Chronic lymphocytic leukemia (CLL) is characterized by clonal accumulation of CD5؉ CD19 ؉ B lymphocytes that are arrested in the G 0 /G 1 phase of the cell cycle and fail to undergo apoptosis because of overexpression of the antiapoptotic B-cell CLL/lymphoma 2 (BCL-2) protein. Oncolytic viruses, such as vesicular stomatitis virus (VSV), have emerged as potential anticancer agents that selectively target and kill malignant cells via the intrinsic mitochondrial pathway. Although primary CLL cells are largely resistant to VSV oncolysis, we postulated that targeting the apoptotic pathway via inhibition of BCL-2 may sensitize CLL cells to VSV oncolysis. In the present study, we examined the capacity of EM20-25-a small-molecule antagonist of the BCL-2 protein-to overcome CLL resistance to VSV oncolysis. We demonstrate a synergistic effect of the two agents in primary ex vivo CLL cells (combination index of 0.5; P < 0.0001). In a direct comparison of peripheral blood mononuclear cells from healthy volunteers with primary CLL, the two agents combined showed a therapeutic index of 19-fold; furthermore, the combination of VSV and EM20-25 increased apoptotic cell death in Karpas-422 and Granta-519 B-lymphoma cell lines (P < 0.005) via the intrinsic mitochondrial pathway. Mechanistically, EM20-25 blocked the ability of the BCL-2 protein to dimerize with proapoptotic BAX protein, thus sensitizing CLL to VSV oncolytic stress. Together, these data indicate that the use of BCL-2 inhibitors may improve VSV oncolysis in treatment-resistant hematological malignancies, such as CLL, with characterized defects in the apoptotic response.

Bovine leukemia virus (BLV) expression is controlled at the transcriptional level through three Tax Bovine leukemia virus (BLV)7 infection is characterized by viral latency in the large majority of infected cells and by the absence of viremia. These features are thought to be due to the transcriptional repression of viral expression in vivo (1, 2). BLV transcription initiates at the unique promoter located in the 5Ј-long terminal repeat (5Ј-LTR) of the BLV genome. The 5Ј-LTR is composed of the U3, R, and U5 regions and transcription initiates at the U3-R junction. BLV exhibits two distinct functional transcriptional states as follows: a low basal level of transcription ensured by host cellular transcription factors, and a high level of transcription directed by the virus-encoded transcriptional activator Tax BLV (3,4). In the early stages of BLV transcription, before Tax BLV expression and transactivation, the basal transcriptional promoter activity is ensured by several cis-acting elements located in the 5Ј-LTR. In the U3 region are present the promoter CAAT and TATA boxes (5, 6), and three 21-bp enhancers, each containing an imperfectly conserved 8-bp cyclic AMP-responsive element (CRE), which binds at least three proteins: CRE-binding protein (CREB) and activating transcription factors 1 and 2 (ATF-1 and ATF-2) (7-10). Importantly, the 21-bp enhancers are also called Tax BLV -responsive elements (TxREs) because transactivation of the BLV LTR by Tax BLV requires these enhancers. It has been proposed that Tax BLV activation of transcription