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Clinical Cancer Research Vol. 6, 1796-1803, May 2000
© 2000 American Association for Cancer Research


Molecular Oncology, Markers, Clinical Correlates

Expression and Prognostic Significance of IAP-Family Genes in Human Cancers and Myeloid Leukemias1

Ingo Tamm2, Steven M. Kornblau, Harry Segall, Stanislaw Krajewski, Kate Welsh, Shinichi Kitada, Dominic A. Scudiero, Gabriela Tudor, Yi Hua Qui, Anne Monks, Michael Andreeff and John C. Reed3

The Burnham Institute, La Jolla, California 92037 [I. T., S. K., K. W., S. K., J. C. R.]; University of Texas, M. D. Anderson Cancer Center, Houston, Texas 77030 [S. M. K., H. S., Y. H. Q., M. A.]; and National Cancer Institute, Developmental Therapeutics Program, Frederick Cancer Research and Development Center, Frederick, Maryland [D. A. S., G. T., A. M.]


    ABSTRACT
 Top
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
Expression of several inhibitor of apoptosis proteins (IAPs) was investigated in the National Cancer Institute panel of 60 human tumor cell lines, and the expression and prognostic significance of one of these, XIAP, was evaluated in 78 previously untreated patients with acute myelogenous leukemia (AML). XIAP and cIAP1 were expressed in most cancer lines analyzed, with substantial variability in their relative levels. In contrast, NAIP mRNA was not detectable, and cIAP2 was found at the mRNA and protein levels in only 34 (56%) and 5 (8%) of the 60 tumor cell lines analyzed, respectively. Interestingly, XIAP, cIAP1, and cIAP2 mRNA levels did not correlate with protein levels in the tumor lines, indicating posttranscriptional regulation of expression. High levels of XIAP protein in tumor cell lines were unexpectedly correlated with sensitivity to some anticancer drugs, particularly cytarabine and other nucleosides, whereas higher levels of cIAP1 protein levels were associated with resistance to several anticancer drugs. The relevance of XIAP to in vivo responses to cytarabine was explored in AML, making correlations with patient outcome (n = 78). Patients with lower levels of XIAP protein had significantly longer survival (median, 133 versus 52.5 weeks; P = 0.05) and a tendency toward longer remission duration (median, 87 versus 52.5 weeks; P = 0.13) than those with higher levels of XIAP. Altogether, these findings show that IAPs are widely but differentially expressed in human cancers and leukemias and suggest that higher XIAP protein levels may have adverse prognostic significance for patients with AML.


    INTRODUCTION
 Top
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
Suppression of apoptosis contributes to carcinogenesis by several mechanisms, including prolonging cell lifespan (thus facilitating the accumulation of gene mutations), permitting growth factor-independent cell survival, promoting resistance to immune-based cytotoxicity, and allowing disobeyance of cell cycle checkpoints that would normally induce apoptosis (1, 2, 3, 4) . Defects in apoptotic mechanisms also play an important role in resistance to chemotherapy and radiation (1) .

The IAPs4 are a family of antiapoptotic proteins that are conserved across evolution, with homologues found in both vertebrate and invertebrate animal species (5) . The baculovirus IAPs, Cp-IAP and Op-IAP, were the first members of this family to be identified based on their ability to functionally complement defects in the cell death inhibitor, p35, a baculovirus protein that binds to and inhibits caspase-family cell death proteases (6 , 7) . Subsequently, five human (XIAP, cIAP1, cIAP2, NAIP, and Survivin) and two Drosophila IAP homologues have been identified, which have been demonstrated to inhibit cell death (4 , 8, 9, 10, 11, 12, 13, 14) . The human IAPs, XIAP, cIAP1, and cIAP2, have been reported to bind and potently inhibit caspase-3 and caspase-7 with Kis in the range of 0.2–10 nM (15 , 16) . These IAP-inhibitable caspases operate in the distal portions of apoptotic protease cascades, functioning typically as effectors rather than initiators of apoptosis (17, 18, 19) . Although quantitative studies are lacking, the IAP-family member Survivin also binds and inhibits some effector caspases (14 , 20) . Moreover, at least some IAPs, such as XIAP, are capable of binding and suppressing specific initiator caspases such as caspase-9, the pinnacle caspase in the cytochrome c/mitochondrial pathway for apoptosis (21) .

