Abstract

Acute lymphoblastic leukemia (ALL) is an aggressive malignancy. Adults with ALL have more than 50% relapse rates. We have previously validated that overexpression of nucleophosmin (NPM) is involved in the multidrug resistance (MDR) development during ALL; and a synthetically engineered recombinant NPM binding protein (NPMBP) has been developed in our group; NPMBP and doxorubicin (DOX) can be conjugated in a nanoparticle-based drug delivery system named DOX-PMs-NPMBP to counteract MDR during ALL. Here, we evaluated the antileukemia potential of DOX-PMs-NPMBP in resistant ALL cells. This study demonstrates that DOX-PMs-NPMBP significantly enhances chemosensitivity to DOX in ALL cells. Despite at variable concentrations, both resistant and primary ALL cells from relapsed patients were sensitive to DOX-PMs-NPMBP. In detail, the half maximal inhibitory concentration (IC50) values of DOX-PMs-NPMBP were between 1.6- and 7.0-fold lower than those of DOX in cell lines and primary ALL cells, respectively; and apoptotic cells ratio was over 2-fold higher in DOX-PMs-NPMBP than DOX. Mechanistically, p53-driven apoptosis induction and cell cycle arrest played essential role in DOX-PMs-NPMBP-induced anti-leukemia effects. Moreover, DOX-PMs-NPMBP significantly inhibited tumor growth and prolonged mouse survival of ALL xenograft models; and no systemic toxicity occurrence was observed after treatment during follow-up. In conclusion, these data indicate that DOX-PMs-NPMBP may significantly exert growth inhibition and apoptosis induction, and markedly improve DOX antileukemia activity in resistant ALL cells. This novel drug delivery system may be valuable to develop as a new therapeutic strategy against multidrug resistant ALL.

Highlights

  • Acute lymphoblastic leukemia (ALL) is an aggressive, malignant disease

  • Bioluminescence images of the ventral/dorsal area taken at pre- and post-treatment. (B) Body weights at each time point. (C) Representative photographs of liver and spleen excised from implanted NCG mice. (D) Liver and spleen weight changes in different conditioning group mice. (E) Representative Wright-Giemsa-stained sections of harvested bone marrow (BM) cells in each group mice. (F) Representative images of flow-cytogram illustrating the CD19+ Nalm6-Luc/DOX cells in BM

  • Dot plots reflect CD19-APC vs. side scatters. *p < 0.05, ***p < 0.001, ****p < 0.0001. (G) The percentages of CD19+ cells in BM were measured by flow cytometry. **p < 0.01, ***p < 0.001, ****p < 0.0001

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Summary

Introduction

Improvements in multiagent chemotherapy treatments, along with tailored risk assessment, have raised survival rates in pediatric ALL. Antibody-based therapies, such as monoclonal antibodies and antibody-drug conjugates have shown promising activity profiles for the treatment of ALL (Phelan and Advani, 2018; Schmied et al, 2019).

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