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Retargeted natural killer cells for adoptive cancer immunotherapy (2011)
Christiane Knopp: NK cells are part of the innate immune system, and are important players in the body’s first defence line against virus-infected and malignantly transformed cells. While T cells recognize neoplastic cells in an MHC-restricted fashion, NK cells do not require prior sensitization and education about the target. In leukemia and lymphoma patients undergoing allogeneic hematopoietic stem cell transplantation not only T cells but also NK cells have been found to mediate potent graft-versus-tumor effects. Hence, autologous or donor-derived NK cells hold great promise for cancer immunotherapy. Since the generation of highly purified NK cell products for clinical applications is labor-intensive and time consuming, established human NK cell lines such as NK-92 are also being considered for clinical protocols. NK-92 cells display phenotypic and functional characteristics similar to activated primary NK cells. While NK-92 cells are highly cytotoxic towards malignant cells of hematologic origin, they do not affect healthy human tissues. NK-92 cells can be expanded under GMP-compliant conditions, and can therefore be provided in sufficient numbers with defined phenotypic characteristics for clinical applications. Safety of NK-92 cells for adoptive immunotherapy was already shown in two phase I/II clinical trials. In contrast to malignant cells of hematologic origin, most solid tumor cells are not sensitive to unmodified NK-92 cells. Hence, to overcome resistance mechanisms of tumor cells and to broaden the target spectrum of NK-92 cells, gene-modified variants have been generated which express chimeric antigen receptors (CARs) that specifically target tumor surface antigens. The expression of these CARs is sufficient to redirect their cytotoxic activity towards otherwise NK cell-resistant target cells. Extending these earlier approaches, in the framework of this work optimized CAR constructs that target the pancarcinoma antigen epithelial cell adhesion molecule (EpCAM) were derived and functionally characterized. In collaboration with Heike Daldrup-Link’s laboratory (University of California San Francisco, USA) non-invasive imaging modalities to analyze biodistribution and tumor homing properties of retargeted NK-92 cells were evaluated. To enhance the persistence of adoptively transferred NK-92 cells in vivo, means to overcome NK-92 cells’ dependence on exogenous IL-2 for survival and cytolytic activity were investigated. EpCAM is expressed on a variety of tumors of epithelial origin including ovarian, gastric, colorectal, pancreatic, breast, lung and endometrial cancers. In epithelial cells EpCAM is mainly expressed at basolateral membranes, and EpCAM is involved in calcium-independent homotypic cell-cell adhesions. In tumor cells high and de novo EpCAM expression is not only restricted to basolateral membranes but can also be found on apical membranes. Tumor cells retain EpCAM expression throughout tumorigenesis and metastasis formation. Due to its surface expression and immunogenicity EpCAM has been exploited as target for immunotherapy. In earlier work in our group a prototypic, first generation EpCAM-specific CAR construct (31.z) harboring a murine flexible hinge region and murine CD3 ζ as signaling domain was derived and functionally characterized in NK-92 cells. To reduce the immunogenicity for their potential clinical application, this CAR construct was humanized by exchanging the hinge region and the intracellular signaling domain with corresponding sequences of human origin. In T cells incorporation of additional co-stimulatory domains derived from CD28 and 4-1BB significantly enhanced persistence and anti-tumor effects of adoptively transferred cells. Based on these findings a modified, second generation CAR construct encompassing transmembrane and intracellular regions of CD28 in addition to CD3 ζ intracellular signaling domains was derived (31.28.z). Both CAR constructs were stably expressed in NK-92 cells, and furthermore, expression of both CAR variants promoted antigen-specific lysis of antigen-expressing prostate and breast cancer cell lines. In competition experiments the cytotoxic activity of NK-92/31.z and NK-92/31.28.z cells towards antigen-expressing tumor cells was significantly reduced in the presence of