The common structural feature of all IAP family members is an ~70 amino acid zinc-binding fold termed the BIR domain, which is present in one to three copies (22) . Using a mutagenesis approach, we showed previously that the second of the three BIR domains (BIR2) of XIAP is necessary and sufficient for inhibiting the effector caspase-3 and caspase-7 (23) , implying that a single BIR domain can possess antiapoptotic activity. However, for caspase-9 suppression by XIAP, the third BIR domain is required (24) .

To learn more about the importance of IAPs in cancer and leukemia, we examined the expression of several members of the IAP family in the well-characterized NCI panel of 60 human tumor cell lines, correlating their expression at either the mRNA or protein levels with other tumor-related genes and with in vitro chemosensitivity data for 30,000 compounds. In addition, the prognostic significance of one of the IAPs, XIAP, was examined in AML, revealing correlations with clinical outcome, thus suggesting that analysis of IAP-family proteins may provide predictive information about responses to chemotherapy and survival for at least some subgroups of patients with AML.


    MATERIALS AND METHODS
 Top
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
Patient Materials.
Patient-derived AML samples (n = 97) were randomly selected from a large assortment of patient samples collected, Ficoll-purified, and cryopreserved between 1983 and 1995. Only samples with >15% blasts were selected for further analysis (n = 78) to avoid contributions from contaminating normal cells. The median follow-up of survivors is nearly 5 years. Clinical characteristics of these patients are presented below.

Immunoblot Analysis of AML Samples.
Immunoblotting of AML patient samples derived from 78 newly diagnosed patients with AML and 10 normal individuals was carried out using cell lysates from mononuclear fractions of peripheral blood generated by Ficoll separation. Whole-cell lysates from 5 x 105 cells were electrophoresed through 8–14% SDS-PAGE gradient gels and electroblotted to Immobilon polyvinylidene difluoride membranes (Millipore, Bedford, MA) using a semi-dry transfer apparatus at 0.8 mA/cm2 for 1.5 h (25) . Each gel included a XIAP-expressing positive control cell line (HeLa), two to three peripheral blood mononuclear cell samples from normal individuals, and molecular weight markers. The membranes were blocked in Tris-buffered saline with 0.05% Tween 20 (TBST) and 3% nonfat dry milk (Blotto) at 4°C for 4 h and then exposed overnight to a mouse anti-XIAP monoclonal antibody (Pharmingen, San Diego, CA) at a 1:350 dilution at 4°C overnight. Subsequently, the membranes were washed twice in Blotto, exposed to sheep antimouse IgG conjugated to horseradish peroxidase (1:4000) for 1 h, washed in Blotto and TBST, and then exposed to SuperSignal West Pico substrate chemiluminescence mixture for 1 min according to the directions of the manufacturer (Pierce Corp., Rockford, IL). Images were collected on a ChemiImager 4400 system (Alpha Innotech, San Leandro, CA), and densitometry was performed using the best image. To normalize for variation in antibody concentration or time of exposure, the XIAP signal from the patient was normalized against the XIAP signal of the control cell line HeLa. Results are expressed in terms of this ratio.

Immunoblot Analysis of Tumor Cell Lines.
Detergent lysates were prepared in the presence of protease inhibitors from established tumor cell lines essentially as described (26) . After normalization for total protein content (50 µg/lane), samples were subjected to SDS-PAGE/immunoblot analysis using monoclonal anti-IAP antibodies specific for XIAP (Transduction Laboratories, Lexington, KY) or for cIAP1 and cIAP2 (R&D Systems, Minneapolis, MN). Data on X-ray films were quantified by scanning densitometry using the IS-1000 image analysis system (Alpha Innotech Co.), and the results from a standard curve generated using purified recombinant GST-XIAP, GST-cIAP1, or GST-cIAP2 protein were used to estimate the amounts (ng) of XIAP, cIAP1, and cIAP2 protein per 50 µg of total protein. Data from two independent protein standard-containing blots were within 10% agreement.

