Nutlin-3 plus tanshinone IIA exhibits synergetic anti-leukemia effect with imatinib by reactivating p53 and inhibiting the AKT/mTOR pathway in Ph+ ALL

Biochem J. 2017 Dec 6;474(24):4153-4170. doi: 10.1042/BCJ20170386.

Abstract

Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL) is triggered by BCR/ABL kinase. Recent efforts focused on the development of more potent tyrosine kinase inhibitors (TKIs) that also inhibit mutant tyrosine kinases such as nilotinib and dasatinib. Although major advances in the treatment of this aggressive disease with potent inhibitors of the BCR/ABL kinases, patients in remission frequently relapse due to drug resistance possibly mediated, at least in part, by compensatory activation of growth-signaling pathways and protective feedback signaling of leukemia cells in response to TKI treatment. Continuous activation of AKT/mTOR signaling and inactivation of p53 pathway were two mechanisms of TKI resistance. Here, we reported that nutlin-3 plus tanshinone IIA significantly potentiated the cytotoxic and apoptotic induction effects of imatinib by down-regulation of the AKT/mTOR pathway and reactivating the p53 pathway deeply in Ph+ ALL cell line. In primary samples from Ph+ ALL patients, nutlin-3 plus tanshinone IIA also exhibited synergetic cytotoxic effects with imatinib. Of note, three samples from Ph+ ALL patients harboring T315I mutation also showed sensitivity to the combined treatment of imatinib, nutlin-3 plus tanshinone IIA. In Ph+ ALL mouse models, imatinib combined with nutlin-3 plus tanshinone IIA also exhibited synergetic effects on reduction in leukemia burden. These results demonstrated that nutlin-3 plus tanshinone IIA combined TKI might be a promising treatment strategy for Ph+ ALL patients.

Keywords: leukemia; mechanistic target of rapamycin; p53; tyrosine kinase inhibitor.

MeSH terms

  • Abietanes / administration & dosage*
  • Animals
  • Antineoplastic Agents / administration & dosage
  • Antineoplastic Agents, Phytogenic / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Dose-Response Relationship, Drug
  • Drug Synergism
  • Female
  • Genes, p53 / drug effects
  • Genes, p53 / physiology
  • Humans
  • Imatinib Mesylate / administration & dosage*
  • Imidazoles / administration & dosage*
  • K562 Cells
  • Mice
  • Mice, Inbred NOD
  • Mice, SCID
  • Oncogene Protein v-akt / antagonists & inhibitors*
  • Oncogene Protein v-akt / metabolism
  • Piperazines / administration & dosage*
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / drug therapy
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / genetics
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / metabolism*
  • Signal Transduction / drug effects
  • Signal Transduction / physiology
  • TOR Serine-Threonine Kinases / antagonists & inhibitors*
  • TOR Serine-Threonine Kinases / metabolism
  • Treatment Outcome

Substances

  • Abietanes
  • Antineoplastic Agents
  • Antineoplastic Agents, Phytogenic
  • Imidazoles
  • Piperazines
  • tanshinone
  • nutlin 3
  • Imatinib Mesylate
  • MTOR protein, human
  • Oncogene Protein v-akt
  • TOR Serine-Threonine Kinases