Third Department of Medicine, Technical University, Munich, Germany.
Leukemia. 2011 May;25(5):838-47. doi: 10.1038/leu.2011.2. Epub 2011 Feb 4.
Chronic lymphocytic leukemia (CLL) has a high prevalence in western countries and remains incurable to date. Here, we provide evidence that the multikinase inhibitor sorafenib induces apoptosis in primary CLL cells. This strong pro-apoptotic effect is not restricted to any subgroup of patients, based on Binet stage and the expression of ZAP70 or CD38. Mechanistically, sorafenib-induced cell death is preceded by a rapid downregulation of Mcl-1 through the inhibition of protein translation. Subsequently, the cell intrinsic apoptotic pathway is activated, indicated by destabilization of the mitochondrial membrane potential and activation of caspase-3 and -9. In contrast to sorafenib, the monoclonal vascular epidermal growth factor (VEGF)-antibody bevacizumab failed to induce apoptosis in CLL cells, suggesting that sorafenib induces cell death irrespectively of VEGF signalling. Notably, although sorafenib inhibits phosphorylation of the Scr-kinase Lck, knock-down of Lck did not induce apoptosis in CLL cells. Of note, the pro-apoptotic effect of sorafenib is not restricted to cell-cycle arrested cells, but is also maintained in proliferating CLL cells. In addition, we provide evidence that sorafenib can overcome drug resistance in CLL cells protected by microenvironmental signals from stromal cells. Conclusively, sorafenib is highly active in CLL and may compose a new therapeutic option for patients who relapse after immunochemotherapy.
慢性淋巴细胞白血病(CLL)在西方国家发病率较高,至今仍无法治愈。在这里,我们提供的证据表明,多激酶抑制剂索拉非尼可诱导原代 CLL 细胞凋亡。这种强烈的促凋亡作用不仅限于任何亚组患者,无论是基于 Binet 分期还是 ZAP70 或 CD38 的表达。从机制上讲,索拉非尼诱导的细胞死亡是通过抑制蛋白质翻译而迅速下调 Mcl-1 引起的。随后,细胞内源性凋亡途径被激活,表现为线粒体膜电位的不稳定性和 caspase-3 和 -9 的激活。与索拉非尼相反,单克隆血管表皮生长因子(VEGF)抗体贝伐单抗未能诱导 CLL 细胞凋亡,表明索拉非尼诱导的细胞死亡与 VEGF 信号无关。值得注意的是,尽管索拉非尼抑制 Scr-激酶 Lck 的磷酸化,但敲低 Lck 并未诱导 CLL 细胞凋亡。需要指出的是,索拉非尼的促凋亡作用不仅限于细胞周期停滞的细胞,而且在增殖的 CLL 细胞中也能维持。此外,我们提供的证据表明,索拉非尼可以克服由基质细胞的微环境信号保护的 CLL 细胞的耐药性。总之,索拉非尼在 CLL 中活性很高,可能为免疫化疗后复发的患者提供新的治疗选择。
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