Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Manuscript
  • Published:

Differentiation

Retinoid/arsenic combination therapy of promyelocytic leukemia: induction of telomerase-dependent cell death

Abstract

Acute promyelocytic leukemia (APL) is efficiently treated with a cell differentiation inducer, all-trans retinoic acid (ATRA). However, a significant percentage of patients still develop resistance to this treatment. Recently, arsenic trioxide (As2O3), alone or in combination with ATRA, has been identified as an alternative therapy in patients with both ATRA-sensitive and ATRA-resistant APL. Previous investigations restricted the mechanism of this synergism to the modulation and/or degradation of PML-RARα oncoprotein through distinct pathways. In this study, using several ATRA maturation-resistant APL cell lines, we demonstrate in vitro that the success of ATRA/As2O3 treatment in APL pathology can be explained, at least in part, by a synergistic effect of these two drugs in triggering downregulation of telomerase efficient enough to cause telomere shortening and subsequent cell death. Such long-term low-dose combinatorial therapy strategies, developed also to avoid acute side effects, reinforce the notion that the antitelomerase strategy, based on a combination of active agents, should now be considered and evaluated not only in APL but also in other malignancies.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  1. Hahn WC . Role of telomeres and telomerase in the pathogenesis of human cancer. J Clin Oncol 2003; 21: 2034–2043.

    Article  CAS  PubMed  Google Scholar 

  2. Stewart SA, Hahn WC, O'Connor BF, Banner EN, Lundberg AS, Modha P et al. Telomerase contributes to tumorigenesis by a telomere length-independent mechanism. Proc Natl Acad Sci USA 2002; 99: 12606–12611.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Mergny JL, Riou JF, Mailliet P, Teulade-Fichou MP, Gilson E . Natural and pharmacological regulation of telomerase. Nucleic Acids Res 2002; 30: 839–865.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Fu W, Begley JG, Killen MW, Mattson MP . Anti-apoptotic role of telomerase in pheochromocytoma cells. J Biol Chem 1999; 274: 7264–7271.

    Article  CAS  PubMed  Google Scholar 

  5. Dudognon C, Pendino F, Hillion J, Saumet A, Lanotte M, Segal-Bendirdjian E . Death receptor signaling regulatory function for telomerase: hTERT abolishes TRAIL-induced apoptosis, independently of telomere maintenance. Oncogene 2004; 23: 7469–7474.

    Article  CAS  PubMed  Google Scholar 

  6. Tallman MS, Nabhan C, Feusner JH, Rowe JM . Acute promyelocytic leukemia: evolving therapeutic strategies. Blood 2002; 99: 759–767.

    Article  CAS  PubMed  Google Scholar 

  7. Mistry AR, Pedersen EW, Solomon E, Grimwade D . The molecular pathogenesis of acute promyelocytic leukaemia: implications for the clinical management of the disease. Blood Rev 2003; 17: 71–97.

    Article  PubMed  Google Scholar 

  8. Puccetti E, Ruthardt M . Acute promyelocytic leukemia: PML/RARalpha and the leukemic stem cell. Leukemia 2004; 18: 1169–1175.

    Article  CAS  PubMed  Google Scholar 

  9. Gallagher RE . Retinoic acid resistance in acute promyelocytic leukemia. Leukemia 2002; 16: 1940–1958.

    Article  CAS  PubMed  Google Scholar 

  10. Ohno R, Asou N, Ohnishi K . Treatment of acute promyelocytic leukemia: strategy toward further increase of cure rate. Leukemia 2003; 17: 1454–1463.

    Article  CAS  PubMed  Google Scholar 

  11. Zhang P . The use of arsenic trioxide (As2O3) in the treatment of acute promyelocytic leukemia. J Biol Regul Homeost Agents 1999; 13: 195–200.

