A Novel Mechanism for Imatinib Mesylate (STI571) Resistance in CML Cells: Contribution of TC-PTP to Modulating Signals Down-Stream from the BCR-ABL Fusion Protein.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1984-1984
Author(s):  
Takatsune Shimizu ◽  
Yoshitaka Miyakawa ◽  
Satoshi Iwata ◽  
Akiko Kuribara ◽  
Tony Tiganis ◽  
...  

Abstract Acquired resistance to imatinib mesylate (STI571) in chronic myelogenous leukemia (CML) patients has become a serious problem. To adress the novel molecular mechanism for imatinib-resistance in CML, we previously established imatinib-resistant sublines (designated KTR cells) from the CML cell line KT-1. We have analyzed p-glycoprotein expression, the number of bcr-abl fusion gene and the sequence of ATP binding site of ABL kinase domain. However, these were not responsible for imatinib-resistance in KTR cells. Interestingly, T-cell protein tyrosine phosphatase (TC-PTP) protein levels were markedly down-regulated in all KTR cells as compared to parental KT-1 cells. Therefore, we examined whether the suppression of TC-PTP expression might contribute to imatinib-resistance in KTR cells. We transduced the nuclear isoform of TC-PTP (TC45) and catalytically inactive TC45-D182A cDNA into KTR cells by retroviral gene transfer. Subsequently, we analyzed the sensitivity to imatinib by MTT proliferation assays. We also studied the signaling pathways in all transduced cells by Western blottings. KTR cells successfully expressed TC45 and TC45-D182A protein (designated KTR-TC45 and KTR-D182A cells, respectively). In MTT proliferation assays, the proliferation of KTR-TC45 cells restored their sensitivity to imatinib, but not in KTR-mock or KTR-D182A cells, indicating that transduced catalytically active TC45 restored the sensitivity to imatinib in KTR cells. In KTR2-mock cells, the percentage of annexin V positive apoptotic cells was 8% in the control and was increased to 25% upon imatinib treatment. In KTR-TC45 cells, the percentage of apoptotic cells was increased from 12% to 56% by the treatment with imatinib, suggesting that TC45 expression in KTR cells restored the susceptibility to apoptosis by imatinib mesylate. Taken together, these results indicate that the sensitivity to imatinib in KTR cells can be modulated by TC-PTP expression. In parental KT-1 cells, phosphorylation of STAT5 was abolished with the treatment of 0.5 μM imatinib for 1 hour. In contrast, STAT5 phosphorylation in KTR cells was stronger than that of KT-1 cells and only slightly suppressed upon exposure to 0.5 μM imatinib. In KTR-mock and KTR-D182A transduced cells, STAT5 phosphorylation was augmented compared to KTR-TC45 transduced cells. Upon treatment with 0.5 μM imatinib for 1 hour, phosphorylation of STAT5 was abolished in KTR2-TC45 cells whereas it remained elevated in KTR-mock and KTR-D182A cells. The expression of TC-PTP had no effect on the phosphorylation of the JAK2 or BCR-ABL in KTR cells. Besides, expression of TC-PTP did not alter protein kinase PKB/AKT or mitogen-activated protein kinase signaling in KTR cells. These results indicate that the loss of TC-PTP could enhance tyrosine phosphorylation of STAT5 and was involved in the acquired resistance to imatinib in KTR cells. In conclusion, we demonstrated that reconstitution of TC-PTP in imatinib-resistant KTR cells restored the sensitivity to imatinib. Although it will be necessary to ascertain the relevance of our studies in primary samples, we would like to propose that the loss of TC-PTP may represent a novel mechanism by which CML cells can acquire imatinib-resistance.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 1087-1087 ◽  
Author(s):  
Nicholas J. Donato ◽  
Ji Wu ◽  
Ling-Yuan Kong ◽  
Feng Meng ◽  
Francis Lee ◽  
...  