RNase Protection Assays.
Total RNA was isolated from the NCI 60 tumor cell line panel or freshly isolated AML cells using the RNeasy Mini kit (Qiagen, Germany), according to the manufacturer’s manual. After normalization for total mRNA content (12 µg/lane), samples were subjected to RPA, as described in the manufacturer’s manual (Riboquant; Pharmingen, La Jolla, CA). Briefly, a multiprobe was used for the T7 polymerase-directed synthesis of a 32P-labeled antisense RNA probe set. The probe set was hybridized in excess to target RNA in solution, after which free-probe and other single-stranded RNA were digested with RNases. The remaining "RNase-protected" probes were purified, resolved on denaturing polyacrylamide gels (4.75%), and quantified by autoradiography and phosphorimaging (Bio-Rad Laboratories, Inc.; Molecular Analyst, Version 2.1). The quantity of each mRNA species in the original RNA sample was then determined based on the intensity of the appropriately sized, protected probe fragment relative to the loading control (GAPDH).

Statistical Analysis.
Comparison of IAP mRNA and protein levels with chemosensitivity data for the 60 cell line panel (NCI) resulted in a rank order of drugs from the standard agent database of the NCI. Pearson correlation coefficients and two-tail Ps were used to assign possible significance to these data. P <= 0.005 was considered significant in all analyses.

For analysis of patient data, results were rank-ordered according to XIAP protein levels and divided into thirds, thus assessing possible threshold effects of XIAP on survival while avoiding searching for optimal cutpoints for levels of XIAP (27) . The top two-thirds demonstrated similar outcomes, and therefore those arms were collapsed. Unadjusted survival analyses were performed using Kaplan-Meier plots (28) , and comparisons of survival between patient subgroups were made using the log-rank test (29) . For comparisons of clinical variables between patients within the lowest third of XIAP expression versus the top two-thirds, either Student’s t test or {chi}2 analysis was performed. All computations were performed using Statistica version 5.1 M (StatSoft Inc., Tulsa, OK).


    RESULTS
 Top
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
IAP mRNA Levels in the NCI Panel of Tumor Cell Lines.
We analyzed the levels of XIAP, NAIP, cIAP1, and cIAP2 mRNAs in the NCI 60 tumor cell line panel by RNase Protection Assay (RPA). Examples are shown in Fig. 1Citation . GAPDH was included as a control to ensure equal loading. Data on X-ray films were quantified by scanning densitometry (Fig. 2)Citation . The mRNAs for XIAP and cIAP1 were detectable at variable levels in all cell lines analyzed (Fig. 2, A and B)Citation . In contrast, cIAP2 was more restricted in its expression. cIAP2 mRNA was abundant, for example, in most CNS and many renal tumor cell lines but almost undetectable in ovarian and breast cancer lines (Fig. 2C)Citation . Thus, in contrast to XIAP and cIAP1 mRNAs that were present in all tumor lines, the presence of cIAP2 mRNA was detectable in only 34 (56%) of the 60 tumor cell lines within the NCI screening panel. NAIP mRNA was undetectable in the entire panel of 60 tumor cell lines but was plentiful in some normal tissues, such as peripheral blood lymphocytes (not shown).



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Fig. 1. IAP-family mRNA levels in the NCI panel of tumor cell lines: examples of RPAs. 32P-labeled antisense RNA probes for XIAP, NAIP, cIAP1, cIAP2, and GAPDH were hybridized with target human mRNAs (12 µg) from the NCI panel of tumor cell lines. The remaining "RNase-protected" probes were purified, resolved on denaturing polyacylamide gels according to their size, and imaged by autoradiography. Examples are shown for several human tumor cell lines.

 


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Fig. 2. IAP-family mRNA levels in the NCI panel of tumor cell lines: graphical summary of results. Graphical summary of the XIAP (a), cIAP1 (a), and cIAP2 (c) mRNA expression levels in the form of a mean graph, where expression above average is drawn to the right of the center line, and levels of specific mRNAs below the mean are drawn to the left of the center line. The cell lines are grouped according to type. "Deltaval sum" is the expression value of IAPs (relative expression) for each cell line after subtracting the mean of that expression of IAP as determined from all the cell lines analyzed. A "Deltaval sum" of -1.8S for cIAP2 equals "not expressed."