    CAS  PubMed  Google Scholar 

  12. Chen GQ, Shi XG, Tang W, Xiong SM, Zhu J, Cai X et al. Use of arsenic trioxide (As2O3) in the treatment of acute promyelocytic leukemia (APL): I. As2O3 exerts dose-dependent dual effects on APL cells. Blood 1997; 89: 3345–3353.

    CAS  PubMed  Google Scholar 

  13. Au WY, Chim CS, Lie AK, Liang R, Kwong YL . Combined arsenic trioxide and all-trans retinoic acid treatment for acute promyelocytic leukaemia recurring from previous relapses successfully treated using arsenic trioxide. Br J Haematol 2002; 117: 130–132.

    Article  CAS  PubMed  Google Scholar 

  14. Shen ZX, Shi ZZ, Fang J, Gu BW, Li JM, Zhu YM et al. All-trans retinoic acid/As2O3 combination yields a high quality remission and survival in newly diagnosed acute promyelocytic leukemia. Proc Natl Acad Sci USA 2004; 101: 5328–5335.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Chen GQ, Zhu J, Shi XG, Ni JH, Zhong HJ, Si GY et al. In vitro studies on cellular and molecular mechanisms of arsenic trioxide (As2O3) in the treatment of acute promyelocytic leukemia: As2O3 induces NB4 cell apoptosis with downregulation of Bcl-2 expression and modulation of PML-RAR alpha/PML proteins. Blood 1996; 88: 1052–1061.

    CAS  PubMed  Google Scholar 

  16. Huang X . [Regulation of arsenic trioxide-inducing apoptosis]. Zhonghua Xue Ye Xue Za Zhi 1999; 20: 258–260.

    CAS  PubMed  Google Scholar 

  17. Zhu J, Lallemand-Breitenbach V, de The H . Pathways of retinoic acid- or arsenic trioxide-induced PML/RARalpha catabolism, role of oncogene degradation in disease remission. Oncogene 2001; 20: 7257–7265.

    Article  CAS  PubMed  Google Scholar 

  18. Zhu J, Koken MH, Quignon F, Chelbi-Alix MK, Degos L, Wang ZY et al. Arsenic-induced PML targeting onto nuclear bodies: implications for the treatment of acute promyelocytic leukemia. Proc Natl Acad Sci USA 1997; 94: 3978–3983.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Zhang Y, Cao EH, Liang XQ, Qin JF . Increasing sensitivity to arsenic trioxide-induced apoptosis by altered telomere state. Eur J Pharmacol 2003; 474: 141–147.

    Article  CAS  PubMed  Google Scholar 

  20. Zhang TC, Schmitt MT, Mumford JL . Effects of arsenic on telomerase and telomeres in relation to cell proliferation and apoptosis in human keratinocytes and leukemia cells in vitro. Carcinogenesis 2003; 24: 1811–1817.

    Article  CAS  PubMed  Google Scholar 

  21. Liu L, Trimarchi JR, Navarro P, Blasco MA, Keefe DL . Oxidative stress contributes to arsenic-induced telomere attrition, chromosome instability, and apoptosis. J Biol Chem 2003; 278: 31998–32004.

    Article  CAS  PubMed  Google Scholar 

  22. Chen YC, Lin-Shiau SY, Lin JK . Involvement of reactive oxygen species and caspase 3 activation in arsenite-induced apoptosis. J Cell Physiol 1998; 177: 324–333.

    Article  CAS  PubMed  Google Scholar 

  23. Hei TK, Liu SX, Waldren C . Mutagenicity of arsenic in mammalian cells: role of reactive oxygen species. Proc Natl Acad Sci USA 1998; 95: 8103–8107.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Liu SX, Athar M, Lippai I, Waldren C, Hei TK . Induction of oxyradicals by arsenic: implication for mechanism of genotoxicity. Proc Natl Acad Sci USA 2001; 98: 1643–1648.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Chou WC, Hawkins AL, Barrett JF, Griffin CA, Dang CV . Arsenic inhibition of telomerase transcription leads to genetic instability. J Clin Invest 2001; 108: 1541–1547.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Roussel MJ, Lanotte M . Maturation sensitive and resistant t(15;17) NB4 cell lines as tools for APL physiopathology: nomenclature of cells and repertory of their known genetic alterations and phenotypes. Oncogene 2001; 20: 7287–7291.