Abstract BCR-ABL is an unregulated tyrosine kinase expressed as a consequence of a reciprocal chromosomal translocation that is common in chronic myelogenous and acute lymphocytic leukemia. BCR-ABL induces transformation of hematopoetic stem cells through tyrosine phosphorylation of multiple substrates. The src-family kinases (SFKs), Lyn and Hck, are highly activated by BCR-ABL in leukemic cells and recent studies suggest that they are substrates and essential mediators of BCR-ABL signal transduction and transformation. In cells selected for resistance to the BCR-ABL inhibitor, imatinib mesylate, Lyn kinase is overexpressed and its activation is not dependent on or regulated by BCR-ABL, suggesting that autonomous regulation of SFKs may play a role in imatinib resistant. In this report, activation of Lyn and Hck was compared in CML specimens derived from imatinib responsive and resistant patients that did not express a mutant BCR-ABL protein as their primary mediator of resistance. In imatinib sensitive cell lines and specimens derived from imatinib responsive CML patients imatinib effectively reduced activation of both BCR-ABL and SFKs. However, in multiple specimens from resistant patients, imatinib reduced BCR-ABL kinase activation but failed to reduce SFK activation. The dual ABL/SRC inhibitor, BMS-354825, blocked activation of both BCR-ABL and SFKs expressed in leukemic cells and correlated with clinical responsiveness to this agent. Animal models demonstrated that loss of imatinib-mediated inhibition of Lyn kinase activation significantly impaired its anti-tumor activity which was recovered by treatment with BMS-354825. Direct silencing of Lyn or Hck reduced CML cell survival in imatinib resistant patient specimens and cell models, suggesting a direct role for these kinases in cell survival. Our results show that SFK activation is mediated by BCR-ABL in imatinib responsive cells but these kinases escape control by BCR-ABL in CML patients that develop imatinib resistance in the absence of BCR-ABL point mutations. This form of resistance can effectively be overcome by BMS-354825 through its dual SRC and ABL kinase inhibitory activities. Dual specificity kinase inhibitors may be indicated for the treatment and prevention of imatinib resistance in CML when it is associated with constitutively activated src-family kinases.


Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 2097-2097 ◽  
Author(s):  
Joya Chandra ◽  
Jeannette Tracy ◽  
Mercedes Gorre ◽  
Moshe Talpaz ◽  
James Griffin ◽  
...  

Abstract The impetus for kinase inhibition as a therapeutic endpoint in leukemia research has been driven largely by the success of imatinib mesylate in chronic myelogenous leukemia. However, while imatinib mesylate has been extremely effective in the treatment of chronic phase CML, resistant disease often emerges in both Philadelphia positive ALL and aggressive phase CML patients. Adaphostin is a tyrphostin inhibitor originally developed to target the bcr/abl kinase and demonstrates selectivity in CML patient isolates. Here we show that in vitro, adaphostin is cytotoxic in numerous models that are resistant to imatinib. Features of adaphostin action in bcr/abl containing cells include apoptosis induction via an oxidant dependent mechanism and degradation of bcr/abl protein. Cell lines containing point mutations in p210 bcr/abl which confer imatinib resistance exhibit intracellular peroxide production and DNA fragmentation in response to adaphostin. Bcr/abl degradation also occurs but can be dissociated from peroxide production and subsequent apoptosis signaling. Similar data has also been obtained in cell lines containing p190 bcr/abl. Studies extending these observations into mononuclear and polymorphonuclear cells from imatinib resistant CML patients and Ph+ ALL patients confirm the same mechanism in primary clinical isolates. Collectively, these data suggest that reactive oxygen species generation by adaphostin bypasses imatinib resistance in CML and Ph+ ALL. Further studies dissecting the mechanism of ROS generation by adaphostin in imatinib resistant cells may lead to the identification of new therapeutic targets.


