Tretinoin tocoferil as a possible differentiation-inducing agent against myelomonocytic leukemia.

Tretinoin tocoferil is an alpha-tocopherol ester of all-trans retinoic acid (ATRA) and safely used to treat skin ulcers. Tretinoin tocoferil stimulates the formation of granulation tissue in the ulcer, and enhances the migration of guinea pig macrophages and stimulates the proliferation of human skin fibroblasts. These effects are different from those of either ATRA or alpha-tocopherol. Tretinoin tocoferil induces the granulocytic differentiation of human promyelocytic leukemia HL-60 cells, and more than additively enhances cellular differentiation induced by sub-optimal concentrations of ATRA. Tretinoin tocoferil and ATRA synergistically inhibit the proliferation of HL-60 cells, suggesting that tretinoin tocoferil acts differently than ATRA on leukemia cells. Tretinoin tocoferil also enhances the differentiation of HL-60 cells induced by dimethyl sulfoxide, phorbol ester and 1alpha,25-dihydroxyvitamin D3(VD3). Tretinoin tocoferil and VD3 synergistically inhibit the proliferation and induce the differentiation of other myelomonocytic leukemia cells. Toxicity tests in animal models have shown that tretinoin tocoferil is at least 150 times less toxic than ATRA and does not induce teratogenesis. Therefore, the combination of tretinoin tocoferil and VD3 may be useful for treating myelomonocytic leukemia.