 
IAP Protein Levels in the NCI Panel of Tumor Cell Lines.
To compare the relative levels of IAP mRNAs and proteins in the 60 cell line panel, we analyzed the relative levels of XIAP, cIAP1, and cIAP2 proteins by immunoblot assay using monoclonal antibodies. Data on X-ray films were quantified by scanning densitometry and compared with results obtained from defined amounts of recombinant protein (standard curve) to estimate the amount (ng) of IAP protein per 50 µg of total protein. Examples of immunoblot data are shown in Fig. 3A.Citation Higher levels of XIAP protein were generally found in renal cancer and melanoma cell lines, whereas lower levels of XIAP were typically present in CNS tumor cell lines (Fig. 3B)Citation . cIAP1 protein was expressed at higher levels in colon cancers, whereas lower levels were found in melanoma cell lines Citation . The expression of cIAP2 was far more restricted; cIAP2 protein was detectable in only 5 (8%) of the 60 tumor cell lines analyzed (MCF7, HT29, A549, NCI H322M, and K562). Thus, protein data for cIAP2 did not correlate with mRNA data.



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Fig. 3. IAP-family protein levels in the NCI panel of tumor cell lines. a, examples of immunoblot data are shown for several human tumor cell lines using monoclonal antibodies specific for XIAP, cIAP1, and cIAP2. In all cases, lysates were normalized for total protein content (50 µg/lane). a, graphical summary is presented. XIAP and cIAP1 protein levels in the form of a mean graph are shown, where expression above average is drawn to the right of the center line and XIAP protein levels below the mean are graphed to the left of the center line. The cell lines are grouped depending on tumor type. "Deltaval sum" is the expression value of XIAP (relative expression) for a given cell line after subtracting the mean of XIAP expression as determined from analysis of all 60 cell lines.

 
Similarly, XIAP and cIAP1 protein levels did not correlate with mRNA levels. For example, XIAP mRNA levels were above the mean for the NCI 60 cell screening panel in the leukemia lines HL60 and RPMI-8226, the lung cancer cell lines NCI-H322M and NCI-H460, the colon lines COLO 205 and HCC-2998, the brain tumor lines SF-539 and SNB-75, and the breast cancer lines MCF7 and HS 578T, whereas XIAP protein levels were below the mean in these same tumor lines (compare Figs. 2ACitation and 3BCitation ). Conversely, XIAP mRNA levels were below the mean of tumor cell lines in the leukemia lines K562 and MOLT4, the lung cancer line HOP-62, the colon cancer line KM12, the melanoma cell lines LOX-IMVI, MALME-3M, and M14, the ovarian line OVCAR-3, the renal cancer lines 786-0, ACHN, CAKI-1, and TK10, the prostate cancer PC3, and the breast cancer line MDA-MB 231, whereas XIAP protein levels were above the mean within these same tumor cell lines.

Correlation of IAP Protein Levels with Chemosensitivity Data from the NCI 60 Cell Screening Panel.
XIAP and cIAP1 protein levels were correlated with cytotoxicity data for compounds tested against the NCI 60 cell screening panel. Because cIAP-2 protein was found in only five cell lines, it was excluded from statistical analysis. Several nucleoside DNA chain-terminating drugs were positively correlated with XIAP protein levels, suggesting that drug sensitivity may be associated with expression of this protein (Table 1A)Citation . The most significant correlation was between XIAP protein levels and in vitro chemosensitivity to cytarabine, indicating a possible role for XIAP in conferring sensitivity to this agent in vitro (Pearson correlation coefficient, 0.44; P (two-tail) < 0.0006). For cIAP1, the most significant correlation was seen between cIAP1 protein levels and in vitro chemoresistance to carboplatin (P < 0.002) and cisplatin (P < 0.002; Table 1BCitation ). Significant associations between higher levels of cIAP1 protein and resistance to several DNA alkylating agents and the topoisomerase inhibitor VP-16 were also observed (Table 1B)Citation .5 No significant correlations with drug cytotoxicity data and IAP-family mRNA levels were found.


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Table 1

Correlation of IAP protein levels with chemosensitivity data from the NCI 60 cell screening panel

Comparison of IAP protein levels and chemosensitivity data for the 60 cell line panel (NCI) resulted in a rank-order correlation. Representative results are shown for XIAP (Table 1A)Citation and cIAP1 (Table 1B)Citation protein levels. Positive correlation indicates that a greater abundance of the target may be associated with sensitivity to the drug, whereas a negative correlation is indicative of more target conferring cellular resistance to the given drug. Pearson correlation coefficient and two tail Ps were used to assign possible significance to these data.

