Retinoic acid and arsenic synergize to eradicate leukemic cells in a mouse model of acute promyelocytic leukemia

• Published in: The Journal of experimental medicine Vol. 189; no. 7; pp. 1043 - 1052
• Main Authors: Lallemand-Breitenbach, V, Guillemin, M C, Janin, A, Daniel, M T, Degos, L, Kogan, S C, Bishop, J M, de Thé, H
• Format: Journal Article
• Language: English
• Published: United States The Rockefeller University Press 05.04.1999
• Subjects: Animals; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Apoptosis - drug effects; Arsenic - administration & dosage; Arsenic - pharmacology; Cell Differentiation - drug effects; Drug Screening Assays, Antitumor; Drug Synergism; Hematopoiesis - drug effects; Humans; Leukemia, Promyelocytic, Acute - drug therapy; Leukemia, Promyelocytic, Acute - pathology; Liver - pathology; Lung - pathology; Mice; Mice, Transgenic; Neoplasm Proteins - metabolism; Neoplasm Transplantation; Neoplastic Stem Cells - drug effects; Oncogene Proteins, Fusion - metabolism; Remission Induction; Spleen - pathology; Tretinoin - administration & dosage; Tretinoin - pharmacology; Tumor Cells, Cultured
• ISSN: 0022-1007; 1540-9538
• DOI: 10.1084/jem.189.7.1043

In acute promyelocytic leukemia (APL) patients, retinoic acid (RA) triggers differentiation while arsenic trioxide (arsenic) induces both a partial differentiation and apoptosis. Although their mechanisms of action are believed to be distinct, these two drugs both induce the catabolism of the oncogenic promyelocytic leukemia (PML)/RARalpha fusion protein. While APL cell lines resistant to one agent are sensitive to the other, the benefit of combining RA and arsenic in cell culture is controversial, and thus far, no data are available in patients. Using syngenic grafts of leukemic blasts from PML/RARalpha transgenic mice as a model for APL, we demonstrate that arsenic induces apoptosis and modest differentiation, and prolongs mouse survival. Furthermore, combining arsenic with RA accelerates tumor regression through enhanced differentiation and apoptosis. Although RA or arsenic alone only prolongs survival two- to threefold, associating the two drugs leads to tumor clearance after a 9-mo relapse-free period. These studies establishing RA/arsenic synergy in vivo prompt the use of combined arsenic/RA treatments in APL patients and exemplify how mouse models of human leukemia can be used to design or optimize therapies.