Although the
BCR/ABL tyrosine kinase inhibitor
imatinib is highly effective for treatment of
chronic myeloid leukemia (CML) and
Philadelphia-chromosome positive
acute lymphoblastic leukemia (ALL), relapse with emerging
imatinib-resistance mutations in the BCR/ABL
kinase domain poses a significant problem. Here, we demonstrate that
rottlerin, a putative
protein kinase C-delta (PKCdelta)-specific inhibitor, acts synergistically with
imatinib to induce apoptosis of BCR/ABL-expressing K562 and Ton.B210 cells. However,
rottlerin inhibited neither PKCdelta nor BCR/ABL in these cells. On the other hand,
rottlerin, previously characterized also as a mitochondrial uncoupler, transiently but significantly reduced mitochondrial membrane potential and gradually induced mitochondrial membrane permeabilization. Moreover, two other mitochondrial uncouplers,
FCCP and DNP, very similarly induced apoptosis of BCR/ABL-expressing cells in a synergistic manner with
imatinib.
Imatinib synergistically enhanced mitochondrial membrane permeabilization induced by mitochondrial uncouplers, which led to release of
cytochrome c into the cytoplasm and activation of caspases-3 and -9.
Rottlerin also enhanced the cytotoxic effect of
imatinib in leukemic cells from patients with CML
blast crisis and Ph-positive ALL or a cell line expressing the
imatinib-resistant E255K BCR/ABL mutant. The present study indicates that
rottlerin synergistically enhances
imatinib-induced apoptosis through its mitochondrial uncoupling effect independent of PKCdelta and may contribute to the development of new treatment strategy to overcome the
imatinib resistance and to cure the BCR/ABL expressing
leukemias.