Endogenous and combination retinoids are active in myelomonocytic leukemias

Orsola di Martino, Haixia Niu, Gayla Hadwiger, Heikki Kuusanmaki, Margaret A. Ferris, Anh Vu, Jeremy Beales, Carl Wagner, María P. Menéndez-Gutiérrez, Mercedes Ricote, Caroline Heckman, John S. Welch

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Retinoid therapy transformed response and survival outcomes in acute promyelocytic leukemia (APL) but has demonstrated only modest activity in non-APL forms of acute myeloid leukemia (AML). The presence of natural retinoids in vivo could influence the efficacy of pharmacologic agonists and antagonists. We found that natural RXRA ligands, but not RARA ligands, were present in murine MLL-AF9-derived myelomonocytic leukemias in vivo and that the concurrent presence of receptors and ligands acted as tumor suppressors. Pharmacologic retinoid responses could be optimized by concurrent targeting of RXR ligands (e.g., bexarotene) and RARA ligands (e.g., all-trans retinoic acid), which induced either leukemic maturation or apoptosis depending on cell culture conditions. Co-repressor release from the RARA:RXRA heterodimer occurred with RARA activation, but not RXRA activation, providing an explanation for the combination synergy. Combination synergy could be replicated in additional, but not all, AML cell lines and primary samples, and was associated with improved survival in vivo, although tolerability of bexarotene administration in mice remained an issue. These data provide insight into the basal presence of natural retinoids in leukemias in vivo and a potential strategy for clinical retinoid combination regimens in leukemias beyond APL.

Original languageEnglish (US)
Pages (from-to)1008-1021
Number of pages14
Issue number4
StatePublished - Apr 2021

ASJC Scopus subject areas

  • Hematology


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