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1248970 
Journal Article 
CDK inhibitors up-regulate BH3-only proteins to sensitize human myeloma cells to BH3 mimetic therapies 
Chen, S; Dai, Y; Pei, XY; Myers, J; Wang, L; Kramer, LB; Garnett, M; Schwartz, DM; Su, F; Simmons, GL; Richey, JD; Larsen, DG; Dent, P; Orlowski, RZ; Grant, S 
2012 
Yes 
Cancer Research
ISSN: 0008-5472
EISSN: 1538-7445 
72 
16 
4225-4237 
English 
22693249 
WOS:000307881100033 
BH3 mimetic drugs induce cell death by antagonizing the activity of anti-apoptotic Bcl-2 family proteins. Cyclin-dependent kinase (CDK) inhibitors that function as transcriptional repressors down-regulate the Bcl-2 family member Mcl-1 and increase the activity of selective BH3-mimetics that fail to target this protein. In this study, we determined whether CDK inhibitors potentiate the activity of pan-BH3 mimetics by directly neutralizing Mcl-1. Specifically, we evaluated interactions between the prototypical pan-CDK inhibitor flavopiridol and the pan-BH3-mimetic obatoclax in multiple myeloma (MM) cells in which Mcl-1 is critical for survival. Co-administration of flavopiridol and obatoclax synergistically triggered apoptosis in both drug-naive and drug-resistant MM cells. Mechanistic investigations revealed that flavopiridol inhibited Mcl-1 transcription but increased transcription of Bim and its binding to Bcl-2/Bcl-xL. Obatoclax prevented Mcl-1 recovery and potentiated release of Bim from Bcl-2/Bcl-xL and Mcl-1, accompanied by activation of Bax/Bak. Whether administered singly or in combination with obatoclax, flavopiridol also induced up-regulation of multiple BH3-only proteins, including BimEL, BimL, Noxa, and Bik/NBK. Notably, shRNA knock-down of Bim or Noxa abrogated lethality triggered by the flavopiridol/obatoclax combination in vitro and in vivo. Together, our findings demonstrate that CDK inhibition potentiates pan-BH3-mimetic activity through a cooperative mechanism involving up-regulation of BH3-only proteins with coordinate down-regulation of their anti-apoptotic counterparts. These findings have immediate implications for the clinical trial design of BH3 mimetic-based therapies that are presently being studied intensively for the treatment of diverse hematopoietic malignancies, including lethal multiple myeloma.