 
A comparison of the relative levels of IAP-family mRNAs and proteins with the expression of more than 30 genes evaluated previously in the NCI 60 tumor cell line screening panel failed to reveal any significant correlations (Pearson, -0.10). This search for correlations included p53, Bcl-2, Jun, Fos, Ras, and Rb.6

Comparisons of IAP Expression with Clinical Response to Chemotherapy in AML.
The observed correlation of higher levels of XIAP protein with greater sensitivity to nucleoside analogue drugs was paradoxical in terms of a priori expectations based on gene transfection evidence that overexpression of XIAP protects tumor cell lines from apoptosis induced by various anticancer drugs (reviewed in Refs. 30 and 31 ). Because XIAP protein levels showed the greatest correlation with cytarabine (AraC), we explored the relation of XIAP expression to in vivo drug responses in a clinical context where AraC-based therapy is standardly used, i.e., in patients with AML (32) . All patients were treated with high-dose AraC-containing regimen. The relative levels of XIAP protein were compared with clinical responses to chemotherapy, consisting of high-dose AraC plus idarubicin, using leukemia cell samples derived from 78 AML patients. Expression of XIAP protein was detected by immunoblotting in 76 of 78 samples tested; however, the level of XIAP was very low (<5% of the control cell line) in 20 cases. The range of expression of XIAP was heterogeneous across all French-American-British and cytogenetic categories, except for promyelocytic leukemia where there was a narrow range of expression (not shown). Bcl-2, Bax, caspase-2, and caspase-3 expression have been measured previously for most of these patients (25 , 33 , 34) . No significant correlation between expression of these other apoptosis-related proteins and XIAP protein levels was found (data not shown).

To assess possible threshold effects of XIAP protein on survival while avoiding searching for optimal cutpoints for expression, results were rank-ordered and then divided into thirds. Because data derived from patients with XIAP levels in the top two-thirds were similar (not shown), they were collapsed into one arm for further analysis and comparison. Patients with lower XIAP levels had significantly longer survival (median survival, 133 versus 52.5 weeks; P = 0.05) and a tendency toward longer median remission duration (87 versus 52.5 weeks; P = 0.13) than those with higher levels of XIAP. (Table 2Citation and Figure 4Citation ). For example, 42% of the patients with low XIAP expression are alive today, as compared with 23% with high XIAP expression (P = 0.004; Table 2Citation ). Patients with low levels of XIAP had only a slightly higher complete remission rate with induction chemotherapy (73% versus 65%; P = 0.42) but a lower relapse rate (42% versus 65%; P = 0.17) compared with patients with XIAP levels in the top two-thirds (Table 2)Citation . However, neither the complete remission rate nor relapse rate data reached statistical significance. No statistically significant differences were noted between the XIAP high and low groups with respect to age, cytogenetics, frequency of an antecedent hematological disorder, or gender; however, patients with higher XIAP were more likely to have poor Zubrod performance status (Table 2)Citation .


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Table 2

Clinical characteristics of AML patients

The cohort was divided into thirds based on rank-order analysis of XIAP protein levels. As discussed in the text, the top two-thirds were collapsed into one group.

 


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Fig. 4. Effect of XIAP protein expression on AML patient survival and remission duration. The plots show Kaplan-Meier survival (a) and remission duration (a) for 79 AML patients stratified according to XIAP protein levels. The cohort was divided into thirds based on rank-order analysis of XIAP protein levels. As discussed in the text, the top two-thirds were collapsed into one group.

 
From this evaluation, we conclude that higher levels of XIAP protein tend to be associated with shorter remission durations and shorter overall survival in AML patients treated with AraC-containing regimens. Thus, these findings are at odds with in vitro correlations derived from analysis of the NCI 60 cell screening panel and are fitting with expectations based on knowledge of the antiapoptotic activity of XIAP in cells.


    DISCUSSION
 Top
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
In this study, we show that expression of several members of the human IAP family of antiapoptotic genes is differentially regulated within the NCI panel of 60 human tumor cell lines and in freshly isolated human leukemia samples. XIAP and cIAP1 were widely expressed in tumor cell lines. However, the relative levels of these IAP-family members were variable among the tumor lines evaluated, implying differential regulation of the expression of these antiapoptotic genes within cancers. In contrast to XIAP and cIAP1, the expression of cIAP2 appears to be more restricted because cIAP2 mRNA was detectable in only approximately half of the analyzed tumor cell lines, and cIAP2 protein was found at detectable levels in only 5 (8%) of tumor cell lines. In comparison, NAIP mRNA was undetectable in all tumor cell lines tested. Thus, this particular member of the IAP family appears not be to a major participant in solid tumors. The IAP-family member Survivin has been shown previously to be widely expressed in the tumor cell lines of the NCI 60 cell line screening panel (14) .