Blood ◽  
2003 ◽  
Vol 101 (11) ◽  
pp. 4611-4614 ◽  
Author(s):  
Amie S. Corbin ◽  
Paul La Rosée ◽  
Eric P. Stoffregen ◽  
Brian J. Druker ◽  
Michael W. Deininger

Abstract Imatinib mesylate is a selective Bcr-Abl kinase inhibitor, effective in the treatment of chronic myelogenous leukemia. Most patients in chronic phase maintain durable responses; however, many in blast crisis fail to respond, or relapse quickly. Kinase domain mutations are the most commonly identified mechanism associated with relapse. Many of these mutations decrease the sensitivity of the Abl kinase to imatinib, thus accounting for resistance to imatinib. The role of other mutations in the emergence of resistance has not been established. Using biochemical and cellular assays, we analyzed the sensitivity of several mutants (Met244Val, Phe311Leu, Phe317Leu, Glu355Gly, Phe359Val, Val379Ile, Leu387Met, and His396Pro/Arg) to imatinib mesylate to better understand their role in mediating resistance.While some Abl mutations lead to imatinib resistance, many others are significantly, and some fully, inhibited. This study highlights the need for biochemical and biologic characterization, before a resistant phenotype can be ascribed to a mutant.


Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 497-497
Author(s):  
Paul La Rosée ◽  
Susanne Holm-Eriksen ◽  
Thomas Ernst ◽  
Heiko König ◽  
Philipp Erben ◽  
...  

Abstract AMN107 is a new, highly potent and selective BCR-ABL inhibitor currently in clinical development for the treatment of imatinib-resistant chronic myelogenous leukemia (CML) or Philadelphia positive acute lymphoblastic leukemia ALL (Ph+ALL). Pre-clinical testing has revealed AMN107 to inhibit all but one (T315I) BCR-ABL mutants which have been associated with imatinib resistance. We sought to determine the pharmacodynamic activity of AMN107 by measuring the proportion of phosphorylated CrkL (CrkL-P) as a surrogate of BCR-ABL activity in vivo. Assay validation revealed a CV-value of 13%, which was defined as cut-off value for significant modulation of the Crkl-P/CrkL ratio. A total of 34 patients (median age 61 years, range 35–80) diagnosed with imatinib resistant Ph+ ALL (n=10), CML in chronic phase (n=1), accelerated phase (n=13), myeloid (n=7), or lymphoid blast crisis (n=3) were investigated in a phase I study permitting individual dose escalation (50–1200 mg/day). Proportion of CrkL-P (Crkl-P/total Crkl) was determined by Western blot, ratio BCR-ABL/ABL by quantitative RT-PCR, and mutation status by direct sequencing in 73 peripheral blood or bone marrow samples from baseline and during treatment with AMN107. Median follow up was 89 days (range 13–386). Patients expressed e1a2 (n=7), b2a2 (n=12), b3a2 (n=14), and b2a2&b3a2 (n=1) BCR-ABL transcripts. At baseline, 18 pts exhibited BCR-ABL mutations (P-loop, n=4; T315I, n=3; others, n=11), in 4 pts two different mutations were found in parallel. Prior to treatment with AMN107, the median proportion of CrkL-P indicating BCR-ABL activity was 47% (range 0–69%). Significant reductions of the proportion of CrkL-P were observed from a dose level of 200 mg AMN107/day. CRKL-P (0%) became undetectable during treatment with AMN107 indicating complete suppression of BCR-ABL in 16 pts starting at AMN107 dose levels of 200 (n=1), 400 (n=2), 600 (n=4), 800 (n=8) or 1200 mg/d (n=1). At baseline, patients had unmutated BCR-ABL (n=8), M244V, Y253H, E255K, T315I, M351T, L384M/H396P, A217V/F311L, L324Q/A350V (n=1 each). Undetectability of CrkL-P, correlated with a good molecular response (ratio BCR-ABL/ABL <2%) in 3 pts. We conclude that a minimum of 200 mg of AMN107 is required to induce effective BCR-ABL inhibition in patients. Effectively repressed CrkL phosphorylation in patients lacking molecular response indicates multifactorial resistance mechanisms. Even in patients with BCR-ABL mutations, BCR-ABL may be inactive suggesting alternative signaling pathways that stimulate proliferation. However, treatment with AMN107 is associated with a reduction of the proportion of CrkL-P indicating suppression of BCR-ABL activity in a significant proportion of patients after imatinib resistance. The CrkL phosphorylation status may help to determine alternative treatment strategies including dose optimization in phase I studies.


Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 2121-2121
Author(s):  
Ajoy K. Samanta ◽  
Hui Lin ◽  
Tong Sun ◽  
Hagop Kantarjian ◽  
Ralph B. Arlinghaus

Abstract In most CML patients Bcr-Abl, a constitutively active tyrosine kinase derived from the Philadelphia chromosome, is highly expressed and is the causative factor in most CML patients. Imatinib mesylate, an inhibitor of the Bcr-Abl kinase, is a very effective drug for treatment of CML. However in some CML patients, drug resistance develops and the patients relapse. Thus, alternative drug targets need to be identified. We have shown that Bcr-Abl activates its downstream target, the Jak2 tyrosine kinase, leading to the enhancement of c-Myc expression (Xie et al. Oncogene21: 7137, 2002; Samanta et al. Cancer Res.66: 6468, 2006). Our recent studies showed that Bcr-Abl activated the transcriptional factor NF-kB through Jak2, which in turn activated c-Myc transcription. Jak2 also activated Akt, which increased c-Myc protein levels by inhibiting GSK3. Addition of AG490, an inhibitor of the Jak2 kinase, prevented enhanced expression of c-Myc and caused induction of apoptosis in BCR-ABL+ leukemia cells. Immunoprecipitation experiments showed that Bcr-Abl is associated with a cluster of signaling proteins including Jak2, Gab2, Akt and GSK3b. Treatment of CML cell lines and mouse BCR-ABL+ 32D cells (myeloid lineage) with the either Jak2 siRNA or the Jak2 kinase inhibitor AG490 caused inhibition of pTyr Gab2 formation, pSer Akt formation and the activation of NFkB. Of interest, treatment of BCR-ABL+ 32 D cells with IL-3 reversed the apoptotic effects of imatinib by activation of Jak2 even though Bcr-Abl was inhibited. Importantly, mouse BaF3 hematopoietic cells expressing the T315I and E255K imatinib-resistant mutants of BCR-ABL underwent apoptosis upon exposure to either the Jak2 inhibitor AG490 or siRNA for Jak2, yet were resistant to imatinib. Cells from a number of CML patients (including six chronic phase, one accelerated phase, and two blast crisis patients who failed imatinib treatment) were induced to enter apoptosis upon treatment with AG490, whereas normal samples were not affected by AG490. Further analysis of imatinib resistant Bcr-Abl cell lines showed that transfection of the cells with Jak2 specific siRNA or by treating the cells with AG490 reduced levels of pLyn, pAkt, c-Myc and pGSK3 level compared to untreated cells. Transfection of Lyn specific siRNA into K562 and 32Dp210 cells resulted in down-regulation of pGab2, pAkt, pGsk3 and c-Myc, but did not alter pJak2 levels; this result indicates that pLyn is downstream of Jak2 but upstream of Gab2, pAkt, pGSK3 in BCR-ABL+ leukemia cells. We hypothesize that Jak2 activation of Lyn tyrosine kinase in BCR-ABL+ leukemia cells leads to tyrosine phosphorylation of the YxxM motif of Gab2, which activates the PI-3 kinase-Akt pathway. In conclusion, since inactivation of Jak2 inhibits many of the critical oncogenic targets of Bcr-Abl (resulting in apoptosis induction), we propose that Jak2 is a potential therapeutic target for CML, in both imatinib sensitive and imatinib resistant patients.