parental MOC31 monoclonal antibody, indicating that binding of the EpCAM-specific CAR to its antigen on tumor cells is necessary to trigger antigen-specific cytotoxicity. At high effector to target ratios NK-92/31.28.z cells displayed slightly higher cytotoxic activity towards EpCAM-expressing target cell lines than NK-92/31.z cells, suggesting that incorporation of co-stimulatory domains had beneficial effects on the cytotoxic activity. For clinical applications the development of non-invasive imaging methods is necessary to follow the biodistribution of adoptively transferred cells and guide the identification of responders and non-responders at an early time point. In collaboration with Heike Daldrup-Link’s laboratory the homing properties of EpCAM-specific NK-92 cells to prostate tumor xenografts in rodent models was analyzed (University of California San Francisco, USA). At that time NK-92 cells expressing the second generation EpCAM-specific CAR 31.28.z were not yet available, and thus homing experiments were performed with NK-92 cells expressing the first generation CAR 31.z. For magnetic resonance imaging studies parental and EpCAM-specific NK-92 cells were labeled with clinical applicable ferumoxide particles. Labeled, gene-modified NK-92 cells displayed reduced CAR expression and reduced cytotoxic activity towards EpCAM-expressing DU145 prostate cancer cells in vitro. Nevertheless, MRI revealed specific accumulation of ferumoxide labeled EpCAM-specific NK-92 cells in DU145 tumor xenografts in athymic rats. In tumor sections of treated animals the presence of EpCAM-specific NK-92 cells was verified by Prussian blue and CD57 staining of tumor sections. In another study homing of DiD-labeled EpCAM-specific NK-92 cells to DU145 tumor xenografts was shown by optical imaging. These findings imply that specific targeting of NK-92 cells is retained in vivo, and that non-invasive imaging strategies can be employed to analyze biodistribution of NK-92 cells. Enhanced persistence of adoptively transferred cytotoxic effector cells has a major impact on the effectiveness of immunotherapy. Primary cytotoxic effector cells as well as NK-92 cells require IL-2 for their proliferation and to gain full activity of their effector functions. To bypass the need of exogenously supplied cytokines, the expression of chimeric cytokine receptors (CCR) harboring IL-2R β and IL-2R γ chains instead of CD3 ζ as signaling domains might initiate cytokine-like signals upon contact with the respective antigen. These interactions might support growth and survival of NK-92 cells in the absence of exogenous IL-2. As a starting point, a codon-optimized ErbB2-specific CAR consisting of the scFv(FRP5) single chain antibody fragment, a human CD8 α hinge region and human CD3 ζ transmembrane and intracellular domains was used. Transmembrane and intracellular domains of IL-2R β and IL-2R γ chains were amplified from NK-92 cell-derived cDNA, and were used to exchange the CD3 ζ domain in the ErbB2-specific construct. In human primary tumors EpCAM and ErbB2 overexpression are frequently found, and often correlate with poor prognosis. Hence, co-expression of ErbB2-specific CCRs with an EpCAM-specific CAR may provide NK cells with antigen-specific killing via EpCAM recognition and with antigen-dependent growth via binding to ErbB2. However, attempts to activate CCRs in NK-92 cells via co-incubation with antigen-expressing cells or cross-linking of the CCRs with recombinant antigen did not result in cytokine-independent but antigen-dependent growth. Likewise, no triggering of signal transducer and activator of transcription 5 (STAT5) was observed, which is a hallmark of IL-2 mediated signal transduction. The interactions between CCRs and their antigen might not be strong enough to trigger cytokine-like signals supporting the growth of cells in the absence of exogenous cytokines, and furthermore, might not lead to a significant up-regulation of STAT5-mediated signal transduction. An alternative approach to circumvent the need of exogenous cytokines is ectopic expression of homeostatic cytokines IL-2 and IL-15 in lymphocytes. In T cells expression of these cytokines is sufficient to render cells independent from exogenously supplied cytokines. In this work a lentiviral expression vector encoding IL-15 (SIEW-IL15) was generated, and used for transduction of NK-92 cells. This resulted in ectopic expression of