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Blood, 1 November 2000, Vol. 96, No. 9, pp. 3200-3208
NEOPLASIA
Altered ligand binding and transcriptional regulation by
mutations in the PML/RAR ligand-binding domain arising in retinoic
acid-resistant patients with acute promyelocytic leukemia
Sylvie Côté,
Dacheng Zhou,
Andrea Bianchini,
Clara Nervi,
Robert E. Gallagher, and
Wilson
H. Miller Jr
From the Lady Davis Institute for Medical Research, Sir
Mortimer B. Davis Jewish General Hospital, and the McGill University
Department of Oncology and Medicine, Montreal, Quebec, Canada;
Montefiore Medical Center and Albert Einstein Cancer Center, Bronx, NY;
and Dipartimento di Istologia ed Embriologia Medica, Università
di Roma "La Sapienza," Rome, Italy.
Acute promyelocytic leukemia (APL) is characterized by a specific
translocation, t(15;17), that fuses the promyelocytic leukemia (PML) gene with the RA receptor RAR .
Pharmacologic doses of retinoic acid (RA) induce differentiation in
human APL cells and complete clinical remissions. Unfortunately, APL
cells develop resistance to RA in vitro and in vivo. Recently,
mutations in PML/RAR have been described in APL cells
from patients clinically resistant to RA therapy. The mutations cluster
in 2 regions that are involved in forming the binding pocket for RA.
These mutant PML/RAR proteins have been expressed in vitro,
which shows that they cause a diversity of alterations in binding to
ligand and to nuclear coregulators of transcription, leading to varying
degrees of inhibition of retinoid-induced transcription. This contrasts
with the nearly complete dominant negative activity of mutations in
PML/RAR previously characterized in cell lines developing RA
resistance in vitro. Current data from this study provide additional
insight into the molecular mechanisms of resistance to RA and suggest
that alterations in the ability of mutants to interact with
coregulators can be determinant in the molecular mechanism of
resistance to RA. In particular, ligand-induced binding to the
coactivator ACTR correlated better with transcriptional
activation of RA response elements than the ligand-induced release of
the corepressor SMRT. The diversity of effects that are seen in
patient-derived mutations may help explain the partial success to date
of attempts to overcome this mechanism of resistance in patients by the
clinical use of histone deacetylase inhibitors.

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