Interestingly, IAP mRNA and protein levels were commonly noncongruent, suggesting the likelihood of posttranscriptional regulation of the expression of these antiapoptotic genes, perhaps through translational mechanisms or by differential rates of protein turnover. In this regard, evidence of translational control of XIAP has been reported recently, revealing the presence of an internal ribosome entry site within the XIAP mRNA (35) . This lack of correlation between XIAP, cIAP1, and cIAP2 has important implications with respect to any future attempts to use cDNA arrays or related technologies for assessing IAP-family gene expression in cancers. The finding that cIAP1 protein but not cIAP1 mRNA levels were associated with resistance to several anticancer drugs among the tumor cell lines of the NCI 60 cell screening panel lends additional support to the argument that measurements of protein and not mRNA levels are critical to understanding the role of this family of antiapoptotic genes in cancer.

The variability in IAP protein levels seen here among the NCI’s 60 human tumor cell lines suggests that further correlative studies of IAP expression with clinical outcome and with other biomarkers should be informative with regards to assessing the prognostic significance of these antiapoptotic proteins. Moreover, the lack of correlation of IAPs with other known tumor-related genes assessed previously in the NCI 60 cell panel (e.g., c-Jun, Ras, Fos, p53, and Rb) raises the possibility that IAPs could serve as independent risk factors for some types of malignancies, as suggested recently for Survivin (11 , 36 , 37) .

The paradoxical association of XIAP protein levels with sensitivity rather than resistance to AraC and some other nucleoside analogues among the NCI panel of 60 tumor cell lines remains unexplained. We might speculate that a fortuitous correlation exists between XIAP and levels of other proteins that might sensitize cells to such agents, such as nucleotide kinases and phosphatases. Moreover, the correlation between XIAP levels and sensitivity of cell lines to various drugs in vitro does not take into account the clinical usefulness of this approach, e.g., AraC is not the cytotoxic agent of choice for solid tumors. Given the overwhelming evidence that XIAP is a caspase-inhibiting, antiapoptotic protein (reviewed in Refs. 30 and 31 ), this observation illustrates the difficulty in drawing conclusions about protein function from correlative approaches. In this regard, the NCI 60 tumor cell line panel was assembled originally for the purpose of identifying compounds with potential antitumor activity (38) . In recent years, however, attempts have been made to use bioinformatics and genomics technologies to reveal associations between cytotoxic responses of cancer cell lines to compounds and various biomarkers. Future efforts of this type may ultimately provide a molecular explanation for the paradoxical correlation of XIAP protein with greater sensitivity to nucleoside agents.

Although little attempt has been made thus far to compare the levels of IAPs in tumors with other biomarkers or with clinical outcome, it has been reported that Survivin expression in neuroblastomas correlates with clinically more aggressive, histologically unfavorable disease (37) . Moreover, higher levels of Survivin protein as determined by immunostaining and p53 accumulation (indicative of mutant p53) were positively correlated in a survey of gastric cancers (36) , implying an association of Survivin with more aggressive disease.

Prompted by an unexpected inverse correlation between XIAP protein levels and resistance to AraC in the NCI 60 cell screening panel, we compared the expression of this IAP-family member in AML blasts derived from newly diagnosed, untreated patients, making correlations with clinical outcome. Patients with low levels of XIAP (lowest third) enjoyed a significantly longer survival and tended to have longer median remission durations. These data suggest that XIAP may have prognostic potential in AML, a finding that should be evaluated in additional studies involving larger numbers of AML patients and extended to other types of cancer. Moreover, these in vivo data are fitting with expectations based on knowledge of the antiapoptotic activity of XIAP in cells.

These results thus warrant further research on both the functions and prognostic relevance of XIAP and other IAP-family genes in cancer and leukemia.


    ACKNOWLEDGMENTS
 
We thank members of the laboratory and Zeev Estrov for helpful discussions, Sunil Patel for aid with immunoblot analysis, and Tim Myers and Ed Sausville for aid with statistical analysis of the cell line data.