IL-15 and cellular proliferation in the absence of exogenously supplied cytokines. Even after prolonged culture without exogenous IL-2, NK-92/IL15 cells retained their cytotoxic activity towards NK-sensitive target cells. Although expression of IL-15 in HC11 and COS-7 cells using the same vector led to secretion of bioactive IL-15 into culture supernatants, neither secreted nor surface-bound IL-15 was detected in NK-92/IL15 cells, implying that IL-15 promotes survival of gene-modified cells in a strictly autocrine fashion. In addition, NK-92 cells that were freshly transduced with SIEW-IL15 could be efficiently enriched by cytokine withdrawal. NK-92/IL15 cells that were co-transduced with an EpCAM-specific CAR retained their ability to grow in the absence of exogenously supplied cytokines and their antigen-specific cytotoxic activity. Based on these results, a bicistronic vector construct was generated allowing the simultaneous expression of a CAR construct and IL-15 as selection marker. EpCAM-specific CAR constructs (31.28.z and 31.TM) were inserted into the bicistronic expression cassette. NK-92 cells were transduced with these bicistronic expression constructs and selected by cytokine withdrawal. After 14 to 21 days of culture in the absence of IL-2 transduced cells grew out from which CAR-expressing NK-92 cells with high and homogenous surface expression were further enriched by FACS sorting. NK-92/31.28.z.IL15 cells displayed high cytotoxic activity towards EpCAM-expressing breast cancer cell lines, while EpCAM-negative melanoma cells were not lysed. The results of this work demonstrate that the expression of first (31.z) and second (31.28.z) generation CARs in NK-92 cells is sufficient to induce antigen-specific cytotoxicity. Furthermore, a specific accumulation of NK-92/31.z cells but not unmodified NK-92 cells was detected in EpCAM-expressing prostate carcinoma xenografts in athymic rats, indicating that specific targeting of these cells is retained in vivo. Ectopic expression of IL-15 renders the cells independent from exogenous cytokines, while they retain their cytotoxic activity even after prolonged culture without IL-2. Furthermore, ectopic expression of IL-15 in NK-92 cells can be used for selective enrichment of gene-modified cells by cytokine withdrawal. Subsequently, bicistronic expression constructs that allow simultaneous expression of a CAR construct and IL-15 as selection marker were generated. Expression of these bicistronic expression vectors in NK-92 cells is feasible, and might facilitate enrichment of gene-modified cells for clinical applications.

Novel approaches of molecular targeting in Philadelphia chromosome positive leukemia (2009)
Afsar Mian: In Philadelphia Chromosome (Ph) positive ALL and CML the fusion between BCR and ABL leads to the BCR/ABL fusion proteins, which induces the leukemic phenotype because of the constitutive activation of multiple signaling pathways down-stream to the aberrant BCR/ABL fusion tyrosine kinase. Targeted inhibition of BCR/ABL by ABL-kinase inhibitors induces apoptosis in BCR/ABL transformed cells and leads to complete remission in Ph positive leukemia patients. However, a large portion of patients with advanced Ph+ leukemia relapse and acquire resistance. Kinase domain (KD) mutations interfering with inhibitor binding represent the major mechanism of acquired resistance in patients with Ph+ leukemia. Tetramerization of BCR/ABL through the N-terminal coiled-coil region (CC) of BCR is essential for the ABL-kinase activation. Targeting the CC-domain forces BCR/ABL into a monomeric conformation, reduces its kinase activity and increases the sensitivity for Imatinib. Here we show that i.) targeting the tetramerization by a peptide representing the Helix-2 of the CC efficiently reduced the autophosphorylation of both WT BCR/ABL and its mutants; ii.) Helix-2 inhibited the transformation potential of BCR/ABL independently of the presence of mutations; iii.) Helix-2 efficiently cooperated with Imatinib as revealed by their effects on the transformation potential and the factor-independence related to BCR/ABL with the exception of mutant T315I. These findings suggest that BCR/ABL harboring the T315I mutation have a transformation potential which is at least partially independent from its kinase activity. Targeted inhibition of BCR/ABL by small molecule inhibitors reverses the transformation potential of