Enhancement of differentiation and cytotoxicity of leukemia cells by combinations of fluorinated pyrimidines and differentiation inducers: development of DNA double-strand breaks.

We have previously shown that pretreatment of mouse erythroleukemia (MEL) cells with the fluorinated pyrimidines 5-fluorouracil (FUra) or 5-fluorodeoxyuridine (FUdR) followed by the differentiation inducer hexamethylene bisacetamide (HMBA) greatly enhanced the magnitude of their differentiation and caused extensive cell death. We have now extended these studies to address the mechanism that may be responsible for this enhancement and have also examined a human leukemic cell line (HL-60) for its sensitivity to this combination cytotoxic-differentiation therapy. We found that in HL-60 cells, pretreatment with FUdR, but not FUra, followed by 1.2% dimethylsulfoxide (DMSO) led to an 8 to 10-fold enhancement of cell death as compared to FUdR alone. When all-trans-retinoic acid (ATRA) was used instead of DMSO, the enhancement of differentiation and cytotoxicity was 5-fold. The percent of cells induced to differentiate was dependent on the concentration of both FUdR and ATRA. In HL-60 cells resistant to ATRA-induced differentiation, the combination of FUdR and ATRA did not result in enhanced cytotoxicity. Leucovorin (LV), a compound known to enhance the inhibitory effect of FUra or FUdR on DNA synthesis, increased the effectiveness of the cytotoxic-differentiation therapy, whereas thymidine inhibited its effectiveness. This suggests that inhibition of DNA metabolism may be an integral part of the differentiation-enhancing cytotoxic mechanism. To further explore inhibition of DNA synthesis, DNA was extracted under alkaline or neutral conditions from 3H-thymidine-labelled cells that were treated with FUra/LV and HMBA individually or in combination. The emergence of single and double-strand DNA breaks was monitored by agarose gel electrophoresis. In parallel to the enhancement of cytotoxicity, the combination treatment (FUra/LV followed by HMBA) also produced a 2.5-3-fold increase in the DNA breaks when compared to the same effect obtained by the agents applied individually. Thus, we propose that DNA degradation may be the mechanism responsible for the enhanced loss of cell viability. In summary, we report here an approach which is targeted to increasing the death rate of leukemic cells through the combined use of low doses of cytotoxic drugs and differentiation inducers.