosis in APL-derived NB4 cells, whereas other leukemic cells are resistant to As2O3 or undergo apoptosis only in response to greater than 2 µmol/L As2O3. In this report, we show that the ability of As2O3 to induce apoptosis in leukemic cells is dependent on the activity of the enzymes that regulate cellular H2O2 content. Thus, NB4 cells have relatively low levels of glutathione peroxidase (GPx) and catalase and have a constitutively higher H2O2 content than U937 monocytic leukemia cells. Glutathione-S-transferase pi  (GSTpi ), which is important for cellular efflux of As2O3, is also low in NB4 cells. Moreover, As2O3 further inhibits GPX activity and increases cellular H2O2 content in NB4 but not in U937 cells. Selenite pretreatment of NB4 cells increases the activity of GPX, lowers cellular H2O2 levels, and renders NB4 cells resistant to 1 µmol/L As2O3. In contrast, concentrations of As2O3 that alone are not capable of inducing apoptosis in NB4 cells induce apoptosis in the presence of the GPx inhibitor mercaptosuccinic acid. Similar effects are observed by modulating the activity of catalase with its inhibitor, aminotriazol. More important from a therapeutic point of view, U937 and HL-60 cells, which require high concentrations of As2O3 to undergo apoptosis, become sensitive to low, clinically acceptable concentrations of As2O3 when cotreated with these GPx and catalase inhibitors. The induction of apoptosis by As2O3 involves an early decrease in cellular mitochondrial membrane potential and increase in H2O2 content, followed by cytochrome c release, caspase 3 activation, DNA fragmentation, and the classic morphologic changes of apoptosis.


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G.-Q. Chen, L. Zhou, M. Styblo, F. Walton, Y. Jing, R. Weinberg, Z. Chen, and S. Waxman
Methylated Metabolites of Arsenic Trioxide Are More Potent Than Arsenic Trioxide as Apoptotic but not Differentiation Inducers in Leukemia and Lymphoma Cells
Cancer Res., April 15, 2003; 63(8): 1853 - 1859.
[Abstract] [Full Text] [PDF]


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The OncologistHome page
D. Douer, W. Hu, S. Giralt, M. Lill, and J. DiPersio
Arsenic Trioxide (Trisenox(R)) Therapy for Acute Promyelocytic Leukemia in the Setting of Hematopoietic Stem Cell Transplantation
Oncologist, April 1, 2003; 8(2): 132 - 140.
[Abstract] [Full Text] [PDF]


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Mol. Pharmacol.Home page
P. Sancho, A. Troyano, C. Fernandez, E. De Blas, and P. Aller
Differential Effects of Catalase on Apoptosis Induction in Human Promonocytic Cells. Relationships with Heat-Shock Protein Expression
Mol. Pharmacol., March 1, 2003; 63(3): 581 - 589.
[Abstract] [Full Text] [PDF]


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ASH Education BookHome page
G. Mufti, A. F. List, S. D. Gore, and A. Y.L. Ho
Myelodysplastic Syndrome
Hematology, January 1, 2003; 2003(1): 176 - 199.
[Abstract] [Full Text] [PDF]


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J. Biol. Chem.Home page
J. Li, P. Chen, N. Sinogeeva, M. Gorospe, R. P. Wersto, F. J. Chrest, J. Barnes, and Y. Liu
Arsenic Trioxide Promotes Histone H3 Phosphoacetylation at the Chromatin of CASPASE-10 in Acute Promyelocytic Leukemia Cells
J. Biol. Chem., December 13, 2002; 277(51): 49504 - 49510.
[Abstract] [Full Text] [PDF]


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Clin. Cancer Res.Home page
N. J. Bahlis, J. McCafferty-Grad, I. Jordan-McMurry, J. Neil, I. Reis, M. Kharfan-Dabaja, J. Eckman, M. Goodman, H. F. Fernandez, L. H. Boise, et al.
Feasibility and Correlates of Arsenic Trioxide Combined with Ascorbic Acid-mediated Depletion of Intracellular Glutathione for the Treatment of Relapsed/Refractory Multiple Myeloma
Clin. Cancer Res., December 1, 2002; 8(12): 3658 - 3668.
[Abstract] [Full Text] [PDF]