BCR/ABL. We definitively proved that targeting the tetramerization of BCR/ABL mediated by the N-terminal coiled-coil domain (CC) using competitive peptides, representing the Helix-2 of the CC, represents a valid therapeutic approach for treating Ph+ leukemia. To further develop competitive peptides for targeting BCR/ABL, we created a membrane permeable Helix-2 peptide (MPH-2) by fusing the Helix-2 peptide with a peptide transduction tag. In this study, we report that the MPH-2: (i) interacted with BCR/ABL in vivo; (ii) efficiently inhibited the autophosphorylation of BCR/ABL; (iii) suppressed the growth and viability of Ph+ leukemic cells; and (iv) was efficiently transduced into mononuclear cells (MNC) in an in vivo mouse model. The T315I mutation confers resistance against all actually approved ABL-kinase inhibitors and competitive peptides. It seems not only to decrease affinity for kinase inhibitors but to confer additional features to the leukemogenic potential of BCR/ABL. To determine the role of T315I in resistance to the inhibition of oligomerization and in the leukemogenic potential of BCR/ABL, we investigated its influence on loss-of-function mutants with regard to the capacity to mediate factor-independence. Thus we studied the effects of T315I on BCR/ABL mutants lacking functional domains in the BCR portion indispensable for the oncogenic activity of BCR/ABL such as the N-terminal coiled coil (CC), the tyrosine phosphorylation site Y177 and the serine/threonine kinase domain (ST), as well as on the ABL portion of BCR/ABL (#ABL-T315I) with or without the inhibitory SH3 (delta SH3-ABL) domain. Here we report that i.) T315I restored the capacity to mediate factor independence of oligomerization_deficient p185BCR/ABL; ii.) resistance of p185-T315I against inhibition of the oligomerization depends on the phosphorylation at Y177; iii.) autophosphorylation at Y177 is not affected by the oligomerization inhibition, but phosphorylation at Y177 of endogenous BCR parallels the effects of T315I; iv.) the effects of T315I are associated with an intact ABL_kinase activity; v.) the presence of T315I is associated with an increased ABL_kinase activity also in mutants unable to induce Y177 phosphorylation of endogenous BCR; vi.) there is no direct relationship between the ABL-kinase activity and the capacity to mediate factor_independence induced by T315I as revealed by the #ABL-T315I mutant, which was unable to induce Y177 phosphorylation of BCR only in the presence of the SH3 domain. In contrast to its physiological counterpart c-ABL, the BCR/ABL kinase is constitutively activated, inducing the leukemic phenotype. The N-terminus of c-ABL (Cap region) contributes to the regulation of its kinase function. It is myristoylated, and the myristate residue binds to a hydrophobic pocket in the kinase domain known as the myristoyl binding pocket in a process called “capping”, which results in an auto-inhibited conformation. Because the cap region is replaced by the N-terminus of BCR, BCR/ABL “escapes” this auto-inhibition. Allosteric inhibition by myristate “mimics”, such as GNF-2, is able to inhibit unmutated BCR/ABL, but not the BCR/ABL that harbors the “gatekeeper” mutation T315I. Here we investigated the possibility of increasing the efficacy of allosteric inhibition by blocking BCR/ABL oligomerization. We demonstrate that inhibition of oligomerization was able not only to increase the efficacy of GNF-2 on unmutated BCR/ABL, but also to overcome the resistance of BCR/ABL-T315I to allosteric inhibition. These results strongly suggest that the response to allosteric inhibition by GNF-2 is inversely related to the degree of oligomerization of BCR/ABL. Taken together these data suggest that the inhibition of tetramerization inhibits BCR/ABL-mediated transformation and can contribute to overcome Imatinib-resistance. The study provides the first evidence that an efficient peptide transduction system facilitates the employ-ment of competitive peptides to target the oligomerization interface of BCR/ABL in vivo. Further the data show that T315I confers additional leukemogenic activity to BCR/ABL, which might explain the clinical behavior of patients with BCR/ABL -T315I-positive blasts. In summary, our observations establish a new approach for the molecular targeting of BCR/ABL and its resistant mutants represented by the combination of oligomerization and allosteric inhibitors.

