Imatinib mesylate (imatinib) is highly effective in the treatment of chronic myeloid leukemia (CML) but is less effective in eliminating CML stem cells. We investigated whether SKI-606, a potent Bcr-Abl and Src kinase inhibitor without anti-PDGF or c-Kit activity, could effectively target primitive CML progenitors. CML and normal progenitors were cultured with SKI-606 or imatinib. SKI-606 effectively inhibited Bcr-Abl kinase activity in CML CD34 ؉ cells and inhibited Src phosphorylation more potently than imatinib.However, SKI-606 and imatinib resulted in similar suppression of CML primitive and committed progenitor proliferation and growth in CFC and LTC-IC assays. Exposure to either agent alone or in combination resulted in only modest increase in apoptosis. Evaluation of downstream signaling pathways indicated that Akt and STAT5 activity was not changed, but a delayed increase in MAPK activity was seen at high concentrations of SKI-606. SKI-606 inhibited normal progenitor proliferation to a lesser extent than imatinib.
SKI-606 effectively inhibits
IntroductionTreatment with the Bcr-Abl kinase inhibitor imatinib mesylate (imatinib) has markedly improved the outcome for patients with chronic myeloid leukemia (CML). High response rates have been reported for CML patients in chronic phase (CP) of the disease, whereas patients with later stages of CML (accelerated phase and blast crisis) are prone to develop imatinib resistance. 1 Several mechanisms of resistance have been identified, including mutations in the BCR-ABL kinase domain, BCR-ABL amplification, and overexpression and abnormal, constitutive activation of growth stimulatory signaling pathways independent of Bcr-Abl. [2][3][4][5] Mathematical modeling of in vivo kinetics of response to imatinib, based on analysis of quantitative polymerase chain reaction (Q-PCR) data, suggests that imatinib inhibits production of differentiated leukemia cells but does not deplete leukemia stem cells. 6,7 Analysis of bone marrow samples from CML patients in complete remission on imatinib treatment confirms the persistence of leukemia stem and progenitor cells in this patient population. 8 Reports of recurrence occurring after discontinuation of imatinib therapy indicate that residual CML cells remaining after imatinib therapy possess pathogenic potential. 9,10 The eradication of malignant stem and progenitor cells thus appears to be necessary to improve the treatment outcome for these patients.We have shown that suppression of CML progenitor growth by imatinib is primarily accomplished through inhibition of abnormally increased proliferation rather than through induction of apoptosis, and that nondividing primitive progenitors are insensitive to imatinib-induced apoptosis. 11,12 Our studies indicate that inherent resistance of quiescent CML progenitors to apoptosis plus microenvironmental activation of signaling pathways that contribute to maintenance of viability in imatinib-treated CML progenitors may be potential mechanisms underlying the persistence of malignant proge...