Basic principles for utilizing combination differentiation agents.

The induction of differentiation in several tumor lines serves as a basis for a new approach to cancer treatment. In vitro studies in the mouse erythroleukemia (MEL) cell system have identified about 300 agents capable of inducing differentiation by mechanisms that remain to be elucidated. The design of differentiation therapy will depend on the specific tumor cell type, an effective time course, and the synergistic interaction among combinations of two or more inducers. The induction of differentiation may be followed by terminal cell division (TCD) or programmed cell death in several tumor cell systems. This mechanism for the destruction of tumor cells is one goal of differentiation therapy and differs from nonspecific cytotoxic therapy. To evaluate the effect of differentiation therapy, a clear distinction must be made between nonspecific cytotoxicity and the programmed TCD of induced cytodifferentiation. One possible parameter for assessing the commitment to TCD in the MEL cell system is a selective decrease in DNA ligase activity, which does not appear to occur following treatment with nonspecific cytotoxic agents. These biological and biochemical parameters should be helpful in designing agents capable of inducing TCD in vivo.