TK.007: a novel, optimized HSVtk-variant for suicide gene therapy (2010)
Ellen Preuß: Suicide genes have been broadly used in gene therapy. They can serve as safety tools for conditional elimination of infused cells or for directed tumor therapy. To date, the Herpes simplex virus thymidine kinase/ ganciclovir (HSVtk/GCV) system is the most prominent and the most widely used suicidegene/prodrug combination. Despite its promising performance, the system displays limitations, which include relatively slow killing kinetics and toxicity of the prodrug GCV. Consequently, several groups have either developed new suicide-gene/prodrug combinations or attempted to improve the established HSVtk/GCV suicide system. The present study also aimed towards optimization of the HSVtk/GCV system. To do so, a novel, codon-optimized point mutant (A168H) of HSVtk was developed. The novel mutant was named TK.007. It was extensively tested for its efficiency in two relevant settings: (1) control of severe graft-versus-host disease (GvHD) after adoptive immunotherapy with Tlymphocytes, and (2) direct elimination of targeted tumor cells. TK.007 was compared to the broadly used wild-type, splice-corrected scHSVtk and to a codon-optimized HSVtk (coHSVtk) not bearing the above point mutation. (1) For experiments related to the adoptive immunotherapy approach, HSVtkvariants were expressed from a γ-retroviral MP71 vector as a fusion construct with the selection and marker gene tCD34. Expression levels for TK.007 in transduced lymphoid and myeloid cell lines were significantly higher at initial transduction and over a 12 week period compared to the commonly used scHSVtk and coHSVtk indicating reduced toxicity of TK.007. Killing kinetics of transduced cell lines (PM1 and K562) and primary human T cells were significantly faster for TK.007 in comparison to scHSVtk and coHSVtk in vitro. In vivo-functionality of TK.007 was assessed in an allogeneic transplantation model. T cells derived from C57BL/6J.Ly5.1 donor mice were transduced with MP71 vectors expressing scHSVtk or TK.007. Transduced cells were selected and transplanted into Balb/c Rag2-/- γ-/- immune-deficient recipient mice. Acute, severe GvHD occurred and was effectively abrogated in all mice transplanted with TK.007- transduced T cells, and in five out of six mice transplanted with scHSVtk-transduced cells. In a slightly modified quantitative allogeneic transplantation mouse model, significantly faster and more efficient in vivo killing was demonstrated for TK.007 as compared to scHSVtk, especially at low doses of GCV. (2) In order to assess TK.007 functionality in cells derived from solid tumors, HSVtk-variants were expressed from lentiviral gene ontology (LeGO) vectors in combination with an eGFP/neo-opt selection cassette. Transduced and selected tumor cell lines that derived from several tissues were eliminated at significantly lower GCV doses and to higher extents when transduced with TK.007 compared to scHSVtk. Moreover, a significantly stronger bystander effect of TK.007 was demonstrated. The superior in vitro efficiency of TK.007 was confirmed in an in vivo subcutaneous xenograft mouse model for glioblastoma in NOD/SCID mice. Mice transplanted with TK.007 transduced cells stayed tumor-free after treatment with different GCV-doses. On the contrary, mice of the scHSVtk group either demonstrated only transiently reduced tumor growth in the low-dose GCV group (10 mg/kg) compared to the control groups or suffered from relatively fast relapses after initial tumor shrinking in the standarddose (50 mg/kg) GCV group. As a result, all mice in the scHSVtk group died from vigorous tumor growth. In summary, in two different applications for suicide gene therapy the present study has demonstrated superior functional performance of the novel suicide gene TK.007 as compared to the broadly used wild-type scHSVtk. Differences became particularly pronounced at low doses of GCV. It can be concluded that the new TK.007-gene represents a promising alternative to the commonly used scHSVtk for gene therapeutic applications.