2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 6534-6534 ◽  
Author(s):  
H. M. Kantarjian ◽  
N. Gattermann ◽  
S. G. O’Brien ◽  
K. Bhalla ◽  
A. Hochhaus ◽  
...  

6534 Background: AMN107 is a potent, highly selective, aminopyrimidine inhibitor which in vitro is 30-fold more potent than imatinib and active against 32/33 imatinib resistant Bcr-Abl mutations. Methods: This open-label study was designed to evaluate the safety and efficacy of AMN107 (400 mg bid) defined by hematologic/cytogenetic response (HR/CyR) rates in imatinib resistant or intolerant CP pts. Results: For this study which remains open to enrollment, preliminary data are reported for 67 pts including 39 (58%) with imatinib-resistant and 27 (40%) imatinib-intolerant CML (1 pt unknown). The median age was 62 (range 31–80) yrs and the median time from first diagnosis to treatment was 52 (range 5–279) mos. BCR-ABL mutations associated with imatinib resistance were detected in 11/17 (65%) pts at baseline. The median duration of AMN107 exposure was 129 (range 3–225) days. Treatment is ongoing for 50 (75%) pts with 17 (25%) pts discontinued (9 adverse events, 2 disease progression, 6 other). Major CyR was observed in 13 (19%) pts (6 complete, 7 partial), minor CyR was observed in 4 (17%) pts, and minimal CyR in 5 (7%) pts. Complete HR was reported in 35 of 42 (83%) pts without a baseline CHR. AE’s in ≥ 10% of pts were headache in 24 (36%) pts, fatigue in 21 (31%) pts (Gr 3/4 in 2 (3%)), pruritus in 19 (28.4%) pts (Gr 3/4 in 1 (2%)), rash in 18 (27%) pts (Gr 3/4 in 2 (3%)), nausea in 18 (27%) pts, diarrhea in 18 (27%) pts (Gr 3/4 in 1 (2%)), constipation in 11 (16%) pts, vomiting in 10 (15%) pts, thrombocytopenia in 10 (15%) pts (Gr 3/4 in 9 (13%)), anemia in 10 (14.9%) pts (Gr 3/4, 1 (2%)), neutropenia in 9 (13%) pts (Gr 3/4 in 8 (12%)), bone pain, muscle spasms, arthralgia, peripheral edema in 8 (12%) pts each, abdominal pain and myalgia in 7 (10%) pts each (Gr 3/4 in 1 (2%) each), and dyspnea in 7 (10%) pts. No deaths occurred. Conclusions: AMN107 has clinical activity and an acceptable safety and tolerability in pts with imatinib-resistant or intolerant CML-CP. [Table: see text]


2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 7007-7007 ◽  
Author(s):  
G. Rosti ◽  
P. le Coutre ◽  
K. Bhalla ◽  
F. Giles ◽  
G. Ossenkoppele ◽  
...  