    Article  CAS  PubMed  Google Scholar 

  27. Pendino F, Flexor M, Delhommeau F, Buet D, Lanotte M, Segal-Bendirdjian E . Retinoids downregulate telomerase and telomere length in a pathway distinct from leukemia cell differentiation. Proc Natl Acad Sci USA 2001; 98: 6662–6667.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Pendino F, Sahraoui T, Lanotte M, Segal-Bendirdjian E . A novel mechanism of retinoic acid resistance in acute promyelocytic leukemia cells through a defective pathway in telomerase regulation. Leukemia 2002; 16: 826–832.

    Article  CAS  PubMed  Google Scholar 

  29. Pendino F, Dudognon C, Delhommeau F, Sahraoui T, Flexor M, Bennaceur-Griscelli A et al. Retinoic acid receptor alpha and retinoid-X receptor-specific agonists synergistically target telomerase expression and induce tumor cell death. Oncogene 2003; 22: 9142–9150.

    Article  CAS  PubMed  Google Scholar 

  30. Lanotte M, Martin-Thouvenin V, Najman S, Balerini P, Valensi F, Berger R . NB4, a maturation inducible cell line with t(15;17) marker isolated from a human acute promyelocytic leukemia (M3). Blood 1991; 77: 1080–1086.

    CAS  PubMed  Google Scholar 

  31. Duprez E, Ruchaud S, Houge G, Martin-Thouvenin V, Valensi F, Kastner P et al. A retinoid acid ‘resistant’ t(15;17) acute promyelocytic leukemia cell line: isolation, morphological, immunological, and molecular features. Leukemia 1992; 6: 1281–1287.

    CAS  PubMed  Google Scholar 

  32. Gianni M, Koken MH, Chelbi-Alix MK, Benoit G, Lanotte M, Chen Z et al. Combined arsenic and retinoic acid treatment enhances differentiation and apoptosis in arsenic-resistant NB4 cells. Blood 1998; 91: 4300–4310.

    CAS  PubMed  Google Scholar 

  33. Stewart SA, Ben-Porath I, Carey VJ, O'Connor BF, Hahn WC, Weinberg RA . Erosion of the telomeric single-strand overhang at replicative senescence. Nat Genet 2003; 33: 492–496.

    Article  CAS  PubMed  Google Scholar 

  34. Douer D, Tallman MS . Arsenic trioxide: new clinical experience with an old medication in hematologic malignancies. J Clin Oncol 2005; 23: 2396–2410.

    Article  CAS  PubMed  Google Scholar 

  35. Zhou J, Meng R, Yang BF . Comparing two arsenic trioxide administration methods in APL therapy. Chin Med J (Engl) 2004; 117: 1411–1413.

    CAS  Google Scholar 

Download references

Acknowledgements

This work was supported by INSERM, the Ligue contre le Cancer, the Association pour la Recherche contre le Cancer (ARC nos. 4513 and 3416), and OTKA T-038163 (Hungary) research grant, BIO-00032/2001 Biotechnology Grant and F-1/03 French–Hungarian Bilateral Intergovernmental S&T Cooperation. FP was funded by the Fondation pour la Recherche Médicale (FRM). CD is a research fellow of Association pour la Recherche contre le Cancer. IT is supported by EMBO, the Société Française du Cancer and Société Française d'Hématologie.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to E Ségal-Bendirdjian.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tarkanyi, I., Dudognon, C., Hillion, J. et al. Retinoid/arsenic combination therapy of promyelocytic leukemia: induction of telomerase-dependent cell death. Leukemia 19, 1806–1811 (2005). https://doi.org/10.1038/sj.leu.2403923

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.leu.2403923

Keywords

This article is cited by

Search

Quick links