Method developments in coupling gel electrophoresis with mass spectrometry (2011)
Dimitrios George Papasotiriou: Proteomic analysis is the large-scale identification and characterization of proteins including post translational modifications. Proteomics encompasses a number of approaches including bottom-up and top-down workflows which are widely used independently and complementary as tools for the successful study of protein species. However, up to the present day these techniques have not been able to overcome every analytical limitation. Mass spectrometry has played a vital role alongside proteomics in providing the required analytical means of detecting protein amounts down to the atomole range. Soft ionization methods such as matrix assisted laser desorption/ionization (MALDI) and electrospray ionization (ESI) have permitted the transfer of peptides and intact proteins into the gas phase without extensive degradation. The introduction of recent developments in MALDI technology such as the highly sensitive 4-chloro-alpha-cyanocinnamic acid matrix (Cl-CCA) as well as the commercial availability of a MALDI-LTQ-Orbitrap which boosts peptide mass accuracy below 3 parts per million (ppm), have offered new prospective in protein analysis. The aim of the current study is to incorporate these new aspects and provide further advancements in gel-based as well as gel-free proteomic workflows. Peptides of proteolytically digested proteins are routinely analyzed by means of peptide mass fingerprinting (PMF) often combined with MS/MS analyses to complement and substantiate PMF results by peptide sequence information. The most widely used protease for enzymatic digestion is trypsin, since it exhibits a very specific cleavage behavior limited to C-terminal hydrolyses after basic amino acids. However, less specific enzymes such as chymotrypsin, elastase and pepsin have emerged as useful tools in the analysis of particular protein classes e.g. membrane, cereal, and phosphorylated proteins. In this work a comprehensive bottom-up proteomic investigation including in-solution and in-gel protein digestions of analytes covering small to large, acidic to basic, and hydrophobic to hydrophilic proteins in combination with a series of less specific enzymes are presented in order to show the superiority of the novel MALDI matrix Cl-CCA. The Cl-CCA matrix proved to be highly superior compared to standard α-cyano-4-hydroxycinnamic acid (CHCA) since an average detection of more than 2- to 3-fold peptide amount was possible depending on the used protease and, therefore, resulting in strongly increased sequence coverage. Additionally, protein identification of chymotrypsin and elastase in-gel digested protein standards was evaluated. The MALDI-LTQ-Orbitrap providing peptide mass accuracy below and up to 3 ppm in combination with Cl-CCA as matrix and newly optimized digestion conditions led to unambiguous protein identifications of all chymotryptic digests outperforming its tryptic counterparts in the case of hydrophobic bacteriorhodopsin and α-globin from hemoglobin A (α-HgbA). In addition, significantly higher sequence coverage and increased number of detected peptides was acquired. Moreover, a proposed workaround for elastase digestions was capable of providing a solution for successful identification results. Apart from digestions of singly separated proteins, solution isoelectic focusing (sIEF) was evaluated. OFFGEL fractionation is an efficient means of fractionating peptides and proteins according to their isoelectric point (pI) values through immobilized pH gel (IPG) strips after which samples are recovered in solution. Consequently, an issue of peptide recovery arises as a category of peptides relatively insoluble to the recovery solution should be present. A method was developed including the scraping of gel matrix from the IPG strips and peptide extraction using acetonitrile as organic solvent in combination with analytical techniques such as nLC-MALDI-MS/MS for peptide identification. The nature of the peptide species remaining in-gel was analysed and attributed to peptide solubility. A general trend in which a high percentage of neutral and hydrophobic peptides remaining entrapped in the IPG gel strip was observed. The present work also examines a new top-down proteomic workflow involving protein elution from cleavable gels containing the labile crosslinker ethylene-glycol-diacrylate (EDA). Protein amounts of as low as 100 ng loaded onto EDA gels were detected using MALDI-TOF MS in the linear acquisition mode. Proteins from 8.5 up to 78 kDa were successfully measured including a hydrophobic 15 kDa core protein attaining a GRAVY score of +0.079. Additionally, the method was compatible with one dimensional protein separation as well as for 2-D IEF/SDS-PAGE. Lastly, two methods for protein identification were tested and found to be compatible to the proposed technique.