7007 Background: Nilotinib is a highly selective Bcr-Abl tyrosine kinase inhibitor that is 30-fold more potent than imatinib. The objective of this phase II open-label study was to evaluate the safety and efficacy of nilotinib in imatinib-resistant or -intolerant CML-CP pts Methods: Imatinib-resistance was defined using standard criteria and had failed imatinib >/= 600mg/day. Imatinib intolerance was defined as intolerant symptoms and lack of MCyR. Primary endpoint was MCyR determined by conventional ITT analysis. Planned nilotinib dose was 400mg BID with escalation to 600mg BID for inadequate responses Results: 316 pts were enrolled and included for safety analysis; efficacy results are from 279 pts with at least 6 mos of follow up. 221 (70%) pts were imatinib-resistant and 95 (30%) were imatinib- intolerant. Median duration of CML was 58 mos; median prior imatinib use was 33 mos. 227 (73%) pts had prior imatinib dose >/= 600mg/day. Treatment with nilotinib is ongoing for 221 (70%) pts. 95 (30%) pts have discontinued treatment (41 for AEs, 32 for disease progression). Median duration of nilotinib exposure was 247 days; overall median average dose intensity was 797mg/day. Median cumulative duration of dose interruptions was 19 days. MCyR was achieved in 145 (52%), 96 (34%) were complete and 49 (18%) partial. Median time to MCyR was 2.8 mos. CHR was achieved in 137/185 (74%) pts without baseline CHR. Median time to CHR was 1.0 mos. Response rates were similar in imatinib- resistant and -intolerant pts. After 10 mos of follow up, the median duration of CHR and MCyR has not been reached. The most frequent Grade 3/4 laboratory abnormalities included thrombocytopenia in (29%), neutropenia in (28%), and asymptomatic lipase elevation in (15%) pts. Rare (<1%) pleural effusion, pericardial effusion, or pulmonary edema were observed. Requirements for growth factors and platelet transfusions were minimal. Conclusions: Nilotinib resulted in significant response rates in pts with imatinib-resistant or -intolerant CML-CP and excellent tolerability as indicated by high dose intensity, favorable rates of myelosuppression, and no serious episodes of fluid retention. No significant financial relationships to disclose.


2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 8562-8562
Author(s):  
Lu Si ◽  
Xiao wei Xu ◽  
Yan Kong ◽  
Keith T. Flaherty ◽  
Zhi Hong Chi ◽  
...  

8562 Background: c-Kit mutation is a common genetic abnormality in certain melanoma subtypes, and is a target for treatment. However, the mechanisms of secondary (acquired) resistance and how to treat patients in the second line are unknown. Methods: Tissuesamples were obtained from c-Kit-mutated melanoma patients who failed of imatinib after having PR or SD for at least 6 months pre- and post-imatinib therapy. Somatic mutations in genes in MAP kinase (c-Kit, BRAF, NRAS, etc) and PI3K-AKT-mTOR (AKT1, TSC1, PTEN, etc) pathways were detected by DNA sequencing. The expression of pS6RP, p4E-BP1, pAKT and pERK1/2 were examined by immunohistochemistry (IHC) assays. Results: Four paired samples (formalin-fixed, paraffin-embedded) were analyzed. 1) Laboratory results: No secondary mutations in addition to the c-Kit mutations identified at baseline were identified. However, IHC showed increased pS6RP and p4E-BP1 (two targets of mTOR activation) as well as increased pAKT and pERK1/2 in imatinib-resistant samples, suggested that mTOR signaling pathway was selectively activated in these secondary imatinib-resistant melanomas. 2) Treatment: Everolimus is an orally administered inhibitor of mTOR. The four patients received everolimus (10 mg/day) by continuous daily dosing. The tumor response revealed 1 PR and 3 SD (all >3 months) with grade 1-2 toxicities consisting of myelosupression, hyperglycemia, hypercholesterolemia and hypertriglyceridemia, consistent with previously reported toxicities for everolimus. Conclusions: The case series provides an important clue that activation of the mTOR signal pathway may be one of the mechanisms for secondary imatinib resistance in c-Kit-mutated melanomas. The results also show that everolimus may be effective and safe for melanoma patients who develop resistance to imatinib and could be investigated in combination with c-Kit inhibitors in treatment-naive patients.


2019 ◽  
Vol 2019 ◽  
pp. 1-12 ◽  
Author(s):  
Lianrong Xu ◽  
Yan Zhao ◽  
Fei Pan ◽  
Mengxia Zhu ◽  
Liqin Yao ◽  
...  

