Research Papers:

Smac mimetic induces cell death in a large proportion of primary acute myeloid leukemia samples, which correlates with defined molecular markers

Sonja C. Lueck, Annika C. Russ, Ursula Botzenhardt, Richard F. Schlenk, Kerry Zobel, Kurt Deshayes, Domagoj Vucic, Hartmut Döhner, Konstanze Döhner, Simone Fulda and Lars Bullinger _

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Oncotarget. 2016; 7:49539-49551. https://doi.org/10.18632/oncotarget.10390

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Sonja C. Lueck1, Annika C. Russ1, Ursula Botzenhardt1, Richard F. Schlenk1, Kerry Zobel2, Kurt Deshayes2, Domagoj Vucic2, Hartmut Döhner1, Konstanze Döhner1, Simone Fulda3,4,5,*, Lars Bullinger1,*

1Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany

2Early Discovery Biochemistry, Genentech, Inc., South San Francisco, CA, USA

3Institute for Experimental Cancer Research in Pediatrics, Goethe-University, Germany

4German Cancer Consortium (DKTK), Heidelberg, Germany

5German Cancer Research Center (DKFZ), Heidelberg, Germany

*Shared senior authorship

Correspondence to:

Lars Bullinger, email: [email protected]

Simone Fulda, email: [email protected]

Keywords: smac mimetic, IAP proteins, apoptosis, acute myeloid leukemia (AML), gene expression profiling (GEP)

Received: March 31, 2016     Accepted: June 13, 2016     Published: July 02, 2016


Apoptosis is deregulated in most, if not all, cancers, including hematological malignancies. Smac mimetics that antagonize Inhibitor of Apoptosis (IAP) proteins have so far largely been investigated in acute myeloid leukemia (AML) cell lines; however, little is yet known on the therapeutic potential of Smac mimetics in primary AML samples. In this study, we therefore investigated the antileukemic activity of the Smac mimetic BV6 in diagnostic samples of 67 adult AML patients and correlated the response to clinical, cytogenetic and molecular markers and gene expression profiles. Treatment with cytarabine (ara-C) was used as a standard chemotherapeutic agent. Interestingly, about half (51%) of primary AML samples are sensitive to BV6 and 21% intermediate responsive, while 28% are resistant. Notably, 69% of ara-C-resistant samples show a good to fair response to BV6. Furthermore, combination treatment with ara-C and BV6 exerts additive effects in most samples. Whole-genome gene expression profiling identifies cell death, TNFR1 and NF-κB signaling among the top pathways that are activated by BV6 in BV6-sensitive, but not in BV6-resistant cases. Furthermore, sensitivity of primary AML blasts to BV6 correlates with significantly elevated expression levels of TNF and lower levels of XIAP in diagnostic samples, as well as with NPM1 mutation. In a large set of primary AML samples, these data provide novel insights into factors regulating Smac mimetic response in AML and have important implications for the development of Smac mimetic-based therapies and related diagnostics in AML.

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