Search

Introduction: Acute Myeloid Leukemia (AML) is a malignant neoplastic disease arising from myeloid cell lines. AML is characterized by the proliferation of immature, nonfunctional cells in the bone marrow. Acute Promyelocytic Leukemia (APL) is a subtype of AML characterized by proliferation of immature promyelocytes. Growth Hormone Releasing Hormone (GHRH) is a hypothalamic peptide that stimulates the release of Growth Hormone from the anterior pituitary. This study aimed to investigate the role of MIA-602, a growth hormone-releasing hormone receptor (GHRH-R) antagonist as front line-combination therapy in the K-562 in-vitro model of AML as well as its potential for treating ATRA/ATO resistant APL. Design: Western blot analysis was used to detect the GHRH-R in both K-562 and NB4 cell lines. K562 cells were maintained as a cell suspension in the RPMI medium, with 10% heat-inactivated fetal bovine serum and gentamicin. Doxorubicin treatment concentrations were 0.005, 0.01, and 0.05 μg/μl. Combination therapy concentrations were 0.005, 0.01, and 0.05 μg/μl of doxorubicin and 5 μmol/L of MIA-602. Proliferation was observed and recorded at 24h and 48h. Wild type NB4 cells and NB4 cells resistant to both ATRA and ATO (NB4-RAA) were cultured in suspension. Cell lysates were prepared after incubation with MIA-602. Cell viability was measured at 24, 48, and 72h. Flow cytometry was also performed to assess expression of CD-56. Results: Incubation of cells with doxorubicin showed a decrease in proliferation in a dose-dependent manner. Co-incubation of K562 cells with MIA-602 and doxorubicin showed a significantly greater reduction in proliferation (p5.8-fold; p,0.05) in NB4-RAA cells as compared to the parent cell line. Discussion: Co-administration of doxorubicin and the GHRH-R antagonist MIA-602 was shown to have a synergistic effect in reducing proliferation of the K-562 AML cell line. Use of MIA-602 in front-line combination therapy with anthracycline-based regimens may help prevent the acquisition of resistance in AML. CD-56 plays an essential role in the regulation of cell survival and stress resistance. Aberrant expression of CD-56 is also associated with reduced complete remission rates, higher relapse rates, and poor overall survival. The equal effectiveness of MIA-602 in cells with increased expression of CD-56 may provide an important therapeutic option in the setting of resistance. Citation Format: Ravinder S. Chale, Mario Rodriguez, Stephanie M. Almeida, Shelly Sclatter, Anastasia Singaready, Andrew V. Schally, Joaquin J. Jimenez. Synergistic effects of MIA-602 and its potential for use in ATRA/ATO Resistant APL [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 385.

Acute Promyelocytic Leukemia (APL) is characterized by proliferation of immature promyelocytes. Combination therapy using retinoic acid (RA) and arsenic trioxide (ATO) is considered standard treatment in the clinical environment. Resistance to both RA and ATO is associated with an increased risk of mortality. In addition, relapse occurs in approximately 10-20% of patients undergoing treatment for APL. Growth Hormone Releasing Hormone (GHRH) is a hypothalamic peptide that stimulates the release of Growth Hormone from the anterior pituitary. Our previous studies have demonstrated that human AML cell lines (K-562, THP-1, and KG-1a) display the GHRH receptor (GHRH-R). Incubation with GHRH-R antagonist MIA-602, inhibited proliferation and induced apoptosis. The purpose of this study is to examine the effects of GHRH-R antagonist MIA-602, on the NB4 Human Promyelocytic Leukemia cell line and its ATRA and ATO resistant sub-clone. NB4 cells expressed both GHRH-R and SV1 variants via western blot analysis. Wild type NB4 cells, as well as NB4 cells resistant to both ATRA and ATO (NB4-RAA), were cultured in suspension in RPMI and 10% fetal calf serum. NB4-RAA were established in Dr. Jimenez's lab from the wild type NB4 parent cell line. NB4 and NB4-RAA were plated in triplicate on multi-wells at 50,000 cells/mL. Cell lysates were prepared after incubation with 0.05-5 µmol/L of MIA-602. Cell viability was measured at 24 and 48h. Flow cytometry was also performed on the naïve NB4 parent cell line in addition to NB4-RAA to assess expression of CD-56 the cell surface marker. Upregulation of CD-56, also known as Neural cell adhesion molecule 1 (NCAM-1), has been shown to confer drug resistance in AML and is an important prognostic marker in APL. The viability of both cell lines decreased to similar levels at 24 h and 48 h when exposed to concentrations of MIA-602 higher than 0.05 μmol/L (p < 0.05). A significant decrease in cell viability was seen above 0.5 μmol/L after 48h. No viable cells were found in either cell line after 48h when exposed to 5 μmol/L of MIA-602. No difference in cell viability was found between naïve NB4 and resistant NB4-RAA when exposed to the same concentrations of MIA-602. MIA-602 induced significant changes in the expression level of many death-related genes including CASP9 (>1.5-fold; P5.8-fold; p,0.05) in NB4-RAA cells as compared to the parent cell line. These results indicate that resistance to ATRA and ATO in APL cells does not confer subsequent resistance to MIA-602. As a result, MIA-602 targets a pathway that is distinct from that of ATRA & ATO. More importantly, upregulation of pro-apoptotic genes by MIA-602 indicates an alternative pathway elicited by the GHRH-R antagonist in the setting of resistant APL cells. Our results indicate that the resistance to frontline APL therapy can be effectively overcome by using MIA-602. Citation Format: Ravinder S. Chale, Stephanie M. Almeida, Ivan Jozic, Andrew V. Schally, Joaquin J. Jimenez. A novel approach to the treatment of ATRA/ATO resistant acute promyelocytic leukemia [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5317.