The use of arsenic-containing compounds in the treatment of leukemias and other malignancies dates several decades back in time (1). Despite the known existence of arsenic compounds for hundreds of years, only recently has a derivative of this heavy metal, arsenic trioxide (As 2 O 3 ), found an established role in the treatment of a human disease. Extensive work has now established that As 2 O 3 exhibits potent pro-apoptotic effects against malignant cells and has important antineoplastic activities in vitro and in vivo (2-6). Importantly, As 2 O 3 has been approved for the treatment of acute promyelocytic leukemia (APL) 2 in humans, and its introduction in the therapy of this form of acute leukemia has had a major impact in medical oncology (1,(7)(8)(9)(10). Notably, APL is a form of leukemia with unusual sensitivity to the effects of arsenic trioxide. It is well established that induction of differentiation of APL cells occurs at low concentrations (0.5 M), whereas higher (Ն2 M) concentrations are required for the generation of its pro-apoptotic effects in other cell types (2-6). As 2 O 3 is also currently under investigation for the treatment of other hematological malignancies and clonal disorders, including chronic myelogenous leukemia, multiple myeloma, and myelodysplastic syndromes (2, 4, 11-13). A remaining challenge in introducing arsenic trioxide in the treatment of other malignancies is the development of means to enhance arsenic-dependent apoptosis at lower final concentrations. Thus, identification of cellular pathways that could be targeted to enhance the antineoplastic properties of As 2 O 3 are of high translational potential and interest.Previous work has suggested that the pro-apoptotic effects of As 2 O 3 on APL cells correlate with targeting and degradation of the abnormal PML-RAR␣ fusion protein (5, 14, 15), although independent mechanisms also exist (16). Among the genes regulated by the PML-RAR␣ fusion protein is the mitogen-activated protein kinase (MAPK)-interacting kinase 1 (Mnk1) (17, 18), a kinase that was recently shown to be post-translationally stabilized by PML-RAR␣ fusion protein and participate in the control of differentiation of myeloid cells (19). Mnk1 and the related Mnk2 are known to be activated downstream of MAPKs, via phosphorylation at Thr-197 and Thr-202 located in their activation loop (20 -23), and after their activation, they in turn phosphorylate the cap binding eukaryotic initiation factor 4E (eIF4E) at Ser-209 in response to mitogens and stress signals (22,23).In previous work, we had demonstrated that the p38 MAPK is activated in response to treatment of leukemic cells with As 2 O 3 (24) and shown that such activation occurs in a negative feedback regulatory manner, to control and limit arsenic-dependent apoptosis. This was established by studies demonstrating that pharmacological inhibitors of p38 promote generation of As 2 O 3 -dependent apoptosis (24), whereas pro-apoptotic * This work was supported by National Institutes of Health Grants CA121192, CA77816, a...