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J. Biol. Chem.Home page
A. Verma, M. Mohindru, D. K. Deb, A. Sassano, S. Kambhampati, F. Ravandi, S. Minucci, D. V. Kalvakolanu, and L. C. Platanias
Activation of Rac1 and the p38 Mitogen-activated Protein Kinase Pathway in Response to Arsenic Trioxide
J. Biol. Chem., November 15, 2002; 277(47): 44988 - 44995.
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Molecular Cancer TherapeuticsHome page
T. Hayashi, T. Hideshima, M. Akiyama, P. Richardson, R. L. Schlossman, D. Chauhan, N. C. Munshi, S. Waxman, and K. C. Anderson
Arsenic Trioxide Inhibits Growth of Human Multiple Myeloma Cells in the Bone Marrow Microenvironment
Mol. Cancer Ther., August 1, 2002; 1(10): 851 - 860.
[Abstract] [Full Text] [PDF]


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Cancer Res.Home page
W. H. Miller Jr., H. M. Schipper, J. S. Lee, J. Singer, and S. Waxman
Mechanisms of Action of Arsenic Trioxide
Cancer Res., July 15, 2002; 62(14): 3893 - 3903.
[Abstract] [Full Text] [PDF]


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The OncologistHome page
J. L. Slack, S. Waxman, G. Tricot, M. S. Tallman, and C. D. Bloomfield
Advances in the Management of Acute Promyelocytic Leukemia and Other Hematologic Malignancies with Arsenic Trioxide
Oncologist, April 1, 2002; 7(90001): 1 - 13.
[Abstract] [Full Text] [PDF]


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The OncologistHome page
W. H. Miller Jr.
Molecular Targets of Arsenic Trioxide in Malignant Cells
Oncologist, April 1, 2002; 7(90001): 14 - 19.
[Abstract] [Full Text] [PDF]


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Clin. Cancer Res.Home page
R. B. Gartenhaus, S. N. Prachand, M. Paniaqua, Y. Li, and L. I. Gordon
Arsenic Trioxide Cytotoxicity in Steroid and Chemotherapy-resistant Myeloma Cell Lines: Enhancement of Apoptosis by Manipulation of Cellular Redox State
Clin. Cancer Res., February 1, 2002; 8(2): 566 - 572.
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BloodHome page
M. S. Tallman, C. Nabhan, J. H. Feusner, and J. M. Rowe
Acute promyelocytic leukemia: evolving therapeutic strategies
Blood, February 1, 2002; 99(3): 759 - 767.
[Abstract] [Full Text] [PDF]


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Mol. Cell. Biol.Home page
S.-H. Hong, Z. Yang, and M. L. Privalsky
Arsenic Trioxide Is a Potent Inhibitor of the Interaction of SMRT Corepressor with Its Transcription Factor Partners, Including the PML-Retinoic Acid Receptor {alpha} Oncoprotein Found in Human Acute Promyelocytic Leukemia
Mol. Cell. Biol., November 1, 2001; 21(21): 7172 - 7182.
[Abstract] [Full Text] [PDF]


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Cancer Res.Home page
H. Maeda, S. Hori, H. Nishitoh, H. Ichijo, O. Ogawa, Y. Kakehi, and A. Kakizuka
Tumor Growth Inhibition by Arsenic Trioxide (As2O3) in the Orthotopic Metastasis Model of Androgen-independent Prostate Cancer
Cancer Res., July 1, 2001; 61(14): 5432 - 5440.
[Abstract] [Full Text] [PDF]


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BloodHome page
O. Sordet, C. Rebe, I. Leroy, J.-M. Bruey, C. Garrido, C. Miguet, G. Lizard, S. Plenchette, L. Corcos, and E. Solary
Mitochondria-targeting drugs arsenic trioxide and lonidamine bypass the resistance of TPA-differentiated leukemic cells to apoptosis
Blood, June 15, 2001; 97(12): 3931 - 3940.
[Abstract] [Full Text] [PDF]


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The OncologistHome page
S. Waxman and K. C. Anderson
History of the Development of Arsenic Derivatives in Cancer Therapy
Oncologist, April 1, 2001; 6(90002): 3 - 10.
[Abstract] [Full Text]


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The OncologistHome page
S. L. Soignet
Clinical Experience of Arsenic Trioxide in Relapsed Acute Promyelocytic Leukemia
Oncologist, April 1, 2001; 6(90002): 11 - 16.
[Abstract] [Full Text]