    FOOTNOTES
 
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked advertisement in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

1 Generously supported by NIH Grants CA-55164-08, AG 15402, 5P01CA69381-04, and 5RO1CA97329-05 and a grant from IDUN Pharmaceuticals, Inc. I. T. is the recipient of a postdoctoral fellowship from the Mildred-Scheel-Stiftung fuer Krebsforschung, Germany. Back

2 Present address: Humboldt-Universität, Charité, Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie, Lindenberger Weg 80, D-13125 Berlin, Germany. Back

3 To whom requests for reprints should be addressed, at The Burnham Institute, 10901 North Torrey Pines Road, La Jolla, CA 92037. Phone: (858) 646-3140, Fax: (858) 646-3194; E-mail: jreed{at}burnham-inst.org Back

4 The abbreviations used are: IAP, inhibitor of apoptosis protein; BIR, Baculovirus IAP repeat; NCI, National Cancer Institute; AML, acute myelogenous leukemia; AraC, cytarabine; RPA, RNase Protection Assay; GAPDH, glyceraldehyde-3-phosphate dehydrogenase; CNS, central nervous system; VP-16, etoposide. Back

5 A complete list of the tested cytostatic drugs is available through the Internet at http://epnws1.ncicrf.gov:2345/dis3d/dtp.html. Back

6 A complete list of the gene targets is available through the Internet at http://epnws1.ncicrf.gov:2345/dis3d/dtp.html. Back

Received 4/15/99; revised 12/28/99; accepted 2/ 8/00.


