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Molecular pathways: induction of polyploidy as a novel differentiation therapy for leukemia.

Abstract
Differentiation therapy has emerged as a powerful way to target specific hematologic malignancies. One of the best examples is the use of all-trans retinoic acid (ATRA) in acute promyelocytic leukemia (APL), which has significantly improved the outcome for patients with this specific form of acute myeloid leukemia (AML). In considering how differentiation therapy could be used in other forms of AML, we predicted that compounds that induce terminal differentiation of megakaryocytes would be effective therapies for the megakaryocytic form of AML, named acute megakaryocytic leukemia (AMKL). We also speculated that such agents would reduce the burden of abnormal hematopoietic cells in primary myelofibrosis and alter the differentiation of megakaryocytes in myelodysplastic syndromes. Using a high-throughput chemical screening approach, we identified small molecules that promoted many features of terminal megakaryocyte differentiation, including the induction of polyploidization, the process by which cells accumulate DNA to 32N or greater. As the induction of polyploidization is an irreversible process, cells that enter this form of the cell cycle do not divide again. Thus, this would be an effective way to reduce the tumor burden. Clinical studies with polyploidy inducers, such as aurora kinase A inhibitors, are under way for a wide variety of malignancies, whereas trials specifically for AMKL and PMF are in development. This novel form of differentiation therapy may be clinically available in the not-too-distant future. Clin Cancer Res; 19(22); 6084-8. ©2013 AACR.
AuthorsDiane S Krause, John D Crispino
JournalClinical cancer research : an official journal of the American Association for Cancer Research (Clin Cancer Res) Vol. 19 Issue 22 Pg. 6084-8 (Nov 15 2013) ISSN: 1557-3265 [Electronic] United States
PMID23963861 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
Chemical References
  • Antineoplastic Agents
  • Azepines
  • MLN 8237
  • Protein Kinase Inhibitors
  • Pyrimidines
  • Tretinoin
  • AURKA protein, human
  • Aurora Kinase A
Topics
  • Antineoplastic Agents (therapeutic use)
  • Aurora Kinase A (antagonists & inhibitors)
  • Azepines (therapeutic use)
  • Cell Differentiation (drug effects)
  • Cell Line, Tumor
  • Humans
  • Leukemia, Megakaryoblastic, Acute (drug therapy, genetics)
  • Leukemia, Promyelocytic, Acute (drug therapy, genetics)
  • Megakaryocytes (cytology, metabolism)
  • Mitosis (drug effects, genetics)
  • Polyploidy
  • Primary Myelofibrosis (drug therapy, genetics)
  • Protein Kinase Inhibitors (therapeutic use)
  • Pyrimidines (therapeutic use)
  • Tretinoin (therapeutic use)

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