Anthracycline action has been thought to involve the neosynthesis of proapoptotic gene products and to therefore depend on protein synthesis for optimal effect. We found that inhibition of general, but not rapamycin-sensitive (cap-dependent), protein synthesis in the preapoptotic period enhanced anthracycline-induced acute myelogenous leukemia (AML) cell death, both in vitro and in several animal AML models. Pre-apoptotic anthracyclineexposed AML cells had altered translational specificity, with enhanced synthesis of a subset of proteins, including endoplasmatic reticulum chaperones. The altered translational specificity could be explained by perturbation (protein degradation, truncation, or dephosphorylation) of the cap-dependent translation initiation machinery and of proteins controling translation of specific mRNAs. We propose that judiciously timed inhibition of cap-independent translation is considered for combination therapy with anthracyclines in AML.
IntroductionDespite recent achievements, 1,2 progress in therapy is slow for most malignancies, including acute myelogenous leukemia (AML). 3 A more thorough understanding of how the most successful current drugs, such as the anthracyclines, induce cancer cell death can reveal novel therapeutically valuable death mechanisms, which can be targeted more efficiently by specifically tailored compounds than by current drugs. It can also reveal that present drugs activate cancer cell survival pathways in ways that can be overcome by, for example, coadministering complementary agents.The aim of the present study was to undertake a proteomicsbased survey 4 of protein expression and modification in anthracycline-treated AML cells to explain in molecular terms previous observations that inhibitors of translation could protect completely 5 or partially 6-9 against anthracycline-induced cell death. Anthracycline treatment up-regulates the activity of signaling pathways stimulating the transcription factor nuclear factor-B, 10 and we have found that drug-resistant AML cells have up-regulated signal transducers and activators of transcriptions 3 and 5. 11 Because these factors induce genes coding mainly, although not exclusively, for presumed survival promoting proteins, 12-15 the reported dependence on protein synthesis for death implies either that the proapoptotic genes are induced in excess, that anthracycline treatment tips the balance between translation of mRNA coding for proapoptotic and prosurvival proteins in favor of the former, or can convert short-lived prosurvival proteins to prodeath proteins by, for example, dephosphorylation 16 or cleavage. [17][18][19] We found that the first-line AML anthracycline drugs, such as daunorubicin (DNR), modified or altered the expression of several proteins known to alter the translation of specific mRNAs or direct translation from cap dependence to internal ribosome entry site dependence. This might explain that the DNR-treated AML cells in the late preapoptotic phase had enhanced synthesis of a subset of proteins, includ...