Nuclear factor erythroid 2-related factor 2 (Nrf2) is involved in tumor drug resistance, but its role in imatinib resistance of chronic myeloid leukemia (CML) remains elusive. We aimed to investigate the effects of Nrf2 on drug sensitivity, thioredoxin reductase (TrxR) expression, reactive oxygen species (ROS) production, and apoptosis induction in imatinib-resistant CML K562/G01 cells and explored their potential mechanisms. Stable K562/G01 cells with knockdown of Nrf2 were established by infection of siRNA-expressing lentivirus. The mRNA and protein expression levels of Nrf2 and TrxR were determined by real-time quantitative polymerase chain reaction and western blot, respectively. ROS generation and apoptosis were assayed by flow cytometry, while drug sensitivity was measured by the Cell Counting Kit-8 assay. Imatinib-resistant K562/G01 cells had higher levels of Nrf2 expression than the parental K562 cells at both mRNA and protein levels. Expression levels of Nrf2 and TrxR were positively correlated in K562/G01 cells. Knockdown of Nrf2 in K562/G01 cells enhanced the intracellular ROS level, suppressed cell proliferation, and increased apoptosis in response to imatinib treatments. Nrf2 expression contributes to the imatinib resistance of K562/G01 cells and is positively correlated with TrxR expression. Targeted inhibition of the Nrf2-TrxR axis represents a potential therapeutic approach for imatinib-resistant CML.


Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 2338-2338
Author(s):  
Natalie J. Serkova ◽  
Douglas J. Kominsky ◽  
Jaimi L. Brown ◽  
Jelena Miljus ◽  
Laszlo G. Boros ◽  
...  

Abstract The development of imatinib resistance has become a significant therapeutic problem, in which the etiology appears to be multifactoral (Bcr-Abl mutation and/or overexpression, multidrug-resistance, protein overexpression, etc.) and poorly understood. As of today, there are no precise clinical criteria to predict the development of imatinib resistance in CML, other than relapse of the disease. However, there is evidence that the control of glucose-substrate flux is an important mechanism of the antiproliferative action of imatinib. Thus, imatinib-resistant gastrointestinal stromal (GIST) KIT-activated tumors reveal highly elevated glucose uptake in PET scans. Currently, there is no information about the changes in glucose cell metabolism during development of imatinib resistance in CML patients. We used nuclear magnetic resonance (NMR) spectroscopy and gas chromatography mass spectrometry (GC-MS) to assess 13C glucose uptake and metabolism (glycolysis, the TCA cycle, nucleic acid ribose synthesis) during imatinib treatment in cultured human CML cells with different sensitivity to imatinib. Our results demonstrate that imatinib-sensitive K562 and LAMA84 Bcr-Abl positive cells have decreased glucose uptake, decreased lactate production and improved oxidative TCA cycle upon imatinib treatment. The LAMA84-r (resistant to imatinib due to Bcr-Abl overexpression) and the K562-r (unknown mechanism of resistance) cells maintained high glycolytic metabolic phenotype with elevated glucose uptake and lactate production in the presence of imatinib (Figure 1). In addition, oxidative synthesis of RNA ribose from 13C-glucose via glucose-6-phosphate dehydrogenase was decreased and RNA synthesis via the non-oxidative transketolase pathway was increased in imatinib resistant cells. CML cells which exhibited an [oxidative/non-oxidative] flux ratio for nucleic acid ribose synthesis > 1, were sensitive to imatinib. The resistant K562-r and LAMA84-r exhibited the [oxidative/non-oxidative] flux ratio < 0.7. We correlated 13C glucose uptake and metabolism with intracellular expression and localization of GLUT-1 transporter protein in these cells. There was no difference in total protein load of GLUT-1 upon imatinib treatment between imatinib-sensitive and resistant cell lines. However, the changes in glucose uptake and metabolism were accompanied by intracellular trans-location of GLUT-1 from the plasma membrane to the cytoplasm in imatinib-sensitive treated cells, while GLUT-1 remained at the membrane surface in LAMA84-r and K562-r cells (Figure 1). In summary, elevated glucose uptake and non-oxidative glycolytic metabolic phenotype can be used as sensitive markers for imatinib resistance in Bcr-Abl positive cells with different origins of resistance. Figure 1: Figure 1:.


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