Members of the
inhibitor of apoptosis protein (IAP) family play a role in mediating apoptosis. Studies suggest that these
proteins may be a viable target in
leukemia because they have been found to be variably expressed in acute
leukemias and are associated with chemosensitivity, chemoresistance,
disease progression, remission, and patient survival. Another promising therapeutic target, FLT3, is mutated in about one third of
acute myelogenous leukemia (AML) patients; promising results have recently been achieved in clinical trials investigating the effects of the
protein tyrosine kinase inhibitor
PKC412 on AML patients harboring mutations in the FLT3
protein. Of growing concern, however, is the development of drug resistance resulting from the emergence of point mutations in targeted
tyrosine kinases used for treatment of acute
leukemia patients. One approach to overriding resistance is to combine structurally unrelated inhibitors and/or inhibitors of different signaling pathways. The proapoptotic IAP inhibitor,
LBW242, was shown in proliferation studies done in vitro to enhance the killing of PKC412-sensitive and PKC412-resistant cell lines expressing mutant FLT3 when combined with either
PKC412 or standard
cytotoxic agents (
doxorubicin and
Ara-c). In addition, in an in vivo imaging assay using bioluminescence as a measure of
tumor burden, a total of 12 male NCr-nude mice were treated for 10 days with p.o. administration of vehicle,
LBW242 (50 mg/kg/day),
PKC412 (40 mg/kg/day), or a combination of
LBW242 and
PKC412; the lowest
tumor burden was observed in the
drug combination group. Finally, the combination of
LBW242 and
PKC412 was sufficient to override stromal-mediated viability signaling conferring resistance to
PKC412.