    REFERENCES
 Top
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 

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Y. Hu, G. Cherton-Horvat, V. Dragowska, S. Baird, R. G. Korneluk, J. P. Durkin, L. D. Mayer, and E. C. LaCasse
Antisense Oligonucleotides Targeting XIAP Induce Apoptosis and Enhance Chemotherapeutic Activity against Human Lung Cancer Cells in Vitro and in Vivo
Clin. Cancer Res., July 1, 2003; 9(7): 2826 - 2836.
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I. Tamm, M. Trepel, M. Cardo-Vila, Y. Sun, K. Welsh, E. Cabezas, A. Swatterthwait, W. Arap, J. C. Reed, and R. Pasqualini
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Functional Blocks in Caspase Activation Pathways Are Common in Leukemia and Predict Patient Response to Induction Chemotherapy
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A. M. Hunter, D. Kottachchi, J. Lewis, C. S. Duckett, R. G. Korneluk, and P. Liston
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F. Ravandi, M. Talpaz, and Z. Estrov
Modulation of Cellular Signaling Pathways: Prospects for Targeted Therapy in Hematological Malignancies
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Genes Dev.Home page
S. Jin, M. Kalkum, M. Overholtzer, A. Stoffel, B. T. Chait, and A. J. Levine
CIAP1 and the serine protease HTRA2 are involved in a novel p53-dependent apoptosis pathway in mammals
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BloodHome page
T. Hasegawa, K. Suzuki, C. Sakamoto, K. Ohta, S. Nishiki, M. Hino, N. Tatsumi, and S. Kitagawa
Expression of the inhibitor of apoptosis (IAP) family members in human neutrophils: up-regulation of cIAP2 by granulocyte colony-stimulating factor and overexpression of cIAP2 in chronic neutrophilic leukemia
Blood, February 1, 2003; 101(3): 1164 - 1171.
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W. L. Carroll, D. Bhojwani, D.-J. Min, E. Raetz, M. Relling, S. Davies, J. R. Downing, C. L. Willman, and J. C. Reed
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C. R. Arnt, M. V. Chiorean, M. P. Heldebrant, G. J. Gores, and S. H. Kaufmann
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Molecular Cancer TherapeuticsHome page
C.-P. Ng and B. Bonavida
X-linked Inhibitor of Apoptosis (XIAP) Blocks Apo2 Ligand/Tumor Necrosis Factor-related Apoptosis-inducing Ligand-mediated Apoptosis of Prostate Cancer Cells in the Presence of Mitochondrial Activation: Sensitization by Overexpression of Second Mitochondria-derived Activator of Caspase/Direct IAP-binding Protein with Low pI (Smac/DIABLO)
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I. Imoto, H. Tsuda, A. Hirasawa, M. Miura, M. Sakamoto, S. Hirohashi, and J. Inazawa
Expression of cIAP1, a Target for 11q22 Amplification, Correlates with Resistance of Cervical Cancers to Radiotherapy
Cancer Res., September 1, 2002; 62(17): 4860 - 4866.
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BloodHome page
I. M. Pedersen, S. Kitada, L. M. Leoni, J. M. Zapata, J. G. Karras, N. Tsukada, T. J. Kipps, Y. S. Choi, F. Bennett, and J. C. Reed
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Molecular Cancer TherapeuticsHome page
M. Guzey, S. Kitada, and J. C. Reed
Apoptosis Induction by 1{alpha},25-Dihydroxyvitamin D3 in Prostate Cancer
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C. G. Ferreira, M. Epping, F. A. E. Kruyt, and G. Giaccone
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M. Parton, S. Krajewski, I. Smith, M. Krajewska, C. Archer, M. Naito, R. Ahern, J. Reed, and M. Dowsett
Coordinate Expression of Apoptosis-associated Proteins in Human Breast Cancer before and during Chemotherapy
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CarcinogenesisHome page
G. J. Gordon, K. Appasani, J. P. Parcells, N. K. Mukhopadhyay, M. T. Jaklitsch, W. G. Richards, D. J. Sugarbaker, and R. Bueno
Inhibitor of apoptosis protein-1 promotes tumor cell survival in mesothelioma
Carcinogenesis, June 1, 2002; 23(6): 1017 - 1024.
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Molecular Cancer TherapeuticsHome page
A. Wallqvist, A. A. Rabow, R. H. Shoemaker, E. A. Sausville, and D. G. Covell
Establishing Connections between Microarray Expression Data and Chemotherapeutic Cancer Pharmacology
Mol. Cancer Ther., March 1, 2002; 1(5): 311 - 320.
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BloodHome page
J. C. Byrd, S. Kitada, I. W. Flinn, J. L. Aron, M. Pearson, D. Lucas, and J. C. Reed
The mechanism of tumor cell clearance by rituximab in vivo in patients with B-cell chronic lymphocytic leukemia: evidence of caspase activation and apoptosis induction
Blood, February 1, 2002; 99(3): 1038 - 1043.
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Genes Dev.Home page
Y. Deng, Y. Lin, and X. Wu
TRAIL-induced apoptosis requires Bax-dependent mitochondrial release of Smac/DIABLO
Genes & Dev., January 1, 2002; 16(1): 33 - 45.
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BloodHome page
A. D. Schimmer, D. W. Hedley, L. Z. Penn, and M. D. Minden
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Blood, December 15, 2001; 98(13): 3541 - 3553.
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I. Imoto, Z.-Q. Yang, A. Pimkhaokham, H. Tsuda, Y. Shimada, M. Imamura, M. Ohki, and J. Inazawa
Identification of cIAP1 As a Candidate Target Gene within an Amplicon at 11q22 in Esophageal Squamous Cell Carcinomas
Cancer Res., September 1, 2001; 61(18): 6629 - 6634.
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C. G. Ferreira, P. van der Valk, S. W. Span, I. Ludwig, E. F. Smit, F. A. E. Kruyt, H. M. Pinedo, H. van Tinteren, and G. Giaccone
Expression of X-linked Inhibitor of Apoptosis as a Novel Prognostic Marker in Radically Resected Non-Small Cell Lung Cancer Patients
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M. MANDERSCHEID, U. K. MEßMER, R. FRANZEN, and J. PFEILSCHIFTER
Regulation of Inhibitor of Apoptosis Expression by Nitric Oxide and Cytokines: Relation to Apoptosis Induction in Rat Mesangial Cells and RAW 264.7 Macrophages
J. Am. Soc. Nephrol., June 1, 2001; 12(6): 1151 - 1163.
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BloodHome page
B. Z. Carter, M. Milella, D. C. Altieri, and M. Andreeff
Cytokine-regulated expression of survivin in myeloid leukemia
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J. C. Reed
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J. T. Isaacs
Apoptosis: Translating Theory to Therapy for Prostate Cancer
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G. M. Kasof and B. C. Gomes
Livin, a Novel Inhibitor of Apoptosis Protein Family Member
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G.-Q. Wang, B. R. Gastman, E. Wieckowski, L. A. Goldstein, A. Rabinovitz, X.-M. Yin, and H. Rabinowich
Apoptosis-resistant Mitochondria in T Cells Selected for Resistance to Fas Signaling
J. Biol. Chem., January 26, 2001; 276(5): 3610 - 3619.
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