The sonic hedgehog factor GLI1 imparts drug resistance through inducible glucuronidation
Hiba Ahmad Zahreddine1, Biljana Culjkovic-Kraljacic1, Sarit Assouline2
1Institute for Research in Immunology and Cancer and Department of Pathology and Cell Biology, Université de Montréal, P.O. Box 6128, Downtown Station, Montréal, Québec H3C 3J7, Canada.
Abstract:
Drug resistance is a major hurdle in oncology. Responses of acute myeloid leukaemia (AML) patients to cytarabine (Ara-C)-based therapies are often short lived with a median overall survival of months. Therapies are under development to improve outcomes and include targeting the eukaryotic translation initiation factor (eIF4E) with its inhibitor ribavirin. In a Phase II clinical trial in poor prognosis AML, ribavirin monotherapy yielded promising responses including remissions; however, all patients relapsed. Here we identify a novel form of drug resistance to ribavirin and Ara-C. We observe that the sonic hedgehog transcription factor glioma-associated protein 1 (GLI1) and the UDP glucuronosyltransferase (UGT1A) family of enzymes are elevated in resistant cells. UGT1As add glucuronic acid to many drugs, modifying their activity in diverse tissues. GLI1 alone is sufficient to drive UGT1A-dependent glucuronidation of ribavirin and Ara-C, and thus drug resistance. Resistance is overcome by genetic or pharmacological inhibition of GLI1, revealing a potential strategy to overcome drug resistance in some patients.
Insights
Drug resistance in acute myeloid leukemia (AML) to cytarabine and ribavirin was overcome by targeting GLI1. Inhibiting GLI1, a transcription factor, prevents drug inactivation, offering a new strategy for AML treatment.
Area of Science:
- Oncology
- Molecular Biology
- Pharmacology
Background:
- Drug resistance is a significant challenge in acute myeloid leukemia (AML) treatment.
- Cytarabine (Ara-C)-based therapies offer limited long-term survival for AML patients.
- Ribavirin, an eIF4E inhibitor, showed initial promise in AML but resistance developed.
Purpose of the Study:
- To identify mechanisms of drug resistance to ribavirin and Ara-C in AML.
- To investigate the role of GLI1 and UGT1A in mediating this resistance.
- To explore strategies for overcoming drug resistance in AML.
Main Methods:
- Analysis of gene expression in resistant AML cells.
- Investigating the functional role of GLI1 in drug metabolism.
- Assessing the efficacy of GLI1 inhibition in preclinical models.
Main Results:
- Elevated levels of glioma-associated protein 1 (GLI1) and UDP glucuronosyltransferase (UGT1A) enzymes were observed in resistant cells.
- GLI1 was found to be sufficient to induce UGT1A-dependent glucuronidation of ribavirin and Ara-C, leading to drug resistance.
- Inhibition of GLI1, either genetically or pharmacologically, restored sensitivity to ribavirin and Ara-C.
Conclusions:
- A novel mechanism of drug resistance involving GLI1 and UGT1A in AML has been identified.
- GLI1 plays a critical role in the inactivation of ribavirin and Ara-C through glucuronidation.
- Targeting GLI1 presents a potential therapeutic strategy to overcome drug resistance in AML patients.
Related Concept Videos
Phase II Reactions: Glucuronidation
Drug Metabolism: Phase II Reactions
Hedgehog Signaling Pathway
Hedgehog Signaling Pathway
Pharmacogenetics of Phase II Enzymes: N-acetyltransferase, Thiopurine S-methyltransferase, UDP-glucuronosyltransferase
Pharmacogenetics of Drug Transporters: P-Glycoprotein and Solute Carrier Transporters