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BloodHome page
Y. Jing, L. Wang, L. Xia, G.-q. Chen, Z. Chen, W. H. Miller, and S. Waxman
Combined effect of all-trans retinoic acid and arsenic trioxide in acute promyelocytic leukemia cells in vitro and in vivo
Blood, January 1, 2001; 97(1): 264 - 269.
[Abstract] [Full Text] [PDF]


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Clin. Cancer Res.Home page
R. Uslu, U. A. Sanli, C. Sezgin, B. Karabulut, E. Terzioglu, S. B. Omay, and E. Goker
Arsenic Trioxide-mediated Cytotoxicity and Apoptosis in Prostate and Ovarian Carcinoma Cell Lines
Clin. Cancer Res., December 1, 2000; 6(12): 4957 - 4964.
[Abstract] [Full Text]


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J. Pharmacol. Exp. Ther.Home page
M. J. McCabe Jr., K. P. Singh, S. A. Reddy, B. Chelladurai, J. G. Pounds, J. J. Reiners Jr., and J. C. States
Sensitivity of Myelomonocytic Leukemia Cells to Arsenite-Induced Cell Cycle Disruption, Apoptosis, and Enhanced Differentiation Is Dependent on the Inter-Relationship between Arsenic Concentration, Duration of Treatment, and Cell Cycle Phase
J. Pharmacol. Exp. Ther., November 1, 2000; 295(2): 724 - 733.
[Abstract] [Full Text]


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BloodHome page
G. J. Roboz, S. Dias, G. Lam, W. J. Lane, S. L. Soignet, R. P. Warrell Jr, and S. Rafii
Arsenic trioxide induces dose- and time-dependent apoptosis of endothelium and may exert an antileukemic effect via inhibition of angiogenesis
Blood, August 15, 2000; 96(4): 1525 - 1530.
[Abstract] [Full Text] [PDF]


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Cancer Res.Home page
Y. Huang, C. M. Horvath, and S. Waxman
Regrowth of 5-Fluorouracil-treated Human Colon Cancer Cells Is Prevented by the Combination of Interferon {{gamma}}, Indomethacin, and Phenylbutyrate
Cancer Res., June 1, 2000; 60(12): 3200 - 3206.
[Abstract] [Full Text]


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J. Biol. Chem.Home page
S. Zhuang, J. T. Demirs, and I. E. Kochevar
p38 Mitogen-activated Protein Kinase Mediates Bid Cleavage, Mitochondrial Dysfunction, and Caspase-3 Activation during Apoptosis Induced by Singlet Oxygen but Not by Hydrogen Peroxide
J. Biol. Chem., August 18, 2000; 275(34): 25939 - 25948.
[Abstract] [Full Text] [PDF]


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J. Biol. Chem.Home page
B. A. Wagner, G. R. Buettner, L. W. Oberley, C. J. Darby, and C. P. Burns
Myeloperoxidase Is Involved in H2O2-induced Apoptosis of HL-60 Human Leukemia Cells
J. Biol. Chem., July 14, 2000; 275(29): 22461 - 22469.
[Abstract] [Full Text] [PDF]


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J. Biol. Chem.Home page
Y. Yang, J.-Z. Cheng, S. S. Singhal, M. Saini, U. Pandya, S. Awasthi, and Y. C. Awasthi
Role of Glutathione S-Transferases in Protection against Lipid Peroxidation. OVEREXPRESSION OF hGSTA2-2 IN K562 CELLS PROTECTS AGAINST HYDROGEN PEROXIDE-INDUCED APOPTOSIS AND INHIBITS JNK AND CASPASE 3 ACTIVATION
J. Biol. Chem., May 25, 2001; 276(22): 19220 - 19230.
[Abstract] [Full Text] [PDF]


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J. Biol. Chem.Home page
M. Neuss, R. Monticone, M. S. Lundberg, A. T. Chesley, E. Fleck, and M. T. Crow
The Apoptotic Regulatory Protein ARC (Apoptosis Repressor with Caspase Recruitment Domain) Prevents Oxidant Stress-mediated Cell Death by Preserving Mitochondrial Function
J. Biol. Chem., August 31, 2001; 276(36): 33915 - 33922.
[Abstract] [Full Text] [PDF]



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