Role of enhanced stem cell capacities in leukemogenesis (2006)
Xiaomin Zheng: Unlimited self-renewal is an absolute prerequisite for any malignancy, and is the ultimate arbiter of the continuous growth and metastasis of tumors. It has been suggested that the self-renewal properties of a tumor are exclusively contained within a small population, i.e., the so-called cancer stem cells. Enhanced self-renewal potential plays a pivotal role in the development of leukemia. My data have shown that APL associated translocation products PML/RARalpha and PLZF/RARalpha increased the replating efficiency of mouse lin-/Sca1+ hematopoietic stem cells (HSCs). This effect is partly mediated by induction of gamma–catenin which is an important mediator of the Wnt signaling pathway and has been shown to be up regulated by the AML associated translocation products(AATPs). Suppression of gamma–catenin by siRNA can abrogate the increased replating efficiency induced by AATPs. Transduction of gamma–catenin in lin-/Sca1+ HSCs led to increased replating efficiency and the expression of stem cell markers Sca1 and c-kit. Additionally it induced accelerated cell cycle progression of mouse bone marrow HSCs. Transduction/transplantation mouse models have shown that ectopic expression of gamma–catenin in HSCs led to acute myeloid leukemia without maturation. These data suggest important roles of Wnt signaling pathway in the leukemogenesis induced by PML/RARalpha, PLZF/RARalpha and AML1/ETO. In contrast to AATPs, CML and Ph+-ALL associated translocation products p185(BCR-ABL) and p210(BCR-ABL) did not affect the self-renewal potential of hematopoietic stem/progenitor cells. However my studies indicated that their reciprocal translocation products p40(ABL/BCR) and p96(ABL/BCR) actually increased the replating efficiency of hematopoietic stem/progenitor cells. The effect is stronger when induced by p96(ABL/BCR) than by p40(ABL/BCR). It is very intriguing that p96(ABL/BCR) can activate Wnt signaling and up regulate the expression of HoxB4. Transduction/transplantation mouse model has shown that p40(ABL/BCR) and p96(ABL/BCR) both have their own leukemogenic potential. Given the fact that leukemic stem cells maintain the growth of tumor and are the origin of relapse, the cure of leukemia is dependent on the eradication of the leukemic stem cell and abrogation of aberrantly regulated self-renewal capability. Both t-RA and As2O3 have been shown to induce complete remission in APL patients with PML/RARalpha translocation product. However, t-RA as a single agent achieves completeremission (CR) but not complete molecular remissions (CMR). Therefore, virtually all patients will experience a relapse within a few months. In contrast to t-RA, As2O3 as a single agent is able to induce CR as well as CMR followed by long-term relapse-free survival in about 50% of APL patients even if relapsed after treatment with t-RA-containing chemotherapy regimens. Nothing is known about the mechanisms leading to the complete different clinical outcomes by the two compounds although both have been shown to induce differentiation of blast cells, proliferation arrest, induction of apoptosis and degradation of PML/RARalpha. We investigated the effect of t-RA and arsenic on PML/RARalpha-expressing cell population with stem cell capacity derived from the APL cell line NB4 as well as Sca1+/lin- murine bone marrow cells. We found that t-RA did not reduce the replating efficiency in PML/RARalpha- and PLZF/RARalpha-infected Sca1+/lincells whereas it selected small compact colonies representing very early progenitor cells. T-RA was unable to reduce the capacity to form colony forming units-spleen (CFU-S) of Sca1+/lin-cells expressing PML/RARalpha, additionally t-RA did not impair the capability of engraftment of NB4 cells in NOD/SCID mouse. On the contrary to t-RA, As2O3 abolished the aberrant self-renewal potential of Sca1+/lin- cells expressing PML/RARalpha. As2O3 not only abolished the replating efficiency of PML/RARalpha positive cells but also completely abrogated the ability of PML/RARalpha-positive HSC to produce CFU-S in vivo. On the contrary to As2O3, t-RA increased the absolute cell number and the percentage of cells in the side population with respect to the whole cell population in NB4 cells. Taken together these data suggest that arsenic but not all-trans retinoic acid overcomes the aberrant stem cell capacity of PML/RARalpha positive leukemic stem cells. My data prove for the first time that there is a direct relationship between the capacity of compounds to effectively target the LSC and their capacity to eradicate the leukemia, and, thereby, to induce complete molecular remission and long-term relapse-free survival. Thus, in order to increase the curative potential of leukemia therapies, future studies need to include the effect of given compounds on the stem cell compartment to determine their ability to eradicate the LSC.

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